Ukuqonda ukufumaneka konyango lwengingqi: Isiseko sentsika esisiseko yoluntu

Ukufikelela konyango lwezempilo lwasekuhlaleni kubuchule babantu ngabanye bokufumana iinkonzo zezonyango ezifike ngexesha elifanelekileyo, nezifanelekileyo kwingingqi yabo. Asikokubakho nje kwesibhedlele okanye kwikliniki; yingcamango efuna ukuba abemi abaninzi bafumane inkathalo na xa beyifuna. IWorld Health Organization ichaza ukufikelela “ngokulula kokufikelela nokufumana iinkonzo ezifanelekileyo zempilo kwiimeko ezibonisa ukuba kukho imfuneko,” ezisekelwe kwimilinganiso emihlanu: ukufumaneka, ukufumaneka, ukufumaneka, ukufumaneka, ukufumaneka, ukulingana, ukukwazi ukufumaneka, kunye nokukwazi ukufikelela, kunye nokusoloko kubizwa ngokuba“ ngu-5 ufikelelo lwempilo.”

Imilinganiselo Emihlanu Yonyango

Ukufumaneka: Ukubonelela ngokwaneleyo kweenkonzo

Ubuchule bubhekisela ekubeni kukho ubuncwane obaneleyo bokunyamekela impilo kwindawo ethile. Oku kuquka inani lezibhedlele, iikliniki eziphambili, ii-ofisi zoogxamezi bonyango olungxamisekileyo, amaziko okunyamekela izigulana zengqondo, kunye noqheliselo lwamazinyo olunxulumene nabemi basekuhlaleni. ISebe leMivuzo kunye neSebe leNkonzo (HRSA) lichaza ukuba kukho i-Health Professional Shortge Areages (HPS) apho umlinganiselo wabasebenzi be-ofisi yezonyango abahlala phantsi kwemiqobo. Umzekelo, kukho ii-HPSA iziqinisekiso ezingaphezu kwama-7000 eUnited States, ezichaphazela abantu abangaphezu kwezigidi ezili-100.

Ukufikeleleka: I-ographic nezothutho

Ufikelelo ludlulela ngaphaya kobukho beziko; kuvavanywa ukuba abantu banokufikelela ngokoqobo kwezo nkonzo. Imiqobo yezothutho iphakathi kweyona miqobo ikhankanyiweyo yokunyamekela, ingakumbi kwiindawo zasemaphandleni apho uthutho lukawonke-wonke lungahlali kunye. Uhlolisiso lwamashumi amabini anambini anesibini lufumaneka luthi phantse izigidi ezi-5.8 zamaMelika alibazise ukunyanyekelwa kwezonyango minyaka le kuba engenazo ezothutho. Ukufikeleleka kubandakanya ixesha, iimeko zohambo, ukufumaneka kweendlela, ukusetyenziswa kwe-patrol, kunye nokusondela kweenkonzo ezikolweni, emsebenzini, nakwiindawo zabemi abahlala apho.

ICandelo: Indlela Iinkonzo Ezizifanela ngayo Iimfuno zesigulana

Ikompathiswa iqwalasela indlela ezilungelelaniswe ngayo iinkonzo zonyango ukuze zihlangabezane nocwangciso lwezigulana kunye nolindelo lwazo. Oku kuquka iiyure zekliniki (umz. iingokuhlwa neempelaveki), ukulinda amaxesha, ukuhamba-hamba, iinkonzo zokutolika, kunye nokuqondana kwabezo iikliniki. Xa iikliniki zisebenza kuphela ngexesha lezoshishino, abantu abadala abasebenzayo basenokuzama ukuya kwimiqathango ngaphandle kokuphuma ngaphandle kwentlawulo. Ngokufanayo, izigulana ezithetha isiNgesi ezithe cwaka zisoloko zijongene nookanye nokungafumani buchule obufanelekileyo ukuba iinkonzo zabatoliki azikho.

