Although a Western governmental model has been set up f br the Marshall Islands, the old stratified mode? of governance still exigts, exerting a very real influence on decisions affecting the new nation. [n establishing any comprehensive health plan for the Marshalls this dualit y of influence and decision must be taken into consideration, with proper provision made for the positive influence of the traditional leadership g up. It would be difficult to over-emphasize i the impor ance of being sensitive to Marshallese culture in the planning of any hea th care system for the islands. Care in this respect at least equal to th it expressed in Article 16, Section C of the health contract between the Go ernment of the Marshall Islands and the Seventh-day Adventist Guam-Micn pnesia Mission should be expected: “The Contractor hereby agrees to take Marshallese custom and tradition into account in its administration of the health services system and to respect the same... "On question of custom and tradition the Contractor, as the party responsible for management and control of the health services system, shall have the same right as any department or agency of the Government to seek advice of the Traditional Rights Court of the Marshall Islands on questions of custom and tradition." As the Chief Secretary of the Government of the Marshall 141ands recently said: “The Western world does not always understand us and our culture. They may mean well, but they are often unsuccessful because,. .. in the past they have been planning for people instead of planning with people." B. _ Government Policies and Perceptions The perceptions and policies of the Marshallese Governm nt are colored by the traditional social structure. family and to his followers. chiefs. The Each person has duties Iroij, or chiefs, have d This responsibility applied to health care has fo his extended tes to their en formalized in the constitution as a right of the individual to health cdre provided by the government. The implementation of this governmental dut is through the U.S. model of medical science-based technology and practice, difed to meet local geographic and al's sociologic conditions. The indivi symbolized by a nominal fee at the time care is required. 2 duty is