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 The chronic underfunding of Micronesia’s ailing healthcare systems


Micro Waves By Jack Niedenthal

Majuro—One special aspect of my previous job as secretary of Health & Human Services in the Marshall Islands was spending time each day with members of the medical staff in our hospitals and clinics. I routinely visited the various wards and stations throughout the hospital. I attended grand rounds with the doctors every two weeks, where we visited each ward in the hospital to discuss unusual and interesting cases with the interns. It was a great and valuable educational experience. 

I felt like I knew these professionals well. I went out of my way to make sure I understood their issues, whether professional or personal. I tried to address their concerns with the respect they deserved.

Over the years, I witnessed these amazing people in stressful situations. Through this constant observation, I came to admire their decision-making abilities, and I felt honored to stand up for them when it came time for me to do so.

Because of the pandemic that required a tremendous amount of information-sharing among U.S.-affiliated Pacific islands every week, I had constant contact with many health officials throughout the region, especially those from the freely associated states, so I know many of the challenges that doctors and nurses face in the Marshall Islands are the same as those experienced by others in the region.

There has always been a troubling “societal cycle” experienced by medical professionals here in Micronesia. A seriously ill person is reluctant to go to the hospital for treatment because of a commonly held concern that “sick people who go to the hospital often wind up dying there.” 

This familiar belief causes the patient to wait until the very last minute to go to the hospital, so when they arrive, it is usually way too late. Because they did not act promptly to tend to what typically starts as a minor issue, their situation turns into a complicated medical problem as a result. Unfortunately, some wind up passing away, which again perpetuates this awful cycle: “If I get sick and go

to the hospital I may die there.”    

During the pandemic, we had 17 Covid-related deaths in the Marshall Islands. Only three of those people died in our hospitals, while the rest were dead on arrival. Guam and all the other Micronesian countries encountered the same trend where Covid-afflicted people who hesitated to go to the hospital passed away in their homes, often unnecessarily.

Compounding this dreadful cycle, islanders these days are quick to post their complaints on social media when they see situations “go wrong” in our hospitals. You rarely see posts when things “go right,” such as when lives are saved, illnesses cured and patients are put back on their feet and sent back into the world. The medical professionals who accomplish these feats often work in ancient health facilities with obsolete equipment as they routinely experience critical drug and medical supply shortages. 

Inadequate funding is the main issue that causes weaknesses in healthcare systems in Micronesia. During the pandemic, all ministries in the Marshall Islands government, including the health agency, weathered severe budget cuts for two fiscal years. Slashing the budget for healthcare at such a critical time was brutal for those of us trying to maintain our preparations and defense systems against Covid-19.

These cuts prevented us from giving pay increments to our medical staff. If healthcare were truly a priority with the government, we would not have seen these kinds of cuts at such a dire time in our history, which eventually amounted to a 38-month state of health emergency.


“If you want better healthcare for your citizens,” health leaders always used to tell the politicians during budget hearings, “then you must pay for it.” In the Marshall Islands, we spend a little over $700 per person for healthcare annually. In the U.S., that number is over $12,000 annually per person. And our health problems throughout Micronesia are –in reality– worse than in the U.S. as we have one of the highest per capita diabetes rates in the world, which leads to many diabetes-related illnesses.

We have high rates of cancers and heart issues in adults that we can’t resolve on island, and many of our children have malnutrition issues.  These serious and burdensome health issues combined with severely underbudgeted health systems put an incredible amount of strain and pressure on our medical professionals. 

Which brings me to this essential point: medical professionals in Micronesia have always been drastically underpaid. And now that climate change is bringing about more frequent and deadly disease outbreaks in our region, we expect these frontline Micronesian “soldiers” to battle these diseases. Given what they are confronted with on a daily basis, these doctors and nurses deserve better pay and more benefits. Higher salaries create vastly improved attitudes, which in turn lead to more efficient and dedicated performance.

Majuro Hospital/Photo courtesy of MHHS

This is a well-proven theory that goes back over a century. In 1914, when Henry Ford radically doubled the salaries of his autoworkers, his car production plant in Detroit instantly yielded incredible work performance. The employee turnover was low due to the workers’ unquestioned loyalty to the company.

If the governments of Micronesia want to improve healthcare for our people, it is imperative that they immediately upgrade our healthcare facilities, provide our medical professionals with updated training so they can stay abreast of the latest technologies, and pay them adequately.

We had hoped that under the newly ratified Compacts of Free Association, the FAS healthcare systems would finally receive the financial boost they have always sorely needed. However, we are now beginning to see what the healthcare budget will look like under the new compacts. I can say that the amount of money being given to this sector still seems woefully inadequate and will lead to our hospitals experiencing continued budgetary shortfalls. Very sad. 

Healthcare is an efficient way to provide benefits for virtually every citizen in each of the countries of the FAS, but the way this new funding has been formulated under the compacts looks like another setup for failure.  I truly hope I am wrong about this. Only time will tell.

Jack Niedenthal is the former secretary of Health Services for the Marshall Islands, where he has lived and worked for 42 years. He is the author of “For the Good of Mankind, An Oral History of the People of Bikini,” and president of Microwave Films, which has produced six award-winning feature films in the Marshallese language. Send feedback to


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