Country profile Republic of the Marshall Islands 2000
by World Health Organization

COUNTRY SITUATION AND TRENDS
Geography, Demographic Statistics

The Republic of the Marshall Islands consists of 29 major atolls, each made up of many islets, and 5 islands located in the North Pacific Ocean. The atolls and islands are situated in two almost parallel chain-like formations known as Ratak (Sunrise) group and Ralik (Sunset) group. Scattered over 2 million sq. km. of the Pacific Ocean, the total land area is only 179 sq. km., 20 per cent of which is uninhabitable because it was previously used as a nuclear testing site or because it is now used for United States military purposes. Approximately half of the population live in Majuro, the region's capital, which is only 3.75 square miles, and about 20 per cent of the population live in Ebeye, located on the southwest corner of Kwajalein Atoll, the site of the U.S. Army's Kwajalein Missile Range. Majuro and Eveye represent some of the world's highest population densities. The land mass is distributed over 1 225 atolls, islands and islets, with a mean height of only 7 feet above sea level. These low elevations make the atolls vulnerable to damage from storms and high waves.

  As of 1998   As of 1998
POPULATION [Total]  62 569 LIFE EXPECTANCY AT BIRTH (years) [Both]  ...
[0-14 years] 30 105 (48.10%) [Male] 64.40
[65+ years] 1 443 (2.30%) [Female] 67.90
CRUDE BIRTH RATE
(per 1 000 population)		 26.21 TOTAL FERTILITY RATE 5.70 (1994)
CRUDE DEATH RATE
(per 1 000 population)		 4.47 % OF POPULATION SERVED
WITH SAFE WATER 		[Total] 82.00 (1995)
[Urban] 82.00 (1995)
[Rural]
INFANT MORTALITY RATE
(per 1 000 live births)		 25.85 % OF POPULATION WITH ADEQUATE
SANITARY FACILITIES		 [Total]
[Urban] 88.00 (1995)
[Rural] 57.14 (1995)
MATERNAL MORTALITY RATIO
(per 100 000 live births)		 None *    

* There are no cases of maternal deaths as a result of childbirth.

The Republic of the Marshall Islands has one of the world's highest rates of population growth, 3 per cent to 4 per cent (based on 1988 census data and UNFPA reports) and fully half of the population is below 15 years of age. Even though more recent statistical analyses indicate that the rate of population growth may be decreasing in some areas, the population is still expected to double in less than 20 years. The population has outpaced the facilities for the provision of safe water and sanitation.

HEALTH STATUS


Morbidity, Mortality, Major health problems

In 1998 the leading causes of morbidity and mortality were:

MORBIDITY
(Rate per 100 000 population)		 MORTALITY
(Rate per 100 000 population)
Gastroenteritis 1 614.22 Malnutrition 31.96
Scabies 1 603.03 Accidents (all types) 31.96
Influenza 1 595.04 Sepsis 27.17
Conjunctivitis 1 422.43 Pneumonia 19.18
Diarrhoea - adults 0 974.92 Cancer (all types) 19.18

Diseases not listed in the preceding tables which cause significant morbidity, but which are not reflected in mortality data, include sexually transmitted diseases (syphilis and gonorrhoea), tuberculosis and leprosy. There has been one death from AIDS in a non-resident Marshallese person and there is now one confirmed HIV positive case in the Marshall Islands.

Deaths are severely underreported in the Marshall Islands; in 1986, it was estimated that 57 per cent of adult deaths were not reported. In 1993, of the 240 reported deaths, 18 per cent were of persons aged 75 and older, while infant deaths accounted for 14 per cent of the total. The main causes of infant deaths in 1993 were prematurity (33 per cent), and pneumonia (21 per cent). Childhood malnutrition is a very significant health problem of children below five years of age, accounting for approximately 17 per cent of all deaths in that age group.

In the context of decreasing financial resources, high population growth and overcrowding in urban areas, the people of the Republic of the Marshall Islands continue to suffer from the infectious diseases usually associated with rapidly growing, low income countries, while at the same time they are increasingly being affected by the negative effects of a modern lifestyle. Leprosy and tuberculosis coexist with increasing rates of diabetes, hypertension, cerebrovascular accidents and heart disease. Immunization coverage in 1998 was reported as 81 per cent for BCG while the coverage for measles, the basic series of OPV and DPT averaged 88 per cent in the same time period.

The consumption of imported foods high in sugar and fat has led to adult obesity and a rise in noncommunicable diseases. Teenage pregnancy, suicide, and alcoholism are at unacceptable levels. The use of tobacco under conditions of overcrowding contributes to increasing numbers of patients with asthma and bronchitis.

NATIONAL HEALTH PRIORITIES

The national health priorities are to:

HEALTH RESOURCES


Human, financial, resource requirements

Training of indigenous personnel is considered a government priority as the lack of a well-trained indigenous workforce remains one of the main impediments to progress in health development. An inordinate proportion of the health budget is spent on the salaries of expatriate doctors, dentists and nurses due to the lack of a well-trained national health workforce.

In 1995, the government allocated 13 per cent of the total budget to health expenditures. The overall per capita recurrent budget was US$85.00, as compared to US$143.00 in 1988.

A significant proportion of health services are funded under external aid or grant programmes including United States Federal Health Grants and grants under the Compact of Free Association between the Marshall Islands and the United States of America; the 177 Health Care Plan for populations affected by nuclear testing, and bilateral donor grants for developmental programmes sponsored by WHO, UNDP, UNICEF, and UNFPA.

Since 1992, the Asian Development Bank has lent the Marshalls more than US$40 million for projects or technical assistance.

Internally generated funds include recurrent budget appropriations, a Basic Health Plan (Social Security Health Fund), and a smaller Supplemental Health Plan established in 1992. Over 32 per cent of the health fund has been budgeted for health services outside the Marshalls, services which benefit only a very small percentage of the population. The United States funded share of health care financing has amounted to over 45 per cent of the budget. Economic reforms have been planned, including government budget cuts, as financial crises are imminent given that the Compact of Free Association aid monies to the Marshalls will end in 2001. The implementation of programmes to address many of the main health problems would be greatly facilitated if there were adequate numbers and types of Marshallese health workers who could provide appropriate services.

WHO COLLABORATIVE PROGRAMMES

Expected results 2000-2001 Projections for 2002-2005

1. Human resources for health.
Provision of health services by qualified national health personnel.

Qualified nurses and midwives providing integrated, quality services in local health facilities and settings.

It will be necessary to continue activities to strengthen the national workforce throughout the next biennium and beyond.

2. Health promotion.
Improved national capacity for planning, implementing and evaluating health promotion policies and programmes.

It is expected that continued support for health promotion programmes and activities will be required.

3. Leprosy.
Progress in leprosy elimination evaluated. Leprosy elimination activities sustained.

It will be necessary to continue to support the strengthening of leprosy monitoring and surveillance activities.

4. Tuberculosis.
Tuberculosis control programme strengthened.

It is expected that continued support will be required for implementation of DOTS in the country and for on-site staff training activities.




Originally published by WHO Western Pacific Region as part of the Country Health Information Profile .


(c) WHO Western Pacific Region 2000
Reproduced with permission