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DHHS report reveals Am Samoa’s MCH funding largely diverted to COVID vax campaign


Pago Pago, AMERICAN SAMOA — The recent Department of Health and Human Services (DHHS) Title V report says a majority of American Samoa’s objectives and initiatives in the territory’s Maternal and Child Health FY2021 State plan were not obtained due to the COVID mass vaccination campaign.

American Samoa’s Maternal and Child Health (MCH) Title V program has expended $484,544 of its $493,983 federal allocation for FY 2021, as outlined in the DHSS report on the Title V MCH block grant.

The report says the block grant together with local funds (state match) and other additional federal funds, is used to address American Samoa’s MCH priority needs, improve performance related to targeted outcomes, and expand systems of care for Children with Special Health Care Needs (CSHCN) as well as MCH.

 “In the budget allocation for FY2021, the Title V federal allocation included one third of funds to support CSHCN and an additional one-third to support the MCH priorities for preventive and primary care initiatives for children ages 1 to 21 years of age.

 “FY2021 budget was initially aligned according to state action plan initiatives.

 “These initiatives included direct services for CSHCN; enabling services for all population domains; and supporting public health services and systems to improve overall health for all women and children.

 “However, the majority of these objectives and initiatives in the FY2021 State plan were not accomplished due to the island-wide mass vaccination campaign.

 “Majority of Title V staff including the program director were deployed out in vaccination sites, Risk Communications and Surveillance, as well as operating the Suicide Lifeline after-hours.

 “We continued to see a rise of suicide cases in 2021 with a total of 4 cases whose ages range from 14 to 19 years of age.

 “Both CSHCN Case Manager Emalaine Lam Yuen and Service Coordinator Fetinaí Taitai continued to provide care coordination services for their clients.”

According to American Samoa’s Title V expenditure report, 31.4% of funds were used for children with special health care needs, up to 21 years of age, and 46.5% of funds were utilized to fund preventive and primary care initiatives for children ages 1 to 19 years.

 “This 16.5% increase for children services was definitely unplanned. 

Due to COVID restrictions including travel restrictions, funds were redirected to allow Title V staff to support mass COVID vaccinations, working after-hours and weekends.

 “Towards the ending of American Samoa’s second COVID surge and reopening of borders for traveling to neighboring island country of Samoa (June 2022), funding was also utilized to support program staffing attendance at the Disability Network Leadership Summit to plan and 2023 work plan for CSHCN.”

Funds have also been encumbered and should be fully expended September 30, 2022 after executing the current rheumatic heart disease (RHD) island-wide screening for new cases in collaboration with the visiting Cardiology team from BYU, Utah.

Other federal funds assisted with Title V office operations, office lease, client transportation, data capacity and staffing. Preventive Health Services assisted with the Heart Health Week Initiative that promoted RHD screening and Bicillin medication compliance.

American Samoa’s MCH Title V Block grant funds 12 employees which includes the MCH Program Director Dr. Anaise Uso, who oversees the daily operations at the Title V office and staff.

She was deployed out in the field to be a vaccinator and support the territorial-wide mass vaccination campaign.

Four MCH staff are cost shared with local match, which includes 2 nurse practitioners, one registered nurse and the RHD Program Manager.

One nurse practitioner mainly provides training, administration for nurses and covers at the Women’s Health or Well Baby Clinics when clinics are short with nurses as well as vaccinating.

The other nurse practitioner provides prenatal care and postpartum check-up and assists with the mass vaccination by monitoring those who completed their vaccinations. Another Title V funded LPN nurse Manulelei Aitaoto, was either assigned to the vaccination sites or was at the quarantine facilities.

One health educator, who is also a Certified Nurse Assistant (CNA) Conference Alailefaleula, worked between vaccination sites, or at the quarantine facilities. Another CNA Faafetai Meleisea worked at the Leone Well Baby Clinic to provide enabling services for children.

RHD Client Navigator Lotu Tupuola, continued to schedule and provide reminder calls for RHD Clinic patients. She monitors the RHD data in a spreadsheet. This year, RHD data all the way back to 2019 is slowly being entered in the web database SILAS. 

There is also a Social Security Disability Insurance funded Epi Tech, Ruta Ropeti, who assists the MCH Epidemiologist with MCH Surveillance, which contributes to Public Health services and systems capacity.

She joined the nursing program at the community college ASCC during the 2021 fall semester and has now completed her program. She is currently working at the Title V office or in the clinics until she can sit her board exam. Once she receives her license it’s in the plan she assists with managing care for CSHCN as well as run the RHD clinic and administering the Bicillin treatment.