Perhaps the most serious gaps in living standards between rural and urban areas were in education and health care.[1] Primary schools existed in most rural localities, and 80 percent of the country's primary-school teachers worked in rural schools.[1] Secondary schools were less widely distributed; only 57 percent of the total number of secondary-school teachers served in rural schools.[1] Most rural schools were less well equipped, and their staffs less adequately trained than their urban counterparts.[1] Health care had been greatly improved in rural areas in the 1960s and 1970s through sanitation campaigns and the introduction of large numbers of barefoot doctors, midwives, and health workers.[1] Most modern hospitals, fully trained doctors, and modern medical equipment, however, were located in urban areas and were not easily accessible to rural families.[1] In 1985 two-thirds of all hospital beds and medical staff personnel were located in urban hospitals.[1] The economic reforms affected rural education and health care positively in places where farm communities used their higher incomes to improve schools and hospitals and negatively in localities where the reduced role of the collective resulted in deterioration of collective services.[1]