II.A. OVERVIEW OF THE STATE

 

The Federated States of Micronesia (FSM) is made of four group of island states: Pohnpei (the Capital state), Chuuk (the largest in population), Yap, and Kosrae (the smallest, one-island state). Altogether, the FSM has 607 small islands located in the Western Pacific, about 2,500 miles southwest of Hawaii. Some of the islands are volcanic and others are small atolls. Except the state of Kosrae doesn’t have any other smaller atolls. The four FSM states are widely spread apart by the ocean, hundreds of miles from east to west. From farthest east is the state of Kosrae, which is more closer to the islands of the Republic of the Marshalls than to the islands of Yap, then going Westward to the states of Pohnpei, Chuuk, and farthest west is the state of Yap, which is more closer to the islands of the Republic of Palau than the rest of the FSM. The four states are united and regulated under the FSM National Constitution.

 

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States Geography & Demography

 

Chuuk State

Formerly known as Truk District, was one of the six districts of the former Trust Territory of the Pacific Islands (TTPI), which were administered by the United States of America under the Trusteeship of the United Nations after World War II. In 1979, four of the six former districts chose to end the trusteeship and form a new government, which is now called the Federated States of Micronesia. Chuuk is one of the four states of the Federated States of Micronesia (FSM). It is the most populated State among the four states with an approximate population of 48,000 during the 2010 FSM Census. It has two major volcanically formed island groups, located in the lagoon with mountain peaks, and they are divided into two regions--the Namoneas region and the Faichuk region. The Namoneas region is divided into the Northern (Weno, Piis-Panew, and Fonoton Islands) and Southern (Fefen, Uman, Tonoas, Etten, Siis, and Parem Islands).  There are also the “outer island” groups: the Mortlock Islands to the southeast, the Hall Islands (Pafeng) to the north, Namonuito Atoll to the northwest, and the Pattiw region to the west. These islands are coral formations and are situated outside the lagoon.

 

The State of Chuuk consists of 15 high volcanic islands in the Chuuk Lagoon and a series of 14 outlying atolls and low islands. There are three geographic aspects to Chuuk, the administrative center of the state on the island of Weno (formerly Moen), the islands of the Chuuk Lagoon, and the islands of the outlying atolls - a total of approximately 290 islands. The 15 islands of the Chuuk Lagoon have a total land area of 39 square miles; and the lagoon itself has a total surface area of 822 square miles surrounded by 140 miles of coral reef. Because of the vast expanse of water between islands, travel within the state is difficult. Within the lagoon, travel by boat from Weno to any of the other islands will take from 1.5 hours to 2 hours. Access to the outer islands is even more difficult with travel times on a cargo ship taking from four hours up to two days. The provision of health care, including MCH services, to the population is made difficult by the lack of transportation and communication between widely dispersed, small clusters of the populations on outer and lagoon islands. Of the total population of Chuuk of 48,651 residents, 32,738 (67% of total state including Weno) live on the islands in the Chuuk Lagoon. The administrative center, Weno Island claims 14,113 residents (29% of total state), followed by Tol (4,579), Tonoas (3,517), Fefan (3,471), Uman (2,554), Udot (1,680), Polle (1,498), Patta (1,107), Romanum (865), and Fanapanges (672). The remaining islands have less than 650 residents each. Approximately 48.7% (23,697 persons) of the total Chuuk population are under 20 years of age. Of this group, 5,987 are children under 5 years of age. The median age is 20.7 years, which makes it the youngest population in the FSM. There are 10,806, (22% of the female population) women of child-bearing ages between15-44 years that live in the state.

 

