-16- Any program of health care for the people affected by radiation should be integrated, to the maximum extent possible, with a future health care program of the Government of the Marshall Islands. The contractor, accordingly, will be required to examine current facilities and proposed hospital and dispensary facilities and staff to determine how such local staff and facilities can be utilized to provide comprehensive health care for the peoples of the affected atolls. (5) Primary care. Because many of the peoples concerned will be living in an “out-island" context, the contractor should set forth reconmendations on how “primary care“ can best be provided to the people in such a context. This should include recommendations on the type of staff, facilities, training of practitioners, etc. It will be necessary to determine whether present out-island facilities and programs maintained by the Government of the Marshalls Islands can be upgraded and subsidized to provide this essential primary care for the peoples concerned, or whether a separate primary health care system, supported and operated by the U.S, will be required? (6) Secondary and Tertiary care. The contractor will be required to set forth recommendations on where and in what manner secondary and tertiary care can be most effectively provided, both from treatment and cost standpoints. (7) Cost of Provision of Comprehensive Health Care for all of the Marshalls. The peoples of the designated affected atolls will require both “on-atoll” and "off-atoll” comprehensive care. Many of the individuals requiring the comprehensive care will be in the present major populated centers. The numbers away from the home atolls may well | run into several thousand. The contractor will be requested to draw up cost estimates of a comprehensive health care program for all of the Marshalls that would give the type of comprehensive care required for the peoples of the affected atolls.