Since then, the NBHPP has delivered over $2 billion to hospitals and health care systems in all 50 states, as well as five territories, three freely associated states and four large metro areas: New York City, Chicago, Los Angeles County and Washington, D.C.

This year, $460 million were awarded to these jurisdictions to strengthen the ability of hospitals and other health care facilities to respond to bioterror attacks, infectious diseases and natural disasters. Hospitals play a critical role in both identifying and responding to any potential terrorist attack or infectious disease outbreak.

During the first four years of the program, states used grant funds to develop surge capacity to deal with mass casualty events, such as expanding the number of hospital beds and developing isolation capacity at hospitals. Other priorities included identifying additional health care personnel who could be called into action in the event of an emergency, as well as establishing hospital-based pharmaceutical caches.

Recipients also used the funds to increase coordination of disease reporting among hospitals and local and state health departments and to improve coordination and communication between public health laboratories and hospital-based laboratories.

Jurisdictions were required to improve their ability to provide mental health services, strengthen trauma and burn care, and increase their supplies of personal protective equipment. Money could also be used to support training, education, and drills and exercises.

This year, the program’s focus turns to efforts to improve the capability of local and regional health care systems to manage mass casualty events and integrate preparedness activities across disciplines and agencies. The goal is to ensure that each jurisdiction has a system in place that will result in fewer deaths, long-term disabilities and required hospitalizations.

For more information on HRSA’s National Bioterrorism Hospital Preparedness Program, visit http://www.hrsa.gov/bioterrorism.

• Kerry Nesseler is the first director of the new Office of Commissioned Corps Affairs, reporting directly to the Administrator.
• Jim Macrae is associate administrator for Primary Health Care.
• Steve Smith is the agency’s acting Chief Financial Officer.
• In Health Professions, Michelle Snyder is associate administrator, Steve Pelovitz is deputy associate administrator for financial management, and Tanya Raggio will serve as senior advisor to the associate administrator.
• Also in Health Professions, Nettye Debisette is director of the Division of Nursing.
• Rick Smith is on a six-month detail from Healthcare Systems to Health Professions, serving as acting director of the National Health Service Corps.
• Remy Aronoff will act as deputy associate administrator for Healthcare Systems while Rick Smith is on detail.
• Denise Geolot is director of the Center for Quality.
• At the Office of Performance Review, Becky Spitzgo will be the acting associate administrator and Dennis Malcomson is deputy associate administrator.
• Tina Cheatham will be acting director of the Office of Communications.
• Cheryl Dammons is director of the Office of Policy Review and Coordination.

Each year in the United States, about 6 million women become pregnant. Most have safe pregnancies and deliver healthy infants, but some give birth too early, see their babies die during or soon after birth, or die themselves in pregnancy-related deaths. These difficulties continue to occur in greater numbers among women who are members of racial and ethnic minorities.

According to the most recent available data available, the national infant mortality rate in 2003 was 6.9 deaths per 1,000 live births. The racial and ethnic breakdown was 14 per 1,000 for African-Americans, 5.9 per 1,000 for Hispanics, and 5.7 per 1,000 for whites.

Since its beginning in 1991 at 15 demonstration sites, Healthy Start has expanded into 97 communities with high rates of infant mortality in 37 states, District of Columbia and Puerto Rico. The program has served hundreds of thousands of women and their children, more than 90 percent of whom are African-American, Hispanic, or Native American.

Healthy Start emphasizes a community-based approach that is strongly reflected in local project consortia, which bring together neighborhood residents, perinatal care consumers, medical and social service providers, and representatives from the faith and business communities.

Consortia members work to address barriers to care such as fragmentation in service delivery, lack of culturally appropriate health and social services, and transportation. Projects also collaborate with state maternal and child health programs, Medicaid, the State Child Health Insurance Program, and community health centers to add more resources to the effort.

Getting women into prenatal care in the first trimester of pregnancy or as early as possible is critical, since prenatal care is critical to improving birth outcomes. Healthy Start has made proven impacts on participants’ access to prenatal care: in 1998, participants’ first trimester entry into prenatal care was only 41.8 percent; by 2003, this number had risen to 71.4 percent – an increase of 73 percent in five years.

Outreach is another key element of Healthy Start projects. Outreach workers – sometimes working out of mobile vans – often visit pregnant women at home, the best way to reach the most at-risk women and encourage them to get care.

Additionally, Healthy Start helps mothers and infants find “medical homes” to provide ongoing sources of primary and preventive health care. It also helps resolve related problems such as affordable housing, social and psychological support, nutritional and educational assistance, and building job skills.