Kosrae State

Kosrae, formerly known as Kusaie, is the easternmost State of the Federation with 42 square miles of land and no lagoons. It is located approximately 370 miles north of the equator, between Guam and the Hawaii Islands. Kosrae is an Island State, and it is subdivided into four major municipalities: Tafunsak, Lelu, Malem, and Utwe. The 2010 FSM Census also indicates that the 6,616 persons lived in 1,143 households with an average household size of 5.7.  Kosrae’s population of 6,616 (2010 FSM Census) made up 6% of the total FSM population. In comparison with the other three FSM States, Kosrae is the least populated, the only single-island state, is the furthest southeastern point of the four states. Kosrae is the second largest inhabited island in the FSM with a land area of approximately 42.3 square miles. Because of the steep rugged mountain peaks, all of the local villages and communities are coastal communities connected by paved roads. Travel around Kosrae island is not difficult and it is possible to drive from one end of the island to the other end in approximately two hours.  The community of Walung (approximate population of 200) is part of Tafunsak municipality, is isolated and only accessible by a ½ hour boat ride at high tide.  Of the total Kosrae population of 6,616 residents, 2,173 people reside in Tafunsak, 2,160 persons in Lelu, 1,300 in Malem, and 983 residents on Utwe. Approximately 47% (3,135 persons) is less than 20 years of age and of that group 798 (12%) are less than 5 years of age. The population of women 15-44 years number 1,369 and comprise 20.6% of the total female population.

 

Pohnpei State

Pohnpei State, formerly called Ponape, is the Capital of the Federated States of Micronesia (FSM) and the largest Island in the four FSM States. It is also the second largest populated State in the FSM. Pohnpei Island is encircled by a series of inner-fringing reefs, deep lagoon waters and an outer reef. Pohnpei has two groups of outlying atolls which are made of corals. The eastern atolls consist of Pingelap and Mokiloa, and the southern atolls consist of Sapuwafik, Nukuoro, and Kapingamarangi . The Nukuoro and Kapingamarangi people are of Polynesian origins.

 

The main Island of Pohnpei is located at approximately 6 degrees 45 minutes north latitude and 158 degrees 15 minutes east longitude which is about 2,600 miles southwest of Japan, 2,200 lies east of the Philippines, 3,100 miles east of Hawaii, and 500 miles north of the equator.  The island of Pohnpei, the largest island in the FSM, is approximately 13 miles long with a land mass of 129 square miles. There are five municipalities of Pohnpei Island, plus the Kolonia Town, which is the Capitol City of Pohnpei State. They are: Madolenihmw, Kitti, U, Nett, and Sokehs. Majority of Kolonia Town residents are from the outer islands and from outside of Pohnpei State.   The total population of Pohnpei State is 35,981 (per Census in 2010), 39% on the outer islands while the rest is distributed throughout the five (5) municipalities and the Kolonia Town.  Of the outer islands of Pohnpei, to the south lies Kapingamarangi (410 miles from Pohnpei proper), Nukuoro (308 miles), Sapwuahfik (100 miles), Oroluk (190 miles), Pakin (28 miles), and Ant (21 miles). To the east lie the islands of Mwoakilloa (95 miles) and Pingelap (155 miles). These outer islands together comprise a land mass of approximately 133 square miles and 331 square miles of lagoons. Travel on the island of Pohnpei proper is increasingly easier to outlying communities with the completion of pavement of the road around the island. However, because of scattered housing along feeder unpaved dirt roads, there are still many residents who have difficulties in accessing health care, including MCH. The outer islands are the most difficult to reach because of the infrequent and undependable cargo ships. The regular field trip on the ship takes place once a month to each of the outer islands.  The population of Pohnpei is 35,981 residents. Based on the annual population growth rate, the population is projected to reach 41,033 by the year 2025. About half (46.7%) of the population (16,832 persons) are less than 20 years of age with the median age of 21.8 years. There are 8,250 women of child-bearing age between 15-44 years comprising 46.4% of the female population. 

 

Yap State

From farther east to west, the FSM states are Kosrae, Pohnpei, Chuuk, and Yap State. Yap State or Wa’ab, formerly known as Yap District, was one of the six former districts of the former Trust Territory of the Pacific Islands (TTPI), which was administered by the United States of America under the trusteeship of the United Nations after World War II. It is located midway between Guam and Palau. Yap Proper is comprised of four high, volcanic islands--Yap, Gagil, Tomil, and Rumung. Among these islands, there are 22 inhabited ones, including Ulithi, Woleai and Satawal, whose population speaks three different languages, other than the Yap proper main language. Two-thirds of its estimated population of 11,377 residents (2010 Census population) lives on Yap Island. The rest are scattered throughout the Outer islands.

