Title V Workforce Capacity and Workforce Development

Infrastructure Capacity

Public health infrastructure

Severe differences exist in FSM infrastructure and essential resources, with some areas provided with better access than others.  Most of the population relies on a public health care system that is regulated by the State. To compensate for the lack of funding and the unequal distribution of health care, a growing number of traditional healers have attempted to persist alongside public health care services, providing health care adjusted to cultural competency.

Expanding primary care accessibility and aimed at increasing population coverage is part of FSM’s current Health Development Plan. HSDP envisions a review of the existing service network to decentralize public health programs and expand essential services to include primary care programs at the public health facilities. Coordination between community, primary, and secondary care levels will be a priority to link education and awareness interventions with early detection and patient management, particularly for managing non communicable diseases and reducing the incidence of communicable diseases. The creation of a national health promotion unit will support these efforts and promote cross-sectoral resource optimization. Efforts will also focus on patient safety through ensuring access to affordable, quality medicines, establishing medicine regulations, procurement guidelines, and frameworks for antimicrobial resistance, and strengthening infection prevention and control measures at health facilities.

Health Workforce

The FSM Department of Health and Social Affairs recognizes the need for a competent, motivated, and unbiased distributed health workforce to meet population needs, reduce migration, and strengthen capacity to deliver essential services according to quality standards. A national governance structure will oversee workforce planning, guiding the development of a Strategic Human Resources for Health Plan (SHRHP) in the current HSDP. This plan will address workforce shortages and focus on improving performance evaluation, incentivizing work in remote areas, and expanding eLearning opportunities. The SHRHP will also identify the gaps in technical and specialized healthcare skills and outline short- and long-term training and education options for building capacity domestically and abroad.

The availability of the workforce in FSM has shown a positive trend after 2021, that is following the COVID-19 pandemic. Currently, the overall ratio of doctors to registered nurses (RNs) is just below the Sustainable Development Goal (SDG) recommended density threshold of 44.5. However, it is reported that the workforce does not have the level of specialization that the states require. In addition, there is an unequal distribution of healthcare workers across the states.                               

The loss of doctors and to a lesser extent RN and other specialized professionals through migration is a problem that affects the overall health system triggered by comparatively lower remunerations, career opportunities, and the search for better social conditions overseas. The 2024 health workforce salary increase of 45% seems to have delivered results in attracting and retaining the workforce; however, the lack of planning and forecasting of health professionals is reflected in the lack of prevision to replace the current ageing work force particularly doctors and health assistants, and in attracting and recruiting recent/young graduates, particularly health technicians (biomedical and laboratory technicians and pharmacist), and specialized doctors. Equally, job profiles are not adapted to the changes in the epidemiological profile of the population and the increasing health services demand related to NCDs, eye care, behavioral and oral health, recently added to the essential service package. It is widely acknowledged that the skills of health assistants and nurses have not yet been fully developed to meet the new service standards. Additionally, the existing formal and informal education and training curricula often fail to address the competencies gap. Shortages in training programs, including the training of trainers, along with inadequate formative supervision, have further contributed to this skills deficiency, particularly among primary care staff. Furthermore, limited governance capacity regarding human resources impacts coordination across states, hindering efforts to promote workforce mobility and optimize in-country human resources.

MCH Program workforce

The four State MCH Coordinators are responsible for assuring that clinical services are provided to pregnant women, infants, children, and CSHCN. Three of the MCH Coordinators are Registered Nurses. There is one CSHCN Coordinator in Chuuk. In addition, each of the State hospital and public health provide its medical doctor for the MCH Program. Together they are responsible for assuring that clinical services are provided.  Other National Family health staff although paid for by a different program, also assist the National MCH Program Coordinator in the planning, developing, implementing, and monitoring of MCH program services and activities at the national and state levels on a daily basis.

A total of 28 full-time MCH employees in 2024; 22 positions are filled and 6 are vacant. Assessing the Workforce Capacity of the FSM MCH Program, in 2024, there are 22 full-time staff at the national and states MCH programs. Out of the total 22 employees, two are at the national government, seven are in Chuuk state; three in Kosrae state; six in Pohnpei state; and four in Yap state. At the National level, the interim MCH Program manager staff is paid by the MCH program. The National Family Planning Program Coordinator and financial specialist, although paid for by a different program, also assist the National MCH Program manager in the planning, developing, implementing, and monitoring of MCH program services and activities at the national and state levels on a daily basis. These staff constitute the core staff at the national level and the National MCH Program Coordinator reports directly to the Secretary of H&SA.

Of the 7 staff in Chuuk state, two are staff nurses, two coordinators, one health assistant, one health educator, and one dental assistant. Out of the total three employees in Kosrae state there is one coordinator, one staff nurse, and one dental nurse. In Pohnpei state, there is one coordinator, one dental nurse, two staff nurse, and one lab technician and one admin staff. There are two coordinators in Yap, one staff nurse, one dental nurse and one dental technician. In addition, there are four data specialists funded by the SSDI Program that play an integral role in the Title V Program, who work in each State’s Vital Statistics and Record Division. These staff constitute the MCH Programs in each of the State Public Health Depts and they directly provide all of the preventive and primary health care services at no cost to clients.

The following are brief biographies of senior level national and state management and key staff who manage and oversee the FSM MCH Program and services on a daily basis. These senior and key staff directly provide all of the preventive and primary health care services at no cost to clients. They are also involved in the management and operation of Title V needs assessment and application processes every five years and annually, thereafter.

Interim Program Manager, Family Health Services Unit, Division of Health Services, FSM Department of Health and Social Affairs. The Family Health Services Program Manager position is funded at 1.0 FTE through Title V Block Grant funds and is still vacant.

System and Data Manager, Family Health Services Unit, Division of Health Services, FSM Department of Health and Social Affairs position is funded at 1.0 FTE through Title V Block Grant fund.  Title X Family Planning Program Coordinator is an in-kind position to MCH program.

Financial Management Specialist, Family Health Services Unit, Division of Health Services, FSM Department of Health and Social Affairs position is funded by Title X program and is an in-kind contribution to the MCH program.  All MCH Program Coordinators and CSHCN coordinators at the State level are 1.0 FTE through Title V Block Grant funds.

Training and education of the MCH staff are carried out at three levels:

• On-site consultations - provided twice a year for the coordinators in the four states on developing policy and procedures, program implementation, data collection, data analysis and interpretation, and improving data capacity.
• The FSM Annual MCH Workshop - is held each year bringing together the MCH Coordinators, the MCH Data Clerks, the CSHCN Coordinators, hospital and public health administrators, physicians, nurses, and stakeholders from the National Government and State Health Depts where issues are discussed related to improving services and state data capacity and early intervention services for CSHCN; and
• Special conferences and other educational opportunities provided to staff who attended in-person or on-line courses from the Fiji School of Medicine, PACRIM Conference in Honolulu, Pacific Basin Medical Association Conferences, and American Pacific Nurses Leadership Conference.

The WHO and other UN partners organized workshops for health management to help the FSM address the issue of the excessive out-migration of qualified health professionals. Workshops were done that were attended by FSM Health leaderships and two of the shared issues on the workforce in the health sector are: standardization of salaries across the different states and the improvement of training of its health workforce. Health care in Micronesia still has opportunities for growth and improvement. Through their commitment to address prevailing issues and make long-lasting change, WHO and other aid-focused organizations are currently working to provide Micronesians with a positive outlook for their future, especially on their workforce development.