AMERICAN SAMOA–WHO Country Cooperation Strategy 2018–2022
OVERVIEW American Samoa comprises five volcanic islands and two atolls covering 199 square kilometres in the South Pacific Ocean. American Samoa is an unincorporated and unorganized territory of the United States of America – the furthest United States territory to the east and south of the equator. Its population was 55 519 in 2010, a decrease of 3.1% since 2000. The head of government is the governor who is elected by popular vote every four years. Major economic activities in American Samoa include tuna canning and handicrafts. In 2010, it was estimated that over 90% of the population resided in urban areas.
HEALTH AND DEVELOPMENT The Department of Public Health is responsible for public health issues, communicable disease control and health services at district and community levels. The national hospital, Lyndon B. Johnson Tropical Medical Center in Pago Pago, is managed by a hospital board and is subject to the rules and regulations of the United States of America. Noncommunicable diseases (NCDs) are the main cause of premature illness and death. Key risk factors for NCDs are prevalent. Limitations on human and financial resources impair institutional capacity to implement comprehensive strategies for NCDs. To strengthen the local public health workforce, good training opportunities need to be made available at home and abroad. The health services delivery model needs to be reoriented to respond to the burden of NCDs including by balancing the curative and preventive health needs of the population. American Samoa is also vulnerable to emerging and re-emerging infectious diseases including dengue, chikungunya and Zika. Ongoing challenges in emergency management include local capacity for epidemiologic surveillance, laboratory capacity and risk communications.
NATIONAL STRATEGIC PRIORITIES WHO AND THE GOVERNMENT 2018–2022 The World Health Organization (WHO), working with partners, will support the Government in pursuing its national strategic priorities. Each strategic activity is linked to at least one of the subregional focus areas that are detailed in the Pacific Island Countries and Areas–WHO Cooperation Strategy 2018–2022:
1. To set the strategic public health agenda 1.1 Facilitate policy dialogue on the strategic direction of the health sector and the role of health partners to deliver on it. 1.2 Strengthen collaboration with partners. 1.3 Contribute to the annual health forum agenda and delivery. 2. To plan and implement the health sector agenda 2.1 Improve whole-of-sector coordination and planning to implement the Strategic Action Plan for Non-Communicable Disease Prevention and Control (2013–2018). 2.2 Implement the NCD monitoring framework for American Samoa by establishing and strengthening monitoring and surveillance of NCD risk factors and behaviours. 2.3 Improve coverage of essential NCD interventions at the primary and secondary level through adoption of the Package of Essential Noncommunicable (PEN) Diseases Interventions for Primary Health Care in Low-Resource Settings protocols, service delivery plans, treatment guidelines and capacity-building. 3. To develop capacity across the health sector to address ongoing and emerging challenges 3.1 Identify imbalances in health workforce and target areas to improve the delivery of priority public health and clinical services. 3.2 Identify and promote health workforce performance, quality and retention. 3.3 Develop and enact legislation and regulations to promote health workforce performance, quality and retention. 3.4 Match continuing professional development opportunities with health workforce needs (e.g. through Pacific Open Learning Health Net, fellowships and specialized training). 3.5 Build core capacities for International Health Regulations (2005) with Asia Pacific Strategy for Emerging Diseases and Public Health Emergencies III as a framework to strengthen epidemiologic surveillance, laboratory capacity and risk communication.
NATIONAL HEALTH POLICY Currently there are no overarching health or development strategies in American Samoa, although in 2010 there were moves to develop a territory health plan. American Samoa’s Strategic Action Plan for Non-Communicable Disease Prevention and Control (2013–2018) recognizes that development can only be achieved through improved NCD prevention and management. The plan’s strategic framework includes supportive environments (policy change), healthy lifestyle promotion, appropriate clinical services, community mobilization through advocacy and communication, and evidence-based action using surveillance and monitoring. Priority, or “best buy”, interventions include policy and advocacy targeting behavioural risk factors such as unhealthy diet, tobacco and alcohol use. The plan also highlights the need for better primary and secondary prevention of cardiovascular diseases, diabetes and cancers.
PARTNERS In implementing this country cooperation strategy, WHO and the Department of Public Health will work with other government departments, other sectors, academia, civil society, other United Nations agencies, bilateral development partners, regional and global health initiatives, philanthropic foundations and others in support of planned national health priorities.
HEALTHY ISLANDS INDICATORS Number of skilled health workers* per 10 000 population Per capita total expenditure on health at average exchange rate (US$) Total expenditure on health as a percentage of gross domestic product (%) Tuberculosis incidence (per 100 000 population) Life expectancy at birth (both sexes) Under-five mortality rate (per 1000 live births) Absolute number of maternal deaths Maternal mortality ratio (per 100 000 live births) Adult mortality rate from NCDs at ages 30–69 years (%) Number of suicides Immunization coverage rate for diphtheria-tetanus-pertussis (three doses) (DTP3) (%) Immunization coverage rate for measles-containing vaccine (first dose) (MCV1) (%) Current tobacco smoking among persons 15 years of age and over (%) Population using improved drinking-water sources (%) Population using improved sanitation facilities (%) Proportion of endemic neglected tropical diseases (NTDs) having reached elimination goals envisaged in the global NTD Roadmap to 2020 (%) – target 100% NA = not available *Skilled health workers are defined as physicians, nurses and midwives.
28.3 546.4 NA 6 73 9.4 0 86.1 22 3 94 86 NA 100 63 0
2003 2003
2009 2012 2012 2010-12 2013 2010-12 2014 2008 2008
2012 2012 2017
WPRO/2017/DPM/006 © World Health Organization 2017 Some rights reserved. This work is available under the CC BY-NC-SA 3.0 IGO licence. Photo credits Cover: ©AFP
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