Overview of State 2021

Geography: American Samoa is a self-governing territory of the United States and consists of a group of seven islands in the southern Pacific Ocean. It is located about half way between Hawaii and New Zealand south of the equator line. The total land area of American Samoa is approximately 76 square miles (200 square km). The main island of Tutuila, the largest island of the group, covers an area of 55 square miles (143 square km), just slightly larger than Washington DC. The center of Tutuila is called Pago Pago, the political, administrative, and commercial center of the Territory of American Samoa.

Aunu'u Island is one mile off the southeast tip of Tutuila (a 15-minute ferry ride), with a land mass of 0.6 square miles and a population of about 300 people.  Sixty miles east of Tutuila is the Manu'a Island group (a 30-minute airplane ride or a 12-hour boat ride from Tutuila) that includes the volcanic islands of Ofu and Olosega, connected by a bridge, and the Island of Ta'u. These islands are sparsely populated, with a total 2010 Census population of 1,400 residents, and each village having a few hundred residents. The Swains Island is a privately-owned coral atoll located 214 miles north of Tutuila with approximately 1.25 square miles of land mass and a population less than 20 (2010 Census). Swains Islanders raise coconuts and grow bananas, taro, breadfruit and papaya, and supplement their diet with fish from outside of Swains' reef. Rose Island (coral atoll) lies 78 miles east of Ta`u with a landmass of 0.1 square miles, is uninhabited and is named a national monument.

Geographically, Pago Pago has one of the best natural deep-water harbors in the South Pacific Ocean, sheltered by shape from rough seas and protected by peripheral mountains from high winds. American Samoa climate is typically hot, humid and rainy throughout the year, moderated by southeast trade winds. Maximum rainfall averages about 122 in (3,100mm) per year. Rainy season is also typically hurricane season, happening from November to April, while dry season occurs from May to October. Maximum temperatures range from upper 70’s to mid 90’s throughout the year.

Population: According to US Census 2020 for American Samoa, information released accounts for a total population count of 49,710 as of April 1, 2020.  This is a 10.5 percent decrease compared to the 2010 Census report for American Samoa. 

     American Samoa is divided into four geo-political districts: Western District, Eastern District, Manu`a District, and Swains Island District.    The numbers counted for each district have significantly decreased over the last decade, with residents migrating to the US mainland and elsewhere.  Swains island had residents per the 2010 census but has now been deserted due primarily to climate change and the environmental threats to this isolated island, lack of access to necessary resources, and many other viable reasons.   Manu’a and Eastern Districts have seen a drop in their counts while the Western District sees an increase of their residents.  This may be attributed to the west side of the island becoming more urbanized, with more businesses and job opportunities available on this side of the island.  Also, the west side has more flat areas of land for people to build homes on compared to the rest of the island.  There are more rental homes on the west side as well which likely contributes to more residents of the territory migrating to the west side of the island.

Population Growth: Growth of the population has been estimated at -2.1%.  This is evident in recorded numbers of birth & death rates.  Birth rate is at 14.2 per one thousand while death rate is 4.8 per one thousand. Infant mortality rates are marked 8.5 per one thousand births, in which males at 5.7 deaths per one thousand live births, and for females at 2.8 deaths per one thousand live births.  Life expectancy for the total population is noted at 75.1 years.

Ethnicity: Of the population, 92.6 percent reported as Pacific Islander are native Samoans, 3.6 percent are Asian, 2.7 percent as mixed, 1.7 percent is of other origin. Although the majority of the population is consistent of native Samoans, more than two-fifths of the population were born outside of the territory, largely in the neighboring independent Samoa Island, with smaller proportions from the United States, other Pacific Islands, and Asia Countries. 

Language:  Most people are bilingual and can speak English and Samoan fluently. Samoan, a language closely related to Hawaiian and other Polynesian languages, is spoken natively by 9 percent of the people as well as the co-official language of the territory.  While 80 percent speak English and Samoan, 2.4 percent speak Tongan, 2 percent speak Asian languages, and 2 percent speak other Pacific Islander languages.   Tokelauan language is also spoken in Swains Island. Literacy is calculated at 97 percent.