Ukufumaneka: Ixabiso neSigqumo se-Inishorensi

Ukufumaneka kwe-inshorensi kusenokuba yeyona mqobo ibhalelwe ngokubanzi. Naxa iinkonzo zikhona kufutshane, ziphezulu kakhulu iindleko ze-odocte, iindleko ezingahlawulwayo, ukuhlawulwa, nokunqongophala kwe-inshorensi kungathintela abantu ekufuneni inkathalo. I-U.S. Bureaunivation Bureauments inikela ingxelo yokuba malunga nama-7,5 ezigidi zabantu baseMelika babengenayo i-inshorensi yempilo ngowama-2021, yaye izigidi ezingaphezulu zaziphantsi kwentengiso. Ukufumaneka kwamaxabiso athe ngqo anjalo alahlekelwa yimali ngexesha lohambo kunye neendleko zokuzithutho.

Ukwamkelwa: Ukuthemba kunye nokhuphiswano lwenkcubeko

Ukwamkelwa kubonisa ukuba iinkonzo zonyango ziyazihlonela okanye ziyasabela iinkolelo zomonde, ezikhethwayo, kunye neemvelaphi zenkcubeko. Izigulana zidla ngokulandela amacebiso ezezamayeza kwaye zigcine inkathalo ethe rhoqo xa abanikezeli bebonisa ubuchule benkcubeko. Ucalucalulo, okanye ukuxhatshazwa ngokwembali (njengokuba uhlolo lwegcushuwa) lungaphelisa ukuthembana, ingakumbi phakathi kweqela elincinane lobuhlanga nolohlanga. [FLT:] Ubuchule bophando nobunjani na obuqhubekayo bobunjani na obubonisa ukuchasana kwimfuno-ntle yempilo [[[FLTLT:1]] ingxelo ebalaselubala inteko eqhubekayo kwixabiso lobuMnyama, iShunyuke, i-Inggnognognog, i-Ivan, inxenye eqhutywa ziinkonzo ezisezantsi.

Ukubaluleka Kokunyamekela Unyango Lwasekuhlaleni: Isizathu Sokuba Kubaluleke Kubantu Nakubantu

Ukufikelela konyango lwempilo olungenazingxaki zasekuhlaleni kuchaphazela iziphumo ezingqalileyo zempilo, imveliso yezoqoqosho, kunye nokungabi nantsebenziswano kwentlalo. Xa abantu benokufumana inkathalo lula, bafumana iqondo eliphantsi lokufa, ulawulo olungcono lwemeko ezinganyangekiyo, kunye nokuncitshiswa kwexabiso lempilo ekuhambeni kwexesha.

Ukuthintelwa Kwezifo Nokubonwa Kusekuseni

Ukufikelela rhoqo kwinkathalo ephambili kunceda ukuba ukhuseleko lwemeko ezinjengokugonywa, uvavanyo lomhlaza, uvavanyo loxinzelelo lwegazi, kunye novavanyo lwecholesterol. Iziko lolawulo lwezifo kunye nothintelo (CDC) liqikelela ukuba ama-60% abantu abadala baseMerika anesifo esinye esingapheliyo, kwaye ezininzi zezi meko zinokuthintelwa okanye zibekwe kude zihlolwe. Umzekelo, uvavanyo lomhlaza wemibala olubonisa uxinzelelo lwegazi, luphantse lube malunga nama-20% ezindaweni ezinobuchule bokunyamekela obuphambili obunokuthelekiswa nangaphantsi kwemimandla egciniwe. Ukufumanisa kwangaphambili akugcini ubomi kuphela kodwa kunciphisa ubunzima bemali yonyango oluphambili.

Ulawulo lweemeko ezimandundu

Izifo ezingapheliyo ezifana nesifo seswekile, uxinzelelo lwegazi oluphezulu, isifo soxinzelelo lwegazi, kunye nesifo sentliziyo zifuna ulawulo oluqhubekayo, ukuxilongwa kwamayeza, nokulandelwa rhoqo. Ukufumaneka koogqirha basekuhlaleni, iinkqubo zokulawula izifo, kunye nemfundo yomguli kunceda abantu ukuba balawule iimeko zabo. IAmerican Diabetes Association inikela ingxelo yokuba abaguli abanesifo seswekile abakwaziyo ukumelana nezonyango abakwaziyo ukumelana neengxaki zedlala ledlala ledlala, bambalwa kakhulu abanokuba neengxaki ezifana nokungasebenzi kwezintso okanye ukunqanda. Ngaphandle kwabaguli abakufuphi, ngokufuthi baxhomekeke kumagumbi ongxamiseko ukwenzela iziganeko ezingxamiseko, ezibiza imali eninzi nezingancediswayo kunezo eziqhubekayo.

