Expenditures:

Overview of Expenditures

The mission of the Federated States of Micronesia (FSM) Maternal and Child Health (MCH) Program is to promote and improve the health and wellness of women, infants, children, including children with special health care needs (CSHCN), adolescents, and our families through the delivery of quality prevention programs and effective partnerships. The FSM MCH Program works towards achieving this overarching work through the Divisions of Primary and Preventive Care under the Department of Health and Social Services in each of the four (4) FSM States and with our internal and external partnerships. During Fiscal Year 2021, from 10/01/2020 through 09/30/2022 the FSM MCH Program reported to have a total collaborative funds in the amount of $1,614,727. Of the total, $521,427 was provided by the Title V MCH Program.

The chart below shows the collaborative funds available to the FSM MCH Program for use during fiscal year 2021.

The FSM Department of Health and Social Affairs, Division of Health, Family Health Services Unit, manages the following programs:

USE OF THE TITLE V FUNDS

The chart, below, shows the 2021 Title V MCH Budget as prepared to also include FSM States’ activities to response to the current and emerging needs resulting from the Covid-19 pandemic. The emerging needs, mostly are evolved around the FSM States’ Health Departments prevention and containment efforts of the Novel Coronavirus.

Use of Federal Title V Funds

1. MCH Budget for FY 2021.

The budget was developed in order for the MCH Program to also respond to and support FSM States’ prevention and containment efforts of the Covid-19 pandemic as well as to support the States’ decentralization efforts of Essential Services for the Public Health Preventive Programs, including the Maternal and Child Health (MCH) Program. The decentralization of Essential Services initiative includes relocating or shifting of essential public health services from the main/central public health clinics to the dispensaries and Community Health Centers around the main islands in the four FSM States.

Legislative Requirements Met

The FSM MCH Program is continuously striving to ensure that the program is complying with the legislative financial requirements for the Title V Block Grant. The Family Health Financial Management Specialist provides the Family Health Services (FHS) Unit Program Manager a monthly fund status report that consist of current funds available, funds encumbered, funds expended and the legislative required 30-30-10 percentage status report. In collaboration with the FHS Unit Program Manager and programmatic staff, the FHS Unit Financial Management Specialist develops the Title V Block Grant Budget and continuously monitor and track expenditures to ensure compliance with the legislative financial requirements. Expenses are monitored and tracked through the National and State’s accounting system called the, FUNDWARE. The Title V legislation requires a minimum of 30% of the block grant funds to be utilized for preventive and primary care for children and a minimum of 30% of the block grant funds for services for CSHCN. In addition, no more than 10% of the grant may be used for administration costs.

Based on expenditure report provided by the state department of finance in the Four FSM States including the FSM Investment Division showed that FSM MCH Program spent $158,284 or 31% on Preventive and Primary care for children, $159,132 or 33% on Children with Special Health Care Needs, and $42,157 or 6% on Administrative Costs. This shows that FSM MCH Program has not met the required legislative percentages of 30-30-10 for FY 2021. The remaining balance will spend not later than September 30, 2022.

The chart below provides an overview of the required federal allocation for the FY 21 expenditures.

Other Federal Funds

The chart below provides an overview of the Other Federal Funds expended that were also under the direction of the FSM Department of Health and Social Affairs, Family Health Services (FHS) Unit Program Manager, which are also listed in Form 2 [State Systems Development Initiative (SSDI), Early Hearing Detection and Intervention (EHDI) and Title X Family Planning]. The Other Federal Funds total expenditure for 2021 was $653,300.

As stated, the Other Federal Funds listed herein above were administered under the FSM Department of Health and Social Affairs, FHS Unit. Therefore, the Unit continues to align its goals and objectives that serve the MCH population to maximize and leverage resources across all programs. This strategy is in line with the FSM Division of Health Services, FHS Unit’s

efforts for utilizing the life course framework in implementing programs and interventions to address the health and wellness needs and outcomes for the FSM MCH populations.

Total State Match

The total State Matching Funds in the amount of $440,000 is the required match requirement, which includes a $3 match in non-federal funds for every $4 of federal MCH Block Grant Funds expended, which is also the Maintenance of Effort for FSM as established in 1989. Included in the total state match was personnel salaries for staff at the National Department of Health and Social Affairs and staff at the FSM States Department of Health and Social Services, that provides direct services to the MCH population. Since the Funds contribute to direct services, majority of the Title V funds contributes to enabling services and public health services and systems. The actual total amount of in-kind support provided by the States to the maternal and child health population in 2021, was much greater than the $440,000 reported as established in 1989.  However, and since we cannot increase the State Match amount, the Title V MCH program will only report budgeted salary percentages that were stated on the proposed non-federal budget.

The chart below shows how the $440,000 of State Matching Non-Federal funds were expended by type of service as defined by the Title V guidance: direct, enabling and public health services and systems.

The chart below shows how the $521,427 of Title V MCH funds were expended by type of service as defined by the Title V guidance: direct, enabling and public health services and systems.

