Recommendations 1. Majuro and Ebeye both require intensified immunization programs capable of delivering full coverage to 100% of the school children and 90% of the population at large, within a one year period of the programs initiation. 2. Utilization must be made of Air Marshall Islands for the delivery of immunization supplies, and occasionally teams, to the outer islands. 3. All children enrolled in outer island schools must be able to present an up-to-date immunization card showing current full coverage within one year of program implementation. teams and local health This can be obtained through mobile assistants operating from the atoll's main clinic, with cold chain maintenance capacity. 4. Upgrade the supply and logistics system for immunizations, develop a functioning cold chain system, and establish a detailed statistics and record The keeping outer service for surveillance, evaluation, island clinic refrigerators and and reporting. central cold storage facilities at Majuro and Ebeye will be crucial to ongoing programs on the atolls. 4. Chronic Diseases Unlike many developing countries, the Marshall Islands are developing Significant health cardiovascular problems diseases, with the latter chronic diseases. representing the Cancer end and effect of hypertension and diabetes, are the leading killers. While the clinical care of these problems will be covered by primary and secondary facilities, the education and detection is often coordinated by public health personnel. A federally funded (DHEW) cervical completed in 1978 with moderate success. cancer screening program was After initial reluctance, there seemed to be general acceptance of the program, including male workers doing pap smears. The program was limited primarily to Majuro and Ebeye where coverage ranged from 12-47% in different years and locations. cancer screening or education programs have been undertaken No other to any significant degree. Hypertension is increasingly being recognized as a significant problem in Micronesia. affected. It appears that from 7-15% of all Micronesians may be The high mortality statistics for cerebrovascular disease are undoubtedly a result of this problem, Adequate evaluation and treatment of hypertension component has not been a strong of the health assistant curriculum, so the existing primary care workers appear to be doing a rather 6