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Improving Grants Management in the U.S. Virgin Islands: Q&A with Tatia Monell-Hewitt Improving Grants Management in the U.S. Virgin Islands Anya Groner Learn about how the U.S. Virgin Islands Department of Health streamlined grants management, as explained by its Chief Finance Officer Tatia Monell-Hewitt. Public health agencies have an important role in piecing together federal and local funding to support a comprehensive, cohesive array of programs and services for their communities. Optimal management of these funds ensures communities maintain access to these crucial initiatives. In the U.S. Virgin Islands (USVI), decentralized and inefficient processing coupled with high staff turnover caused delays in grant procurement that, at times, caused funds to go unspent. In the aftermath of Hurricanes Irma and Maria, Category 5 storms that devastated the islands in 2017, USVI Governor Albert Bryan Jr. sought assistance to manage and spend the federal funds available for the massive recovery process. In collaboration with ASTHO and the Department of the Interior, the territorial government began a three-year business process improvement initiative to streamline grants management. Nine agencies, including the governor’s office, came together to establish official grant and financial management systems, ensuring that federal funding could be accessed faster once approved. By maintaining a long-term vision, consistency of effort, and steadfast support from leadership and staff, USVI has been highly successful in streamlining the grants management process. Since the new system launched in 2023, initial sample data showed a range of 25-64% reductions across agencies in the time to set up federal grants, which enables the health agency to begin work sooner – highlighting what is possible with continual improvement. Furthermore, communication channels established through the business process improvement initiative have enabled interagency collaboration. This initiative built the foundations for improving grants management in USVI, and the Department of the Interior awarded additional funds to continue interagency communication, collaboration, and improvement to sustain the gains. In this interview, the USVI Department of Health’s Chief Finance Officer Tatia Monell-Hewitt discusses how changes to USVI’s grants management process and increased interagency collaboration impact public health. What prompted the update to USVI's grants management process? Was there a particular event or series of events? The update was prompted by the USVI’s Department of Health’s successful Business Process Improvement initiative in 2019-2021, along with a broader recognition of inefficiencies and inconsistencies in how federal grants were being managed across government agencies. An analysis of several grants conducted by ASTHO throughout government agencies revealed that, in some cases, the setup process from the receipt of a Notice of Award (NOA) to having the budget available online, could take up to 255 days or the better part of a year. These delays significantly hindered program execution and the timely drawdown of funds. The findings highlighted the urgent need for a streamlined and standardized grants management process. What were some of the biggest changes that you made to the grant process, and why are they so valuable? The most impactful changes include adoption of a standardized federal grant planning and setup process across the nine agencies defined as receiving the NOA to having an approved budget online. We moved from paper to an electronic process to improve transparency, speed, and accountability, and agreed to/established defined time frames for each step. Lastly, the creation of the Federal grant community of practice allowed for ongoing training, problem identification and resolution, and building process consistency across and within agencies. These improvements reduce delays, increase first-time accuracy, and enhance compliance, ultimately allowing agencies to deliver services to the community more quickly and effectively. The grants management process is often invisible to the public. Have USVI residents noticed the quicker turnaround? Yes! A more efficient grants management process has strengthened community trust in the U.S. Virgin Islands public health system. Improved customer satisfaction, faster service delivery, increased outreach participation, and more responsive agency communication have made a real difference. The community sees that the department is being a responsible steward of federal funds, which builds confidence in our ability to serve and protect. How did the improvements to the grants management process impact health agencies in particular? The Department of Health benefits from clearer roles and responsibilities in grant execution. That translates to quicker access to funding. A key example is the Epidemiology and Laboratory Capacity grant. The budget was approved and online within 30 days of the NOA. This enabled a swift response to the dengue outbreak that began in December 2024 on St. Thomas and St. John. Using real-time surveillance from the dengue dashboard, the epidemiology team targeted mosquito control efforts in hotspot communities. Supported by case mapping and proactive prevention strategies, the combined efforts — surveillance, lab