af It is suggested that the hospitals develop separate maintenance departments completely dedicated to the maintenance of tha@ hospitals and They can be trained to handle the special Equipment found their equipment. in the hospital and be ready to deal with the emergencies which invariably Some equipment will obviously need to be sent out come. however, much of the routine preventive maintenance fo be repaired; be shoufd provided locally, In support of this, the budget which has been allotted fo Public Works for maintenance of the hospital should be reallocated to the hpspital for use in the support of its own department. An alternative to the health care system providing its @wn maintenance would be to contract out to an organization such as Global Ass@ciates for all maintenance work or some of the maintenance on certain more t chnical pieces of equipment. effective and A study should be done to see which would be the more cost efficient. A third alternative which cou d be done in conjunction with either of the preceeding two would be that a contract could be arranged for the training of specialized repair sven would facilitate the ability of the Marshallese to eventual The latter handle their own health system by themselves. Recommendations 1. Separate the maintenance budget from include it in the health care budget. Public Works Pepartment and Work performed Hy Public Works would be paid from the health care system. Examine potential for a training contract with Global] Associates to prepare personnel to perform more technical maintenance}activities. 3. Capital expenditure should be made to bring the facijJities and the equipment up to an acceptable standard in each health delivery location. 4, OQuter atoll clinics should be equipped to perform maintenance on their equipment and facilities, and one imple routine person on each ato!] should be trained to perform the necessary duties 5. The hospital in Majuro should be established as the centgal location to send the more difficult repair problems which cannot be handled on the outer atolls. (It is expected that some repairs cannot be handled in Majuro will need to be sent out of the Marshall Islands.