 

The town of Colonia on Yap proper is the capital. Yap has a total of 78 outer islands stretching nearly 600 miles east of Yap Proper Island of which 22 islands are inhabited. Although these islands encompass approximately 500,000 square miles of area in the Western Caroline Island chain, Yap state consists of only 45.8 square miles of land area. Most of the outer islands are coral atolls and are sparsely populated. Transportation on Yap Proper is easier because of the development of paved roads; however, there are clusters of villages that are still inaccessible to health and MCH services because of unpaved dirt roads. The outer islands are also difficult to reach because of infrequent cargo ships. The regular ship field trip is once a month to each of the outer islands bringing supplies and health personnel to deliver goods and services.  The population distribution are: Yap Proper with 64.7% (7,371 persons); Ulithi Lagoon has four inhabited islands (Asor, Falealop, Fatharai, Mogmog) with a population of 847 residents (7%); Wolaei is comprised of two lagoons (the West Lagoon and the East Lagoon) with five of the 22 islands inhabited with a population of 1,039 persons (9%); Fais, population 294; Eauripik, population 114; Satawal, population 501; Faraulep, population 193; Ifalik, population 578; Elato, population 105; Ngulu, population 6; and Lamotrek, population 329. The median age for Yap is 25.1 years; the highest median age among the four states. Approximately 42.7% are under 20 years of age (4,864 persons). There are 2,545 women between 15-44 years, which is 44% of the total female population.

 

National Demographics

Although the FSM population size in 2010 census was estimated at 102,843 persons residing in 16,767 households, the current FSM population size depicted in the FSM 2013-2014 HIES was estimated at 103,382 compared to 102,843 in 2010, indicating a population increase of 0.5% representing about 539 more people. The average household size remains about the same with 6.1 persons per household in 2010 and 6.2 in 2013.

 

According to the FSM Statistics 2010 Housing Characteristics Report, it was stated that similar to the population statistics, the housing and household information is derived from the regularly conducted Population and Housing Census in the country and its states.

 

The projected census data from 2016 to 2020 was shown below in Table 2. 

 

Projected Population by State (2016-2020)
State	2016	2017	2018	2019	2020
	Total	Total	Total	Total	Total
FSM	102,453	102,622	102,797	102,980	103,169
Chuuk	46,688	46,503	46,322	46,145	45,973
Kosrae	6,227	6,181	6,135	6,090	6,047
Pohnpei	37,893	38,236	38,583	38,932	39,282
Yap	11,645	11,701	11,758	11,813	11,867

Source: FSM Statistics Office

 

According to World Bank, the FSM’s latest demographic in 2018 is depicted below:

 

 

 

Population growth. +0.3%. 2018 · GDP per capita (USD). 3,154. 2016. Key Reports. Federated States of Micronesia- Sources Include: World Bank

 

System of Care Population Served

The 2019 FSM population projection estimates showed that there were 22,642 women of reproductive age (defined as women 15-44 years old). It was reported that about 21% of the women of reproductive age had received direct services from the MCH programs in 2019.

 

 

2019 FSM Census POPULATION ESTIMATES
Sex/Age	Total	Male	Female
Total	102,980	52,243	50,737
0 to 4	10,734	5,557	5,178
5 to 9	11,308	5,822	5,486
10 to 14	11,324	5,767	5,557
15 to 19	11,326	5,828	5,498
20 to 24	10,840	5,596	5,244
25 to 29	8,658	4,556	4,102
30 to 34	6,012	3,156	2,856
35 to 39	5,110	2,530	2,580
40 to 44	4,804	2,442	2,362
45 to 49	4,704	2,242	2,462
50 to 54	4,644	2,227	2,417
55 to 59	4,366	2,179	2,187
60 to 64	3,760	1,828	1,932
65+	5,391	2,514	2,877
Sources: FSM Census Population Projection

 

The number of infants (less than one year old) in the 2019 FSM population projection was 2,156. The 2019 population estimates show that there were 19,886 children 1- 9 years of age. There were 22,650 children 10-19 years of age in the FSM. The MCH programs served 46,502 of these groups (0-19 years old) including the CSHCN population.

