Oceania > Micronesia > Micronesia Health Profile 2011

Micronesia: Micronesia Health Profile 2011

2010/12/26

Ministry of Health's mission, vision and objectives

The mission of the Department of Health and Social Affairs is to promote and protect the health status and the social welfare of citizens and residents in the Federated States of Micronesia. The vision is a healthy island nation. The Division of Health has established five health-related strategic goals with the objective of improving the health services. These are:

improvement of primary health care services;
improvement of secondary health care services;
prioritization of health promotion and services for major health problems;
development of a sustainable health care financing mechanism; and
improvement of capacity and accountability systems.

A total of 10 outcome measures were developed and used during the period from 2003 to 2005 to indicate progress in meeting these goals. In 2005, however, modifications were proposed involving the addition of four new measures. These modifications also known as the 14 Health Indicators and endorsed by all four state directors, the Secretary, the Assistant Secretary and programme managers, remain in effect until 2010, and will be reviewed and modified in 2011.

The proposed outcome measures involve increasing access to health services, improving immunization coverage, improving the availability of essential drugs, increasing the functionality of biomedical equipment, reducing the length of the average hospital stay, reducing infant mortality, reducing mental illness, increasing the number of individuals enrolled in a health insurance plan, reducing off-island medical referral costs, increasing the number of children under seven years receiving protective sealant, reducing the incidence of diarrhoeal disease, reducing the incidence of diabetic hospitalization, and implementing a functioning quality assurance system in all States. Baseline data have been collected in each of these areas and specific goals have been established to measure progress.

Organization of health services and delivery systems

Each State government in the Federated States of Micronesia maintains its own health services. Although similar in many aspects, each system is also unique autonomously. Each State maintains a centrally located hospital that provides a minimum range of primary- and secondary-level services, including both preventive and curative services. There are six private health clinics in the Federated States of Micronesia and one private hospital. Health services are highly subsidized by the State governments except in the private clinics.

The Division of Health of the Department of Health, Education and Social Affairs does not have a direct role in the provision of health services. The Department of Health Services in each State has primary responsibility for curative, preventive and public health services. This responsibility includes the main hospital, peripheral health centres, and dispensaries (primary health centres). Only residents of urban centres have direct access to the main hospital in each State. Transportation issues between islands often prevent residents who live on the outer islands from accessing these hospitals.

Dispensaries (similar to health clinics) are located in municipalities and outlying islands and are part of the state health department. Their location is based on population, need and political considerations. Local mayors and the dispensary supervisors are responsible for day-to-day operations. Diagnosis and treatment of common ailments are the primary services provided, with more advanced cases being referred to central hospitals.

The Secretary of the Department of Health and Social Affairs is responsible for the oversight of all health programmes and ensures compliance with all laws and executive directives. Major mandates are coordination, monitoring, technical assistance and capacity-building. In addition, the Department:

provides overall supervision of the division;
sets priorities within financial, manpower and material constraints as approved by the Secretary;
conducts annual programme and staff performance audits and evaluations;
enforces Department and national policies;
improves accountability within the Division of Health;
implements Federated States of Micronesia health strategies and the Strategic Development Plan in accordance with the Secretary’s directives;
works to increase external funding to support implementation of health strategies;
develops and implements property inventory systems; and;
coordinates financial support and assistance to the States.

The State-based delivery system is an effective way of administering health. Given the geographical dispersal, remote nature and cultural diversity of the many island communities, the system has the best chance of developing more responsive and effective services to meet the needs of the community. In this environment of politically independent states, there are constraints on implementation of national policies.

Health policy, planning and regulatory framework

The Division of Health of the Department of Health and Social Affairs provides health planning, donor coordination, and technical and training assistance. It coordinates and manages the preventative medicine and public health programmes funded by the United States Department of Health and Human Services. While the Division of Health does not have a direct role in the provision of health services, it has significant influence in the provision of health services as a result of its managerial responsibilities. Most state departments of health services have very limited planning and programming capabilities. This area needs support and improvement.