testing, provider education and resource deployment — helped contain the outbreak and safeguard public health. How have partnerships strengthened health access and preparedness? Has that culture of collaboration and communication across government agencies continued in other projects? Absolutely. Agencies such as the Department of Health, Department of Human Services, Department of Finance, Department of Justice, and the Office of Management and Budget now coordinate processes, resolve issues collaboratively, and share training initiatives. Strong partnerships ensure that the Department of Health can align financial resources quickly to support health programs and improve access to care and emergency preparedness. Shared accountability has enabled timely and effective service delivery for the community. Have other improvements to grants management and agency coordination resulted from the business process improvement initiative? Definitely. The process has led to a uniform process across departments. Shared expectations include ongoing performance measures, a focus on timelines, a standard operating procedure checklist, and shared tools such as Adobe Acrobat Sign. Regular communication and updates shared in the community of practice meetings have made the grants management process more efficient, trainable, and adaptable to new challenges. What does the Department of Health’s grants management data collection show, and how does it use this data for continued improvement? The Department of Health uses a scorecard to track critical metrics such as milestone completion times, low spending rates, slow drawdowns, and the number of corrections needed. This data driven approach has helped us identify bottlenecks, guide training, and informed standard operating procedures. It has also highlighted programs that consistently manage their grants well. How do you see this work continuing over the long term? This work is built for long term sustainability. We’ve set up continuous education using the-train-the-trainer model, ongoing performance reviews and interagency meetings, and accountability by the community of practice and the cross-agency leadership team. We have a shared vision of efficiency and citizen-focused service delivery. What about this work are you most proud of? I am most proud of how multiple agencies came together to build a unified, efficient system. We've significantly shortened the time between the NOA and getting the budget online. We’ve established timeframes for each step of the grant procurement process — two days to receive the NOA, 10 days to adjust the spending plan, three days to obtain financial codes, seven days to submit the budget, and three days to get the budget online. That’s 25 days total for the entire grant turnaround. That alone has enabled us to serve our community much faster, which is what matters most. CDC-HHS - $1,000,000 article yes

For Emman Parian, Strong Partnerships Are at the Heart of Public Health Strong Partnerships Are at the Heart of Public Health Anya Groner Learn about Immunization Program Manager Emman Parian's approach to public health success: strong partnerships and collaboration. As immunization program manager for the Commonwealth Healthcare Corporation (CHCC) in the Commonwealth of the Northern Mariana Islands (CNMI), Emman Parian and his team work closely with a range of organizations: school systems, government agencies, private businesses, other Pacific Island jurisdictions, and national partners including ASTHO and the Association of Immunization Managers. Maintaining relationships through effective and regular communication sustains those networks and the communities they serve. Thus, the immunization program meets with partners regularly, basing the meeting frequency on partner’s roles and preferences. They also encourage off-island partners to visit in person so they can better understand the CNMI context. According to Parian, they rely on each other for their successes — a lesson he has learned throughout his public health career. Developing a Knack for Community Engagement In less than a decade, Parian has built an impressive career in public health. His journey began in 2018 as a student intern in public health at CHCC. Though he initially planned to become a nurse, his role offering support to community members with hypertension identification and control changed his trajectory. He was able to support people trying to navigate which services they could utilize to improve their health. When his internship ended, participants reported that his calls helped them manage their blood pressure and inspired them to make changes in their nutrition, medication compliance, and regular clinical visits — demonstrating Parian’s impact and providing him with fulfillment.   The Commonwealth Healthcare Corporation Immunization team attend a professional development workshop.   