Richard Napolitano: November 2016 Outstanding Advocate

richThe NACHC advocacy team is excited to announce the Outstanding Advocate for November 2016—Richard Napolitano, Senior Vice President, External Relations/Chief Development Officer at Greater Lawrence Family Health Center (GLFHC) in Methuen, Massachusetts.

Rich got involved with NACHC advocacy in March, when he attended the 2016 Advocacy Leadership Program (ALP) which kicked-off during the 2016 Policy & Issues Forum. He’d recently been charged with ramping up GLFHC efforts on advocacy – ready to hit the ground running, he took the ideas and best practices learned during the conference and throughout the six-month ALP curriculum and brought it all back home to Massachusetts to put plans into action.

Rich, along with fellow Advocacy Coordinator Gia Angluin, have worked hard to implement various programs and initiatives at GLFHC that bolster the organization’s advocacy infrastructure and framework. Three key steps in that process have led to great success for both GLFHC and their advocates. Each of the three serve as best practices that others should think about implementing at their organizations in order to ramp up advocacy efforts.

First, Rich made it a priority to sign up all GLFHC staff and board members as Health Center Advocates. But, because advocacy is more than just having names on a list, everyone (new and existing staff alike) was provided training and education on what being an advocate means and why it is important for every individual to be involved. Being personally invested, as well as understanding why and how taking action impacts your Health Center, are crucial parts of being a successful and effective advocate.

Next, GLFHC established the Advocacy Champions Team (ACT). Rich says, “The ACT serves as the steering committee for advocacy efforts and includes staff, board members, and volunteers from the community.” By including board and community members in the group, ACT gains valuable feedback and input from those who have a slightly different perspective on the Health Center than staff, and this will ultimately help ensure that the ACT is being responsive to issues that require advocacy at all levels- federal, state, and local. In addition, Rich worked hard to incorporate board members and community partners that often underestimate the unique voice they have in speaking to the value of the Health Center in the community; engaging them in this group was deliberate in an effort to empower them as advocates.

The third step Rich and the team took was to establish the Advocacy Rapid Response Team. Per Rich, “The ARRT is a larger group of people [than the ACT] that can be counted on and called upon for immediate action on an issue or topic that needs support. Our goal is to continue to keep them engaged in these efforts and ready to act when it comes time to garner support for the Community Health Center movement.” The ARRT’s first charge was to take action on HR 5667, a bipartisan bill that will make it easier for FQHCs to participate in ACOs; within just a few days, the response to this alert was over 25% (for context, the average national response rate for a health-related action alert is currently only 3%).

Another important factor in GLFHC’s success in advocacy is buy-in and support from leadership, which Rich is fortunate to have from CEO John Silva. John says of Rich, “[His] vision, enthusiasm and focus helped move GLFHC from a health center that paid casual attention to advocacy to an organization that understands the intrinsic value of embedding daily advocacy into our culture and involving our staff, Board and patients as the leaders of our advocacy team.”

In case more evidence is needed that Rich’s efforts to prioritize advocacy have been an incredible success, GLFHC was one of the first Health Centers in the country to achieve Bronze status in NACHC’s ACE Program (currently the only ACE Health Center in Massachusetts), and will shortly be applying for Gold status, thanks in large part to the outcomes and success of the ACT and ARRT.

Kudos, Rich! We look forward to working with you, Gia, and the rest of the team on advocacy efforts moving forward. We will continue to look to you and the whole GLFHC team to set the advocacy bar for the nation – WELL DONE!

Do you know an Outstanding Advocate who deserves this recognition? Let us know! Email Elizabeth Kwasnik at

Looking for answers? Simple answer…ADVOCACY!

Coming out of Tuesday’s election all of us at NACHC have had a steady flow of emails and calls from Health Center Advocates across the country asking nearly the same three questions; what does this mean for health centers? What does this mean for our patients? What should we be doing?

For today, it’s far too early to know what Congress and the Administration have in mind for Health Centers, or for the patients we currently serve and those that still lack access to care. NACHC’s outreach to EVERYONE sitting in Congress, candidates and now the victors of the election began months ago – to ensure that Health Centers and our patients were understood and recognized as a part of any effort toward systemic change or new programming – that rightly so, health centers are and should continue to be at the center, serving as the foundation of any effort to change or improve our nation’s healthcare system.  That work continues today and is even more exciting as we welcome the opportunity to work with a new class of policymakers and a new Administration.

But the third question – what should we be doing? That answer remains not only unchanged, but ever more clear and critical as we begin work with a new Congress, a new Administration and countless new Governors and State Legislators. The answer is building your advocacy capacity, actively engaging in advocacy at every level of government – from your city councilors to your county selectmen, from your state legislators and governor to your Members of Congress. Today, as the nation’s policymakers consider what they will do upon taking office in a few short weeks – YOUR ADVOCACY; your efforts to educate on what we do well as Health Centers, where we need support and resources and how they are used, the role Health Centers play for their patients and in their community, and what is at stake should Congress or the State falter in its support for Health Centers – these conversations, THIS ADVOCACY, has never been more important.

