,<e regular salary checks for duties not performed. Instructions gfven by work supervisors are often not carried out. The incentive and morale of health workers is very flow. It is recommended that salaries and other benefits for health workersIbe increased (particularly for those who work on the outer islands) so that[new recruits can be obtained. Rewards, both monetary and otherwise (i.e. awafds, bonuses, position advance) should be given specifically to those medical assistants who fulfill their “expanded roles", both curative and preventfive, and who remain in Majuro. the rural The present reward system favofs moving to areas. A great effort should be made so the first priority n equipment, supplies and supervisory support be given to the outer island. This will help change the perception that “only the flunkies" get sent [to the outer islands. Housing, food, and other domestic needs of the medic 1 assistants must be adequately taken care of as well. It is suggested t at the staff housing on the outer island health centers be better than Majuro and provided without rental charge, while in Majuro a rental fee i Perhaps the greatest administrative problem sufficient trained administrative personnel. is required. that o not having In most develop ng countries technical and professional personnel are available before admi istrative and Support personnel, progress of the such as accounting. professionals due to This often greatly hinders inefficient admini tration the and inappropriate manpower utilization. In the Marshall Islands t is situation exists, lack compounded by an extreme technical and professional. of all personnel It is further complicated by the Cluding the ow incentive training in such that at present there are essentially no candidates in nursing schools, medical assistant schools, medical officer schools, or ancillary medical worker schools. This situation requires that at expatriate personnel must be utilized. present an inordina’ e In all such cases it recommended that Marshallese counterparts be identified to expatriate for on-the-job training and experience and th Marshallese personnel be selected for training at appropriate number of is strongly rk with the additional ites. It is strongly recommended that the organizational patte as outlined The specific intent is to emphasize thq rural health component to avoid the all too frequent utilization of 90% o the manpower previously be followed. and budget for approximately 10% of the population that ; urrounds the hospitals. This plan requires the establishment of five office: » each headed