Puerto Rico Response and Recovery: Health in Schools

Commitment by International Medical Corps

In 2018, International Medical Corps committed to improve access to primary healthcare for school-aged children in Puerto Rico by partnering with Med Centro to expand their health in schools program. After Hurricane Maria, health organizations in Puerto Rico have experienced increased numbers of patients seeking care at Mobile Medical units (MMUs) as opposed to traditional clinic sites. In recognition of this new reality, International Medical Corps will support Med Centro in procuring an additional MMU, which will allow Med Centro to reach an additional five elementary and middle schools with comprehensive preventive health screenings. Additionally, International Medical Corps will provide training and capacity building to all Med Centro staff to strengthen existing services as well as services provided in the new MMU, particularly in the areas of adolescent health and mental health. As a result of this commitment, more than 1,000 elementary and middle school students will receive increased access to primary care services.



Puerto Rico Response and Recovery: Health in Schools



Est. Duration

1 Year

Estimated Total Value



Latin America & Caribbean


Puerto Rico

Commitment by

International Medical Corps

Partner(s) of the Commitment Maker(s)

Asociación de Salud Primaria de PR

To address the current gap in access to health care, International Medical Corps commits to partnering with Med Centro to expand its Health in Schools programs. Med Centro belongs to La Asociación de Salud Primaria de Puerto Rico (ASPPR), a non-profit health network. Based in Ponce, Med Centro operates six facilities and three mobile medical units (MMUs) to reach vulnerable communities. MMUs provide services through schools, so students can access a full range of health care services. International Medical Corps will provide surge capacity, training, and equipment to help Med Centro reach an additional five primary and middle schools with MMUs in remote, hurricane-affected areas. Training will benefit existing and new clinic and MMU staff, expanding available services to all and strengthening the care provided across all Med Centro sites. Activities will include: First, Procuring an additional MMU to expand geographic reach. Second, access to primary care to five schools weekly, including general wellness and preventative health checks; treatment for acute and chronic illness; provision of medicine, health education, and hygiene promotion; surveillance and treatment for communicable conditions (ie., lice, conjunctivitis, scabies); nutrition; and more. Based on needs, the MMU can expand to additional services. Third, mental health services. To address a gap in mental health services, International Medical Corps will provide training in psychological first aid and mental health services to all Med Centro staff (including the new MMU staff). Fourth, launch adolescent health services. As many students in Puerto Rico do not have access to routine adolescent health services and information, International Medical Corps will train Med Centro staff to educate students on adolescent health, including: general hygiene, menstrual management, healthy diets, peer pressure, psychosocial well-being, prevention of unwanted pregnancies, prevention and treatment of substance abuse and STIs, prevention of violence and more. In addition to providing ongoing and needed primary care, MMUs support direct referral to Med Centro’s clinics, ensuring a streamlined referral process and continuity of care when required.

Over the next year, International Medical Corps will expand Med Centro’s capacity to provide School-Based Health Programming by: April 2018: Develop detailed work plan with Med Centro for procurement and training program. June 2018 – September 2018: Procure and equip an additional MMU to expand access to services for five additional schools. June 2018 – September 2018: Train new and existing Med Centro staff on mental health services and adolescent health care services. September 2018 and ongoing: Launch MMU services to five additional elementary and middle schools weekly, visiting one school per day, integrating new mental health and adolescent health care services. September 2018 and ongoing: Conduct M&E, refresher training and supportive supervision as needed to 1) track effectiveness of services; 2) support the adoption of new mental health and adolescent health care services; and 3) enhance services as needed, based on local needs and gaps.