Without question there are many “red flags” that should have all of us on high advocacy alert – the return of the Primary Care Funding Cliff, which equates to a 70% reduction in funding for the Health Center Program and is slated to take effect in October 2017 should Congress fail to act; many uncertainties about the future structure and support for entitlement programs, Medicaid and Medicare, both of which are vital to Health Center patients and to financial solvency; and likely challenges to the Affordable Care Act which has enabled more than 20 million Americans, including millions of Health Center patients, to leverage health insurance coverage, in many cases for the first time ever. No matter the challenges, we believe in and we all have witnessed our ability to be successful.

To be clear, effective Health Center Advocacy is coming together as a network of hundreds of thousands of advocates, it’s using one voice to deliver the Health Center message, it’s engaging each of the relationships you have built with policymakers at every level of government, it’s fighting like hell for our future because we know that our mission and our work is just. When we do this, our advocacy is among the most effective and we are among the most powerful and influential voices in the nation.

So, to question number 3…what should you be doing? Building your advocacy capacity: Recruiting new advocates to add their voice to the Health Center Advocacy Network, establishing an advocacy plan that engages EVERYONE at your Health Center – staff, board, patients, volunteers and partners, collecting and analyzing your Health Center data to help illustrate what’s at stake, MAKING A PUBLIC COMMITMENT from the top down that ADVOCACY is a Health Center priority. Advocating for your Health Center and your patients: Telling your Health Center story – Educating policymakers about the success of your Health Center, how effectively – in terms of both cost and quality – you care for your patients and community, sharing what’s at stake should Congress decide to block grant the Medicaid program, or fail to act to fix the Primary Care Funding Cliff and what a 70% reduction in funding would mean to your Health Center. Making plans NOW to attend the 2017 NACHC Policy & Issues Forum in Washington D.C. – in this critical time for Health Centers and our patients, we need to turn out our advocacy troops in force this March to be sure we deliver the Health Center message to Congress and the Administration loud and clear!

The future of the Health Center Program belongs to YOU, our advocates. While many answers and information are yet to come, one answer is clear – that our path forward is advocacy.

Let’s all get to work.

Sign up to become an Advocate today!


Tina Sopiwnik: October 2016 Outstanding Advocate

The NtinaACHC advocacy team is excited to announce the Outstanding Advocate for October 2016, Tina Sopiwnik, Dentist and Advocacy Director at NorthLakes Community Clinic in Wisconsin. Tina’s innovation in advocacy and commitment to engaging as many people as possible in the process is one of many reasons she’s in the spotlight this month.

Tina has been part of the Health Center movement her entire career—after graduating from Tufts University Dental School with a National Health Service Corps scholarship, she found that her work with Community Health Centers was “more than payback for a loan.” She spent three years at Sunshine Community Health Center in Talkeetna, Alaska before moving back to her home state of Wisconsin to be the dental director of what was then The Lakes Community Health Center in Ashland, WI (now NorthLakes Community Clinic, which serves six communities in northern Wisconsin). In addition to her clinical responsibilities, she has also become the advocacy director, and was a participant in NACHC’s Advocacy Leadership Program (ALP) this past year.

After returning home from the P&I last March, Tina set to work building on NorthLakes’ already strong advocacy program. She and her other colleagues who comprise the advocacy team worked to put together a work plan that provides a solid framework for their advocacy activities. One of the highlights of the plan is to actively engage providers (who have an incredibly important and unique voice and perspective as Health Center advocates!) in telling their stories, as well as the stories of their patients. NorthLakes’ providers and other staff, are incredibly passionate about their work, and Tina found they would often stay after hours discussing and “brainstorming ideas that could not only help… individual patients, but our entire community.” These informal conversations led to what is referred to during a March ALP workshop as a BHAG (big, hair, advocacy goal): the Big Ideas Breakfast. These morning meetings (and subsequent Facebook group) began as an opportunity for colleagues to get together and chat about health care news and other ideas for the organization, but have grown exponentially and are now a community-wide conversation. The Big Ideas Breakfast now has a counterpart, the Big Ideas Happy Hour, and both the meetings and Facebook group are no longer open only to NorthLakes staff. Tina is even finding that people who haven’t previously been interested in policy and advocacy are excited about the group and want to get involved. Building this important advocacy program further, Tina has also begun bringing community partnerships into the equation by working with a local small business to host the Big Ideas events. Tina sees the ultimate goal of these gatherings as “continued awareness, collaboration, and sharing ideas with our community and health center. We are still new and informal but I can see “Big Ideas” supporting the culture of trust and community collaboration leading to grassroots advocacy.”

NorthLakes CEO Reba Rice cannot say enough good things about Tina and all of her efforts on advocacy. “Dr. Tina has come up with dozens of wonderful big and small ways to encourage staff, patients and legislators to learn more about what makes health centers special, why our model makes a difference, and the importance of our unique attention to the social as well as clinical determinants of health. She is so compelling, no one can resist her!”

Eventually, the Big Ideas group(s) will move from conversation to action—but it’s important to remember that all big ideas start small, and no matter the size of your Health Center or availability of resources, every organization can (and should) participate in advocacy in some way. If you or someone at your Health Center would like to get involved with advocacy but aren’t sure where to start, don’t hesitate to contact the NACHC advocacy team at We can help you create an advocacy program that works for both your center and your community.

