TNAG-0531-FCO40-626-Application-of-International-Labour-Convention-to-Hong-Kong-1975 — Page 87

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Public health services

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4. The public health services have an important role and attract a major element of total social security expenditure in the developing countries.' seeking to provide medical care free or for nominal charges to populations of a considerable size in many countries, governments face a task of the first magnitude. This is especially true in the case of the large sections of these populations who have lived in unhealthy conditions and have been accustomed to very rudimentary standards of medical care. Thus the problem facing the public health authorities has been of immense proportions. Their achievements must be measured against this background. The following table giving, for selected countries in the region, the ratio of the population to each physician, and to each hospital bed shows both that there have been significant recent improvements and that there are still acute shortages in these respects. There are similar shortages of nurses and other para- medical personnel. As a result, it is a widespread feature of the public health services in developing countries of the region that patients

have to endure very lengthy delays before receiving treatment, and, if hospitalised, they have to suffer overcrowding sometimes of a serious nature. There are limited funds available for the development of the health services, due in part to the competing demands of the other social services (see Appendix I), which also precludes the purchase of medicines, materials and equipment on the scale required. The increasing cost cf health services, attributable in part to the charges made for modern drugs, coupled with the general phenomenon of rising demands for medical care, constitute severe constraints on the effectiveness of public health programmes.

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feature of considerable significance is that of the maldistribution of medical facilities in developing countries. The figures qucted in table 1 refer to the countries as a whole, but there are very wide disparities between, for instance, populated centres and rural areas in which the great majority of persons live (Appendix II, column 5). For example, in Afghanistan, 89 per cent of all the country's physicians and 50 per cent of the hospital beds are located in the capital city. In the developing countries as a whole, large groups of the population have very limited access to medical facilities despite the efforts of those national authorities who have required doctors to servce for periods in rural areas, offered incentives to rural health workers, and have mobilised teams of para- medical personnel to visit outlying districts.

6. In the circumstances described above, it is inevitable that to meet the demand for speedy and effective medical care a large private sector has developed in many countries. This attracts personnel from the public health system with further repercussions on the effectiveness of these services. When social insurance systems are introduced for the provision of medical care they face the same problem of shortages of staff and facilities. In some respects the provision of medical care as a right derived from membership of the scheme evokes even stronger demands for the extension of medical care, for example, to dependants of insured persons. It is of paramount importance that social security medical care programmes should be integrated with the over-all national health plan so as to make optimum use of scarce resources. The channelling of additional revenue into a fully co-ordinated system of medical care is a valuable contribution to the development of effective health services.

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1 "Social Security in Asia", Appendix XI.

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