Overview

The Family Health Unit (FHU) works to improve the health of families in Palau “through the provision of quality and comprehensive public health and medical services.” Among the grants that FHU manages, the Title V Maternal and Child Health (MCH) block grant contributes essential efforts into reaching this mission. Palau’s MCH Program works to achieve such all-encompassing work through internal partnerships within the Ministry of Health and Human Services (MHHS) and external partnerships with other government and community-based organizations.

For Fiscal Year 2022 (FY22), MCH services has a combined value of $783,320 – this number is inclusive of Federal (Title V, $144,482), State (185,124), and Other Federal Funds ($453,714). FHU has managed to spend 96% of Title V MCH Funds as of June 2023; the remaining balance of $5,858 is allocated for the team’s traveling expenses to attend the Title V MCH Block Grant Review taking place in Hawaii. The team is confident Title V Funds will be expended by the end of the project period.

Title V Federal Funding

Title V Funds, broken down based on HRSA’s budget categories, consist of the following:

• Personnel - 37%
• Travel  - 26%
• Others  - 21%
• Supplies  - 9%
• Fringe  - 5%
• Indirect - - 2%

Majority of the Title V Funding provide salaries for FHU employees including two coordinators (MCH and Adolescent Health), a counselor, and 20% of the only Palauan pediatrician on-island – all very vital positions in protecting MCH health. In terms of workforce, many of the FHU staff perform additional duties and tasks (sometimes outside of their position description) to maintain the all-encompassing work necessary for MCH. For instance, some are managing admin work with data capacity, budget handling, and/or hearing screening. The Newborn Hearing Screening Coordinator is also the only person in Palau certified to administer Family Planning implants, is also MCH’s case manager for families with special needs and conducts home visitations. There is a great need to increase workforce capacity with limited funding. To help reduce this challenge, FHU seeks to form new and strengthen existing partnerships internally and externally.

Legislative Requirements

The Palau MCH team continues its work to ensure that the program is compliant with the grant’s financial legislative requirement. Ms. Lauver’s TA also covered this aspect of the grant and we were fortunate to have members of the Ministry of Finance (MOF) attend, strengthening communication and understanding between the two parties. Palau has spent 32.6% for Primary and Preventive Care for Children, 34.08% for Children with Special Health Care Needs (CSHCN), and 8.9% on Administrative Costs as of June of 2023; Palau Title V Program is compliant with the 30-30-10 legislative requirement.

Type of Services

Through Ms. Lauver’s TA, we were able to correct our reporting on the types of services provided by the MCH program. For FY22, FHU reports that the Title V Fund provided $0 for Direct Services, $56,215 for Enabling Services and $88,267 for Public Health Services and Systems. Careful discussion with Ms. Lauver allowed us to correctly identify funds and determine that Palau does not provide any direct services from the Title V grant.

Type of Individuals Served

Of the $144,482 Title V dollars that have been expended as of June 2023, 91.1% were spent on services devoted to five different groups of individuals: Pregnant women, Infants under the age of 1 year old, Children aged 1 to 21 years old, Children with Special Health Care Needs (CSHCN) and others. With receiving technical assistance earlier in 2023, FHU acknowledges that assessment and corrections in finance is required to improve reflections towards data and in reporting.

State Funding

Early in 2023, Palau received technical assistance (TA) from HRSA consulted by Cassie Lauver in finances. The FHU team expresses immense gratitude to Ms. Lauver’s assistance; her help has provided guidance in our team’s ability to better understand and identify, manage and report finances – especially regarding State/matching funds. Compared to previous years, our state match funds has remained at a constant amount of $120,000, overlooking various resources that have and continue to support MCH priorities. The Palau MCH team, although continuing to work on gathering accurate information for this issue, is pleased to report that State funds for FY22 are currently at $185,124. Much of this increase are mainly the salaries of the nurses and patient care assistants who are the health providers at the Central Community Health Center I (CCHC I) administering the all the FHU clinics. FHU is tightly connected to the Community Health Center (CHC), thus, MCH services are extended throughout the other health centers on island and the OB ward within the hospital. The program will continue to quantify the in-kind resources available at those settings that did not make it to this annual report, for future submissions.

