IX. 4EALTH MANPOWER A. Introduction There are various levels of medical practitioners based on function and responsibilities involving both the medical and nursing cadres. Primary medical care is usually rendered by the health assistant whose training varies from minimal instruction and continuing education given by a mid level practitioner to a more formal course, often of approximately duration. six months Approximately 55 health assistants have been trained for duty in the Marshalls. The largest problem at present in terms of manpower jis the high attrition due to retirement and lack of a recruitment system to encourage young people to enter the system. Incentives to enter the health system are very low compared to other types of government service. Within a few years severe shortages of all types of health manpower are to be experienced unless something is done soon. In developing medical manpower programs it is important to establish a scheme of service to enable every qualified person to advance according to his ability, interest and effort. procedures, work assignments, All training salary scales, scheme of service or career ladder. etc. programs, licensing should reflect such a After appropriate periods of service and work recommendations, selected health assistants could advance to medical assistants and from there potentially to medical officers. Likewise nursing assistants should be able to advance to practical nurses and from there to graduate nurses and on to become bachelor or master degree nurses many of whom would become specialists in specific nursing areas such as administration, education, public health, midwifery, critical care, etc. In general there are sufficient educational institutions for _ the various health manpower needs in the South Pacific areas such that it should not be necessary to establish any new schools for manpower training programs. B. Administrative The administrative employees will current understand problems supervisors. structure is the that of must line be clearly defined and staff organization. insufficient Many of the nursing personnel authority of so that all One of the Marshallese report sick or are late in returning from vacation, sometimes even months late, yet continue to receive