 

Government

One of the strengths that impact the health status of the FSM MCH population is the existing governmental structure.  Although the FSM National Constitution holds the four FSM states together, each of the four states has its own state Constitution. Each of them replicates that of the national government with three branches of separate powers. Each of the FSM states has considerable autonomy and each one of them is equally unique in its own geography, ecology, language and cultures. Each state has unique cultural characteristics which are as important as the others. One of the known challenges that the four MCH programs encountered is the cultural diversity which in itself is challenging and typified by the existence of eight major indigenous languages (Chuukese, Kosraen, Pohnpeian, Yapese, Ulithian, Woleaian, Kapingamarangi and Nukuoro). However, with the existence of English language as the official language throughout the islands in the governments, schools, and commercial businesses, it lessens the burden of not understanding one another when languages become the barrier.

 

The President and the Vice President of the Federated States of Micronesia are the highest Chief Executives of the FSM. They are elected from among fourteen members of the National Legislative branch, which is the national Congress. Four of them represent each of the four states for four-year terms, and the other ten members apportioned based on the population. They only serve their terms for two years. Currently, Chuuk has six seats in the Congress, Pohnpei has four, and the remaining four are two seats for Yap and two seats for Kosrae. All members of the Congress get elected by their respective state eligible, registered voters.

 

The four states are united and regulated under the FSM National Constitution. The Constitution provides separation of power of the three branches of government, the Executive, Legislative and Judiciary. Unlike the USA, most of the government functions are carried out at the state levels, except foreign policy and national defense are carried out at the national level.

 

Each state governments under their constitutions are structurally similar mimicking the national government, all utilizing three co-equal branches of government, the executive, legislative and judicial.  Each of the state constitutions contain provisions recognizing and preserving local custom and tradition.

 

 

People, Cultures, and Religion

People from the FSM are classified as people from Micronesia (The Micronesia region encompasses  five sovereign, independent nations—the Federated States of Micronesia, Palau, Kiribati, the Marshall Islands and Nauru—as well as three U.S. territories in the northern part: Northern Mariana Islands, Guam and Wake Island) according to Wikepedia.org.  Traditionally, like the rest of the Micronesians the FSM people rely on fishing and farming for subsistence. Skills such as woodcarving, traditional canoe and cottage constructions, fine weaving from hibiscus and coconut palms are regularly practiced and carried on as part of their traditional culture. The older people teach and pass them down to the younger generation.

Christianity is the predominant religion in the FSM, divided between Roman Catholic (50%) and Protestant (47%).  Churches of many denominations can be found throughout the islands. Other churches (3%) include Latter-Day Saints, Seventh-Day Adventist, Assembly of God, Jehovah's Witnesses, and the Baha'i Faith. In 2015, a Muslim society, the Ahmadiyya Muslims was registered in the country (Kosrae State) despite stiff opposition from the locals.

 

The people of the FSM are generally known as friendly people. They have a relaxed island lifestyle which very common among the island people. They have their own culture for particular ethnic group, and religion plays a major role in the culture. For example, Sundays in Kosrae, is a

day of worship and for rest. Almost all stores and shops are closed on Sundays. Drinking alcohol on a Sunday is prohibited.

 

Culturally, there are important aspects to FSM culture that give context to the development of an effective FSM prevention infrastructure.  Islanders have not completely understood the concept of medical confidentiality and many people are reluctant to be seen and examined by the physician, nurse or health aide.  Because of this reluctance and lack of understanding of preventive measures, people seek medical care only when conditions are too serious to be ignored any longer, and sometimes that is too late. Micronesians often believe that illnesses and other diseases are brought upon a person by gods and/or ancestors for various reasons (such as punishment for certain members of the family or clan who have offended the gods or ancestors), and illnesses are thought to be remedied only by reconciliation of the gods, families or individuals.

 

Language

The cultural diversity is challenging and typified by the existence of eight major indigenous (Chuukese, Kosraen, Pohnpeian, Yapese, Ulithian, Woleaian, Kapingamarangi and Nukuoro) languages in the FSM. However, with the existence of English language as the official language throughout the islands, in the governments, schools, and commercial businesses, it lessens the burden of not understanding one another when languages become the barrier. English is taught in the schools throughout the Islands in the FSM. Several older people speak Japanese, the language they learned during the Japanese Administration before the World War II. English is the official and common language.  Beside it the following Austronesian languages are being spoken in the FSM: Chuukese, Pohnpeian, Kosraen, Yapese, Mortlockese, Ulithian, Satawalese, Kapingamarangi, Nukouro, Woleain, Pwuluat, Ngatikese, Mwoakilese and Pingilapese.

