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Summary
Pages 1-14

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From page 1...
... , and Republic of Palau (Palau~are independent countries, but are freely associated with the United States. The total population of all these jurisdictions is 454,1 18, roughly the same population as Portland, Oregon, but that population is scattered across 104 inhabited islands covering an expanse of ocean larger than the continental United States.
From page 2...
... These challenges are also embedded in the islands' many strengths and resources: cultures that remain vibrant even after years of foreign occupation and influences strong familial ties and roles for women highs HP`/Plnn-H PEA ~ ~ ~ ~ ^ ^ ^; i ^ A 8 } ~ 1 ~ ~ ~ ~ ~ 1 l ~ organized communities, traditional health practices, and powerful religious beliefs. THE INSTITUTE OF MEDICINE STUDY The Institute of Medicine (IOM)
From page 3...
... However, rapid economic development and the resulting increase in the number of immigrants, primarily from Southeast Asia, brought in for contract work have placed significant strains on the infrastructure and health services. Federated States of Micronesia: Although the quality of the health care system varies markedly from one state to another among the states of the FSM almost all health care services are extremely dependent on U.S.
From page 4...
... mainland states, Alaska, and Hawaii on most health indicators, and is experiencing population growth from neighboring freely associated states that is beginning to strain public health services. Republic of the Marshall Islands: The RMI has one of the world's highest population densities in its two main urban areas and the youngest population of the six jurisdictions (half of the population is under 16 years of age)
From page 5...
... The committee cautions, however, that if the two main priorities are not given serious attention by all parties involved, the desired goal of improving the health care systems in the region and ultimately the health of the island populations will not be achieved-even if the other recommendations are fully implemented. 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.
From page 6...
... Promote Prudent Privatization As many of the jurisdictions have begun or are considering contracting out and privatizing many of their health care services, the committee cautions that technical assistance should be provided to the prospective private businesses. Business plans for these businesses should be developed that include realistic fee collection goals and carefully considered policies regarding supervision and other personnel matters.
From page 7...
... Consider Multiple Uses of Military Facilities The committee recommends that officials from all U.S. military health care facilities in the region enter into dialogue with the jurisdictions to determine the optimal ways of sharing regional resources and providing training opportunities to serve local populations.
From page 8...
... continue to 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 Establish a Pacific Basin Health Coordinating Council.
From page 9...
... grants; · facilitate the provision of technical assistance and training in such areas as health administration for all Ministers and/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, the Asian Development Bank, the South Pacific Commission, and others)
From page 10...
... , and programs under its direction through the development of sound annual budget development practices, the use of monitoring systems, and timely annual audits. The Health Authority or Board should have both men and women, and include community volunteers such as business people, clergy, educators, and health care professionals.
From page 11...
... Promote Education and Training of the Health Care Workforce The committee is gravely concemed about maintaining the skills and knowledge of the current health care workforce and strengthening the region's local human capacity. The committee therefore recommends several education activities for health professionals to address the present lack of adequate training opportunities available to the health care workforce in the U.S.-Associated Pacific Basin.
From page 12...
... CME must be required for all levels of practitioners and incorporated into each jurisdiction's health care workforce training plan. The committee is particularly concerned about the graduates of PBMOTP and recommends that they receive continuing medical education to improve and maintain their clinical skills and knowledge.
From page 13...
... Provide Health Administration and Systems Management Tra Chief Health Administrator lining to the Advanced training for the jurisdiction's chief health administrator should be provided through a certificate or degree program. The training should include coursework taken at institutions of higher education that offer high-quality programs in this subject area combined with practical applications and fieldwork within the administrator's own jurisdiction.


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