Annual Needs Assessment Update
Process
MCH continues to collect and analyze data through the various programs under the CNMI MCHB, CHCC hospital, CNMI Health and Vital Statistics Office, and other partners such as the CNMI Public School System and WIC.
Active participation in community events and partner meetings allows the program to interact with stakeholders and gather valuable qualitative information that is used to further guide program activities.
In addition, membership on local groups and committees such as the Disability Network Providers (DNP), Early Intervention Services Program’s Interagency Coordinating Council, and the Head Start Advisory Council (HSAC) provides MCH the opportunity to network with agency partners for obtaining updates on annual plans, objectives, needs, and any emerging issues occurring through partner programs.
MCH conducts a monthly review on Health & Vital Statistics Data, periodic review of hospital admissions data, and conducts chart reviews to help inform ongoing needs assessment processes.
Work was initiated to develop an MCH jurisdictional survey to assist the CNMI, and other US territories, on reporting of national performance measures and other MCH indicators necessary for MCH outcomes. This survey will be implemented in the CNMI in 2020.
MCH Population Needs
Perinatal/Infant Health- Breastfeeding
While breastfeeding initiation rates in the CNMI of 95.8 percent is higher than US national rate of 83.2 percent[i] , its 6 months breastfeeding rate (38 percent) trails behind the US average of 57.6 percent. A review of data on CNMI infants breastfed indicates that 54 percent of infants are breastfed at 3 months, 38 percent at 6 months of age, and 23 percent at 12 months. And while there was a 3 percent increase in the number of infants who are reported to be breastfed at 3 months, there were decreases in percentages of infants breastfed at 6 and 12 months of age. High breastfeeding initiation rates indicates that a vast majority of mothers in the CNMI want to breastfeed and start out doing so. However, despite the recommendations for exclusive breastfeeding through 6 months, only a little over 50 percent of infants are being breastfed by 3 months of age and by 6 months, less than 40 percent are breastfed.
Many factors contribute to success in continued breastfeeding and support to breastfeeding moms is critical. Having to return to work is one factor and women typically return to work before a baby is 3 months of age. Little is known about the types and level of breastfeeding support provided by local employers. The WIC program is the only program in the CNMI that provides peer counseling services dedicated to supporting moms in breastfeeding. Unfortunately, peer breastfeeding counseling services are not available before 7:30am, after 4:30 pm, and on weekends.
Child Health- Obesity
According to the World Health Organization, childhood obesity is associated with a greater likelihood of premature death and disability in adulthood. The most significant health consequences of childhood overweight or obesity, that often do not become apparent until adulthood are: cardiovascular diseases, diabetes, musculoskeletal disorders, and certain cancers[ii].
Review of available data on overweight and obesity rates in the CNMI illustrates a steady increase in the number of young children and teens who are reported to be overweight or obese.
In 2018, 395 (22.89 percent) of young children ages 2 to 5 years old enrolled in the CNMI WIC program out of a total of 1,726 were reported to have Body Mass Index (BMI) levels between the 84.9 and 94.9 percentiles. This number of children enrolled in WIC identified as overweight has gradually increased since 2016, where a little over 18 percent (329 out of 1,764 children) were reported to be overweight.
In 2018, 10.25 percent (122) of a total of 1,726 children ages 2 to 5 years enrolled in WIC were reported to be obese with BMI levels at the 95th percentile or higher. The number of children enrolled in WIC identified as obese has also gradually increased since 2016 (8.45 percent).
The CNMI has also seen a steady increase in the number of teens reporting to be overweight or obese on the Youth Risk Behavior Survey (YRBS). A review of the 10-year trends on data available through the CNMI YRBS, both the number of middle school and high school students who reported to be overweight or obese had increased by almost 10 percent since 2007.
The burden of non-communicable diseases in the Northern Mariana Islands and its impact on the overall quality of life of many families in our communities in the addition to the continued rise in overweight and obesity among children demonstrates the significance for interventions and programs to address this need/issue.