Health care financing

Total expenditure on health goods and services and capital formation in the Federated States of Micronesia in 2008 was estimated as US$ 32.7 million (see Table 3). This represents an increase of US$ 2.1 million over the preceding year, equivalent to an annual growth of 6.7% in nominal terms and 4.6% in real terms.

Human resources for health

Human resources is a critical area in the health care setting nationally as many of the current workforce will be retiring in five to 10 years and their replacement is not imminent. Development of the health workforce remains a government priority. The need has been partially met through overseas fellowship training and by the several dozen graduates of the Pacific Basin Medical Officer Training Programme from 1991 to 1996, but serious constraints remain. These include the lack of a nursing school and gaps in speciality training for both nurses and physicians. However, the Government, especially the Department of Health and Social Affairs is very concerned about the shortages of health personnel manning the state hospitals and community health facilities and, in collaboration with the College of Micronesia, has started a certificate course in public health and is planning to establish a nursing school. In addition, Yap state has established a partnership with Palau Community College for the training of nurses. At present most doctors, nurses and allied health workers pursue their education in institutions like the Fiji School of Medicine, the Republic of the Marshall Islands Nursing School and the University of Guam.

Government health services also lack specialized allied health professional workers, particularly hospital administrators, epidemiologists, medical record administrators, pharmacists, laboratory technicians, radiologists and environmentalists. Due to limited resources, medical and nursing fellowships have been prioritized, based on the States' requests.

Four Pacific Open Learning Health Network (POLHN) Centres have been established, one in each of the four States, and are providing access to online courses and resources. A full-time Coordinator is being hired to provide support for local health professionals in accessing and participating in online courses and continuing education.

Partnerships

Apart from the usual hospital-based health care, community participation in health promotion and disease prevention is critical to successful partnership in the Federated States of Micronesia. Local civil societies, nongovernment organizations (NGOs) and church groups have played key roles in increasing public awareness on important health issues. The national Department of Health and Social Affairs is working in partnership with the four state departments of health services on policy direction, coordination, monitoring and technical assistance.

External partnerships with the United States Federal Government through various health agencies (Centers for Disease Control and Prevention, Health Resources and Services Administration, Department of Interior) largely take the form of funding assistance for programme activities in public health and preventive health services. With the exception of funding through the Amended Compact, infrastructure and capacity development have been on an ad-hoc basis.

The loan funded by the Asian Development Bank (ADB), Basic Social Services, has ended. The project was set up to assist the Government in providing capacities in health and education. Activities included training in primary health care and medical coding. Capacity-building in continuous quality initiative training is still seen as a priority for health personnel to stay abreast of new developments in health care delivery services. Partnership with the Department of Education is also essential for scholarships to prospective students in health careers.

As a Member State, the Federated States of Micronesia is also in partnerships with United Nations agencies, such as WHO, the United Nations Children's Fund (UNICEF), and the United Nations Development Programme (UNDP), as well as other regional organizations, such as the Secretariat of the Pacific Community (SPC) and the Pacific Island Health Officers Association (PIHOA). In partnerships with all these international and regional health organization the goal is to improve the health status of small-island communities.

Challenges to health system strengthening

Strengthening primary health care services is among the many challenges facing the Department of Health and Social Affairs, and enhancing local health departments with specialized medical services continues to be a priority. At present, and for years to come, there are 10 key health system issues confronting the Federated States of Micronesia. These are:

improving health status;
setting clear priorities to ensure the most efficient use of resources;
addressing the shortage of staff (health workers due to retirement and out-migration);
establishing new health system funding and financial management approaches;
building managerial capacity;
testing innovative approaches in every aspect of the system to increase quality, including improving both access for, and responsiveness to and for the community;
introducing cost-effective new technologies;
focusing on functions that constitute public goods;
establishing national policies, measurable outputs, and standards to be met, including their monitoring and regulation; and developing the private health sector;
improving primary health care services, including community environmental health conditions in the remote areas and outer islands (accessing Internet, using solar power to acquire health information and sharing of health data through satellite links).

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