II. Executive Summary Because of significant time limitations and an already existing 5-year plan for the Marshall Islands (1981-86) developed by the Trust Territory of the Pacific Islands, Loma Linda University concentrated more on developing a health strategy proposal than a detailed health plan. Particular attention was paid to the issues involved in a national vs. 4 atoll health care system. The Trust Territory of the Pacific Islands is currently phasing down. Many functions previously covered by that office, i.e. licensing, planning, personnel, etc. will need to be assumed by the Marshall [sland Government. Existing health care financing in the Marshalls comes partly from the U.S. and partly from internal Marshallese sources. It is recommended that additionalmonies available from P.L.96-205 be combinedwith these. _existing funds rather than components of. of ‘the health care system receive monies from different unrelated budgetary sources. There are a Marshalls. minimal radiation related ot " health effects pine evident in the The primary need is for a basic health care system capable of providing primary, secondary and tertiary care. The system should have an awareness of a radiation effects as an integra] and identifiable component of comprehensive care. The Government of the Marshall Islands is seeking to rapidly expend its air, ship and radio communication with the outer atolls. Rather than attempt to develop a distribution referral and supervision system for health ahead of outer sectors, at an exorbitant cost, it is recommended that the health care system be built around these current inadequacies. One of the biggest detriments to basic health are, even on Majuro and Ebeye, is Tack of adequate supplies and maintenance. It is imperative that a strong support system be developed to meet this need. The primarycarewill be built on medical assistants and health ee emer am blir > ea assistants on Majuro and Ebeye- as well as the outer islands. Small populations with minimal work loads are adequately covered by these workers, with consultation from the hospital physicians, verbally via radio or by referral, for the more difficult cases. either wee ee A.