US Department of Health and Human

ServicesInvestments, Activities and Opportunities for Collaboration in the Freely Associated States

April 5, 2013

CAPT Cathy Wasem MN, RNCDR Tai-Ho Chen MD

Bill Gallo MBA

Presentation Objectives• Provide an overview of the Department of

Health and Human Services (HHS) and its agencies

• Describe types and amounts of HHS support to the Freely Associated States (FAS)

• Provide examples of HHS coordination with government and non-government agencies

• Recommend strategies for improving interagency coordination

HHS MISSION:

To protect the health of all Americans and provide essential human services, especially for those who are least able

to help themselves

The Department of Health and Human Services (HHS)

HHS Agencies and offices perform a wide variety of tasks and services, including• public health technical assistance • health care systems support• research• food & drug safety• health related grants and cooperative

agreements• health insurance

HHS Agencies

• Centers for Disease Control and Prevention• Health Resources and Services Administration• Substance Abuse and MH Services Administration• Administration for Children and Families• Office of the Assistant Secretary for Health• Administration for Community Living• Agency for Healthcare Research and Quality• National Institutes of Health• Agency for Toxic Subst. and Disease Registry• Food and Drug Administration• Indian Health Service• Center for Medicare and Medicaid Services

• Centers for Disease Control and Prevention• Health Resources and Services

Administration• Substance Abuse and MH Services

Administration• Administration for Children and Families• Office of the Assistant Secretary for Health• Administration for Community Living• Agency for Healthcare Research and Quality• National Institutes of Health• Agency for Toxic Subst. and Disease Registry• Food and Drug Administration• Indian Health Service• Center for Medicare and Medicaid Services

HHS AgenciesSupporting the FAS

Health and Human ServicesSupport to the Freely Associated States

• Centers for Disease Control and Prevention• 18 different grant programs totaling $12.8m• Funds support disease prevention and health promotion

programs, public health emergency preparedness, and cross cutting public health improvement programs

• Health Resources and Services Administration • 3 different grant programs totaling $4.6m• Funds support Maternal and Child Health Services,

Community Health Centers and HIV Care

Health and Human ServicesFunding to the Freely Associated States

• Substance Abuse and Mental Health Services Administration• 4 different grant programs total $3.5m• Funds support Community Mental Health Services,

Substance Abuse Services and Drug Free Communities

• Administration for Children and Families• 3 different grant programs totaling $1.8m• Funds support Head Start and teen pregnancy prevention

• Office of the Secretary • 1 grant program totaling $568k • Funds support Family Planning Services

Teen Preg1%

Head Start6%

Chronic10%

Comm Dis6%

Imm & Vax22%Preparedness

9%

PH capac-

ity/other

8%

Fam Plan2%MCH

8%

HIV Care1%

CHC12% Comm

Mtl Hlth1%

Sub Ab/MH

13%

Drug Free1%

OS

HRSA

ACF

HHS Funding to the FAS (2012)

CDC

SAMHSA

Other types of HHS Support to the FAS

• Personnel• HQ and Regional Staff• Hawaii and Pacific Island Field Staff

• Regional Partnerships• PIHOA, PIPCA, SPC, WHO

• On-site Training and Technical Assistance• Program and Grants Management Training• Outbreak Response

2011–12 RMI and FSM Dengue Outbreaks

Lessons Learned

Dengue Fever Mosquito-borne disease Fever, rash, joint pain can cause complications:

bleeding, death Not routinely present in RMI and FSM before 2011

Late 2011 Separate dengue outbreaks detected in RMI and Yap,

FSM HHS reached out to RMI and FSM to offer assistance Coordinated USG and international partner responses

initiated RMI: over 1600 cases, no deaths Yap: over 1400 cases, 2 deaths No translocation to Hawaii or Guam

CDC PHIL

Strengths USG inter-agency coordination and support of

unified response

US Embassies, USAID, DOI, DOD, HHS, USCG

International coordination with WHO and SPC

Rapid deployment after request for assistance

Clinical management support saved lives

Public-private partnerships

Challenges/Areas for Improvement

Long-term waste management and vector control

Local procurement mechanisms

Communications with deployed personnel

Insufficient regional information sharing with other countries and jurisdictions

Shipping issues delayed outbreak confirmation

RMI-specific issues Strengths

Early outbreak detection Early request for USG assistance facilitated High level RMI government commitment DOD support

• NAMRU-2, NEPMU-6, PHCR-Pacific, USAKA, Guam defense rep

USCG air transport support Challenges

Inventory awareness and projections Majuro/Ebeye information sharing Outer atoll surveillance

I. Sutherland, NAMRU-2

FSM-specific Issues Strengths

Yap State response Inventory management Internal FSM surge capacity deployed Department of Interior re-allocation of funds USAF Christmas Drop of IV fluids to Fais

Challenges Delayed FSM request for USG assistance FSM challenges in accessing USAID Disaster Emergency

Assistance Funds

T. Hancock, CDC

Human Resources for Health in the FASNursing Workforce – an Education Perspective

• Nurses are the backbone of the health care systems in the FAS

• Issue: Lack sufficient numbers of nurses with the level of education/skill mix required to address complex health care problems

