Organizational Structure

There are two dominant levels of government in the FSM, the National Government level and the State Government level, while the municipal government is the third level of government. The FSM is self-governing with locally elected President, Vice President and Legislature at the National level. Each State also elects a Governor, Lieutenant Governor, and Legislature. For the purposes of receiving US Federal Domestic Assistance, the National Government is designated as the "State Agency". However, all funds approved by the US Federal Government to support Title V and allocated to the FSM Government are further allotted to each State MCH Program through advice of allotment issued by the National Budget Office.

At the National level, the Secretary of the Department of Health and Social Affairs (H&SA) manages health affairs for the nation. There are several divisions under H&SA, including the Division of Health Services which houses the Family Health Services Section. The Title V Maternal Child Health (MCH) Program is one of the Five programs under the Family Health Services Section along with Title X Family Planning program, UNFPA Family Health Project, HRSA funded Early Hearing Detection and Intervention (EHDI) Programs, and State System Development Initiative (SSDI).

Health service delivery is the responsibility of the Department of Health Services (DHS) at state level which manages the states´ hospitals to provide curative care, and a network of state-run dispensaries and community health centers (CHCs) to provide preventive and public services across the states. The primary care facilities are not integrated and display significant variance in terms of capacity and resources. For example, the CHCs do not follow the essential service package for the primary care level.  Furthermore, different service delivery models co-exist at primary care level according to the state’s context and resources. For example, Chuuk state is expanding the CHC model building state run super-dispensaries in the maritime areas; Kosrae and Yap are relying on non-state CHCs in the main island and Yap OI are covered by the state dispensaries; Pohnpei state is consolidating a mobile team model, where dispensary services are expanded on certain days per month or per year depending on the dispensary location. Kosrae state relies on a network of CHC to decentralize certain public health services while other essential services remain centralized at the state hospital. Multi-program outreach services are regularly available and operational across all four states; however, limited community profiling and weak mobilization around outreach services in certain states, diminish their effectiveness.

There are two main divisions under the Secretary of Health and Social Affairs, which are the Division of Health and the Division of Social Affairs. The Family Health Services Section, Division of Health, covers the areas of MCH, family planning, and reproductive health. Under the Program Manager of Family Health Services, MCH, Children with Special Health Care Needs (CSHCN), Early Hearing Detection and Intervention (EHDI) supervisors of DHSA collaborate with the States of Health Services monitoring the three relevant programs (MCH, CSHCN, and EHDI). Also, the Family Planning /Reproductive Health Coordinator supervises the State of Health Services with the Family Planning/Reproductive Health Program. Family Health Services mainly has four programs: State Systems Development Initiative (SSDI), MCH /Children with Special Health Care Needs (CSHCN), Early Hearing Detection and Intervention (EHDI), and Family Planning (FP) /Reproductive Health (RH) Program（See Appendix). These MCH programs are funded by the Health Resources and Service Administration (HRSA)2 (Title V MCH Services Block Grant), between 2021 and 2025. Every five years, the FSM is required by Title V legislation to comprehensive state-wide needs assessment (NA) to evaluate current MCH situations in FSM, risk factors, access, capacity, and outcomes

Title V MCH Program Structure

The administration and management of the Title V Program is under the direct supervision of the National MCH Program Manager at the FSM Department of Health and Social Affairs, who provides guidance and works closely with each of the four State MCH Coordinators. Within each of the four States, under the direction of the State Director of Health, the Public Health Division administers the Title V Program. The MCH Programs provide primary care and preventive services to women of childbearing age, children, adolescents and CSHCN. Community outreaches are conducted through education and awareness in the communities and schools, and counseling services to mothers during antenatal and postpartum clinics. The Title V Program also prioritize and continue to strengthen its partnerships with relevant health programs, stakeholders, National and State Non-Governmental Organizations (NGO’s), and affiliated UN partners – WHO, UNFPA, UNICEF, JICA etc.

Depicted below in figure 2. is the org structure for Pohnpei Health Services

The FSM Title V Program is managed by the FSM National Government, Department of Health and Social Affairs (DHSA).  For the purposes of receiving U. S. Federal Domestic Assistance, the National Government is designated as the "State Agency".  However, all funds approved by the U. S. Federal Government to support Title V program and allocated to the FSM Government are further allotted to each State Title V Program by way of Advice of Allotments issued by the National Division of Budget, under the administration of the Department of Finance and Administration.  The Title V program employs a Program manager at the National level, and the State Title V program employs all clinical and non-clinical staff who are taking care of the management of the Title V programs in their respective States. All MCH clients seeking Title V services in the four FSM States have reported either low incomes or no income at all. The Public Health Department provides all the preventive and primary health care services at no cost to the clients. 

System of Care Population Served

The 2024 population projection estimates showed 38,355 women of reproductive age (defined as women 15-44 years old). It was reported in 2024 that 1585 of pregnant women received services from the MCH programs.

The number of infants (less than one year old) in 2024 FSM population projection was 2,573. The 2024 population estimates show that there were 49,887 children ages (0-19 years old) including the CSHCN population.  About 65% of this age group was reached by the MCH programs services through enabling and public health systems.