WOMEN/MATERNAL HEALTH

                   

A total of 18.7 percent of women ages 18 thru 44 years in the CNMI accessed preventive medical services in 2018. This was a slight increase from the previous year which was at 18.2 percent. The denominator value for this measure is based on the US Census population for the CNMI in 2018, which was 7,690 women ages 18 thru 44 years. Numerator information is based on the total number of women of reproductive age who completed a pap exam on the islands of Saipan, Tinian, and Rota in 2018. Numerator is gathered through laboratory data on pap specimens. The CNMI currently does not have a national data set to gather preventive medical visit rates among the women of childbearing age demographic, therefore the number of pap exams completed is used as a proxy measure.

 

Strategy: Utilize the mobile clinic to bring preventive screenings and other health services into non-traditional sites and into under-served communities.

 

CNMI Annual Women’s Health Month

Each year during the month of the May the CNMI celebrates Women’s Health Month. Women’s Health Month planning and event coordination is directed by a committee formed of partnerships of a variety of Public Health programs and includes members from external agency partners such as the CNMI Office of Youth Affairs, Lady Diane Torres Foundation, and others. In 2018, the MCH Program spearheaded a four (4) day Mobile Clinic Outreach at the Nutrition Assistance Program (NAP) Office, the CNMI’s local food stamp program, which is located at a southern village on the island of Saipan.  The outreach was held during food stamp voucher issuance days in the month of May 2018. Food stamp issuance days is held during the first week of each month and provides assistance to a total of 2,709 households on the island of Saipan. The Mobile Clinic outreach was held in partnership with other programs such as the Title X Family Planning, Breast and Cervical Cancer Screening Program, and the Maternal, Infant, Early Childhood Home Visiting (MIECHV) Program.

                  

The MCH Program provided free blood pressure and blood glucose screenings to a total of 206 individuals during the Food Stamp office outreach event. Services provided included diabetes, hypertension, and anemia screening. Family Planning services along with breast and cervical cancer screenings were also available and accessible on site through the use of the Public Health Mobile Clinic. Individuals were also screened for insurance coverage and offered assistance on applying to the Medicaid program or the CHCC Sliding Fee program. Individuals identified at risk for diabetes, hypertension, or anemia were counseled on risk factors that contribute to the health conditions and provided a referral to either the CHCC Family Care Clinic or the Kagman Community Health Center (KCHC), which is the only Federally Qualified Health Center (FQHC) in the Northern Mariana Islands. Additionally, health education materials, such as brochures and flyers, were available on site and shared with food stamp program recipients. Informational materials provided included topics such as prenatal care, breastfeeding, early childhood developmental screening, newborn screening, and preventive screenings for women, etc.

 

 

In addition to the NAP office Mobile Clinic Outreach event, the MCH Program also provided basic health screenings on the island of Rota, at the 2nd Annual CNMI Run 4 Mom Event on Saipan and provided Family Planning and BCSP services through the use of the mobile clinic in the villages of Tanapag, Garapan, and Koblerville. The MCH Program saw an additional 124 community members at these outreach events providing free basic screenings and health education regarding risk factors of non-communicable diseases and the importance of completing annual well-visits.

 

The MCH Program was able to provide preventive screenings to 330 individuals through outreach clinic events mentioned above. Seventy-five (75) percent of the event participants were women and 79 percent of participants being between the ages of 18 and 45 years. More than half (51%) reported to be uninsured and 28 percent reported Medicaid/Medicare coverage as a source of health insurance. Only 11% of those screened reported to have private insurance coverage.

Figures 4-7: Age distribution, gender, insurance, and ethnic breakdown of Women’s Health Month outreach events

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Mobile Clinic Outreach

SAN ROQUE CHURCH OUTREACH

 

The CNMI MCH Program and Breast and Cervical Cancer Screening Program partnered with the San Roque Catholic Church to provide women’s preventive health services through the use of the Public Health mobile clinic. Mobile clinic services were made available on the church grounds and included breast and cervical cancer screening. Women were also informed of services available through the CNMI Family Planning Program and referrals to Family Planning service sites made to those who expressed interest. Basic health screenings, such as screening for diabetes, hypertension and anemia risk, were provided to all members of the community that visited the outreach event.

 

The CNMI population is predominantly Catholic, therefore the partnership with the Catholic Diocese and the Churches in the CNMI supports the MCH Program’s efforts for increasing the numbers of community members, most especially women, that are served through preventive health programs and services. The San Roque church is a Catholic parish that is located on the northern most part of the island of Saipan. There are no health clinics located in the village of San Roque.

