geographical significance i took as due to it following the question on maps - to refer to this a little. about the poorest living in the west and this is where the high altitude is..therefor difficult for the health system..also more rain = worse roads = more difficult. And went through some of their issues with the health system and related it to why in terms of ' not many staff in rural as it is at high altitude, with little road network to reach them - and also said about getting paid more by the private sector in urbanised areas ' and then about transport - lorries not suited to the high altitude..this is what i took ' geographical significance' as