Pacific Partnerships for Health Charting a Course for the 21st Century (1998) / Chapter Skim
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3 Charting a Course for the 21st Century: A Strategic Plan for Future Health Initiatives in the U.S.-Associated Pacific Basin
3 Charting a Course for the 21st Century: A Strategic Plan for Future Health Initiatives in the U.S.-Associated Pacific Basin
Pages 55-76
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From page 55... ...
The nature and scope of this involvement and investment, however, must change. Beyond merely providing health carea great challenge in its own right the United States and the island communities must work together with a renewed sense of partnership to produce improved health of Pacific Islanders.
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From page 56... ...
Although it was beyond the charge, expertise, and capability of the committee to make detailed estimations of the costs of implementing these recommendations, the committee believes most of the costs can be covered through the reallocation of current levels of health care funding-especially as a more locally sustainable and viable system of community-based primary care and preventive services is adopted. In the 1993 landmark report, Investing in Health, the World Bank calculated the cost of providing a minimum package of public health and essential clinical services in low- and middle-income countries (World Bank, 1993~.
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From page 57... ...
In some jurisdictions, it will also require the reorganization of delivery systems to better integrate the acute care, primary care, preventive care, and public health sectors. To combat the inappropriate and discretionary use of funds for health care services, the committee recommends that each jurisdiction place the funds reserved for this purpose in a separate cost center within the overall health budget.
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From page 58... ...
federal health care programs. Each of the three freely associated states is strongly urged to establish its own standards for available resources and appropriate technology, including provisions for the licensure of health care providers and legislative practice acts.
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From page 59... ...
, and other users of regional health data. Reform Health Care Facility Management Health care facilities throughout the region are generally in poorly maintained buildings, experience chronic and commonplace shortages of vital supplies and equipment, and have outdated and broken equipment.
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From page 60... ...
Ideally, the money formally used on off-island tertiary care can be used for primary health care, wellness and health promotion, health education, and on-island acute care to help reduce the need for such referrals in the first place. IMPROVE COORDINATION WITHIN AND BETWEEN THE JURISDICTIONS AND THE UNITED STATES To maximize scarce resources and minimize wasteful duplication of efforts, the committee calls for greater coordination and collaboration as well as improved management on both sides of the Pacific.
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From page 61... ...
of Agriculture 61 - IGCOHP FIGURE 3.1 Overview of recommended organizational arrangements to improve coordination between the U.S.-Associated Pacific Basin jurisdictions and the United States. ROLE OF THE UNITED STATES Use of Block Grants That Require Meaningful Measures of Accountability U.S.
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From page 62... ...
Research is needed to examine the major causes of morbidity and mortality in the region such as diabetes, substance abuse, tuberculosis, nutritional deficiencies, women's health issues, and other topics identified by Pacific Islanders as important to improving their overall health. Studies on health systems development that take into account the unique social and cultural belief systems in the U.S.-Associated Pacific Basin jurisdictions are also strongly encouraged.
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From page 63... ...
Establishment of an Interagency Governmental Committee on Pacific Health The committee believes that coordination of U.S. funding for all healthrelated activities in the Pacific Basin is needed to increase the coherent and consistent application of rules, regulations, and accountability requirements for expenditures, which should be based on the previously discussed outcomes measures.
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From page 64... ...
Department of State. IGCOHP Tasks The specific responsibilities of the committee should include: ensure coordination of health programs, administrative oversight, research and technical assistance to the region; · propose and support the rationale for any future federal health initiative for the Pacific Basin jurisdictions before its implementation and be explicit about the goals and objectives of such initiatives; coordinate coherent and consistent rules and regulations on federal health expenditures in the region, review agency grant reporting requirements and emphasize consistency on performance measures among agencies; · identify resources throughout the federal agencies that could provide technical assistance with health sector reform; and · report annually to the President and to Congress on the committee's progress.
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From page 65... ...
identify technical assistance and consulting strategies that promote the prudent use of the expertise available within the region. INTERFACE BETWEEN THE UNITED STATES AND THE ISLAND JURISDICTIONS Establishment of a Pacific Basin Health Coordinating Council Finally, the committee recommends that the governments of the United States and the six island jurisdictions establish or designate a nongovernmental organization in the region to coordinate health affairs and facilitate collaboration between the United States and jurisdiction governments.
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From page 66... ...
facilitate training in health administration for ministers or directors of health and for members of jurisdictional health authorities or boards; and · identify and establish working relationships with U.S. federal agencies and international organizations and other aid donors (e.g., the World Health Organization, Asian Development Bank, and South Pacific Commission)
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From page 67... ...
Island communities should consider taking some fundamental steps, including the following: establish a jurisdictional health authority or board, develop a health improvement benchmarking process, use nongovernmental community organizations to provide health services, and increase community involvement with primary care sites. These steps are described in more detail below.
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From page 68... ...
This should include training to help Health Authority members understand and interpret the methods and findings of health research in the science of epidemiology and public health; conduct focus groups and analyze focus group information; improve their community organizing skills; and communicate information to the public. Develop Health improvement Benchmarking Process Health improvement benchmarking is a method of comprehensive, longterm health planning.
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From page 69... ...
The committee does not recommend any particular health improvement benchmarking process. Each community and jurisdiction will need to determine what works best, given its unique circumstances and culture.
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From page 70... ...
However, they remain a potent and much underutilized force, particularly in the freely associated states. The committee believes that nongovernmental community organizations should be enlisted to provide a variety of health-related activities not currently being provided by the jurisdiction's government, including health education and peer counseling, whenever possible.
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From page 71... ...
The committee therefore recommends several educational activities to address the present lack of adequate training opportunities available to the health care workforce in the U.S.-Associated Pacific Basin. These individual activities should be based on a comprehensive workforce development and training plan established by each jurisdiction.
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From page 72... ...
provide health administration and systems management training to the chief health administrator in each jurisdiction. Improve and Support Basic Education Currently, the primary and secondary educational systems throughout the region do not adequately provide students with the skills that they need to participate in the health care workforce.
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From page 73... ...
Provide Postgraduate and Continuing Medical Education Programs Continuing medical education (CME) must be required and incorporated into the health care workforce training plan for the entire region.The committee is particularly concerned that the graduates of the Pacific Basin Medical Officers Training Program (PBMOTP)
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From page 74... ...
federal government and local jurisdictions sponsor dental training immediately. A dental officer program based on the PBMOTP model was developed by PIHOA in consultation with the University of Kentucky School of Dentistry in the early 1990s (University of Kentucky, 1993~.
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From page 75... ...
HRSA's Bureau of Health Professions and its Division of Nursing should provide funds for nurse traineeships and other special training programs identified by the regional nursing programs. Provide Health Administration and Systems Management Training to the Chief Health Administrator meet.)
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