| There are some 1.5 million physicians in the world: of these, approximately 1.2 million live and work in the "privileged" countries, where less than one-third of the world's population resides. The same imbalance exists for other health professionals and paramedical personnel, and the rate at which personnel graduate from training programmes is lagging behind the population growth rate. Nevertheless, health services must cater to both quantitative and qualitative demands, to ambulant care and institutional care, to medical care and health care. People who are surrounded by a multiplicity of disease demand curative medicine as an overriding priority and will not participate in preventive measures until some curative service is provided. The answer to this dilemma is to reconstruct the health team on two tiers. The first, which provides for quality of care, would be made up of highly trained professionals restricted to referral care or consultant and advisory roles and located in hospitals. The second tier, which provides for the quantitative aspect of cure, would comprise middle-level health workers trained to provide primary care, i.e., extension of, not replacements for, the high level personnel. Operating from a health centre, three basic types of auxiliary would then offer primary medical care (mainly curative work), community-oriented MCH care (including family planning), and communicable disease control. |