1. Acknowledgements Executive Board Members
Associate and Affiliate Members
Palau Board Members & Partners
Guam Board Members & Partners
CNMI Board Members & Partners
FSM Board Members & Partners
RMI Board Members & Partners
American Samoa Board Members and Partners
Pacific Basin Dental Association Board
Pacific Basin Medical Association
Pacific Basin Mental Health Association
Pacific Islands Primary Care Association

2. Pacific Islands Health Organization Association Pacific Basin Primary Care Office
Angela Techur-Pedro, MO/PhD/PB-PCO Coordinator;
E. Chutaro, Director
Dr. G. Dever, Senior Advisor
A. Whitt, Guam Liason

3. Health Inequalities
There is a persistent widening gap in health equity between developed countries like the United States (US) and developing countries like the US- Affiliated Pacific Islands.
Analogously, significant health inequalities persist between the USAPI Flag Territories (American Samoa, Guam, and Northern Mariana Islands) and the Freely Associated States (Federated States of Micronesia, Marshall Islands, and Palau).

4. Health Inequalities
Health inequalities = inequalities in availability, access, and services.
In recognition of the health inequalities globally, in 1978, The Alma-Mata Conference put forth the “primary health care movement”
of health professionals, governments, and affiliations
to confront the “politically, socially, and economically unacceptable health inequalities across all countries” and
endorsed the primary health care (PHC) model as a critical key to “social justice and the right to better health for all for all countries”1.
1Primary health care: report of the International Conference o 1. n Primary Health Care, Alma-Ata, USSR, 6–12 September, 1978, jointly sponsored by the World Health Organization and the United Nations Children’s Fund. Geneva, World Health Organization, 1978 (Health for All Series No. 1).

5. Health Inequalities
Today, the World Health Organization (WHO)1 and the US Department of Health and Human Services (USDHHS) 2
continue to reaffirm the critical role primary health care model plays in improving access to health care;
to uphold “health as a fundamental human right” and “attainment of the highest possible level of health.” 3-4
USDHHS Health and Resources Administration (HRSA) through the Bureau of Health Workforce and Division of Policies and Shortage Designation and Bureau of Primary Health Care Administration
funds programs and community health centers to eliminate health inequalities and improve availability, access, and services in America
including its territories and the insular areas. 3-4
1. Primary Health Care, Alma-Ata, USSR, 6–12 September, 1978, jointly sponsored by the World Health Organization and the United Nations Children’s Fund. Geneva, World Health Organization, 1978 (Health for All Series No. 1).
2. U.S. Code Title 42: The Public Health and Welfare, CHAPTER 6A, SUBCHAPTER II, Part D: Primary Health Care.
3. Primary health care et al.,
4. U.S Code Title 42 et al.,

6. Health Inequalities
The US-Affiliated Pacific Islands (USAPI) leadership and the PIHOA Board also recognize the persistent health professional shortages, medical underservices, and poor access to primary care in the region.
In response, the PIHOA Board Resolution #43-11, endorsed & affirms the recognized critical role PHC plays in the attainment of health equality in the region.
Resolution #43-11 calls for the US federal government Health Center Program to fund a minimum of 6 community health centers (CHCs) in the US Pacific Island Jurisdictions in an effort to improve availability, services, and access to primary health care.
Result: HRSA funds more than 6 CHCs ( and satellite sites ~ 34) across the region and the PIHOA Primary Care Office (PCO).

7. Pacific Basin PCO Program
HRSA’s programs improve access to health care by
Strengthening the health care workforce,
Building healthy communities,
and Achieving health equity.
These programs provide health care to people like us who are
Geographically isolated,
Economically
or Medically vulnerable.5
5HRSA Data Warehouse at

8. Pacific Basin PCO Program
Background
This is the 9th year that PIHOA has served as the PCO for the region. We are entering the 4th year (4/1/2017) of our new 5-yr grant cycle.

9. Pacific Basin PCO Program
Mission
Facilitate Access to Primary Care Across the US-Pacific (Region & Jurisdictions)

10. Pacific Basin PCO Program
Generally, the State PCO program has 3 core deliverables:
Conduct Statewide Primary Care Needs Assessment;
TA for HPSA/MUA Designations; and
TA for NHSC site certification/recertification for NHSC provider recruitment, placement, and retention

