RMI Health Care Service System

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 60 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 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 – This is a new committee created in 2019 by the cabinet to study and approve the use of traditional medicine as part of the medicine formulary. 

COVID-19 Preparedness and Response

The Secretary of Health and Human Services immediately acted upon the threat of 2019-nCOV diseases in January 2020. As of 24 January 2020, a travel alert was released for any traveler with travel originating from or transiting through the People’s Republic of China  must spend at least 14 days in a country not affected by 2019-nCoV. In the event a traveler arrives in RMI within the 14 day period, entry will be denied. Screening at the airport included the symptoms 2019-nCOV. By January 31, RMI closed air and sea borders to people coming from all COVID-19 countries. With this quick and definitive decision, RMI is still COVID-19 free. President David Kabua proclaimed State of Emergency due to the Global Public Health Emergency of International Concern on the COVID-19 on the 7th of February 2020.

Ministry of Health and Human Services Responsibilities on this proclamation:

Infrastructure: Building and Renovation to retrofit for COVID-19 prevention and response:

• COVID-19 Isolation Unit completed
• PCR-Laboratories on Majuro Hospital and Ebeye Hospital completed and equipped
• COVID 19 Isolation ward completed

Current projects:

• Labor and Delivery Repair completed

• Warehouse completed
• Fencing of the whole Hospital completed
• Crisis Holding Unit for Human Services completed (Mental Health patients)
• Solar streetlights & parking completed
• 3 additional central air cons

Trainings:

• PPE Trainings/hand-washings
• Infection Control and Prevention
• Ventilator’s training
• Isolation trainings and simulations
• Numerous lectures (locally and on-lines) on covid-19
• Waste management

Surge Staffing:

• Prepositioned Staff – Staff will be included in the repatriation trips
• Molecular Laboratory Scientists
• Lab Administrative Assistants (2) for Majuro and Ebeye
• Lab Serologists (2) for Majuro and Ebeye
• Surveillance Staff for Majuro and Ebeye
• Epidemiologists (2) for Majuro and Ebeye
• Nurses and doctors for Majuro and Ebeye have been identified and are being prepared for transport to RMI.
• Respiratory Therapists
• Biomedical Engineers
• Public Health Nurses

Due to the closure of borders and contract processing, there is a huge delay in hiring and repatriation of surge staff. As of the end of 2021, we have opened the posts and in the process of reviewing and interviewing.

MCH Clinics including Prenatal, Family Planning, Children’s Clinics and other Public Health Programs developed its COVID-19 condition category plan. Once we are on condition three, RH/FP clinics will be closed closed. But known pregnant patients will be given appointments and services will be provided. For new patients, they will be screened at ER and referred to the program. Labor and Delivery and Maternity Wards will be renovated to accommodate known or suspected COVID-19 patients.

In 2021, we are developing plans for TeleHealth Program that will address the remote consultations where COVID-19 community transmission is present.