O-czommendations 1. Maintain a maternal and child health section in the Public Health Department for promotion of maternal and child health activities at all levels of health care. Coordinate an immunization system with the communicable disease section that maintains adequate services in all atolls. Implement a family planning/child spacing program in a culturally acceptable manner. Identify and upgrade the skills of the traditional birth attendants who are currently active. Encourage wider use and understanding of prenatal and postnatal clinic visits. Institute the use of a "Road to Health" card system for the under-5 population for better monitoring of growth and record keeping e.g. immunizations (sample included in Appendix K). Encourage legislation that requires complete immunization before school entry is permitted. Strengthen health screening and educational activities in primary and secondary schools. Promote nutrition education in the mother and child population. 3. Communicable Diseases Services with respect to communicable diseases are rendered in various components of health care. Those diseases spread by improper sanitation and hygiene are discussed under the section of environmental health. Other communicable diseases are discussed in connection with social problems. A number of communicable diseases can be prevented or reduced through an effective immunization program. A comprehensive immunization program is essential to maintaining a healthy outer island population. In the past, these immunizations were administered by personnel on the field ships. They were delivered at whatever interval such scheduling required, and were only effective in reaching the few children who were within easy reach. In the past year, immunization rates have fallen from 80% to about 19% in the under-2 year olds. To deliver adequate viable protection to the population at large is a very difficult task. This is especially so when the distances are so great, the population widely diversified, and cold chain maintenance so difficult.