personnel management systems; poorly maintained and equipped health care facilities; the enormous costs involved with sending patients off-island for tertiary or specialized care; and shortages of adequately trained health care personnel. In many cases, the island jurisdictions are also contending with significant social change brought about by incredible population growth, rapid economic development, and a shift away from a way of life based on communal farming and fishing to one that is market and consumer oriented. Attempts to address these health conditions and challenges come at a time when U.S. federal government aid to the region has begun to decrease, a trend that is likely to continue.
These challenges are also embedded in the islands' many strengths and resources: cultures that remain vibrant even after years of foreign occupation and influence, strong familial ties and roles for women, highly developed and organized communities, traditional health practices, and powerful religious beliefs.
The Institute of Medicine (IOM) was asked by the U.S. Department of Health and Human Services, Health Resources and Services Administration (HRSA), to examine these issues and suggest possible approaches to improve the situation. Specifically, IOM was to:
The status of the health care delivery systems varies markedly from island to island. The following is a brief overview of the current situation in each jurisdiction (more complete assessments are provided in Appendix D).
American Samoa: Government management and financial difficulties caused by unpaid debts threaten the functioning of the health care system. Critical