 

Economy

Since the inception of the FSM independent government, the government has become the main employer of the Island.  Like today, the public sector continues to depend greatly upon the assistance provided to FSM under the Compact of Free Association Agreement, other federal grants and foreign grants. Majority of the people in the FSM earning an income are employed by either the State government or the FSM National government. The private sector relies on the moms and pops retail stores, restaurants, and hotels, and farming and fishing.

In the recent FSM 2013-2014 Household Income and Expenditure Survey (HIES) report, it stated that in all four FSM states, wage and salary income make the most significant contribution to total HH income. There is a large degree of difference in household (HH) income in Chuuk when compared with the three other states of the Federated States of Micronesia (FSM). Average annual HH income in Chuuk is US$8,415 while it is around US$15,500 in other states. Kosrae has a high proportion of income in the form of cash (94%), while in all other states, cash makes up around 80% of total HH income. The large majority of the remaining income is subsistence – the value of items that are home-produced and consumed by the HH. The distribution of income for all states diverts significantly from equality, showing that there is a significant degree of income inequality in FSM.

 

  

https://fsm-data.sprep.org/dataset/federated-states-micronesia-2013-14-hies-states income/resource/

 

According to the Poverty Profile of FSM, 2013, about 10% of the people in FSM spend below what is needed to secure a minimal health diet. When both food and nonfoods are considered, 41.2% of the population live below the total poverty line. The poverty gap index, which indicates the extent to which average adult equivalent expenditures fall short of the poverty lines, is estimated at 3.6% at the food poverty line and 15.1% at the total poverty line.  Generally, poverty is most severe in Chuuk: With more than 16% living below the food poverty line, Chuuk primarily drives FSM’s overall food poverty rate.  No Kosrae household lives below the food poverty line, and food poverty in Yap and Pohnpei are 10% and 2.6% respectively. The fact that poverty is relatively higher in Chuuk even when the poverty line is the lowest there implies that incomes are lower in Chuuk than elsewhere.

 

FSM is not eligible for US Medicare and Medicaid Programs.  It is also significant that in the FSM, there are no cash‑supplemented welfare programs except the FSM Social Security Benefit program.  Therefore, services provided by the MCH programs are free to the public. 

 

 

Transportation

Nowadays people on the islands rely on vehicle transportation to go from one village to another and the only 2 national ships that provide services among the main islands and the outer islands. Shipping services to and from the four FSM States are provided by outside shipping companies like Kyowa Line from Japan, Mariana Express Lines Pte. Ltd. from Singapore and etc. Currently, the United Airline is the only commercial airline that provides flight services to and from United States of America to the four islands States via island hopper en route Guam once a week. Transportation within and between states significantly impacts the quality and coordination of health care, including MCH program services. Yap is additionally serviced by Pacific Missionary Aviation (PMA), which makes regularly scheduled trips from Yap to Ulithi and Woleai atolls.  With the exception of Ulithi and Woleai Atolls, no other outer islands in Yap receive air transportation. Caroline Islands Air (CIA) services Pingelap, Mokil and Sapwuafik, three of the outer islands of Pohnpei, twice a week and to Ta Atoll, in the Mortlocks Chuuk, once in two weeks, is currently immobilized due to the Covid-19 Pandemic.  Major field trip ships to the outer islands are operated by the National Transportation Department and field trip schedules are shared with the States government., Smaller inter-island ships on which health service field teams make intermittent trips are operated by local state government or private companies.  In cases of medical emergencies, these ships and/or the PMA and CPA airlines evacuate patients.  Transportation provided by airplane, small private motor boats or canoes, is very expensive domestically within the FSM four States or within individual lagoons.

 

Healthcare System

The FSM National Government Department of Health and Social Affairs provides advice and support to the FSM states. Each state has its own health services department. There is only one hospital in each State and several private clinics in two States. They also have a few community health centers that are serving the community people in the villages. The health centers are more accessible to the community people than the hospital. The hospital in each state serves more as a last resort for the sick people to seek for health care if the community centers do not have what they need. Very few doctors are available at the community clinics to assist the regular or daily

health assistant. Not all the centers have adequate medical supplies and equipment. However, most people on the islands prefer to visit the health centers because they are closer to their homes, and they have affordable medicines.

