MCH Workforce Development 2019-2020

Presently, the Maternal Child Health Program continues to experience positive changes along with minor setbacks that have an effect on the overall progress of the program and its priorities.  Overall, there are approximately DOH 17 employees who work directly under the umbrella of Maternal Child Health, and are fully or partially funded by Title V grant monies. A mixture of clinicians and support staff work on addressing priorities for the health of women and children in the territory. Clinical personnel are assigned to health centers to provide direct services while supporting and administration staff focus on providing support for programmatic efforts.  Title V also uses funds for a partial salary of a financial administrator and an assigned epidemiologist for MCH.

Although a few of the MCH team had to relocate to the US mainland for various reasons, the program has learned from previous years to push on hiring of vacant positions so that services and programmatic efforts are not delayed due to shortage of staff.  Despite the lengthy hiring process, there have been exciting new additions to the MCH staff in the past year.  Of the remaining, these Title V employees also have been assigned additional responsibilities within the Health Department that may or may not directly relate to MCH population but impact the health of the community as a whole. Such roles include participating in the Lymphatic Filariasis Campaign, the Meningococcal campaign, and other community events that require full participation from DOH personnel.   Ideally, it would be most beneficial if all 13 employees would work full time on MCH initiatives; however, supporting overall health objectives for the department continues to be most valuable and significant to the operations of MCH. 

Of those working full time on MCH priorities, 2 are seasoned health educators with backgrounds as Nurse Assistants.  They are assigned to the Health Centers to provide health education during the prenatal and well baby clinics, as well as to the OBGYN clinic and maternity ward at the LBJ Hospital.  They are Mrs. Conference Alailefaleula and Mrs. Manulelei Silva-Aitaoto.  Both health educators also were sent for an off-island training on breasfeeding, as Lactation Counselors.  One passed her examination while the other is continuing to make progress and preparation for the next testing opportunity.  This trip was made possible by Title V funds.

Towards the ending of 2019, as we gained 2 new employees to operate the newly established Family to Family Health Information Center, our only personnel for CSHCN program has to relocate to Hawaii for personal reasons.  Training was then posed on 2 Zika Navigators, who will be exciting the Zika program once it closes in November 2020, and will transition into the CSHCN program as case managers for the special needs population.  The F2FHIC staff will also work closely with these 2 Zika Navigators to conduct case management type of work to support the program objectives and quality of care for this specific population.

The MCH Data Technician, Ms. Ruta Ropeti, has an Associate of Science Degree from the local community college who works closely with our newly hired Epidemiologist, Ms. Mata’uitafa Fai’ai.  Ms. Fai’ai holds a Master’s in Public Health with an emphasis on Epidemiological work.  Ms. Fai’ai has extensive experience with health projects in American Samoa addressing women’s health, actively involving herself in data collection, interpretation, and dissemination. Both employees have been heavily involved with DOH projects which required data support personnel.  Ruta has completed all courses required for the Data for Decision Making (DDM) Certificate, while Mata’u assisted in teaching these courses for our local public health workforce.  They continue to participate in Department wide functions and projects that need assistance with data. Ms. Mata’u also serves as a part time Epidemiologist for the MIECHV program.

The MCH Coordinator, Anaise Uso, has worked as a Dentist for the past 18 years, and has extensive experience in school-based preventive dental care for young children.  Since her appointment to coordinate the MCH Program, she spends all her time managing MCH, SSDI, and Zika efforts, to say the least.  Dr. Uso also participates in Dental activities throughout the year and is a strong advocate for preventive dental work for young children.  Dr. Uso continues to serve the DOH through several avenues, one of which is telehealth.  She is deeply involved in Others include support within the Command Post during outbreaks and pandemics locally. 

