March 18, 2026 | Saisha Adhikari
The Republic of Palau is navigating a rapidly shifting public health landscape with an approach rooted in creativity, clarity, and community. Rather than slowing down in the face of limited staffing and competing priorities, the Ministry of Health and Human Services (MoHSS) has chosen to use this moment to build systems that will last.
Through Public Health Infrastructure Grant (PHIG) funding, Palau hired HealthEfficient, a health care consulting organization, to support data modernization (DM) initiatives, including a new national electronic health record (EHR). Palau previously collaborated with HealthEfficient through the Pacific Islands Primary Care Association (PIPCA), which introduced HealthEfficient to the region through a multi-year initiative to support regional EHR planning, readiness, and adoption. During that time, HealthEfficient developed a strong understanding of Palau’s priorities, needs, and operating context. Palau subsequently joined HealthEfficient’s Health Center Controlled Network. This multi-phased, ongoing partnership has helped Palau bring structure to complex work, expand internal capacity, and make progress on long-standing priorities.
Laying the Groundwork for Meaningful Progress
As part of its PHIG workplan, MoHSS is committed to adopting modern, flexible technologies and standards, reducing data silos, and strengthening its workforce. Given the need for external support to implement the EHR, Palau also considered how to leverage its partnerships to advance broader DM efforts.
MoHSS collaborated with ASTHO to clarify needs and what success should look like. This preparation, combined with HealthEfficient’s familiarity with Palau’s health system and cultural context, created a strong foundation for their partnership.
HealthEfficient has been instrumental as Palau transitions from a largely manual system to a modern, comprehensive EHR. The consultant’s ability to understand local realities of how staff work, how communities engage with health services, and what modernization means in Palau’s context has helped decisions remain grounded in what the country truly needs.
Project Management as a Capacity-Building Strategy
HealthEfficient serves as an extension of the MoHSS team, managing day-to-day coordination and creating structure around the DM work. They lead agendas, capture meeting notes, track progress, and manage overall project flow. This allows Palau MoHSS staff to stay focused on vision, strategy, and local leadership.
Palau MoHSS and HealthEfficient meet on a consistent cadence: twice weekly on EHR implementation and twice monthly on broader DM activities. As demand has increased, additional meetings and hours are scheduled as needed throughout the week. This rhythm keeps the work aligned while giving each workstream to move at its own pace.
Due to capacity, MoHSS moved the EHR launch from December 2025 to the first half of 2026. Rather than treating this as a setback, they used the new timeline as an opportunity to refine workflows and better support staff. Together, MoHSS and HealthEfficient updated their approach and kept the work moving.
Although the workload is still considerable, the partnership has made it manageable. Clear roles, shared communication, and reliable structure have allowed the team to maintain momentum without overwhelming MoHSS staff. This progress is also driven by a strong internal MoHSS team of five staff members, several of whom are featured in this blog, who are working closely with HealthEfficient and the EHR vendor to move implementation forward.
Sherilynn Madraisau, Director of the Bureau of Public Health Services at MOHSS, explained:
“Even with limited staffing, leadership recognized how critical this project was for Palau and contracted HealthEfficient not only to manage much of the day-to-day work but also to help build our internal capacity, ultimately strengthening overall systems and creating long-term impact.”
Navigating Challenges with Cultural Awareness
Like many small jurisdictions, Palau MoHSS faces:
- Limited staffing and competing priorities.
- Navigating technical jargon.
- The need to coordinate across multiple external partners.
These challenges show up in real ways: teams are stretched across responsibilities, vendors may not understand local context, and cross-agency communication requires ongoing attention.
Edolem Ikerdeu, Executive Director of the Palau Community Health Center, noted the importance of cultural mediation in this work:
“Our consultants bring valuable expertise and guidance, but it’s equally important that the work reflects our culture and our priorities.”
Her role includes working with staff members to help partners understand context, smoothing miscommunication, and ensuring all stakeholders stay aligned around the mission of serving Palau’s people. That spirit of shared learning and adaptation is echoed across the team. Tmong Udui, Acting Chief of Division of Health Informatics and Intelligence at MoHSS, added, “A lot has been new for [staff], but learning together and building skills in this new area has been a good experience.”
Partner engagement remains personal and intentional. The MoHSS team keeps partners engaged by having real conversations, naming the shared purpose, and showing exactly how the EHR will help the whole country, not just the health sector.
Early Wins and Emerging Strengths
Even just a few months into the EHR migration, MoHSS is already seeing measurable progress:
- Accelerated EHR Implementation: After years of anticipation, MoHSS now has a clear structure, dedicated support, and renewed momentum behind the EHR work.
- Informed Technology Decisions: With HealthEfficient at the table for external stakeholder discussions, MoHSS has had a trusted advisor to help evaluate system options and advocate for what best fits the country’s needs.
- Growing Internal Capacity: Through trainings and ongoing collaboration with subject-matter experts, staff are strengthening their skills in cybersecurity, systems upgrades, and process improvement.
- Stronger Organizational Coordination: Clear oversight and consistent communication have helped reduce the burden on staff and increased alignment across the ministry.
These wins reflect progress beyond just technology, but in confidence, communication, and long-term planning. The work is strengthening the system as a whole and not just a single project.
A Foundation for the Future
With HealthEfficient managing much of the operational load for DM, Palau can focus on guiding strategy and determining long-term direction. HealthEfficient advances the work; MoHSS shapes the vision.
Edolem Ikerdeu shared, “If you hire people and the funding goes away, then what is this for? We want a stronger system that includes the people who are already here.”
Palau’s approach offers a compelling model for other resource-limited jurisdictions:
- Start with clarity.
- Build the right partnerships.
- Protect space for local leadership.
- Design systems that will outlast short-term funding.
By centering community, embracing thoughtful project management, and working with culturally aligned partners, Palau MoHSS is building public health infrastructure that will serve its people well into the future.
Reviewed by Lindsey Myers, MPH, Vice President, Public Health Workforce & Infrastructure.
This work was supported by funds made available from the Centers for Disease Control and Prevention (CDC) of the U.S. Department of Health and Human Services (HHS), National Center for STLT Public Health Infrastructure and Workforce, through OE22-2203: Strengthening U.S. Public Health Infrastructure, Workforce, and Data Systems grant. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by CDC/HHS, or the U.S. Government.
