Indima yoncedo lwamazwe angaphandle ekuphuhlisweni konyango lwasemaphandleni

Imisebenzi yoncedo lwamazwe angaphandle njenge-injini ebalulekileyo yokuhambela phambili kwezibonelelo zonyango kwimimandla yasemaphandleni ephantsi naphakathi yamazwe afikayo. Le minikelo yemali kunye nobugcisa — evela kumasebe karhulumente alandelanayo (njenge-USAID, DFID, ne-GIZ), imibutho emininzi elandelelanayo (njengeBhanki yehlabathi kunye neWorld Health Organization), kunye neziseko ezizimeleyo (kuquka iBill & Melinda Gates Foundation) — idla ngokujolisa kwimimandla apho imali kawonke esetyenziswa kwimpilo ihlala ingaphantsi kwama-10 (i-USAID, i-DFID, kunye ne-GIZ), oovimba bangaphandle banokuthetha umahluko phakathi kwedolophana engenakteriniki kunye nomntu onemisebenzi yezonyango eqeqeshiweyo nabasebenzi bezonyango.

Umlinganiselo wale nkxaso uyinto eninzi. NgokweMbutho wezezoqoqosho noPhuhliso, uncedo olusemthethweni lwempilo olufikelelekayo ngaphezu kwama-R340 ezigidi ngonyaka kwiminyaka yakutshanje, nomlinganiselo obalulekileyo obhekiswe ekuqiniseni iinkqubo zokunyamekela eziphambili kumaphondo asemaphandleni. Oku kudityaniswa kwekomkhulu nobuchule kuvelisa amathuba okwakha izibonelelo, abasebenzi boololiwe, kunye nokuseka iinkqubo zezoshishino ezisebenza ngelinye ixesha ebezingafikeleleki ngokwemali ngenxa yoorhulumente basekuhlaleni abahlawulwa ngemali.

Ukuphucula Izakhiwo

Enye yezona ziphumo zibonakalayo zoncedo lwamanye amazwe kukwakhiwa nokuhlaziywa kwezibonelelo zomzimba. Kumakhaya asemaphandleni ase-Saharan Afrika naseMzantsi Asia, iinkqubo zoncedo ziye zaxhasa amawaka eendawo eziphambili zezempilo, amakhaya okuzalana, kunye neekliniki ezihambayo. Ngaphandle kokumisa izakhiwo, iprojekthi ezisoloko zinika inkxaso yesiseko sezezimali — ukufaka izibonelelo zelanga ukuqinisekisa umbane othembekileyo we-frijini yonyango, ukubhola imingxube yamanzi acocekileyo, kunye nokwakha izindlu zangasese ukufikelela kwimilinganiselo yococelo. Umzekelo, iWorld Bank’s International Development Association ixhasa ukulondolo lwempilo yasemaphandleni kumazwe anjenge-Ethiopia neBangladesh, ukudibanisa ukwakhiwa kwekliniki-mastia kunye nonyuko.

Kwakhona ukufumaneka kwezithuthi kufumana ingqalelo. Ngamanye amaxesha amaqumrhu oncedo afaka imali kwinkqubela yendlela okanye anike abasebenzi bezempilo izithuthuthu neebhayisekile ukuze bafikelele kwimibhobho ekude. ENepal, iprojekthi exhaswe yiAsian Development Bank yakha iibhulorho ezinciphisa ixesha lokuhamba kwizonyango lwezempilo ngeeyure eziliqela. Le nkqubela yomzimba ichaphazela ngokuthe ngqo enoba ibhinqa elikhulelweyo linokufikelela esibhedlweni okanye enoba umntwana onenyumoniya ufumana unyango lwentsholongwane esusela ngexesha elifanelekileyo.

Iinguqu Zonyango Nobugcisa

Uncedo lwangaphandle lomeleza lonke unikezelo lwamayeza ayimfuneko, amachiza, kunye nezixhobo. Iinkqubo ezinjengeNkxawa yehlabathi Lonke Yokulwa NoGawulayo, Isifo Sephepha neMalariya zisasaza izigidi zeminatha eleleyo, amayeza alwa nentsholongwane elwa namagciwane, kunye novavanyo lokuhlola izinto ezisetyenziswa kumagumbi asemaphandleni nyaka ngamnye. Kwakhona uncedo luxhasa ii-shirt à à à quaifirence — izithuthi ezifakwe esiqandisini nakugcinwa zibalulekile — ezimele zigcinwe kubushushu obuchane ngqo. Kumazwe anjengeMalawi, ukuveliswa kwe-lawi, ukusetyenziswa kwe-lanearth fractive gradient kuncid gradice kucureed trans kucums kwikliniki ezi-679.

