all countries should reexamine training curricula and the delegation of responsibilities within the healthcare delivery system in order to reduce frequent unnecessary and costly reliance on physicians and on secondary and tertiarycare facilities while maintaining effective referral services access to healthcare services for all people and especially for the most underserved and vulnerable groups must be ensured the reservation is to be interpreted in terms of the statement made by the representative of the holy see at the th plenary meeting on september the involvement of users and the community in the financial management of healthcare services should be promoted