Located in the heart of the Pacific Ocean, the Federated States of Micronesia (FSM) is an independent nation comprising over 600 islands known for their abundance of cultures and traditions. However, despite the nation’s wide range of cultural diversity, the FSM grapples with significant challenges in the realm of health care. In 2021, the World Bank reported that 41.2% of Micronesians were living below the basic needs poverty line, underscoring the urgent need for improved health care access. Overall, five prominent challenges hinder access to health care in Micronesia and highlight ongoing efforts to enhance the country’s national health policy. 

Access to Health Care in Micronesia

1. State Constraints: The FSM operates under the Compact of Free Association States (COFA), which grants the nation financial assistance and access to U.S. domestic programs in exchange for exclusive military access and defense responsibilities. While the COFA initially provided Micronesians access to Med-QUEST, the state’s managed care Medicaid program, inadequate funding and inconsistent state efforts to reduce health care coverage have left citizens uncertain about their entitlements. This confusion has hindered many Micronesians and health care providers from accessing quality healthcare.
2. Economic and Demographic Factors: Despite exponential economic growth in recent years, Micronesia remains dependent on foreign aid due to limited natural resources. Initially, in 2010, public health was estimated to be around 20% of the FSM government’s total expenditure. However, in 2019, health expenditures dropped to only 11% of Micronesia’s GDP, reflecting challenges in accessibility to health care in Micronesia which can be attributed to the shrinking labor force and reduced government budgeting. The allure of better opportunities in other regions has led to a considerable exodus of Micronesian health care workers seeking higher compensation, which has further exacerbated the issue of strained health care resources for those in need. 
3. Health Care Infrastructure: Severe disparities exist in FSM infrastructure and essential resources, with some areas provided with better access than others. A majority of the population relies on a public health care system that is regulated by the state. To compensate for the lack of funding and the unequal distribution of health care, a growing number of traditional healers have attempted to persist alongside public health care services, providing health care attuned to cultural competency. 
4. Non-Communicable and Infectious Diseases: Micronesia grapples with a high prevalence of non-communicable diseases, with cardiovascular diseases, diabetes, and obesity being major contributors to the country’s health crisis. Additionally, despite successful vaccination efforts against infectious diseases, tuberculosis, leprosy, and occasional cholera outbreaks continue to sweep across the nation. Addressing these challenges requires a comprehensive strategy and increased awareness that cannot be achieved without advancements in health care. 
5. Extreme Weather Conditions: Located in tropical regions, the FSM is subject to recurring extreme weather conditions, including periodical heavy rains, typhoons, and monsoons. Emergency health care, particularly Emergency Medical Technicians (EMTs), are crucial during disasters. The need for organized emergency health care in Micronesia highlights the importance of preparedness and training beyond standard hospital practices for local medical practitioners.

Health Aid Strategies

In response to these challenges, the World Health Organization (WHO) has actively engaged in planning and programming medical and public health care within the FSM. The WHO Country Cooperation Strategy, spanning from 2018 to 2022, has played a pivotal role in collaborating with the FSM to prioritize the education and retention of a stable health care workforce and achieve national health goals. 

The WHO Country Cooperation Strategy has made significant progress in addressing challenges to Micronesian health care. Early disease detection and prevention efforts, including the intensification of medical screenings, have reduced communicable diseases. The establishment of a robust risk communication system has enhanced the FSM’s preparedness for natural disasters. The Dispensary Strengthening Program, part of the WHO-FSM government partnership, has proven successful in improving health care infrastructure. Outreach activities in remote villages have provided essential health services, detected illnesses and connected patient data to hospital information systems.

While the precise quantifiable impact of the WHO Country Cooperation Strategy in Micronesia remains elusive, there is a discernible trend of improved health conditions across the Western Pacific Region. Death caused by tuberculosis in the Western Pacific Region has dropped by 42% between 2000-2021, while the number of people infected by this disease were reduced to at least 17%. In 2022, 75% of the Micronesian population was reported to have received Bacillus Calmette-Guérin (BCG) vaccination against tuberculosis. There has also been a significant decline in reported cases of other vaccine-preventable diseases and a rise of immunization coverage among Micronesians. Between 2019-2022, the number of reported leprosy cases in the FSM had dropped from 144 to 92 people per year. 

Looking Ahead: A Secure Health Workforce

In 2023, the WHO organized a workshop for health management in the Western Pacific region to help the FSM address the issue of the excessive outmigration of qualified health professionals. The workshop proposed several solutions, two of which were intended to produce tangible results: the standardization of salaries across the different states and the improvement of training of its health workforce.

Health care in Micronesia still has opportunities for growth and improvement. Through their commitment to address prevailing issues and make long-lasting change, the WHO and other aid-focused organizations are currently working to provide Micronesians with a positive outlook for their future.

– Naomi Ronner
Photo: Flickr