. 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