In the following passage, some of the words have been left out. Read the passage carefully and select the correct answer for the given blank out of the four alternatives. Blank focus: ________ the base of psychiatrists is low in relation to the need, the use of trained general practitioners as the first line of contact assumes importance.

Introduction / Context:
This question forms part of a cloze passage about mental health services and the shortage of psychiatrists. You are given one specific blank and must choose the conjunction that best connects the ideas logically and grammatically. The sentence explains that because the number of psychiatrists is low compared to the need, trained general practitioners must be used as the first line of contact. Therefore, a conjunction expressing cause and reason is required.

Given Data / Assumptions:

• Sentence fragment: ________ the base of psychiatrists is low in relation to the need, the use of trained general practitioners as the first line of contact assumes importance.
• Options: Since, Why, As soon as, Where.
• The passage discusses a shortage (low base) and its implication (use of general practitioners).

Concept / Approach:
The sentence is clearly causal: the low base of psychiatrists leads to the importance of general practitioners. Among the options, since is a conjunction that can introduce a reason, similar to because. Why is used to ask questions and cannot introduce such a clause here. As soon as introduces a time relationship, not cause. Where is used for location, not reason. Therefore, the correct conjunction is Since.

Step-by-Step Solution:
Step 1: Interpret the meaning: Because there are not enough psychiatrists, general practitioners must play a greater role. Step 2: Identify that a reason conjunction like since or because is needed at the beginning of the sentence. Step 3: Examine option a, Since, which correctly introduces a reason clause. Step 4: Examine option b, Why, which is normally used in questions (Why is he late?) and does not fit as a conjunction here. Step 5: Examine option c, As soon as, which denotes time, as in As soon as he arrived, we left. It does not convey causation. Step 6: Examine option d, Where, which relates to place or condition, not to cause. Step 7: Conclude that Since is the only option that logically and grammatically fits.

Verification / Alternative check:
Read the full sentence with Since: Since the base of psychiatrists is low in relation to the need, the use of trained general practitioners as the first line of contact assumes importance. This is clear and correctly shows cause and effect. If you try the other options, the sentence either becomes ungrammatical or loses its intended meaning. For example, As soon as the base of psychiatrists is low does not make sense because low is a state, not an event.

Why Other Options Are Wrong:
Why cannot begin a declarative sentence like this and is reserved for interrogative contexts. As soon as introduces a time clause and would require an event that happens suddenly, which is not the case with a general shortage. Where is used with locations or conditional descriptions, not as a causal conjunction. None of these convey the idea of because, which is what the sentence needs.

Common Pitfalls:
Some candidates confuse as soon as with as, assuming any phrase starting with as expresses cause. Others may be tempted by where due to its use in some abstract conditions, but here the logic is clearly about reason, not place or condition. Whenever the sentence structure shows a problem followed by its solution or consequence, look for conjunctions like since, because, or as (in the sense of because). In this passage, since is the most appropriate choice.

Final Answer:
The correct word for the blank is Since, giving: Since the base of psychiatrists is low in relation to the need, the use of trained general practitioners as the first line of contact assumes importance.