 

Title V programs are a key entry point into the health care system. For young and low-income women who are more likely to utilize Title V/MCH program clinics as their main source of medical care. The Title V services provided through the FSM MCH program clinics are a vital source of care for the many uninsured individuals in the four FSM States. Nationally, more women who utilize MCH program services consider it their usual source of care, a number that is even higher for women in poverty, with no public insurance or no insurance at all.  The importance of Title V clinics’ roles in helping manage women’s health care needs above and beyond reproductive health, and as an entry point into the health care system cannot be overstated, especially given the shortage of primary care providers throughout FSM. The Public Health and MCH program clinics serve as FSM’s main provider of primary care for low-income women, children and families providing preventive medical visits, prenatal care, well-baby and well-child care, routine immunizations, and developmental screening at no cost, across generations for most families.

 

There are five (5) Department of Health Services in the FSM; one at the national level and four at the State levels.  All of the departments of Health services in the four States do serve the population domains under the MCH program. Mostly, the Public Health is in charge of the primary care programs to such population domains.  The Health services are provided by the State Department of Health Services and other health programs; both primary and secondary health system of cares are made available through the State hospital only. Patients with complications or those requiring tertiary cares are referred off-island to Guam, Philippines or Honolulu, depending on availability of funds provided by either the State governments or Micare Health Insurance.  

 

General Health

The highlights of the 2018 FSM BRFSS Comprehensive Report include the general overview of the general health and health-care accessibility among the adult respondents, prevalence of chronic diseases, and their health-risk behaviors. Among the 2,712 survey respondents, 71.3% of respondents said they did not have health-care coverage. Of the total, 70.3 % of the males did not have health-care coverage and 72.3% females lacked health-care coverage. In total, 5.3% of FSM respondents rated themselves to be in poor health. The data showed that female respondents are more likely to have poor health than male respondents. High ratings for one’s poor health were most common among individuals in the oldest age groups. More than 90% of the survey population reported that they have fair to excellent health.  One out of ten individual respondents mentioned that they had 14 or more mentally unhealthy days during the previous 30 days.

 

The most-common chronic disease in the FSM was high cholesterol, hypertension, arthritis, asthma and diabetes. Those who reported ever having high cholesterol was among female

respondents (45.7%); males reported ever had high cholesterol (37.1%). The highest prevalence of high cholesterol was shown among FSM respondents aged 55 to-64 years old (61.2%). Overall, (37.8%) in the survey population are obese. There was a significant gender difference in obesity. A higher percentage of females (44.5%) reported being obese than males (32.9%).  About one-third of the study population (32.2%) was overweight. The percentage of overweight in males (33%) is slightly higher than overweight in females (31.1%).

 

The prevalence of current daily tobacco smokers was 13.3 % and less than daily tobacco smokers was 8.6%, significantly higher in the male survey population. The highest percentage of current daily smokers was in the age groups 45-54 years old, while current less than daily smokers was in the earliest age groups 18-24 years old.

 

Integration and Financing of Services

 

Youth Suicide and Youth Mental Health in the FSM

There have been some assumptions that culture may contribute to suicidal behaviors but there is a lack of research in terms of suicide across the different cultures. The development of necessary evidence-based interventions for the prevention of suicide has been affected due to this lack of research.

 

According to current FSM Behavioral Health & Wellness program Psychiatrist, Dr. Victor Wasson, he said "I feel that more of this much needed research is to be done in order to ensure that we establish prevention/intervention strategies that are culturally orientated/sensitive". He has stated that mental illness may have not been an important factor in Micronesian suicides but this can be debated (due to the lack of expertise for identification/diagnosis during that time, lack of awareness/under-reporting along with the stigma that accompanies them and the cultural explanations of certain symptomatology with traditional management if any). Among the victims who were actually diagnosed with a mental illness (10%), the common illness was schizophrenia. Alcohol was blamed as a contributing factor towards suicide method motivation or method. It was stated that 41%- 68% were intoxicated/drinking at the time of completed or attempted suicide.

