Marshall Islands
Health System Profile



I. General State Information

A. Selected Sociodemographic Indicators

                                       Republic      United States

Population (1988) 43,355 245,803,000 Population Density (1988) 656.9 69.4 (per/sq.mi.) Number of Counties NA 3,139 Median Age (1987) NA 31.7 Percent Below Poverty Level (1985) NA 14.0 Percent of Population Rural (1980) NA 26.0 Percent of Population White (1980) NA 83.1 Percent of Population Non-white (1980) NA 16.9 Median Years of Education (1980) NA 12.5 (25 years of age and over)

B. Location, Geography, and People

The Republic of the Marshall Islands is located in an area of the Pacific Ocean known as Micronesia. The islands are about 2,000 miles southwest of Hawaii and about 1,300 miles southeast of Guam. The Marshall "Islands" are made up of two chains of atolls. These chains have 29 low-lying coral atolls and 5 low-lying coral islands. Atolls consist of loosely connected coral masses which ring a central lagoon. The lagoons may be only a few miles across or massive in their breadth. Although the islands which comprise the atoll chain are usually considerable distances apart, some are sufficiently close to walk between them at low tide. The republic consists of 66 square miles of land mass. The population is distributed unevenly over 24 populated atolls and 2 small islands. The islands are only a few feet above sea level and most are less than 15 miles in length and 400 yards in width. None of the islands have sufficient space for more than two parallel roads on the atoll. On most islands the population lives on either side of a single road or street.

C. Republic Government Structure

The Republic of the Marshall Islands and the United States signed a Compact of Free Association in 1982. Since that time the Data for this territory are based on the best available information and were updated December 1990.political relationship of the Republic of the Marshall Islands with the United States has been as a freely associated state. The Republic has a President who is elected by the Legislature from among its own members. The legislative branch of government is a unicameral legislature (the Nitijela) that has 33 members.

II. State Health Agency (SHA)

A. General

The Republic of the Marshall Islands Department of Health Services (RMIDHS) is the SHA. Almost all medical and health care is provided by the government through this agency. The principal facility is an 81-bed acute care hospital in Majuro. A second 22-bed hospital is located on Ebeye in the Kwajalein Atoll. Management staff for all medical, dental, and public health services are located at these facilities. In addition, most out-patient clinics, emergency medical services, and public health clinics are at these two locations. There are, however, 60 dispensaries located on 25 outer islands. Health assistants staff the clinic, often living in the facility. These individuals are trained to provide basic medical care for common illnesses, diseases, and minor injuries. Patients who need more sophisticated care than that available at the dispensaries must be transferred to one of the hospitals.

B. Head of State Health Agency

The Minister of Health is a cabinet-level officer responsible for public health. The Secretary of Health Services is the chief executive for operating health services. The only other administrative officer is a health services administrator who reports directly to these officials.

C. State Board of Health/Council

Information on the presence and function of a territorial board or council of health was not available at the time of printing.

D. Regional/District Health Offices

The Republic of the Marshall Islands does not have regional or district health offices.

E. State-local Liaison

The RMIDHS functions as both a state and a local health agency, thereby eliminating need for a state-local liaison function.

F. Budget

No budget information for the SHA was available at the time of printing.

III. Local Public Health Agencies (LPHAs)

A. General

The Republic of the Marshall Islands does not have local health departments but provides public health services through the SHA.

B. Services Provided

Hospitals provide general medical and surgical care, pediatric and obstetrical care. General clinical laboratory, radiological and pharmacy services support both in- and out-patient care. Rehabilitative services are available at the Majuro Hospital. Public health services include prenatal, well-baby, and child health services including immunizations. Environmental health services, which include surveillance over water quality and food sanitation, are also provided. Public health dentistry is limited to clinical dentistry, with much of the care provided by dental nurses. Health education activities are limited to those that can be supported by one individual. Rudimentary vital statistics are kept. Communicable disease investigations, screening, and casefinding for some chronic diseases are performed on a limited basis by public health nurses.

C. Local Health Officer

Information about the presence or function of local health officers was not available at the time of printing.

D. Local Board of Health

The Republic of the Marshall Islands does not have local boards of health.

E. Staff

Public health staff are employed and supervised by the Department of Health Services.

F. Budget

The budget for local health services was not available at the time of printing.

Data for this territory are bvased on the best available information and were updated December 1990.