Emergency Preparedness for MCH Population
In October of 2018, the Northern Mariana Islands was again struck with a major super typhoon, this time categorized as the strongest storm to have hit any part of the United States since 1935. Yutu was a category five (5) super typhoon with wind speeds reported upwards of 180 miles per hour. The resulting damage was reported to have been more severe than what was experienced just three (3) years prior during typhoon Soudelor with two (2) fatalities and dozens of injuries reported. An emerging need that has been identified is prioritizing the development and implementation of a disaster response plan that specifically addresses the needs of Women, Children, including children with special healthcare needs during emergencies. The MCH program will need to develop protocol and identify processes in order to effectively integrate a plan for addressing MCH population group priorities within the overall Northern Mariana Islands emergency preparedness plan in addition to addressing the needs of staff members affected by disasters. Focus areas will include: Reproductive Health, Access to Contraception, Pregnancy Estimation Tools, Communication Capacity, Psychosocial Effects of Disasters, Data Collection during Emergencies, Safe Sleep, Infant & Young Child Feeding, etc.
Title V Program Capacity
Organizational Structure & Leadership
The Title V Block Grant is administered within the Division of Public Health of the Commonwealth Healthcare Corporation (CHCC). The CHCC has a Governor-appointed Board of Directors and in that way is part of the central government of the CNMI.
The CHCC is the operator of the Commonwealth's healthcare system and the primary provider of healthcare and related public health services in the CNMI, including management of federal health related grants. The Chief Executive Officer of CHCC is the authorized representative for the MCH Program. The Public Health Medical Director also provides oversight to the program. There are three divisions under the corporation: 1) Public Health -- provides preventive and community health programs of which many are federally funded; 2) Community Guidance Center; and 3) Hospital. The following are senior leadership positions: Ms. Esther Muna, Chief Executive Officer; Ms. Margarita Torres-Aldan, Director of Public Health Services; and Dr. Ngoc-Phuong Luu, Medical Director of Public Health.
The Division of Public Health provides management oversight to the Maternal and Child Health Bureau. The Title V Block Grant is administered through the MCH Bureau, which was formed in 2014. The MCH Program is one of the six programs under the Maternal Child Health Bureau along with Family Planning, HRSA and CDC funded Universal Newborn Hearing Screening/Early Hearing Detection and Intervention Programs, Public Health Dental Clinic, H.O.M.E. Visiting, and State System Development Initiative. The Administrator of the MCH Bureau also serves as the MCH Program Coordinator.
All MCH services are provided at the Tinian and Rota Health Centers either directly or through Resident Directors or rotating physicians.
Agency Capacity
The MCH Program through its partnership with the CHCC Women and Children's Clinic and the Community Guidance Center provide primary and preventive health services to the community. Services include medical, dental, mental health, substance abuse counseling, women's health, nutrition counseling, and family planning. Collaboration with other Public Health programs and community partners make it possible to bring health services out into the community. This work is supplemented by enabling services including outreach, case management, educational materials, and transportation for MCH target populations. The MCH Program has strong collaborative relationships with key physician providers for the MCH populations. The Chief Obstetrician/Gynecologist, Chief Pediatrician, Family Planning Medical Director, Chief Dentist, and Public Health Medical Director all guide and support the program.
MCH Workforce Development and Capacity
Medical Director of Public Health/ Epidemiologist: Ngoc-Phuong Luu, MD, MHS joined the Division of Public Health in 2016. She graduated from the University of Washington School of Medicine in 2010 and completed a Master’s in Health Sciences with a focus on Clinical Epidemiology from Johns Hopkins University Bloomberg School of Public Health in 2015. Her position is supported by CNMI state funding. Dr. Luu provides assistance to the CNMI Title V MCH program by assisting with reviewing data collection processes and data analysis.
MCH Program Coordinator/MCH Bureau Administrator: Heather Santos Pangelinan, assumed the role as MCH Program Coordinator and MCH Bureau Administrator in August of 2016. As Administrator, she works closely with the several MCHB Program/Project Coordinators to manage the programs under MCHB. Mrs. Pangelinan has a MS in Counseling from Grand Canyon University and started in MCHB as the Data Specialist for the MIECHV Home Visiting program. She later served as the CNMI Early Childhood Comprehensive Systems program coordinator. Mrs. Pangelinan has been with the Division of Public Health Services since 2014.
