. Jrganizaticnel issues
A.
Organizational Chart
The present structure of the Marshall
Islands health care system is
typical down to the level of Secretary of Health.
several views as to what exists.
recent
contract
with
Adventist Church.
the
Below that level there are
This problem has been magnified by the
Guam/Micronesia
Mission
of
the
Seventh-day
The best concensus appears to be that the Guam Mission has
contracted to administer the two hospitals, and traditionally all health care
activity is under the direction of the hospitals.
(See following section IV.
B. and the contract in appendix F for additional information).
Another factor which complicates the administration and delivery of
health care is that other departments outside the Ministry of Health are
responsible for providing support services to the hospitals and clinics.
For
example, the Department of Public Works is responsible for providing ground,
equipment, and facility maintenance.
or money, things
do not get
delivery of health care.
When Public Works doesn't have the time
done regardless of need
and
impact on the
The proposed organizational structure anticipates
all support services to be budgeted items and under the control of the health
delivery system.
In designing the proposed organizational structure, the following items
were of concern:
1.
Effective and accessible health care
2.
Interests of the two governments
3.
A functional health care organization
The organizational chart which follows reflects an organization that
deals with these concerns.
To facilitate an understanding of the proposed
structure, a short description of the function/responsibilities for certain
areas will be provided.
Financial
Intermediary/Program Implementator (FIPI) :
It is envisioned
that this wil] be an entity mutually agreed to by the U.S. and the Marshal]
Islands.
This would be a university, a private firm, or some appropriate
agency.
Its primary function would be to provide fiscal
implement
the
approved
program.
Under this proposed organization,
Guam/Micronesia Mission would not be the FIPI.
their
participation
in
the
health
integrity and
care
the
We are recommending that
delivery
system
focus
on
the
management of the two hospitals (division of secondary and tertiary care).
1&2