Assisting the MCH coordinator is her colleague, Ipuniuesea Eliapo-Unutoa, who has also worked for MCH for more than 18 years, primarily with the CYSHCN program and the newly assigned Rheumatic Heart Disease (RHD) Control & Prevention Program.  Ipu, as many call her, also has used some of her time in the past year to manage the Preventive Health & Health Services Block Grant.  Ipu is also the Project Director for the newly acquired Family to Family Health Information Center (F2FHIC) for American Samoa called “Leo o Aiga”, as she is also a mother of a child with special needs and has been in the forefront in attaining this assistance for families of CYSHCN in Am. Samoa.   Her background is in Occupational Therapy; however, she spends all of her time performing administrative responsibilities for Title V, F2FHIC, and RHD.

The Program Director for MCH, Mrs. Margaret Sesepasara, is also the Director for the Nursing Division; she houses an office assistant, Tolua Tavai, who also manages financial reports for the Title V and MIECHV programs. Other responsibilities include office management, clerical duties that support the Regulatory Board and the Nursing Administration, securing resources to support nursing home visitations to hospital discharge referrals, and all meetings that are required for the Director of Nursing/MCH Program Director.  All MCH activities and reports are directed to the Program Director’s office for guidance and recommendations.

Aside from her managerial positions, it should also be mentioned that the Program Director is a Nurse Practitioner by profession.  She, along with a colleague who is also a Nurse Practitioner, Mrs. Tele Hill, has worked for MCH and Department of Health for more than 30 years.  They provide clinical support within the prenatal and Well-Baby clinics at the satellite health centers, as well as home-visitations for the Elderly, the chronically ill, and the special needs population per referral requests.  A registered nurse who is also funded by MCH Title V during 2019, works in the Health Centers primarily with the Well Child Clinics, and also assists with RHD Bicillin Clinics.  This nurse also plays a huge role in DOH outreaches and mass drug administrations.

Staff recruitment and retention is a challenge for MCH among other things.  Its been several years since annual governmental increments have been granted for career service employees, so retaining those who have been trained and are experienced in the field is very difficult.  The hiring process through the government is extremely frustrating and lengthy, affecting recruitment of the most qualified applicants.  Most often, applicants with clinical training are preferred to those without a clinical background.  This is to accommodate shortages of clinical support when the need arises; however then, programmatic activities pushed aside to be second priority.  

MCH staff takes advantage of training opportunities that promote skill advancement for the work they perform daily.  Title V team have had the opportunity to be trained on using GIS Mapping to layout locations of patients, clients, health centers, etc. so that it can be used MCH data collection methods.  A trainer was financed by MCH to come to American Samoa and provide a week long training for not just Title V staff but other program staff under DOH.  Other trainings such as Data for Decision Making (DDM), WebIZ training during the measles outbreak, as well as the Lymphatic Filariasis surveys and mass drug administrations were some of the department wide functions and trainings Title V team was involved in 2019.

Challenges will continue to exist in the MCH workforce.  With limited funding to support additional staffing, the existing workforce has and will continue to learn to assist one another in addressing priority needs.  Cross training has been a continued strength of the ASMCH team, specifically when it calls for public outreach, island-wide emergency responses to natural disasters, and departmental activities.  The Title V team has learned to support one another by learning each other’s work and being able to step in to cover when it is needed.  The leaders of DOH highly regard the Title V team when it comes to supporting overall DOH missions.

In moving forward, prioritization of recruitment and retention is necessary to reach goals for the following years.  MCH leaders have recently been working on salary adjustments to compensate for additional skills and years of experience across the workforce.  A proposal to convert employees from contract to career service status has been requested for process.   MCH leaders have also integrated the entire staff more into taking more involvement with the application process for Title V, designating specific roles and responsibilities per their assigned job descriptions within the program. This has helped increase their perception on the Title V program objectives and has given them more opportunities to provide input on the application and proposed plan.

Staff retreats have also been implemented to help with team building skills, time away from the office so that team members can focus on how to best work with each other.  And lastly, conducting periodic evaluations on work performance and providing constructive feedback to improve on personal and professional growth is on a continual basis.