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


• 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


HHS FUNDING !


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?


• 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


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?


• 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


• 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


• 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


• 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


• 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


• What next?– Some of your thoughts

• ??• ??• ??• ??• ??• ??



• 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.


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


• 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


• 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


• Coord. with USAPI and HHS/HRSA and CDC on Hansen’s disease response


• CAPT John Walmsley– [email protected]– 415-437-8114

• CAPT Cathy Wasem– [email protected]– 808-541-2015

mailto:[email protected]

mailto:[email protected]

health-related investments in the usapi us department of health and human services

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