Housing Unit Count:  According to the 2020 census, the housing unit count for American Samoa has increased by 7.7 percent compared to the 2010 Census.  As seen in the graph below, the Eastern, Manu’a, and Swains records a drop in housing while an increase of 21.7 percent is seen at the western district of the territory.  This aligns with the increase of population referenced for this part of the main island Tutuila.  A more detailed description of households has not been released before the completion of this application. In addition to the fact that the vast majority of the population of American Samoa is concentrated on one island, Tutuila, the residents of American Samoa are culturally a relatively homogeneous population.  

Economic Environment: The government and the tuna canning industry remain as the two largest economic drivers in the Territory. For fiscal year 2022, the US Department of Interior provided $26.6 million for the government operations, supporting education, healthcare and judicial initiatives. To date, $95 million in Bipartisan Infrastructure Law funding has been announced and is headed to American Samoa with over 12 specific projects identified for funding.

The local inflation throughout 2022 had finally come down to 9.7 from a double digit (13.5) at the end of the year. Food was the highest expenditure group followed by Housing and Transportation. Changes in the food, alcohol and housing affected the overall rise and fall in cost of goods and services. These changes were driven by the global cost of fuel and oil, the COVID-19 pandemic, the 2022 Russian invasion of Ukraine and supply chains.

Federal Government:  Since the Bipartisan Infrastructure Law passed, approximately $12.9 million has been announced for transportation – to invest in roads, bridges, public transit, ports and airports – and roughly $74 million has been announced for clean water. And, as of today, more than 2,000 households across the territory are receiving affordable highspeed internet due to the Bipartisan Infrastructure Law. Many more projects will be added in the coming months, as funding opportunities become grant awards and as formula funds become specific projects. By reaching communities all across American Samoa – including rural communities and historically underserved populations – the law makes critical investments that will improve the lives of the people of the territory and position them for success.

To maximize our use of this worthy economic development investment, ASG is also implementing workforce development opportunities with an emphasis on the information technology industry. Given these unprecedented times as a result of the coronavirus pandemic, the broadband investment came through right in time when virtual learning, telehealth and e-commerce is the way to engage and do business in these challenging times. American Samoa’s current broadband capacity is American Samoa’s primary means of communication beyond its shores as the Territory was currently under a state of public health emergency and border closure. 

To address food insecurity in American Samoa and provide more equitable resources to U.S. territories, USDA Food and Nutrition Service released a $10 million grant to bolster the American Samoa Nutrition Assistance Program, or ASNAP in September 2022. This funding is in addition to the annual block grant the territory receives and will be used to increase nutrition assistance benefits for ASNAP participants for one year. Benefits will be spent locally, which in turn will increase the purchasing power of local grocery stores to purchase food from local producers and farmers.

This $10 million grant is funded by the American Rescue Plan Act and supports USDA’s goals of transforming local food systems and increasing nutrition security. The funds allow American Samoa to provide $277 per month to all current ASNAP participants from October 1, 2022, through September 30, 2023. This is an increase of between $100 and $183 per month over current benefit levels. For the lowest-income ASNAP participants, American Samoa will also provide $208 per month to an additional household member, raising the total household benefit to $485 per month.

This grant has helped mitigate the lasting effects of the pandemic and stimulate the local food system. It has also strengthened current efforts by the local government to diversify and increase food production on the island, starting with traditional and specialty crops and livestock.  Through the years, residents of American Samoa have struggled to put food on their tables and have relied on USDA’s nutrition assistance programs. They are among the most far-reaching, powerful tools available to ensure that all Americans, especially vulnerable populations such as women and children, including children with special healthcare needs, regardless of race, ethnicity, or background, have access to healthy, affordable food.

Tuna Industry: The tuna industry has a pervasive impact on the local economy. It is one of the two economic pillars, which drive all business activities in the Territory. The tuna industry is presently facing increasing challenges perpetrated by rising operational costs causing the reciprocal decline in competitive advantage. Starkist Samoa, the remaining tuna processing plant, is second to the American Samoa Government as the largest employers on the island. In spite of the myriad of operating disincentives, such as the recently imposed 40 cents federal minimum wage, loss of federal incentives, China’s growing dominance of the fishing industry and others, Starkist Samoa is contemplating expansion of its production in American Samoa which could mean 200 to 300 new jobs. With this increased production capacity, it will raise its total production volume based in American Samoa beyond its current 80% level. The fact that Starkist is increasing its American Samoa based production, indicates that Starkist is committed to remain in the Territory in the coming years thus providing confidence that the tuna industry will continue to grow in the coming years.