11. Goal 1: SPCNA--UPDATE
57th Board Meeting – endorsed a template for SPCNA across the region
Between 5/2014 and 9/2016  SPCNA Data Book (Draft version)
SPCNA Teams
CNMI—CEO Muna, Dr. Kohen, C. Strong, R. Gibbons, and CHC V. Castro;
Palau—Dr. C. Decherong, Dr. A. Marcil, Dr. S. Wally, Dr. D. Ngemaes, S. Kyota, S. Garcia
Yap—Director M. Reinhardt; Dr. E. Lirow, Dr. A. Akapito, ED J. Gilmatam, D. Gilmatam, P. Falan
Guam—Pres. Gillan, L. DeNorcey, Dr. Kaneshiro, Medicaid Staff, HPLO, Dr. Taitano; Dr. Sheik
Chuuk—Dr. B. Buliche, Dr. D. Fred, Dr. A. Yomai,
Pohnpei—Dr. J. Hedson; P. Moses, Dr. J. Saimon
Kosrae—Dr. T. Alik
Marshall Islands—G. Jeadrik, Dr. Thein, Dr. T. Jack, Dr. K. Briand, Dr. T. Briand, Dr. M. Lanwi-Paul, Dr. H. Garstang
PIHOA—ED E. Chutaro and admin staff, Dr. G. Dever (Senior Advisor), and A. Whitt***
American Samoa—Dr. Anaise Uso, L. Hunt, M. Sesepasara, J. Tulafono, Dr. S. Gurr; Dr. P. Pedro,

12. Pacific Basin PCO Program
SPCNA – designed in alignment with Goal of the PCO program
To Improve Access to Primary Care --
Define “Access to primary care” is “the timely use of personal health services to achieve the best health outcomes” (HP 2020)

13. Pacific Basin PCO Program
To operationalize “Access to PC” based on the definition: 4 Indicators of Access to PC across the 9 USAPIJs
Coverage (accessible (<30” away), affordable (Medicaid), appropriate (culturally sensitive--language),
Services (primary, dental, and mental health)
Timeliness (appointment time for regular and new patients—2 weeks); clinic visit wait time (2 hours)
Workforce—qualified, permanent resident of similar background

14. Pacific Basin PCO Program
Goal 2: HPSA and MUAP Designations (New or Update)
HPSA: Health Professional Shortage Areas (HPSAs)
3 Types:
Primary care (Highest score=25)
Dental Health (Highest score=26)
Mental Health (Highest score=25)
MUAP
Primary Medical Care Only
Provider/Population; IMR; % pop below 100% FPL; and % elderly population (>64 y. o.)
Status Update: Updates by July 1, 2017
HPSA

15. HPSA & MUA Designation Update
USAPIJs
Sites #
Grantee
NHSC Approved Sites
HPSA
MUA AS 5 1 4 6
CNMI 3
Guam 2
FSM 10 18
RMI
ROP
Total 34 17 46

16. HPSA and MUAP Designations (Handout)
Table 4 HPSA and MUAP Designation Scores for the USAPIs in the Pacific Region, August 2016
USAPI
Primary Care HPSA
Dental HPSA
Mental Health HPSA
MUA (IMU)
CHC-Primary Care HPSA
CHC-Dental HPSA
CHC-Mental Health HPSA
American Samoa 21 23
32.5 19 18
CNMI
46.7 15 16
Guam NA 12
61 (Dededo) 10 5
Chuuk 20
34.5
Kosrae
46.1
Pohnpei
24.6 17
Yap 14
29.9
RMI
ROP

17. Example: MUA (IMU) Designation Scores
Table 7 Medically Underserved Area Designation Scoring Methodology and Scores
Indicators and weighted values
American Samoa
CNMI
Guam
RMI
Palau
Chuuk
Kosrae
Pohnpei
Yap
Total Population
55519
53883
159358
53158
17501
48,654
6,616
36,196
11,377
Eligible Primary medical FTE
2.0
21.0
57.0
0.0
1.0
Population to provider ratio (per 1000)
0.04
0.39
0.36
0.00
0.11
0.03
provider to 1000 population value
Provider to 1000 pop weighted values 9
1.5
% Population <100% FPL
57.8
52.3 23 60
Poverty weighted values
12.2
Infant Mortality Rate (IMR)
8.6
5.2
11.6
18.5
12.7
20.6
14.6
10.3
IMR weighted values 26
25.6
23.2
16.4
19.1
14.2
20.5
22.4 24
% Population age 65 or older
4.7%
2.9%
6.7%
2.0%
6.6%
5.0%
7.0%
5.2%
7.2%
% of population of 65 or older weight value
20.2
20.1
IMU Score
46.2
54.8
64.6
36.6
40.8
34.4
40.6
42.6
44.1

18. Pacific Basin PCO Program
2 Core Benefits of HPSA and MUAP Designation
Qualifies USAPIJ to apply for $ Funding for Community Health Centers (MUAP) among other funding opportunities
Qualifies USAPIJ sites for provider placements and other funding opportunities (CAH), Rural Health Clinics

19. Pacific Basin PCO Program
Goal 3:
NHSC site certification and recertification
a. Certification (4/1-6/2); Recertification
b. Bureau of Health Workforce (BHW) Program Portal (
Each USAPIJ can create accounts for advertisements, recruitments, and profile sharing of sites information
Benefits: Placement of NHSC provider (LRP, Zika LRP)
Status Update: Field Strength Report

