May 5, 2004
Hyannis, Massachusetts 

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Thanks to the Massachusetts League of Community Health Centers for inviting me to speak with you.  HRSA Administrator Betty Duke sends her greetings and her regrets for being unable to attend.
 
Today I want to give you an update on where we are with the President’s Health Center Expansion initiative.  I also want to tell you about several other exciting new HRSA initiatives.
 
Before I start with that, however, I’d like to share with you a summary of HRSA’s impact in Massachusetts.  HRSA may not be as well-known as our sister HHS agencies like CDC or FDA, but our grant programs have a surprising impact on communities large and small.  In Federal Fiscal Year 2003, for example, HRSA invested $157 million in Massachusetts.
 
Let’s look at some of the major programs that are included in that $157 million.  First, there’s the $35.6 million in health center grants and $3 million in Healthy Communities Access Program grants that some of you administer.  In addition, HRSA grants to public and private organizations in Massachusetts include:

• $12 million to the state’s maternal and child health block grant program;
• $46.8 million in Ryan White grants to fight HIV and AIDS, including a $515,000 grant to Cape Cod Hospital right here in Hyannis for early intervention outpatient services; and
• almost $11 million in hospital preparedness funds to prepare local hospitals to treat victims of a bioterror attack or other mass casualty event.

We also distributed nursing education and training grants worth $2.3 million to 20 universities, community colleges and health centers across the state.
 
I mention these grants to give you an idea of HRSA’s reach into states and local communities.  And I’ll give you a better indication of the range of issues we deal with in a few minutes when I discuss some of our latest initiatives.  But first let me focus on health centers.
 
With 2004, HRSA entered the middle years of our efforts to meet the goals of President Bush’s health center expansion initiative.  So far we’re ahead of schedule.  In 2002, the first year of the expansion, HRSA created 171 new center sites and expanded capacity at 131 existing centers.  In 2003, year two, we funded 100 new centers and expanded capacity at more than 88 existing centers.
 
HRSA now supports nearly 3,700 health center sites; that’s 49 sites ahead of our budget goal for 2004.  We estimate that those sites served 12.5 million people in 2003, an increase of more than 2 million patients in just two years.  A remarkable achievement!
 
Patient encounters in 2003 totaled 50 million, up from 40 million in 2001, and health centers treated an estimated 450,000 more uninsured patients than in the previous year.

In 2003, 39 percent of patients had no health insurance, and two-thirds had incomes below the federal poverty line.
 
More Medicaid patients and more minority patients received care.
 
The number of babies delivered at health centers increased.  So did the number of HIV tests and Pap smears.
 
And, last year 82 percent of health centers offered dental care either on site or through contracts. This exceeds our Healthy People 2010 goal six years early – 7 percentage points ahead.
 
I think we can agree that all of these numbers look pretty good – good from HRSA headquarters and good from your vantage point on the front lines.
 
Without a doubt, you have earned bragging rights about the health center program. An evaluation of health centers completed last year by the President’s Office of Management and Budget gave the program a grade of 85, which tied for the best mark given to any HHS program.  Furthermore, the health center score was among the top 10 scores in the 234 programs OMB evaluated across the federal government.

This favorable impression of our work is also why the President asked Congress in his FY 2005 budget for an additional $219 million for the health center system.  If approved, it will set the FY 2005 appropriations for health centers at more than $1.8 billion, an increase of 57 percent over the last four years.
 
As we move forward with the health center expansion, I think it’s critical that the centers retain their reputation as a front door to our nation’s vast prevention, surveillance and treatment systems.
 
The importance HRSA places on prevention is most evident in our efforts to spread the obvious value of health disparities collaboratives throughout the health center system.
 
You know better than anyone that health centers are seeing more patients with costly chronic diseases like diabetes, asthma, obesity, heart disease and cancer.
 
By promoting greater teamwork among health professionals, by improving procedures to track treatments and reach out to community residents, and by encouraging patients to take greater responsibility for monitoring their illnesses, collaboratives reduce the harm done by chronic diseases.
 
Dr. Duke visited 12 pilot Cancer Collaborative sites this year to further our big push for outreach to overcome the myth Americans have about cancer’s eventuality – it is not – and about why early detection is not a death sentence.
 
Soon HRSA will launch its first Perinatal Care and Patient Safety pilot collaborative.  There is much to be done in this area, and we are making progress. We can make a difference.
 
And with the health center expansion I just spoke about, come many other new challenges.  One of the biggest is finding the right people to fill many new positions.  We estimate that the health center system will need to add 36,000 new health center staff positions through 2006, including more than 11,000 clinicians.
 
This is a difficult task, no doubt about it.  We did pretty well in FY 2002, exceeding one goal, just missing another.  Our goal in 2002 was to add 7,200 additional staff to the health center network; we added 7,600.  We wanted to add 2,200 additional clinicians; we added 2,000.
 
