Public and Private Partnerships

The Health Care Delivery system in the Federated States of Micronesia (FSM) involves a collaborative effort between the MCH Program and other Federal Programs providing preventive care services to serve the MCH population domains. The State leadership has established policies and passed State laws to waive costs of health care for all MCH population domains. The overall goal for this collaborated effort is to ensure delivery of quality health care and needed services for the MCH population.

The FSM has one national Department of Health services which is headed by a Secretary and four (4) State Departments of Health services that are overseers by the Directors. The national and state governments work jointly to provide reliable, accessible and quality services to its citizens.  The national government provides coordination while the delivery of services within each state is the primary responsibility of the state governments. By mutual agreement between the states and the national government, administration, monitoring and reporting of federal programs such as the Maternal and Child Health rests with the national government.

The state health care delivery system is divided into clinical and preventative health and is managed by a Director. The day‑to‑day management and operation of the MCH Program rests with the MCH Coordinator who is supervised by the chief of public health.  In the provision of direct services to the women of child‑bearing age population, the other public health staff nurses, state hospital physicians and nursing staff assist the coordinator. 

This organization and structure provided a unique opportunity for integrated services between clinical and public health services. However, in such a financially constrained environment - systematic, evidence based, and outcome driven change is challenging. The MCH Title V Program is administered by the FSM Department of Health and Social Affairs, Division of Health Services, within the Family Health Services Unit. Preventive and primary care services for women and children are provided at the Division of Preventive and Primary Care Women’s Clinic, Children’s Clinic – both are located at the State Division of Public Health Services. MCH services include prenatal care, postpartum care, women’s health, education and counseling, case management of high-risk pregnancies, family planning, HIV/STI Prevention, and preventive screenings such as Pap smear, blood pressure screening, diabetes screening with blood sugar testing, well-child visits, developmental screenings for infants and children, newborn screening, and oral health services. Since its inception, the Family Health Services Unit, and primarily the MCH Program, has worked diligently with the State Hospitals’ outpatient clinics and its medical providers on applying evidence-based approaches towards improving healthcare and health outcomes within the population. In addition to working closely with Hospital and public health clinic providers, the MCH program works closely with community-based partners on a variety of projects.

A significant role that MCH plays towards ensuring access to healthcare is by working towards reducing barriers to access. The inability to pay or lack of insurance is often cited as a major obstacle in seeking preventive healthcare. For the FSM, federally funded programs’ commodities and services are provided at no cost to the client. FSM has a Health Insurance Program known as “Mi-Care” Insurance Program.  Mi-Care is optional for private businesses and State Government employees however it is mandatory enrollment of all National Government employees. In the 2018 FSM BRFSS, it shows that among the 2,712 survey respondents, 71.3% of respondents said they did not have health-care coverage.
 

The Department of Health Services (DHS) in each of the four (4) States is responsible for running curative, preventive and public health services, including the main hospital, peripheral health centers, and primary health care centers. There is a main public hospital in each of the four states. The health care system in FSM is provided by both public and private health care facilities. The facilities provide wide range of health care services from outpatient services to certain surgical procedures.  However, there are some specific tests and procedures that these facilities cannot perform due to lack of medical specialists, specific diagnostic procedures and various types of complicated health care services and medical equipment, which cause patients to be referred off-island. The Title V MCH Program funds provided the critically needed funding that makes a major difference for families in the FSM.  The MCH and other federally funded programs are at the “core” or the main pillars to provide needed preventive services for families in the FSM.

Part of the Healthcare delivery system for the people of the FSM is through partnership with affiliated entities like the US military programs.   According to the Pacific Basin Tele-health Resource Center, a bill submitted by Hawaii Senator Schatz: April 30, 2019 - A new bill aims to use telemedicine to help some of the nation’s most remote veterans access healthcare: The Compacts of Free Association Veterans Review Act, introduced by Sens. Brian Schatz (D-HI) and Lisa Murkowski (R-AK), would create a three-year pilot program to improve access to care for veterans living in Palau, the Marshall Islands and the Federated States of Micronesia. The three countries are covered by a treaty called the Compact of Free Association with the United States, which enables residents of those nations to work and live in countries under the US jurisdiction. While residents of US territories like Guam and the Commonwealth of the Northern Marianas Islands receive full health benefits from the Department of Veteran Affairs after serving in the military, veterans living in other Pacific island nations do not have that benefit.