South Dakota is the 16th largest state in terms of land area within the United States with more than 75,000 square miles (U.S. Census) in its territory. It lies in the Upper Midwest and is divided into east and west by the Missouri River. South Dakota is home to approximately 882,235 residents who live in a rural and frontier landscape. South Dakota averages 10.7 persons per square mile. There are nine federally recognized Indian tribes within the South Dakota borders, and 9% of the state’s total population is Native American. 84.9% of the population is Caucasian with other racial groups including Black, Hispanic and Asian comprising 6.1% (U.S. Census Bureau, 2016). The State is comprised of 66 counties, ranging in population from 928 residents to 192,876 residents. Only nine of the 66 South Dakota counties have more than 20,000 residents. The remaining counties are either rural (23 counties) or frontier (34 counties); 26% of the State’s population lives in a frontier county.
According to 2018 population estimates from the US Census Bureau, 24.7% of the state’s population are children (under the age of 18) while 7.1% are age 4 or younger. Roughly 37% of the state’s female population is considered to be of childbearing age (age 15 through 44). In 2017, there were 12,032 resident births, and 12,551 estimated pregnancies.
According to the latest 2013-2017 U.S. Census, the median household income in South Dakota is $54,126. The percentage of persons at poverty level is approximately 13%. The 10 poorest counties are either part of or adjacent to one of nine AI reservations, with poverty levels from 22.3%-48.6%. Overall, 10.7% of South Dakotans were uninsured.
About two-thirds of the state is designated by the federal government as a Health Professional Shortage Area (HPSA). As of June 4, 2019, there were 4,442 physicians and 654 physician assistants licensed in the state. In addition, there were 1,140 actively licensed nurse practitioners and 34 actively licensed nurse midwives in South Dakota.
Another factor to consider is transportation to access services. For some, this means traveling great distances (over 50 miles) to see a primary care provider and even further to see a specialist. The majority of specialists and two children's hospitals are located on the eastern side of the state. This adds additional travel and expense for families of children in the central and western regions of the state. On Indian reservations, this problem is further complicated by the lack of a reliable transportation system.
South Dakota has 49 general community hospitals, of which 38 are critical access hospitals. There are five federally qualified health centers with 32 delivery sites and 60 rural health clinics. There are five Indian Health Services (IHS) hospitals in South Dakota, of which only two provide routine obstetrical services.
South Dakota's healthcare industry is projected to be among the largest growth industries from 2012-2022. The industry is projected to add 7,305 workers to SD's economy (from a level of 52,875 in 2012 to a level of 60,180 in 2022). The rate of growth is projected to be 13.8 percent, nearly double the 7.0 percent growth projected in total employment for all industries.
Between 2016-17 and a new peak projected for 2024-25, the number of high school graduates in South Dakota could rise by almost 1,700 - about 20%. The 65 and older population will increase by 95% between 2015 and 2035. As a percent of total population, ages 65 and over will increase from 14% in 2010 to 23% in 2035.
This means that as our baby boomers retire and leave the healthcare workforce, they are subsequently aging, requiring additional healthcare services. A focus has been placed on high school graduates who can replace the retirees in the workforce and continue to provide quality healthcare services across the state.
The South Dakota Departments of Education, Health, and Labor and Regulation, and the South Dakota Board of Regents have created a program to address this critical need for healthcare workers in the state. Health Occupations for Today and Tomorrow (HOTT) focuses on health career information and opportunities for South Dakota students at all grade levels.
The MCH program continues to identify potential strategies to address challenges such as the disparities within our Native American population; successfully marketing program services to reach all eligible populations; recruiting and retaining adequately trained/prepared individuals for workforce, especially in remote counties and reservation communities; appropriately working with cultural differences and beliefs; impact of social media, both good and bad; and access to dental and mental health services. South Dakota is also seeing new geographical pockets of culturally diverse populations in areas with very limited resources.
Steps in the right direction:
The DOH remains committed to fostering relationships with both IHS staff and statewide tribal government/tribal health to discuss MCH services on South Dakota Indian reservations.
In addition, the DOH also remains committed to providing comprehensive public health services to underserved populations and communities throughout the state which includes over 54 Hutterite colonies as well as the refugee resettlement of the Burmese Karen populations in the Huron and Aberdeen areas. A wide array of public health services are provided to these communities which includes interpreter services, direct services, and outreach services provided by WIC, Title X Family Planning, and Nurse Home Visiting program. Furthermore, the SD MCH program is able to provide additional services including: infant safe sleep education; health and safety information; immunizations; growth and development screenings; case management for high risk pregnancy; postpartum care and prenatal education; and support services for families with children and youth with special health care needs.
