Alubo O
Department of Sociology, University of Jos, Jos, Nigeria.
Health Policy Plan. 2001 Sep;16(3):313-21. doi: 10.1093/heapol/16.3.313.
Developments in health are easily among the best known human development indicators. Comparisons of life expectancy, infant mortality, access to safe water and similar data indicate the positions of individual countries. The political and economic processes which these indices reflect, or which inform the nature of health policy, are often not as clear or visible. These structural factors are either frequently ignored or mentioned only in passing, as illustrated in a recent paper published in this journal on the private medical enterprise in Nigeria (Ogunbekun et al. 1999). According to the authors, the generally low quality of public health services and high user fees have combined to make private medicine the 'unavoidable choice' of Nigerians. They identify benefits of private medicine as higher technical efficiency and contributing to fill the gap created by inadequate public sector services and to medical training. This paper argues that these claims are exaggerated, and that the authors seem to ignore Nigeria's political and economic processes, the health seeking behaviour of Nigerians, as well as the prevailing causes of morbidity and mortality. It is suggested that whereas the contributions of private medicine are significant, there are also several limitations, some of which originate from its for-profit raison d'être. The ultimate aim of health development must include improved access to services and better health status for the majority of the people. Without any form of public supported programme of payments in Nigeria, these objectives are circumscribed, especially with high fees in the private system. It is concluded that while private medicine will continue to be available for those who can afford it, it is unlikely to provide solutions to Nigeria's morbidity and mortality problems, particularly in relation to epidemics such as the growing burden of HIV/AIDS.
健康发展成果无疑是最为人熟知的人类发展指标之一。对预期寿命、婴儿死亡率、安全饮用水获取情况及类似数据的比较，能表明各个国家的状况。这些指标所反映的政治和经济进程，或者那些影响卫生政策性质的进程，往往并不那么清晰或明显。这些结构性因素要么常常被忽视，要么只是被顺带提及，正如近期发表在本期刊上一篇关于尼日利亚私立医疗企业的论文所示（奥贡贝昆等人，1999年）。据作者称，公共卫生服务普遍质量低下以及高昂的用户费用，共同使得私立医疗成为尼日利亚人的“无奈选择”。他们指出私立医疗的好处在于更高的技术效率，有助于填补公共部门服务不足所造成的缺口，并对医学培训有所贡献。本文认为这些说法有些夸张，而且作者似乎忽视了尼日利亚的政治和经济进程、尼日利亚人的就医行为，以及发病率和死亡率的普遍成因。有人认为，尽管私立医疗的贡献很大，但也存在一些局限性，其中一些源于其营利性的存在理由。健康发展的最终目标必须包括让大多数人有更多机会获得服务并改善健康状况。在尼日利亚没有任何形式的公共支持支付计划的情况下，这些目标受到限制，尤其是私立医疗系统费用高昂。结论是，虽然私立医疗将继续为有能力支付的人提供服务，但它不太可能解决尼日利亚的发病率和死亡率问题，特别是与诸如日益加重的艾滋病毒/艾滋病负担等流行病相关的问题。