 

 The most common methods used in Micronesia among men (86%) and women (69%) is by self strangulation/asphyxiation or in other words hanging. There may have been a cultural patterning of this particular method having not been influenced by models of a foreign kind.

 

 

Following were major reasons for committing suicide in the FSM:

1. Alterations in the family relationships and structures following the colonization periods and moving on into a new era where change is inevitable.
2. A reduction in dependence on subsistence production and more reliance on cash economy may have affected the importance of clan activities and lineage.
3. Undermining of the social supports structures for adolescents caused by unaccustomed reliance on the nuclear family leading to a rise in parent-adolescent conflicts
4. Suicide has somewhat been accepted/expected (to some extent) and become more familiar among youths in the resolution of conflicts/social problems faced in society.
5. The Micronesian belief system that pertains to communication in spirit may also be another factor for influence from one suicide to another.
6. Despite the findings that suicides were a result of impulsive behavior, there is a trend involving long term intolerable situations and the preference to withdraw and handle matters indirectly rather than confrontation.

 

According to the 2018 FSM BRFSS National Report, more than 10% individuals reported that they had more than 14 mentally unhealthy days. There was gender similarity when reported ever had more than 14 mentally unhealthy days each month.

 

Financial Management

The FSM Title V Program is managed by the FSM National Government, Department of Health and Social Affairs (DHSA), which is located at Palikir on the island of Pohnpei.  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 programs employ all clinical and non-clinical staffs 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 of the preventive and primary health care services at no cost to the clients. 

 

Emergency Preparedness

There is a National Disaster Response Plan established in 2016 for the FSM which is called “Federated States of Micronesia National Disaster Response Plan 2016”.  This plan provides for the establishment of national institutional arrangements for the Federated States of Micronesia (FSM) government for responding to emergency and disaster events within the country. It includes arrangements for preparedness, monitoring for potential events and response at the national level to manage national level events and support state level events. It also outlines arrangements to guide state disaster response plans and their connection to the national level arrangements. It includes provisions for accessing international support.

 

FSM has been the recipient of two cooperative agreements: Public Health Emergency Preparedness (PHEP) and Hospital Preparedness Program (HPP). The main functions of these cooperative agreements are preparedness and response planning.

 

When Zika virus was reported in the state of Kosrae, one of four states within the Federated States of Micronesia (FSM), the territory responded with a PHEP-funded mosquito control and elimination campaign. Campaign activities included an island-wide mosquito survey, communication efforts such as travel advisory brochures, radio programs, and posters, and mosquito spraying at the homes of all reported cases.

 

HPP Capabilities are:

Capability 1: Foundation for Health Care and Medical Readiness

Capability 2: Health Care and Medical Response Coordination

Capability 3: Continuity of Health Care Service Delivery Goal of Capability

Capability 4: Medical Surge

 

FSM's SITUATION in COVID-19, PREPAREDNESS AND RESPONSE

As of August 4, 2020, there is still no confirmed case of COVID-19 in the Federated States of Micronesia. All countries of the world including the FSM, have benefited from the many guidance documents and recommendations for COVID-19 issued by the WHO, US HHS and US CDC.  However, the FSM has found it necessary to adapt some of the guidance documents and recommendations from these health organizations in order to address our unique islands and cultural settings. The document is called for our own FSM National Guidelines for COVID-19.

 

Other Issues

The FSM, like many Pacific island countries and territories, face a triple burden including communicable disease, noncommunicable disease, and the health impacts of climate change. Adverse effects of climate change and highly vulnerable nature disaster are areas that the nation is still focusing on for the country and its partners. These natural disasters tore through the islands of the FSM causing fatalities, damaging houses, crops, and public infrastructure, and causing millions of dollars in damage.

 

As usual, other barriers and challenges that all the MCH programs in the four FSM States do encountered are shared and exist in the MCH population domain.  Demographic Setting of the islands is always a challenge, and it has been a major barrier in the healthcare services delivery to the in-need population.  Transportation issues either by land or air is very expensive and most families could not afford in the long run.  Data collection from hard to reach areas and the Outer Islands is an ongoing issue that the MCH programs are still tackling.  All of these existing issues in the MCH programs had been discussed and deliberated upon for better solutions.