. . . . .. .- . . ..—..--— ----- ......+-.. -11- 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 recommendations 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 r.cce~sary to determine whether present out-island facilities and progrZuns r,,zintzir.ed by the Government of the Marshalls Islands can be upgraded anc su.asidized to prot’ide this essential primary care for the peoples c~nc~yr,e~, 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 ar.a tertiary care can be most effectively provided, both from treatment and cost standpoints. (7) Cost of Provision of Comprehensive Health Care for The peoples of the “designated affected atolls” all of the Marshalls. 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. 7. . Further comments Because some representatives who are required by the statute to be directly involved in the preparation of the plan may not be present at the meeting of August 4, and because some who are present may wish to supplement comments made at the meeting, the Interior Department will welcome the receipt of views by no later than the close of business on Monday, August 18. Views may be expressed either in writing or, if the representative prefers, orally to pertinent officers or employees of the Whether in writing or otherwise, however, such Interior Department. views must be received no later than August 18, in order to permit the contract procedure to commence immediately thereafter. As this Discussion Paper attempts to make clear, the Interior Department’s position as to the directives to a contractor is not now fixed. This paper has been prepared solely as a guide to further discussions and exchanges of views. The Interior Department will welcome, and will give careful consideration, to any views that may be presented to it, particularly from the representatives of the people of the affected atolls and the Government of the Marshall Islands.