Central Harlem is one example of a Healthy Start success story. The infant mortality rate there has dropped significantly since its project began in 1991, when there were 27.7 infant deaths per 1,000 live births. By FY 2003, the rate had dropped to 7.3 deaths per 1,000 births – a 273 percent decline.

Other locations have had real success in reducing low birth weight. In Baltimore, the percentage of very low birth weight babies was 2.0 percent among participants with single births enrolled in Healthy Start – 99 percent of whom are African-American – compared to a 3.7 percent rate of very low weight births among African-American women throughout the city.

Recently HRSA awarded the “Eliminating Disparities in Perinatal Health” grants, a vital component of the Healthy Start program. The 12 grants, totaling more than $9 million in FY 2006, will help reduce higher-than-average infant mortality rates in targeted communities in Arizona, Indiana, Kentucky, Maryland, New Jersey, New York, North Carolina, South Carolina, South Dakota, Virginia and Puerto Rico.

President Bush has asked for $101.5 million for Healthy Start in his FY 2007 budget – an amount equal to the FY 2006 appropriation.

For more information on Healthy Start and other programs administered by HRSA’s Maternal and Child Health Bureau, visit http://mchb.hrsa.gov/programs/womeninfants/prenatal.htm. For information on prenatal services in local communities, call 1-800-311-BABY (1-800-311-2229); and for information in Spanish, call 1-800-504-7081.

And run two full-service hospitals, an elderly housing facility, and an economic development organization?

The chief executive officer of the East St. Louis-based Southern Illinois Healthcare Foundation (SIHF), the organization responsible for these deeds, says the growth was made possible by a structure built into every health center: the community-based board of directors that runs the Foundation’s operations.

“We don’t operate in a corporate structure,” CEO Bob Klutts explained. “We need community involvement, a board that represents the community. They’re our leaders and they tell us where we need to be and what we need to do.”

Klutts said board members’ intimate knowledge of conditions in East St. Louis and neighboring communities helps SIHF look at health care in a context that encompasses not just access to care but employment, economic development, transportation and other related issues.

“If you ask the question, ‘How do we make people’s lives better?’ you realize that health care is essential, but it’s not the whole answer,” Klutts stated. “You can’t compartmentalize people’s problems. You can’t stop with health care.”

Board members have overseen two decades of impressive growth in health care operations beyond East St. Louis to 10 other rural and suburban communities. In 2004, patient visits to SIHF health care sites totaled more than 191,000 with 6,000 hospital admissions.

Hospital Operations

SIHF didn’t set out to be in the hospital business, but circumstances forced the board to act to avoid the loss of vital community health services, Klutts explained.

In 1993, SIHF took over a failing Centreville Township Hospital. After renaming it Touchette Regional Hospital and reorganizing its operating structure, the hospital became recognized in the region for its top-quality obstetrical care. In 2003, SIHF took over the struggling St. Mary’s Hospital in East St. Louis. Renamed as Kenneth Hall Regional Hospital, the facility has 500 employees. It is the only Level 2 trauma center in the Metro East region and sees more than 18,000 emergency patients annually.

The hospitals – which had provided health care to medically underserved residents for decades – now are separate, nonprofit affiliates of SIHF.

“Both of the hospitals were about to go out of business,” Klutts said. “We took them over to maintain health care services in the community.”

With hospital services as part of their overall operations, SIHF’s health center patients gained access to important new services.

“One problem all primary care docs have is that they need a hospital for patients with serious problems,” Klutts explained. “They also need access to the technology – radiology, imaging, labs – that hospitals have. With good diagnostic support, primary care docs practice better medicine and patients get better care.”

Maintaining Financial Stability

Klutts said SIHF keeps its varied operations going by “always looking to diversify our income sources. There’s money out there, but you have to figure out how to get it. There’s no one single source. It takes a lot to piece it all together.”

In building a patient transportation system, for example, SIHF seeks and wins grants to buy multi-passenger vans, which take clients to and from medical appointments and education programs. Then, Klutts explained, a vehicle replacement program operated by the Illinois Department of Transportation pays for new vans once the old ones rack up 90,000 miles.

A good working relationship with state officials and agencies is an important factor in SIHF’s growth and success. Klutts said the state of Illinois has been “very helpful in helping us operate the hospitals. They understand our vision of being a regional safety net health care provider.”

SIHF’s funding stream from HRSA consists of several grants from the Bureau of Primary Health Care and others from the Maternal and Child Health and HIV/AIDS bureaus. SIHF’s health center grant covers about 20 percent of total expenses for its health center operations, close to the national grantee average of 21.5 percent in 2004. The other HRSA grants lift that figure to about 32 percent of SIHF’s health center expenditures.

