Health Care for Some: A Nigerian Study of Who Gets What, Where and Why?

Abstract

The persistent underdevelopment of health in the Third World belies the optimism of the "Health care for all by the year 2000" campaign. In order to understand the underdevelopment of health, it is essential to examine the historical evolution of specific health systems. These ideas are developed in a case study of health care in Kano State, Nigeria. The nature and contemporary development of the health care system, which includes state voluntary agency and private sector outlets for Western scientific medicine and a large and varied traditional medicine sector, are examined. Although the deepening health care crisis may potentially spur a reconsideration of priorities and strategies, past experience suggests that a stubborn retention of a pared-down and increasingly unjust version of the present system is more likely.

New approaches to spatially analyse primary health care usage patterns in rural South Africa

“…1998). In developing countries where health facilities are relatively sparse and access is often achieved on foot (Stock 1985), it has been assumed that patients will preferentially use the health facilities nearest to them and that there is a limit to the distance that patients will travel for health care. These assumptions may not hold in countries like South Africa, where well resourced facilities of reasonable quality are available and where public transport may increase access to facilities some distance away from home.…”

“…The effect of distance on patient travel to health care facilities and the estimation of critical distance thresholds for different levels of health care have been subject of extensive study (Morrill & Earickson 1968, 1970Shannon & Dever 1974). There is ample evidence to suggest that physical accessibility of services is a major factor in¯uencing patient choice of health care facility (Shannon et al 1969) and that attendance rates at health facilities decline markedly with distance (Rahaman et al 1982;Stock 1983;Kloos 1990;Mu È ller et al 1998). In developing countries where health facilities are relatively sparse and access is often achieved on foot (Stock 1985), it has been assumed that patients will preferentially use the health facilities nearest to them and that there is a limit to Tropical Medicine and International Health volume 6 no 10 pp 826±838 october 2001 the distance that patients will travel for health care.…”

Maternal responses to childhood fevers: a comparison of rural and urban residents in coastal Kenya

“…Household responses to illness are influenced by socioeconomic and cultural factors (Kleinman 1980;CunninghamBurley 1990) and by ease of access to treatment sources (Stock 1985;Kloos et al 1987;Mburu et al 1987;Glik et al 1989). In sub-Saharan Africa, rural and urban populations differ demographically, in socio-economic and cultural composition, and in proximity to formal and informal treatment sources.…”

Doctoring as business: A study of entrepreneurial medicine in Nigeria

“…As a matter of fact, this perceived efficiency is adduced as the mison d'etre for privatisation now the major rallying cry of the ongoing Economic Recovery Programme. Secondly, the public medical system is in acute crisis without drugs, equipment and basic essentials (Alubo 1985a;Stock 1985aStock , 1985b. 3 These growing shortages are in addition to a general lack of trust in public hospitals and institutions in general.…”

“…But on the other hand, the high demand for medical services outstrips budgetary allocations. Consequently, available services are rationed in the process of which power, including economic power, is a key factor (Alubo 1987;Stock 1985a). Further, the history of Western biomedicine in Nigeria, as is true of other former colonies, entails a civilizing mission (the white man's burden), a conception which bred a condescending attitude towards the indigenous population construed as "benighted" (Onoge 1975:223;Aidoo 1982;Fanon 1965).…”