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The provision of psychiatric services on a national scale poses many formidable problems for homogenous communities which are traditionally accustomed to adequate and sophisticated medical services. In countries like Rhodesia and Malawi these problems are even greater and more diverse. A simple example which is common to all countries is the impact on these services of variations in population density. In large cities it should be possible to cope with most patients on an outpatient 5 basis or in a day hospital, but in more isolated areas there is a greater demand for inpatient accommodation because of the difficulty in organizing intensive supervision and treatment outside. Furthermore, duration of stay in hospital tends to be more prolonged in rural areas because of delays in obtaining information from relatives and others, and the reluctance to discharge early because of the uncertainty of adequate follow-up. The effectiveness of social workers is also diminished because of the large distances involved.