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. ASMCH 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 ASMCH 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 2021, the Title V program staff were heavily involved in overall DOH COVID related prevention outreaches as the territory of American Samoa continued to implement strict measures to keep COVID out of its shores.

In working through these COVID response efforts, the MCH staff incorporated opportunities to continually monitor and assess priority needs from its selected populations.  Clinical services were forced to close while manpower was redirected to assist in COVID campaigns across the islands.  The MCH team utilized COVID outreach efforts such as call centers, vaccination campaigns, quarantine operations, and surveillance work to reach clients and their families throughout the year. 

Internally, the MCH team also engaged in reviews to compare the initial needs assessment of the five-year cycle to the collective data sources for 2021.  There were no opportunities to conduct actual needs assessment activities as were done in 2020, however, MCH utilized the limited opportunities available through the COVID response efforts to attain information that can be used to gauge changes and progress in the ongoing needs assessment. 

ASMCH Priority Needs and Emerging Needs:

The MCH Team and stakeholders identified priority needs 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, seen throughout the year from MCH populations. 

The Title V Program State Action Plan overall will generally remain as determined from the 2020 Needs Assessment process, with inevitable changes due to the recent COVID-19 pandemic and its overall continued effect on the community and the healthcare system.  Although the American Samoa Government undoubtedly kept the territory COVID free through 2021 with its robust response activities and surveillance, these pre COVID efforts still had multiple effects on MCH populations across the islands.  The hope to continually keep COVID at bay therefore impacted in one way or another some changes to the Action Plan for the remaining four years of this cycle.  The State Action Plan will be revised accordingly to correspond with changes and challenges brought about with the COVID pandemic, as well as the input from Title V stakeholders. 

Some of these adjustments address challenges women and children, as well as children and youth with special needs, have had to endure throughout the year and onward due to the pandemic. These challenges include access to preventive healthcare during “shut-down” mode among the entire community, having an appropriate system in place for families to access necessary services during the pandemic or an island-wide emergency evacuation plan that is adopted by the community as a whole. Due to COVID-19, ASMCH has also begun initiating programs that will teach clients and their families on how to engage by utilizing telehealth as an option during these challenging times to ensure continuity in care and wellness.

The ASMCH team has reviewed its Strategic Plan and has determined to continue with the current plan at hand. The MCH team believes this strategic plan and identified priorities is appropriate to continue guiding efforts in improving health for pregnant women and women in general, as well as all children, adolescents, and those with special needs even during pandemic responses. While pandemic response efforts were significant in keeping the territory prepared for COVID, these works also imposed some negative impacts on MCH populations.  Clinics were closed because all clinicians were assigned to vaccination sites, therefore causing services such as prenatal and dental care to be redirected to the local hospital.  This became an issue for our clients to access care as the local hospital were only catering to primarily emergency cases and not providing preventive care.  For most of 2021, pregnant women had very little to no access to prenatal care, this was the same across all other MCH populations in regards to preventive care, except for the Rheumatic Heart Disease Bicillin clinic. 

Some of the positive efforts during the COVID response in 2021 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 also include weekends, offering stipends to those who receive a vaccine.  Call centers were created to remind people to follow through with second doses and booster shots if they were eligible.  Quarantine sites were operated to monitor repatriated residents from the US and contain the virus so it would not spread into the community.  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 at the comfort of their homes. 

MCH partnered with other programs who also serve children populations under the Department of Health to conduct a toy drive for all children with special needs in the territory.  This became a territorial wide effort as local non-profit organizations as well as student clubs from the local community college joined in the efforts.  This created a promotional effort for young students who were interested in occupations or careers for the special needs populations.  Funding made possible through an AMCHP project afforded technology equipment from MCH to the Intersections group where young students were able to create short videos, podcasts, and public service announcements addressing suicide, depression, drug use, and COVID vaccinations as well as preventive measures.  Telehealth equipment were distributed through a memorandum of understanding between MCH and EPIC (Empowering Pacific Island Communities)- a non-profit organization working with teens to address suicide in local high schools.  The Department of Education was also looped in to play a role in allowing EPIC to introduce an approved suicide prevention curriculum to each high school, install a telehealth system that was purchased by AMCHP funding, and together develop a response plan when cases are identified. 

Overall, the priority list for this five-year cycle continue to align with the current healthcare needs of our MCH populations.  Although the pandemic response efforts have made some negative impact along the way, there are still some positive outcomes that impact the lives and wellbeing of the women and children we serve.  American Samoa reached 84% of full vaccination for the entire 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:  

ASMCH gathered input from stakeholders and community participants on the work that is provided and supported for women and children, as well as children with special needs and their families. Quarterly reports are submitted to the DOH office for leadership to review and provide feedback on the progress of the program and how the public is served through our objectives and efforts. 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. ASMCH staff also attend various meetings and training where primary healthcare providers are present and can share their feedback, request for specific support, and provide valuable insight into healthcare improvements for our women and children. These are various ways that the ASMCH use to evaluate the work we are tasked to do throughout the year.