Ukuthunyelwa kobugcisa ngomnye umkhamo. Amanyathelo axhaswa yimibutho yoncedo avumela abasebenzi bezempilo basemaphandleni ukuba badibane nogqirha ngefowuni okanye ngonxibelelwano lwesatellite. EIndiya, iArogya Setu iqonga kunye neenkqubo ezifanayo ziye zandisa amandla okuxilonga. Kwakhona ii-dolara zoncedo zithenga izixhobo ezibalulekileyo ezifana noomatshini be-ultrasound, imikroskopu yelebhu, kunye nezithinteli-ntsholongwane, ukunceda amakhaya afumaneke ngaphambili kwizibhedlele zasedolo.

Uqeqesho nokwakhiwa komsebenzi

Izibonelelo zomzimba zomzimba zingenako ukuphucula iziphumo zempilo ngaphandle kwabasebenzi abanobuchule. Uncedo lwamazwe angaphandle lunikezela ngobuncwane obubalulekileyo ekuqeqesheni abasebenzi bezonyango, oonongogo, oonozakuzaku, kunye namagcisa olwazi. Iinkqubo zisoloko ziquka imfuno yemfuza kubafundi abasemaphandleni ababophelele ekubuyeleni kwimimandla yabo emva kokuphumelela. i-Afrikan Centre for Disease Control and Prevention, exhaswe ngooooooooooooooooooooooooooooooomati abanikela ngezo, iqhuba iinkqubo zokuhlola izifo ezibekwe kwimimandla yasemaphandleni.

Ukuzigcina kungucelomngeni oluqhubekayo. Ukubekwa kwemiphandle kudla ngokungabikho kwezindlu, imfundo yabantwana, kunye namathuba okuhambela phambili. Imisebenzi yoncedo ithetha oku ngokwakha iindawo zokuhlala zabasebenzi, ukubonelela ngeenzima, nokuseka imfundo eqhubekayo kumgama wokufunda. ERwanda, umanyano phakathi korhulumente neClinton Health Acces Intection Iniction oluqeqeshelwe amakhulu abasebenzi bezempilo abasebenza ekulawuleni izifo zobuntwana, kunye namanani okuzinzisa ama-80% emva kweminyaka emihlanu. Imigudu yokwakha iqinisekisa ukuba ukuveliswa kwezitena kunye nodaka kusetyenziswa ekuxhaseni okuzinziswa, ukulingana okuphezulu kwe-2003.

Imiphumo Efanelekileyo Yoncedo Lwasemzini Kwimpilo Yasemaphandleni

Xa kucetyiwe kakuhle, uncedo lwamanye amazwe lwenza uphuculo olunokufikeleleka kwizalathiso zempilo kunye nendlela yokuzinzisa. Ezi ziphumo zilandelayo zisoloko zibhaliwe ekuhlolweni kweenkqubo ezinkulu zesikali esinesiqingatha:

  • Ukufa kwabantwana kunye nomama: Igalelo lokugoma elixhasweyo, ukuqeqesha abazalelweyo, kunye nokunyamekela umhlaza kongxamiseko kufakelele ukunciphisa inani labantu abafayo abangaphantsi kwekhulu elinesihlanu kwimimandla yasemaphandleni. Umzekelo, phakathi ko 2000 no-2020, ngaphantsi kwekhulu elinamashumi amane anesihlanu kukufa eAfrika esezantsi, ityekelo olunxulumene kakhulu nophuhliso loncedo lwempilo.
  • Ingxelo enwenwesiweyo yokugoma:, i-Givi, i-Vaccine Alliance — exhaswe ngoorhulumente neziseko ezinikelayo — iye yanceda abantwana abangaphezu kwezigidi ezingama-80 kwimimandla yasemaphandleni esemaphandleni abanomqhano wokulwa nezifo ezinjengepoliyo, imasisi kunye ne-nyumoniya. Oku kuye kwakhokelela kwi-poliyo ekufuphi ne-priyo kwiindawo ezigqugqileyo.
  • Uphando olungcono lwezifo kunye nokuphendula kobhubhani: utyalo-mali loncedo kwiinkqubo zogcino-lwazi kunye neengxelo zenkqubo zempilo zasemaphandleni zibangela ukuba amaziko ezempilo asemaphandleni avelise ukuqhambuka kwekholera, i-Ebola, okanye imasisi kusemgxeni, ekuthinteleni ukusasazeka kakhulu. Ngexesha lesifo se-COVID 201619, uncedo lwamanye amazwe oluxhaswa ngemali kuvavanywa nokuhanjiswa kwemichiza kumazwe amaninzi.
  • Iinkqubo zolwazi lwezempilo ezomelezekileyo: Abanikazi basoloko bexhasa iirekhodi zezamayeza e-elektroniki kunye nezixhobo zokongezwa kogcino-lwazi lwexesha eliyi-196. ETanzania, inkqubo yeUSAID à chaza ukubuyiselwa kwabaphathi besithili banceda amayeza okugcina amaphepha kunye nemiqulu yomguli, nto leyo ekhokelela kwizabelo ezifanelekileyo zogcino-mali.
  • Ukuphaphela impilo okuthe kratya: amaphulo onxibelelwano nokuziphatha, axhaswa ngamasebe oncedo, akhuthaza ukuhlanjwa kwezandla, uqheliselo olukhuselekileyo lwesondo, nokubakho kwezesondo. Imidlalo ye-Radio, iimiyalezo ezihambayo, kunye neencoko zoluntu — konke oku kuxhaswa yimali yangaphandle — kufikelela abantu abangakwazi ukufunda nokubhala.