Information and Communications Technologies (ICT) Industry: As a result of the American Samoa Government’s $30 million-dollar investment into the new Hawaiki submarine fiber optic cable, the Territory of American Samoa now has significantly more bandwidth than most small island developing states in the region (200Gbps with access to more). Additionally, the fiber-to-the-premises project, more commonly known as the BLAST project, ensures that end users have state-of-the-art access to this new bandwidth, opening opportunities for developments across many industries and sectors. This new connectivity is well positioned to support the much-needed diversification of our economy.

Tourism:  By the end of year 2021, Congresswoman Uifa’atali Amata welcomed a federal funding announcement from the Economic Development Administration (EDA) of a travel and tourism grant of $1,395,492 for American Samoa. This grant, based on the American Rescue Plan Act passed by Congress in March 2021, is part of a pool of $10 million created by EDA then assessed by population among the territories.

According to the territory’s representative, this grant will ensure the smaller territories of the US can focus on building up local businesses and tourism efforts for the future.

These travel, tourism and outdoor recreation grants are focused on accelerating the recovery of communities that rely on these sectors, and have faced pandemic challenges. The grants help localities invest in marketing, infrastructure, workforce or other needs to support recovery and resilience of these industries.

Combined territorial and federal government spending in American Samoa is noted at over 500 million in both loans and grants from multiple sources, according to the American Samoa profile on USAspending.gov site. The accelerated growth in government spending in the early years of this forecast, along with the swell in relief funds to individuals and families, is anticipated to have created as many as 500 jobs in the government and private sectors in 2018, however the rate of unemployment within the territory continues to steadily rise each year.

According to the Comprehensive Economic Development Strategy Report for American Samoa 2018-2022, a SWOT analysis identified several strengths and weaknesses that have contributed to the economy of American Samoa.  One noted weakness was the quality of healthcare, stating “The Lyndon B. Johnson Tropical Medical Center (LBJ) is the sole hospital in the territory. As a result, patients frequently experience long delays when seeking medical care. Of those surveyed, 33.3% identified quality of healthcare a weakness. There are only a small number of private health care practices located in the territory, mainly due to an inability of patients to afford the high cost of unsubsidized health care services. The Department of Health (ASG DOH) does operate five other Community Health Centers, which has helped to alleviate some of the strain on LBJ. The territory has also long struggled with securing and retaining high quality health care practitioners. This is due, in part, to the territory’s remote location, the relatively heavy workload, inadequate funding, and uncompetitive wages.

The American Samoa Government (ASG) provides all Territory and local governmental services to the Territory. There are no local governments under the ASG. The major services provided by ASG are split between governmental services and business-type services. ASG provides traditional governmental services which are funded from taxes and federal grants. These services include:

1. Public Safety
2. Health and Welfare
3. Education
4. Culture
5. General Administration
6. Public Works
7. Transportation

Other business-type services are also provided by ASG. These services are funded by user fees, charges, and grants. These services include:

1. Airport
2. Industrial Park
3. Shipyard Authority
4. Territorial Bank of American Samoa

Component Units are other services to the Territory which are provided by component units of the government. These services are funded by fees, taxes, and grants.

1. American Samoa Power Authority – provides electricity, water, wastewater, and solid waste services. Before FY 2014, ASPA also provided fueling services but this function has reverted to the private sector.
2. American Samoa Community College
3. Lyndon B. Johnson Hospital
4. American Samoa Telecommunications Authority (ASTCA)

Cultural and Social Environment:  The Samoan culture plays a very significant role in the community and social context.   Traditionally, the family and culture are of utmost importance to the people.   The Samoan family or “aiga” has strong bonds and is a key factor in both service delivery and patient decision-making.   Families make decisions together and often, the family as a group makes health decisions rather than as individuals.

Key members of the Samoan community are family leaders, cultural leaders, and church leaders.  The Samoan cultural leaders are the “matai” or the chief of each respective clan or family.  Land ownership and family dwellings are also tied directly to family, clan and matai titles where the land is communally owned by the family and under the stewardship/authority of the matai.  The matai system provides an extension to the conventional or western idea of families, where any given family or clan includes several households or sections of a village.  Respect and compliance for both the matai and/or family leaders such as parents and grandparents are paramount in Samoan society.   Matai and family leaders are important members of the Samoan cultural and social environment.

