After the Bolivarian Revolution, extensive inoculation programs and the availability of low- or no-cost health care provided by the Venezuelan Institute of Social Security made Venezuela's health care infrastructure one of the more advanced in Latin America. Pre-Bolivarian Revolution 1970s Venezuelan state governments operated only five facilities in 1979, down from about sixty hospitals in 1970 since the Ministry of Health and Social Assistance (MSAS) took over many of the hospitals. In 1978, a presidential election year, medical sales in Venezuela hit an all-time high, but dropped in 1979. In 1979, there were approximately 250 hospitals in Venezuela with MSAS operating the majority of them (58%). Venezuela had a shortage of medical professionals and hospital beds in the late 1970s due to a large increase in the population and a lack of specialization among health care professionals. The lack of both professionals and beds was higher in the rural areas compared to the more populated, urban areas. Between 1978 and 1980, Venezuela had 14,771 doctors, 8,805 nurses and 2,804 nursing auxiliaries. 1980s Under President Luis Herrera Campins's Sixth National Plan, the government planned to increase medical funding by 9.7% annually between 1981 and 1985, with medical expenditures planned to reach $2.1 billion in 1985. $1.2 billion were designated to the construction of new facilities to combat bed shortages, with a main focus on establishing clinics in order to avoid the inefficiency of larger hospitals. The rehabilitation of handicapped individuals and a focus on addressing heart disease (the leading cause of death in Venezuela) were also highlighted in the Sixth National Plan. Medical professionals in Venezuela were "extremely U.S. oriented", with most doctors attending post-graduate work in the United States. These doctors were able to speak English, read U.S. medical journals, and attended gatherings of United States medical experts. In 1981, over 70% of health care services were administered by the government. 1990s Foreign medical equipment developed abroad was quickly adopted and shipped to Venezuela with most of the country's medical goods needing to be imported. In 1980, Venezuela imported 47% of its medical goods from the United States, 13% from Germany, 8% from Japan, and 3% from the United Kingdom. The majority of the medical equipment was distributed by a conglomerate of about 45 distributors known as the Asociación Venezolana de Distribuidores de Equipos Medicos (AVEDEM), while 15% of medical products were distributed by smaller entities. From 1992 to 1993,