58 SOCIAL SCIENTIST neglected till they too become late or complicated. Nobody seems to be bothered about this vicious circle. The primary health centres and subcentres are unable to contribute much due to staff inadequacy, lack of motivation and non-recognition. Their coverage is unsatisfactory too. A North India study11 reports only 6-10 percent coverage. Probably it is a little more in Kerala. Each PHC was originally proposed to cover a population of 40,000 in the short term. to be reduced to 10,000 to 20,000. But now a centre has to cater for 1,50,000 on an average. Individual workers too have a very large population. Unrealistic plans and impossible targets are fixed by superiors who generally have little knowledge of field conditions and difficulties. Moreover, financial and material support and distribution are often unsatisfactory. No wonder that plans fail or that targets are hardly ever reached. While small-pox eradication has succeeded, other health programmes have not been so successful. Crash programmes are good in an emergency. But they are no substitute for the development of basic health services. The training of health staff, specially doctors and nurses, is unsatisfactory. There are many misfits in this field. This is mainly because there is no aptitude testing, vocational guidance or motivation of health workers. Common attitude is one of self-interest rather than service to humanity. Though the health personnel are often elaborately overtrained in unnecessary sophisticated details, simple fundamental, practical aspects are often neglected. The training is generally modelled on Western standards despite the fact that conditions are vastly different here. The training is neither need based nor relevant. Despite high educational status of Keralites, the level of health education is really poor. While many people know that water supply and sanitary waste disposal are desirable they do not understand that these are far more important than doctors^ hospital beds or medicines. Lack of health education, together with ignorance of health economics, has led to distorted development of health services. In short, the neglect of health promotion and of disease prevention, disinterest in the rural areas and common people, concentration of facilities jn urban areas, excessive dependence on hospital and costly facilities, catering mainly for the privileged, lack of health education orientation towards disease, obsession with specialization, apathy and indifference, vested interests,