Kudos to Tina for being this month’s Outstanding Advocate—thanks for all you do, and keep those big ideas coming!


Do you know an Outstanding Advocate who deserves this recognition? Let us know! Email Elizabeth Kwasnik at

Congratulations to the Advocacy Leadership Program’s Class of 2016!

The Grassroots Advocacy Leadership Program (ALP) is a six-month education and skills-building program that begins during the NACHC Policy & Issues Forum (P&I) in the Spring and continues through the subsequent fall. It is designed to provide intensive training and hands-on experience in all aspects of Health Center Advocacy.

The administrators, clinicians, board members, and other health center and primary care association staff below have worked tirelessly over the past six months digging into advocacy best practices, networking and brainstorming advocacy ideas with their peers, and working tirelessly to promote and institutionalize advocacy at their organizations and within their communities. We thank and applaud them for their energy and enthusiasm for supporting the Health Center Movement! Congratulations to the ALP Class of 2016!

cragunAlex Cragun

State Legislative Coordinator at the Association for Utah Community Health

Salt Lake City, UT

“I’ve been involved in issue advocacy for nearly a decade and the ALP program provided insight into the Health Center program that I didn’t have. I was able to bounce ideas and strategies off of people from different PCAs and health centers. It was well worth the time and effort!”

fb_img_1460492008422Cassidy Heit

Public Policy & Communications Associate

Oklahoma Primary Care Association | Oklahoma City, OK

“Advocacy amplifies the voices of the underserved that community health centers serve every day. I was extremely grateful to participate with so many other concerned advocates and changemakers!”

Heather Blatchley

Clinic Operations Director

Clinica Campesina Family Health | Lafayette, CO

“The Advocacy Leadership Program was a wonderful resource for learning the history of our health centers and the importance of continuing advocacy work.   Community Health Centers provide much needed care to an underserved population and this magnifies the need for all of us to be involved in advocacy work.  ALP served as a foundation for learning for me and I’m so thankful to have this in my toolbox!”

kpateKelley Pate

340B Compliance Coordinator

Community Action Committee of Pike County | Piketon, OH




laura-larsonLaura Larson

Director of Advocacy and Fund Development Programs

Metro Community Provider Network | Englewood, CO

“Advocacy is a movement – it’s about sharing stories and engaging people in meaningful causes and programs.  Sharing the story of the work Community Health Centers do in the community allows us the ability to provide a voice to our patients, the ones who so often feel like they are unheard.  The story you tell can have a ripple effect on others and create changes in ways you’d never expect!”

marjorie-noleen_headshotMarjorie Noleen

VP of Communication

Peak Vista Community Health Centers | Colorado Springs, CO

NACHC’s Advocacy Leadership Program (ALP) provided valuable information on planning,      executing and reporting results; key aspects to a having successful legislative impact on our communities. Additionally the follow-up ALP meetings, best-practices from peer health centers and PCAs, and the final report provided multiple opportunities to keep advocacy in focus, particularly when faced with competing priorities associated with delivering care to people in need. Thank you!”

Photography by Portland Oregon Photographer Craig MItchelldyer 503.513.0550Martha Farlow

Policy and Legislative Coordinator

Massachusetts League of Community Health Centers | Boston, MA

“Health centers have been so successful in large part because of the incredible advocacy work of our patients, boards, and staff. It’s critical for our emerging leaders in this movement to learn how to harness and organize that strength, and how to use it for the benefit of our CHCs and communities as we face new challenges.”

image1Mary-Michal Rawling

Director of Governmental Affairs

Golden Valley Health Centers | Merced, CA

“Advocacy is critical to the work that community health centers do every day. I love fighting for our patients and the services we provide to them!”


Michelle Kellermichelle-keller

VP – Patient Services

Swope Health Services | Kansas City, MO

“Participating in NACHC’s Advocacy Leadership Program was a game-changer for me. I no longer have a fear of working on legislative issues or reaching out to my elected officials. The ALP gave me the confidence I needed to begin advocating on behalf of my health center and the thousands of patients we serve. Being able to give voice to their concerns and our mission is truly a privilege, and I’m thankful I now have the skills to do that more effectively.”

rjn-headshot-2016Richard Napolitano 

Senior Vice President

Greater Lawrence Family Health Center | Lawrence, MA

“Strong, consistent Grassroots Advocacy is vital for the future of Community Health Centers.  There isn’t a better way to spread the good word of creating and expanding Access to quality healthcare than through each of our health center networks – staff, clinicians, patients, and the community can all play a role.  The Advocacy Leadership Program offered by NACHC is a first-rate program that served as the perfect primer and motivation for me and my team to ramp up our advocacy efforts at Greater Lawrence Family Health Center.”

tinaTina Sopiwnik

Advocacy Director

NorthLakes Community Clinic | Iron River, WI

“I had a great experience with the ALP.  It was fantastic to collaborate with other health centers and get the opportunity to dig a little deeper into advocacy issues and activities around the country.  From the policy and issues forum on Capitol Hill to the patients I see on a daily basis, I feel gratitude for the work we all do at community health centers and will continue to advocate with honor and respect to change outcomes for our patients facing health disparities.  Thank you for your support! It’s been a great year!”

