Federated States of Micronesia

The Federated States of Micronesia (FSM) is an independent nation in the western Pacific. The nation consists of four states (Yap, Chuuk, Kosrae, and Pohnpei), which wield significant power, alongside the national FSM government. FSM lies on the other side of the date line from the continental U.S.

Relationship With the United States

Following WWII, FSM was placed under the administration of the U.S. by the United Nations as part of the Trust Territory of the Pacific Islands. FSM adopted its constitution in 1978, then in 1986, FSM entered into a Compact of Free Association (COFA) with the United States.

Under the Compact, the U.S. government agreed to provide economic and technical assistance (including significant funding for health), ensure U.S. military defense support, and allow unrestricted travel to and from the United States for these non-resident Micronesian citizens. In return, FSM agreed to give the U.S. government unlimited and exclusive use of their land, airspace, and waterways for strategic purposes.

Financial assistance, as currently structured within the FSM Compact, extends through 2023. FSM receives significant funding for health and health system development through the Department of the Interior, which administers Compact funding. It is also eligible for some U.S. federal programming, including grants from the U.S. Department of Health and Human Services.

Healthcare and Facilities

FSM’s health department is fairly decentralized, with a National Division of Health based in Pohnpei and state-level Departments of Health that wield significant power. The National Division of Health has a Secretary of Health, Assistant Secretary of Health, and national program managers and coordinators. Yap, Chuuk, Kosrae, and Pohnpei each have a Department of Health led by Directors of Health and Deputy Directors of Health. Each state has one government-run hospital, with small clinics throughout the outer islands staffed by either full-time or part-time health assistants. No hospital in FSM provides tertiary care; patients are referred off-island to Honolulu or the Philippines for specialized care.

FSM residents are not eligible for Medicaid. FSM migrants who meet Medicaid thresholds within their state of residence in the continental U.S. are eligible for Medicaid. A key source of funding for healthcare provision in FSM is financial assistance through the Compacts of Free Association, which supports hospital care in FSM. Read more about COFA funding via ASTHO's Fully Fund the Renegotiated Compacts of Free Association and Reduce Compact Impact in U.S. Territories and States Policy Statement.

Key Priorities

In the 2016 ASTHO Profile report, FSM Ministry of Health highlighted five key priorities:

• Addressing the decreasing funding in the Compact of Free Association.
• Chronic disease.
• An aging health workforce.
• Putting qualified students into health and medical fields.
• Upgrading the quality of medical care in the country.

Disease Burden

Like the rest of the Pacific, FSM faces a noncommunicable diseases crisis and a significant communicable disease burden. The top causes of death in 2019 were:

• Ischemic heart disease
• Stroke
• Diabetes
• Chronic kidney disease
• HIV/AIDS