Staffing Structure

The CNMI MCH workforce is primarily housed within the CHCC and spread across clinical and population health programs, primarily under the MICAH programs unit. A consolidation of MCH serving programs was done in 2014 to address the needs of the CNMI MCH population, transformation of the MCH Title V Block Grant, and link all opportunities between MCH programs to work through challenges common across programs since the transition of the Corporation into a semi-autonomous agency. While most of the staff is funded by sources other than Title V, all contribute to the Title V mission and MCH priorities. For example, a substantial number of MICAH staff work within the Healthy Outcomes for Maternal and Early Childhood Visiting Program, carrying out the implementation of the CNMI HOME visiting work plan.

While the MCH Program is working closely with the CHCC administration to improve current workforce capacity, the capacity to effectively meet the varying needs of the maternal and child population in the CNMI might be challenged by the limited amount of professionals working directly for the MCH program. The consolidation of programs into a single unit was meant to align priorities for all programs that serve the maternal and child populations in the CNMI. However, there still remains the fact that each program under MICAH is responsible for administering a separate federal grant that includes individual program reporting requirements and project objectives.

Recruitment & Retention

Recruitment of staff is handled through the CHCC Human Resource office and coordinated in accordance with CHCC Human Resource policies and procedures. The CNMI as a whole experiences difficulty in workforce recruitment as the shortage in local skilled workforce has forced organizations, both public and private, to recruit from other countries through a CNMI only workforce permit that is scheduled to phase out after 2019 but was subsequently granted and extension by US legislation through 2029. Nursing positions are the most difficult to fill due to a national workforce shortage in this specific field. The CNMI, like many US states and other jurisdictions and territories, recruits a large majority of its nursing workforce from the Philippines. However, due to annual reduction in available CNMI conditional worker permits until the program eventually phases out in 2029, the CNMI faces increasing challenges in recruiting and retaining nurses. Various industries compete for these limited number of permits and as such the healthcare field, and CHCC in particular, competes with both public and private agencies across the CNMI. The CNMI also faces challenges in recruiting medical providers. Due to CMS Conditions for Participation, CNMI regulations require that medical providers be US trained or US board certified in order to be licensed providers in the CNMI and this has limited recruitment to the US mainland. The CNMI’s geographic location and distance from the US mainland poses as a challenge for recruiting medical providers and turnover is high.

Staffing for the population health programs, including the Title V MCH Program, is largely made up of a local workforce. The MICAH Administrator, Fiscal Specialist, Services Coordinator, and SSDI Project Coordinator, for example, are local to the CNMI. Because of limited opportunity for post-secondary education locally, many community members move off-island to attend colleges and universities in the US mainland. While some eventually return to the CNMI, many do not return for various reasons.

The CHCC has been working diligently in implementing strategies to support workforce retention. Standardization and updating of employee classification scales, recruitment tools such as pre-employment skills assessments, and a focus on performance improvement and professional development are key advances. To support these efforts, the CHCC has expanded its HR team to include a Recruitment Manager and Retention Manager.

Training

The CHCC MICAH is working closely with the CHCC Professional and Organization Development (POD) office on coordinating training needs for both MICAH staff and personnel across the health department who work MCH target groups. The CHCC’s strategy is to provide comprehensive and holistic community health services, including medical, dental, mental health and substance abuse screening perinatal, nutrition, and family planning, all supplemented by enabling services including outreach, case management, and transportation.  Other strategies are:  1) work with schools to ensure that all children enrolled are up to date with their immunization; 2) collaborate and partner with other agencies, both private and governmental, during island-wide community events which will strongly emphasize lifestyle behavioral changes especially with health care practices, diet, and physical fitness; 3) establish a network linkage with other providers to inform them of health news, health alerts, awareness events, training, etc.; 4) develop partnership with other agencies to ensure continuity of care. Staff are given the opportunity to attend trainings provided by internal partners, such as the Non Communicable Disease Bureau’s Diabetes’ Management training.  The established partnership with other agencies has also provided numerous training opportunities for the staff. 

Web based training opportunities provide an ideal training format for MCH staff in the CNMI, especially since many of our technical assistance and training needs are not easily met by local capacity. However, while virtual learning sessions provide the MCH workforce in the CNMI the opportunity to interact with experts and other technical assistance that are not readily available on island, the time difference between the CNMI and the US mainland makes it challenging for staff to participate as often times sessions are held early mornings, in some cases 3 am CNMI time.
 

The need to build and improve the workforce for sustainability of the population health programs is imperative to improving delivery of services to the community. The shortage of local manpower impacts health service delivery in that there is a need to recruit manpower from the U.S. mainland. This recruitment process is lengthy and at a high cost for CHCC plus the turnover rate is high. One of the goals of CHCC is to establish a sustainable healthcare manpower program.  The CHCC administration is focused on developing competent, committed and compassionate MCH professionals. The CHCC works closely with the Northern Marianas College school of Nursing and has a robust clinical rotation partnership for nursing students to gain training through clinical rotations throughout the health system.
Additionally, MICAH programs coordinate training offerings to CNMI health system staff, both clinical and non-clinical, and partner agencies on topics related to improving maternal and child health, such as:

• Lactation/Breastfeeding Training
• Screening, Brief Intervention and Referral to Treatment (SBIRT)
• Motivational Interviewing
• Infant and Child Oral Health (Fluoride Varnish and Silver Diamine Fluoride) Training
• Routine Childhood Vaccination Administration
• Vaccine storage and handling
• Contraceptive Counseling
• Ages & Stages Questionnaire, 3rd Edition, Developmental Screening Training
• Infant Safe Sleep
• Group Prenatal Care