Andrew Ward

Media & Public Policy Manager

Odyssey House Louisiana | New Orleans, LA

Doug Jaeger

Chief Executive Officer

Open Door Health Center | Mankato, MN


Janice Morrill

Outreach and Enrollment Coordinator

Maine Migrant Health Program | Augusta, ME

Kelsey Clough

Education & Communication Coordinator

West Virginia Primary Care Association | Charleston, WV

Rachel Hartford 

Community Relations Director

Heartland Community Health Center | Lawrence, KS


Thomas Drake

Executive Director

Christ Community Health Services | Augusta, GA

Kelley Pate: September 2016 Outstanding Advocate

kpateNACHC’s advocacy team is excited to announce the Outstanding Advocate for September 2016, Kelley Pate, 340B Compliance Coordinator for Valley View Health Centers in Ohio. In addition to her work on the 340B drug pricing program, Kelley has devoted extensive time to advocacy through the Community Action Committee of Pike County and by organizing events for National Health Center Week.

In her current position, Kelley helps to provide patients with access to affordable prescription medications by ensuring that Valley View Health Centers are compliant with the 340B program. Kelley is proud of the fact that she and the clinical staff at Valley View work together to accomplish their shared goals to increase health awareness, improve primary care services, and develop new innovations in the current medical and legislative environments. It was through her work with the clinical staff, in fact, that she was introduced to NACHC.  “When I attended my first NACHC event,” she recalls, “I was hooked.”  While attending the Policy and Issues Forum in D.C. this past March, Kelley participated in the Advocacy Leadership Program (ALP). The ALP introduced her to the policy & advocacy side of the Health Center Program and she’s “been riding the wave since March!”


Congressman Bill Johnson and Kelley Pate

Over the summer, Kelley worked to revamp the planning committee for Valley View’s National Health Center Week events, in an effort to increase participation in the week of celebrations. She took much of what she learned about advocacy strategy and best practices for outreach and brought a number of new ideas to the table. In particular, Kelley reached out to Governor John Kasich’s office and secured a resolution proclaiming August 7th to 13th Health Center Week in the state of Ohio. Putting her advocacy expertise to work on the ground further, she served as lead coordinator for visits with Congressmen Bill Johnson and Brad Wenstrup during events at two of Valley View’s sites.  Kelley was able to speak with both Congressmen about the success and accomplishments of Valley View due in part to key Congressional support for program funding and resources.


Valley View staff and Congressman Brad Wenstrup

She was also able to speak to remaining unmet need in the community, and the ways in which additional dollars would enable Valley View to provide comprehensive dental services, behavioral health services, and substance abuse treatment for their community. To round out NHCW, Kelley also helped organize an open house and ribbon cutting at Valley View’s Waverly location, which she described as “the sexy and crown-jewel event for the week.” Her tireless efforts on NHCW increased Valley View’s participation by 400% from last year!


On top of all of her hard work for National Health Center Week, Kelley also worked to recruit Health Center advocates for the national 100K in 100 Days challenge. Kelley shared that she finds that she gets “real, personal joy” when she helps others; advocacy being central to those feelings. Her work with the Community Action Committee of Pike County, Valley View Health Centers, and NACHC allows this self-proclaimed “legislative nerd” to be involved in both medicine and law, two areas she cares deeply about.  Thank you, Kelley, for your dedication to advocacy and the Health Center Movement! Congratulations on being our Outstanding Advocate this September!

Do you know an Outstanding Advocate who deserves this recognition? Let us know! Email Elizabeth Kwasnik at

We Did It! 100,000 Advocates Strong!

14142017_1073935932641627_707524288807866312_nWe did it! With your help we achieved our most recent goal of growing the Health Center Advocacy Network to 100,000 individuals in 100 days! Today, we are proud to announce that our Network of Health Center Advocates now totals close to 101,000 advocates who, like you, are committed to raising their voices on behalf of America’s Health Centers and the patients they serve. 

To be clear, you and all our advocates are NOT just names on a list. In the coming year the Health Center Program will once again face threats to its ability to carry out its mission. The return of the Primary Care Funding Cliff – which could mean a 70% reduction in funding for the Health Center Program should Congress fail to act – will  again demand a massive response from Health Center Advocates in order to deliver the health center message and secure critical support and resources to serve those we already care for and those in need of care.

Thanks to your efforts, more than 100,000 voices now stand ready to fight for the Health Center Program. The importance of this growth in our Advocacy Army cannot be overstated as we prepare to take on the challenges that lie ahead. You are at the heart of the Health Center Program – Health Center Advocates like you, who stepped up and reached across their network to bring new advocates into our community to help achieve this ambitious goal and ensure a bright future for Health Centers and their patients. This is indeed a major benchmark in our efforts, but we will not and cannot stop here. With nearly 200,000 staff and board members and more than 25 million patients, all of whom have a stake in the success of our advocacy, we have the potential for an even larger and even more powerful army that we will continue to build.

For now, we want to thank you for your tireless advocacy, for pushing us across the finish line to achieve 100,000 Advocates in 100 Days –  THANK YOU for all you do to support America’s Health Centers and the patients they serve. Keep up the incredible work!

