thirds of Ethiopia's health budget would be required to run it. And so the hospital remained unopened for 7 years until the Swiss agreed to finance and staff it - now the hospital is running at two thirds its capacity. Lesotho is now planning a referral hospital in Maseru, its capital. It will reportedly cost up to $23 million and its operating costs will be about $4.6 million. At present, the entire health budget of Lesotho is just over $3 million and the existing Queen Elizabeth II hospital in Maseru already absorbs about $770 000, close to one quarter of the health budget. Despite these excesses, centralized hospital complexes don't always provide what developing nations need.
One comparative study done in Tanzania showed that the dollars spent operating a network of 15 rural health centres went much further and touched far more people than did the operations of one 200-bed hospital. For capital costs of $850 000 and annual operating costs of approximately $300 000 the 200-bed hospital accounted for 400 000 outpatient visits compared with over 1 million outpatient visits provided at the health centres. In addition the hospital served 9000 inpatients, the health centres 15 000 inpatients; the hospital covered a population base of 30000, the centres 500 000. In many of the developing nations, that kind of centralizing of the system not only involves ruinous cost, but encourages neglect of the greatest
need - decentralization of health care. Most people, especially those in the third world, do not live within the shadows of a medical centre and often those who do are not the best cared for. The fact is, as WHO has claimed, fewer than 10% of the rural population of developing countries lives within walking disance of any kind of health facility. In case that statistic doesn't make much of an impact, consider that WHO thinks of "walking distance.. to be anything within 10 km. The second part of this series looks at which countries contribute how much to UNICEF and how self-help stretches that money.
Fewer Canadian medical students entering US training programs Graduates of Canadian medical schools are reducing their entries into US training programs, reports a census of medical education recently released by the American Medical Association. The report, issued annually, shows a total of 183 Canadian medical school graduates in US residencies in 1977. This is a sharp decrease from 297 in 1976. This reduction of Canadian graduates is consistent with an overall pattern of decreasing involvement of foreign medical graduates in US house-staff positions. The AMA report noted a 33% decline in the total number of foreign graduate residents in 1977 compared with 1976. The decline is attributed to new provisions of the Health Manpower Act which made permanent residency in the US more difficult for foreign medical graduates. Canadians were generally exempted from most of those provisions. Graduates of Quebec's medical schools continue to make up the largest single provincial contingent in US house-staff positions. In 1977 there were 80 graduates of Quebec
schools training in the US. There were 52 graduates from Ontario schools, 15 from Manitoba, 13 from Alberta, 7 each from British Columbia and Nova Scotia, 5 from Newfoundland and 4 from Saskatchewan. Of the 183 Canadian graduates in US residency programs, 6 are 1styear residents (4 of these from Ontario). Of the total number of graduates of Canadian schools, California training programs have attracted the largest number (34). The next largest number of Canadian graduates are in training in New York (28). Massachusetts and Minnesota each have 17. Total enrolment in the 122 US medical schools reached its highest level in 1977-78 with 60 456, an increase of 2190 over the previous year. But there were some clear indications within these figures that the peak may have been reached and that the upward trend in ratio of rejections to acceptances (2.5:1 in 1977 against a peak of 2.8:1 in the mid-1970s) may have been reversed. For the first time in many years, the AMA noted a significant slowing
474 CMA JOURNAL/FEBRUARY 17, 1979/VOL. 120
in the number of applicants to medical schools. The number of applicants in 1977 was 40 569; down from 42 155 the previous year. Applications are now back down to early 1970s levels. The total enrolment of 60456 undergraduates in 1977 included 74 students from Canada (there were 60 in 1976) and 732 students from other countries (645 in 1976). The AMA report also reveals dramatic shifts in the funding of medical schools during the past decade. Ten years ago, federal dollars for research, targeted teaching and training and multipurpose programs accounted for more than half of medical school revenues. Now the federal government provides 32%. Federal research funds are now less than one fifth of total revenues compared with one third in 1967-78. Ten years ago, federal contracts and grants for teaching and training, including federal capitation grants, provided 13% of total medical school funds. Federal support for these targeted programs now accounts for but 5% of total funds. M.K.
One comparative study done in Tanzania showed that the dollars spent operating a network of 15 rural health centres went much further and touched far more people than did the operations of one 200-bed hospital. For capital costs of $850 000 and annual operating costs of approximately $300 000 the 200-bed hospital accounted for 400 000 outpatient visits compared with over 1 million outpatient visits provided at the health centres. In addition the hospital served 9000 inpatients, the health centres 15 000 inpatients; the hospital covered a population base of 30000, the centres 500 000. In many of the developing nations, that kind of centralizing of the system not only involves ruinous cost, but encourages neglect of the greatest
need - decentralization of health care. Most people, especially those in the third world, do not live within the shadows of a medical centre and often those who do are not the best cared for. The fact is, as WHO has claimed, fewer than 10% of the rural population of developing countries lives within walking disance of any kind of health facility. In case that statistic doesn't make much of an impact, consider that WHO thinks of "walking distance.. to be anything within 10 km. The second part of this series looks at which countries contribute how much to UNICEF and how self-help stretches that money.
Fewer Canadian medical students entering US training programs Graduates of Canadian medical schools are reducing their entries into US training programs, reports a census of medical education recently released by the American Medical Association. The report, issued annually, shows a total of 183 Canadian medical school graduates in US residencies in 1977. This is a sharp decrease from 297 in 1976. This reduction of Canadian graduates is consistent with an overall pattern of decreasing involvement of foreign medical graduates in US house-staff positions. The AMA report noted a 33% decline in the total number of foreign graduate residents in 1977 compared with 1976. The decline is attributed to new provisions of the Health Manpower Act which made permanent residency in the US more difficult for foreign medical graduates. Canadians were generally exempted from most of those provisions. Graduates of Quebec's medical schools continue to make up the largest single provincial contingent in US house-staff positions. In 1977 there were 80 graduates of Quebec
schools training in the US. There were 52 graduates from Ontario schools, 15 from Manitoba, 13 from Alberta, 7 each from British Columbia and Nova Scotia, 5 from Newfoundland and 4 from Saskatchewan. Of the 183 Canadian graduates in US residency programs, 6 are 1styear residents (4 of these from Ontario). Of the total number of graduates of Canadian schools, California training programs have attracted the largest number (34). The next largest number of Canadian graduates are in training in New York (28). Massachusetts and Minnesota each have 17. Total enrolment in the 122 US medical schools reached its highest level in 1977-78 with 60 456, an increase of 2190 over the previous year. But there were some clear indications within these figures that the peak may have been reached and that the upward trend in ratio of rejections to acceptances (2.5:1 in 1977 against a peak of 2.8:1 in the mid-1970s) may have been reversed. For the first time in many years, the AMA noted a significant slowing
474 CMA JOURNAL/FEBRUARY 17, 1979/VOL. 120
in the number of applicants to medical schools. The number of applicants in 1977 was 40 569; down from 42 155 the previous year. Applications are now back down to early 1970s levels. The total enrolment of 60456 undergraduates in 1977 included 74 students from Canada (there were 60 in 1976) and 732 students from other countries (645 in 1976). The AMA report also reveals dramatic shifts in the funding of medical schools during the past decade. Ten years ago, federal dollars for research, targeted teaching and training and multipurpose programs accounted for more than half of medical school revenues. Now the federal government provides 32%. Federal research funds are now less than one fifth of total revenues compared with one third in 1967-78. Ten years ago, federal contracts and grants for teaching and training, including federal capitation grants, provided 13% of total medical school funds. Federal support for these targeted programs now accounts for but 5% of total funds. M.K.
