Lo Two budget items require special comment, training and new construction. etl, A major concern throughout the development of the program has been providing for the training of individuals so the Marshall Islands in time can use more and more of their own people. For this reason it may appear to be an over-budgeted item but in part is cost effective and culturally desirable. The other item, construction, is a result of the fact that from a practical point of view, housing is going to have to be provided to the Medical Assistant/Health Assistant on the atolls. There is little available housing and in one instance they had to leave an atoll because of this. It becomes a major budget item in years two thru five as this re- presents the timing for individuals coming off training programs. C. Secondary/Tertiary Care As with any health delivery system, costs for this level of care are the highest single component of the system. Contributing to the cost are the short useful life of equipment and maintenance costs because of the hostile environment (climate). It is anticipated that with improved main- tenance the average useful life of most equipment will be three to four years. As discussed in the previous section, training and upgrading of personnel is something that must be included early in the program. We have not budgeted for any major renovation of the Majuro Hospital, as it appears that a new one will be built. Since it seems to be beyond the scope of this study and there are funds already available for this new hospital, it was not included in this budget. Should plans change and a new hospital not be built, this could bea major addition to the cost of the health care delivery system.