Needs Assessment Update

COVID-19

July 2023, there are 16,098 COVID-19 cases in RMI with 17 deaths and 147 hospitalizations. 100% of 6 months and above received full COVID-19 vaccination based on the projected population from the new census of 2011. The number of fully vaccinated with COVID-19 6 months and above is 41,468 while population for 6 months and above is 41,339. 33% of the 5 years old and above received bivalent COVID-19 vaccines. We continue to provide testing and vaccinations. In 2022, preparedness and response to COVID-19 affected the implementation of activities.

Ministry of Health and Human Services Strategic Plan (MSP) 2022-20230

MSP was conducted from April to June, 2022. The Secretary, Deputies, Assistant Secretaries, Bureau Directors, and Chiefs were oriented to MSP process via an organizational meeting held before the retreats. In addition, separate meetings were held with the chiefs of each of the Bureaus falling into three retreat groups (Public Health & Primary Care; Hospital & Referral Services; Administration, Finance & Planning). Leaders of the Kwajalein Atoll Health Care Services Bureau were invited to all Bureau-level retreats. In addition to the MSP retreats, results from a Neighboring Islands Health Services Summit between MOHHS and the Marshall Islands Mayors Association (MIMA), which was held in April 2022, is included in the MSP. The scope of the MSP was limited to MoHHS strategies plus laws and policies and did not include consideration of possible changes to the RMI government health insurance plan, or insurance-supported health funds, MoHHS partners or other segments of society that affect health. Prior to each retreat staff in the respective bureaus were delegated to perform SWOT (strengths, weaknesses, opportunities, threats) analyses of their bureaus, review current endorsed (or nearly endorsed) strategic plans for categorical areas within their bureaus, and review existing laws, regulations, and policies relevant to their bureaus for presentation at their retreats. Open strategic planning discussions were held following these presentations conducted by facilitators chosen by Bureau chiefs.

Ministry of Health and Human Services Strategic Plan, 2022-2030 is our blueprint for continuous improvement over the next eight years and expands on the approaches to improving health set forth by our leaders in the RMI National Strategic Development Plan, 2020-2030.  In keeping with our mission, the Plan emphasizes ways to work smarter and in closer partnership with communities to expand delivery of prevention and primary care services, which are most cost effective, to work with our policy makers to accelerate the adoption of policies to improve health, to take innovative approaches toward easing the hidden burden of red tape that compromises our effectiveness and customer service, and to raise standards of our workforce, our hospitals and our outlying health centers.

Below is the section related to MCH services:

The Inaugural Tole Mour Leadership Conference was held from July 19-21, in Majuro. The conference brings together the RMI Ministry of Health and Human Service’s (MOHHS) Ministry Leadership Team (MLT), Bureau Leads, Senior Management Team (SLT), and partner technical assistance (TA) agencies to share strategies and resources for accelerating the shift to a more integrated and sustainable health system. This year’s meeting will focus on the first year of the RMI MOHHS’ Strategic Plan 2022-2030 (MSP 2022-30) and chart the way to move forward with the business practice and service delivery model innovations that the Plan calls for.

Revitalize MOHHS’ efforts to implement the RMI National Strategic Development Plan 2020-2030 (NSDP) as outlined for the health sector in the RMI MOHHS MSP 2022-30, with areas of emphasis including revitalizing leadership, nurturing a more flexible and resilient workforce, elevating health equity and coverage of public health services, collaboration with community-based organizations, and improved use of digital and communications technology.

Health Information System Deliverables

The MOH HS Strategic Plan 2022-2030 calls for decentralization, integration, and data-driven approach to delivery of public health & primary care services to the RMI population. MOHHS Strategic Plan components, designed to meet these strategic goals:

Establishment of a new Zone Outreach Unit (ZOU) linked to a new Registry Data Unit (RDU). Both units will consolidate workers from across multiple categorical health programs into integrated units (zone nurses & CHOWs for the ZOU and Data officers for the RDU).

Deliverables:

• Data collection system for recording outreach visits in Majuro

• Standardized monthly reports of outreach activities and outcomes

• Enhanced registries capable of tracking patients in high risk/high needs groups in the Majuro communities

• Standardized outreach lists linked to deployment of Zone Nurses and Community Health Outreach Workers (CHOWs)

• Standard Operating Procedure (SOPs) for ZOU and RDU processes

• Action Matrix for implementation of ZOU and RDU

Establishment of Neighboring Islands Enhanced Services Support Project (NIESSP)

Deliverables:

• Data collection system for Field Officer visits to Nls(Good to Expand)

• Record system for tracking high risk/high needs groups in the NI community

• Analysis of costs for current system using Majuro-based staff for direct services delivery to Nls compared with costs for NIESSP(Good to Expand)  service delivery system

• SOPs for field trip assessment/continuing education/supportive supervision of NI staff

• SOPs to report results of field trips to PH(Good to Expand)  programs and Outer Islands Health Care Services

  • SOPs to link field trip reports to payments for NI Local Atoll Performance                Agreements and for fee-for- service Maternal Health & Child Development Aides

 • Action Matrix for implementation of NIESSS

On-going Needs Assessment Activities

MCH Program continues to collect and analyze data from different programs that provides services to MCH populations. Continued partnerships with Public School System, Vital Statistics, Preparedness program, Hospital services, NGOs like Marshall Islands Disable People Organization, Women United Together Marshall Islands and other agencies.

