Republic of Palau

The Republic of Palau is an independent nation in the western Pacific. It lies on the other side of the date line from the continental United States.

Relationship With the United States

Following WWII, Palau was placed under the administration of the U.S. by the United Nations as part of the Trust Territory of the Pacific Islands. In 1981, a constitution was adopted, and the country became internally self-governing. Palau entered into a Compact of Free Association with the United States that came into full effect in 1994.

Under the Compact, the U.S. government agreed to provide economic and technical assistance (including significant funding for health), ensure U.S. military defense support, and allow unrestricted travel to and from the United States for these non-resident Palauan citizens. In return, Palau agreed to give the U.S. government unlimited and exclusive use of their land, airspace, and waterways for strategic purposes. Financial assistance, as currently structured within the Palau Compact, extends through 2024.

Palau receives significant funding for health and health system development through the Department of the Interior, which administers Compact funding, and is also eligible for some U.S. federal programming, including grants from the U.S. Department of Health and Human Services.

Healthcare and Facilities

The Palau Ministry of Health has four bureaus: the Bureau of Public Health Services (which includes Divisions of Environmental Health, Oral Health Services, Primary and Health Services, and Behavioral Health), the Bureau of Hospital and Clinical Services (oversees Belau National Hospital), the Bureau of Nursing (oversees both public health and clinical services nurses), and the Bureau of Hospital Administration and Support Services. Palau has one hospital: the Belau National Hospital, a modern, well-equipped, American-style hospital, located on Koror. The hospital can be reached from most regions of the country within two hours.

Palau residents are not eligible for Medicaid. Palau migrants who meet Medicaid thresholds within their state of residence in the continental U.S. are eligible for Medicaid. The Compact funding is not a significant source of healthcare funds in Palau.

Key Priorities

In the 2016 ASTHO Profile report, the Palau Bureau of Public Health defined its top five priorities as:

• Strategic planning
• Workforce development
• Health promotion
• Surveillance and data capacity building
• Research and policy development

Disease Burden

Like the rest of the Pacific, Palau faces a noncommunicable disease crisis and a significant communicable disease burden. The top causes of death in 2019 were:

• Ischemic heart disease
• Diabetes
• Stroke
• Lower respiratory infection
• Chronic kidney disease