The mission of the Republic of Marshall Islands (RMI) Maternal and Child Health (MCH) Program is to promote and improve health and wellness of women, children, infants, children with special health care needs, adolescents, and families by providing quality preventive services.  The RMI MCH Program Director manages the Title V Program, Children with Special Health Care Needs Program, and the Family Planning program.  The MCH program coordinates with other Public Health (PH) programs, the States Systems Development Initiative (SSDI), as well as international partners such as, Centers for Disease Control and Prevention (CDC) United Nations International Children’s Educational Fund (UNICEF), Early Childhood development (ECD), the United Nation’s Population Fund (UNFPA), Early Hearing Detection Initiative (EHDI), and the World Health Organization (WHO) on program activities.

The RMI MCH is awarded $230,524.00 each year from the Title V MCH Services Block Grant. The MCH Program is among the eight programs under the Bureau of Primary Health Care Services (BPHCS), under the Ministry of Health and Human Services (MOHHS). Together with MCH state funds and other federal funds, the Title V MCH block grant is used to address RMI’s priority needs, improve performance and expand systems of care for the MCH target population. Title V funds compliment the state plans in supporting healthcare for women and children by addressing gaps and priority needs which are not achieved by state funds or other federal funds. MCH continues to work with members of the MCH Needs Assessment Steering Committee to assess the impact of the strategies implemented towards addressing the priority needs of the target populations served. Focus groups discussions with the key stakeholders and selected people from the community and key in-depth interviews with the medical providers, and other program managers are also conducted to gather information in assessing the needs of the MCH target populations.

The ever-changing MCH target population demographics, emerging of new diseases, the change in health trends over-time, and the shift in program capacity influences the MCH program routine assessments of the needs of the MCH target population in RMI. In 2020, the MCH program in collaboration with Marshall Islands Epidemiology Initiative (MIEPI) and key stakeholders completed a 5-year comprehensive needs assessment which examined areas of priority and alignment between local MCH priority needs and the national Title V National Outcome Measures (NOMs) and National Performance Measures (NPMs). This assessment resulted in the identification of the NPMs in each of the five population health domains for programmatic focus over the 5-year cycle and development of State Performance Measures (SPMs) for priorities not addressed by NPMs. State priorities identified were aligned to the MOHHS wide strategic plan.

Priorities and Performance Measures Linkage

The MCH block grant provides support to the RMI MOHHS MCH program activities through comprehensive, coordinated, and family-centered services (inclusive of children with special healthcare needs). These are also supported through decentralizing services through to the communities (clinic outreach, community awareness, family support services, case management/coordination), and transportation to and from Majuro, Ebeye and the Neighboring islands (NI) which also allows for referrals to Shriners for surgery and domestic referrals to the two main hospitals. These activities are coordinated through partnerships with local programs across systems that serve the MCH populations.  Partners include Youth to youth in health, Women United together in the Marshall Islands, Ministry of Internal Affairs, Public School System and other non-profit and/or non-governmental organizations. These partnerships are critical in the MCH Bureau’s efforts in expanding its reach for serving target groups and for integrating services to support a comprehensive system of care for the women, children, and their families.  With the COVID-19 pandemic, activities and services for the program were affected due to the staff being reassigned to assist in outreach activities for assessment, vaccination, and quarantine on Majuro, Ebeye and Neighboring Islands.  The information submitted in the Marshall Islands Title V Block Grant Annual Report/Application reflects the efforts over the past year in implementing strategies identified in the State Action Plan to address RMI MCH Priorities across the five (5) health domains: Women/Maternal Health, Perinatal/Infant Health, Child Health, Adolescent Health, and Children with Special Healthcare Needs. The following is a summary of accomplishments during 2022, challenges, and plans for 2024.

Women/ Maternal Health

Priority: Improve women/maternal health through cancer screening, prenatal and family planning services.

Highlights:

• Continue partnership with Cancer Program to increase the rate of cervical cancer screening through after-hours clinics and patient navigation. Increase the number of women detected with abnormal pap smears and referred for tertiary care for immediate treatment.
• Continue to provide education and awareness of importance of annual women checkup and availability of services to the communities and faith-based organizations
• Spot checks on inventory of family planning commodities and availability of supplies and equipment for MCH services like prenatal, birth delivery, infant care and other related services in Majuro, Ebeye and Neighboring Islands.
• Dental outreach visits to Neighboring Islands in collaboration with Taiwan Health Center and ECD Program
• Distribution of safe delivery kits to the Neighboring Islands health centers.
• Availability of Prenatal via telehealth services when hospital/public health clinics were closed due to COVID-19 community transmission.
• World Cancer Awareness Month activities 182 participants Age range from: 3yrs – 60+ on the kickoff activity with a walkathon, sponsored tennis and volleyball tournaments with NCD and cancer screening of players, and Ebeye breast cancer screening,
• Cancer Summit in Majuro where all our key stakeholders and cancer coalition members attended to reflect on all the accomplishments and challenges the past five years; breakout sessions with coalition members and health providers
• No Maternal Death in 2022