• What we know – Double burden of disease • Diseases of developing countries – high infant mortality

rates, Hansen’s disease (leprosy) and TB/MDRTB epidemics,

• Diseases of ‘developed’ countries – obesity, diabetes, tobacco and substance abuse

Primer: Levels of Nursing Education •Licensed Practical Nurse (hospital-focused care – basic skills)

–6-12 month hospital training program (certificate) OR

–12-18 month college program (PCC-AAS degree, ASCC –certificate)

•Registered Nurse –Associate Degree (ADN) - 2 year – Hospital focus with intro to public health

–Baccalaureate Degree (BSN) – 4 year– Emphasizes public health, leadership, management, specialty care

–Masters in Nursing •Required to direct LPN or AD and to teach in LPN, AD & BSN programs•Nurse practitioner or nurse/midwifery or specialty

–Doctorate •Required to direct a baccalaureate nursing program•Research Doctorate (PhD) or Practice Doctorate (DN)

– Post AD/BSN Certificate •Nurse practitioner/midwife or specialty care through the Fiji School of nursing)

Jurisdiction

H = Hospital

PH = Public Health

Total Nurses

Total LPNs

LPN Training

Total RNs

RN-ADN

RN-BSN

% LPN and type of preparation % AD / # of BSN

Hospi- tal

College

RMI – Majuro H 84 13 71 16% LPNs (hospital-based tx) 84% RNs (majority are ADNs)

RMI – Ebeye H 27 5 22 6 16 19% LPNs (hospital-based tx) 81% RNs (majority BSN- Philippines)

PH 17 10 X 7 59% LPNs (hospital-based tx)

Pohnpei H 52 27 X 25/* 52% LPNs (hospital-based tx) 48% RNs (majority are ADNs)

PH 19

8 X 11 42% LPNs (hospital-based tx)

Kosrae 36 7 X 29 19% LPNs (hospital-based tx) 81 % RNs (majority are ADNs)

Chuuk 96 55 X 41 57% LPNs (hospital-based tx) 43% RNs (majority are ADNs)

Palau 76 51 X * 35 67% LPNs (hospital-based tx) 33% RNs (majority are ADNs)

Data from the Directors of Nursing Jurisidiction Reports – APNLC 2012

Nursing Workforce in the FAS

Challenges / Initiatives • Lack of awareness – educational levels• Lack of faculty • Isolation • Lack of solid student preparation• Sector Blinders• ____________________________________________________________________________________________

• RWJ Foundation Partners Investing in Nursing’s (PIN) Future Initiative / Partner philosophy– FCMI Foundation, Bank of Guam, WHO, HHS, DOI, DOD, PIHOA, APNLC,

UH, Dreyfus Foundation– Faculty training, new faculty development

– PINNED Alliance (Pacific Island Network of Nursing Education Directors)

• Regional Nursing Education Strategic Plan• Quality Improvement Initiative • Regional BSN-distance education program at University of Guam

• AHEC student preparation programs • DOI/HHS initiative - AHEC supplement to support PINNED

activities

HHS Recommendations for Improved Coordination Across

Agencies• Identify priorities of mutual interest

– Ex. Climate change, NCD Emergency, Federal Grants Management

• Educate one another on our agencies’ capabilities and limitations (OPM)

• Work closely with embassies to coordinate activities with other USG agencies as well as international partners/donors

HHS Recommendations (cont.)

• Ambassadors/ Embassies• Foster public/private sector “health in all policy”

approach • Foster awareness of & coordination with the local

college

• Other USG Departments & Agencies • Inclusion of college faculty in trainings / foster

budding research capacity in the colleges • Innovative utilization of college/health professions

students • Recognition of educational levels/base when

providing training

HHS Recommendations (cont.)

• Establish mechanisms for regional coordination of emergency responses that do not trigger currently established response protocols (USAID or FEMA)

• Enhance disease surveillance and laboratory capacity for early detection of public health emergencies

Thank youCathy Wasem, MN, RNCAPT, USPHS Commissioned CorpsSenior Public Health AdvisorOffice of Pacific Health, HHS-Region IXOffice of the Regional Health Administrator300 Ala Moana Blvd., Rm. 6-247 / PO Box 50166 Honolulu, HI 96850808-541-2015 808-783-6229 (cell)Cathy.Wasem@hhs.gov cathy.wasem@gmail.com

Bill Gallo MBAAssociate Director for Insular Area SupportOffice of State, Tribal, Local and Territorial

SupportCenters for Disease Control and Prevention300 Ala Moana Blvd. Room 8-125Honolulu HI 96850office: 808 541 3760cell: 404 319 9996bgallo@cdc.gov

Tai-Ho Chen, MDCDR, U.S. Public Health ServiceQuarantine Medical OfficerDivision of Global Migration and QuarantineNational Center for Emerging and Zoonotic Infectious DiseasesCenters for Disease Control and PreventionCDC Honolulu Quarantine Station300 Rodgers Blvd #67Honolulu, HI 96819Phone: 1-808-861-8530Fax: 1-808-861-8532tdc5@cdc.gov