Health-Related Investments in the USAPI US Department of Health and Human Services
Health-Related Investmentsin the USAPI
US Department of Health and Human Services
Health and Human Services
Objectives• Provide an overview of DHHS
agencies, programs and funding• Provide info on purpose, types and
mechanisms of HHS funding• Describe coordinating strategies and
activities
Health and Human Services
• HHS MISSION: To protect the health of all Americans and provide essential human services, especially for those who are least able to help themselves
• HHS Agencies and offices perform a wide variety of tasks and services, including research, public health, food & drug safety, grants and other funding, health insurance, and many others
Health and Human Services• Centers for Disease Control and Prevention• Health Resources and Services
Administration• Center for Medicare and Medicaid Services• Substance Abuse and MH Services
Administration• Administration for Children and Families• Administration for Community Living• Agency for Healthcare Research and Quality• National Institutes of Health• Agency for Toxic Subst. and Disease Registry• Food and Drug Administration• Indian Health Service
Health and Human Services
HHS FUNDING !
Health and Human Services
Federal Funding is Used To:• Promote an agenda (e.g., HP 2020)• Meet a legislative requirement• Fulfill part of a “Strategic Plan”• Pilot test an idea• Promote special initiatives
FEDERAL FUNDING
How Does It Work?
Health and Human Services
• TYPES OF FUNDING– Entitlement funding– Competitive funding
• FUNDING MECHANISMS– Grants: not for direct benefit or use of
USG– Contracts: for direct benefit or use of
USG– Cooperative Agreements: like grants
but HHS shares responsibilities with grantee
Health and Human Services
Centers for Disease Control and Prevention
(CDC)- Amounts and types of investments
(COAG, grants, TA, in-region staff, etc.)
- Consultation and priority setting practices and protocols (how are program priorities aligned with USAPI needs? How does consultation/alignment occur?
Centers for Disease Control and Prevention
• CDC support to the USAPI…– goes mostly to Ministries and
Departments of Health– targets categorical public health
programs (with a couple of exceptions) – comes through Cooperative Agreements– is in the form of money and direct
assistance– includes technical assistance through site
visits, grantee meetings and ad hoc requests
Immunization22%
Cancer15%
Pre-paredness12%
Tobacco Diabetes BRFSS12%
Other11%
HIV/AIDS9%
NPHII8%
Coord Chroni
c7%
TB6%
CDC Cooperative Agreements and Grants to the USAPI (2011)
Total $18,913,907
• How are CDC program priorities and support aligned with USAPI needs?– Begins with Congressional appropriation– Initial estimates of funding levels are
usually formula-based (population, morbidity)
– Needs are then outlined by grantee in application for funding
– Project officers work with grantees to further refine grantee needs based on availability of funding, grantee capacity and performance
Centers for Disease Control and Prevention
• How does consultation and alignment occur?– Through interactions between project
officers and grantees (usually program managers)
– Through interactions between health officials and CDC leadership or Senior Public Health Advisor
– Through regional or national grantee meetings
– Through requests by CDC for USAPI input on program planning
Centers for Disease Control and Prevention
• How’s it going? Some good…some not so good
– Examples of success:• More USAPI specific FOA’s (STD/HIV/TB,
NCD)• More CDC funding in the region (PHEP, TB,
ELC, NPHII)• More CDC field staff support to USAPI in the
region (Immunization, TB, OSTLTS, DGMQ, PHPS)
• Establishment of OSTLTS
Centers for Disease Control and Prevention
• How’s it going? continued
– Examples showing that we’re not there yet. • Most of CDC still doesn’t understand the unique
needs and challenges in this region• FOA’s and grant requirements are still less
relevant to USAPI than to US states and large urban areas
• Cooperative Agreement funding doesn’t align with public health priorities in the region
• CDC funding mechanisms make it difficult to share grant funded resources across programs or across the region
Centers for Disease Control and Prevention
• What next?– Some of our thoughts
• Solicit USAPI input more often before policies affecting the region are adopted
• Make better use of the CDC USAPI Work Groups (to provide written guidelines for FOA development, program planning, management and TA support)
• Improve field based assistance through more regional meetings and more frequent or better coordinated site visits (including increased use of information technology)
• Increase the number of CDC staff and fellows/associates in the region
Centers for Disease Control and Prevention
• What next?– Some of your thoughts
• ??• ??• ??• ??• ??• ??
Centers for Disease Control and Prevention
Health and Human Services
• Total amount provided to the Pacific by HHS in FY 2011 (approx.):– $153 million
• Percentage of USG funding to the Pacific in FY 2011 by department (approx.):– USDA = 33%– HHS = 26%– Education = 11%– HUD = 9%
Health and Human Services“Grants to the Outer Pacific FY 2011”
report– Issued annually by Federal Regional
Council’s “Outer Pacific Committee”– Annual compilation of many funding
programs provided to USAPI (not comprehensive!!!)
– Includes narrative description of grant programs and points of contact
– Tables list annual funding amounts and program eligibility info
– Can see at a glance if you’re missing a program
– However, there may be grant programs available that aren’t listed
Health and Human ServicesHow are program outcomes evaluated?- Agency administrators and P.O.s
meet with elected officials, health officers and program managers/staff to discuss priorities/challenges/outcomes
- Project officers use site visits, calls and email to review reports and evaluate program performance- Communication is challenging element
Health and Human ServicesWhat are mech. for intra-agency and
cross-agency coord. for work in the USAPI?
• Federal Regional Council mtgs/initiatives
• Joint FRC/MCES meetings + 1-on-1 mtgs.
• Outer Pac. Comm. + Guam Buildup T.F.
• Insular Health and Human Services Policy Group (+ Working Group)
• CDC Pacific Workgroup/Epi/Lab mtgs.• CNMI Task Force• Interagency Group on Insular Affairs
Health and Human ServicesCross-agency HHS Coordination
(cont.)• WH Initiative on AAs and PIs
– WHIAAPI: HHS Plan focusing on NCDs• Native Hawaiian and Pacific Islander
HHS Work Group (meets internally & with NHPI Stakeholder group)
• National Partnership for Action to End Health Disparities– Regional Health Equity Council
• HHS participation in WHO reg/int’l mtgs.
Health and Human Services
Cross-agency HHS Coordination (cont.)
• Consultation with PIHOA Affiliates– Health workforce dev/nursing– Pharmacy– Behavioral Health– Environmental Health
• HHS internal strategizing on USAPI issues
• Coordination with ASTHO, WHO, SPC
Health and Human Services
• Linking US FDA to NPEHA and curriculum development in Environmental Health– FDA conducts quarterly calls with USAPI
EH• Coord. with PEACESAT staff on HIS
dev.• Coord. with USAPI USEPA and UoH on
safe drinking water issues• Coord. with USAPI and DOI/DOD/CDC/
EPA on dengue fever response• Coord. with USAPI, CDC, HRSA and
others on MDR-TB response
Health and Human Services
• Coord. w/DOI and FAS on Compact Impact issues
• Ongoing coord. with DOI/OIA on JEMCO/JEMFAC & topical USAPI issues
• Participating in Pacific NCD Forum in NZ to dev. linkages with regional entities and policies to address NCD epidemic
• Connected to APIAHF and Native Hawaiian Pacific Island Alliance
Health and Human Services
• Coord. with USAPI and HHS/HRSA and CDC on Hansen’s disease response
Health and Human Services
• CAPT John Walmsley– [email protected]– 415-437-8114
• CAPT Cathy Wasem– [email protected]– 808-541-2015