 

The MCH Program saw a total of 51 individuals during the mobile clinic outreach with a majority of them (67%) women. A majority of the individuals seen (61%) were uninsured, 20 percent had reported private insurance coverage, and just eight percent had Medicaid/Medicare coverage. A large proportion of the individuals seen during the San Roque outreach clinic were Filipinos (72%), followed by 20 percent Chamorro, 2 percent African American and 2 percent Carolinian.

 

Figures 8-9: Insurance and Gender for San Roque Clinic Outreach

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

NUTRITION ASSISTANCE PROGRAM (NAP) OUTREACH

The MCH Program partnered with the Family Planning program and CHCC Women’s Clinic to provide basic preventive health screenings, such as blood glucose and blood pressure screening, and Family Planning Services to food stamp recipients during benefit distribution days. MCH was able to provide services to 227 individuals. Of the 227 individuals seen, 167 were women and 75 were women ages 18 thru 45 years. In addition to offering basic screenings, such as blood glucose and blood sugar, the MCH program screens for insurance status and provides information and/or assistance on applying for the CNMI Medicaid program or the CHCC Sliding Fee Program to those who report to be uninsured.

 

TINIAN & ROTA

The MCH Program partnered with the Family Planning Program and the Breast and Cervical Cancer Screening program to conduct Women’s Clinic Outreach to the outlying islands of Tinian and Rota. The MCH Program funds travel for an OB/GYN to travel from Saipan to Tinian and Rota on a quarterly basis to provide prenatal care and women’s preventive healthcare services including breast and cervical cancer screening and family planning services. Through the partnership, total of 7 outreach clinics, 4 on the island of Rota and 3 on Tinian, were conducted. In Rota, there were a total of 32 patients seen for pap and breast exams with 24 of them being women between the ages of 18 and 45 years. In Tinian, a total of 45 women were provided pap smears and breast exams and 26 of the 45 (57.8 percent) being between the ages of 18 and 45 years.

 

                                                     

             

 

Transportation and financial barriers are often cited by community members as challenges to receiving preventive healthcare. Additionally, many primary and preventive care clinics only operate during usual business hours, Monday thru Friday between the hours of 8 a.m.-4:30 p.m. Healthcare limited to the usual business hours is a challenge for many who work or attend school during those hours. To address these challenges, the MCH Program has partnered with other Public Health programs to bring women’s preventive healthcare into village and community settings.

 

The MCH Program conducted 3 Outreach Clinics on the island of Saipan, 4 on the island of Rota, and 3 on the island of Tinian. A total of 251 women between the ages of 18 to 45 years accessed services through the Outreach Clinics. The US Census estimates that the population of women ages 18 thru 45 years in the CNMI in 2018 is 7,690, which means that 3.3 of the total population of women of reproductive age in the CNMI accessed services through Clinic Outreach in 2018. This percentage has increased from last year’s rate of 1.6 percent.

 

Strategy: Utilize Print, Radio, and Social Media to promote the importance of Preventive Screenings.

 

Live Radio Shows

The MCH Program utilized print, social media, and radio advertisements as a means for increasing community awareness regarding the importance of preventive medical visits, preventive screenings, and availability of services and assistance in the community. In 2018, the program conducted 4 live radio shows on a variety of women’s preventive health services. MCH partnered with providers from the CHCC Women’s Clinic and program managers from programs such as Family Planning and MCH were on live radio providing information regarding the importance of preventive healthcare, i.e. annual check-ups, preventive health screenings, prenatal care, etc., and informing listeners about available programs and services to address healthcare needs, i.e. Family Planning Program, Women’s Clinic, Tobacco Cessation Program, Dental Clinic, Medicaid assistance, etc. Live radio provided an opportunity for community members to call in to the station to ask questions or gather additional information about services. Additionally, the information was translated by the radio hosts into the indigenous languages spoken by the Chamorro and Carolinian groups. 

 

Print and Online Advertisements

The MCH Program also utilized online newspaper advertisements, Facebook and Instagram social media platforms to advertise information on available program services, outreach events, and preventive health education information. In 2018, the MCH program published 248 Facebook Posts, almost doubling Facebook posts conducted in 2017 (125 posts in 2017).

 

Additionally, the Program partnered with the Family Planning Program and the CDC’s Division of Reproductive Health to develop print materials utilizing models who more closely resembled the local demographics. While the program has utilized health education materials by organizations such as CDC, WHO, and HRSA, community members have shared through informal interviews that adapted print materials are more appealing and relatable, therefore more likely to be viewed and read by the CNMI community. Title V funds were used to support the development and printing of brochures and posters that provide information on services for preventive women’s health. Posters have been distributed to various partnering agencies, such as the WIC, Division of Youth Services, etc., and are included in Newborn Packets provided to women prior to discharge from the CHCC Obstetrics unit.

 

Strategy: Increase the number of women seen through the Family Planning Program.

