Health care in Africa
非洲的医疗
Of markets and medicines
市场与药品
Big donors are betting on Africa's private sector to improve health
大型捐助机构希望依靠非洲的私人组织来改善非洲的医疗卫生状况
IS THIS privatisation through the back door? That is a question sure to come up about the $1 billion health-care strategy for Africa unveiled on December 17th by the International Finance Corporation (IFC), the private-sector arm of the World Bank. The IFC plans to set up an equity investment fund, ultimately worth up to $500m, including money from other donors, to invest in small and medium-sized enterprises in the health-care industry. It also wants to create a $400m-500m debt vehicle that will fund local banks that lend to such entrepreneurs.
这是在给私有化开后门吗？当世界银行集团面向私人部门的分支机构-国际金融公司（简称IFC）在12月17日宣布面向非洲的价值10亿美金的医疗援助计划时,肯定会有人提出这样的疑问. IFC准备建立一家价值5亿美金的投资基金(这其中也包括其他捐赠机构的援助),这家基金将投资于非洲那些中小型的医疗保健类的公司.除此之外它还准备为那些企业家提供4到5亿美金的贷款担保,使非洲当地的银行能够向这些企业提供贷款.
This could be controversial stuff. Lars Thunell, the IFC's chief executive, anticipates the objections: “I am from Scandinavia where the government provides health care, so I initially asked myself, 'Who am I to promote the private sector in Africa?'” The reason he forged ahead, he explains, is that it became pretty plain that Africa's governments “simply do not have the resources and capacity to do everything.”
这样做肯定是有争议的. IFC的首席执行官Lars Thunell也已经预见到会有反对的声音,他说“我最初也曾自问：我来自斯堪的纳维亚（北欧四国的泛称），那里都是由政府来提供医疗保健的服务的，我为什么要用巨资促进非洲私人医疗卫生产业的发展呢？”他自己的解释是：很明显，非洲的政府没有足够的资源和能力来（像北欧国家那样）去做每件事情。”
Big donors are finding that African ministries are overwhelmed by aid money. Tachi Yamada of the Bill & Melinda Gates Foundation, which supports the IFC's new approach even as it continues to fund Africa's public sector, observes: “The paradox is that the poorest of the poor often get health care through the private sector.”
大型捐助机构也发现非洲国家的政府正在被这些援助资金所压垮。比尔·盖茨和梅琳达基金会的Tachi Yamada对IFC的新举措表示支持(他也同时表示将继续对非洲国家的公共部门提供援助),他说:“在这里有一个悖论就是穷人中的最贫困者所得到的医疗保健往往是由私人部门提供的。”
About half of the region's $16.7 billion spending on health care already comes via private enterprise and charities. McKinsey, a management consultancy, argues in a new report for the IFC that this share will grow larger—to 60%, or an estimated $21.2 billion, by 2016. Optimists think this coming boom may even produce substantial profits. Merrill Lynch put out a recent report that ranked the attractions of Africa's health-care industry to foreign investors above even infrastructure and telecoms.
非洲一年在医疗卫生方面的花费大概是167亿美金，这其中大约有一半左右是由私人企业和慈善团体提供的。麦肯锡（一家世界知名的管理咨询公司）在一份给IFC的报告中预测到2016年非洲用于医疗卫生方面的支出大约是212亿美金，而私人部门在其中所占的比例将达到60%。有乐观主义者认为这种将要到来的繁荣将带来实质性的利润。美林证券公司在最近的一份研究报告中对非洲医疗卫生产业的推荐等级甚至高于基础设施和电信行业。
If the IFC's scheme stimulated private capital, that would be good. Sub-Saharan Africa, which has 11% of the world's people, suffers 24% of the burden of disease, measured by the years lost to sickness and early death. But it absorbs less than 1% of the planet's health-care spending.
如果IFC的这一计划可以促进私人资本的发展，那实在是件好事情。撒哈拉以南非洲占到了世界人口的11%，但是如果按照因疾病致死和夭折的人数来衡量，它负担了全球疾病的24%，而它在医疗卫生方面的支出只占到全球总量的不到1%。
To grease the skids for private capital, and to ensure it does not go only into fancy facilities that serve the urban rich, the IFC and McKinsey propose a bundle of technical fixes. These include regulatory reform to repair the weak standards and lack of enforcement that result in dangerous drugs being sold on the open
market. They want to help countries set up partially subsidised but market-driven health-insurance schemes. Both Nigeria and Rwanda have fledgling programmes of this type that involve both government subsidy and market providers.
在促进私人资本发展的同时，必须保证这些成果不被城市里的富人所独享，因此IFC和麦肯锡提出了一揽子的技术建议.这其中包括一些规章制度的改革,以提高非洲国家的药品监督检查水平和力量,将危险的药品赶出市场.它们希望帮助非洲国家建立一个由市场提供医疗保险,政府提供部分补贴的计划. 尼日利亚和卢旺达已经有了一个包含政府补贴和市场提供的计划的雏形.
That, argues Julian Schweitzer, director of health at the World Bank, points to an important insight that should mollify the critics. “The public sector can pay, but anybody can deliver services,” he insists. As the financing of health care is separated from its delivery, the region's long-suffering poor may at last get the
health services they deserve.
