How Countries Are Meeting Problems / 93
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is that entirely newsystems for health care are called for with new
approaches to educating the personnel who will implement those
epuntries. They evolved in the more developed countries and were
datroduced into the less developed countries with only superficial
adaptation to local need. They are based on the principle of indimidual medical care provided by professional personnel, assisted
systems.
" Different countries will find different answers to these problems.
There are similar problems, to be sure, as one looks from country
to country, and it is tempting to generalize not only on problems
but also on solutions. But solutions will be shaped bythe individual
perhaps by auxiliaries. This principle did not evolve in systems
td@signed to meet the needs of large numbers of people but none“theless has been incorporated into newer systems that attempt to
serve total populations. A network of hospitals and health centers
may extend across a country, but the system is paralyzed by lack
of professional personnel together with refusal to allow nonprofessionals to do part of the professionals’ work. Efforts to give auxiliaries more responsibility are frequently blocked by unyielding
professional opposition.
Thus, both the design of health care systems and efforts to
change them are inhibited by the heavy hand of Western tradition.
context of each nation. Priorities, for example, will differ from one
country to another because of social choice and style of government and because one country has five or ten times as much to
spend on health, a fact that immediately affects what can be done
and the way in which it can be done.
Now,let us proceed to a further examination of the major prob-~
lems in the health field and the attempts to meet them. As we do
so, we will develop the basis for considering what newdirections
might be taken in both the provision of health services and the
education of health personnel.
The irony of this story is that some of the more developed nations
from which these concepts were exported are now vigorously reassessing and modifying their own systems, which they see as
inadequate to meet the needs of their own populations.
The guidelines for change can be stated simply—to ease the
suffering and improve the health of all people as much as resources
will allow. But we knowthe simplicity of the statement is deceptive. Trying to reach all the people of a population, rather than a
few, places extreme pressure on every aspect of the health system
—description of problems, planning, resourceallocation, evaluation
of ‘results. At every turn, the same denominator is there—all the
people.
Resources will vary greatly in different countries, but it is clear
that they are and will continue to be desperately short considering
the size of the need andthe rising costs of health care. The reality
of both the present and the future, stated most succinctly, is that
most rural people will receive health care under conditions in which
one physician and one nurse together with a team of lesser trained
personnel will care for 50,000 to 100,000 people, often with much
less than $1 per person per year. Urban problems are described in
different terms but present no less difficulty.
We know that we must literally develop a technology around
effective use of resources and that the dual problems of serving all
the people and of making use of limited resources will condition
our thinking at every turn. Indeed, what emerges from these issues
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92 / HEALTH AND THE Devetopinc Wor.tp