Challenges:

• Socio economic reasons which affect the visitation to the services
• Due to strong cultural practices, women would resort to traditional medicine before coming for consult or even after consult with a physician.
• Limited availability of female Health Assistants in the Neighboring Island which resulted to low prenatal visits, late identification of high-risk pregnancy, and low annual screening.

Plan:

• To expand cancer screening services to the communities
• MCH One Stop Shop for domain population
• Buildup of workforce capacity by Midwifery; 15 Neighboring Islands Female health care workers; training of the Community Health care workers and continuing education for BS in Nursing

Perinatal/Infant Health

Priority: Improve perinatal/infant’s health through adequate and quality prenatal services and newborn screening

Highlights:

• Counselling on importance of exclusive breastfeeding to all lactating mothers.
• Radio awareness and spots on importance of early prenatal visits are ongoing
• Distribute baby bags to mothers who attended prenatal care in their 1st trimester
• 22 solar powered freezer donations received to build the capacity of Neighboring Islands Health centers for cold chain equipment.

Challenge:

• Limited newborn screening for Neighboring Islands due to lack of equipment and trained staff
• Availability of immunization services in the Neighboring Islands is dependent on the outreach mobile visits for the 2 main islands (Majuro and Ebeye).
• The hiring of nutritionist and lactation nurse that will train the health care workers was stalled because of the closure of RMI borders which limited the capacity to bring subject matter experts.

Plan:

• Improvement of services in the NI Health Centers by providing cold chain equipment, training of health assistants on vaccination
• Partner with community-based organizations to promote and support breastfeeding practices, Baby friendly initiative projects including breastfeeding awareness and education
• Partner or seek technical assistance to update birthing hospitals SOP for delivery and management of newborns

Child Health

Priority: Improve child health through early childhood developmental screening and vaccinations/Promote child safety in the community.

Highlights:

• COVID-19 vaccinations for children are available and provided in Majuro and Ebeye. Increase number of immunization outreach visits in the Neighboring Islands through the COVID-19 vaccination campaign
• Early Childhood program supports the Parents as Teacher project under the Women United Together Marshall Islands.
• Continue to support the oral health with supplies and travel to the Neighboring Islands.

Challenges:

• Availability of immunization services in the Neighboring Islands is dependent on the outreach mobile visits for the two main islands (Majuro and Ebeye). Currently, there is no cold chain equipment in the Neighboring Islands Health Centers

Plan:

• Implement cold chain equipment system in the Neighboring Islands for storing of vaccination. Build the capacity of the health assistants to vaccinate and monitor the cold chain of the vaccines.
• Conduct community awareness on the proper immunization schedule and the benefits of immunization
• Continue to provide outreach services to improve access to services

Adolescent Health:

Priority: Improve adolescent health through promotion of adolescent wellbeing and reducing teen pregnancy

Highlights:

• Climate Change Art Seminar for high school students linking health to climate change using the medium of art to foster a deeper engagement with the issues of climate change and health.
• Youth friendly sexual reproductive health training 
• Family planning supply chain management design training
• Launching of Sexual and Gender Based Violence Clinical guidelines
• No suicide and motor vehicle mortality reported.

Challenge:

• Encounter hindrances in Family Planning awareness in the school. Sexual Reproductive Health subject is not part of the curriculum.

Plan

• Development of the Comprehensive Sexual Education Curriculum
• Advocate FP services for parents’ consent during PTA meetings

CSHCN

Priority: Improve enrollment and special care of CSHCN through developmental screening and referrals to proper care.

Highlights:

• Referrals from MCH clinic to Human Services for evaluation.
• Parents and Doctor sessions
• Family group session with parents with children with hearing problems

Challenges:

• Lack of specialty care of CSHCN in RMI. CSHCN are referred off island to seek specialty care and treatment which adds financial and emotional burden to the families and the government.

Plan:

• Develop transition plan in partnership with government agencies and NGOs

• Hire a CSHCN Manager that will oversee the CSHCN projects and report to the MCH Director