US Department of Health and Human Services

1. US Department of Health and Human Services Investments, Activities and Opportunities for Collaboration in the Freely Associated States April 5, 2013 CAPT Cathy Wasem MN, RN CDR Tai-Ho Chen MD Bill Gallo MBA

2. 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

3. HHS MISSION: To protect the health of all Americans and provide essential human services, especially for those who are least able to help themselves

4. 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

5. 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

6. HHS AgenciesSupporting the FAS • 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

7. Health and Human ServicesSupportto 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

8. 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

9. HHS Funding to the FAS(2012) SAMHSA CDC

10. 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

11. 2011–12 RMI and FSM Dengue OutbreaksLessons 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

12. 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

13. 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

14. 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

15. 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

16. 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

17. 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)

18. Nursing Workforce in the FAS

19. 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) FutureInitiative/ Partner philosophy • FCMI Foundation, Bank of Guam, WHO, HHS, DOI, DOD, PIHOA, APNLC, UH, Dreyfus Foundation • Faculty training, new faculty development • PINNEDAlliance (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

20. 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

21. 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

22. 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

23. Thank you Tai-Ho Chen, MD CDR, U.S. Public Health Service Quarantine Medical Officer Division of Global Migration and Quarantine National Center for Emerging and Zoonotic Infectious Diseases Centers for Disease Control and Prevention CDC Honolulu Quarantine Station 300 Rodgers Blvd #67 Honolulu, HI 96819 Phone: 1-808-861-8530 Fax: 1-808-861-8532 tdc5@cdc.gov Cathy Wasem, MN, RN CAPT, USPHS Commissioned Corps Senior Public Health Advisor Office of Pacific Health, HHS-Region IX Office of the Regional Health Administrator 300 Ala Moana Blvd., Rm. 6-247 / PO Box 50166 Honolulu, HI 96850 808-541-2015 808-783-6229 (cell) Cathy.Wasem@hhs.gov cathy.wasem@gmail.com Bill Gallo MBA Associate Director for Insular Area Support Office of State, Tribal, Local and Territorial Support Centers for Disease Control and Prevention 300 Ala Moana Blvd. Room 8-125 Honolulu HI 96850 office: 808 541 3760 cell: 404 319 9996 bgallo@cdc.gov