The South Dakota Department of Social Services contracts with Delta Dental of South Dakota to administer the SD Medicaid dental benefit. In addition to managing the daily operations of the SD Medicaid dental benefit, Delta Dental of South Dakota recently implemented Dental Care Coordination in an effort to assist recipients with overcoming barriers in oral health through education and advocacy. Dental Care Coordinators located in Sioux Falls and Rapid City work closely with SD Medicaid recipients, their parents/caregivers, dental providers, medical providers, community agencies, and other stakeholders. Among the many goals of Dental Care Coordination are the goals to increase the rate of Medicaid recipients who have a dental home and to increase the rate of Medicaid recipients who receive a preventive service.
In January 2016, the DOH released its 2015-2020 Strategic Plan. The strategic plan provides a road map for the future of the DOH and helps staff work together as a department to achieve meaningful outcomes. The plan is not designed to be a compilation of all DOH programs and services but instead helps the DOH identify new things to be accomplished as well as reflect key strategic initiatives the DOH is doing today and will continue in the future. The DOH strategic planning workgroup included both central and field office staff and both administrators and program staff. An internal SWOT analysis was sent to all DOH employees to get input regarding strengths, weaknesses, opportunities, and threats of the department. In addition, an external SWOT was sent to partners (i.e., healthcare providers, health organizations/ associations, legislators, IHS/tribal representatives, medical/nursing schools, philanthropic foundations, other state agencies) to get input regarding the strengths, weaknesses, opportunities, and threats of South Dakota’s public health system.
The strategic plan consists of the DOH vision (Healthy People, Healthy Communities, Healthy South Dakota), mission (to promote, protect and improve the health of every South Dakotan) and guiding principles (serve with integrity and respect, eliminate health disparities, demonstrate leadership and accountability, focus on prevention and outcomes, leverage partnerships, and promote innovation). The strategic plan was updated in January 2017 and includes the following goals and objectives:
Goal 1 – Improve the quality, accessibility, and effective use of healthcare
A. Promote the right care at the right time in the right setting
B. Sustain healthcare services across South Dakota
C. Provide effective oversight and assistance to assure quality healthcare facilities, professionals, and services
Goal 2 – Support life-long health for South Dakotans
A. Reduce infant mortality and improve the health of infants, children, and adolescents
B. Increase prevention activities to reduce injuries
C. Prevent and reduce the burden of chronic disease
Goal 3 – Prepare for, respond to, and prevent public health threats
A. Prevent and control infectious disease
B. Build and maintain State Public Health Laboratory capacity and ensure a culture of biosafety
C. Identify the top hazardous environmental conditions in South Dakota that negatively impact human health
D. Strengthen South Dakota’s response to current and emerging public health threats
E. Prevent injury and illness through effective education and regulation
Goal 4 – Develop and strengthen strategic partnerships to improve public health
A. Reduce completed and attempted suicides through statewide and local efforts
B. Reduce the health impact of substance abuse and mental health disorders
C. Reduce health disparities of at-risk populations through innovative and collaborative efforts
Goal 5 – Maximize the effectiveness and strengthen the infrastructure of the Department of Health
A. Increase effective communication
B. Promote a culture of organizational excellence
C. Leverage resources to accomplish the Department of Health’s mission
Each objective has key strategies to help guide DOH activities. There are also 32 key performance indicators that will be tracked to allow the DOH to monitor progress towards these goals. More information about the plan can be found at http://doh.sd.gov/strategicplan/.
In May 2011, former Governor Daugaard appointed a Task Force on Infant Mortality to study the state’s infant mortality rate and how to reduce it. The recommendations and accompanying strategies of the Task Force were intended as a starting point for action by state government, health care providers, hospitals, tribes, parents, communities, and others to reduce infant mortality and improve infant health in South Dakota. Initial recommendations that continue to drive the focus of current activities include: (1) improve access to early, comprehensive prenatal care; (2) promote awareness and implementation of safe sleep practices; (3) develop community-based systems of support for families; (4) conduct statewide education campaigns to reduce infant mortality; (5) develop resources for health professionals specific to infant mortality prevention; and (6) improve data collection and analysis. A copy of the Task Force final report from 2012 can be found at: http://doh.sd.gov/infant-mortality/.
