YAP, FSM – Health leaders from across the Federated States of Micronesia (FSM) gathered in Yap for a three-day national health convening, joined by FSM MiCare and development partners including the Asian Development Bank (ADB), United Nations Population Fund (UNFPA), United Nations Children’s Fund (UNICEF), and the World Health Organization (WHO). While a range of pressing health issues were addressed, the summit underscored a sobering reality: FSM is in the midst of a full-scale Non-Communicable Disease (NCD) crisis requiring urgent and coordinated action.
NCDs—including diabetes, cardiovascular disease, cancer, and chronic respiratory conditions—are now the leading cause of premature death in FSM, accounting for over 80% of such deaths. Diabetes alone contributes to nearly one in five deaths among adults aged 30–69. The economic impact is equally severe, with the nation spending approximately $6 million annually on overseas medical referrals, the majority linked to NCD complications.
Despite past efforts—including state-level emergency declarations and the adoption of national and regional frameworks—NCD risk factors remain widespread. Increasing rates of obesity, persistent tobacco and betelnut use, unhealthy dietary habits, and declining physical activity continue to accelerate the crisis. FSM health leaders emphasized that this is not a distant challenge but a current and intensifying emergency.
A virtual presentation by Dr. Peter Brett, an oncologist based in the Commonwealth of the Northern Mariana Islands (CNMI), highlighted the strong correlation between betelnut chewing and oral cancer. The presentation noted striking similarities in cancer cases between the CNMI and FSM. Dr. Brett expressed interest in collaborating with FSM to investigate trends and offer clinical services. FSM officials acknowledged the potential of this regional partnership, particularly given shared risks and geographic proximity.
Other Key Issues Addressed at the Convening of the FSM Health Directors’ Meeting
Health Dispensary Assessment
The National Assessment Team confirmed the completion of a nationwide assessment of health dispensaries. However, the publication of the report has been delayed due to missing and incomplete data from several states. The Team has been tasked to finalize the report within the next three months. Once completed, the findings will provide a critical evidence base for health leaders to advocate for greater investments from state and national governments, as well as development partners, to improve frontline service delivery across the country.
Health Workforce Development
To address urgent gaps in the primary healthcare workforce, especially in remote and outer island communities, FSM is currently exploring ways to strengthen local health education. Negotiations are underway with the College of Micronesia-FSM (COM-FSM) to revise the Health Assistant curriculum, ensuring graduates are equipped with the skills, tools, and competencies necessary to meet today’s healthcare demands. The Public Health Infrastructure Grant (PHIG) Team also presented updates on the number of healthcare staff onboarded since the program’s inception and engaged in dialogue with the states on future workforce support. The health leadership also discussed opportunities for training of new and existing doctors, nurses, and other health workers that are in the pipeline with other partners and institutions. It was clear that more needs to be done to attract students into medical and other health fields after high school.
Universal Health Coverage and Primary Health Care
Achieving Universal Health Coverage (UHC) remains a core commitment of FSM’s health sector. The health leadership reaffirmed that strengthening Primary Health Care (PHC) systems—particularly at the community and dispensary level—is key to achieving UHC and reducing reliance on costly off-island care. Discussions centered on expanding access to essential services, improving health literacy, and integrating care delivery across all levels of the system.
Climate Resilience & Health – Green Climate Fund (GCF) Project
On July 01, 2025, the Green Climate Fund (GCF) approved FSM’s project proposal “Increasing Resilience to the Health Risks of Climate Change”. The project aims to address the increasing impacts of climate change from vector-, water-, and food-borne diseases. The project will address policy, capacity and collaboration for effective management of climate-sensitive health risks, harmonize climate and health information systems, and adaptation intervention in vulnerable communities across FSM. Funding in the amount of $17.9M is made available from GCF to support this project over the next 5 years.
FSM Competent Authority- World Bank PROPER Project
The PROPER project has three broad components and several sub-projects to be implemented collaboratively by various National and States departments/agencies/programs in support of overall fisheries and economic development in FSM. The total budget for PROPER is $56M and DHSA’s share is $2.5M to support further development of our Competent Authority (CA) to enable FSM to access the lucrative European Union (EU) Fish Market. The key DHSA activities to be supported by the PROPER project include: (1) strengthening of our CA through additional trainings for CA Officers, securing additional CA assets, maintenance of health and sanitary conditions of fishing vessels and processing facilities through audits, monitoring of safety of fish products through sampling and analysis for microbiological and chemical contaminants, and through other means as may be prescribed by EU Regulations; (2) establishment of a national reference laboratory to strengthen FSM’s capability to carry out required tests in-country instead of sending samples off-island for testing, and (3) improving the fish landing site structure and provisioning of safer and cleaner water to the Kosrae seaport. All these activities will support strengthening of FSM’s CA to fishing industry and eventually gaining access to the EU market.
Vaccine Security and Management – UNICEF
UNICEF reported that FSM currently funds only the Pneumococcal Conjugate Vaccine (PCV) through Congressional appropriations, with all other vaccines provided through support from the U.S. Centers for Disease Control and Prevention (CDC). Recent U.S. funding cuts, following the enactment of the so-called “Beautiful Bill,” place FSM’s vaccine supply chain at risk. To address this, UNICEF is collaborating with GAVI, The Vaccine Alliance, to explore alternative vaccine support mechanisms and maintain uninterrupted immunization coverage.
Sexual and Reproductive Health and Rights (SRHR) – UNFPA
UNFPA highlighted the critical importance of advancing sexual and reproductive health and rights in FSM. Strengthening SRHR services is seen as vital for reducing maternal and adolescent health risks, achieving equitable health outcomes, and accelerating progress toward the Sustainable Development Goals (SDGs) and Universal Health Coverage (UHC).
Health Financing and Infrastructure – ADB
The Asian Development Bank confirmed the allocation of $4 million in health sector funding for FSM, pending national decisions on how the resources will be used. Proposed priorities include revitalizing rural health dispensaries and enhancing air and sea transport to outer islands. FSM’s recent reclassification from “low” to “moderate” debt distress also opens the possibility of accessing concessional loans alongside traditional grants, offering greater flexibility in health financing options.
Antimicrobial Resistance (AMR) and Stewardship (AMS) – FSM Pharmaceutical Unit
The FSM Pharmaceutical Unit highlighted the escalating threat of antimicrobial resistance, which is driven by inappropriate antibiotic use and poses serious public health risks. The unit called for Health Leadership commitment to strengthening of AMR and AMS committees in all states and encouraged health providers to take a more active role in promoting the responsible use of antibiotics. Recommendations also included forming national medical associations and establishing systems for clinical governance, with the National Government expressing readiness to support and fund these initiatives.
A Roadmap for the Future
At the conclusion of the convening, FSM’s health leadership endorsed the FSM Health Strategic Development Plan (HSDP) 2024–2034, a ten-year roadmap focused on advancing health equity, resilience, and sustainability. The plan outlines a unified path forward and reinforces the nation’s collective commitment to improving health outcomes for all communities.
The convening concluded with a clear message: the health of the FSM population is in crisis, and the moment to act is now.
