Kagman Community Health Center
The CNMI Community Health Center was established in 2005 with the mission To provide the residents of District 10 and surrounding villages comprehensive health services, including medical, mental, dental, and home health care. To provide these services without discrimination, and to respect and honor the dignity and rights of each patient, regardless of the patient’s ability to pay.
Kagman is located on Saipan, in the Commonwealth of the Northern Mariana Islands (CNMI), a U.S. Commonwealth formed in 1978. Prior to 1978, the Northern Mariana Islands were included in the post-WWII designation of the U.S. Trust Territory of the Pacific Islands, incorporating all of Micronesia except for Guam. The CNMI is comprised of 14 islands with a total land area of 176.5 square miles spread out over 264,000 square miles of the Pacific Ocean, approximately 3,700 miles west of Hawaii, 1,300 miles from Japan, and 125 miles north of Guam. The CNMI’s population lives primarily on three islands; Saipan, the largest and most populated island, 12.5 miles long and 5.5 miles wide, as well as Tinian and Rota, which lie between Saipan and Guam.
The CNMI’s total area could be compared to two and half times the size of Washington, D.C. The nearest U.S. tertiary medical center for referral is in Honolulu, Hawaii, which is over eight hours away by air. The isolation and disparities apparent in the CNMI create unique and challenging barriers to a struggling health care system.
The CNMI’s residents (excluding foreign contract workers) are U.S. citizens but do not vote in federal elections. In addition to funds received from the U.S., the economy of the CNMI depends in large part on tourism from Japan and other Asian countries. Revenue from tourism has declined significantly in recent years with the downturn of the Asian economy.
According to the 2000 U.S. Census, the total population in CNMI was 69,221, with approximately 90% living in Saipan. Both CNMI and U.S. government categorize its population into three segments: local, other Micronesians and foreign contract workers. Local residents are primarily Chamorro (~18,000) with smaller groups of Carolinians (~4000). Chamorro and Carolinian are considered the two ethnic groups indigenous to the CNMI. Micronesians include other ethnic groups, such as Palauan (~1600) and Chuukese (~1400). The U.S. “Compacts of Free Association” permit the free movement of people between the freely associated states, flag territories, Hawaii and the mainland U.S. These “Compact” islands include the Republic of Palau; the Republic of the Marshall Islands; and the islands comprising the Federated States of Micronesia, Kosrae, Chuuk, Pohnpei, and Yap. Foreign contract workers from Asia (primarily Chinese and Filipino) comprise over half of the CNMI’s population. These contract laborers work in CNMI’s private and public sector in difficult-to-fill positions. While the CNMI originally maintained control over its own labor and immigration regulation and enforcement, recent federal legislation has mandated a normalization of labor and immigration. Normalization of the CNMI immigration system, which began in June 2009, is expected to significantly decrease the number of foreign workers in the CNMI. The median age of the population in CNMI is 28.7 years old, which is higher than other islands in the Pacific region. This is in part due to a high number of foreign contract workers who are usually above 18 years old (18-44 years).
Health Care Delivery System in the CNMI
The CNMI-DPH is responsible for public health services in the CNMI. CNMI-DPH is comprised of three divisions: the Division of Public Health Administration which provides preventive and community health programs – many of which are federally funded, the Hospital Division which focuses on medical diagnostic and curative services, and the CNMI-DPH Community Guidance Center (CNMI-DPH CGC), which provides mental health and substance abuse prevention and counseling programs. The Commonwealth Health Center operates an 86-bed Federal Insurance Contributions Act (FICA) certified hospital (the only hospital in the CNMI) located in Saipan. It is primarily local government-financed and staffed by government-employed physicians, including physicians board-certified in internal medicine, pediatrics, obstetrics and gynecology, surgery, anesthesiology, emergency medicine, and nephrology.
The CNMI-DPH also operates several outpatient facilities, providing an estimated 80% of all outpatient health care in the CNMI. Several clinics are physically located at the Hospital, including adult clinics (providing internal medicine, surgery, orthopedics, and ear-nose-and-throat services), a hemo-dialysis unit, a women’s clinic focusing on obstetric and gynecologic care, a pediatric clinic for children from birth to age 16, an emergency department, and a walk-in acute-care clinic. The CNMI-DPH also supports an adolescent health center located within Marianas High School. There is a clinic/small hospital on Tinian and another on Rota without surgical abilities; each is staffed by two physicians and midlevel clinicians. There are fewer than ten private-practice physicians in the CNMI, working through approximately five private outpatient clinics. Homecare nursing services are available through two private sector agencies.
Complex medical cases that cannot be managed in the CNMI may be referred to a facility outside of the CNMI for care. Most of the off-island referrals are to Guam, Philippines, Hawaii and Nagoya, Japan, dependent upon the clinical nature of the referral and health insurance coverage. Budget cuts have resulted in a reduction of available off-island services. Of all medical referrals in 2007, over 50% were for care related to cardiology, oncology, and radiology, due in part to a lack of medical specialists within the CNMI.
The CNMI as a whole is designated as a medically underserved population group. Health Professional Shortage Areas (HPSA) scores for Primary Care is 18, for Mental Health 19, and for Dental Services 26. These HPSA scores are evidence of the CNMI’s struggle to provide adequate care to its population and District 10 (Service Area) is Saipan’s largest and fastest growing District. Health issues affecting the Kagman population include extremely high rates of cardiovascular disease, early onset and high rates of diabetes, low prenatal care rates, high childhood and adult asthma rates, poor oral health care, and high alcohol and tobacco use among adults and teens. The nearest health facilities are located on the west side of the island, which include the Commonwealth Health Center along with several, small out-patient only, private clinics.
The KCHC Board of Directors (the “Board”) was originally formed in 2003 by the Kagman Kommunidat Association, a resident community association in District 10, to partner with the CNMI-DPH to establish the KCHC. In 2010, the Board was re-established and re-organized with the aid of CNMI-DPH staff. The CNMI-DPH is the primary, public entity applicant for this proposal, but there is a Co-Applicant Agreement between the CNMI-DPH and the KCHC that outlines KCHC’s governance as well as CNMI- DPH’s intended contributions. A Memorandum of Understanding further details the particulars of CNMI- DPH’s referral services agreement, which is discussed in detail at the Summary of Contracts, Agreements and Sub-recipient Agreements.
The Board developed its by-laws following the expectations of governance as a section 330(e) Community Health Center. Its by-laws and mission statement were approved and adopted by the KCHC Board on September 27, 2010.
Kagman Community Health Center
P.O. Box 5723 CHRB
Saipan, MP 96950
Phone: (670) 256-5248
Fax: (670) 256-5249