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.