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Centralizing Administrative Functions, with Lessons Learned from Guam Megan Drake-Pereyra Centralizing administrative functions, such as procurement or grants management, is a strategy many organizations utilize. Having administrative functions concentrated with a specific team rather than dispersed or managed within separate teams can work well. There is potential for standardized processes and procedures, increased efficiency and quality, more control and accountability, and consistent data collection and monitoring. This brief details how health departments can utilize existing, evidence-based frameworks to centralize administrative functions and build off lessons learned from others, such as the Guam Department of Public Health and Social Services (Guam DPHSS). Getting Started Considerations When transitioning from a decentralized structure to a centralized structure, it is important to clearly outline the what, why, how, and benefits. Consider the following components to kickstart success: Leadership vision: Start with the leader’s visionary perspective. When the leader allocates sufficient time and consistently reinforces the vision, it allows for the necessary decisions, trust, and support to be established during the transition. Data-driven design: Use data and existing information, such as current standard operating procedures or process diagrams, to understand the decentralized process differences/similarities, and guide effective centralized processes and procedures. Role clarity: Clearly outline and define the new centralized infrastructure, purpose, roles, responsibilities, expectations, and procedures. This helps everyone understand and follow the new processes more consistently, with better results. Performance measures: Establish and use performance measures from the outset (e.g., team knowledge, skills, competency, process time and quality, outcomes, impact, etc.), for insight into the value, or return on investment, of the centralized model. This will help indicate the quantity, quality, and impact of programs/processes. Documentation: Capture and share decisions, vision, goals, structure, standard operating procedures, and relevant details in writing for new team members and users of the centralized functions. Communication: Transparently share plans, timelines, and additional knowledge to maximize utilization and value. Additionally, anticipate and proactively address resistance to change to help everyone embrace and adhere to the new, centralized approach. The Plan-Do-Study-Act Method Change management, quality planning, and process improvement models can also support organizational and process change. For example, the quality improvement methodology, Plan-Do-Study-Act (PDSA), offers an effective framework for centralizing administrative functions and complements many of the aforementioned considerations: Step one, plan, relies on leaders to decide the vision, scope, structure, roles/responsibilities, goals, and purpose of the centralized team. Here leaders establish and reinforce the leadership vision, using existing data to guide the design of the new centralized team. Step two, do, is dedicated to onboarding centralized team members, defining their work processes and procedures, and ensuring effective communication with all stakeholders. This requires thorough documentation and strong communications plans. Step three, study—an often overlooked but crucial building step—is for testing the processes, procedures, roles, and responsibilities, to confirm and build confidence that this centralized structure will yield the desired results. Performance measures provide clarity into what is working well and what is not. Step four, act, is for launching and rolling out the structure, ongoing monitoring of performance, and continuing to educate and coach for successful, sustainable improvements. Lessons Learned from Guam Guam DPHSS, a joint health and social services agency, is working to centralize its administrative functions to reduce inefficiencies and redundancies as well as improve quality and consistency. This has been a big change for Guam DPHSS, but leadership vision, documentation, role clarity, and communication have proven to be key throughout the process. In 2021, Guam DPHSS established a centralized Office of Grants Management (OGM). In its early stages, programmatic teams saw OGM as a regulatory body that would audit and direct their work, while OGM’s true objective was to provide support and ease administrative burden, allowing program staff to focus on accomplishing their goals and deliverables. By clarifying and documenting the vision, roles, and responsibilities as well as focusing on communication, the OGM built trust, addressed specific concerns, and established a shared vision of their role as supportive and helpful. In 2023, Guam DPHSS began the process of establishing a centralized Procurement Management Office (PMO). While Guam DPHSS reorganized and co-located staff into the new, centralized PMO, Guam was undergoing a governmentwide business process improvement (BPI) project focused on procurement—presenting an opportunity for Guam DPHSS to involve new PMO staff and other key DPHSS team members in improving its functions and centralizing the procurement process. Through the BPI project, which utilized PDSA, DPHSS clarified roles and responsibilities, defined work processes and procedures, and developed training and communications plans that supported process improvement and centralization of procurement functions. Guam DPHSS has learned many lessons throughout their journey to create a centralized OGM and PMO, including that change of this magnitude is hard—more specifically, balancing change management while ensuring maintenance of key operations. Ultimately, they found that the aforementioned considerations and methods for getting started were critical in supporting the change to centralized administrative functions. Establishing the Ideal Structure for Administrative Functions Determining if and how centralized administrative functions will work for an organization is multifaceted. An organization’s culture, size, infrastructure (including technology and systems), and workforce and skills all play crucial roles in shaping the ideal structure. The methods and considerations noted previously can help health departments determine and support the best path forward for each unique organization. ASTHO has several additional resources and tools that can support administrative change and improvement. Visit the ASTHO STAR Center to learn more. website yes

