52nd PIHOA Meeting“Managing Regionalism for
Health”
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
Pacific Island Health Officer Association
PIHOA Secretariat(Regional Collaborative for the Pacific Basin [RCPB] Grantee)
PIHOA PresidentRepublic 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
Navigating RegionalismConvening meetingsSetting the agenda
Facilitating and interpretingDeciding who speaks
Defining what is “participation” and “consensus”Assessing needs
Allocating resourcesDeveloping policyIdentifying values
Hiring staff for regional effortsDeveloping 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
Public Health Planning
QA/Evaluation &Data
Human Resources for Health
Speaking with a Unified Voice
Connectivity (Communications &
Governance)
Policies, Principles, Agreements
LAB
Polic
y
Regional Health Priorities
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NCDs(emerging
issuesNTDs?)
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Conn
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QA
/QI/
Perf
Man
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lthFigure 1: NCD platform for practicalizing PIHOA’s regional health priorities
New Strategic Period
Vasiti UluivitiRegional Lab CoordinatorGreg Dever,MDHuman Resources for Health (HRH) Coordinator
Alicia SitanFiscal Officer
Michael EppExecutive Director
Mark Durand, MDQA/QI and Health Information
Systems Specialist
Regie TolentinoAdministrative Officer
Current PIHOA Secretariat
Angie Techur-PedroData Specialist
Cerina MarianoProgram Administrator
Thomas BaneNCD Policy Analyst
An Emerging Pacific Approach
Sovereignty as Health“Socialization”
Communities of Practice Coaching
The Viral ApproachRegional Mobilization Infrastructure
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
Managing Regionalism as Sovereignty:
• “No Man’s Land is between:Development Partners & Donors
What happens here?(Focus of the 52nd PIHOA MTG)
Small recipient countries and territories
No Man’s Land
Four “IONS” of managing regional resources:
PrioritizationImplementation
EvaluationCoordination
“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
The Health Transformation JourneyAre 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.
BA We want to be here.
“Our job is to cultivate justifiable discontent”
The Health Transformation Journey
BA
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 C 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
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
COPsHealth 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
COPsDisease 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
COPsHealth 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
APNLC
PIPCA
AUL
NPEHAPCDC
PPEC
PREL
CCPI
PIHOA
PSAMHCC
PDMA
PBMA
PIJAAG
Regional Structure PIHOA SECRETARIAT
PBDA
PCDC
PPTFI
CCPIPIPCA
PBHCC
PBMA
APNLC
Education
NPEHA
PPEC
PHNNEHIS
SWAT
PHARMLAB
Ex-Off
QAQIPM
PIHOA
Other
Lords Of The RingAka “USAPI Health Leadership
Council”
Lords Of The RingAka “USAPI Health Leadership
Council”
Resource Committee
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
13 months of meetings
1. Cancer Council – November 2010 (travel, finance)2. NHPII Working Group – Honolulu, Dec 2010, 15 participants3. PIHOA 50th Annual Meeting – Palau, April 2011, 100 participants4. 1st Annual QA/QI Workshop / Meeting –Honolulu, September 2010, 35
participants5. HRH Meeting / Workshop – Guam, June 2011, 30 participants 6. Lab Meeting / Workshop– Guam on June 2011 with about 35
participants7. Pharmacy Meeting / Workshop –Guam, June 2011, 30 participants 8. 2nd Annual QA-PM Meeting / Workshop – Guam, September 2011, 50
participants. 9. Cancer Registrars – April 2011 (travel, finance)10. Cancer Council – November 2011 (travel, finance)
Polic
y
Regional Health Priorities
Hea
lth P
lann
ing
Hea
lth In
fo M
an S
yste
ms
NCDs(NTDs?)
Anc
illar
y Se
rvic
es
Conn
ectiv
ity
QA
/QI/
Perf
Man
agem
ent
Hum
an R
esou
rce
for
Hea
lthFigure 1: NCD platform for practicalizing PIHOA’s regional health priorities
New Strategic Period
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
Some Longer Term Successes
• Regional Lab Infrastructure (transportation)• Empowering Communities of Practice /
Regional Associations / AHEC• Regional NCD Road Map • National Public Health Infrastructure
Initiatives
Benchmarks since 51st 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
HRSA Expectations1. 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 netd. 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.
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.
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