Discovering the Power of Collaboration The power of personal interactions inspired Parian to pursue a bachelor’s degree in health care management and a master’s degree in public health. When the COVID-19 pandemic began, he was shadowing CHCC’s CEO, Esther Muña, and corporate quality and performance manager, Halina Palacios, getting a front row seat as the organization’s leadership team developed their initial response to the pandemic. From this position, he learned effective strategies for addressing public health crises, like leveraging partnerships and building community trust, as well as approaches for successful workforce development. Eventually, he landed a permanent position as a vaccine specialist, managing storage, handling, and distribution of vaccines for the jurisdiction, then becoming the vaccine program coordinator overseeing the COVID-19 vaccination program for several years. Parian attributes his success to the supportive culture at CHCC where program managers and leadership regularly collaborate to align their missions for the benefit of the community. Making Advancements Through Outreach These days, Parian is a leader at CHCC, working as the immunization program manager for CNMI. Post-pandemic, vaccine hesitancy is on the rise. Parian’s team is responding by building trust through relationship-building activities and education. Emman Parian 1 - Strong Partnerships Are at the Heart of Public Health The team regularly visits villages, schools, health programs, and community centers, and even runs Saturday clinics/outreach events to ensure that all community members have the opportunity to get vaccinated. Efforts like these are particularly important given CNMI’s geography, which includes 14 islands, with three populated islands (Saipan, Tinian, and Rota). Even so, CNMI is in a better position to respond to future public health emergencies post-pandemic due to their expanded and improved partnerships and collaboration.   Parian attends a regional meeting with other Pacific Island managers and staff in Saipan.   Leading with Open Communication As a manager, Parian emulates the leadership models that he encountered early in his career. Open communication enabled Parian’s rise in the field, and he encourages discussion among his team. Whether feedback is positive or negative, Parian takes it into consideration. For him, leadership doesn’t mean dictating what your team does but instead working alongside them and being open-minded. That approach resonates. Emman Parian 2 - Strong Partnerships Are at the Heart of Public Health Building a leadership approach that works is important, as turnover can hinder programs due to lost institutional knowledge and a constant need to retrain employees. But lately, there’s less turnover. Parian notes that young people are increasingly invested in health care careers, a shift he attributes to recent health crises. Like him, they have a drive for outreach work and find fulfillment in it. Positioned for Future Public Health Success Strong collaboration builds the sustainability and infrastructure necessary for CHCC to succeed in their public health efforts. Should a new health crisis emerge, CHCC will be able to coordinate with partners to quickly identify resources, technical assistance, and subject matter experts. With strong teams and partnerships in place, Parian believes CHCC is ready for the future. article yes

Strengthening Public Health Systems: CNMI Food Safety Program Spotlight Strengthening Public Health Systems: CNMI Food Safety Spotlight Anya Groner, Taylor Francis Learn a few essential steps for strengthening public health systems, as exemplified by CNMI and their work to adopt the FDA Food Code. Public health systems are designed to protect and improve population health. These vital systems — from food safety programs to disease surveillance — help to prevent disease, respond to health threats, and ultimately improve well-being. To best benefit communities, public health agencies must remain committed to strengthening these existing systems. The Commonwealth of the Northern Mariana Islands (CNMI), a U.S. territory in the western Pacific with a population of approximately 50,000, models this work in their exceptional efforts to improve their food safety system. Managing the risks of foodborne illness requires clear guidelines, government support, and regulatory authority. Yet, when the Environmental Health Disease Prevention Program (EHDP), part of the Commonwealth Healthcare Corporation in CNMI, conducted a voluntary review of their food regulations, the jurisdiction met only a small percentage of the FDA retail program standards, which define what constitutes a highly effective and responsive program for the regulation of retail food establishments. From there, EHDP launched an ambitious plan for the jurisdiction to adopt the FDA Food Code for the first time. The EHDP Office spent several years analyzing the legal and technical implications of adopting the FDA Food Code and garnering leadership support. In November 2024, it was officially adopted — an extraordinary accomplishment. EHDP will now embark on a five-year implementation process which has a strong focus on training, technical assistance, and partnerships with local stakeholders — with an emphasis on education instead of enforcement. Their journey serves as an example for other jurisdictions working to strengthen their public health systems. Getting Started Building better systems starts with identifying opportunities to strengthen those already in place. When EHDP reviewed their existing local regulations against the 2017 FDA Food Code, they found that theirs fell short of the criteria related to risk factor interventions, good retail practices, and effective compliance and enforcement measures. This led to the realization that they needed to strengthen their food safety program and adopt their