In Guam, the delivery of healthcare services is mixed. Services are provided by the Department of Public Health and Social Services (DPHSS) and the Guam Behavioral Health and Wellness Center (GBHWC), formerly known as the Department of Mental Health and Substance Abuse (DMHSA). The Guam DPHSS is organized under five divisions, the Division of General Administration, the Division of Public Health, the Division of Environmental Health, the Division of Public Welfare, and the Division of Senior Citizens.

There are two civilian hospitals in Guam, the Guam Memorial Hospital Authority (GMHA) in Tamuning and the Guam Regional Medical City (GRMC) in Dededo. There is a U.S. Naval hospital for the military and their dependents located on the Guam Naval Base. There are also several private clinics located in Guam, including many specialty clinics.

The U.S. Department of Health and Human Services has designated Guam as a Health Professional Shortage Area (HPSA). HPSA status is granted to areas that demonstrate a need in one or more of the following categories: primary care (including family and general practitioners, pediatricians, obstetricians, and general internists in allopathic or osteopathic), mental health, and dental care.

Guam was also designated as a Medically Underserved Area (MUA), which now provides stateside doctors an option to work off a portion of their medical education loans by serving as a physician on Guam. Guam has a mix of public and private providers, including four large private primary care and multi-specialty clinics (all located centrally within a few miles of the public hospital), about a dozen private practice clinics, and a privately-owned birthing center.

In 2019, Guam had 609 physicians licensed to serve its population; this includes physicians at the Guam Regional Medical City (GRMC), licensed military physicians working part-time. Other data shows a ratio of 24 active physicians per 10,000 residents, compared to the national average of 14 per 10,000 residents. Some off-island physician specialists visit Guam on a quarterly and semi-annual basis to provide services not typically available in Guam.

Guam Behavioral Health and Wellness Center (GBHWC) is a single-step agency offering comprehensive behavioral health services to adults and children in Guam and private providers. All individuals are eligible for services at GBHWC, although the agency prioritizes the most indigent clients.

GBHWC has a wide range of facilities around the island, including a medication clinic that caters to less severe mentally ill individuals who cannot care for their mental condition due to a lack of resources and individuals experiencing acute emergencies and/or crises.

Guam Behavioral Health and Wellness Center (GBHWC) is responsible for addressing Guam's behavioral health services, including a child and mental healthcare for adults, drug and alcohol abuse, and treatment and rehabilitation of these issues. GBHWC has a wide range of different facilities around the island dedicated to certain assistance or treatment. A medication clinic caters to less severe mentally ill individuals who cannot care for their mental condition due to a lack of resources and individuals experiencing acute emergencies and/or crises.

There has been a recent increase in private mental health providers in Guam. Private providers are mostly psychiatrists, clinical psychologists, and individual, marriage, and family therapists. Private clinics also provide some mental health services. Only a limited number of private providers and pharmacies accept government insurance, such as Medicaid and the Medically Indigent Program (MIP), due to factors such as slow reimbursement.

The Healing Hearts Crisis Center (HHCC) is Guam's Rape Crisis Center. As a division of GBHWC, HHCC exists with the intent to provide survivors of sexual assault with "discrete, immediate, and full medical attention."

HHCC incorporates a holistic approach for the survivor of sexual assault or abuse. HHCC services include intake assessment and crisis intervention, forensic and multi-disciplinary team interviews, short-term case management, and linkage to other needed services such as individual and family therapy. HHCC also provides medical services, including forensic examinations and collection of forensic evidence, and outreach and training to schools, service providers, and the community-at-large.

Also affecting Guam's ability to meet its population's health care needs is that a large percentage of the island's population does not have adequate health insurance to cover medical costs. It is estimated that 23% of Guam's population is uninsured or underinsured if they possess private health insurance but do not adequately cover necessary treatments. Furthermore, many individuals who have health insurance cannot afford the co-pays for treatments or medications and will turn to government health services for free services. Government health agencies' mandates are to serve all those that come in through the door.

Although they do have processes to verify whether an individual is insured or not, private insurance companies are unwilling to release their clients' names due to confidentiality issues. Often if individual states they do not have health insurance, agency staff must take their word for it.

Medical tourism is how insurance providers and people outside the healthcare system attempt to deal with the high cost of specific procedures. Many Guamanians go and have gone to St. Luke's Hospital in the Philippines to seek expertise or treatment for their ailments. For the uninsured that need major operations done, places like Thailand, Singapore, and India are becoming medical tourism destinations.

Public and Private Partnerships

Guam MCH focuses on multiple determinants of health, and those determinants make it impossible for one entity or one sector alone to bring about population health improvement. There are broader efforts that include many sectors needed to make a more significant societal commitment to health.

There are also multiple collaborations ongoing between Title V programs and other Guam DPHSS program areas. Those partners include the Office of Vital Statistics, Bureau of Community Health that houses - Chronic Disease Prevention, Tobacco and the Guam Diabetes Program, the HIV and STD Prevention Program, the Guam WIC Program, the Guam Immunization Program, Division of Environmental Health and The Office of Performance Improvement Management.

Several agencies, programs, and community-based organizations serve vulnerable populations of women of reproductive age, children, and adolescents (especially those with special health care needs). Coordination with all these agencies, programs, and community-based organizations is vital to reduce the duplication of efforts and fragmentation of services. (Please see attachment 1)

Guam was one of the teams participating in the 2nd cohort in the Roadmap to Collaboration among Title V, Home Visiting, and ECCS. Team members included: the Guam Title V Program, the Guam Preschool Development Grant, Guam’s Family Health Information Resource Center, and the Guam Early Learning Council. The members of Guam’s team embarked on a journey with the advantage of having a history of a close collaborative relationship across their respective programs. The group decided to leverage this existing strength and build partnerships with stakeholders outside their immediate MCH network. They also agreed on their priority to build MCH program partnerships with Guam’s childcare sector.

Another new partnership formed is Project Minetgot: Guam Act Early Territorial Team to ensure that young children and families are supported early in preparation for life, especially during the current Covid 19 pandemic. The project will develop, implement, and evaluate prioritized early childhood strategies to help Guam’s Covid 19 recovery and strengthen resilience skills, behaviors, and resources for children, families, and communities. The Chamorro word “Minetgot” means to have collective strength. So, all early childhood partners (MCH, Project Bisita, FHIRC, PDG, Head Start, GEIS, CEDDERS, and CCDF) come together to work collectively