WASHINGTON, DC and NEW YORK, NY (November 1, 2017) — In the weeks since Hurricane Maria ravaged Puerto Rico, the island has struggled to recover from unprecedented devastation. Community health centers, which serve as medical homes for more than one in ten of the island’s residents, have been at the front lines, serving as essential first responders to a humanitarian and public health crisis. A new report by the Geiger Gibson/RCHN Community Health Foundation Research Collaborative at George Washington University’s Milken Institute School of Public Health (Milken Institute SPH) details how the island’s twenty federally funded health centers are helping residents to cope with urgent and emerging health care needs, at a time when communication is limited and access to electricity and clean water remains scarce. The authors make an urgent case for federal aid to restore health center services.
“Community health centers play a crucial role in Puerto Rico because of the territory’s high levels of poverty and unemployment, as well as the generally poor health of its residents,” said co-author Sara Rosenbaum, JD, the Harold and Jane Hirsh Professor of Health Law and Policy at Milken Institute SPH.
“The lack of power and clean water elevates the risk for infectious disease, particularly in rural areas where two-thirds of the community health center facilities operate. Medicaid and grants are absolutely essential to their ability to carry out their critically important mission.”
One month after the hurricane, 83 of Puerto Rico’s 93 community health center sites are open. Yet, as detailed in the report, power has been restored at just 13 percent of 70 assessed sites as of mid-October. Health centers must instead rely on diesel fuel, which is in short supply, to run generators that power essential health care equipment such as x-ray machines, refrigerators for medication storage, and electronic health records. With little or no electricity, many sites are able to offer only limited hours and services. Post-storm conditions are precarious: over half of the health centers report that their communities have only intermittent access to drinking water, and 70 percent report that their communities need food. Health centers also report urgent needs for a wide range of vaccines and drugs, including antibiotics, insulin, anti-inflammatory drugs, gastrointestinal drugs, and eye drops.
In the wake of the storm, care is anything but routine. The combination of standing water, high temperatures, and contaminated water sources elevate the risk for communicable diseases associated with hazardous environmental conditions; providers also express concern about the serious, increased threat of vector-borne infections such as chikungunya, dengue, and Zika.
These conditions are a further blow to an island already beset by deep poverty and critical economic challenges. Medicaid and grants from the U.S. Health Resources & Services Administration (HRSA) together provide 83 percent of revenue for the territory’s community health centers.
At present, Puerto Rico is responsible for 80 percent of the cost of its Medicaid program. In comparison, Mississippi, the poorest state, must fund only 25 percent of its Medicaid program. Adding to the worrisome financial picture is the expiration of the Community Health Center Fund on September 30. This fund represented 70 percent of all federal health center grant funding, and legislation to extend it is still pending in Congress.
“Like their counterparts on the mainland, Puerto Rico’s community health centers have long offered the high-quality care needed on the island, and served as important local economic engines,” said RCHN Community Health Foundation President and CEO Feygele Jacobs. “What is needed to ensure their survival, and prevent a major public health catastrophe, is targeted relief in federal aid packages, additional investment in the Medicaid program, and immediate continuation of the Community Health Center Fund.” RCHN Community Health Foundation provides funding support for the work conducted by the Collaborative.
The report, “Puerto Rico’s Community Health Centers: Struggling to Recover in the Wake of Hurricane Maria” can be accessed here.