The Department of Health and the National Hospital continue to co-exist as two separate systems. The Department of Health is responsible for public health issues, communicable disease control (including tuberculosis and HIV/AIDS) and health dispensaries at district and community levels. The National Hospital in Pago Pago is under the management of the Hospital Board, designated by the Governor, and is subject to the federal rules and regulation of the United States of America (i.e. the Hospital does not have to report to the Department of Health).

Financial management of public health programmes is mainly grant-driven rather than programme-driven. The hospital generates financial resources from user fees, local government appropriations and federal health care financing through the Medicaid and Medicare programmes. The total government health budget amounts to 14% of the territory’s total budget and the bulk goes towards curative care, with only about 10% going to public health. Total health expenditures are around US$ 32.3 million, which corresponds to a per capita health expenditure of US$ 500.

http://www.wpro.who.int/countries/2008/ams/health_system.htm (accessed 29.04.2009)