1. 52 nd PIHOA Meeting “Managing Regionalism for Health”

2. Pacific Island Health Officer Association Mission – Improve the health and well-being of USAPI communities by providing, through consensus, a unified credible voice on health issues of regional significance. History & overview – Founded by 6 USAPI Health Ministers, Directors or Secretaries – Non-profit incorporated in CNMI since 1986 – A network of 6 directors, 11 associate members, 14 organizational members, and hundreds of partners – Secretariat: 8 staff and 2 consultants in Hawai’i, Guam, and Palau – $1.4 million budget in FY2012

3. Pacific Island Health Officer Association PIHOA Secretariat (Regional Collaborative for the Pacific Basin [RCPB] Grantee) PIHOA President Republic of Palau American Samoa Commonwealth of the Northern Mariana Islands Guam PIHOA Board of Directors: 6 Voting members Comprises the Ministers, Directors, or Secretaries of Health for their country or territory Associate Members 4 FSM State Health Dept Directors Leaders of hospitals in Guam & AS Health Deputies in RMI, Palau & Guam Affiliate Members Professional associations Organizations that are Pacific-governed, charitable, & have impact on health policy Federated States of Micronesia PIHOA Vice President Republic of the Marshall Islands PIHOA Secretary

4. Navigating Regionalism Convening meetings Setting the agenda Facilitating and interpreting Deciding who speaks Defining what is “participation” and “consensus” Assessing needs Allocating resources Developing policy Identifying values Hiring staff for regional efforts Developing regional strategies & work plans for the health and wellbeing of the USAPI “NO MAN’S LAND” Small countries & territories Development partners & donors Slide courtesy of PIHOA

5. Public Health Planning QA/Evaluation & Data Human Resources for Health Speaking with a Unified Voice Connectivity (Communications & Governance) Policies, Principles, Agreements LAB

6. New Strategic Period

7. Vasiti Uluiviti Regional Lab Coordinator Greg Dever,MD Human Resources for Health (HRH) Coordinator Alicia Sitan Fiscal Officer Michael Epp Executive Director Mark Durand, MD QA/QI and Health Information Systems Specialist Regie Tolentino Administrative Officer Current PIHOA Secretariat Angie Techur-Pedro Data Specialist Cerina Mariano Program Administrator Thomas Bane NCD Policy Analyst

8. An Emerging Pacific Approach Sovereignty as Health “Socialization” Communities of Practice Coaching The Viral Approach Regional Mobilization Infrastructure

9. Sovereignty as Health Sovereignty: prerequisite to health at all levels National/Territorial, community, family, individual Also, regional: – Best managed from the ground up – Secretariats are administrative / programmatic only – Authority resides in Boards – Learning discipline: The “terror” of getting ahead of the Board

10. Managing Regionalism as Sovereignty: “No Man’s Land is between: Development Partners & Donors What happens here? (Focus of the 52 nd PIHOA MTG) Small recipient countries and territories

11. No Man’s Land Four “IONS” of managing regional resources: Prioritization Implementation Evaluation Coordination

12. “Socialization” (Key to health planning) Health planning is key to managing regionalism Why the “Vast Cemetary of Health Plans”? 2010 meeting in Palau on Health Planning resulted in idea of “socialization” Kuartei, Jim, Finau, Cuboni, Dever, Durand, Maskarinic Therapy offered to all participants after meeting “Socialization” – pre-planning work. Similar to “Readiness to Change” models “Socialization” must be factored into timeline; takes time. Example: NCD emergency declaration: Socialization / Alignment tool

13. The Health Transformation Journey Are we satisfied? (probably no) We are dissatisfied; we want to change. Are we ready to change? Do we have the will to change? How will we change? What does change look like? How will we get there? We are here. We want to be here. “Our job is to cultivate justifiable discontent”

14. The Health Transformation Journey MOHs / DOHs Role: Internal socialization getting to yes / getting to ready: Now we are ready for the traditional planning process - more information gathering and situational analyses, then planning, etc. Socialization Strategic Health Plan Now we are ready to start planning PIHOA’s Role: Ongoing technical assistance & consultation PIHOA’s Role: TA, etc Dissatisfied ?Ready for change

15. Communities of Practice Implementation Science: Dissemination & Training alone are ineffective. Communities of Practice: Sustained engagement, networks of mutual accountability, strategic development Strength in numbers, can speak corporately what can’t be said alone. Important in Pacific Much work being done to help COPs do what they are uniquely positioned to do (e.g., standards, education, advocacy, policy) Provides venue for jealousy factor / viral approach

16. COPs Health Professions Pacific Basin Medical Association Pacific Basin Dental Association American Pacific Nursing Leaders Council Pacific Behavioral Health Collaborating Council Northern Pacific Environmental Health Association Association of USAPI Laboratories Association of USAPI Pharmacies