Strengthening Maternal and Infant Health Data in the U.S. Territories ASTHO, association of state and territorial health officials, maternal and infant health data, U.S. territories, public health, surveillance programs, pregnancy risk assessment monitoring system, improving the health, live births, health problems, reproductive health, federal government, toggle the centers for disease control and prevention cdc, risk assessment monitoring system, assessment monitoring system prams, pregnancy risk assessment monitoring, maternal and infant health, information collected, table of contents, population based, health status, supreme court, prams data, toggle the table, risk factors, prenatal care, collecting information Stephany Strahle The U.S. territories—Puerto Rico (PR), U.S. Virgin Islands (USVI), Guam, Commonwealth of the Northern Mariana Islands (CNMI), and American Samoa—are largely excluded from most statistical data systems in the United States. This gap leaves island health leaders, national partners, and federal agencies without the surveillance necessary to inform timely and robust public health programs and policies. This is also seen in critical maternal and child health surveillance programs like the Pregnancy Risk Assessment Monitoring System (PRAMS), Maternal Mortality Review Committees, and the Pregnancy Mortality Surveillance System, which either do not include or only recently included territories in their scope of coverage. This incomplete information creates challenges in identifying the aspects health systems need to address to reduce adverse maternal and infant health outcomes. Applying a life course perspective to maternal and infant health data reveals gaps in public health systems that impact outcomes before, during, and after birth. PRAMS provides vital insights into these lived experiences and pregnant people’s interactions with health care services. PRAMS data can also be linked to other administrative datasets, such as Medicaid, child welfare services, and Community Healthy Start programs, to provide a broader understanding of determinants of health across the life course for both the birthing parent and their child. With the breadth of contextual experiences that PRAMS captures in its data and the potential for data linkage projects to explore outcomes and their contributing factors, U.S. territories can leverage this wealth of information to assess the needs of their pregnant communities and their children. Despite its development in 1987, PRAMS has been implemented in only two territories, PR and CNMI, within the past decade. This brief highlights the work of these two islands and the potential to gain further insights into maternal and infant health outcomes using data linkage methods. Island Expansion of Maternal and Infant Health Surveillance Using PRAMS Since beginning PRAMS data collection in 2017, PR has made considerable strides in providing their communities with comprehensive reports on various topics. In 2021, one in eight live births was preterm in PR—the U.S. average is one in 10 live births. This outcome is one example of a potential research area in PR that could leverage PRAMS linkages to clinical administrative data sources to investigate contributing factors. In a special project conducted from 2016 to 2018, PRAMS served as an avenue for assessment of Zika awareness among pregnant people and their partners. Moreover, PRAMS informed numerous reports and educational materials on topics ranging from dental care to lactation and opioid use during pregnancy. Linking PRAMS to other administrative datasets could illuminate more information about health care utilization and access among pregnant people in PR. Although limited research exists on maternal and infant health outcomes in CNMI, available evidence reveals disparities in preterm birth among the territory’s indigenous Chamorro and Carolinian communities and Asian and Pacific Islander groups. Since CNMI started administering PRAMS in 2021, strong relationships with entities outside the territory (e.g., the Hawaii Department of Health) have facilitated PRAMS implementation by helping navigate Internal Review Board regulations and applications—both of which are necessary to conduct PRAMS collection and potential research using PRAMS data, like data linkage projects. Moreover, the CNMI PRAMS team’s deep familiarity with their communities could help identify local administrative data sources that, when linked to PRAMS, capture priority areas for improved health care and social service delivery. Considerations for Future Maternal and Infant Health Data Exploration With the existing gaps in surveillance data available for maternal and infant health, this recent implementation of PRAMS and the potential for data linkages to other data sources could provide enhanced insights for U.S. territories. The following considerations can inform best practices to optimize this data. Building Partnerships to Support a Linked Maternal and Infant Health Data Network To build capacity for further data exploration, building partnerships with other agencies and PRAMS jurisdictions can facilitate the information-sharing necessary to navigate data use agreements and other considerations before successfully linking data. Leveraging these connections can also supply more avenues to administer educational tools about PRAMS and perinatal services, linking their pregnant populations to the services they need. A robust web of partnerships can create a network of linked data capturing the life course perspective to inform high-quality programs for the ongoing care of pregnant people and their infants. Leveraging Community Input and Data on Social Determinants of Health Territories are uniquely positioned to leverage closer community ties to examine how data linkages can inform initiatives that improve experiences surrounding pregnancy and the life course after birth. As with PR, integrating the voices of pregnant people, their families, and the people providing their care into their advisory committees allows for better identification of what communities need. Active engagement ensures agencies can be efficient with their linkage efforts by tailoring their projects to high-priority maternal and infant health outcomes. Moreover, to foster community awareness about PRAMS and possible linked data sources, territories could create dashboards such as those created by Washington D.C.’s PRAMS program to provide a comprehensive and interactive view of the data. Data on social determinants of health collected through PRAMS—such as insurance coverage throughout pregnancy and postpartum as well as access to social support and a wide range of services—can also be leveraged for potential data linkage to identify inequities in health outcomes and the delivery of care. website yes