Ukunyanyekelwa kwemeko engxamisekileyo nokusabela okumandundu

Iingxaki ezingxamisekileyo ezifana nokuhlaselwa sisifo sentliziyo, ukubethwa zizifo ezimandundu, kunye nokuchaphazeleka komzimba zifuna unyango olukhawulezileyo. Ukuvaleka kwesebe longxamiseko okanye iziko lonxunguphalo kungundoqo wokusinda. Izigulana ezifikayo “kwiyure yokuqala yama-60" (imizuzu yokuqala) zineziphumo ezingcono, kodwa abahlali basemaphandleni basoloko bejamelana neziphumo ezingaphezulu kwemizuzu engama-60 ngenxa yokuvalwa kwesitokisi. Ukuvalwa kwezibhedlele zasemaphandleni ngaphandle kwe-United States kukhawuleze ngeshumi leminyaka elidlulileyo, izibhedlele ezingaphaya kwe-140 ezivaliweyo ezihlala emaphandle zivalekile ukususela ngo-2010, ngokuchaphazela ukufika koncedo olungxamisekileyo.

Impilo yengqondo kunye nokusetyenziswa

Ukufikelela ekunyamekeleni impilo yengqondo yasekuhlaleni kubaluleke ngokufanayo. INational Institute of Mental Health ibonisa ukuba phantse umntu omnye kwabantlanu abantu abadala base-U.S. uphila ngesifo sengqondo, ukanti ngaphezu kwesiqingatha akafumani nyango olukhoyo qha kuba akukho mniki-mfako kufutshane. Ukusebenzisa kakubi imithambo-luvo, kuquka i-opioids, kufuna unyango oludityanisiweyo oludibanisa amayeza, ukucebisa kunye nenkxaso yoluntu. Ingingqi yengingqi efumana amanani aphezulu empilweni yokuzibulala, amathuba amaninzi ongxamiseko-msw, kunye nokungabi namakhaya amaninzi. I-Telehealth ivela njengesisombululo esisicombululo esisi sithile, kodwa izigula ezininzi azina mayeza adityaniweyo okanye izigulana ezisekumgangatho esiphezulu sotyelelo-o.

Impembelelo Kubemi Abaneendleko Ezininzi

Amaqela angenangxaki .Kuquka iintsapho ezikhulileyo, ezifumana imali ephantsi, ezineziphene, abantu abaneziphene, abaphambukeli, nabangabhalwanga phantsi, nabambalwa abavela ezindaweni ezincinane, kwaye abahlanga lunye. Aba bantu basoloko bejongene nemiqobo encinci njengezinto ezithintelwayo zemali, iilwimi, ukungalingani kwamalungu empilo, kunye nokucalulwa. Umzekelo, iMedicare iyanceda kwiindawo ezisemaphandleni kungama-60% anokwenzeka kakhulu ukuyeka ukukhathalelwa okufunekayo kunalawo asezidolophini. Ukuthetha ngezi zinto zingekho mthethweni akungombandela nje wemithetho esesikweni; ukuphucula impilo yabemi bonke. Intlangano yeWorld Health Organization igxininisa ixesha elide ukuba “ithreth ingumntu olungileyo" kwaye ukufikelela ekufikeleleni okufanelekileyo kuyimbopheleleko engundoqo yoorhulumente kunye neenkqubo zempilo.

Iingxaki Ezingundoqo Zokufumana Unyango Lwasekuhlaleni

Phezu kwako nje ukubaluleka kwayo, abantu abaninzi bajamelana nemiqobo emikhulu ethintela ukufikelela ngokupheleleyo ekunyamekeleni impilo yasekuhlaleni.

