The Title V Maternal and Child Health block grant is administered by the Family Health Unit under the Division of Primary & Preventive Health within the Bureau of Public Health, one of four bureaus under the Ministry of Health.  The vision of the Family Health Unit is ‘Palau’s Families are Healthy and Leading Quality Lives: Allowing them to be productive members of their families, their communities and the nation’.  Our mission is ‘To improve the health of families through provision of quality and comprehensive public health and medical services’.  It is through this vision and mission that the program aims to provide services to ensure success in preconception and inter-conception care through improved birth outcomes that support healthier women, mothers, infants, children and adolescents.

The Maternal and Child Health Program is the only program in the Republic of Palau that provides promotive, primary and preventive services especially to children 0-5 years of age.  Tertiary health care services for children 0-5 years of age are referred to visiting specialist physicians and off island medical centers.  A majority of Palau’s population fall below the 100% federal poverty guideline and by US standards, the entire nation of Palau is a rural area.  With the limited medical capabilities and resources, Palau remains a medically underserved area. Health services in Palau continue to be heavily subsidized by the Government with a great proportion of this budget spent on funding of secondary and tertiary medical services. Almost all funding that goes into supporting MCH basic services are derived from U.S. Federal and other bi-lateral and multi-lateral sources. These services are provided through the Bureau of Public Health within the Family Health Unit and the Community Health centers.  In proactively responding to limited faculties, the program provides mass education through public radios, television, community education, school talks and interest group discussions to further encourage primary and preventive health care among the MCH population.

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The program completed a needs assessment in 2019 to assess the health status of women, infants and children in Palau and to identify priority needs for Title V block grant.  The information from this needs assessment was presented to our stakeholders and partners for their comments and input.

Each year following the development and reporting of the five-year Needs Assessment, the program completes mini assessments on program activities that provides us direction on activities that are developed for the following year.  These assessments provide an opportunity for the program to measure success of activities that were planned and implemented and plan for new activities to respond to changing needs.  These also provides the program the opportunity to look at our own capacity resources and gaps in our operations and develop contingency response plans.  From these needs assessments the following priorities were identified for the MCH Program.

Women’s/Maternal Health

Priority - increase the percentage of pregnant women accessing prenatal care

Accomplishments

Palau continues its effort to promote and educate mothers on the importance of early prenatal care.  In 2018, 38% of females delivering a live birth received prenatal care beginning in the first trimester.  About 40% received prenatal care in the second trimester. However, through community partnerships and awareness efforts other pregnant women access early prenatal care through private clinics.  These women are then referred by the private clinics to public health for subsequent prenatal care and booking (2nd and 3rd trimesters).  Availability of Family Planning Services are offered to all women within the reproductive age group to include postpartum women during their 6 weeks visit.

Challenges

Access to care is still an issue for women in Palau.  This encompasses a wide array of access from entry into prenatal care, seeking education for health improvement in terms of tobacco cessation, weight management, chronic disease management to name a few.  It is believed to be that women are taking on too many roles that they seldom take time to consider to manage their own health status as they are busy taking care of others.

Plans

• Continue to maintain and align reproductive health community outreach with other public health programs to maximize availability of resources and improve birth outcomes

• Strengthen efforts to ensure traditionally and culturally competent services reflective to the needs of women and men of reproductive age in Palau (i.e. Clinic hours, clinic locations, and identifying providers who better address client needs)
• Maintain strategic collaborations with community partners (such as the Civic Action Team) in providing a diverse workforce to provide services to Palauan’s who are not comfortable speaking to a Palauan provider.
• Advocate for increased male participation in seeking preventive health so that they can support and encourage women to access available health care services

Perinatal/Infant Health

Priority - reduce the number of infant mortality

Accomplishments

Through strong community partnerships with the “Breastfeeding Community Workgroup”, a designated area within the health facility was established to provide health education and promote safe sleep and breastfeeding as a protective factor and a strategy to prevent infant mortality.  Exclusive breastfeeding up to 3 months has remained the same in the last 5 years.  In promoting safe sleep, women are provided counseling and educational materials as part of the discharge plan.  Furthermore, the Palau Non-Communicable Disease prevention and control included in their action plan (2015-2020) under “Improving Nutrition” to increase breastfeeding by mothers of infants up to 6 months of age by collaborating with Palau MCH and other community partners.

Challenges

An emerging challenge that the program is facing is the lack of adequately trained and certified service providers within the public health and clinical services. Reluctance of policy makers to enact legislation on maternity leave and breastfeeding policies.

Plans

• Continue to advocate and encourage parents on the importance of bringing their infants in for their scheduled immunization.
• Support breastfeeding initiative through public health partners to increase education and awareness of the importance of exclusive breastfeeding up to six months
• Strengthen safe sleep campaign and first embrace participations with men and women, clinic providers, particularly the OB/GYN and pediatrician
•  Reduce tobacco use of women in collaboration with partner public health programs, such as the Prevention Unit

Child/Adolescent Health

Priority - increase percentage of children and adolescents who participate in the annual school health screening, decrease prevalence of childhood obesity, reduce the burden of adolescent injury and improve immunization rates

Accomplishments

The school health program continues to provide comprehensive health screening services annually to all schools in the Republic of Palau, including both public and private schools.  All children are offered immunization based on the national immunization schedule.  The Ministries of Health and Education are working together to ensure that children who miss their age appropriate immunizations receive their needed vaccinations by reaching out to the parents for consent.

Challenges

Parental consent for participation in the annual school health screening remains a challenge that we are dealing with. An added challenge is COVID-19 fears and uncertainty of availability of services available on island to respond to positive cases.

Plans

• Increase the number of children that participate in the annual school screening
• Reduce the obesity rate
• Reduce the rate of adolescent suicide ideation
• Increase immunization coverage rate for school age children

Children with Special Health Care Needs

Priority – improve systems of care for children with special health care needs

Accomplishments

The program works with interagency partners to strengthen collaborations and to also refine referral process for children who are diagnosed with special conditions.  The program works with the Family Health Unit’s ‘Family Based Organization’ to identify, educate and provide services for children and their families that have difficulties in accessing services.  Case conferencing is provided on a monthly basis for updates and follow ups and trainings are provided on case management and entry into available early intervention services.

Challenges

With the limited medical capabilities and resources, Palau remains a medically underserved area and this creates challenges for families with children with special health care needs they are reliant on visiting specialist physicians.  This coupled with the costs of seeking specialized care outside of Palau places added burden to families.  There remains a lack of transition services and programs, community based rehabilitation services for those in the outlying states and especially for those children that age out of our care.

Plans

• Expanding the membership of the interagency collaborative
• Strengthen partnership with our family support organization and disseminate information to educate parents about the concept of a medical home
• Increase care coordination with partner agencies

The Title V program works in tandem with public health programs, partner ministries and community organizations to provide comprehensive care and services to our MCH population.  The program, through a holistic lens, strives to work with partners in the community and within the government and through our Family Support Organization - Palau Parents Empowered.  Within the public health spectrum, program offices that work around areas of non-communicable diseases, communicable diseases, immunization and the community health centers partner with each other’s activities to address common identified needs.  The program relies on these partnerships to provide comprehensive services such as health screenings for children, adolescents as well as women (and men) and immunization for children.  Current funding is limited and so the program relies heavily on these partnerships (public health and non-public health programs) to enable provision of preventive care and health maintenance for our MCH population.