Heart disease and stroke are the leading causes of death in Guam, Palau, and the Commonwealth of the Northern Mariana Islands. These jurisdictions are taking innovative steps to reduce hypertension among their populations.

Collecting and sharing data are crucially important to improving health equity, because those datasets inform effective policymaking. Despite having some of the most challenging population health outcomes, the U.S. island areas are often absent within federal public health datasets.Federal, island, and nonprofit partners should prioritize efforts to increase their inclusion.

Learn how increasing the use of indirect cost rates in the territories and freely associated states can help improve public health financing in these jurisdictions.

Establishing an Office of Health Equity or Minority Health Learn how to establish, structure, and fund a health equity or minority health office. A dedicated office of health equity or minority health can provide a focus on cross-cutting efforts and strategies that help to improve services, outreach, and engagement with marginalized communities. This report delves into the typical scope for setting up a health equity or minority health office, including how to establish, structure, and fund it—providing a blueprint to island areas working to build one or considering establishing one in the future. In addition, it explores lessons learned from state offices of health equity or minority health, including California, Michigan, Nebraska, Nevada, New Jersey, New York, Ohio, Vermont, and Washington. Get the Report (PDF) website yes

This report aims to highlight the unique vector-borne disease challenges faced by Island Areas and to dive into the key components of a mosquito control program, that are relevant to these unique jurisdictions.

Learn more about current and upcoming public health trends through ASTHO's annual Environmental Scan.

Engage in meaningful dialogue in island grantor/grantee relationships, with support from these sample questions and comments.

Leveraging the NIH Bookshelf to Showcase Health Agency Research Island Areas Workgroup, Data Capacity Subgroup Learn how to submit your health agency research to the NIH Bookshelf to increase visibility and expand reach. If you’re looking to strengthen ties with the academic community and increase the visibility of your public health agency’s published population health reports, consider submitting them to the National Institute of Health’s Bookshelf platform. This free, searchable collection feeds into the PubMed database and accepts “gray literature,” or research produced outside of traditional commercial or academic publications. It is a great opportunity for public health agencies to expand their reach. Application and Review Process Submit content Initial screening Scientific review Technical review Publication Before submitting your content, make sure it meets Bookshelf requirements: Is your content: Full text (a full report, not just an abstract or data) with an executive summary or abstract? Aligned with at least one of the subjects priotitized by Bookshelf? Written in English? Accessible via a PDF/Word Document or online via a web link? While drafting the document, did you undergo some sort of peer review process? (E.g., an advisory council reviewed, offered feedback, and approved the final draft.) The peer review process must be publicly documented within the content, in a separate document, or via a description on the website. If you answered yes to the previous questions, follow these steps to apply: Download and complete the application for a single title or application spreadsheet for multiple titles. Complete publisher information sheet (if you are new to submitting to Bookshelf). Email your application to bookshelf@ncbi.nlm.nih.gov. Other information you will include in your application: Title of content. PDF/Word Document or URL where content can be accessed. Publishing information (name, management, qualifications, policies). Short author/editor biographies or CVs (1-2 pages). Resources for writing a professional CV (PH resume and examples). Copyright information. Abstract or summary. If you have questions about the application process or the suitability of your content, please contact bookshelf@ncbi.nlm.nih.gov. Note: If you have been publishing related content for at least two years, Bookshelf may review your content as a collection. This means any future materials may be added to the collection without an additional application. Once you have submitted your content: Initial Screening: Bookshelf staff checks that your application is complete and meets the minimum submission requirements. If Bookshelf staff have questions, they will contact you. Be ensure the project point of contact is responsive to inquiries, as timely responses are critical to moving your application forward without delays. If all submission requirements have been met, your content will move into the Scientific Quality Review. Scientific Quality Review: Bookshelf staff will assess whether your content meets the platform’s scientific standards (e.g., whether its content is substantive and valuable). Your content will either pass or fail this review; there is no opportunity to revise in response to feedback. If rejected, you may resubmit the content after two years. If your content passes this review, it will move to the technical review. Technical Review: Bookshelf staff will assess whether your content meets the platform’s technical requirements (e.g., an XML document with proper formatting and accessibility). This is typically the longest stage of the process, as there can be some back and forth between Bookshelf staff and applicants, as applicants strive to address any technical issues with the content. An applicant can contract with a commercial vendor to produce the necessary XML document, if needed. If your content is accepted: Bookshelf will give you an opportunity to preview the content. Make sure you’re comfortable with how the content looks, as this preview represents how the content will look on the platform. Ensure there are no typos or formatting issues! Sign the participation agreement, discussing questions with NIH Bookshelf staff as relevant. Celebrate your success, and share the link with peers and partners! Additional Resources from NIH How to Include Content in Bookshelf: Summarizes the Bookshelf application process. Bookshelf Copyright Notice: Summarizes relevant copyright restrictions that apply to Bookshelf. NLM Retention Policy: Summarizes the National Library of Medicine’s retention policies, which apply to Bookshelf. Background This product was created by the Island Areas Workgroup (IAW) — Data Capacity Subgroup. Established in October 2021, IAW brings together representatives from island jurisdictions, federal agencies, and trusted partners to address key administrative challenges impacting health outcomes in island jurisdictions, including efforts to strengthen procedures and organizational policies affecting health financing, data capacity, and workforce development. The Data Capacity Subgroup drafted this resource to support territorial and freely associated state public health leadership and researchers in their efforts to expand the reach of local population health data and research. OE22-2203 and PW-24-0080 article yes

