The Marshaii Islands Government nas served as a most important source of information, insight, understanding and background. We were fortunate to meet with the king, president, ministers of health, finance, resources and development, communication, the chief secretary, many of the other ministerial secretaries, and personnel in the operational levels within the health department. Also brought into discussions were the Guam-Micronesia Mission subcontractors who are currently managing the health care system. Half of the atolls and islands were visited, including: Majuro, Ebeye, Enewetak, Rongelap, Utirik, Mejit, Wotje, Likiep, Maloelap, Ailinglapalap, Arno, Jaluit and Mili. useful. Visits on these islands were all well received and The team was able to visit and study both hospitals, both super clinics, and over a third of the dispensaries. with local leaders, magistrates, Iroij, On each island the team met alab, councils, representatives, health personnel, and other local people. group meetings were held. chief secretary Many extensive Four survey instruments were used, dealing with the health facilities, clinic personnel, general information, environmental and resident needs assessment (samples are in Appendix G). These surveys gathered applicable a great deal of information, from which plans to currently existing needs and project demands can be built. C. Assumptions The following represent major activities that are being implemented by the Marshallese Government independent of the existing health budget. Obviously impact the health care system and this proposal, so They its relationship to each is discussed. 1. Majuro Hospital Plans are currently being discussed regarding the building of a new hospital in Majuro. The current hospital is in poor physical condition and the land where it is located "must" be returned to its owner at the end of the 25 year lease in 1981. The possibility of constructing an "interim" facility is being considered, which could later serve as an outpatient clinic. Neither the advisability of rebuilding vs. renovating nor the budgetary implications are dealt with in this proposal. 2. Nursing School The Board of Regents, College of Micronesia has recently voted to move its nursing school from Saipan to Majuro. Funding for this move, builiding requirements on Majuro,. available faculty, etc. are unclear at the present