Religion: Christianity is the foremost religion in American Samoa, reported to be 98.3 percent of the population.  Churches are embraced as an important component of society.  Church leaders are revered in all social, cultural and professional settings.  Church groups are among the most organized and well attended non-governmental organizations in the community.  Most families and individuals are active participants in a church organization of some fashion. Health promotions and outreach activities are often delivered in religious settings as it reaches the majority of people.

Way of Life:  Samoans live a communal way of life, participating in activities collectively. In a Samoan village, each ‘aiga’ or family live on family or communal land, often next to each other. Though each family within the family may live in their own housing structure, the family is one – everyone works the same land, cook together, eat at one ‘fale ai’ or family dinner house, pray in one home together and are only separated by night to rest. This continues to be a practice today in many Samoan communities.

These key factors play an important role in health planning.  It is well understood in the health community that any service provided at any level must take into consideration the cultural and social environment of the family.  Many of the services delivered at the community level are designed to be family-friendly, culturally appropriate, or religiously acceptable as most people in American Samoa are active participants in one or all of these groups.

Health Care System:  Under the American Samoa legislative code all residents are entitled to free medical care.  Therefore, all health care services are heavily subsidized by the government and delivered at little or minimal cost to residents.   Services are administered through the Department of Health and the American Samoa Medical Center Authority (LBJ Hospital). 

The relationship between the sole local hospital and the Department of Health is one of strengths and weaknesses.  The LBJ hospital is assigned to address acute hospital care to the entire island, with support services that enhance diagnostics and treatment to those who seek care from this facility.  DOH serves the community through the community-based health centers spread across the islands, along with preventive programs that are federally funded with local matching requirements for sustainability of services.  These two healthcare entities deliver services in a range that complements one another.  For instance, Community Health Centers provide prenatal care free of charge for all pregnant mothers, with the exception of those with high-risk pregnancies who would be referred to the hospital for follow up care throughout their entire pregnancy.  By the 3rd trimester, the pregnant mother will be referred from Community Health Clinics to the LBJ hospital for continued care until after giving birth.  Preventive and primary care services are the sole responsibilities of the Health Department while the LBJ hospital provides acute care.

The American Samoa Medical Center Authority (ASMCA), the only hospital in American Samoa, provides all acute medical services and includes outpatient clinics as well as inpatient hospital care.  The ASMCA provides outpatient care at the Emergency Room, Primary Care Clinic, Pediatric Clinic, Obstetrics and Gynecology Clinic, Surgical Clinic, Orthopedic Clinic, Medical Clinic, Ear Nose Throat Clinic, Dialysis Clinic, Psychiatry Clinic, Dental Clinic, Physical Therapy Clinic, and the Eye Clinic.  The inpatient services include 128 patient beds in six wards: Labor and Delivery, Nursery, Maternity, Internal Medicine, Surgical, Intensive Care, and Psychiatry. 

The LBJ Tropical Medical Center (LBJ TMC) is a 150-bed general acute care hospital, with an approximate footprint of 150,000 square feet, constructed into six (6) separate linear buildings connected by two primary corridors bisecting each, in a grid pattern. The facility was originally constructed in the mid 1960’s and attained full operation in 1968. The facility is a single-story concrete bent frame, sloped roof and wood framed structure which has undergone a number of minor renovations over the years.

The facility is certainly approaching the end of its serviceable life cycle (50 years). Currently, 41 percent of the facility has been renovated to meet CMS standards. Upon completion of the current labor/delivery nursery expansion and renovation project, LBJ facility will be 65 percent renovated. Administrators of the local hospital continue to face the challenge of increased outpatient visits and high inpatient census. One of the solutions that they are presently exploring is a new 200-bed hospital to accommodate increase in population, as well as inpatient and outpatient visits. Space in the present location is severely limited, and LBJ is unable to expand the existing building which, in turn, limits services.

In the last five years, ASMCA has extended its Dialysis Unit to accommodate 32 chairs, providing much needed services to well over 200 patients requiring dialysis.  Most recently, a private-owned dialysis clinic opened its doors to the public. The latest survey reported data that shows 24,623 patients visited the hospital's emergency room. The hospital had a total of 3,937 admissions. Its physicians performed 907 inpatient and 2,521 outpatient surgeries. The ASMCA also provides all laboratory, diagnostic imaging, and pharmacy services for the entire population.   The ASMCA operates as a semi-autonomous agency of the government and is governed by a board of directors whose membership is subject to legislative approval.