20. NHSC Status Update USAPIJs Sites # Grantee NHSC Approved Sites HPSA
MUA AS 5 1 4 6
CNMI 3
Guam 2
FSM 10 18
RMI
ROP
Total 34 17 46

21. NHSC Field Strength Report (Handout)
Table 2. National Health Service Corps Field Strength Data as of 09/27/2016
State
Total
NHSC LRP Total
NHSC SP Total
S2S LRP Total
SLRP Total
PHY DD
RDH NP PA
CNM
Mental
RN (SLRP)
PHARM (SLRP)
Urban
Rural
Grantee
Non-Grantee AS 2 1 GU MP 12 11 9 14 3 4 13

22. Pacific Basin PCO Program
Nationwide, PCOs have been experiencing problems
In Response,
HRSA, FY 3 -- Supplemental funding to help create new or reconfigure existing database to add data fields required for shortage (HPSA & MUAP) designations and compatible with the SDMS (Shortage Designation Management System -- web-based application program

23. Pacific Basin PCO Program
Nationwide, PCOs have been experiencing problems
Issue in the Pacific Basin:
Difficulty collecting provider data for Guam;
Between , I gathered Guam provider data from the CMS Database, Guam Medicaid Office, Guam Health Professional Licensing Office, Guam Medical Association Directory, Guam Dental Association, Guam Health Behavior and Wellness Clinic, and Guam CHC UDS Reports
Not qualified as a MUA Score ~ 64 (SPCNA DataBook);

24. Pacific Basin PCO Program
Update: During the past 10 months
PIHOA PB PCO have met with representative from Guam DPHSS, Guam State Medicaid Office, Guam HPLO, and Guam CHC;
Guam HPLO recently received funding to develop a provider database for the 9 health professional boards in Guam starting with the Medical Board; and
Guam HPLO granted data sharing privileges to the State Medicaid Office and PIHOA PB PCO; and
Guam CHC will assist in the data collection for the other data fields such as % population below poverty level ...

25. Pacific Basin PCO Program
Update: During the past 10 months
PIHOA PB PCO have met or plan to meet with representative from AS, CNMI, FSM, RMI, ROP, PBMA, and PBDA;
Subcontract an affordable webmaster
to develop local and regional provider databases;
with linkages to meet the shortage designation provider data requirements; and
for sharing of health professional resources across the region
Ex.

26. PIHOA Pacific Basin PCO Partners and Point of Contacts in the USAPI
Acknowledgements
PIHOA Pacific Basin PCO Partners and Point of Contacts in the USAPI
AS: Dr. A. Uso, Dr. S. Gurr, J. Tulafono;
CNMI: ED, E. Muna, Dr. B. Cohen, and C. Strong;
Guam: L. DeNorcey, Medicaid Staff, HPLO Director and Staff; Dr. Kaneshiro;
Palau: Dr. S. Wally, Dr. C. Decherong, Dr. A. Marcil, Dr. L. Santos, and Dr. B. Taima;
RMI (Majuro): Dr. K. Briand; Dr. M. Lanwi-Paul, Dr. H. Gurstang, Dr. T. Jack; Dr. T. Briand;
RMI (Ebeye): Ebeye CHC ED, G. Jeadrick and Dr. C. Thein;
FSM (Yap): Director M. Reichhart; Dr. E. Lirow, Dr. Akapito, Wa’ab CHC ED J. Gilmatam;
FSM (Chuuk): Dr. D. Fred, Dr. A. Yomai, and Dr. B. Buliche;
FSM (Pohnpei): Former Director Dr. J. Hedson and Perlina Moses;
FSM (Kosrae): Dr. T. Alik and Dr. C. Masao;
PIHOA (Guam): A. Whitt;
PIHOA (Honolulu): All

27. Pacific Basin PCO Program
Comments?
Questions?
Recommendations?

28. Contact & Helpful US HRSA Health Professional Shortage Designation
HPSA or MUA/P Designation Scores
Primary Health designated Areas or Facilities in the Pacific Basin
D_BCD_HPSA_H1_FederalRegister.pdf (pg. 224 – 234)
Dental Health designated Areas or Facilities in the Pacific Basin
E_BCD_HPSA_H6_FederalRegister.pdf (pg )
Mental Health designated Areas or Facilities in the Pacific Basin
F_BCD_HPSA_H7_FederalRegister.pdf (pg )
(PIHOA & PB-PCO)
Web:
Web: 
Angela Techur-Pedro (HPSA/MUAP/SPCNA)
Dr. Greg Dever (HRH & TA for Workforce Dev.)
Emi Chutaro (PIHOA Ex. Director)
Regie Tolentino (Honolulu Office Manager)
PIHOA/PB-PCO Office in Honolulu, HI
Pacific Guardian Center
Suite #2075, Mauka Tower
737 Bishop Street
Honolulu, Hawaii 96813
Office: (808)  I Fax: (808)