The need for both expatriate and national staff is accdpted now and in the foreseeable future, but appropriate educational progrdms will dependence on outside personnel. lessen Stated priority areas inklude upgrading secondary care facilities and addition of some tertiary @are functions, strengthening managerial and fiscal controls, improving cogmunication and transport capability between clinics on out-islands and cefttral secondary care facilities, activities and recruiting and upgracing staff. including initial qualification and Qublity assurance continuinh education of staff, preventive maintenance of equipment, and the monitofing of process and outcome of care need marked expansion. continued alcoholism, in such areas hypertension, as patient immunization, and Specific emphagis needs to be community diabetes, health and dd@ntal Care of radiation-related illness, although still of majo# education, services. emotional and political importance, is reaching a level that should be inta@grated into the health care system of the country. Tensions among Marshallese perceptions exist with rdgard to family planning, extent of external referrals, degree of support fom terminally i11 and elective care, qualification and level of health care prpviders for the smaller or more isolated population groups, and siting and care facilities. mber of health The Marshallese view the financing of Jheaith care as coming from Marshal! Islands Government general revenue,] Government obligation as Trust Territory administrator and United States a consequence of health effects of the U.S. nuclear weapons testing pr¢@grams, private corporation contribution for the health care of its employees, special program and project grants from foreign governments, foundaEkions and other agencies, and to a limited degree from patient revenue. Al ough there may be a role for private practice, the government intends that through its health care facilities no one needing health care will be dknied access to it. The final overriding concern is related to the phasing qut of the Trust Territory of the Pacific Islands and the assumption of te status of a Freely Associated State by the Marshallese Government. This {will impinge on the health care system in a number of ways, such as mampower training relationships, licensure standards, activities, supply procurement, etc. health planning It is expected that new &nd evaluation expertise wil! need to be developed in a number of critical areas, and that]the full impact of this changed relationship will probably not be known unt§] it occurs.