Te Recommendations l. Majuro and Ebeye both require intensified immunization programs capable of delivering full coverage to 100% of the school children and 90% of the population at large, within a one year period of the programs initiation. 2. Utilization must be made of Air Marshall Islands for fhe delivery of immunization supplies, and occasionally teams, to the odter islands. 3. All children enrolled in outer island schools must be able to present an up-to-date immunization card showing current full coverfage within one year of program implementation. teams and local This can be obtained [through mobile health assistants operating from th@ atoll's main clinic, with cold chain maintenance capacity. 4. Upgrade the supply and logistics system for immunizatipns, develop a functioning cold chain system, and establish a detailedistatistics and record keeping service for surveillance, evaluation, and reporting. The cold outer island clinic refrigerators and central] storage facilities at Majuro and Ebeye will be crucial to ongoing programs on the atolls. 4. Chronic Diseases Unlike many developing countries, the Marshal] Islands significant health cardiovascular problems diseases, with the latter chronic gre developing diseases. representing hypertension and diabetes, are the leading killers. the Cancer e and effect of While thefclinical care of these problems will be covered by primary and secondary facilities, the education and detection is often coordinated by public health A federally funded (DHEW) cervical completed in 1978 with moderate success. cancer screening| personnel. program was After initial relubtance, there seemed to be general acceptance of the program, including malefworkers doing pap smears. The program was limited primarily to Majuro anf Ebeye where coverage ranged from 12-47% in different years and locatiogs. cancer screening or education programs have been underflaken No other to any significant degree, Hypertension is increasingly being recognized as a signifficant problem in Micronesia. affected. It appears that from 7-15% of all Micronesians may be The high mortality statistics for cerebrovasculag undoubtedly a result of this problem. Adequate evaluation anq hypertension component has not been a strong of the treatment of health curriculum, so the existing primary care workers appear to be S disease are assistant doing a rather He