HEALTH CARE IN KERALA 57 ted it but are actually demanding it. According to Bhatia7, the specialities are subdividing into superfluous sub-specialities and are pressurizing for their development—just for the prestige value or as a status symbol. Our meagre resources are being squandered in training them and in acquiring costly, sophisticated equipments both of which are of little benefit. As Usha Luthra8 asks, how much money can a society go on spending on an individual's care and how long can a poor country go on pouring money literally down the drain? In a patient-centred, hospital-based system and run by disease specialists the bulk of efforts, expenditure and expertise is mostly used for treating diseases and their consequences rather than in promoting health or preventing diseases. For example, in 1977-78, the Kerala budget estimates for health was about Rs 32.8 crores, and of this three-fourths was for medical relief and only about a quarter for public health and family welfare together. There is lavish spending on treating degenerative diseases affecting internal organs like heart, brain and kidney, though the diseases are mostly incurable and services are at best available only for a privileged few. Even developed countries like the United States of America and Germany are trying to curb the use of modern sophisticated facilities due to high cost ("mediflation") as opposed to low returns.9 But they have became status symbols and are in much demand in Kerala. The discrimination in favour of the influential minority of rich and the urban sector, a legacy of colonialism, is continuing even after 32 years of independence. To rectify this and to cater for the needs of the rural masses the Central Government started the primary health centre scheme and recently the community health workers scheme.10 But the latter has not been implemented in Kerala due to various reasons. There is also some opposition, mainly due to ignorance of the scheme and its advantages. Our health institutions include the subcentres, primary health centres (PHC), dispensaries and hospitals—governmental and private. The dispensaries and hospitals are heavily loaded in favour of curative aspects, and preventive work is neglected. In hospitals the emphasis is misplaced. The few inpatients get much more attention]than the outpatients though the latter are far more in number. Among the diseases too, usually the late, complicated and often incurable cases get more facilities while the outpatients get less. Consequently, the early, ofteil curable, conditions get