17. COPs Disease Specific Cancer Council of the Pacific Islands Pacific Chronic Disease Coalition Pacific Partners for Tobacco Free Islands Policy / Leadership Pacific Resources for Education and Learning Pacific Post-Secondary Education Council Pacific Island Health Officers Association Association of Pacific Island Legislatures Micronesian Chief Executives Summit

18. COPs Health Systems Specific Pacific Islands Primary Care Association Other Groups – Less Formal Quality Assurance Officers/Performance Improvement Managers Health Information Systems Swat Team Human Resources for Health Managers Public Health, Nursing and Nutrition Educators Vital Statistics Focal Points Medical Librarians Health Systems Strengthening Technical Working Group

19. APNLC PIPCA AUL NPEHA PCDC PPEC PREL CCPI PIHOA PSAMHCC PDMA PBMA PIJAAG

20. Regional Structure PIHOA SECRETARIAT PBDA PCDC PPTFI CCPI PIPCA PBHCC PBMA APNLC Educa tion NPEHA PPEC PHNNE HIS SWAT PHARM LAB Ex- Off QAQI PM PIHO A Other Lords Of The Ring Aka “USAPI Health Leadership Council” Lords Of The Ring Aka “USAPI Health Leadership Council” Resource Committee

21. COP Communications Costs Increased Typical Call budget has increased from $500 to 3k - 5k per month PHII Technical Working Group – quarterly conference calls PITCA/Nurses TB Network – monthly conference calls AUL – quarterly conference calls USAPI HRH/HRM Mangers – quarterly conference calls USAPI Pharmacists – quarterly conference calls QA/QI – quarterly conference calls HIS Swat Team – monthly conference calls PIHOA Education Committee/Affiliate Group – monthly and quarterly conference calls PIHOA Board – monthly conference calls PIHOA Staff – monthly conference calls PIALA/NLM – monthly conference calls Other Ad Hoc – average 1 to 2 a week

22. 13 months of meetings 1.Cancer Council – November 2010 (travel, finance) 2.NHPII Working Group – Honolulu, Dec 2010, 15 participants 3.PIHOA 50 th Annual Meeting – Palau, April 2011, 100 participants 4.1 st Annual QA/QI Workshop / Meeting –Honolulu, September 2010, 35 participants 5.HRH Meeting / Workshop – Guam, June 2011, 30 participants 6.Lab Meeting / Workshop– Guam on June 2011 with about 35 participants 7.Pharmacy Meeting / Workshop –Guam, June 2011, 30 participants 8.2 nd Annual QA-PM Meeting / Workshop – Guam, September 2011, 50 participants. 9.Cancer Registrars – April 2011 (travel, finance) 10.Cancer Council – November 2011 (travel, finance)

23. New Strategic Period

24. Some Longer Term Successes PIHOA Resolution 48-01: NCD Declaration PIHOA Resolution 41-06: Nahlap Action Plan Stronger Policy Making Function (HRH, QA, Cancer as models; NCDs and Nahlap as gold standards) QA/QI programs strengthening in all jurisdictions Associates of Science Degree in Public Health founded at COM-FSM and going viral

25. Some Longer Term Successes Regional Lab Infrastructure (transportation) Empowering Communities of Practice / Regional Associations / AHEC Regional NCD Road Map National Public Health Infrastructure Initiatives

26. Benchmarks since 51 st Meeting PIHOA Strategic Plan Guam Office Program Administrator HIS Swat Team Assessments (FSM) NCD Surveillance TWG Health Leadership Council Foundation Sciences Contract FNU CDC Placements (starting new) CNMI Consultancies

28. HRSA Expectations 1.Serves as a regional Pacific Primary Care Office (PCO). Fosters collaboration and provides technical assistance to a.Organizations/communities wishing to expand access to primary care for underserved populations b.Support needs assessment/sharing of data c.The jurisdictions in workforce development for the NHSC & safety net d.Support jurisdictions’ Shortage Designation Applications and updates 2.Develops and advances a strategic plan that addresses the primary care and public health needs. 3.Promotes partnerships across different regions, disciplines, funding sources, and sectors. 4.Assures a continuous process of community engagement. 5.Provides technical and grant-writing assistance.

29. PCO Expectations 1.Foster Collaboration. 2.Provide Technical Assistance to organizations/communities wishing to expand access to primary care for underserved populations. 3.Provide Technical Assistance to support Needs Assessment/Data Sharing. 4.Provide Technical Assistance for Workforce Development for the NHSC and Safety Net. 5.Provide Technical Assistance to improve Shortage Designation.

30. CDC (NPHII) Expectations Implement relevant and essential activities to accelerate the agency’s readiness to apply for public health accreditation. Identify and implement performance or quality improvement initiatives Engage in cross-jurisdictional partnerships with one or more local health department(s) that have a proven record of performance improvement adoption and/or implementation of public health policies and laws Identify and implement promising and best practices