first FDA Food Code. Pangelinan 1 - CNMI Food Safety Program Spotlight By moving from their old code to the FDA code, EHDP shifted from a focus on basic sanitation to foodborne illness risk factors. With limited resources and staffing challenges, it was vital that the EHDP team knew where to focus their workload and how to streamline inspections. This change will also help EHDP better protect the public’s health. Measuring Progress As health agencies embark on building better systems, it’s vital to have a specific measure to assess progress against. EHDP spent several years working toward adopting the 2022 FDA Food Code. Their previous regulations were outdated, vague, and inconsistent. Plus, there was a lack of clarity around critical food safety practices, like cooking temperatures, cooling procedures, and sanitization. The retail food program standards gave the team a measure to assess their food safety program compared to other programs nationally and helped them better understand gaps. Getting Buy-In and Mobilizing Stakeholders Two additional essential steps are garnering support and coordinating action. For EHDP, there was a lot of training to get internal support not just within the team but also from leadership. Fortunately, the adoption process to implement new regulations was fairly smooth. Their next focus is building the infrastructure, training the staff, and ensuring that the local operators have access to the necessary equipment, supplies, and sample policies. They are also looking to offer certified Food Protection Manager training to food operators. EHDP plans to focus on small behavioral changes, making sure everyone’s on the same page with employee health so retail food establishments can meet the requirements on employee health and reporting. Every September, EHDP hosts food safety week as part of Food Safety Education Month and brings together food handlers and food operators — some of whom are familiar with the FDA Food Code due to working in the continental United States. The EDPH team always talks to them about potential changes that could come about from this new code and, so far, have received great feedback. Pangelinan 2 - CNMI Food Safety Program Spotlight Collaborating with Partners As with any effective public health initiative, collaborating with partners at all levels is crucial – as agencies can learn from others’ skills and experiences. At both the federal and local levels, EHDP worked closely with their FDA retail specialists who provided technical support and training throughout the process. The team also did a three-year mentorship with Northern Nevada Public Health, which helped them improve their field inspections and strengthen internal policies and procedures. These were the key steps in making progress towards the standards and preparing for adoption. In addition, ASTHO connected EHDP with other health departments who had gone through the food code adoption process, enabling them to hear their firsthand insights and practical guidance. The team is willing to support other Pacific Island jurisdictions, like American Samoa, as they work to adopt the FDA Food Code for the first time, too. Pangelinan 3 - CNMI Food Safety Program Spotlight Celebrating Successes It’s always important to take a step back and acknowledge wins throughout essential public health work. EHDP’s work towards the FDA Food Code strengthened the team's skills and expanded training opportunities, as they shifted from focusing on rules and regulations to risk-based inspection and partnering with food operators — emphasizing education, prevention, and collaboration, to get everyone on board. Their biggest success, however, is of course adopting their first FDA Food Code. Pangelinan 4 - CNMI Food Safety Program Spotlight In Conclusion Through EDPH’s efforts to improve their food safety program, they are reducing foodborne illness, protecting public health, and safeguarding their community. As exemplified in CNMI, improving public health systems takes time and hard work — but with that investment comes key successes that benefit communities for years to come. CDC-HHS - $1,000,000 article yes

Population Health Summit Strengthens Pacific Partnership Anya Groner Read about the inaugural Population Health Summit, which was held in the Commonwealth of the Northern Mariana Islands, and learn how it worked to improve collaboration in the Pacific. For Halina Palacios, chief operations officer of public health for the Commonwealth Healthcare Corporation, it was important to break the mold and host a public health summit in the Pacific instead of the Continental United States. She and her team held the corporation's inaugural Population Health Summit in the Commonwealth of the Northern Mariana Islands (CNMI). With firsthand knowledge of the notable work happening across the Pacific, Palacios hoped to create a venue where public health workers from U.S. territories and freely associated states could share their successes and learn from each other. Improving Pacific Collaboration and Confidence Regional collaboration is not new to the Pacific. During the COVID-19 pandemic, the U.S.