', Irganizaticnal Issues A. Organizational Chart The present structure of the Marshall Islands health care system is typical down to the level of Secretary of Health. several views as to what exists. recent contract with Adventist Church. the Below that 1 el there are This problem has been magnified by the Guam/Micronesia Mission of the Seventh-day The best concensus appears to be that the Gu Mission has contracted to administer the two hospitals, and traditionally al health care activity is under the direction of the hospitals. section IV. (See followi B. and the contract in appendix F for additional information). Another factor which complicates the administration and] delivery of health care is that other departments outside the Ministry o Health are responsible for providing support services to the hospitals and clinics. For example, the Department of Public Works is responsible for prov ding ground, equipment, and facility maintenance. When Public Works doesn't have the time or money, things do not get done regardless delivery of health care. of need and in pact on the The proposed organizational structur] anticipates all support services to be budgeted items and under the control f the health delivery system. In designing the proposed organizational structure, the fo lowing items were of concern: l. Effective and accessible health care 2. Interests of the two governments 3. A functional health care organization The organizational chart which follows reflects an orga ization that deals with these concerns. To facilitate an understanding of [the proposed structure, a short description of the function/responsibilitieq for certain areas will be provided. Financial Intermediary/Program Implementator (FIPI) : It that this will be an entity mutually agreed to by the U.S. andj Islands. This would be a university, a private firm, or somP agency. Its primary function would be to provide fiscal implement the approved program. participation in the health envisioned the Marshal] appropriate ntegrity and Under this proposed organization, Guam/Micronesia Mission would not be the FIPI. their s care the We are recommending that delivery system ocus on the management of the two hospitals (division of secondary and te ‘tiary care). 1&2