Island Areas Workgroup: Methodology for Annual Reports Island Areas Workgroup Overview The Island Areas Workgroup (IAW) seeks to improve health outcomes for U.S. territories and freely associated states (T/FAS) through local and federal departmental coordination and administrative change. It brings together leaders from island jurisdictions, federal agencies, and partners to find solutions that can optimize the procedures, organizational policies, and programmatic structures surrounding island health programming. It is hosted by the Island Support Team at the Association of State and Territorial Health Officials, a nonprofit membership organization whose members include the chief health officials of the U.S. states, Washington, D.C., territories, and freely associated states. IAW maintains three subgroups focused on health financing, data capacity, and workforce. These subgroups are responsible for creating deliverables each IAW year, which runs from November to October. Subgroups typically contain island health agency staff, U.S. federal agency staff, non-profit partners, and academic partners. Process: Creating IAW Reports Priority Selection: In the first few months of each IAW year, IAW subgroups discuss and vote on where to devote their energy over the coming nine months. Each subgroup is responsible for creating a deliverable — such as a report — by October of the following year. Research, Drafting, and Review: When a subgroup chooses to produce a report… ASTHO staff lead the research process, which has included surveys and informational interviews, as well as analyses of publicly available data. Subgroup members guide data collection and participate in surveys/interviews as appropriate. ASTHO presents draft reports back to the subgroup approximately three months before the end of the IAW year. The goal of subgroup review is to ensure accuracy and representativeness, and to generate recommendations based on research findings. Subgroup members review and share feedback on the reports during subgroup meetings. Subgroup meetings typically include 15-25 people representing island health agency staff, federal agency staff, and nonprofit/academic organizations. Subgroup members self-select into their subgroup and are united by a shared vision of improving administrative and operational policies at the local and federal levels to improve island health outcomes. Reports also circulate via email to all subgroup members, allowing participants to provide private feedback to the ASTHO team or reply all with more public commentary. This subgroup repeats this process for subsequent report drafts, as relevant. Subgroup participants review and clear the final report, with final approval from subgroup leaders (who are not ASTHO staff). After the subgroup approves the report, ASTHO’s Content Development team copy edits and provides editorial feedback as appropriate. Sample: Review Process for the October 2024 Report, “Addressing Island Participation in Six Priority Federal Public Health Datasets: Report Addendum” As of December 2024, there were 56 participants in the IAW Data Capacity Subgroup. These participants self-selected into the group with a common interest in strengthening island-relevant data structures. The group consists of: 19 island representatives, with at least one representative from each of the eight T/FAS. These representatives work in the public health agency or partner agency (e.g., Ministry of Finance) in these jurisdictions and are involved in collecting and reporting data. 28 federal representatives, with participants from various departments and agencies involved in maintaining or reviewing federal public health datasets, including HHS, DOI, EPA, GAO, and Census. Nine academic or nonprofit representatives who collectively represent three academic institutions and four nonprofits. These partners use island data and/or offer technical assistance to support island data capacity. From December 2023 through March 2024, the subgroup brainstormed, discussed, and ultimately voted on where to devote its energy during the third year of IAW (November 2023 through October 2024 ). The group elected to research barriers affecting island participation in six federal public health datasets: the National Vital Statistics System, the Behavioral Risk Factor Surveillance System, the Youth Risk Behavior Surveillance System, the National Notifiable Disease Surveillance System, the Pregnancy Mortality Surveillance System, and the National Youth Tobacco Survey. From March – August 2024, research proceeded through several avenues: Subgroup participants provided feedback on island participation in each dataset in monthly subgroup meetings and email. Additional 1:1 informal interviews with CDC and partner staff addressed knowledge gaps identified among subgroup members. Outside monthly meetings, ASTHO staff led the research into administrative requirements associated with each dataset, including an analysis of public information on the CDC website, publications featuring that dataset, and outreach to administrative staff associated with each dataset. Drafting and review of the final report: The IAW data capacity subgroup received a first draft of the report in August. They provided feedback during the monthly meeting and via email, with prioritized T/FAS representative feedback to ensure report accuracy. Members could share feedback anonymously (to the group, not to ASTHO) via email, while discussions during meetings provided opportunities for public feedback. The IAW data capacity subgroup received the second draft of the report in September, and gathered feedback via email and over the course of two additional meetings. Subgroup leadership approved the final report (i.e., Janis Valmond, MS, MPH, DrPH, CHES®, Deputy Commissioner of the USVI Department of Health, and Ted Trimble, MD, MPH, Senior Advisor for Global HPV and Cervical Cancer Control, Center for Global Health, National Cancer Institute, NIH) in October 2024, and presented to the full IAW at the Year 3 Closeout Call on Oct. 7, 2024. ASTHO published the report on its website later that month. article yes