-Affiliated Pacific Islands (USAPI) worked together to limit transmission until most of their populations could get vaccinated. Palacios knew that a summit hosted in CNMI would build on this existing regional collaboration. Public health summits are typically held in the continental United States and come with high travel costs, meaning that only one or two representatives from each jurisdiction can attend. As a result, the majority of Pacific public health teams don’t directly benefit from information sharing and networking at such conferences. Holding a summit within the region instead would lower those travel costs and boost attendance. In addition, Palacios felt a local summit would boost confidence in Pacific public health officials: The officials who were able to attend public health conferences in the continental United States sometimes told her they felt imposter syndrome, caused in part by the feeling of being in a tiny minority at a national event and from attending presentations that didn’t necessarily address local realities. Halina Palacios 1 - Population Health Summit Strengthens Pacific Partnership Turning Vision into Reality Putting together a conference is a massive undertaking, but Palacios knew her team could do it. They chose “Navigating Pathways Through the Pacific: Building Healthier and Stronger Island Communities” as the theme of the inaugural summit. Broad and ambitious, it encompassed Palacios’s expansive vision. She wanted the event to encourage public health programs across the Pacific to operate with a population health mindset, addressing not only individual medical concerns but also the social, economic, and environmental factors that influence community health outcomes. Spanning three days, the summit schedule included various plenaries, poster presentations, and panel discussions on behavioral health, public health, and clinical practice — centering topics relevant to the region. The team invited faith group leaders and members of recovery communities to speak alongside specialists from throughout the region. Halina Palacios 2 - Population Health Summit Strengthens Pacific Partnership   Population Health Summit Planning Committee members gather in front of a conference banner.   An Impactful Inaugural Event The inaugural summit occurred this past June in CNMI’s capital city, Saipan, and turnout was high. In addition to strong representation from CNMI, more than 50 people came from off-island to share resources, compare programs, and form new collaborations. Popular topics included data capacity, expanding approaches to behavioral health, technical assistance opportunities, and clinical resources. The impact was immediate. Halina Palacios 3 - Population Health Summit Strengthens Pacific Partnership Two speakers, Oncologist Peter Brett and Dentist Angelina Sabino, with clinics in their respective fields at the Commonwealth Healthcare Corporation, educated attendees on the realities they face treating the community. This session led to post-discussions, opening opportunities to collaborate with other USAPI on addressing oral cancer in the Pacific, which is especially important due to recent reductions in national surveillance, technical assistance, and funding for tobacco prevention programs. Island jurisdictions have high rates of oral cancer as a result of betel nut use with tobacco and high smoking rates — and with patients often seeking treatment in Guam, Hawaii, or elsewhere in Asia, the team knew it was a topic that the summit needed to cover. Another topic of particular interest was research and accountability. A panel discussion, which included Palacios, sought to improve data collection and research across the region. Participants noted the need for a centralized Institutional Review Board in CNMI to review and monitor research on human subjects. Without it, health officials can’t easily standardize research methods and practices. Panelists also expressed a need to set higher expectations for researchers who conduct studies using data from the Pacific Island jurisdictions; many fail to meaningfully share the results of their work with participants or public health teams, often doing little more than emailing a link to an article or a Zoom presentation. Halina Palacios 4 - Population Health Summit Strengthens Pacific Partnership The Population Health Summit purposefully centered on Pacific Island culture — each day, it opened and ended with a prayer. Instead of being part of a tiny minority at a large conference on the mainland, participants saw themselves represented in the daily schedule, with presenters from within their community, speaking on topics that addressed their concerns.   A large group of Population Health Summit attendees convene in a conference room.   Looking Ahead Though only a few months have passed since the summit, new projects and collaborations are underway. Some attendees are contacting presenters to schedule training sessions for staff who couldn’t attend. Others are sharing resources on topics such as men’s behavioral health and accountability. Most encouraging for Palacios are the conversations about the next population health summit: who will host it, when it will be, and what the presentation topics might be. Over the next five years, a new cohort of public health workers will start their careers in CNMI and across the Pacific Island jurisdictions. By then, Palacios predicts that the Population Health Summit will be well established and that standards for the profession will have shifted. Halina Palacios 5 - Population Health Summit Strengthens Pacific Partnership CDC-HHS - $1,000,000 article yes