世界银行负责健康事务的主管Julian Schweitzer提出了一个可以平息外界批评的重要理由:“可以由公共部分支付费用，但由其他部门提供服务。”应当将提供医疗卫生服务本身和为这些服务支付费用区别开来。这样做有可能使这个长期陷于贫困的地区最终得到他们所渴望的医疗服务。
非洲的医疗
Of markets and medicines
市场与药品
Big donors are betting on Africa's private sector to improve health
大型捐助机构希望依靠非洲的私人组织来改善非洲的医疗卫生状况
IS THIS privatisation through the back door? That is a question sure to come up about the $1 billion health-care strategy for Africa unveiled on December 17th by the International Finance Corporation (IFC), the private-sector arm of the World Bank. The IFC plans to set up an equity investment fund, ultimately worth up to $500m, including money from other donors, to invest in small and medium-sized enterprises in the health-care industry. It also wants to create a $400m-500m debt vehicle that will fund local banks that lend to such entrepreneurs.
这是在给私有化开后门吗？当世界银行集团面向私人部门的分支机构-国际金融公司（简称IFC）在12月17日宣布面向非洲的价值10亿美金的医疗援助计划时,肯定会有人提出这样的疑问. IFC准备建立一家价值5亿美金的投资基金(这其中也包括其他捐赠机构的援助),这家基金将投资于非洲那些中小型的医疗保健类的公司.除此之外它还准备为那些企业家提供4到5亿美金的贷款担保,使非洲当地的银行能够向这些企业提供贷款.
This could be controversial stuff. Lars Thunell, the IFC's chief executive, anticipates the objections: “I am from Scandinavia where the government provides health care, so I initially asked myself, 'Who am I to promote the private sector in Africa?'” The reason he forged ahead, he explains, is that it became pretty plain that Africa's governments “simply do not have the resources and capacity to do everything.”
这样做肯定是有争议的. IFC的首席执行官Lars Thunell也已经预见到会有反对的声音,他说“我最初也曾自问：我来自斯堪的纳维亚（北欧四国的泛称），那里都是由政府来提供医疗保健的服务的，我为什么要用巨资促进非洲私人医疗卫生产业的发展呢？”他自己的解释是：很明显，非洲的政府没有足够的资源和能力来（像北欧国家那样）去做每件事情。”
Big donors are finding that African ministries are overwhelmed by aid money. Tachi Yamada of the Bill & Melinda Gates Foundation, which supports the IFC's new approach even as it continues to fund Africa's public sector, observes: “The paradox is that the poorest of the poor often get health care through the private sector.”
大型捐助机构也发现非洲国家的政府正在被这些援助资金所压垮。比尔·盖茨和梅琳达基金会的Tachi Yamada对IFC的新举措表示支持(他也同时表示将继续对非洲国家的公共部门提供援助),他说:“在这里有一个悖论就是穷人中的最贫困者所得到的医疗保健往往是由私人部门提供的。”
About half of the region's $16.7 billion spending on health care already comes via private enterprise and charities. McKinsey, a management consultancy, argues in a new report for the IFC that this share will grow larger—to 60%, or an estimated $21.2 billion, by 2016. Optimists think this coming boom may even produce substantial profits. Merrill Lynch put out a recent report that ranked the attractions of Africa's health-care industry to foreign investors above even infrastructure and telecoms.
非洲一年在医疗卫生方面的花费大概是167亿美金，这其中大约有一半左右是由私人企业和慈善团体提供的。麦肯锡（一家世界知名的管理咨询公司）在一份给IFC的报告中预测到2016年非洲用于医疗卫生方面的支出大约是212亿美金，而私人部门在其中所占的比例将达到60%。有乐观主义者认为这种将要到来的繁荣将带来实质性的利润。美林证券公司在最近的一份研究报告中对非洲医疗卫生产业的推荐等级甚至高于基础设施和电信行业。
If the IFC's scheme stimulated private capital, that would be good. Sub-Saharan Africa, which has 11% of the world's people, suffers 24% of the burden of disease, measured by the years lost to sickness and early death. But it absorbs less than 1% of the planet's health-care spending.
如果IFC的这一计划可以促进私人资本的发展，那实在是件好事情。撒哈拉以南非洲占到了世界人口的11%，但是如果按照因疾病致死和夭折的人数来衡量，它负担了全球疾病的24%，而它在医疗卫生方面的支出只占到全球总量的不到1%。
To grease the skids for private capital, and to ensure it does not go only into fancy facilities that serve the urban rich, the IFC and McKinsey propose a bundle of technical fixes. These include regulatory reform to repair the weak standards and lack of enforcement that result in dangerous drugs being sold on the open
market. They want to help countries set up partially subsidised but market-driven health-insurance schemes. Both Nigeria and Rwanda have fledgling programmes of this type that involve both government subsidy and market providers.
在促进私人资本发展的同时，必须保证这些成果不被城市里的富人所独享，因此IFC和麦肯锡提出了一揽子的技术建议.这其中包括一些规章制度的改革,以提高非洲国家的药品监督检查水平和力量,将危险的药品赶出市场.它们希望帮助非洲国家建立一个由市场提供医疗保险,政府提供部分补贴的计划. 尼日利亚和卢旺达已经有了一个包含政府补贴和市场提供的计划的雏形.
That, argues Julian Schweitzer, director of health at the World Bank, points to an important insight that should mollify the critics. “The public sector can pay, but anybody can deliver services,” he insists. As the financing of health care is separated from its delivery, the region's long-suffering poor may at last get the
health services they deserve.
世界银行负责健康事务的主管Julian Schweitzer提出了一个可以平息外界批评的重要理由:“可以由公共部分支付费用，但由其他部门提供服务。”应当将提供医疗卫生服务本身和为这些服务支付费用区别开来。这样做有可能使这个长期陷于贫困的地区最终得到他们所渴望的医疗服务。