Program Overview

Politically, the FSM is freely associated nation with the United States under a Compact of Free Association entered into with the United States in 1986 with an amended compact entered into on June 30, 2004. Each of the four FSM States has its own constitution, elected legislature and governor. The governments of the FSM and the United States maintain deep ties and a cooperative relationship, with over 25 U.S. federal agencies that maintain programs in the FSM.

To understand the challenges and context of the FSM, a brief review of the geographical location, political status, population, and the significant ethnic and linguistic diversity of the FSM is necessary. The FSM is an island nation with a total population of approximately 104,832 spread out over some 607 widely dispersed islands in the Western Pacific Ocean. The FSM is a constitutional federation incorporating four main states: Pohnpei, Chuuk, Yap and Kosrae. Kosrae State is the only FSM State composed of a single island. Surrounding each of the other three States are sparsely inhabited outer islands. Each of the FSM States are separated by hundreds of miles of Pacific Ocean accessible only by airplane or boat.

The people of the FSM are highly diverse with nine main and different ethnic groups speaking some thirteen (13) different languages. This highly diverse population with different languages or dialect use English to communicate across the four FSM states. English proficiency levels vary, with most of the older population being monolingual in their own native language. Most of the younger population has basic English proficiency skills. In the public school classrooms, children are taught in both their native language and English from first to third grade, after which English is used almost exclusively in middle-elementary to high school. What is truly unique about the linguistic context of the FSM is that each major language is not interrelated with the other language. Each has its own linguistic structure, pronunciation, vocabulary, sentence structures, and semantic, syntactic, and pragmatic rules. With the arrival of many Asian businesses to the FSM, other languages are being introduced, such as Filipino and Chinese. The MCH Program respects this cultural and linguistic diversity and seeks appropriately paired demographics within its staff, community leaders and families that participate in the program on each island state.

Although there have been improvements in some areas, there continue to be disparities which still present challenges. The effects of the remote location preventing access to basic services as well as the population demographics affecting health literacy was seen in the identified priorities.  The MCH Program has been instrumental in forging strong partnerships to enhance disease prevention and public awareness activities. Much of the work accomplished by MCH staff is done in collaboration with other state agency staff, particularly Public Health and Education. MCH personnel work with other state agency staff on a nearly daily basis through coalitions, task forces, advisory groups, committees, and through cooperative agreements. The FSM MCH Program is well‐integrated with Family Planning Program, Immunization Program, Substance Abuse and Mental Health Program, HIV/STD Prevention Program, Non-Communicable Disease Unit including Diabetes, Cancer, Tobacco Control, and the FSM Department of Education, in particular the Early Intervention Service. The MCH Program works with each FSM State’s Community Health Centers to improve accessibility and expand primary care services for low‐income and vulnerable populations. The MCH Program has an established working partnership with the College of Micronesia for training needs of both clinical and programmatic staff, conducting awareness activities in nutrition and physical activity, and to prevent and control non-communicable disease. The MCH Program staff at the state level work closely with parents’ support groups, church leaders, women's groups, and community and traditional leaders.

The annual meeting for all FSM MCH programs was done in June 10-14, 2024 in the State of Chuuk to review the progress of the 2023 work plan and the upcoming plan for the 2025 grant application. The meeting was in-person represented by the FSM State MCH coordinators, data clerks and CHSCN coordinators. Although there were slight improvements in alignment of NPMs, SPMs, and ESMs in this year’s reporting period, there are still existing challenges around measuring the stated indicators due to insufficient data and data sources. 

One of the major discussions during the annual meeting was the change in the budget for MCH program in the upcoming implementation year.  All three FSM states had legislation on salary increase for all government staff including the MCH employees.  This mandate will have an impact on how national MCH program will work with the State MCH programs in terms of budget adjustment within categories.

Upon reviewing the 2023 progress, FSM MCH program will continue to implement existing strategies and activities in the 2025 Plan including preliminary activities with the new additional NPMs on medical home and postpartum. 

