a
regular salary checks for duties not performed.
Instructions givea oy
work
Supervisors are often not carried out.
The
incentive
and
morale
of
health
workers
is
very
low.
It
is
recommended that salaries and other benefits for health workers be increased
(particularly for those who work on the outer islands) so that new recruits
can be obtained.
Rewards, both monetary and otherwise (i.e. awards, bonuses,
position advance) should be given specifically to those medical assistants
who fulfill their "expanded roles", both curative and preventive, and who
remain
in the rural
Majuro.
areas.
The present reward system favors moving to
A great effort should be made so the first priority in equipment,
Supplies and supervisory support be given to the outer islands.
This will
help change the perception that “only the flunkies" get sent to the outer
islands.
Housing, food, and other domestic needs of the medical assistants
must be adequately taken care of as well.
housing on the outer
It is suggested that the staff
island health centers be better than in Majuro and
provided without rental charge, while in Majuro a rental fee is required.
Perhaps
the
greatest
administrative
problem
sufficient trained administrative personnel.
is
that of not having
In most developing countries
technical and professional personnel are available before administrative and
Support personnel,
progress
of
the
such
as
accounting.
professionals
due
to
This often greatly hinders the
inefficient
administration
and
inappropriate manpower utilization.
In the Marshall Islands this situation
exists,
lack
compounded
by
an
extreme
technical and professional.
of
all
personne!
including
the
It is further complicated by the low incentive
such that at present there are essentially no candidates in training in
nursing schools, medical
assistant
schools,
medical
officer schools,
or
ancillary medical worker schools.
This
situation
requires
that
at
expatriate personnel must be utilized.
present
an
inordinate
number
of
In all such cases it is strongly
recommended that Marshallese counterparts be identified to work with the
expatriate
for
on-the-job
training
and
experience
and
that
additional
Marshallese personnel be selected for training at appropriate sites.
It is strongly recommended that the organizational pattern as outlined
previously be followed.
The specific intent is to emphasize the rural health
component to avoid the all too frequent utilization of 90% of the manpower
and
budget
hospitals.
for
approximately
10% of the population
that
surrounds
the
This plan requires the establishment of five offices, each headed