Other Federal Funding

Along with Title V MCH Block Grant, FHU manages three other federal funding as seen on the bar graph figure: these include the State Systems Development Initiative (SSDI), Universal Newborn Hearing Screening and Intervention (UNHSI) and lastly, Title X Family Planning. These funding also provide largely to the program’s personnel, equipment, supplies and travel ensuring the continued work to have the clinics running and efforts in improving the quality of services. The bar graph seen here is a breakdown of all the federal grants side by side, based on budget categories. Personnel continues to be the largest expense across all four grants. UNHSI was the only grant used to purchase equipment for FY22. Travel is secondary in expenditures as the increase/improvement of workforce capacity is a priority need for MCH, and all of FHU.

Overview

Title V funds complements non-federal monies where the state funds experience shortfalls.  These areas include funding of personnel that are not included under the state financing scheme.  The program works with the state to enable preventive services for all pregnant women, well baby clinic and overall well-women care. It also provides preventive screening services for men so that they can be an active participant in the overall well-being of the maternal and child health population.

Title V funds and complementary funds are appropriated to areas such as home visitation, clinic monitoring for quality assurance and improvement, personnel costs for additional services such as newborn screening, pregnancy monitoring and general education and outreach efforts.  These generally enable activities to take place with qualified personnel that have been trained and certified to provide the services that MCH is tasked with. It also enables the home visitations to occur for children with special needs, at risk and/or high-risk pregnant women. Services for well-women care (including pre/postnatal care) and infants under the age of 1, are provided by providers, counselors and program staff, including partner organizations that have a vested interest in the overall success of the program.  In areas where permanent staffing is not available to fill the need, the program steps in to provide the necessary support.  The program complements the state funds in the services of a pediatrician, a counselor and coordinators that ensure delivery of services.  While private clinics provide some services for pre/postnatal care, the MCH program provides the bulk of these services, including immunization services for children 0-5 years old.

Title V dollars enables the program to deliver services such as those mentioned above, develop and promote intervention efforts in response to changing needs as well as equip the workforce with needed trainings and meetings to address emerging issues such future pandemics.

Assurance of Title V Legislative Requirement

Palau’s MCH program has updated its financial tracking process and developed tracking sheets to better keep track of expenses, which will be reported to the Coordinator by the FHU Budget Officer on a monthly basis. This will allow the team’s assurance to trail and monitor expenditures to remain in compliance with Title V’s 30-30-10 legislative requirement. Because a large part of the funding is allocated to personnel, budget officer will be requested to submit payroll reports on a monthly basis as well to provide more accurate tracking.

Reflecting lessons learned from the previous technical assistance from HRSA MCHB on finance reporting

Other Supportive Funding

State Match Funding

Enhanced knowledge and efforts in collecting the accurate value of health services that serve the maternal and child health population has shown an increase in FY22 compared to previous years. Palau MCH Funds have always been in compliance with Title V’s match requirement (a $3 match in non-federal funds for every $4 of federal MCH Block Grant funds), yet our submissions have been underreporting the actual value. This fiscal year, the $185,124 state-matching funds reported are not completely comprehensive of the actual value of services that the state is providing to women and children nationwide. This number is expected to be higher in the next reporting period as FHU continues to gather the extensive amount.

Other Federal Funding

As for other federal funds that support MCH purposes of FHU for Fiscal Year 2024 (FY24), they are as listed below:

1. Universal Newborn Hearing Screening Intervention (UNSHI)
   • Anticipated funding  - - $200,000
   • Continues to support hearing screening services, contracts with specialists to provide diagnoses, access to healthcare, workforce capacity and home visitations with Children with Special Needs and their families
2. State Systems Development Initiative
   • Anticipated funding  - - $100,000
   • Increased from $50,000 on previous year
   • Continues to support data workforce development and improvements in data collection and reporting. Focus for 2024 will be on digitizing surveillances and provide training/refresher courses to providers in the clinic to administer them accurately
3. Title X Family Planning
   • Anticipated funding  - - $235,000
   • Continues to support contraceptive assistance, fertility services, education and counseling on family planning and birth spacing. Will shift focus on reaching adolescent population on education for reproductive and sexual health.