Most recently, funding from the ARPA (300 million) and FEMA (1.9 million) are allocated to assist in renewing LBJ Hospital facilities and constructing additional space to accommodate the territory’s population.  Presently, a committee has been appointed to have oversight of this project to benefit the community and improve healthcare service delivery across the islands.

The Department of Health is responsible for preventive and outreach services to the community.  The Department of Health delivers primary care services through the Federally Qualified Health Centers (FQHC).   There is one FQHC situated on the West side (heavily populated area) called Tafuna Family Health Center (TFHC).  In 2009, TFHC added two new access points to its services, which included Leone clinic on the western tip of the island, and Amouli clinic on the eastern tip of the island. There are 5 satellite clinics spread geographically throughout the island including one in Ta’u and Ofu, of the Manu’a Islands. A newly renovated primary health clinic began its services in mid 2017, located across the LBJ Tropical Medical Center.  This clinic combines services for employment physicals, school athletic clearances, Tuberculosis screenings, RHD echo screening, and Flu shot campaigns.  DOH is continually recruiting additional providers to operate this clinic as only one provider is currently stationed at this site. 

Since the Zika outbreak in 2016, federal funding assistance enabled a satellite pharmacy to open and operate from TFHC, as well as a laboratory to conduct testing for CHC patients.  In the past years, nurses mainly managed Manu’a health clinics, with occasional visits from an available physician.  With continued recruitment of doctors for CHC in the past year, the Manu’a health clinics have been able to entertain a doctor who lives on site and provides services for the Manu’a population.  Also, through the MCH Zika grant, telehealth equipment has been installed in the Ta’u health center, as well as Amouli and Leone health centers, to allow connections during telemedicine and telehealth sessions with US based partners.

The Department of Health is also responsible for infectious and chronic disease surveillance and prevention, community nursing services, environmental health, immunization, Public Health Emergency Preparedness (PHEP), Comprehensive Cancer Control Program (CCCP), HIV and STD screening, early intervention, newborn hearing screening, as well as MCH Program services and the Maternal Infant Early Childhood Home-visiting (MIECHV) Program. 

In November of 2019, the territory raised a response to the measles outbreak which originated from the neighboring independent Samoa Island, and eventually seen in the territory.  DOH led efforts to enforce herd immunity assuring measles infection were minimal and in a controlled situation.  Following the measles outbreak was the COVID19 pandemic, which contributed to the sharp increase of emergency hires to assist with COVID operations led by the Health Department.  To date, the health department workforce contains more than 300 employees, most of which are laymen.

A Medicaid Program exists in American Samoa, operating directly under the Governor’s office.  American Samoa’s Medicaid program was established in 1983. It is a 100% fee-for-service delivery system with one hospital servicing the territory. There are no deductibles or copayments under the American Samoa Medicaid program, however there are some fees charged by the hospital located in American Samoa. Through Section 1108 of the Social Security Act (SSA), each territory is provided base funding to serve their Medicaid populations.

For the period of July 1, 2011 through September 30, 2019, Section 2005 of the Affordable Care Act provided an additional $181,307,628 in Medicaid funding to American Samoa.  These monies have allowed the Medicaid program to support an off-island referral process for cases that cannot be addressed in American Samoa.  These cases are directly referred to New Zealand to further care under the sponsorship of the Medicaid program.  Most recently, American Samoa has been allowed to use Medicaid funds to pay for healthcare services in the state of Hawaii. Hence all outbound flights since June of 2020 have been chartered by Medicaid to transport local patients who require services that are otherwise available locally.  Some of these cases include children who require heart valve replacement surgeries due to complications of Rheumatic Heart Disease and babies born with congenital defects.

Eligibility in American Samoa differs from eligibility in the states. American Samoa does not have a TANF or SSI program and does not determine eligibility on an individual basis. Rather, the territory uses a system of presumed eligibility. Each year the percentage of the population below 200% of the poverty level is estimated and, after CMS approval of the estimate, CMS pays expenditures for Medicaid based on that percentage.  There are plans in the very near future to begin individual eligibility enrollment for Medicaid funding.

