st.mary's hospital make that major once this complex of problems undermines the effective delivery of both specialized care and appropriate primary health care. Effective district health system will be able to treat a large proportion of patients at lower levels of care, it will also be better able to identify patients who require referral for more complex care and, thus, may generate a greater appropriate demand for referral hospital care. medical specialists are viewed as having a higher status than general practitioners and to the premium a society places on having access to advanced health care.