The challenge to public health services in economically poor countries lies in providing primary health care to satisfy the minimum health needs of rural populations. Assistance from advanced nations, however, has often adversely influenced the development of health services because most aid programs do not recognize the priorities involved in the health needs of developing countries.

Assistance programs, with their concern for visibility, frequently include ill-adapted showpieces such as large hospitals, advanced technical apparatus, and specialized training in clinical medicine and surgery. In promoting complicated and expensive projects, outside aid programs dissipate local resources and skilled manpower and perpetuate dependency of poorer nations on the advanced nations. Developing countries need to improve their sanitary systems, provide for adequate nutrition, and immunize their people against communicable diseases. Experience has shown that even programs only partially meeting these needs result in a dramatic reduction of infant mortality and an increase in life expectancy.

A crucial factor for the success of such programs is to provide large numbers of minimally trained individuals who can mobilize the self-help capacities of the people and who can maximize the benefits of whatever health resources are available. A pyramidal structure with a wide base of minimally trained workers, covering even rural areas, with referral of more serious cases to progressively more complex medical institutions, leading to an apex of highly specialized medical and surgical facilities, would provide the health care system most appropriate to developing countries.

In training physicians from developing countries, the major error has been the insistence on levels of competence and areas of study relevant to the advanced countries. Both the medical schools and the authorities of the countries that provide such training have failed to recognize that advanced countries have medical needs markedly different from those of developing countries. This has led to a loss of physicians in developing countries because of the frustrations highly skilled physicians feel upon returning to countries that are unable to satisfy their misplaced expectations. The answer lies in promoting medical education in developing countries that is appropriate to the priorities and essential needs of those countries.

1) According to the passage, a successful medical system in a developing country will have a large number of

A) physicians specializing in urban diseases
B) men or women with limited medical training
C) administrators with experience in managing hospitals and clinics
D) dentists specializing in oral surgery
E) technicians familiar with the latest laboratory equipment


2) Which of the following statements, if true, would most seriously undermine the author’s arguments against expensive assistance programs?

A) People in developing countries have illnesses that are different from those that people in advanced countries have.
B) Advanced countries contribute to a more equal distribution of wealth when they donate medical facilities to other countries.
C) Expensive assistance programs provide useful technical knowledge for use in developing countries.
D) Expensive assistance programs train highly qualified doctors and technicians from both developing countries and advanced countries.
E) Expensive assistance programs improve all medical services available in developing countries.


3) The author’s statements on infant mortality and life expectancy are apparently supported by evidence that is

A) fragmented
B) economic
C) hypothetical
D) empirical
E) biased