Innovations to maximise impact of a data for decision-making training programme in the Federated States of Micronesia

Accurate and timely health information is an essential foundation for strengthening health systems. Data for decision making (DDM) is a training curriculum designed to enhance capacity of health department staff to capture and use high-quality data to address priority health issues. In 2013, the Pacific Public Health Surveillance Network adapted and piloted the DDM curriculum as an ‘at work, from work, for work’ field epidemiology training programme component for low-income and middle-income Pacific Island jurisdictions. Based on lessons learned from the pilot, we made several innovations, including delivery on-site at each district (rather than bringing trainees to a central location), conducting pre-DDM consultations and ongoing contact with health leaders across the programme, taking more care in selecting trainees and enrolling a larger cohort of students from within each health department. The decentralised programme was delivered in-country at four sites (both at national and state levels) in the Federated States of Micronesia. Following delivery, we performed an external evaluation of the programme to assess student outcomes, benefits to the health department and general programme effectiveness. Of the 48 trainees who completed all four classroom modules, 40 trainees participated in the evaluation. Thirty-two of these trainees completed the programme’s capstone field project. Eighteen of these projects directly contributed to changes in legislation, revised programme budgets, changes in programme strategy to augment outreach and to target disease and risk factor ‘hot spots’.

Implementation of the Mental Health Gap Action Programme (mhGAP) in Kosrae State in the Federated States of Micronesia

Improving access to mental health care is a global health priority, and a significant treatment gap exists in Pacific Island Countries. One strategy to bridge the gap is the World Health Organization’s Mental Health Gap Action Programme (mhGAP), which provides evidence-based guidance for managing mental, neurological, and substance abuse conditions. mhGAP has been implemented in more than 90 countries, but there has been limited training within many Pacific Island countries. We describe implementation of mhGAP training in Kosrae, a state within the Federated States of Micronesia. mhGAP training was conducted with 18 members of the Kosrae Community Health Center (KCHC). Our training model included 2 helpful modifications: (1) participants attended a combination of online sessions and a 1-week in-person training, which allowed for more time and flexibility in delivering training; and (2) longitudinal support posttraining, which has been identified as an important factor in successful implementation of mhGAP.

An Analysis of the Sustainability of a Collaborative Care Program Used to Deliver Integrated Mental Health Care Within a Micronesian Island State

Adequate access to mental health care is a global problem, including in the Federated States of Micronesia (FSM). The Collaborative Care Model (CoCM) offers an opportunity to deliver improved access to mental health services in primary care centers, and key factors to program sustainability have been investigated in high-income country settings. This study’s objective was to evaluate how well factors associated with sustainability have been incorporated into a CoCM in Kosrae, Federated States of Micronesia. The Kosraean CoCM’s strengths included its supportive leadership, team member training, and having a strong care manager and engaged primary care provider champion. Opportunities for growth included further development of its financial viability, information technology systems, change readiness, and operational procedures. Our program found that having a stable and invested staff and leveraging its current strengths were important to its viability. In an international partnership, it is also critical to develop strong relationships among team members and to have stable internet connectivity to facilitate regular communication. These lessons learned can be applicable to other integrated care programs in similar Pacific Island countries.

Telepathology by Realtime Screen Sharing Between Japan and Federated States of Micronesia: Opportunities and Challenges

We have been conducting pathological diagnosis of routine cases in the Federated States of Micronesia by telepathology since 2018, using realtime screen sharing via the Internet with Japan. The number of cases covered in the last three years was 378, and by specimen type, gynecologic specimens were the most common, followed by oral cavity / ENT, skin, and mammary gland. Thirty four out of 60 oral cavity cases were diagnosed as malignant including suspicious. The turnaround time between submission of the specimen and the report of pathological diagnosis was markedly decreased. For the continuous development of global telepathology, it is necessary not only to build a system but also to recruit or train those who perform it.