 

For many women in the CNMI, the Family Planning Program is their first entry into the healthcare system and their only source of primary care services. MCH has worked closely with Family Planning to improve breast and cervical cancer screening rates, increase access to contraception and pregnancy testing, and enhance case management. The MCH Program works diligently to ensure that Family Planning services be made available whenever possible during Clinic outreach events.

 

In 2018, MCH published advertisements through the online newspaper outlets to increase community awareness regarding services available through Family Planning. Staff and management of the CNMI Maternal and Child Health Bureau were also provided training on program services, service sites, and eligibility criteria to increase referrals from program such as Home Visiting, Newborn Screening, Oral Health, etc. Additionally, the Title V funds were utilized to provide pap smears for women seen through the program.

 

                    

Numerator data for this measure is obtained through the CNMI Family Planning program and is based on the unduplicated total number of women ages 18 thru 44 years that received family planning services. In 2018, there were a total of 1,085 women ages 18 thru 44 years that accessed the Family Planning program. The US Census estimates that the population of women ages 18 thru 45 years in the CNMI in 2018 is 7,690, which means that 14.1 percent of the total estimated population of women of reproductive age in the CNMI accessed services through Family Planning. This percentage has increased from last year’s rate of 10.4 percent.

 

                             

 

A total of 108 women between the ages of 18 thru 44 years were screened for anemia during Clinic outreach in 2018. Of the 108, 16 women (14.8 percent), were identified with hemoglobin levels below 12 grams per deciliter. These women were referred to primary care for further testing and diagnostic services.

The MCH Program and Needs Assessment Steering committee performed an assessment of State Performance Measure 1, Percent of Women of Childbearing Age with Anemia, to identify the impact and determine whether the measure reflected the intent of addressing the issue of anemia among the maternal population in the CNMI. During the 2015 MCH Needs Assessment, qualitative information gathered through the CHCC Ob/Gyn department identified an increase in the number of prenatal patients being diagnosed with anemia and that there was a need to increase anemia screening among the women/maternal population. As such, anemia was determined to be a priority area for addressing the health of women in the CNMI. The program and Needs Assessment Steering Committee, through guidance received from reviewers during the 2019 block grant review, have determined that instead of focusing on the rate of women diagnosed with anemia, the program will focus on increasing anemia screening rates. Therefore, SPM 1 will be inactivated and an ESM developed for reporting year 2019 to reflect efforts/strategy for anemia screening among the women/maternal population in the CNMI.  

 

Strategy: Integrate Anemia Screenings and Education into Family Planning visits and preconception evaluations.

Through Title V funds, the MCH Program secured non-invasive hemoglobin screening machines. The equipment allows for non-invasive and quick estimation of hemoglobin levels through a finger sensor. The equipment was provided to the Family Planning Program for anemia screening to be conducted among patients during initial yearly visits. In 2018, the Family Planning medical assistant was able to screen 27 patients before experiencing an issue with the anemia screening equipment. It was determined that replacement equipment was needed and therefore screening at Family Planning visits were placed on hold until a replacement unit was obtained. Screening resumed after replacement machine was received in FY 2019.

 

Strategy: Integrate anemia screening during clinic outreach events.

In 2018 the MCH Program was able to provide anemia screenings to 272 community members during Clinic outreach. Of the 272 screened for anemia risk, 108 were women ages 18 thru 44 years. A total of 16 of the 108 women screened, or 14.8 percent, were identified with hemoglobin levels below the average level of 12 grams per deciliter. Normal hemoglobin range for women is between 12 and 15.5 grams per deciliter. Women who are identified during Clinic outreach with hemoglobin levels of less than 12 grams per deciliter were referred to a primary care provider for further evaluation and treatment, if needed. Women were provided educational material regarding potential causes of anemia and importance of prevention and treatment.

 

Challenges

The Public Health mobile clinic is critical to the provision of services to those who are underserved in the community. During the latter part of 2018, the CNMI’s only mobile clinic vehicle was shipped from the islands of Saipan to the island of Rota after Rota was badly impacted by Typhoon Mangkut. The CHCC Leadership is currently working on procuring a replacement mobile clinic vehicle for the island of Saipan.  The MCH Program will work with partnering agencies and organizations to be able to utilize office space to provide preventive women’s health care during clinic outreach events.

Another challenge is around collecting data on annual preventive visits for the maternal population. The MCH program relies mainly on data collected through the CHCC clinics. And although the CHCC provides 100 percent of inpatient care and a majority of ambulatory care, the program at this time does not have access to information on preventive visits conducted at private clinics. Additionally, since the CHCC had implemented the EHR, programs under Public Health are continuously working with the CHCC IT Director and providers at the Women’s Clinic on assessing current data collection made through EHR and developing plans for improving them.