Le ngeniso ibangela ukuba abantwana abatyebileyo babe nesidima: abantwana abatyebe ngakumbi esikolweni rhoqo, abantu abadala bagcina imveliso, yaye iintsapho zonga imali ebeya kuphulukana neendleko zezonyango.

Ucelomngeni Nokugxekwa

Phezu kwazo nje ezi mpumelelo, uncedo lwasemzini lokunyamekela impilo yasemaphandleni lusoloko lugxekwa yaye lunemiqobo esebenzayo.

Ukhuseleko kumacebo angaphandle

Inkxalabo eqhelekileyo yeyokuba uncedo lubangela ukuxhomekeka kwemali, apho oorhulumente basekuhlaleni baxhomekeke kwiindleko ezingaphandle zokuxhasa imali — imivuzo, ukuthengwa kweziyobisi, imisebenzi yekliniki — ngaphandle kokuvelisa imithombo yengeniso ehlala ikho. Xa abanikeli betshintsha izinto eziza kuqala okanye benciphisa inkxaso yemali, iinkqubo zempilo zingaphela. Umzekelo, xa iNgxowa-mali yehlabathi lijongene neengxaki zemali ngo-2010, amanye amazwe kufuneka ancame unyango olulwa notyando lwe-Roseljini lwasemaphandleni kangangeenyanga eziliqela. Abahlalutyisi baphikisa ukuba uncedo lufanele lulungelelazwe ukuze luqhubeke kancinane njengoko umgangatho werhafuthe yasekhaya ukhula.

Ukuphathwa Kakubi Kweemfuno Zasekuhlaleni

Ngamanye amaxesha abanikeli bamazwe baphambili ekungeneleni kwabo ngokwabo kwizinto zezobupolitika okanye ezicwangcisayo kunokuba babonise iimfuno ezithile zempilo yabantu basemaphandleni. Iinkqubo ezithe nkqo ezijoliswe kwizifo ezikhethekileyo (njengeHIV okanye isifo seengcongconi) zingagqwetha ulwabelo lwezibonelelo, ziphambukise abasebenzi kunye nezinto ezisetyenziswayo kwizinto ezisisiseko. E-Uganda, amaziko ezempilo ahlukeneyo ngamaxesha athile aye aphelelwa ngamayeza asisiseko ngelixa iimpahla zemalariya ngenxa yokuba umphini onikela ngemali unesifo sesifo esingu-86. Ukuthatha inxaxheba kwiprojekthi yeprojekthi kuhlala kunganele kwinyathelo elininzi, nto leyo ikhokelela kwizixhobo ezakhiwe kodwa eziphantsi kwendlela ezisetyenziswa phantsi kwenkculo, ngenxa yokuba engena iinkonzo ezifanelekileyo okanye iiyure ezifanelekileyo zokusebenza.

Ukunganyaniseki Nokungahoywa

Uphando lwango-2018 olwenziwa yiWorld Health Organization lufumanise ukuba ama-30% ezinto zonyango kwamanye amazwe alahlekayo okanye aphelelwayo ngenxa yobusela obungentle. Iimali eziphawulweyo zolwakhiwo lwekliniki yasemaphandleni zingatsalwa ngokusetyenziswa kwezivumelwano ezinyusiweyo okanye izigqeba. Uphando lwango-2018 lufumanisekubekweni kwezonyango kwamanye amazwe lungakhange lufumaneke ngenxa yobusela okanye ukuphelelwa kwemali ngenxa yolawulo olungelulo olufanelekileyo. Iinkqubo zokufumana ulawulo olucacileyo kunye nokuzibophelelela ngokwazo — ezisoloko zifunwa ngabani basebenzi abanikelayo — luye lwancitshiswa kodwa aziziphelisi ezi ngxaki. Ukuqhuba intlangano yoogadathanga ukuphendula ityala kodwa ifuna ulwando olungakumbi.

