Insular Areas


Insular Areas

ASTHO supports the work of U.S. territories and freely associated nations to improve population health.


ASTHO's members include the chief health officials of the five U.S. territories1 and three nations with compacts of free association with the United States,2 which we collectively refer to as the ‘insular areas.’ While all of ASTHO's resources and services are available to its members in the insular areas, ASTHO has developed initiatives to meet the unique needs of health agencies in these areas.


ASTHO is committed to working with partners to provide relevant, appropriate, and timely technical assistance to health agencies in the insular areas.


ASTHO works closely with the Pacific Island Health Officers Association (PIHOA) to serve its members in the United States affiliated Pacific islands (USAPI). Projects undertaken with PIHOA focus on workforce and leadership development.

Human Resources Management – PIHOA’s Human Resources for Health initiative aims to increase the capacity of health agency staff in human resources management (HRM) and information systems through workshops and extended on-site coaching.

Lab Strengthening – PIHOA’s Regional Labs Network initiative aims to build capacity in laboratory quality improvement processes and strengthen laboratory-based surveillance of infectious diseases. Its activities include lab training and staff development workshops.

Non-communicable Disease (NCD) Surveillance – PIHOA declared NCDs a regional emergency in 2010. In collaboration with federal and international partners, PIHOA is equipping USAPI health agency staff with tools to monitor the NCD crisis.


ASTHO works with Impactivo to serve the Puerto Rico Department of Health. Following an initial assessment and planning period, this work is now focused on providing technical assistance to strengthen health department performance.

Recent Projects

ASTHO and its partners provide custom-designed technical assistance to senior health officials in the insular areas in order to craft workable solutions to immediate, short-term, and long-term public health program, workforce, and business operations challenges. Current projects have focused on increasing state health agency capacity to improve the performance and quality of the public health system.

What Territorial Health Officials Need to Know About Grants

This introductory presentation is designed to provide territorial health officials and their leadership teams with an overview of grants management. Grants management is critical to health department functioning. Health officials must understand the basics of the grant life cycle and build relationships with key staff throughout the health agency to best utilize current and future grant funding. The presentation will provide you with an overview of grants management and an action planning template. Additionally, Esther Muña (THO-CNMI) and Vincent Camacho (Grants Management Administrator) from the Northern Mariana Islands Commonwealth Healthcare Corporation provide testimonials regarding how they promote effective grants management.

Preventing Cardiovascular Disease in Palau Through Quality Improvement and Systems Change

The Palau Ministry of Health participates in ASTHO’s Learning Collaborative to Improve Blood Pressure Control in support of the Million Hearts initiative. The Palau Million Hearts team, a multidisciplinary team of over twenty dedicated professionals, is currently analyzing how hypertension data can be incorporated into their current chronic disease registry, how data on tobacco use can be captured, and how to leverage their existing public health programs, such as the cervical cancer screening program, to identify individuals with hypertension.

Strengthening Health Department Performance in Puerto Rico

The Puerto Rico Department of Health has been using tools such as ASTHO’s State Health Assessment: Guidance and Resources and other performance management resources to enhance their existing community health assessment and complete their community health improvement plan.

Rallying Around Shared Vision and Goals the Commonwealth of the Northern Mariana Islands

The public health agency and NCD Bureau of the Commonwealth Healthcare Corporation of the Commonwealth of the Northern Mariana Islands each undertook a strategic planning process using the framework found in ASTHO's strategic planning guidance document. Following a three-day strategic planning workshop, the planning team in each territory produced a mission, vision, and values statement; a strategic work plan; a performance management system, and a communication and implementation timeline.

Opening Opportunities for Improvement in Guam

As part of the implementation of their strategic plan, the Quality Improvement (QI) Council in Guam is working on improving select internal organizational processes. ASTHO facilitated process mapping sessions and continues to work with the QI Council on this initiative.

Supporting Preparedness in the Insular Areas

ASTHO distributes an e-newsletter that provides content of interest to public health professionals in the U.S.-Affiliated Pacific and Caribbean Islands concerning public health and healthcare system preparedness and related activities.


  1. American Samoa, Commonwealth of the Northern Mariana Islands, Guam, Puerto Rico, U.S. Virgin Islands
  2. Federated States of Micronesia, Republic of Palau, Republic of the Marshall Islands


For more information about ASTHO's work with the Insular Areas please email