The department continues to promote infant mortality prevention messaging through social media platforms and statewide media campaigns. Culturally appropriate messaging has been developed for outlets serving Native American populations. Key messaging has focused on early recognition of pregnancy, early and adequate prenatal care, infant safe sleep, and tobacco cessation. A recent campaign challenged grandparents to help families start new infant safe sleep traditions. Pregnant women are a priority population of the SD QuitLine for tobacco prevention/cessation. Recent campaigns included additional sessions for pregnant women and expanded services for postpartum women to provide support and incentives to quit and stay quit. Another partner, Medicaid, has also expanded services to pregnant women who were not previously eligible due to citizenship status.
The Department of Health has provided funding since 2012 for the Cribs for Kids program. Safe Sleep Kits are available through 77 public health offices across the state to families with limited resources. DOH partners with several Tribal communities to reach underserved populations and with the Teddy Bear Den, an incentive program serving the low-income population in South Dakota’s largest city.
Key to efforts has been improved data collection through the support of statewide infant death review and the funding of a statewide CDC PRAMS survey in 2017. The DOH supported a PRAMS-like survey in 2014 and again in 2016 to gather data to drive program strategies and measure outcomes. Data briefs and infographics will be developed and disseminated to partners on topics such as pregnant women and tobacco use, breastfeeding, prenatal care and infant death review. A recent ad was placed in the South Dakota Medicine Journal to increase provider awareness of the QuitLine services (tobacco cessation) being available to pregnant and postpartum women.
The Primary Care Task Force Oversight Committee was established in 2013 to monitor implementation of the recommendations of the 2012 Governor’s Primary Care Task Force. The original Task Force was appointed to consider and make recommendations to ensure accessibility to primary care for all South Dakotans, particularly in rural areas of the state, and developed recommendations around five specific areas: (1) capacity of healthcare educational programs; (2) quality rural health experiences; (3) recruitment and retention; (4) innovative primary care models; and (5) accountability and oversight. The 2017 Primary Care Task Force Oversight Committee Annual Report highlights activities and accomplishments over the past year.
Key Highlights:
- Family Medicine Residency Program Rural Training Track – The Primary Care Task Force Oversight Committee recommended development of a rural family medicine training track (RTT) in Pierre. The site is rural but with adequate facilities and volume to support resident learning. Geography was also a key component since national data shows that family physicians often practice within 100 miles of where they did residency. The RTT will have the capacity to train six medical residents (two per year) in an effort to address physician shortages.
- Frontier and Rural Medicine (FARM) Program – FARM is a rural training track program that provides third year medical students with a nine-month clinical training in a rural community with the ultimate goal of increasing the number of primary care physicians practicing in rural South Dakota. Vermillion, Pierre, and Spearfish hosted their first FARM students in 2017. The second cohort of FARM students graduated in May 2017 with four of the six students matching in primary care residency programs.
- Recruitment Programs – Improving access to rural health care is a key component of Governor Daugaard’s South Dakota Workforce Initiatives (SD WINS). Two key programs of SD WINS are the Rural Healthcare Facility Recruitment Assistance Program (RHFRAP) and the Recruitment Assistance Program (RAP). Both programs are designed to help small, rural communities (less than 10,000 population) that do not have as many resources as larger communities.
The DOH was awarded a Prescription Drug Overdose: Data-Driven Prevention Initiative planning grant from CDC to support/build efforts to track and understand the full impact of opioid use and abuse in South Dakota. There are two required strategies:
- Planning strategy – An Advisory Committee has been formed to conduct needs assessment of potential data sources, key stakeholders and gaps. Membership includes DOH, DSS, SD State Medical Association, SD Pharmacy Association, Board of Medical and Osteopathic Examiners, Board of Pharmacy, Attorney General Office, SD Association of Healthcare Organizations, IHS, tribal health, Volunteers of America (treatment/community support), and legislators.
- Data strategy – The DOH is working with partners to enhance and integrate current surveillance efforts for more accurate, timely data (i.e., death certificates, Prescription Drug Monitoring Program, hospital discharge data, Medicaid/ 3rd party payer data, Health Link (hub for data sharing)).
South Dakota Department of Health administrative rules require both the Tdap (Tetanus, Diphtheria, Pertussis) and MCV4 (Meningococcal ACYW) vaccines for 6th grade students. The requirement is a result of legislation passed in 2016 adding meningococcal infection to the list of diseases specified in South Dakota Codified Law 13-28-7.1 for which DOH can require vaccination for school entry in South Dakota. In the two school years since the passing of this legislation, 95% of South Dakota’s 6th grade students are up to date with their Tdap and MCV4 vaccinations.
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