Federated States of Micronesia PIHOA November 2011 Honolulu, Hawaii, USA

COUNTRY DEMOGRAPHIC PROFILE (SNAP SHOT OF FSM) Federation of Four Island StatesKOSRAE/POHNPEI/CHUUK/YAP Number of Islands607 Islands (65 Inhabited Islands) Land Area710 Sq. Km ( 271 Sq. Miles of Land Mass) Population (2010 Census)102,843 (2010 Census) Life Expectancy70 years Crude Birth Rate19/1000 (FSM DHSA/HIS 2010) Crude Death Rate4/1000 (FSM DHSA/HIS 2010) Infant Mortality Rate10.2/1000 (FSM HIS Hospitals’ Reported)

HEALTH SYSTEM FRAMEWORK – FSM SDP National Level (FSM National Government, Department of Health and Social Affairs) Mandates:  Policy Direction (national health and social affairs)  Program Management/Coordination (national programs and donors’ projects)  Monitoring of programs’ activities and funds utilization  Technical Assistance  Repository of national data (health vital statistics and programs’ data for reporting purposes)  Collaboration with regional and international organizations supporting state and community health programs. State Level (State Department of Health Services – Hospital and Public Health):  Implementation of day-to-day direct medical and preventive health services  Patient Referral (OI and Abroad)  State policy on health  Data Collection/Reporting Municipal Level (Primary Health Care and Dispensary Services) Community:  Primary Health Care (PH and Dispensary services)  Data Collection/Reporting  Municipal charters on community health

PROFILE OF PUBLIC (GOVERNMENT) HEALTH FACILITIES: FSM 2011 Facility Type FSM TotalChuukKosraePohnpeiYap Gov’t Owned Hospital41111 Licensed Beds Operating Beds Community Health Centers Dispensaries Dental Clinics41111 Aid Posts6-5-1

PROFILE OF PRIVATE HEALTH FACILITIES: FSM 2011 Facility Type FSM TotalChuukKosraePohnpeiYap Private Health Facilities Hospitals1--1- Licensed Beds Operating Beds Private Health Clinics Private Pharmacies Private Dental Clinics 2--2-

Profile of the Four State DHS: FSM 2011 DescriptionPohnpeiChuukYapKosraeFSM Department or Section Operation/Surgery; Medicine; Dental; Obstetrics/Gynecolog y; Pediatrics; Emergency; Hemodialysis; Radiology; Laboratory; Physical Therapy; Medical Supply; Public Health Operation/Surgery; Medicine; Dental; Obstetrics/Gynecolog y; Pediatrics; Radiology; Emergency; Laboratory; Medical Supply; Public Health Operation/Surger y; Medicine; OB/GYN; Pediatric; Radiology; Emergency; Laboratory; Pharmacy; Public Health and Mobile Clinic; Operation/Surgery; Medicine (OPD/Inpat); OB/Gyn; Radiology; ER; Dental; Pharmacy; Laboratory; PH and Mobile Clinic Program Management, Coordination, Monitoring and Evaluation; TA Policy Development No. of Doctors No. of Dentists No. of Graduate Nurses No. of Pharmacy Technicians No. of X-Ray Techs No. Lab. Techs No. of Med. Supply Techs No. of Patients120/day210/day60/day50/day110/day No. of X-Ray20-33/day50/day18/day-26/day No. of Lab. Works 250/day50/day30/day35/day80/day

PROFILE OF HEALTH WORKFORCE (SNAP SHOT OF THE FSM HEALTH WORKFORCE: FSM 2011) INDICATORSNUMBERRATIO/100,000 POPULATION DOCTORS631:1,632 DENTISTS151:6,856 NURSES AND MIDWIVES2491:413 OTHER NURSING/AUXILIARY STAFF 861:1,196 OTHER PARA-MEDICAL STAFF2821:365 OTHER HEALTH PERSONNEL1831:562 PHARMACY TECHNICIANS131:7,911 X-RAY TECHNICIANS151:,6,856 LAB. TECHNICIANS281:3,673

NCD Conditions As Leading Causes of Morbidity FSM 2010  Other Heart Diseases  Diabetes  Hypertension  Cancer  Kidney Diseases  Stroke  Chronic Obstructive Pulmonary Disease (COPD)  Gout

Leading NCD Conditions as UCOD – FSM 2010  Diabetes  Cancer  Myocardial Infraction  Cerebro-vascular Accident  Renal Failure  Hypertension  Chronic Obstructive Pulmonary Disease

FSMNG Response To NCDs NCD/Chronic Disease Unit (National and State)  Diabetes  Cancer  Tobacco Prevention and Control  Nutrition Action Plan (Advocating for “Go Local”)  Physical Activity (schools and work-place)  Small scheme through SPC for Local Farming and PA  Grant (WHO/SPC)  FSM Endorsement to the Regional Declaration on NCD by FSMNG Leadership (Have not nationally declared); Environment – supportive;  Need to collaborate with the four states for proper declaration (FSM NCD Meeting/Conference in Yap-12/2011)  Secure Political Commitment (Funding Support for sustainability)

What Already Implemented Law/Legislation (Tobacco and Substance Abuse)  Clean indoor Law in all public places - all states  No Sale to Minors Law – all states  No Promotion, Advertisement and Sponsorship Law – all states, except Kosrae  No sale of Single Stick Law – Only in Kosrae  Importation Tax Law on Tobacco Products – at National  No Betel Nut Chew by Minors – Kosrae State  Community Smoke Free Nahs – only in Enpein Powe, Kitti, Pohnpei  Sin Tax - All States Bill  Packaging and Labelling Bill- at FSM National  Ban Tobacco Importation Bill – Chuuk State Policy  Second Hand Smoke Policy in all government buildings/office space rentals and government vehicles  No Soda Drinks/Drinking in Church Activities (receptions/parties)- KKCC Faith Group MOA  Healthy food sections at selected food establishments Draft Policy  FSM Nutrition and Physical Policy for schools  Guidelines for food served during government hosted workshops, meetings, summit, etc. Executive Directive  Two-hour Physical Activity /Exercise – Kosrae State  On Going Actvities Sponsored PA (Fun Wallk/Run Land Grant Agriculture and Nutrition Programs

……What Already In-placed and Needing Review  Chuuk NCD Strategic Plan  Pohnpei NCD Strategic Plan –  FSM National NCD Strategy – Need Review by 12/ Yap  Salt Reduction Program (New)  Kosrae and Yap need to develop their NCD Strategic Plan

Objectives for the Next Two-Year  Review Draft FSM NCD Strategy  National Declaration of PIHOA NCD State of Emergency  Endorsement of FSM National Nutrition and Physical Activity Policy  Endorsement of National Guidelines for food served during government hosted workshops, meetings, summit, etc.  Review and amend existing NCD policies  Fine Tuning the Salt Reduction Program (New Program)  Improving Data Management (NCD Data)  Hiring of a Pathologist

Practices and Successes – Implementing NCD Policy Clean Indoor Law – through collaboration between governments (national and state) and private sectors; Involvement of stakeholders in the process

Lessons Learned - Challenges  Political Commitment and Support (Funding)  Conflict of Interest (Policy Makers are business owners)  Identifying Champions (devising policies/legislations)  Gathering evidenced-based data supporting legislations

Supports Needed for NCD Policy, FSM Technical Assistance  Policy Review/Development  HIS – SWAT Analysis (Linking of various data registries for an Integrated HIS)  HRH – Drafting of HRH Plan - Planning  QA/QI Training (on-site) for:  community change agents  ICS System Funding Opportunities (for Sustainability)

Thank You