Ebeye, anc thereby reduce the substantial volume of seconitary and tertiary care currertly provided in Honclulu. The pla: cails for a training procgrar for medical assistants ans higher-level Marshallese mecical personne] and for irproved supply and facilities Maintenance. The plan relies primarily on local transportation facilities, notably service by the Airline of the Marshall Islands where available, and or field trip ships and chartered vessel service elsewhere, rather than the provision of dedicated surface vessels or aircraft. Improved radio communications between the medical staff at the hospitals and the medical assistants on inhabited islands anc atcils would be essential, not only for the exchance of necessary medical information and instructions but also for decisions as to emergency medical evacuations. This alternative provides a suggested organization of the health-delivery system of the Marshall Islands, with the United States playing a major role in the direction and management of the program but preservince local authority and participation. The estimated cost for the first year of this plan would be 510,908,300, of which $3 million would be funded by the Marshall Islands Government. The second alternative contained in the Loma Linda proposal is comprehensive medical care for only the peoples of the four named atolls of Enewetak, Rongelap, Utirik, and Bikini. This alternative would provide improved primary care on the four named atolls and on other islands and atolls where peoples from these four atolls now reside. This alternative, like the first, provides for the improvement of the secondary and tertiary services at the hospitals on Majuro and Ebeye. The hospital-service improvements would provide the necessary support for the primary care system and would reduce costs associated with medical referrals out of the Marshall Islands. The estimated cost for the first year of the proposal for provision of special care for the peoples of the four named atolls is approximately $10,603,700, of which $3 million would come from Marshall Islands Government funds. This estimated first-year cost is Close to the estimated first-year cost under the first alternative because much of it reflects the cost of improving services at the hospitals at Ebeye and Majuro which would be required under either alternative.