Technical assistance for procuring software to support data dashboard development.

This report shares Puerto Rico’s strategy and recommendations for developing a social determinants of health dashboard.

Explore ASTHO’s policy support for U.S. territories and freely associated states, helping address health challenges and advance equity through strategic partnerships.

U.S. Territories and Freely Associated States Supporting U.S. Territories and Freely Associated States Association of state and territorial health officials, astho, us territories, improve population and community health, freely associated states, territorial support, public health territorial support, insular areas, island jurisdictions, pacific and Atlantic jurisdictions, population health needs, public health services, territorial health officials, Medicaid in the territories, Medicaid financing for us territories, public health topics, insular areas, health equity, freely associated states, federated states of micronesia, guam behavioral health and wellness center, free association with the united states, united states territories, world health organization, public health services, guam behavioral health, american samoa, advance health equity, united states, compacts of free, republic of palau, marshall islands, pacific islands, permanently inhabited, northern mariana islands, health disparities, health services, public health system, virgin islands, free association with the united states, wake island, public health, health and wellness center, 50 states, federated states of micronesia fsm Find tools designed to support U.S. territories and freely associated states in addressing their unique public health needs. ASTHO supports public health leaders across the U.S. territories and freely associated states — including the chief health officials (ASTHO members) — in their efforts to improve the health and well-being of their communities. The territories are under the jurisdiction of the U.S. government, while the freely associated states are independent nations that have entered into Compacts of Free Association with the United States. Note: ASTHO collectively refers to these eight jurisdictions as the territories and freely associated states, T/FAS, island areas, or island jurisdictions. article

Easily download web pages for offline access, allowing you to view ASTHO resources anytime, even with limited internet. Follow our instructions tailored for your device and browser.

Island Areas Glossary Use this guide as a quick reference for unique terminology related to the U.S. territories and freely associated states. The U.S. territories and freely associated states (T/FAS) come with their own unique terminology. This page is designed as a quick reference to get new readers up to speed or give old hands a referesher. All entries are alphabetical. If you are looking for something specific, hit "Control+F" to open a search box in your browser's window. <!--   --> website False

Get insight into the successes and challenges of integrating race/ethnicity data in public health and future directions in this field.

This blog describes public health legislation introduced during the Island Areas’ 2024 legislative sessions.

Learn how CNMI and Palau successfully "planned to plan" in an effort to update and develop new public health plans—developing readiness assessments, team charters, and sequencing plans.