Two Months Before the 2018 Hurricane Season Begins, Health Centers in Puerto Rico and the U.S. Virgin Islands Still Face Serious Threats

April 3, 2018

WASHINGTON, DC and NEW YORK, NY (April 4, 2018) – Six months after Hurricanes Irma and Maria pummeled Puerto Rico and the U.S. Virgin Islands (USVI), the regions’ twenty-three community health centers continue to play a crucial role in responding to the catastrophe, providing direct care and essential community-based public health services. Yet, a new report by the Geiger Gibson/RCHN Community Health Foundation Research Collaborative at the George Washington University’s Milken Institute School of Public Health (Milken Institute SPH), based on a comprehensive survey, finds that health center recovery is uneven, and that while all health centers are open, many are still operating under hardship conditions.

“The community health centers in Puerto Rico and the U.S. Virgin Islands have done a remarkable job of rebuilding and finding ways to remain in operation under challenging conditions,” said Sara Rosenbaum, JD, the Harold and Jane Hirsh Professor of Health Law and Policy and founder of the Geiger Gibson Program in Community Health Policy at the Milken Institute SPH. “However, the centers, as well as their employees and the populations they serve, remain vulnerable as the next hurricane season approaches for a number of reasons. Limited health care access, hazardous living conditions, and heightened risk of infectious disease and mental health concerns put both providers and patients at greater risk. A recent report suggesting that the number of suicides in Puerto Rico has increased significantly merits serious attention.”

In 2016, the health centers in Puerto Rico the U.S. Virgin Islands served nearly 370,000 people. Compared to community health centers in the 50 states and the District of Columbia, the centers in these territories serve higher percentages of patients with incomes under the federal poverty level and those insured through Medicaid.

Presently, the 23 health center organizations in the region operate 99 sites, with 93 in Puerto Rico and 6 in the USVI. At the time of the survey, 91 percent of health center sites were open and operating at full capacity and with a full complement of services. The remaining nine percent were open, but at partial capacity or with a more limited range of services. Of note, all community health centers reported that general primary care services, medical records, and community outreach services are fully restored at all sites that provided these services before the hurricanes. But more than four in ten health centers reported that specialty care services, emergency department services, and night and weekend hours were available at only some sites that provided them prior to the hurricanes. Nearly two-thirds of health centers report needing repair or replacement of their buildings, and nearly half report needing telephone and internet repair or replacement. While the majority of health centers reported that they were able to maintain staffing levels and did not find it necessary to reduce services due to staffing constraints, both recruitment and retention are challenging; physicians, pharmacy staff, substance abuse staff, and mental health staff were reported to be the most difficult positions to recruit for and retain. Health centers also reported the top challenges facing their staff: 70 percent reported workers losing homes and 57 percent reported transportation problems and road conditions as top-three challenges.  More than 80 percent of health centers expect that their organization will be restored to full capacity in less than one year.

“The community health centers in Puerto Rico and the U.S. Virgin Islands are a crucial part of the health care system and have demonstrated extraordinary resilience, both in the immediate aftermath and now six months following Hurricanes Irma and Maria,” said Feygele Jacobs, DrPH, President and CEO of the RCHN Community Health Foundation, whose ongoing gift supports the Geiger Gibson Program. “With the next hurricane season on the horizon, it’s essential that health centers receive the support necessary to aid staff, address staffing and human resource needs, and fully rebuild.”

The report can be accessed here: “The State of Recovery: An Update on Community Health Centers in Puerto Rico and the Virgin Islands.