Ubunzima bomsebenzi

I-United States ijongene nokunqongophala okuthelekelelwayo koogqirha abamalunga nama-124 000 ngonyaka wama-2034, abanononophelo oluphambili kunye nemimandla yasemaphandleni echaphazelekayo. Oogqirha, abenzi boogqirha, kunye neengcali zempilo yengqondo nabo bambalwa. I-Association of American Medical Colleges iphawula ukuba malunga nama-60% eHPS asezindaweni ezisemaphandleni okanye ezisemaphandleni. Ukunqongophala komsebenzi kukhokelela ekulindeni amaxesha amade, ukuncipha kokunyanyekelwa, nokukrwa, kunye nokukrwa phakathi kwabagcini-mali abaseleyo. Kwezinye iinyanga ezine ukuya kwiinyanga ezintandathu, abahlali kufuneka balinde ukunikwa i-ofisi ye-ofisi yokunyamekela abaguli abatsha.

Ukwahlukahlukana Kweemeko Zezulu: Amakhaya aphikisana nedolophu

Uluntu lwasemaphandleni lusoloko lujongene nokufikelela okugqithisileyo kunee-dolophana ezinxulumene nedolophu. I-ofisi kaRhulumente kaRhulumente wase-United States inikela ingxelo yokuba abemi basemaphandleni abanazo izibhedlele, iingcali, kunye neenkonzo zongxamiseko ezimbalwa. Ukususela ngo-2010, izibhedlele zasemaphandleni ezingaphezu kwe- 150 ziye zavalwa okanye zaguqukela kwizakhiwo ezilinganiselweyo, zishiya iindawo ezinkulu ezingenankathalo. Iinkonzo ze-Obstetric ziphela ngexabiso elihlasimli; ngaphezu kwama-50% abantu basemaphandleni abanaso isibhedlele esisekelwe kwizibhedlele, nto leyo ephumela “kukwanda kweminqila ekwintlango yokunyamekela abantwana.

Imida Yetyala Le-inshorensi

NangomThetho wokuLangulwa okuMandulo, izigidi zabantu zihlala zingakhange zifakwe okanye zingafakwanga. Amazwana angayandisanga iMedicaid athe angaphezulu kakhulu ngokwexabiso elingahlawulwanga ngabantu abadala abafumana imali ephantsi. Ngaphandle kwe-inshorensi, abantu ngabanye basoloko belibazisa inkathalo de iimeko zibe zinzima, nto leyo ekhokelela kwiindleko eziphezulu neziphumo ezimbi kakhulu. Izigulana eziphantsi kwemivuzo zijongene nemali ephezulu engakwaziyo nokuhlawula kunye nenkozo zihlawula ezibathintelayo ekuzaliseni imiyalelo okanye ukulandela iingcali. Imali yeSiko soMbutho Soluntu siqikelela ukuba umntu omnye kwabane abasebenzayo abasebenzi abaphantsi kwemivuzo abasebenzi abaphantsi kwemali, ithetha ukuba bachithe iingeniso zabo eziziphesenti ezilishumi kwimali zempilo.

Ukukwazi ukufunda nokubhala ngempilo kunye nokuhamba ngenqanawa kwesixokelelwano

Ubuchule bokufumana, ubuchule, kunye nokuqonda inkcazelo yempilo, qha yilungu elibalulekileyo kodwa elisoloko lityeshelwa. ISizwe sokuKhulula ulwazi lwabadala safumanisa ukuba ngabantu abadala base-U.S. ngabantu abadala abalishumi elinababini kuphela abanobuchule bokufunda ukunyanga. Izigulana ezininzi ziyazama ukuqonda ii-inshorensi, imiyalelo yamayeza, okanye indlela yokucwangcisa. Iinkqubo ze-sthropocrate, izigunyaziso, kunye neengxelo zempilo ezidibeneyo ze-elektroniki zingeza imingxwaba yengxaki. Izigulana ezingakwaziyo ukufunda nokubhala nokubhala amayeza aphantsi zidla ngokugqithisa ukunqanda iinkonzo, ukusetyenziswa kakubi konyango, nokunikwa isibhedlele ngenxa yeemeko ezifanelekileyo.

