The provision of health services is an important aspect of socio~ economic. developent and improving them plays an important part in raising people's standards of living. The provision of adequate health services is, however, far more difficult to realize when the available resources . Ct. cannot cope within rapidly increasing population. When the population is growing very fast, increase~d investment in hospital beds, health personnel and other health units will be required to maintain the existing service ratios. The existing service ratios in terms of health units and health personnel in the country are>however,very 10w~, therefore the services are inadequate. This study investigates the health care delivery system in Kerry a. in the light of health problems and population factor. It also examines the cost of future health care delivery in order to find out the feasibility of meeting these costs. The studYJ accordingly, attempts to propose ways and means,o'f expanding coverage of health services to all parts of the countr~given predominant health problems and scarce resources. The study is organized into five chapters. Chapter One is an introduction, covering problem statement, objectives and significance of the study. It also gives the review of the available literature together with the theoretical framework. Chapter ~wo gives methodology as well as background information to the study. It treats geographical, ecological, demographic and historical factors which are considered important in the analysis of health problems and health services in the country. The study points out some interesting relationships between geographical and ecological factors and the incidence of diseases. It also shows that demoq raph Lc factors do ..in 'ORe way or another affect the health status of the population. The present inadequate pattern of health care , delivery, which apparently needs change, is shown to be an imitation of the colonial system. Chapter ~three presents the health problems in the country and their impact on the population in terms of morbidity and mortality. It is found that the major health problems from which the majority of morbidity and mortality arise are infectious and -- parastic diseases which are generally preventable and controllable. It also examin~s the current health J care delivery system in th~ context of the prevailing (xiv) health problems. It is found that the health services coverage is very low as depicted by the low service ratios in terms of population per physician, per nurse, per clinical officer, per hospital bed. and per health centre. Again, the health care delivery system is hospital based, emphasizing curative services at the expense of preventive services given the predominant diseases. These services take a considerable share of the health budget. Chapter Four examines future requirements of health services in terms of health units and health personnel. It deals with the projection of the health units in rel~tion to service ,f~tios. It also examines the implications of the projected additional units in terms of viability and costs. , The financial implications of the projected additional units when compared with the trends in the Gross Domestic Product (GDP) render improvement of health services rather impossible. Finally Chapter Tive summarizes the study and spells out the conclusions. It also describes a suggested alternative strategy for health care provision. -~n alternative approach in the light of scarce resources and the nature of the health ! J (xv) problems is proposed. Primary health care approach which emphasizes preventive measures is proposed as a viable means through which maximum coverage can be achieved with minimized costs. Recommendations for the improvement of the health care delivery system and for future research are also given in this chapter.

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