PROGRAM OVERVIEW:

The American Samoa Maternal and Child Health (ASMCH) Program under the Department of Health receives funding from the federal Health Resources and Services Administration (HRSA) Title V Block Grant, towards improving the lives and overall health of women and children, including children and youth with special health care needs in the territory. MCH is currently under the leadership of the Deputy Director Fara Utu, who reports to the Director of Public Health. An organizational chart is displayed in Figure 1.

Figure 1: American Samoa MCH Program Organizational Chart:

Needs Assessment Findings:

The MCH Title V Program continues to use the block grant logic model to guide the development of the 5-year program plan. From the initial year of the 5-year cycle, the needs assessment process is strategically done to gather information leading to priority needs on all MCH populations.  Throughout the year 2022, the Title V program staff were heavily involved in overall DOH COVID response as the territory of American Samoa faced the reality of having this viral infection spread in the community.

In working through these COVID response efforts, the MCH staff incorporated opportunities to continually monitor and assess priority needs from its designated populations.  Most clinical services were forced to close for some time while manpower was redirected to assist in COVID vaccination campaigns and sites for COVID treatments across the islands. The only clinics that were allowed to open was the RHD Bicillin clinic and the well child clinic but with restrictions such as social distancing and masking. The MCH team utilized COVID outreach efforts such as call centers, vaccination campaigns, treatment sites, quarantine operations, and surveillance work to reach clients and their families throughout the year. 

Internally, the MCH team engaged in reviews to compare the initial needs assessment of the five-year cycle to the collective data sources for 2022.  The MCH Title V staff collaborated with partners and agencies who are Data Sources in order to collect and analyze the most up to date and accurate data information during the annual Needs Assessment for 2022. This helped to obtain most Quantitative data beside those provided in national and jurisdictional surveys. There was no opportunity to collect qualitative data from consumers and service providers in various focus groups, however feedback and recommendations were obtained and utilized from MCH stakeholders’, other major coalitions and advisory group meetings. This includes meetings by COVID-19 Taskforce (daily then weekly in 2022), NCD Workgroup Committee (weekly), Special Education Board (monthly), DOH Children’s Services Programs (quarterly), Leo o Aiga Support Group for Parents of children with Autism (monthly), Parents for children special needs Network, Medicaid workshop (annual), Money Follow the Person Advisory Group (monthly), DOH Medical Staff CME (weekly), and DOH Key Leaders Meeting (weekly). MCH utilized these opportunities to also obtain information that can be used to gauge changes and progress in the State Action Plan.

ASMCH Priority Needs and Emerging Needs:

The MCH Team and stakeholders identified priority needs at the start of this 5 year plan, that are specific to American Samoa with distinct variations directly related to cultural, economic, and geographical challenges and expectations, but are very similar to the needs of women and children across the vast United States These needs range from improving healthcare early in a young woman’s life, before, during, and after pregnancy, to ensuring best health outcomes for children from newborn to adulthood.  These determinations were also based on the critical changes, challenges, and positive outcomes that derived from the COVID pandemic, and other outbreaks experienced by the territory in the past few years.

AS MCH Title V and partners have reviewed the Strategic Plan and has made two revisions to the current plan in terms of its priority needs. One priority need was slightly revised accordingly to meet the emerging needs of building a more functional RHD registry (Priority Need # 8) for better tracking and reporting in SILAS (MCH centralize electronic database. The second priority need was moving the RHD priority need and strategies from Children to the CYSHCN Domain. This is a more appropriate domain for RHD cases because they meet the definitions for CYSHCN. Most of the objectives for each domain were also revised to reflect future years. Some of the strategies achieved in 2022 were either removed or revised to achieve improved services and health outcomes for the MCH population.

Revisions to plan strategies and activities continued with delays in the plan implementation as a response to everchanging pandemic circumstance/conditions. Key highlights are provided by domain and priority health issue:

DOMAIN:Women/Maternal Health

Promote early prenatal care

• Collaborate with all Prenatal Care Providers and support programs (BCCP, MIECHV, CHC, HIV/STD, NCD, Primary Care, Prenatal Clinics, WIC, Intersections Inc., Media) to promote and refer women for early prenatal care services.

