"Who gets what, where and why" has been a popular catch-phrase, along with Inverse Care Law, 1 used by social scientists in the course of discussing the unequal distribution of social welfare care in Western countries. How much more widespread are such disparities globally and in many parts of the Third World specifically? In the Third World the great majority of people suffer excess mortality and morbidity, while in contrast the affluent enjoy a health status similar to that of most people in developed countries. The health services also show a lopsided pattern with expenditure concentrated on sophisticated facilities in the towns, leaving the rural majority practically unserved. From the health care perspective the noble World Health Organization (WHO) slogan "Health for All by 2000" has proven a great incentive to Third World countries, which are seriously concentrating on achieving this commitment.
The current WHO approach on primary health care addresses some key issues related to this equality/inequality dimension, such as self-reliance, community participation, intersectoral collaboration, integration of primary health care often including traditional medicine with secondary and tertiary care and provision of services to vulnerable and underserved areas. Thus, in principle primary health care could be a useful instrument for coping with problems of inequality in health care. However, to translate this philosophy into reality is an uphill task, mainly owing to widespread intraregional variations, meager health budgets, and the uniqueness of each country. R. Stock has starkly synthesized the plight of the Third World: