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

Hea

lth P

lann

ing

Hea

lth In

fo M

an S

yste

ms

NCDs(emerging

issuesNTDs?)

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

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