ABSTRACT
Access to health care services for the poor and indigent is hampered by current policies of health care financing in sub-Saharan Africa. This paper reviews the issue as it is discussed in the international literature. No real strategies seem to exist for covering the health care of the indigent. Frequently, definitions of poverty and indigence are imprecise, the assessment of indigence is difficult for conceptual and technical reasons, and, therefore, the actual extent of indigence in Africa is not well known. Explicit policies rarely exist, and systematic evaluation of experiences is scarce. Results in terms of adequately identifying the indigent, and of mechanisms to improve indigents' access to health care, are rather deceiving. Policies to reduce poverty, and improve indigents' access to health care, seem to pursue strategies of depoliticizing the issue of social injustice and inequities. The problem is treated in a 'technical' manner, identifying and implementing 'operational' measures of social assistance. This approach, however, cannot resolve the problem of social exclusion, and, consequently, the problem of excluding large parts of African populations from modern health care. Therefore, this approach has to be integrated into a more 'political' approach which is interested in the process of impoverishment, and which addresses the macro-economic and social causes of poverty and inequity.
Subject(s)
Health Policy , Health Services Accessibility/economics , Medical Indigency/economics , Poverty/statistics & numerical data , Africa South of the Sahara , Developing Countries , Financing, Government , Financing, Personal , Health Care Reform , Rural Population , Social Justice , Urban PopulationABSTRACT
We report a case of locked-in syndrome occurring two days after a cranio-cervical trauma in a 28 years old male patient. It was a consequence of basilar thrombosis after left vertebral artery dissection secondary to a vertebral fracture at the C6 level. Decerebrate rigidity and apparent unconsciousness led to misdiagnosing it for post traumatic coma. It took several days to correct this mistake. To avoid this pitfall, we insist on the clinical features of this syndrome and discuss which investigations are needed and which therapy is available.