RMI 2nd MCH Jurisdictional Survey was conducted in 2021. Planning and training were conducted remotely by NORC to the same Non-Government Organization (NGO)  that conducted the 2019 jurisdictional survey.

Women/Maternal Health

Between 2019 and 2021, the number of preventive medical visits among women aged 18 to 44 decreased by 40% (MCH-JS: 48.3% and 29.2%, respectively), but this decline was not statistically significant. Contrarily, although not statistically significant, outcomes like infant mortality (Vital Statistics) declined by 3% between 2019 and 2021, with a greater decline during the postnatal period (average annual percent change - AAPC-32%; p>0.05) compared to the neonatal period (AAPC: -5%; p>0.05). Additionally, between 2019 and 2021, preterm-related mortality declined significantly, by 46% (Vital Statistics). Preterm births decreased significantly by 61% (Vital Statistics); however, there was a significant increase in early term births (AAPC:42%; p<0.05). Other outcomes significantly increased throughout the course of the period (Vital Statistics), including neonatal abstinence (AAPC:19%; p<0.05), teen birth rate (AAPC:13%; p<0.05), and postpartum depression symptoms (AAPC: 38%; p<0.05).

There is no maternal death in 2022. MCH and Cancer programs continued to partner to navigate women to the after-hours Women’s clinic to be able to receive cancer screening. Cervical cancer is still leading cause of death for Marshallese women.

In women aged 15 to 44, the use of family planning services dropped significantly by 5%, from 15.5% in 2017 to 12% in 2021. In 2022, the family planning users for 15 to 44 years old went down to 10%

Perinatal/Infant Health

Periods and sources to measure ever breastfed and exclusive breastfeeding trough 6 months are different. However, MCH-JS data shows a 61% significant increase of infants who are ever breastfed between 2019 and 2021 (55.8% to 90.1%, respectively), while MCH program data from 2017 and 2018 shows a significant increase (percent change PC:4%; p<0.05) for infants exclusively breastfed until 6 months (40.5% to 42.3%, respectively). According to Vital Statistics data, infant (AAPC: -3%; p<0.05) and neonatal (AAPC:-32%; p<0.05) mortality rates decreased even though not significantly, while SUID were only reported during 2020 (97.3 per 1,000 live births). 15% decrease on infant mortality rate from 2019 to 2022. Children aged 19 to 35 months who were fully immunized increased significantly (AAPC: 8%; p<0.05) between 2017 and 2021, from 46.8% to 62.7%.

Child Health

There was a 37% non-significant decline in the percentage of children, ages 1 through 17, who had a preventive dental visit in the past year between 2019 and 2021 (MCH-JS(Good to Expand): 25.2% to 15.9%, respectively). Although not significant, the percentage of children, ages 1 through 17, who have decayed teeth or cavities in the past year improved by 33% during this same period (MCH-JS: 23.8% to 15.9%, respectively). Elementary schools visited by dental programs increased significantly between 2020 and 2021 (PC:31%, p<0.05) as did the percentage of children between the ages of 1 and 17 who received preventive dental care from a dentist (PC: 2%; p<0.05).

Adolescent Health

Between 2019 and 2021, there was a non-significant decline of 42% in preventive medical visits among adolescents aged 12 to 17 (MCH-JS: 45.9% and 26.6%, respectively). However, throughout the same time frame, according to Vital Statistics and the Immunization Program (WebIZ), a number of outcomes significantly improved: Teen birth rates (AAPC:13%; p<0.05), adolescent mortality rate (AAPC: -45%; p<0.05), children aged 6 months to 17 years who receive an annual influenza vaccine (AAPC: 65%; p<0.05), adolescents aged 13 to 17, who have received at least one dose of the Tdap vaccine (AAPC: 47%; p<0.05), and at least one dose of the meningococcal vaccine (AAPC: 163%; p<0.05). Additionally, although not statistically significant, the percentage of obese children aged 10 to 17 (AAPC: -21%; p > 0.05) and the rate of adolescent suicide (AAPC: -66%; p > 0.05) also improved. In 2022, there are no suicide and motor vehicle accidents among adolescents.  On the other side, there was a significant 10% decline in the percentage of adolescents, aged 13 to 17, who had gotten at least one dose of the HPV vaccine (WebIZ). Thirteen-year-old girls' HPV vaccination coverage (ESM 10.3) has increased by 5% during 2017, however this change is not statistically significant. Teenagers 13 to 17 years old used 9% more family planning services between 2017 and 2021 (18.6% and 10.4%, respectively), however this increase was not statistically significant.

Children with Special Health Care Needs

Even though by 2019, 50% of CSHCN, aged 12 to 17, received services to help them transition to adult health care, the 2021 MCH-JS data show that 0% of the CSHCN had received these services. This indicator should be taken with care because the width of the confidence interval is >20%, or >1.2 times the estimate. The MCH-JS offers the same caution for CSHCN, aged 0 through 17, who received care in a functioning system since it reports 0% for both years.  Between 2019 and 2021, there was an 11% decline in the prevalence of children diagnosed with an autism spectrum disorder, however, this decrease was not statistically significant (MCH-JS: 1.8% and 1.6%, respectively). However, this indicator has a confidence interval width >20% or >1.2 times the estimate and should be interpreted with caution Children 3 to 17 years old who were diagnosed with attention deficit /attention deficit hyperactivity disorder showed a 90% non-significant decline between 2019 and 2021 (MCH-JS: 2% and 0.2%, respectively).