The NACHC Advocacy Team,

Amanda Pears Kelly – National Advocacy Director

Alex Harris – Manager, Grassroots Advocacy Special Populations

Elizabeth Kwasnik – Manager, Grassroots Advocacy

Dorian Wanzer – Manager, Grassroots Advocacy Communications & Outreach

Aggressively and systematically addressing the social determinants of health: How a health center in Sioux City, Iowa is using data and enabling services to improve the health of its community

Enabling Services Day Podcast – Q&A with Dave Faldmo | Music:

This year we are celebrating all of the innovative ways health centers create better lives for their communities. Today we are highlighting all of the enabling services health centers provide – services like transportation, interpretation, case management, housing assistance, and countless other programs and initiatives health centers have created in direct response to the unique needs they find in their community. Today we’re hearing from Dave Faldmo, quality director at Siouxland Community Health Center in Sioux City, Iowa. Dave will share with us how their center is using data to learn more about the needs of their patients and addressing those needs through enabling services.

DaveFaldmo Q&A with Dave Faldmo

Tell us a bit about yourself and your role at Siouxland Community Health Center.

I first started seeing patients a few hours a week at Siouxland Community Health Center (SCHC) not long after graduating from the University of Iowa’s PA program in 1992. Since then I’ve worked part-time as a contractor, full-time through the National Health Service Corp federal loan repayment program, and been in roles including assistant medical director, co-medical director, medical director, and now as the quality director. It has been rewarding to be part of an organization that has grown from 15 to over 250 employees and from an old, small office building to a 6,000 square foot building. Most recently we opened up a satellite clinic across the river in South Sioux City, Nebraska which is where I primarily see patients now.

Describe the community you serve – what are some of the biggest needs in the community? The biggest barriers to health care?

I love the diversity of the patients that we serve. We have patients from all over the world. We have full time Spanish, Vietnamese, and Somali interpreters. We also serve patients that speak Cambodian, Laotian, Urdu, Aromo, Punjabi, and other languages. I even have a patient from Iceland. I have learned so much from my patients as I have gotten to know them more deeply and have learned of their cultures and traditions. Many of our patients have so many barriers to good health. Some are laborers at the meat processing plants who work long hours and do shift work, and for some assimilation into the local community is difficult.

SCHC_NEWLOGOWhat is the PRAPARE project? Why did Siouxland decide to participate?

PRAPARE stands for “Protocol for Responding to and Assessing Patient Assets, Risks, and Experiences”. It’s an effort that is led by NACHC to create, implement, and promote a standardized tool to assess patient’s social determinants of health – issues like lack of transportation, food insecurity, and homelessness that have significant effects on a person’s health. Dealing with social determinants of health is what health centers do on a daily basis, and we were excited to be part of a project that documented the work we were already doing and gave structure to our efforts.

I feel that we are just scratching the surface of the potential of the PRAPARE project. Population health is so important in today’s healthcare environment. It is not enough to address the immediate needs of the patients that come through our doors each day – we need to determine the state of the health of the community we serve and identify what has the most impact on health outcomes so that we can identify the best ways to improve our patient’s health. There is so much we can do PRAPARE.

What have you discovered about your community with the PRAPARE tool?

We did not have too many surprises with the PRAPARE data. Major areas of need for our patients include transportation, housing, education, food, clothing, and affording medication and other medical costs. The one thing that surprised me the most was that we all know that we deal with patients with social determinants because they are very obvious to us, but there are many patients who deal with these issues but who stay silent unless asked. It was a good experience for me to personally ask the questions on the PRAPARE tool to the patient. It helped me gain a deeper understanding of the patient.

What interventions, programs, and services have you begun to consider as a result of the data you’ve collected with the PRAPARE project?

 We are working with our local regional transit system to identify how we can better overcome transportation barriers for our patients. We have developed workflows and in-house programs to address food and clothing insecurities. We have also been involved in a project to enhance our partnership with Iowa Legal Aid. One of our board members is an attorney who is very involved with Iowa Legal Aid, which has really been a blessing in strengthening this partnership.

 Why are you passionate about the work you do and an advocate for health centers?

I have always felt the desire to work in a profession and for an organization that provides help to those who need it most. Working at the Siouxland Community Health Center has allowed me to do just that. I love that we provide enabling services like case management and health coaches, interpreters, behavioral health, financial, and enrollment counselors. I love the team-based care we provide that includes dental, pharmacy, and behavioral health. I believe that health centers are best equipped to solve many of the healthcare issues we are facing as a nation. I am a firm believer in the community health center concept and I am inspired by stories of the earliest health centers that were started in the Mississippi Delta and inner-city Boston in the 1960’s. I hope we can return to our early community health center roots by aggressively and systematically addressing the social determinants of health that impact the patients we serve. To do this, we need to be able to capture good data on social determinants at a population level, document the enabling services that we provide, and develop new programs and partnerships to overcome the social determinants of health in the communities we serve. Each community has different needs and different resources.

My work at the Siouxland CHC is at times exhausting and frustrating, but the work is fulfilling. The most rewarding aspect of my job is the relationships that I have built over more than 20 years with patients I care for and other health center employees I serve with.