Hurricane Maria made landfall in Puerto Rico on September 20th as deadly Category 4 storm. Winds as high as 155 mph and torrential rainfall caused widespread flooding, damaged and destroyed infrastructure, and knocked out power, leaving some 3.4 million people without electricity. The storm cut off communication and transportation services, breaking supply chains and leaving residents struggling to find basic resources such as fuel, water, and food. In the wake of Hurricane Maria, health facilities have reported a decrease in the number of primary health care consultations at main clinic sites, and clinics have reported thousands of registered patients who have missed regular appointments or have not refilled prescriptions. Children’s primary health care has also been neglected in the months following Maria, raising concerns about ongoing disease prevention and detection efforts, maintenance of chronic conditions and general wellness promotion. At the same time, health centers operating mobile medical units (MMU) have experienced noticeable increases in patient consultations through these MMUs during community outreach programming. While the hurricane has had a significant impact on most Puerto Rican daily lives, the event also exposed the pre-existing weaknesses of vital infrastructure and social services. For example, prior to the hurricanes, school nurses were not universally employed at primary and middle schools in Puerto Rico, and when they were, their primary role was basic first aid – leaving other child and adolescent health issues like healthy lifestyles and diabetes prevention, sexual and reproductive health education, mental health and substance abuse prevention largely unaddressed. Health worker attrition and school closures as a result of the hurricane have exacerbated these gaps in available care.

Partnership Opportunities

International Medical Corps has secured $500,000 to launch these services, and is seeking an additional $500,000 to implement the expanded services with Med Centro. Funds will primarily be used to provide the capital and training investments required to expand services. Ongoing operating costs will be funded through Med Centro’s existing funding streams. International Medical Corps will procure and provide the required equipment and training to Med Centro, including a new MMU and training in mental and adolescent health services, to expand existing access to care. Should the expansion be successful and funding be available, International Medical Corps will expand the model to additional ASPPR corporations.

Progress Reports

February 2021

In the aftermath of Hurricane Maria, International Medical Corps supported services for more than 280,000 women, men, and children, ensuring hurricane-impacted health facilities could keep their doors open to provide medical care to those affected; provide nutrition care; and deliver hygiene materials to keep families healthy. Hurricane Maria, though, has not only had a significant impact on most Puerto Ricans’ daily lives, but also exposed pre-existing weaknesses within vital infrastructure and social services in the country. Health worker attrition and school closures as a result of the hurricane have exacerbated gaps in available care. Health facilities also reported a decrease in the number of primary healthcare consultations at main clinic sites, with thousands of registered patients missing regular appointments or failing to refill prescriptions. Doctors and teachers noted evidence of increased levels of suicide ideation, suicide attempts, and self-harm among young adolescents; teachers reported an increase in signs of distress among students with increases in spontaneous crying, along with fears of wind and rain. Moreover, the majority of healthcare staff have very limited training in emergency preparedness and in how to provide psychosocial support to distressed children, especially post-disaster.

To meet these needs as quickly as possible, and based on the prolonged period of time to procure and deliver a mobile medical unit, as reported in December 2018, International Medical Corps modified its strategy to focus on training health workers across clinics to exponentially increase their capacity to respond and reach more people in need with mental health services. While the organization changed strategies from a mobile unit to working across a number of static facilities, International Medical Corps continued to collaborate with La Asociación de Salud Primaria de Puerto Rico (ASPPR).

Together, International Medical Corps and ASPPR trained 429 frontline health workers, community and religious leaders, as well as community members on psychological first aid (PFA) reaching all seven regions of Puerto Rico with training. International Medical Corps adapted the training materials to the Puerto Rican context, including translating the materials to Spanish. We selected trainees in coordination with the DoH, FEMA, and religious institutions to target hard-hit communities impacted by Hurricane Maria. International Medical Corps selected community leaders and religious leaders in coordination with religious institutions and local authorities at the region and municipality level.

In addition, between January and October 2019, International Medical Corps and ASPPR conducted ten training sessions and webinars focused on emergency preparedness and resiliency, reaching more than 57 participants across 18 community health centers. These trainings aimed to improve community health centers’ response coordination in future public health emergencies or natural disasters.