The Marshall Islands has a well-developed/organized primary/preventive and public health system.  There are two main hospitals located in the two urbanized islands in the Kwajalein (Ebeye Hospital) and Majuro (Majuro Hospital) Atolls.  Including the two main hospitals, there are 49 active health centers/health clinics located in the various islands that make up the Marshall Islands.  The two main hospitals serve the urban areas including the surrounding islands through referrals and medical evacuation.  The two hospitals provide primary/secondary and some tertiary care.  However, most tertiary care patients are referred off-islands to hospitals in the Philippines, Hawaii (Tripler Army Medical Center) and Taiwan.  The health clinics in the Outer-Islands are staffed by Health Assistants who are locally trained and assigned to these clinics as primary care providers.  The Marshall Islands MCH Title V program is a national program one of the key programs in the Bureau of Primary Health Care Services and provides the mandated services for the MCH population.

The 177 Health Care Program (Victims of Nuclear Fallout of Bikini, Rongelap, Enewetak, and Utrik) Clinics provide primary health care services to the four atolls affected by the nuclear testing.  A primary health care physician manages the 177 Clinics. The Department of Energy has a DOE Clinic which provides medical services to the direct nuclear patients.  The Diabetes Wellness Center which is managed by Canvasback Missions, in collaboration with MOHHS, demonstrates that natural foods and an active lifestyle can reduce or replace the need for diabetic medications and provides a higher quality of life for the participants. They also offer healthy food options for minimal price. Taiwan Health Center concentrates on developing health education materials and training programs primarily used in Non-Communicable Diseases (NCDs) like diabetes and helps with outreach activities, monthly missions on specialties to work at Majuro Hospital. Taiwan Health Center also work with Medical Education Committee for the internship of Medical Interns that graduated in Taiwan. 

These health care services include, but are not limited to : a) clinical services in the hospitals and health center facilities and outreach activities; b) primary health care or preventive services in the hospital and health center settings, school and community compounds, house-to-house outreach; c) health promotions and educational activities, special projects with community groups; d) collection of data for the Health Information System to monitor health indicators, including monitoring and evaluation of health services and the health care systems.

In addition to the above-mentioned government sponsored health care services, there is one private health clinic and 1 private optometry practices in Majuro. All of the doctors practicing in the government and private clinics are licensed under the MOHHS’ Medical Examining and Licensing Board to practice in the RMI including the medical and dental missions.

Medical Referral is handled by the Medical Referral Office. MCH program coordinated the CSHCN referral with Medical Referral Office. RMI has a national health insurance offering basic and supplemental health insurance. For Basic insurance, patient pays a) $5 for full outpatient visit which includes laboratory, diagnostics and pharmacy b) $17 for Emergency visit and c) $10 for admission. For patient with no insurance, patient pays a) $20 for full outpatient visit which includes laboratory, diagnostics and pharmacy b) $35 for Emergency visit and c) $110 for admission. To be able to receive basic referral where patients are referred to tertiary hospitals in Hawaii, Manila, and Taiwan, patients’ needs to be enrolled in Basic Insurance. All Marshallese citizens are automatically under the Basic Insurance. For foreigners living and working in RMI, they need be an active member of Marshall Islands Social Security Administration with regular payment for 1 year and existing legal immigration papers.

Traditional Medicine Committee

Through a decision of the RMI Cabinet, a Traditional Medicine Working Group (TMWG) was formed in 2020 to make recommendations regarding the integration of appropriate traditional medicine/treatment into the RMI Health Care System.  The TMWG conducted a preliminary desktop review of information on global best practices. This included study of the experience of integration in selected other health care systems internationally; evaluated the list of those traditional practices already observed to be used on patients in the RMI health care system; discussed most useful healing plants used in Marshallese Traditional Medicine & identified invasive (ingested) and noninvasive (topical) traditional healing treatments; and reviewed selected traditional massage therapies.  

The working group also identified the complementary therapies and traditional medicine used in the Marshall Islands Health Care system over the years, particularly with respect to maternity health. The group also assessed whether this was enough information to carry out the preliminary assessment stage. At this initial and based only on information that have been obtained to date, the following conclusions are provided for consideration:

• Establishment of a Traditional Medicine Research Unit at the College of the Marshall Islands (CMI) with the primary role to:
• Identify the chemical properties of the most widely used Marshallese medical plants;
• Study how Marshallese medicines interact with western medicines;
• Undertake clinical research programs to study particular treatments and their effect in curing disease;
• Conduct clinical trials, based on research commencing with research into post-partum medicines (kōnnat and kiden) are given to women who have just given birth and the tonic made from the leaves of these trees have proven to greatly enhance the health and well-being of the new mothers. 

Partnership

• Women United Together Marshall Islands

• Patient Navigators to the Women’s health clinics for cervical and breast cancer screening

• Public School System

• Planning and implementation of Disability week program

• United Nations Population Fund (UNFPA)

• Trainings on Contraceptive Management System (CMS), Youth Friendly Health Services Guidelines, Adolescence Sexual Reproductive Health in Emergencies,
• Implementation of Health Facilities Readiness for Sexual Reproductive Health Assessment using Tupaia Meditrak Tool Kit
• Cervical Cancer Policy Consultation
• Drafting the Reproductive Maternal Neonatal Children Adolescent Health (RMNCAH) Policy

• World Bank

• Early Childhood Development Program: Fast Cash Transfer to eligible children; Planning for workforce capacity building like midwifery training, Community Health Care Workers training, Female health aides.

Youth to Youth in Health

• Continue the “After hr” clinic
• Distribution of condoms in the community