To find out more about NACHC’s PRAPARE project, click here or email Michelle Jester at

Centros de salud como protagonistas en la respuesta a la emergencia de salud pública por el Zika

Protegiendo la salud pública – entrevista con Alexandra Conde | Música:

*scroll down to view this post in English

Este año celebramos todas las maneras innovadoras a través de las que los centros de salud crean vidas mejores para sus comunidades. Hoy nos enfocamos en como los centros de salud abordan las crisis de salud pública en sus regiones. Desde la crisis de agua en Flint, Michigan hasta la respuesta al huracán Sandy, los centros de salud por todo el país son expedientes respondedores, organizando recursos y servicios en apoyo de las comunidades que sirven. Hoy escuchamos de Alexandra Conde de la Asociación de Salud Primaria de Puerto Rico (ASPPR). Alexandra nos va a compartir lo que está pasando en los centros de salud de Puerto Rico para tratar a Zika en la Isla.

acondeColaboradora: Alexandra M. Conde Toro

A principios de este año, las autoridades gubernamentales de Puerto Rico declararon una emergencia de salud pública por el Zika. El virus, transmitido mayormente a través de la picada de mosquitos, sexo o de una madre a su feto, puede resultar en serios defectos congénitos en fetos infectados. Aproximadamente 1 de cada 5 personas presentará síntomas, que incluyen fiebre, salpullido, dolor en las articulaciones y conjuntivitis. Hasta el momento no existe vacuna ni tratamiento disponible.

Desde antes, ya la Asociación de Salud Primaria de Puerto Rico, Inc. (ASPPR) estaba monitoreando toda la información referente al Zika y diseminándola a los centros de salud, además de colaborando con el Departamento de Salud en lo que sería una respuesta coordinada e integrada ante el brote emergente. Por su parte, los centros de salud estaban trabajando con la prevención de la infección del virus en las comunidades, principalmente a través de la educación en salud y el alcance comunitario, en colaboración con los municipios, agencias gubernamentales y demás organizaciones.

Para finales del mes de abril, Health Resources and Services Administration (HRSA) otorgó $5 millones a los centros de salud de Puerto Rico para combatir el Zika. Estos fondos iban destinados a proveer el apoyo necesario para la expansión de actividades existentes dentro del scope de los centros de salud, que incluyen outreach, educación al paciente, cernimiento, servicios voluntarios de planificación familiar, incluidos los anticonceptivos, y/o tratamiento. Los centros de salud contrataron y adiestraron nuevo personal y adquirieron variedad de anticonceptivos.

A través de la ASPPR se ha coordinado una serie de adiestramientos al personal de los centros de salud. El primero, en colaboración con la Oficina de Preparación y Coordinación de Respuesta en Salud Pública del Departamento de Salud, fue dirigido a los trabajadores de alcance comunitario. Este se enfocó en la enfermedad y posibles complicaciones, ciclo de vida de los mosquitos Aedes y control de vectores, planificación familiar y consejería centrada en el paciente, y competencia cultural. El segundo adiestramiento, en colaboración con CDC Foundation y PROGyn, fue dirigido a los ginecólogos, enfermeros y educadores en salud, y enfocado en la planificación familiar. En específico, los ginecólogos se adiestraron en la inserción de anticonceptivos reversibles de larga duración (LARCs, por sus siglas en inglés) con el fin de recibir donaciones de estos dispositivos de parte de CDC Foundation para aumentar el acceso de mujeres en edad reproductiva. Próximamente se estará ofreciendo un tercer adiestramiento dirigido a demás personal clínico, con la epidemióloga del estado como recurso principal.

A su vez, la ASPPR ha trabajado varias alianzas que han resultado en donaciones de condones, repelentes, mosquiteros y larvicidas para distribuir a través de los centros de salud a las comunidades. Por su parte, los centros de salud también han trabajado en colaboración con los municipios y demás organizaciones, visitando y educando a las comunidades sobre el Zika, enfocando sus esfuerzos en la prevención. Iniciativas particulares se han trabajado con aquellos centros de salud que poseen programas específicos para trabajadores agrícolas, residentes de vivienda pública, personas sin hogar y  población con VIH/SIDA.

Dada la situación económica de Puerto Rico, los recursos que posee el Departamento de Salud y demás agencias gubernamentales son escasos. Los centros de salud han sido parte esencial de la respuesta al Zika, principalmente por servir de enlace entre el sistema de salud y las comunidades, y por poseer el recurso humano necesario. Están localizados en áreas de mayor necesidad y poseen personal adiestrado para orientar a las personas sobre cómo prevenir la transmisión y controlar el vector. También se han destacado por ofrecer servicios voluntarios de planificación familiar a las mujeres en edad reproductiva, ante la recientemente documentada necesidad en la Isla. Cabe destacar que según datos de UDS 2014, el 97.7% de los pacientes de los centros de salud de Puerto Rico se encuentran bajo el 200% del nivel de pobreza, 69.4% están cubiertos por Medicaid o CHIP, 12.2% no tiene seguro de salud y el 42.4% de las mujeres se encuentra en edad reproductiva (tienen entre 15 a 44 años de edad).

