cf It is suggested that the hospitais develop separate maintenance departments completely dedicated to the maintenance of the hospitals and their equipment. They can be trained to handle the special equipment found in the hospital and be ready to deal with the emergencies which invariably come. Some equipment will obviously need to be sent out to be repaired; however, much of the routine preventive maintenance should be provided locally. In support of this, the budget which has been allotted to Public Works for maintenance of the hospital should be reallocated to the hospital for use in the support of its own department. An alternative to the health care system providing its own maintenance would be to contract out to an organization such as Global Associates for al] maintenance work or some of the maintenance on certain more technical pieces of equipment. A study should be done to see which would be the more cost effective efficient. and A third alternative which could be done in conjunction with either of the preceeding two would be that a contract could be arranged for the training of specialized repair technicians. The latter would facilitate the ability of the Marshallese to eventually handle their own health system by themselves. Recommendations 1. Separate the maintenance budget from Public include it in the health care budget. Works Department and Work performed by Public Works would be paid from the health care system. 2. Examine potential for a training contract with Global Associates to prepare personnel to perform more technical maintenance activities. 3. Capital expenditure should be made to bring the facilities and the equipment up to an acceptable standard in each health delivery location. 4. Outer atoll clinics should be equipped to perform simple routine maintenance on their equipment and facilities, and one person on each atoll should be trained to perform the necessary duties. 5. The hospital in Majuro should be established as the central location to send the more difficult repair problems which cannot be handled on the outer atolls. (It is expected that some repairs cannot be handled in Majuro will need to be sent out of the Marshall Islands.)