Micronesia extends comprehensive care to remote communities
David Pelep, 86, comforts his wife Sulise as she nurses an aching tooth while waiting for treatment from a visiting health worker. The elderly couple live in Wapar, a remote village on the island of Pohnpei in the Federated States of Micronesia.
“The location of our village creates a lot of problems,” says Mr Pelep. “Not everyone here has the means of transportation or money to seek medical attention.”
Today, the Peleps and other villagers are receiving medical care at an outreach clinic set up in their own village. This is thanks to a government programme designed to extend services to the country’s more than 100 000 people scattered across hundreds of islands covering 2.6 million square kilometres of the Pacific Ocean.
The Dispensary Strengthening Programme brings health workers, who travel long distances by road, to remote communities to provide comprehensive outreach services to tackle a variety of health needs – from preventive screenings, health education and immunizations to medicines and simple treatments. The programme was launched in June 2017 as a demonstration project in Mdolenihmw Municipality, Pohnpei State as part of the country’s efforts to implement universal health coverage: to ensure everyone can get the health services they need, where and when they need them, without facing financial hardship.
Leading the programme is the Department of Health Services of Pohnpei State, with support from the national government, the World Health Organization (WHO), the International Organization for Migration, the Japan International Cooperation Agency and the Island Food Community of Pohnpei.
Need to extend services
More than 90 dispensaries were set up in the Federated States of Micronesia to serve as primary health care centres where health workers would dispense medications and other medical supplies. They were also trained to offer services in health promotion, disease prevention and basic treatment. However, due to lacking resources for travel, financial constraints and limited supervision, the dispensary system was unable to deliver adequate services to people in remote areas of the country. Often, the health workers could do little more than give out medicines to the people in the immediate area. The Government recognized that this set-up was not adequate, given the increasing burden of noncommunicable diseases such as hypertension and diabetes that require models of care focused on prevention and disease management.
Coordinating programmes to deliver comprehensive care
“The new Dispensary Strengthening Programme is a major improvement – allowing us to provide various services from different public health programmes, all at the same time,” says Cutelynn Eliou, 44, a health assistant at the dispensary in Pohnlangas. “It also allows us to detect illnesses that otherwise might be missed.”
“The demonstration programmes show great potential,” says Dr Eunyoung Ko, WHO Country Liaison Officer in the Federated States of Micronesia, who led a situation analysis and supported the development of guidelines for integrated outreach services. “First, they’ve taken outreach programmes for noncommunicable diseases, maternal and child health, HIV, and TB – which were accustomed to working in isolation – and brought them together as one multidisciplinary team that travels together to provide comprehensive services.”
“And the outreach activities are also allowing health workers to collect biometric data, such as fingerprints, so that people’s health records can be linked to the dispensary and hospital information systems so they get proper follow-up,” Dr Ko adds.
Engaging communities in programme design
Community engagement has been key to the early success of the demonstration programme. The Government health team consulted community leaders, including the paramount chief and village chiefs, to identify priorities and expectations.
“The discussions we had with health officials before this programme was launched were very important,” said Mathias Pelep, the 91-year-old village leader of Wapar. “And the activities you are seeing today are based on the planning that we took part in. This is our second outreach visit, and I think we are finding hidden illnesses that weren’t being detected before this programme.”
The Dispensary Strengthening Programme is one of two comprehensive outreach programmes currently operating in the Federated States of Micronesia. The second is the Primary Health Care Strengthening Programme, which was launched in Tol Island in September 2017 by the Department of Health Service in Chuuk State, with technical support from WHO and funding from the Republic of Korea. The programme shares similarities in approach with the activities and service delivery model, except in this case, health workers travel to communities by boat.
Going forward, WHO will continue to work closely with the Government in monitoring the programme and in conducting a cost analysis to support its expansion to other municipalities.