Republic of the Marshall Islands

The Republic of the Marshall Islands (RMI) is an independent nation in the western Pacific that lies on the other side of the international date line from the continental U.S.

Relationship With the United States

Following WWII, RMI was placed under the administration of the U.S. by the United Nations as part of the Trust Territory of the Pacific Islands. RMI adopted its constitution in 1979, and in 1986, RMI entered into a Compact of Free Association with the United States.

Under the Compact, the U.S. government agreed to provide economic and technical assistance (including significant funding for health), ensure U.S. military defense support, and allow unrestricted travel to and from the United States for these non-resident Marshallese citizens. In return, RMI agreed to give the U.S. government unlimited and exclusive use of their land, airspace, and waterways for strategic purposes. Financial assistance as currently structured within the RMI Compact extends through 2023.

RMI receives significant funding for health and health system development through the Department of the Interior, which administers Compact funding, and is also eligible for some U.S. federal programming, including grants from the U.S. Department of Health and Human Services.

Healthcare and Facilities

The RMI health care system is comprised of two hospitals, one in Majuro and one in Ebeye, and fifty-nine (59) health care centers in the outer atolls and islands. Both hospitals provide primary and secondary care but limited tertiary care. Patients who need tertiary care are referred to Honolulu or the Philippines. The Ministry of Health is divided into eight bureaus, including Bureaus of Health Care Services, Kwajalein Health Care Services, Majuro Hospital Services, Nursing Services, Office of Administration Personnel & Finance, Oral Health, Health Planning/Policy/Preparedness/Epidemiology, and a Medical Referral Office.

RMI residents are not eligible for Medicaid. RMI migrants who meet Medicaid thresholds within their state of residence in the continental U.S. are eligible for Medicaid. A key source of funding for healthcare provision in FSM is financial assistance through the Compacts of Free Association, which supports hospital care in FSM. Read more about COFA funding via ASTHO's Fully Fund the Renegotiated Compacts of Free Association and Reduce Compact Impact in U.S. Territories and States Policy Statement.

Key Priorities

In the 2016 ASTHO Profile report, the RMI Ministry of Health defined its top five priorities as:

• Address tuberculosis (TB), including multi-drug resistant TB.
• Eradicate leprosy.
• Reduce noncommunicable diseases and their major risk factors.
• Protect against vaccine-preventable diseases.
• Fight childhood malnutrition.

Disease Burden

Like the rest of the Pacific, RMI faces a noncommunicable disease crisis and a significant communicable disease burden. Top causes of death in 2019 were:

• Ischemic heart disease
• Stroke
• Diabetes
• Lower respiratory infection
• Chronic obstructive pulmonary disease