in Majuro under Alec Keju. This program is presently shut fo due to lack of funds either for training new health assistants orfcontinuing education. Many health assistants in the field have not had a continuing education session for as long as ten years. h. An attempt was made sometime in the past to have health! deliver services through well-baby, pre-natal, etc. regularly scheduled special assistants cfinics i.e. This generally broke down due fo the small numbers of patients seen and inefficient use of the healthf assistant's time. Most health assistants have fallen back to going tq the patient when called for by a family member scheduled times. instead of holding clinics at It appears that the community generally knows where to find him if he is needed, 2) General Recommendations @. Expanded role of worker: In the section on “public health" (see section 8) an qutline of the various service needs in the areas of preventive, promotivey# and curative health was presented i.e. health education, maternal and childfhealth, social problems, etc. ~ It was recommended there that separate specialfzed supporting technical staff be provided at the central level to be planning and managing these services i.e. responsible for a “health educatér" to plan and direct health education activities, a “sanitarian” in environmental health, “public health nurse” in maternal and child health and immunizations, etc. Yet at the implementation level in the outer island clinics the emphasis will be on having the main primary care worker assume the “Integrated” role of delivering all types of services - health promotion and pyevention as well as curative services. Furthermore, it is felt that specific kinds of services (be they curative or preventive} should not be delipered by means of specialized clinics at limited times and days i.e. “well baby day and “family planning“ on another day. clinics” on one In summary, thef health worker at the primary care level is to serve an “integrated/expanded® role - he is to be the implementor of all health activities at the locqd] level, and the patient wil] be able to receive a full-range of services Jat any particular time the clinic is utilized during its regular hours. In practice this will mean the primary care worker in the following manner: will spend his time A certain specified number of hqurs each week will be spent at the clinic during which time an individual pdtient may come and receive general health services including: i9 of both preventive dnd curative types