I.E.  Program Overview

The Federated States of Micronesia (FSM) comprises part of what was generally known as the Eastern and Western Caroline Islands. Some of the islands are volcanic and others are small atolls, except the state of Kosrae that doesn’t have any other smaller atolls.  The four FSM states are widely spread apart by the ocean, hundreds of miles from east to west. From farthest east is the state of Kosrae, which is more closer to the islands of the Republic of the Marshalls than to the islands of Yap, then going Westward to the states of Pohnpei, Chuuk, and farthest west is the state of Yap, which is more closer to the islands of the Republic of Palau than the rest of the FSM.  The total distance across FSM, from east to west, is approximately 1,800 miles, the distance from Northern Maine to Miami and encompasses two time zones.

FSM has withstood the incursion of multiple cultures since the late 1800s from Spain, Germany, Japan, and then the United States that have led to social and economic changes.  For example, until the introduction of foreigners, FSM people lived without the burden of NCDs, alcohol and other drugs.  Recently, the FSM market’s increased reliance on a cash economy has required a greater number of citizens to earn cash to buy basic services, such as transportation, groceries etc.  These changes have resulted in more nuclear and less extended family structures and new gender roles. 

In November of 2018, the FSM MCH Program under the FSM Department of Health Services, have received the award from the grantor- MCHB HRSA for the period of 2019 to 2020.  The FSM Title V Program intends to use this current MCHB fund to continue with the MCH needs:

- Significantly reducing infant mortality;

- Providing comprehensive care for women before, during, and after pregnancy and childbirth;

- Providing preventive and primary care services for infants, children, and adolescents;

- Providing comprehensive care for children and adolescents with special health care needs;

- Immunizing all children;

- Reducing adolescent pregnancy;

- National standards and guidelines for prenatal care, safe child care, health supervision of infants, children, and adolescents;

- Assuring access to care for all mothers and children; and

- Meeting the nutritional needs of mothers, children, and families

The Federated States of Micronesia (FSM) Title V program is under the FSM Department of Health and Social Affairs (DHSA). The goal of the division of health services is to improve primary and secondary health care services, prioritize health promotion and services and develop sustainable health financing. One of the roles of the national division of health services is providing assistance to the state health services departments through funding and technical assistance.

The Family Health Services Unit housed the MCH program at the national Health Services Department.   It is obvious that the Title V Maternal and Child Health Services Block Grant is the only program in the department that takes care of the four state MCH programs to strengthen maternal and child health services in their respective states.

The priorities for the FSM MCH population domains are still unchanged from previous year, but with minor modifications made in June 2019. Few updates were being made on the Priorities, ESM, SPM and Strategies. Below table shows the current Priorities, NPM, ESM and SPM that the FSM Title V program currently have and will continue to implement.

The FSM MCH program aims to address the existing and updated priorities under the 5 MCH population domain: Improve women’s health through cervical cancer and anemia screening; Improve perinatal/infant outcomes through Gestational Diabetes and anemia screening during early and adequate prenatal care, hearing and anemia screening of the infant and promoting breastfeeding; Improve child health through providing vaccinations, screening for developmental delays, oral health for children and reduce child injury; Decrease incidence of teenage pregnancy and STI and Provide a transitional services for youth identified as having Special Health Care Needs. See (Supporting Document #1) completed Action Plan for 2020.

DOMAIN: WOMEN/MATERNAL HEALTH

Improve women’s health through cervical cancer and anemia screening

Past Year Accomplishments: The FSM Title V program continue to provide cervical cancer screening and anemia screening to women of child bearing age (15-44 yrs old) in 2018. All of the four MCH programs in the FSM were able to utilize the E-pathology for Pap smears in Pohnpei and Japan. Collaborative efforts with other Public health programs and Community Health Centers are still in effect.  Mass screening of Rheumatic heart disease was done in Pohnpei. 

Challenges: Preventive health screening in the outer islands is still an issue, as there are limited staff and equipments to conduct the services. There were shortages of Midwife/Nurse practitioner in the OB clinics at the state hospitals. There was limitation in skilled staff to handle Pap smear specimen preparation to send off to the center for further examinations. 

Plans: The FSM State MCH programs will continue to send Pap smear slides to Pohnpei for the E Pathology and Pap smear reading and result. FSM States plan to conduct awareness workshops to women’s groups on cervical cancer and anemia screening on an annual basis. Screen all women (child bearing age) in PH, Hospital, Dispensaries, schools, and outreach.  Actual activities on disseminating information on women's health will include text messages, radio announcement and other way of reaching the public for the annual events. The state MCH programs will conduct annual women’s health event for cancer screening for cervical ca, breast cancer and anemia screening for all women ages 15-65 years old. MCH Program anticipates drafting Proclamation and having Governor of each FSM States to sign for all women in the Nation to join the event on Women's Health Day.

Domain: Perinatal/infant Health

Improve perinatal/infant outcomes through Gestational Diabetes and anemia screening during early and adequate prenatal care, hearing and anemia screening of the infant and promoting breastfeeding.

Accomplishments:  There was an increase in the percentage of infant's breastfed exclusively through 6 months.  Existing breast feeding support groups are either active, partially active and need reactivation in all the four FSM states.  All the OB and MCH nurses trained and certified to do new born hearing screening, anemia screening and gestational diabetes screening. 