The National Health Service Corps plays a fundamental role in the staffing strategy.  As part of his plan to expand health centers, President Bush also directed us to reform and expand the Corps.  That makes sense, of course, because about half of the current number of NHSC scholars and loan repayors work in health centers.
 
With support from both sides of the aisle in Congress, we’ve been given the funds to make dramatic increases.  The NHSC has grown from a base of 2,364 clinicians in 2001, to 2,765 in 2002, and to an estimated 3,400 last year.  In 2004, we hope to boost the field strength of Corps clinicians to 4,000, which would represent an increase of about 70 percent in just three years.

When that occurs, it will be the first time in history that the number of NHSC clinicians in the field has topped 4,000.  HRSA has helped boost that number through an internal policy shift that emphasizes loan repayments over scholarships.  That way we sign up more and more physicians and other health care professionals who are ready to work, rather than waiting years for them to finish their studies.
 
But here’s the problem:  even this impressive expansion in the NHSC’s ranks will not provide enough people to cover the positions we need to fill at health centers.
 
How will we do it?   We’ll all need to do the hard work of developing new recruitment and retention strategies.  We’ll need to improve existing strategies by working closely with residency and educational training programs.  The situation will mean expanded opportunities for health care professionals who want to serve America and who may end up in the very health centers where you work.  We welcome your advice as health center administrators in bringing more capable men and women into public health service.
 
Another certain area of growth at HRSA and in 21st century America is in the field of disaster preparedness.  HRSA has three programs that form a major part of the federal government’s response to the challenges posed by terrorist groups.    
 
And in terms of agency funding, nothing matches the infusion of funds and responsibility that marked the creation in 2002 of the National Bioterrorism Hospital Preparedness Program, coming in this year at just over half a billion dollars.  The President is asking for another $476 million for the program in 2005. 

The Hospital Preparedness program increases emergency “surge capacity” at hospitals sufficient to handle mass casualty events. Hospitals – along with health centers and other first-responders -- will play a critical role in identifying and responding to terrorist attacks or outbreaks of infectious disease. Funds cover more hospital beds, the development of isolation areas and hospital-based pharmaceutical caches, and are used for on-call health care personnel, to provide personal protective equipment, mental health services, trauma and burn care.  Those of you who work in health centers simply must have a place at the table in our efforts at hospital improvement. 
 
The second counter-bioterror program HRSA administers is a new “Bioterrorism Training and Curriculum Development Program,” which provides $26.5 million in grants for continuing education and training for health care professionals and to add bioterrorism-related curricula in medical education.

The third element in the arsenal is the $21 million in annual appropriations for poison control operations.  We also fund $1.5 million annually to support efforts to improve collaboration between poison control centers and local public health agencies. 
 
Before I close, I’d like to take a few moments to update you on some exciting new initiatives at HRSA.
 
Just a few weeks ago, Surgeon General Rich Carmona and Dr. Duke – along with a former Miss America and player from the Redskins -- announced a new campaign to educate Americans on ways to prevent bullying and youth violence.  HRSA’s Maternal and Child Health Bureau is leading our efforts in the campaign, which is called -- "Take a Stand.   Lend a Hand.  Stop Bullying Now!"

We’re partnering with more than 70 health, safety, education and faith-based organizations and have produced a Web site that describes various aspects of the campaign: www.stopbullyingnow.hrsa.gov.  There you can find a Resource Kit on bullying prevention programs and activities that can be implemented at the school or community level to help in handling bullying problems and creating bullying prevention programs.  We’ve had a tremendous response thus far, including wide media coverage, and we think this campaign will help reverse this problem among our youth.

Another initiative HRSA is spearheading in the Department of Health and Human Services is “Binational Border Health Week,” which will occur during the week of Oct. 11-17 along the U.S.-Mexico border.
 
In partnership with the U.S.-Mexico Border Health Commission and the Mexico Secretariat of Health, HRSA and several other Federal agencies are using the week to promote lasting improvements in health care and disease prevention education on both sides of the border.  We will sponsor events in at least 13 sister cities along the border in both countries to share easy-to-understand information on immunization, on health problems such as diabetes, on services and programs that can help, and on how residents can access those services.  We also plan to mobilize existing community-based organizations to build networks of care that make better use of their individual contributions, to immunize children and screen for diabetes, and more.
 
Finally, HRSA is stepping up international efforts in HIV/AIDS prevention and treatment.  We recently were given direct authority by the Secretary to work internationally, and since then we’ve engaged our HIV/AIDS Bureau in several activities in support of the President’s Emergency Plan for AIDS Relief.  The President’s plan will provide substantial new aid to 12 African countries and two Caribbean nations that are deeply impacted by HIV/AIDS.
 
In closing, I’d like to tell you how much we appreciate the collegial relationship we have with all of you here at MLCHC.  It’s because of the efforts of fine folks like you that our nation is a healthier and safer place to live for many Americans and their families.
 
Thank you for giving me the opportunity to speak to you today.