American Samoa was awarded $16,510,330 million for its Medicaid program in lieu of establishing a health marketplace. American Samoa must exhaust its Affordable Care Act (Section 2005) allotment prior to using these funds.  Moreover, the FQHC’s became eligible for Medicaid reimbursement for services provided through an amendment in February 2017. Due to this eligibility, FQHC’s were able to offer care without a cost to the public.   An additional amendment proposed coverage and reimbursement of emergency and certain other medical services furnished by off-island and out-of-country providers became effective April 1, 2017.  Due to the current pandemic and the flow of federal funds into the territory, both LBJ and the DOH clinics have been able to serve the community without imposing a fee upfront except for emergency services.

Department of Human and Social Services (DHSS) is the Territory’s Single State Agency for Substance Abuse Prevention and Treatment.  It also serves as the State Mental Health Authority and is the Governor-designated lead agency for Child Welfare Services and Social Services and is the lead agency on underage drinking. This 100% federally funded agency directs four (4) core agencies, including: 1) Social Services; 2) Women, Infants and Children (WIC); 3) Nutrition Assistance Program (Food Stamps); and 4) the Vocational Rehabilitation Division. DHSS provides substance abuse prevention and outpatient counseling to more than 150 families each year, as well as mental health services, 24-hour emergency shelter services and crisis hotline, shelter program for the homeless, victims of crime advocacy, crisis intervention, family support services and subsidized child care for low-income working families.

DHSS and DOH often collaborate in efforts that combine the social and health aspects of the community, respectively.  The MCH Title V program partners with DHSS annually for breastfeeding, nutrition, behavioral health, child care, oral health, and surveillance efforts.  DHSS primarily conducts the SBIRT (Screening, Brief Intervention, and Referral to Treatment) tool to identify, reduce, and prevent the use, abuse, and dependence on alcohol and illicit drugs. Most recently, a 988-suicide hotline was implemented to address the rising number of teen suicide in the territory.  Both DOH and DHSS employees work around the clock to man these lines while also performing their daily jobs.
 

There is a Veterans Affairs Clinic in American Samoa, which caters to veterans and military reservists. The clinic has less than five doctors, and provides outpatient services only during regular business hours five days a week.  The VA clinic also accesses laboratory, pharmacy, dental and radiology services at the ASMCA.   Other private specialized clinics in the community owned by Samoans include services such as Optometry, Primary Care, Sleep Care and Dental operated by an Orthodontist.

Other types of health-related entities also exist within the system of care for American Samoa.  These include the following:

• Hope House - the only nursing home-type of setting on island, housing the elderly and children with severe disabilities
• Alliance for Families – providing support services for victims of domestic abuse and violence, shelter for families in difficult situations, and workshops/educational sessions on community-based services
• Intersections – is a 501 c 3 not-for-profit organization that has been creating opportunities for change among children and families since 2002. Intersections provides intervention and prevention services that empower young people to become successful in making positive choices, promote healthy living, and foster social responsibility
• EPIC - Empowering Pacific Island Communities is a non-profit organization that receives federal funds to address various issues in the community such as sexual assault, behavioral and mental health, community reintegration, trauma counseling and advocacy.

It is also necessary to comment on the Department of Youth and Women’s Affairs (DYWA) under the American Samoa Government. DYWA conducts numerous programs throughout the year, targeting adolescents, youth, and women and includes the Department of Health in its efforts.  Such programs address critical issues that improve autonomy and skills that are applicable to life in general for all women, adolescents, and youth.  Through this collaboration, MCH participates to deliver relevant health education and promotion topics that are vital to their development and well-being. 

MCH also works extensively with nonprofit organizations (NGOs) and the business community to reach goals that aim to improve the health of women and children in American Samoa.  Local chapters of organizations such as the Rotary club, the Lions club, and the Shriners provide financial and humanitarian support to assist in health efforts such as vision & hearing, cardiovascular, and Orthopedic needs.  The Intersections Program and EPIC are non-profit groups that focus on Adolescent Health and conduct sexual abstinence education and peer mentoring groups.  The Paramount Construction Company has continuously donated financial assistance to support the annual Cardiology clinic for children with Rheumatic Heart Disease for the past five years.  Other locally owned businesses have contributed to Health events that cater to the health of women and children.

MCH intends continuing collaborations with its valuable stakeholders to achieve priorities that improve the health and wellbeing of all women and children in American Samoa