Please enter data and material here concerning what you have found concerning the enabling resources in the Federated States of Micronesia (FSM) of the people in the country. Be sure to define what enabling resources are, so others reading this will understand the material also.

According to the Andersen Behavioral Model, enabling resources involve the physical facilities provided to a population that will provide them with care, such as the hospitals, physicians, nurses and other care providers. They also consist of the means of which people receive this care and their accessibility so care, such as health education, insurance, funding, etc.

Analysis of Healthcare Expenditures

The Federated States of Micronesia has an annual national income of $272.4 Million as of 2009, consisting of a $239 Million GDP and extensive foreign assistance, accumulating to $33.4 Million. Of that $272.4 Million nation income, $31 Million is channeled through Public Health initiatives (17%), local hospitals of dispensaries (54%), general administration (6%), referrals to foreign institutions (11%), or other. The largest portion of this $31 Million (96%), is contributed by the government, which accounts to nearly 19% of the entire government budget expenditures. The remaining $1 Million is out-of-pocket expenditures.
In recent history the Federated States of Micronesia has gradually increased its spending and financial emphasis on health care (7% increase per capita in the past decade). However, results remain elusive. Micronesia has reported a 56% increase in communicable diseases and a 54% increase in non-communicable diseases in the past 20 years. Putting these reports, along with statistics such as infant mortality and life expectancy, in perspective by comparing them against those of similar Pacific nations the need for reformation of the Micronesian health care system becomes clear. Experts have pointed out several potential areas of inefficiency and/or areas that are in need of drastic reform. These include, but are not limited to, the current trend of outsourcing patients to institutions of Guam, the Philippines, or Hawaii, the ultimate utilization of resources and funding, the relatively large emphasis on curative care rather than preventative, and the lack of health education and awareness. However, with such a stringent budget which carries so many outside influences and stipulations, our discovery of Micronesia's need of reformation in regards to the financial aspect to its health care system rather than simply more funding offers a glimmer of hope, however small.


Facilities:
The Kosrae hospital is a public hospital that consists of 45 beds and 5 divisions. The genders are separated by room. There are 13 doctors who work at the hospital, most of which are considered “medical officers” as opposed to specialized physicians. Many of these doctors were educated in Fiji or the Philippines. There are 26 nurses who have been trained internationally. There are no mental health facilities, however there is a small isolated psychiatric ward located at the hospital.
The Pohnpei hospital consists of 96 beds and multiple wards, including a room for birthing and midwifery. The wards are separated by gender. There are 20 physicians; few are specialized, and the hospital only has one anesthesiologist. There are 45 nurses, and a nursing program is being started at the College of Micronesia.

Education and Health Promotion:
Studies have found that in the FSM, approximately one in every five babies is born to a teenage mother (Johnson, 2002). Because of the culture and religion in Micronesia, sexual education in the schools is very limited. Contraceptives are often provided in the schools, but not socially and culturally acceptable. For dental health, the dentist in Kosrae claims that dental health promotion is one of their major goals at the moment. Yearly check ups are being performed more often, but dental health could be improved greatly.
There are over 100 dispensaries located on the islands of Micronesia, and 5 are located on the island of Pohnpei. These are important for those living far from the main hospitals in the city. Lastly, diet promotion is an important enabling resource. The “Go Local” campaign in Pohnpei is an example of this.

Problems:
In the FSM, there are many problems with health accessibility. One major issue is transportation on the islands. Functioning vehicles are limited, and roads are often in poor condition or not present at all. There are only two ambulances located on Kosrae and Pohnpei, and no helicopter at all. Staffing is another concern. Many of the doctors are not necessarily specialized at all, meaning that they are only familiar with basic procedures. Nursing shortages are present on both islands as well. At both hospitals, staff members claimed that the islands often loose doctors or nurses to other countries, such as the U.S. or Guam, where the salaries are more.