SSDI Project Coordinator: Richard R. Sablan graduated from California State University San Bernardino with a BS in Health Science, with emphasis in Public Health Education. Related coursework completed included: Statistics for the Health Sciences, Research Methodology in Health Science and Health Program Planning, Implementation and Evaluation. The SSDI Project Coordinator is responsible for managing and improving MCH data collection, analysis, and reporting. The incumbent in this position works closely with the Public Health Medical Director/MCH Epidemiologist.
MCH Services Coordinator: Tony Yarobwemal holds a BS in Education. Prior to his role as MCH Services Coordinator, Mr. Yarobwemal was the Health, Nutrition and Mental Health Manager for the CNMI PSS Head Start Program. As MCH Services Coordinator, Mr. Yarobwemal is responsible to managing referrals to the MCHB, including conducting risk and other needed assessments to be able to assist women, children, and families access health services.
Child Health Coordinator/CSHCN Project Director: Danielle Youn Jung Su holds a Master’s of Science in Education in Rehabilitation Counseling and a Bachelor of Art’s degree in English Language Arts, both from Hunter College of City University of New York. As the Child Health Coordinator, her work focus on development, coordination, implementation and evaluation of children, including children and youth with special health care needs programs and related activities.
Partnerships, Collaboration, and Coordination
The CNMI Public School System continues to be a major partner for strategies and activities targeting children ages zero through 17 years. The PSS Early Intervention Services Program and the Early Head Start program serve children from birth through 3 years. PSS serves children ages 3 through 5 years in Head Start programs and children ages 6 through 17 years are enrolled in PSS K through 12th grade programs. The CNMI Division of Public Health Services has formal MOUs with the PSS to collaborate on programs serving children enrolled throughout the system. MCHB collaborates with PSS to offer school based oral health services for children enrolled in Early Head Start, Head Start, and elementary school. Other initiatives that MCHB has partnered with PSS are: Developmental Screenings, Bullying Prevention, Teen Pregnancy Reduction, Improving Immunization rates, Nutrition, and Physical Activity.
The Child Care Development Fund (CCDF), a program serving low income families through child care subsidies, is an additional key partner in the MCH program’s work for serving children and families. MCH continues to partner with CCDF in the CNMI wide implementation of standardized developmental screening.
The MCH and WIC Programs have worked collaboratively for many years to improve breastfeeding rates, lower childhood obesity rates, and increase access to prenatal care.
The Disability Network Partners (DNP) consists of programs that provide services to individuals with special healthcare needs and their families. The Northern Marianas College’s University Centers of Excellence in Developmental Disabilities, CNMI Office of Vocational Rehabilitation, and Developmental Disabilities Council are the agencies that form that core group of the DNP. Other partners involved in the DNP include the Northern Marianas Protection and Advocacy Systems Inc. (NMPASI), Public School System SPED, Center for Living Independently (CLI), and the MCH Bureau. The DNP meet on a quarterly basis and work on projects such as the CNMI Disability Resource Directory, Annual Transition Conferences, etc.
The CNMI Department of Public Safety and the Division of Fire and Emergency Services are also key partners in promoting the health and safety of the MCH population. MCH partners with the Department of Public Safety on child passenger safety initiatives, which include workforce capacity building that enable child passenger safety technician certification for MCH Bureau staff.
Partnership with programs under the umbrella of the Division of Public Health also help to strengthen efforts of the MCH program. MCH works closely with the CNMI Immunization Program in increasing community awareness on the importance of vaccines and in increasing access to immunizations through collaborations on community outreach events. Collaboration with the NCD Bureau Breast and Cervical Cancer Screening Program positively contributes in the MCH program’s efforts for increasing preventive screening rates among women in the CNMI. Other collaborative efforts include Diabetes, Cancer, Tobacco Control and other chronic disease prevention and health promotion.
The program coordinates with the Health & Vital Statistics Office, CHCC IT Department, CHCC Medical Records Department, and Medicaid Office on initiatives involving access and improving quality of population based data.
[i] Centers for Disease Control and Prevention. (2018). Breastfeeding Report Card.
[ii] World Health Organization. (2019). Global Strategy on Diet, Physical Activity and Health. Retrieved on June 19, 2019 from https://www.who.int/dietphysicalactivity/childhood_consequences/en/
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