a regular salary checks for duties not performed. Instructions givea oy work Supervisors are often not carried out. The incentive and morale of health workers is very low. It is recommended that salaries and other benefits for health workers be increased (particularly for those who work on the outer islands) so that new recruits can be obtained. Rewards, both monetary and otherwise (i.e. awards, bonuses, position advance) should be given specifically to those medical assistants who fulfill their "expanded roles", both curative and preventive, and who remain in the rural Majuro. areas. The present reward system favors moving to A great effort should be made so the first priority in equipment, Supplies and supervisory support be given to the outer islands. This will help change the perception that “only the flunkies" get sent to the outer islands. Housing, food, and other domestic needs of the medical assistants must be adequately taken care of as well. housing on the outer It is suggested that the staff island health centers be better than in Majuro and provided without rental charge, while in Majuro a rental fee is required. Perhaps the greatest administrative problem sufficient trained administrative personnel. is that of not having In most developing countries technical and professional personnel are available before administrative and Support personnel, progress of the such as accounting. professionals due to This often greatly hinders the inefficient administration and inappropriate manpower utilization. In the Marshall Islands this situation exists, lack compounded by an extreme technical and professional. of all personne! including the It is further complicated by the low incentive such that at present there are essentially no candidates in training in nursing schools, medical assistant schools, medical officer schools, or ancillary medical worker schools. This situation requires that at expatriate personnel must be utilized. present an inordinate number of In all such cases it is strongly recommended that Marshallese counterparts be identified to work with the expatriate for on-the-job training and experience and that additional Marshallese personnel be selected for training at appropriate sites. It is strongly recommended that the organizational pattern as outlined previously be followed. The specific intent is to emphasize the rural health component to avoid the all too frequent utilization of 90% of the manpower and budget hospitals. for approximately 10% of the population that surrounds the This plan requires the establishment of five offices, each headed