Expenditures by Population Group

The chart below shows how the $521,427 of Title V MCH funds were expended during this reporting period to serve the Title V population groups: Pregnant Women and Mothers, Infants <1year old, Children 1-21years old; Children with Special Health Care Needs,

The chart below shows how the $440,000 of local funds, non-federal, were expended to serve the Title V population groups: Pregnant Women and Mothers, Infants <1year old, Children 1-21years old; Children with Special Health Care Needs, All Others.

Budget

Budget Overview

The mission of the FSM Maternal and Child Health (MCH) Program is to promote and improve the health and wellness of women, infants, children, including children with special health care needs, adolescents, and their families through the delivery of quality prevention programs and effective partnerships. The MCH Program works towards achieving this overarching work through the Divisions of Preventive and Primary Health Care under each of the four (4) FSM States’ Department of Health and Social Services and with their internal and external partnerships. In Fiscal Year 2023 FSM is estimating a total state MCH budget of $2,105,952.

The MCH Program’s 2023 State Action Plan was developed based on feedback provided in the 2022 MCH Block Grant Review Summary Statement. In a zoom meeting between the FSM MCH staff and the MCHB Region IX Project Officers held during the month of April 2022 the idea for FSM to seek Technical Assistance (TA) was brought up to address the challenges cited in the Summary Statement. However, FSM responded, opting to do the review on our own and provide corrective actions by ourselves. The FSM MCH Program would use the skills and knowledge gained and jam boards developed during the 2020 TA Training to guide and facilitate the review process.

During June 2022, the FSM National and State MCH Program Coordinators and key staff met, virtually, once to review documents and agree to a way forward to complete and submit the 2021 annual report and 2023 action plan for the FSM MCH Program. It should be noted that a series of email messages were exchanged between the National and State MCH Program Coordinators and key staff leading up to this virtual meeting. 

The initial plan for the FSM MCH Program was to have an in-person MCH Annual Planning Meeting for 2022, however our plan was aborted when the Caroline Islands Air (CIA Airlines) broke down and went out of service. CIA is an FSM own airline that provides inter-island travel services between the 4 FSM States. To date CIA has not resumed air service. Pacific Missionary Aviation (PMA Airlines) is a privately owned airline that provides air service for Yap State. PMA can be chartered but it is far too expensive.

Acting on the feedbacks provided in the 2021 Summary Statement, the National MCH Program requested and scheduled an in-person working meeting with the Pohnpei State MCH and Family Planning Programs’ staff and other public health programs’ staff who may be available and can attend, to review the issues raised in the Summary Statement and using those concerns to develop the FSM MCH Action Plan for 2023. The response to the call for an in-person meeting with the Pohnpei Public Health staff was successful and the workshop was very productive.

The Summary Statement Review and 2023 Action Plan Working Workshop, as we called it, was held from June 21-23, 2022. Workshop topics included: Family Planning (FP) Annual Progress Report (guidance, development and submission); 2023 FP Grant Funds (allotments and work plans); MCH Program 2021 Annual Report; 2021 Summary Statement review and response; MCH Program 2023 Action Plan; MCH Program Unobligated Funds; and Miscellaneous business.

The meeting was attended by the staff of the National and Pohnpei State MCH and Family Planning Programs. Also attended the workshop were the Chief, Division of Primary Health Care, Supervisor, Public Health Nurses, selected Health Assistants who provide services at both the public health main clinic and dispensaries in Pohnpei; MCH Data Clerk; Systems of Care Coordinator for Pohnpei State, and the Administrative Officer (AO) for Pohnpei Public Health who oversees MCH grant funds on a daily basis. Also attended, on the last day of the workshop, were Pohnpei State Budget Officer and another staff from the Budget Office and Chief of Finance and the Federal Programs Fund Certification Officer from Pohnpei State Finance office. They were invited to address FSM MCH Program’s ongoing concerns over the large sums of money that Pohnpei has not been able to spend each year.

The workshop started at 8:30 a.m. and ends at 4:30p.m. each day. The workshop format was in both whole (big) group and small work groups. The Workshop sessions were combination of: 1) slide presentations given by the National MCH Staff on the Block Grant Program Requirements; 2) review of the FSM 2022 Grant Application Action Plan focusing on the State Priorities and National Performance Measures selected, Strategies, Evidenced-Based Informed Strategic Measures, and State Performance Measures developed, Data Sources, and discussion on how to improve the alignment and effectiveness of priorities, NPMs, Strategies, ESMs and SPMs;

The whole group reviewed the summary statement to pinpoint areas needing improvements in the 2022 action plan. The whole group also looked at the jam boards developed during the 2020 Technical Assistance (TA) Training, which was facilitated by Dr. Haley Cash, to guide or assist development of effective strategies and sounds State Performance Measures and Evidenced-Based Strategic Measures (ESMs). The smaller work groups, grouped by population domain, actually worked on developing the 2023 MCH Program Action Plan. Other comments and recommendations made in the summary statement relating to the 2022 Action Plan were reviewed and acted upon to assure that strategies are specific or evidence-based in the 2023 action plan for all of the 5 MCH Population Domains. Therefore, the MCH Program’s State Action Plan determines where the MCH federal grant dollars are budgeted. 