Ukungabinakulondolozwa kunye nokuzinziswa kwemigca emide

Uninzi lweeprojekthi ezinika uncedo ezithi zisetyenziswe ziyasilela kwiminyaka embalwa nje embalwa kuba akukho qingqo-mali lukhoyo ukuze lugcinwe ngokuqhubekayo. Ikliniki eyakhiwe ngemali yomnikeli isenokuswela imali yokubuyisela isikhuseli sophahla esaphukileyo okanye ukulungisa uphahla oluvuzayo. Uphando lwendawo yasemaphandleni emazantsi e-88Saharan Afrika — olunobuchule kwizakhiwo zempilo ezifunekayo — lufumaniwe ukuba 30-40% yayingasebenzi ngokomthetho emva kweminyaka emihlanu ngenxa yokuswela iimpahla ezigciniweyo kunye nokuqeqeshwa. Uqeqesho loncedo luquka imali egciniwe yogcino-mali kunye noqeqesho lwasekuhlaleni ngexesha lokwakhiwa kweprojekthi, kodwa olu qheliselo alukabikho kulo lonke.

Iindlela Zokwenza Impembelelo Emandla

Ukuphelisa ezi ngxaki nokuqinisekisa ukuba uncedo lwamanye amazwe luvelisa inkqubela ehlala ihleli kwizibonelelo zempilo yasemaphandleni, oogqirha nabenzi bemigaqo-nkqubo baye bavelisa iqela lemimiselo eqinisekisiweyo.

Ukungahlali nokwenza inxaxheba

Ukuguqula iinkokeli zasekuhlaleni, iikomiti zezempilo, kunye nabasebenzisi bexesha elizayo ekucebeni nasekunyamekeleni kwandisa ukusebenziseka nokuziphendulela. Xa uluntu lunikela ngomhlaba, umsebenzi, okanye iindleko ezincinane, luvelisa imvakalelo yokuba ngumnini ekhuthaza ukusetyenziswa nokugcinwa okufanelekileyo. I-Democratic Republic of Congo’s “Health Reagens” [[FLT Zools] ukusondela, okuxhaswe ngumbutho wophuhliso wase-Belgium, abathunywa bolawulo oluphambili bekomiti yobugcisa yasekuhlaleni esebenza ngamaqela asekuhlaleni. Iziphumo zibonise amaqondo aphezulu kunye nokuphathwa kwezibonelelo ezingcono xa kuthelekiswa ngokupheleleyo iinkqubo ezisembindi.

Ufikelelo lomgangatho odityanisiweyo kunye neenkqubo

Kunokuba kusetyenziswe iprojekthi enye, iinkqubo zoncedo ezisebenzayo eziveliswe kwinkqubo yempilo yonke — ukusuka kwisiseko soncedo kunye nokunikezela ngemixokelelwano ukuya kubuncwane babantu kunye nemali. President’s Emergency Preant’s Prefect yeNkqutyana yokuLungisa uGawulayo (PEPFAR) ekuqaleni zajoliswe kwiHIV, kodwa kamva zavela ukuze zomeleze zomeleze, iinkqubo zekhemisi, kunye nokuqeqeshelwa kwempilo kwibhodi, zinceda ezinye iinkqubo zezempilo. Ukutyala utya emanzini, utya okucocekile, kunye nokutya okusemgangatho okuzinziswa kwemibutho yezo zokwakha kunceda inzuzo zezifo kwaye kunciphise umthwalo wezifo.

Ubuchule borhulumente wasekuhlaleni bomeleza

Ukwakha ubuchule bamagunya ezempilo esithili kunye nengingqi ukuceba, uqingqo-mali, kunye nokuphatha izibonelelo kubalulekile ekufumaneni uncedo. Oku kuquka uqeqesho kulawulo lwemali, uhlalutyo logcino-lwazi, kunye nokufumana. IGavi Izifundo ezipheleleyo zelizwe [ yabonisa ukuba amazwe anenkqubo ezinamandla zolawulo olunempumelelo emva kokuxhasa umphili-gazi. I-Ectic i-active adviers kwi-ofisi yemisebenzi yasekuhlaleni — kunokuba aqhubele ii-ofisi zeprojekthi ezinxulumeneyo — liqhinga eliqhelekileyo lokudlulisela ubuchule.