WOMAN AND MATERNAL HEALTH

The FSM maternal health clinics serve as many women’s first entry into medical care or their medical home. MCH recommends and provides preventive health services in accordance with recognized standards of care. The program aims to improve clients’ access to preventive health services through cervical cancer (Pap & VIA) and anemia screening. Because the preventive health clinics of the FSM all exist within the public health facilities, clients can avail themselves of multiple public health screening and preventive services in one visit. In this way, The MCH Program serves as the gateway to care through partnerships with other public health programs and other health and social programs.

PERINATAL AND INFANT HEALTH

MCH Program continues to strive to improve prenatal care adequacy. The process of prenatal care at the clinic may be a deterrent to some women. There is limited pregnancy expectation education so the community is unaware of what to anticipate during pregnancy and prenatal care. Unplanned pregnancy, late access and inadequate prenatal care, limited preventive health screening services, and poverty play a significant role in poor birth outcomes, causing additional stressors on the family, community, the health care system and the government. The MCH Program is committed to improving prenatal care access and adequacy through the MCH clinics CHCs, and dispensaries on the main island and in remote areas.

Breastfeeding education and awareness continue to be a priority for mothers since childcare education is lacking in the FSM. New mothers rely on families for childcare rearing and for healthy feeding practices.

CHILD HEALTH

Physical activity is not tracked well in the FSM. In addition, it is uncertain if all children’s health care providers are aware of the recommendations for physical activity for children and if this is promoted during well children visits. Processed foods are affordable and plentiful in this remote area where fresh ingredients are often hard to come by, perishable and expensive for the average FSM resident. This highly processed diet in a population with a strong genetic propensity to diabetes and hypertension leads to devastating rates of diabetes, heart disease, stroke, renal failure and dialysis in patients much younger than the average age in the US mainland. FSM MCH Program intends to start young to combat obesity and nutrition to prevent non-communicable diseases.

Currently developmental screenings are only completed on the MCH population but not the population at large. Currently, screening tools are developed by an Australian volunteer Speech pathologist, who assisted 2 of the FSM States (Pohnpei and Kosrae) in developing the screening tools for up to 4 years old in children. Diagnosis often depends on specialist visits from off island so MCH provides gap care until the next specialist is on island. Interventions for those with delays do not begin until age 3 with Special Education, therefore the MCH program provides gap care for these children as well.

ADOLESCENT HEALTH

FSM teens have a high rate of pregnancy, sexually transmitted diseases, alcohol use, non-fatal motor vehicle crashes and suicide. The MCH goal is to encourage positive health behavior activity in adolescents, through comprehensive interventions at age-appropriate levels in a culturally-sensitive manner that will impact the frightening possibilities of adolescent risk behavior activity. Currently the FSM MCH program provides school physicals until age 12 but not again unless required for college entry. As such, well adolescent visits do not occur with regularity. The Program plans to expand these school physicals into the high school grades. During these well adolescent visits, youth will receive assessment on violence and safety and information and education on risky behavior and its possible negative outcomes.

CSHCN

FSM’s MCH Program historically has a solid working collaboration with the public and private sectors as well as governmental and non-governmental organizations.

The Program tracks percent of children identified with a special health care need that are part of the CSHCN Program especially among hard of hearing clients. Most children in the program are identified through Child Find a program of Special Education, when diagnosed as deaf or hard of hearing, or seen and referred by Shriners during Shriners annual visit. However, specialty care and specialists in country continues to be a major problem in all FSM States.

The FSM revisited the seven priorities and strategies based on the 2023 Summary Review:

Access to health services- Improve women’s health through cervical cancer and anemia screening

Improve perinatal/infant outcomes through early and adequate prenatal care services including Gestational Diabetes and anemia screening

Improve child health through healthy weight through physical activity and nutrition promotion

Improve adolescent health by providing well medical visits, assessing violence and safety and promoting healthy adolescent behaviors and reducing risk behavior

Provide care coordination training for parents/caregivers of Children with Special Health Care Needs

Priorities and National Performance Measures

The FSM does not have the following programs or services: Title V- H.O.M.E. Visiting, Title XIX - Medicaid, Title XXI - Child Health Insurance Program, Social Services, Child Welfare Programs, Social Security Administration, WIC Program, or Rehabilitation Services.

The MCH Program leverages funds and resources from and works with international agencies such as Red Cross, World Health Organization and United Nations Children’s Fund and Population Fund.