The Title V funds consist of personnel salaries and fringe benefits that support the following staffing: FSM National MCH Program Coordinator/Program Manager for the Family Health Services Unit, Family Health Services Unit System and Data Manager, FSM States’ MCH Program Coordinators, Heath Assistants, Health Educators, Outreach Workers, Dental Assistants, Laboratory Assistants, and State MCH Financial Specialists. The following staff works not only for the MCH Program but works across all programs under the Family Health Services Unit. In addition to personnel salaries and fringe benefits, the Title V funds are budgeted towards Professional Services, Public Education and All Other Costs to support the MCH Programs activities and initiatives stated on the State Action Plan. Professional services costs will include continuous development of a MCH Web-based database system, specialty services in Pediatric Cardiology, and other related trainings and technical assistance. Public education and awareness costs include print, radio, local newspapers, and social media posts on the importance of preventive screenings, pre-conception health, prenatal care, screening and treating anemia in women. Community awareness includes publicizing available services and programs, oral health care, breast feeding and early booking education. The MCH Program will continue to educate the community on the importance of developmental screenings, healthy weight and physical activity and nutrition.  Title V funds are utilized towards supporting the breastfeeding support groups, adolescent after school initiatives, Women’s Health Month, and all other community outreach events that serve the MCH population.  FSM is currently not doing newborn bloodspots and metabolic screenings. Funds are also utilized towards other costs such as travel, fuel, freight, membership dues and fees, communication costs, space rental, car rental, boat rental, Department’s highspeed internet line, satellite dishes, etc. The chart below provides an overview of the FSM MCH Program’s FY 2023 Budget as reported on Form 2.

Legislative Requirements Met:

The FSM MCH Program is continuously striving to ensure that the program is complying with the legislative financial requirements for the Title V Block Grant. As stated, the Family Health Services Unit Financial Management Specialist is supported by the Title X Family Planning Program.  Because the Family Planning Program is one of the programs within the Family Health Services Unit, the Financial Management Specialist is able to work across programs. One of the major duties and responsibilities of this Financial Specialist is to continuously ensure that MCH funds are being budgeted and expended per the minimum required 30-30-10 percentage. The FHS Unit Financial Management Specialist provides the FHS Unit Program Manager a monthly fund status report that consist of current funds available, funds encumbered, funds expended and the legislative required 30-30-10 percentage.

The Fiscal Year 2023 Title V Block Grant budget proposal of $521,427 consist of the following types of individuals served: Pregnant Women and Infants less than 1 year of age is budgeted at $97,573 which is at 19% of the total federal award. Preventive and Primary Care for Children is budgeted at $157,040 which is at 30.7 % of the total federal award. Children with Special Health Care Needs is budgeted at $165,814 which is 31.8% of the total federal award. Administrative cost is budgeted at $47,450 which is 9.2% of the total direct costs of the federal grant award.

A total of $53,550 is budgeted for All Other Costs such as travel, dues and subscriptions, repairs and maintenance, communication services, meeting venue rental, car and boat rental and freight. The chart below provides a budget overview of the required federal allocation for the FY 23 Budget.

Other Federal Funds

The chart below provides an overview of the Other Federal Funds budgeted that are under the direct authority of the FHS Unit Program Manager which are also listed in Form 2 [Early Hearing Detection and Intervention (EHDI) Grant Funds, State Systems Development Initiative (SSDI) Grant Funds, and Title X Family Planning Grant Funds]. As indicated in Form 2 of this report, the total amount included under the “Other Federal Funds” category is $653,300.

Total State Match

The FSM is in a unique situation where our matching requirement relative to the actual amount of Federal MCH dollars we receive is less than the MOE level in 1989. As an outcome of the Financial TA Training, held in-county from February 15-24, 2021, FSM redefined and recalculated the state match and came up with a new MOE level of $931,225 higher than the level reported in 1989. There was considerable discussion about what qualifies as a match both in terms of dollars spent as well as in-kind contribution.  Many examples were given of what could qualify as match.  These included the FSM purchase of drugs for Rheumatic Heart Disease, rent and supplies contributed by States to assure the effective operation of clinics for the MCH population, funding from other sources that contribute to salaries of individuals that staff maternal and Child health clinics, etc.  However, by law FSM cannot change the MOE as established in 1989. Other federal funds cannot be used to match the Federal MCH Block Grant as well as non-federal funds that are matching other programs cannot be used to also match this program. The MCH match is budgeted at $931,225 which is comprised of the FSM National and States Health Departments in-kind funds that is consistent with the new MOE calculation and as required by the FY1989 Maintenance of Effort requirements. Therefore, the Federal-State Title V Block Grant Partnership subtotal is $2,104,331. The Total State Match funds are budgeted towards the purchase of drugs for Rheumatic Heart Disease, rent and supplies contributed by States to assure the effective operation of clinics for the MCH population, and personnel salaries and fringe benefits for staff at the four FSM State Departments of Health and Social Services that provides direct services to the MCH population. Since the State Match funds contribute to direct services, majority of the Title V funds contribute to enabling services and public health services and systems.