Promote postpartum check-up and postpartum depression screening

• translate health educational materials and disseminate them

DOMAIN: Perinatal/Infant Health

Promote exclusive breastfeeding

•  Promote baby friendly hospital
• Facilitate trainings for programs and service providers, including home visitors

DOMAIN: Perinatal/Infant Health

Establish a newborn bloodspot Screening program.

•  Initiate NBS for congenital hypothyroidism (CH).
• Initiate CCHD screening by pulse oximetry.
• AS DOH and New Zealand NBS will identify appropriate Advisory Committee membership, to include families and community members, and form a project Leadership Team.
• Develop a Birth Condition Surveillance reporting system
• Partner with NBS Excel Awardee

DOMAIN: Child Health

Promote developmental screening

• facilitate a refresher course for service providers
• Translate questionnaires

DOMAIN: Child Health

Promote routine vaccinations

• collaborate with the Immunization Program and the service providers to promote routine immunizations.

DOMAIN: Child Health

Promote fluoride varnish for children 1 through 3 years of age.

• Revise current standard operating procedures and provide refresher training for all medical staff at dental clinics and well baby clinics, at least twice a year.
• Provide promotional oral hygiene kits to give out in the month of February, Children's Dental Health Month.
• Record a Samoan PSA video promoting what to

DOMAIN: Adolescent Health

Improve annual checkups for adolescents

• Initiate a Taskforce who will introduce to legislatures a Healthy Schools Policy to mandate all school children in Elementary and High Schools to to receive a wellness check-up within 3 months prior to the start of every school year.
• Generate an Adolescent Health Check-up Passport according to the Well-visit roadmap. - Weight management (7th grade)- Reproductive health (8th grade) - Mental health (9th grade)
• Collaborate with related partners such as Intersections Inc., ASNOC, Faithbased Youth Organizations, Teen Challenge, DOE and Private schools to refer clients and students for annual medical check-ups.

DOMAIN: CYSHCN

Improve health care system for CYSHCN

• Update Standard operating procedures for care coordiantion
• Autism screening and referral training
• Transition training for providers

DOMAIN: CYSHCN

Reduce Rates of Rheumatic Heart Disease

• Continue call reminders 1 week, then 1 day prior to the appointment date.
• Continue to provide mass media campaigns in promoting RHD Clinic.
• Ensure to enter encounters and Bicillin shots in SILAS to build the RHD Registry for tracking and monitoring.

DOMAIN: Cross-Cutting/Systems Building

Establish a functional  Rheumatic Heart Disease (RHD) registry in SILAS to improve the monitoring, surveillance, and management of these conditions.

• Build an accessible RHD registry in SILAS and ensures it has the capability for appointment reminders, antibiotic documentations, Cardio echo results, cardiology notes and other medical reports.

Some of the positive efforts during the COVID response in 2022 include strengthening partnerships with other existing programs in the community to address priority concerns in our strategic plan. DOH rolled out community vaccination clinics daily to continue increasing the coverage for COVID vaccinations protecting the general public from severe illness and death. Call centers were created to remind people to follow through with second doses and booster shots if they were eligible. MCH staff were part of all these efforts, and at the same time, continually followed up with program clients who needed assistance during these operations. Families of CYSHCN were identified to receive support services such as transportation to a drive through vaccination site, or be referred to a home visiting nursing team to receive their vaccinations or COVID treatment at the comfort of their own homes. 

Although the pandemic response efforts have made some negative impact along the way, there were still some positive outcomes that impacted the lives and wellbeing of the women and children we serve.  American Samoa reached over 85% of full vaccination for the total population, which is an effort to be recognized as it meant great coverage for our families, our women, and our children.  Despite challenges and obstacles, MCH populations continue to thrive and survive through the COVID pandemic.

Program Evaluation:  

MCH gathered input from stakeholders and community participants on the work that was provided and supported for women and children, as well as children with special healthcare needs and their families. The ASMCH program and its non-profit organization partners in the community retains a strong partnership, where consistent discussions and meetings occur to evaluate efforts that target our specific populations. SWOT analysis are done annually to ensure program staff and key stakeholders are made aware of strengths, weaknesses and opportunities for improvements.