Caring for the poor and those in need.

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One key obstacle is the acute shortage of healthcare workers in many poor countries, who are crucial to ensure treatments reach those who need them.

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National and local government agencies need to be supported to develop their capacity to design and implement low cost appropriate systems that are efficient, sustainable, managed by local communities, targeted at those most in need and that address multiple needs of the poor.

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In addition to their operational missteps, both did a poor job (at least initially) of communicating with taxpayers who desperately need those refunds to pay tuition or other bills.

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"When you've got care homes that chronically are not delivering - the care quality is poor and the quality of life of those people is appalling, then we clearly need urgent and robust action, " he said.

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But Medicaid does not pay enough for the poor on the program to get timely, essential health care, particularly the sickest and those most in need of the best health care.

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