Klutts added that SIHF’s size and integrated operations help it economize on expenses. “When you put everything together, you can build economies of scale and save money.”

Jobs and Health Care

The board’s holistic approach to making people’s lives better led SIHF to create another nonprofit affiliate, the Archview Economic Development Corporation, in 2000. The Corporation works with business partners to foster economic growth and train non-college-bound young people to enter the local workforce.

“We consider unemployment” – a chronic problem in the East St. Louis area – “one of our worst health care problems,” Klutts stated.

“When adults have jobs,” he explained, “other things improve as a result – income, access to health insurance, family stability. Getting a job is the way to change things.”

SIHF’s hospitals have intern programs that train some 30 high school kids annually in a variety of hospital jobs. “Many of them end up working for us,” Klutts said.

The pilot was funded and organized by HRSA as part of the Health Disparities Collaboratives implemented in health centers throughout the country. It linked five health centers in states with high rates of infant mortality among African-Americans – Illinois, Michigan, Mississippi and South Carolina – with teams at local hospitals to test ways to improve the quality of prenatal care and help ensure safe in-hospital labor and delivery.

Collaborative pilots begin by bringing together HRSA officials and experts in the field, who meet to discuss the pilot’s aims, identify possible participants, and discuss changes in prenatal care that would lead to improved health outcomes for patients.

Once selected, participating health centers meet for a series of “learning sessions” to develop a better understanding of the “change framework” established by the experts and the model the centers will use to improve their prenatal care. The health centers’ local hospital partners participated in later sessions.

During the length of the pilot, the experts visited each site to check on progress and provide assistance in overcoming barriers and establishing community links. And participating health centers frequently communicated with each other and with experts by phone and through a Web-based “virtual office.”

At the end of the pilot term, participating health centers and hospitals, experts and Federal officials met in February of this year for a “harvesting session” to discuss lessons learned and concepts and resources that should be shared with the entire health center network.

At the harvesting session, participants developed seven “high-leverage change concepts” that they felt had the highest impact in terms of improving perinatal outcomes.

Tops among the “change concepts” was fostering communication and coordination among the health center, local hospital and other agencies to ensure continuity and quality of care.

Other recommended “change concepts” included:

• Organizing and sharing information between the health center and hospital;
• Forming partnerships with community organizations and specialists to support and develop interventions that fill gaps in needed services; and
• Developing a registry system and process to track clinically useful information and data.

Participants measured the effectiveness of the health center-hospital communications by tracking the timely sharing of mothers’ and infants’ charts between the health center and delivery hospital.

Improved communication between health centers and hospitals resulted in better treatment for pregnant women who typically use emergency rooms for limited prenatal care. Because of the partnerships, hospitals referred these high-risk patients to health centers for more comprehensive prenatal care. Many of the women referred to health centers had no previous medical provider.

The harvest report noted that the new hospital-health center-community agencies partnerships gave patients better access to the services they needed, which improved outcomes. Protocols were developed to alert hospital staff to high-risk health center patients who would enter the hospital to give birth.

The increased collaboration also boosted the health center’s credibility among hospital obstetrical staff, as they witnessed the high level of care delivered at the health center and saw the commitment of health center staff to coordinate a continuum of care using a variety of local resources.

The harvest report concluded by urging all health care providers and agencies in a community to work together to embrace the mission of reducing infant mortality.

In partnership with the Institute for Healthcare Improvement, the PCAs will use funds to provide leadership, training and technical assistance to health centers in their regions on ways to accelerate and expand collaboratives, which fighting chronic illnesses like diabetes, heart disease, asthma and depression.

Grant winners and award totals follow:

• California PCA, $2 million;
• Connecticut PCA, $1.8 million;
• Michigan PCA, $2 million;
• Texas PCA, $1.8 million;
• South Carolina PCA, $2.5 million; and the
• Institute for Healthcare Improvement, $1.75 million.

For more information on health disparities collaboratives, visit www.healthdisparities.net.

Launched in November 2001, the Scholars program is designed to attract talented new employees to fill workforce shortages as experienced employees retire.

The Scholars program offers newcomers a year-long training and development curriculum, along with skills development through on-the-job training in HRSA’s various bureaus and offices. Participants rotate on a quarterly basis, gaining a host of skills from grants management and program analysis to budgeting and procurement.

Scholars who successfully complete their year of training receive a grade level promotion and are placed in their first HRSA job.