Niiyama Tomoki
Japan Society for the Promotion of Science 56-1 Toji-in, Kitamachi, Kita-ku, Kyoto, Japan 603-8577.
Nihon Hansenbyo Gakkai Zasshi. 2012 Sep;81(3):185-90. doi: 10.5025/hansen.81.185.
The objectives of this paper are to grasp the current status of an endemic disease in the Republic of Ghana known as Buruli ulcer(BU) and to clarify relationships between the National Health Insurance Scheme(NHIS) and the health care system. As for the method of the study, I have adopted field investigations conducted in Ghana in March, 2009 and August, 2011. All the counter-measurements on BU taken either by the very government or international NGOs have been administered and controlled the disease in accordance with the National Buruli ulcer Control Programme(NBUCP) under the guidance of Global Buruli ulcer Initiative which was established in Geneva, Switzerland in 1998 as an advisory committee of the World Health Organization. BU patients can receive treatments free. The government sponsored NBUCP and direct and indirect donations from various NGOs provide the cost of medical treatments. The Ghanian NHIS of 2003 aimed to ease and improve the health situations of the people. Some of serious endemic diseases like BU, however, are excluded from the schemes. While the NHIS remains ineffective to the diseases like BU, the burden of treatment costs puts the strain on NBUCP. The field researches indicate that the budgets provided by the NBUCP often faile to cover the fundamental medical supplies like bandages. This causes to give an extra burden on the already constrained hospital budgets. Only reliefs the hospitals can rely on are the international aids which often determine the fate of the national disease control. The research reveals that the region's health system remains unsound. Ghana represents such realities of West Africa as a whole.
本文的目的是了解加纳共和国一种名为布鲁里溃疡（BU）的地方病的现状，并阐明国家健康保险计划（NHIS）与医疗保健系统之间的关系。至于研究方法，我采用了2009年3月和2011年8月在加纳进行的实地调查。政府或国际非政府组织针对布鲁里溃疡采取的所有应对措施，都是在1998年于瑞士日内瓦成立的全球布鲁里溃疡倡议（作为世界卫生组织的一个咨询委员会）的指导下，根据国家布鲁里溃疡控制计划（NBUCP）来管理和控制这种疾病的。布鲁里溃疡患者可以免费接受治疗。政府资助的国家布鲁里溃疡控制计划以及各非政府组织的直接和间接捐赠提供了医疗费用。2003年的加纳国家健康保险计划旨在缓解和改善民众的健康状况。然而，一些严重的地方病，如布鲁里溃疡，被排除在该计划之外。虽然国家健康保险计划对布鲁里溃疡这类疾病仍然无效，但治疗费用的负担给国家布鲁里溃疡控制计划带来了压力。实地研究表明，国家布鲁里溃疡控制计划提供的预算往往无法涵盖绷带等基本医疗用品。这给本就紧张的医院预算带来了额外负担。医院唯一能依靠的救济是国际援助，而国际援助往往决定了国家疾病控制的命运。研究表明，该地区的卫生系统仍然不完善。加纳代表了整个西非的此类现实情况。
