,<e
regular salary checks for duties not performed.
Instructions
gfven by
work
supervisors are often not carried out.
The
incentive
and morale
of
health
workers
is
very
flow.
It
is
recommended that salaries and other benefits for health workersIbe increased
(particularly for those who work on the outer islands) so that[new recruits
can be obtained.
Rewards, both monetary and otherwise (i.e. awafds, bonuses,
position advance) should be given specifically to those medical assistants
who fulfill their “expanded roles", both curative and preventfive, and who
remain
in
Majuro.
the rural
The present reward system favofs moving to
areas.
A great effort should be made so the first priority
n equipment,
supplies and supervisory support be given to the outer island.
This will
help change the perception that “only the flunkies" get sent [to the outer
islands.
Housing, food, and other domestic needs of the medic 1 assistants
must be adequately taken care of as well.
It is suggested t at the staff
housing on the outer island health centers be better than
Majuro and
provided without rental charge, while in Majuro a rental fee i
Perhaps
the greatest
administrative
problem
sufficient trained administrative personnel.
is
required.
that o
not having
In most develop ng countries
technical and professional personnel are available before admi istrative and
Support personnel,
progress
of
the
such
as
accounting.
professionals
due
to
This often greatly hinders
inefficient
admini tration
the
and
inappropriate manpower utilization.
In the Marshall Islands t is situation
exists,
lack
compounded
by
an
extreme
technical and professional.
of
all
personnel
It is further complicated by the
Cluding the
ow incentive
training in
such that at present there are essentially no candidates 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
inordina’ e
In all such cases it
recommended that Marshallese counterparts be identified to
expatriate
for
on-the-job
training
and experience and th
Marshallese personnel be selected for training at appropriate
number
of
is strongly
rk with the
additional
ites.
It is strongly recommended that the organizational patte
as outlined
The specific intent is to emphasize thq
rural health
component to avoid the all too frequent utilization of 90% o
the manpower
previously be followed.
and budget for approximately 10% of the population that ; urrounds the
hospitals.
This plan requires the establishment of five office: » each headed