— Services are sparse in rural and urban slum areas 

 largely as a result of a gross maldistribution of 

 facilities and personnel. 



— The health care system is dominated by physicians; 

 developing countries (and developed countries as 

 well) often fail to make optimal use of other 

 health personnel. Current efforts to train and 

 utilize various paramedical workers and community 

 health workers need to be encouraged. 



— A poor balance exists between curative and 

 preventive care. Curative medicine (hospital- 

 based, high technology) usually dominates, 

 particularly in urban areas. 



The health care system, following the Western 

 model, is dominated by high-technology, difficult- 

 to-maintain, costly, hospital-based approaches to 

 curative medicine, which are demanded by those who 

 can afford such care. In the United States, an 

 extreme case, this system has led to per capita 

 health care costs that exceed total per capita 

 income in many developing countries. 



— The health care system is often strongly 

 centralized, highly bureaucratized, "top-down," and 

 inflexible. Recognition of the needs for 

 decentralization and more community and local 

 participation are increasing. 



— The system is usually male-dominated. The role of 

 mothers in child care and feeding cannot be long 

 ignored. There is increasing recognition of the 

 importance of women as health workers and in social 

 change generally. 



Several of these problems stem in part from Western 

 value systems. To the extent that these values foster 

 rigorous scientific or problem-oriented approaches to 

 health care delivery, they are useful. Eut where they 

 foster elitism or superspecialization, they are 

 counterproductive. 



Rationale for Selecting this Topic 



The provision of reasonably accessible and 

 economical basic health care and family planning 

 services for the world's poor deserves the highest 

 priority. It could mean improved nutrition, decreased 

 morbidity, increased survival (especially of infants 

 and children) , smaller families, longer birth 

 intervals, increased productivity, and expanded 

 opportunities for women. All these can mean a basic 

 improvement in the quality of life. The knowledge and 

 technology needed to provide these services are 

 available. There is no doubt that we know how to 



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