IMigaqo-nkqubo Nemiqobo

Imimiselo yomgangatho karhulumente ingaluthintela uqheliselo kuogqirha, abancedisi, kunye noosokhemisi, ithintele ukukwazi kwabo ukunikela unyango kwiindawo ezingaphantsi kwexabiso. Imithetho yesatifiketi efuna imfuneko kwezinye iindawo ifuna imvume yolawulo phambi kokwakha izakhiwo ezintsha okanye ukwandisa iinkonzo, ezinokuthi zithintele ukuvela kwemiqathango. Okungakumbi, imiqathango yetelehealth. Okuyiyo njengemfuneko yokutyelela umntu okwi-person phambi kokucebisana ngokuchana kwento enyani-$_ucrea imiqobo yezigulana ezixhomekeke kwinkathalo ekude. Iinguqu-nkqubo ezithi zivule ezizimiselo zibonise ziphucule ngaphandle kokulala kukhuseleko.

Ubuchule bokuphucula indlela yonyango

Ukufumana imiqobo ekhoyo kufuneka amaqhinga axhaphakileyo abandakanya iinkqubo zonyango, abaququzeleli benkqubo, imibutho yoluntu, kunye nabaxhasi bobugcisa. Ezi ndlela zilandelayo zibonise ukuphumelela ekufikeleleni kwasekuhlaleni.

ISebe leMicimbi yeNkcubeko

ITelehealth yadubula ngexesha lesifo se-COVID-19 kwaye ihlala ikwimeko esisigxina. Inciphisa ixesha lokuhamba, ivumela oogqirha ukuba bafikelele kwiindawo zasemaphandleni, kwaye ixhasa ulawulo lwezifo ezinganyangekiyo ekhaya. ISebe lezempilo neeNkonzo zoluntu lanikela ingxelo yokuba utyelelo lwe-Telehealth lwanyuka ngokuphindwe ka-63 ngonyaka wokuqala wesifo esibulalayo. Ukuxhasa impumelelo, imigaqo kufuneka iqinisekise ukuba i-intanethi ye-Banban ifikeleleka ngokubanzi, ukubuyisela i-telemedicine kwi-partum ngononophere, kunye nokuhla kolula i-infashoni enqumla imigca yesizwe.

Iinkqubo zezempilo zoluntu

Abasebenzi bezempilo zoluntu (i-CHWs) abathembekileyo abasebenzisa i-Gradient yezonyango yoluntu abadibanisa abemi basekuhlaleni ukuze bafumane iinkonzo, ukubonelela ngemfundo yempilo, nokuxhasa intlalo-ntle. ii-CHWs zisebenza kakhulu kuluntu oluncinane olukhoyo kunye nabemi abaphambukeli. Uhlolo lwama-2021 kwiThala leencwadi ze-Gradizi yesizwe ifumanise ukuba i-CHWS ingenelela ngokuphawulekayo ukukhuselwa komhlaza, ukuphuculwa koxinzelelo lwegazi, kunye nokuncitshiswa kwemiqathango yemiboniso ye-CHWW kunye nemifanekiso esetyenziswayo exhasayo inkxaso yeminxeba phakathi kweemeko zonyango kunye noluntu.

I-Eval Clinics yempilo kunye neziko zempilo ezisekelwe kwiSikolo

Iikliniki ezihambayo zizisa ingqalelo ephambili, iinkonzo zamazinyo, kunye nokuxilongwa ngqo kwimimandla engenazibonelelo ezizinzileyo. I-Mobile Healthcarety Association iqikelela ukuba kukho iiyunithi zempilo ezihambayo ezingama-2 000 e-U.S. nganye inceda amakhulu ukuya kumawaka abaguli nyaka ngamnye. Ngokufanayo, amaziko empilo asekelwe esikolweni anika abantwana kunye nabafikisayo inyanzelisayo, ukusingatha yonke into esuka ekugonyeni ukucebisa ngempilo yengqondo. Ezi zimo zezo zinciphisa imiqobo yezithuthi kwaye zinokuthunyelwa kwiindawo ezichaphazeleke ngenxa yeentlekele zemvelo okanye iikhemikhali.

