6. Subcontract the organization. purchasing of supplies to a group purchasing With the current contract between the Marshall Islands and the Seventh-day Adventist Church a likely organization would be Adventist Health Services West in Glendale, California, although there are other organizations who could also serve this function. should result in lower prices and better servicing. This At the same time a regular delivery schedule should be worked out for the delivery of supplies to the Marshall Islands via Matson Lines and Nauru Shipping. By using both of these carriers maintained. with adequate supply levels should be Should any emergencies occur air freight could be utilized either Continental Airlines or Military Air Command through Kwajelein. C. Maintenance One of the factors limiting the level of health care delivery is the inadequate maintenance provided for the physical plants. has led to such problems as leaking roofs Lack of maintenance causing damage to supplies; deteriorating machinery in laboratories and other departments causing poorer quality tests and services (i.e. hemodialysis); and breakdown of refrigerators resulting in decreased storage capacity for perishables and therefore a decrease in activities which depend on the use of perishables (i.e. lab tests, medications). emergency electrical system, Other areas which have suffered are the the plumbing system at Ebeye, conditioning at both hospitals, to name only a few. and the air In a climate such as the one found in the Marshall Islands where the salt air is highly corrosive, and the general quality of public utilities is substantially less than that generally encountered on mainland U.S., it becomes increasingly important and in fact imperative that a top quality maintenance program be developed for the hospitals in order to maintain the desired level of health care and keep capital costs to a minimum. Currently Department of the maintenance is being the Marshallese Government. unsatisfactory from the hospital's understandable since the Public provided by the Public This, however, perspective although Works department has has Works been probably many other responsibilities, limited budget and it would be difficlt for them to provide the special service which the hospitals require.