Los centros de salud sirven a las comunidades de Puerto Rico desde hace ya más de 40 años. Se han insertado exitosamente a estas, volviéndose principales portavoces. Conocen de sus necesidades y barreras, y como mejor trabajarlas, en colaboración con los municipios, agencias gubernamentales y organizaciones. Son principales aliados del Departamento de Salud en esfuerzos e iniciativas de salud pública. Ante la creciente crisis de salud en la Isla, los centros de salud también se han destacado al brindar atención médica de calidad, bajo un modelo de integración centrado en el paciente, a sectores de la población marginados y a personas no aseguradas o con cubierta de salud limitada, independientemente de la capacidad de pago. Son parte esencial de nuestro sistema de salud y pieza clave para el cumplimiento del triple objetivo. Por esto y mucho más es que debemos apoyar a los centros de salud y volvernos defensores del movimiento.

¡Muchas felicidades a todos en la Semana Nacional de los Centros de Salud!

Mapa Centros de Salud Primaria 330Centros de Salud de Puerto Rico:

  • Barceloneta Primary Health Services, Inc.
  • Camuy Health Services, Inc.
  • Castañer General Hospital, Inc.
  • Centro de Salud de Lares, Inc.
  • Centro de Salud Familiar Dr. Julio Palmieri Ferri, Inc.
  • Centro de Servicios Primarios de Salud, Inc.
  • Concilio de Salud Integral de Loiza, Inc.
  • Consejo de Salud de Puerto Rico, Inc.
  • Corporación de Servicios de Salud y Medicina Avanzada, Inc.
  • Corporación de Servicios Médicos Primarios y Prevención de Hatillo, Inc.
  • Corporación SANOS, Inc.
  • Costa Salud Community Health Centers, Inc.
  • HPM Foundation, Inc.
  • Migrant Health Center, Inc.
  • Morovis Community Health Center, Inc.
  • Municipality of San Juan
  • Neomed Center, Inc.
  • Patillas Community Governing Board, Inc.
  • Prymed Medical Care, Inc.


Health centers as protagonists in response to the Zika public health crisis

This year we are celebrating all of the innovative ways health centers create better lives for their communities. Today we are highlighting how health centers address public health crises in their regions. From the Flint water crisis to disaster relief after Hurricane Sandy, health centers across the country are quick to organize resources and services in the support of the communities they serve. Today we’re hearing from Alexandra Conde in Puerto Rico, Community Relations Official at the Primary Care Association of Puerto Rico (ASPPR). Alexandra will share with us what Puerto Rico’s health centers are doing to address the Zika epidemic on the island.

acondeGuest contributor: Alexandra M. Conde Toro

Earlier this year, the Puerto Rico government declared Zika a public health emergency. The virus, which is spread by mosquitos, through intercourse, as well as from a pregnant woman to her fetus, results in cold-like symptoms and can result in severe birth defects for infected fetuses. Currently there is no vaccine for the Zika virus. As such, ASPPR and health centers throughout the island of Puerto Rico have been working tirelessly to disseminate information about the virus and to prevent, identify, and treat the disease among the Island’s residents.

Well before Puerto Rico declared Zika a public health emergency, ASPPR had been monitoring all information related to Zika and disseminating it to health centers as well as collaborating with the Puerto Rico Department of Health to develop a coordinated and integrated response to the emerging outbreak. ASPPR also developed a series of trainings for health center staff to address the virus – trainings that target outreach workers, gynecologists, nurses, and health educators to better understand the virus, the life cycle of the mosquito that spreads it, and family planning techniques. Shortly, ASPPR will be offering a third training directed to other clinical staff, with the Epidemiologist of the State as the main speaker. In addition to conducting trainings, ASPPR has also formed several partnerships that have resulted in donations of condoms, repellents, mosquito nets, and larvicides for health centers to distribute in their communities.

Meanwhile, health centers have been working to prevent the spread of the virus through health education and community outreach in collaboration with municipalities, government agencies, and other organizations. Health centers serving agricultural workers, public housing residents, homeless, and patients HIV/AIDS have developed special health education initiatives with those patient populations in mind, and they have also worked in collaboration with municipalities and other organizations, visiting and educating communities about Zika and focusing their efforts on prevention.

By the end of April, the Health Resources and Services Administration (HRSA) awarded $5 million to health centers in Puerto Rico to fight Zika with the intention of providing support for expanded outreach, patient education, screening, voluntary family planning services (including contraceptives), as well as treatment of the virus. Health centers have been ramping up their efforts on the ground – hiring new staff and training existing staff to help prevent, identify, and treat the virus.

Given the economic situation in Puerto Rico, the Department of Health and other government agencies have scarce resources. As such, health centers have been a crucial part of the response to Zika, serving as a liaison between the health system and communities. They are located in areas of the greatest need and have personnel trained to guide people on how to prevent the transmission of the virus. Health centers also have experience offering voluntary family planning services to women in reproductive age, and given that over 40% of Puerto Rico’s health center patients are women of reproductive age and nearly 98% of patients are under 200% of the poverty level, the need couldn’t be greater.

Health centers have served in Puerto Rican communities for more than 40 years. They are successful, integral parts of their communities and are leaders that speak out on important issues. They know better than anyone else what their communities’ needs and barriers to care are as well as how to best address them; they are experts at collaborating with municipalities, government agencies, and organizations. Finally, health centers are key allies of the Department of Health in public health efforts and initiatives. Given the growing health crisis in the Island, health centers have been prominent in providing quality health care under an integrated patient-centered model to the people who need it most, regardless of their ability to pay. Health centers are an essential part of our health care system and play a key role in increasing access to care, lowering the cost, and improving the quality of care for all who need it. For these reasons and so much more, we must support health centers and become advocates of the health center movement. Happy National Health Center Week!

PR CHC map - EnglishHealth centers in Puerto Rico:

  • Barceloneta Primary Health Services, Inc.
  • Camuy Health Services, Inc.
  • Castañer General Hospital, Inc.
  • Centro de Salud de Lares, Inc.
  • Centro de Salud Familiar Dr. Julio Palmieri Ferri, Inc.
  • Centro de Servicios Primarios de Salud, Inc.
  • Concilio de Salud Integral de Loiza, Inc.
  • Consejo de Salud de Puerto Rico, Inc.
  • Corporación de Servicios de Salud y Medicina Avanzada, Inc.
  • Corporación de Servicios Médicos Primarios y Prevención de Hatillo, Inc.
  • Corporación SANOS, Inc.
  • Costa Salud Community Health Centers, Inc.
  • HPM Foundation, Inc.
  • Migrant Health Center, Inc.
  • Morovis Community Health Center, Inc.
  • Municipality of San Juan
  • Neomed Center, Inc.
  • Patillas Community Governing Board, Inc.
  • Prymed Medical Care, Inc.
  • Salud Integral en la Montana, Inc.


Celebrating America’s Migrant Health Centers: How health centers are working to comprehensively address the needs of our country’s agricultural workers

Farmworker Health Day Podcast – Q&A with Carlos Castaneda | Music:

This year we are celebrating all of the innovative ways health centers create better lives for their communities. Today, during Farmworker Health Day, we are highlighting all of the health centers that serve our nation’s agricultural workers. As agricultural workers continue to contribute billions of dollars annually to our country’s fruit and vegetable industry, health centers provide the support they need in order to access health care and overcome many of the health vulnerabilities working in the fields entails. Today’s guest contributor is Carlos Castaneda. Carlos is the Outreach Director at Adelante Healthcare in the greater Phoenix area of Arizona, and he will discuss the work Adelante does to bring agricultural workers into their clinics for much-needed health care. 

Guest contributor: Carlos Castaneda

The agricultural workers the Adelante Healthcare Farmworker Health Program serves face many of the same challenges that agricultural workers across the nation. Lack of transportation, accessible clinics, and high cost of health care can be significant barriers to these farmworkers’ health and wellbeing. The Phoenix Metropolitan area once had farm fields immediately adjacent to the outskirts of the city. However, the sprawl of the city’s borders have pushed arable farmland to the rural areas of Maricopa County. Where once farmland and farmworkers could be found within miles of the health centers, they are now working between 30 and 50 miles away from these centers. Very few of the farmworkers we see have access to transportation, so access to care for them can be an incredible challenge.

In an effort to address these barriers to health care and better serve the agricultural workers in our area, Adelante has streamlined many of our internal processes to make it easier and quicker for workers to be seen when they make it to one of our health centers. First, outside of the health center, the outreach team collaborates with the growers to conduct eligibility and enrollment fairs in the migrant housing complexes which expedites the patient on-boarding process. Once patients are enrolled, they can either call to schedule an appointment or simply show up at the health center to be seen by a provider, already established as an Adelante patient. If the workers have an acute need that is not an emergency, they can call our Outreach Patient Satisfaction Specialist to walk them through the enrollment process over the phone. By the time the farmworker arrives to one of our health centers, they are set with an appointment to see a provider. Eliminating administrative hassle and streamlining on-boarding procedures specifically for the agricultural worker population have made it easier for these individuals to be seen as quickly and effortlessly as possible once they are at the health centers, saving them valuable time and expense.

Adelante further conducts outreach within the farmworker community by collaborating with all of the Migrant Education Programs throughout the county. Recently we hosted a Mother’s Day Appreciation Luncheon in Mesa where we honored over 70 hard-working moms from the Mesa Migrant Education Program. We also sponsor several yearly back-to-school events during which we give away backpacks filled with school supplies to the children of farmworker families. We strive to go beyond the health care needs of the communities we serve and connect residents to education and other social programs for the wellbeing of their families. During our next farmworker enrollment campaign, we will bring long sleeve breathable cotton t-shirts, sunblock, and hydration education to help workers manage the extreme heat of the Arizona desert fields.

Advocacy for health centers, especially for those serving agricultural workers, is so critical countless communities across the country. In my experience at Adelante, corporate support is sparse, and the county health department is overburdened with health concerns from the larger urban community. Although Maricopa County does support our efforts in providing immunizations to farmworkers and their families, local agricultural communities heavily rely on Adelante for the vast majority of their primary and preventive health care needs. Without the Farmworker Health Program, agricultural workers in our area would not have affordable access to many basic health care services. Furthermore, because of our deep roots in the community as a Migrant Health Center, we truly understand the linguistic, social, and cultural barriers these communities face on a daily basis. Our team of four Farmworker Health Outreach Workers is small, but I am proud to serve alongside colleagues that are dedicated and passionate about this program and our farmworkers.