Implementing the Local Public Health System (LPHS) Performance Assessment in a U.S Associated Pacific Island Nation

The American Samoa Department of Health (DOH) is leading a Territory-wide planning effort with support from the National Public Health Improvement Initiative to ultimately achieve accreditation. As part of this effort, American Samoa implemented the Local Public Health System (LPHS) Performance Assessment Instrument in July 2011 to further the science-base for public health practice improvement. The Centers for Disease Control and Prevention (CDC) created the National Public Health Performance Standards Program (NPHPSP) for implementation at local and state health departments. American Samoa is the first U.S. Territory to implement LPHS and assess its public health system performance. Public health and community-based agencies partnered to complete this data-driven instrument. The lessons gained from the implementation process of a nationally recognized, accreditation tool in American Samoa demonstrate the complex intricacies involved with improving health care service quality and delivery in jurisdictions for which the tool was not initially designed. The tool's prescriptive nature was the most commonly cited limitation, as it required an answer to every question even if inappropriate to the setting, such as those about the local health system's relationship to state and county departments. Cognizant of the limitations, partners and stakeholders were nonetheless able to use key findings to identify the major strengths and gaps in American Samoa's public health delivery system and prioritize quality improvement areas for future health planning efforts.