1. Advances in technology
2. Available resources for the health care delivery services
3. The epidemiology determinants

The first two determinants represent the essence of both the form and content of the health care delivery system. In this discussion, these two major determinants will therefore take centre stage.

In order to understand the scientific and technological factors, which will determine policy in health sector, it is necessary to look at the four watersheds of technological advances of mankind through history. These watersheds are represented by what is referred to as the four scientific and technological waves and these technological waves have created great wealth for their respective nations and civilization that have risen on their crest.

1st Wave
This scientific revolution lasted 9,000 years and produced great wealth for countries and civilization of the Mediterranean rim countries. This age of specialization resulted in individuals carrying out specialized work as artisans, masons and it was from this group that the profession of medicine developed.

Specialists in this situation would have such great skill, that is, production, shoe masonry, butchering, etc was far greater than the communal collective. Our production of these items resulted in an increase in both the quantitative and qualitative output of human production. The physician or doctor by concentrating on his professional pursuit acquired much knowledge and skill in his profession.

The domain of the physician was therefore the home and he trained other physicians through an apprenticeship system. The institution of the hospital was not yet born and home visits were the order of the day.

That was the nature of the scientific and technological revolution that was represented by 1st Wave technology of which the Mediterranean rim countries built massive civilization, were the richest in the world during a period of barbarism. [more]