In no way is the problem in the Americas for the current decade and those to come a technological one. Nor do we believe that it is financial. Basically, what has been lacking is the firm resolve and imaginative effort to integrate the measures indicated into the general health structure. Often the steps have been taken but the changes have not been produced. Inefficiency arises in the most vulnerable areas: programming, in-service training, provision of supplies when and where they are needed, supervision, and evaluation. In general, there is a tendency to dissociate the objectives from the resources that are indispensable in order to achieve them. What should be done is to bring these two components together into a single undertaking, formulated in terms of the best available knowledge of national realities. - p. viii-ix.