Ubuchule obusetyenziswayo

Imali ekhuselwayo isenokunciphisa ukuxhomekeka. Imizekelo iquka imali engqinelanayo, apho abanikeli bemali ilingana nezabelo zikarhulumente zasekuhlaleni zempilo, kunye nemali esekelwe kwimali exhasayo, apho amaziko afumana imali eyongezelelekileyo esekelwe kumgangatho kunye nokusetyenziswa. IBhanki yeWorld Bank Resultś́based FiLtamplification [[ inkqubo encedisa eRwandani naseBurundi ukwandisa amazinga okunikezelwa kwemali kunye nokukhuselwa kokukhusela ngeminxeba ngexesha lokubophelela ngexesha lokudibanisela iziphumo eziqinisekisiweyo. Ezo zinto zisebenza kakuhle kunye nozibo lwasekuhlaleni.

Uhlolisiso Lwetyala Olunoncedo Olunempembelelo

Imizekelo emibini ebalaseleyo ibonisa ukuba uncedo lwamanye amazwe lunokufumaneka njani kwizibonelelo zempilo zasemaphandleni.

PHULA] kwimimandla yasemaphandleni e-Afrika: Iqaliswe ngo 2003, iPEPFAR ithenge ngaphezu kwama-100 amawaka ezigidi zeerandi kwiinkqubo ze-HIV/AIDS, ezininzi zazo kwiikliniki zasemaphandleni. Yakha okanye yaphucula amawaka ezinto zezempilo, yaqeqesha amashumi amawaka abasebenzi bempilo, kunye nokusungula iinkqubo zelebhusayithi ezathi kamva zaxhasa ukuvavanywa kwe-COVID 7619. Nangona inkxabisiswano nge-PEPFAR ngoqikelelo lwezonyango olusuka phezulu, ityala i-PEPPAFAR kunye nokomeleza iinkqubo zempilo ezipheleleyo kumazwe anjengeKenya, Uganda, neZambia — iziko lonyango lwasemaphandleni kunye nolawulo lwe-platinalthilitimes ngaphaya kweenkonzo ze-HIV.

IGavi’s Vaccine Paregoy kwimimandla Ekude: IGVI ixhasa ukukhula kwezixhobo zamatyathanga abandayo, ibonelela ngezixhobo zetsheyina, kunye neenkonzo zothutho lokufikelela kubantwana kunyaka odlulileyo we-“minyaka edlulileyo”. Kumazwe afana neMozambhiki ne-Nepal, iGavi inkxaso yanceda ekuphuhliseni kwezixhobo ezincinane ezibonisa ukuba umntwana ngamnye ufuna ukujoliswa. Uphando lwamashumi amabini anamba asixhenxe kwiBritish Medical Journal luqikelela ukuba ukugonywa komfa okuzinziswayo kungaphantsi kwezigidi eziyi-14 kumazwe angaphantsi kwe-Ghanain kungenisa ishumi leminyaka, kunye nemimandla yasemaphandleni ebamba i-e-eeeeacea.

Isiphelo

Uncedo lwangaphandle luneziphumo eziphucule ngokulula zempilo kunye nokuzinzisa inkqubo yokwakha nokuxhasa impilo kwiindawo ezisemaphandleni apho oovimba borhulumente baphelelwa ziimfuno. Ukusuka ekungeniseni iikliniki ezilawulwa yilanga ukuya ekuqeqesheni oonongendi abasindisa ubomi boomama, uncedo lwangaphandle luneziphumo zempilo eziphuculiweyo kunye nokuzinzisa inkqubo. Kodwa iingxaki zobuxhomekeko, ukulahleka kwemiqathango, kunye nokunyanzeleka koncedo oluqhubekayo. Olona cwangciso lunempumelelo lunenxaxheba ekuthatheleni inxaxheba kwizixhobo zolawulo lwasekuhlaleni, kunye nokuyilwa kwendlela yokulawula ngokuthe ngceleleka. Xa le migaqo ingulo yoncedo lokhuseleko, inokuba negalelo elikhulu kwaye ihlale ihleli.

Ekugqibeleni, uncedo lwamanye amazwe alunakuthabathel' indawo inkqubo yoncedo elungileyo, exhaswa kakuhle yezonyango lukawonke-wonke. Kodwa kunyaka we-interim — kwaye ngokufuthi njengesixhobo sokukhuthaza olo sukelo — lunika ubuncwane, ubuchule, kunye namandla afunekayo ukuzisa ukhathalelo olufanelekileyo lwempilo kubemi behlabathi abakude. Ukuqhubeka ufundo olusebenzayo loncedo, bona iingxelo zeWorld Health Organization [FLT:] [[FLT]]