Uphuhliso lonyanzelo lomsebenzi kunye nenkumbulo

Ukulungisa ukunqongophala kwabasebenzi kufuna uqeqesho kunye neenkqubo zokufumana inkxaso-mali. Iinkqubo zokuhlawula, ezifana neNational Health Service Corps, abanikezeli abasebenza eHPS njengoko behlawula iimali-mboleko zabafundi xa kuthe kwathe kwafuneka umsebenzi owenzelwa iinkonzo. Ukwandisa iinkqubo zemibhobho eqeqesha amakhaya kunye nabafundi abambalwa banokuyila imisebenzi eyahlukeneyo nengaguquguqukiyo. Iinkqubo zokulungisa iiprojekthi ezifana neProject ECHO zivumela abagcini-zimguli abaphambili kwimimandla engaphantsi kwenkonzo egciniweyo ukuba badibane neenkcubeko yonyango, ukwandisa ubuchule bokulawula iimeko ezintsonkothile.

Ukukwazi ukufunda Nokuhamba Ngenqanawa

Ukuphucula ukufundiswa kwempilo kunika izigulana amandla okwenza izigqibo zolwazi nokusebenzisa inkqubo ngendlela ephumelelayo. Ungenelelo olulula njengezinto zolwimi olucacileyo, ukufundisa iindlela ezisemva, kunye neenkonzo zohambo ngenqanawa zomguli (apho abantu abaqeqeshiweyo bakhokela izigulana ngemiqathango, iifomu ze-inshorensi, kunye nee-arhestereral) luye lwangqinela ukuba luphumelele. ISigulana esifundisayo ukuqeqesha i-Coltudiagitive inikela ubungqina obusekelwe kwizifundo zemfundo yempilo ezisekelwe kuhambo yezonyango lwezeelektroniki. Iinkqubo zezempilo ziyakwazi ukuxhobisa izilumkiso eziluncedo zoncedo olulula okanye ukubonelela.

Ukusetyenziswa Kwenkqubo Esemthethweni Notshintsho Lweinshorensi

Ukusetyenziswa kwemiqathango yemali eqingqiweyo, imodeli esekelwe kwixabiso, kunye nokususwa kwemiqathango ethintelweyo yemithetho yokuqhelisela kungaphucula ngokuphawulekayo ukufikelela. Ii-odolo ezandisa iMedicaid zabona unciphiso olukhulu kwinkxaso-mali ekhoyo kunye nolibaziseko oluncinci. Imigudu yomthetho kufuneka ijolise ekuqiniseni izibhedlele zasemaphandleni ngokuphucula intlawulo kunye neminxeba enika imivuzo yempilo yabemi iziphumo kunokuba zibe nomthamo. Amaziko ezempilo oluntu (Iziko zimele ukuba alungele ukunikwa inkxaso ekhoyo karhulumente kwaye kufuneka afumane inkxaso ebambekayo ukuze aqhubeke ekhonza omnye kubemi basemaphandleni abahlanu.

Isiphelo

Ukufikelela konyango lwasekuhlaleni akuyonto yobunewunewu kodwa kungummiselo osisiseko wempilo yabemi, uzinzo lwezoqoqosho, kunye nokungalingani kwentlalo. Njengoko abantu bejamelene nemiqobo engapheliyo yokusebenza, ukunqongophala kombane, ukuthatyathwa kwemali, ukungabikho komsebenzi, iinshorensi, kunye neengxaki zempilo, kubalulekile ukulungiselela izicombululo ezicacileyo kwiindlela ezintlanu ezintlanu ezintlanu. Ulwandiso lwezempilo, abasebenzi, inkqubela-mfolidi, inkqubela yomsebenzi, kunye nenkqubo yokuzihlaziya zonke ezikhoyo zinikezela ngemijelo yenkqubo apho wonke umntu anokufumana khona ngexesha elifanelekileyo, nokuzinyamekela ngentlonelo. Ngokufaka ungeniso lwasekuhlaleni namhlanje, sibeka isiseko sonyango, esiqinileyo, ukuhambela phambili kwemibutho yabantu abasebenza, izizukulwana ezakuza.