Challenges:  

-     Most of the services (GDM test, STDs test,) that are offer in the main islands, are not offer in the remote dispensaries or outer islands

•                    Late booking and inadequate visit of pregnant mothers caused difficulties in monitoring their health status (diabetes, STDs, hypertension and etc)
•                    Most of the breastfeeding support group members are no longer active to provide breastfeeding services in the communities
•                    Shortage of staff nurses and nurse rotation in OB wards.
•                    Private clinics are not screening newborn for hearing loss.
•                    Customary adoption is another challenge.

Plans:  MCH programs will reactivate and recruit new members of the breastfeeding focus groups to implement the activities for the breastfeeding groups.  There will be training to new members on counseling and services regarding breastfeeding. MCH programs at the state level will continue to do prenatal screenings on gestational diabetes, anemia and newborn hearing screening with collaborative efforts with the lab and other public health programs.  Two state MCH programs will continue to work with their legislative leaders to pass the newborn hearing screening law in their states.

Domain: Child Health

Improve child health through providing vaccinations and screening for developmental delays, oral health and reduce child injury

Accomplishments:   There was mass campaign on MMR vaccination for the young children in the state of Pohnpei as well as the other three state MCH programs which they had their own immunization vaccinations in their respective states. Developmental screening was part of MCH programs' routine work through well-baby clinic hours along with some of the Community Health Centers in some of the FSM states. Awareness on road safety and injury prevention by the Public safety department was one major activity that was done by Information strategy mode. Curfew hours for children not roaming around public road after 9:30 pm were observed in most of the states.   There was improvement on oral health care among children and the data shows an increase in the services provided in the past year.  The Association of State and Territorial Health Officials (ASTHO) have recognized the efforts in the decreased on child mortality rates in the FSM which continues to drop from 2010-2016. 

Challenges:

- Procurement of hearing screening supplies

-Shortage of staff affected developmental screening in the dispensaries

-Dental preventive care and children needing immunization are still activities/services that need to be stabilize.

- No developmental screening tools for above 18 months old babies

Plans: FSM MCH national program will continue to seek for tools and training on developmental delay screening tools above the 18-months old.  Collaborative efforts will be continued with the Immunization programs to increase the coverage on children vaccination on Main Island as well as in the outer islands.  Following are activities anticipated:

•                  Increase the number of dental staff in the dental clinic program
•                  Do parental and community education campaign using visual aid, radio, television and posters in prominent areas in the schools and communities.
•                  Develop brochures and poster addressing topics on childhood injury and distributed to the community.
•                  Do parental training on childhood injury prevention with other stakeholders.
•                  Work with public safety and other affiliated agencies on children injury preventive measures

Domain: Adolescents Health

Decrease incidence of teenage pregnancy and STI

Accomplishments: There was an increase in the number of schools in the FSM with the target age group (12 to 17 years old) that have received educational awareness on teenage pregnancy, STDs, alcohol and drug abuse and healthy lifestyles.  MCH programs have collaborated with other Public health program to carry out the implementation on the strategy for this domain population.

Challenges:   There are not enough curriculums on healthy adolescent behaviors that are included in the schools curriculums and policies. Laws on reducing risk behaviors among adolescents are not fully supported and uplifted at the state levels. There is lack of youth friendly clinic services in the states. 

Plans: Continue to provide educational awareness on sexual health (teenage pregnancy) to adolescent ages 12-17 years old in all Public schools on main islands.

•                  Collaborate with other public health programs (HIV/STI, PREP, Family Planning, etc.)
•                  Secure supplies and  materials (IEC materials)
•                  Inform/meet with Director of DOE regarding the schools visits schedule and schedule   meeting with the parents during PTA meeting
•                  To conduct a  presentation on Teen pregnancy and STIs  during PTA meeting
•                  Share strategies with the parents during PTA regarding the schools visits and get their consensus
•                  Presentations on the consequences on STI and teen pregnancy and preventive services available
•                  Distribution of IEC materials (brochures, and pamphlets)

Domain: Children and Youth with Special Health Care Needs

Provide transitional services for youth identified as having Special Health Care Needs

Accomplishments:   FSM MCH continue to support CSHCN youth with special health care needs in their employment efforts. There was an improvement in the CSHCN registry that collects, store and analyze CSHCN data indicators for this population. There was an assessment on Rheumatic Heart Disease in one of the States which the outcome result enlighten the high officials on the significance of RHD screening, and is supported by the FSM national congress leaders by appropriating an amount specifically for RHD in children. 

Challenges:

•                  Not all CSHCN children are in schools or enrolled at the Special Education program.
•                  There is no rehabilitation center where children can learn how to sew, cook, do gardening and build canoe, etc.
•                  No tracking data on transited CSHCN Clients
•                  Communities are not fully aware of the services available
•                  No such existing law regarding CSHCN youth becoming employee
•                  No Rehabilitation services where all this CSHCN youth that are not in school could register and get serve

Plans:  Continue collaboration among programs, entities and community groups.  Maintain collaborative efforts with families, CHC and dispensaries in all states.  MCH programs will continue to strengthening awareness efforts in the communities on the availability and easy access of these health services to CSHCN youths. Work collaboratively with the NGOs, companies, churches, and other related services to help in serving this CSHCN youth.

Another suggestion from one of the MCH programs is to work collaboratively with DOE, DOHSA, NGO’s and Interagency Committee/Stakeholders (IAC) to identify non-medical services and improve existing services to support programs to improve transition services to CSHCN youths.