Imiphakathi yasemaphandleni e-United States iye yalwisana nokutholana kwezindawo zokunakekela impilo ezisezigodini zasedolobheni nasemadolobheni. Ukuhlukaniswa kwezesayensi yezobuchwepheshe, ukuncipha kwezisebenzi zezempilo, kanye nokuvinjelwa kwezimali kudala isiphepho esiphelele sezinkinga zezigidi zamaMelika ezihlala kude nezibhedlela, ochwepheshe, nezinkonzo zokuvimbela. Ababusi bezwe, abami ekwakheni kwezimiso zomthetho kanye nokusetshenziswa kwezindawo zendawo, baye bavela njengabaklami abayinhloko bezisombululo ezintsha. Ngemiyalo yezikhulu, izinto eziza kuqala, nokutshala imali, ababusi balwa izinselele eziqhubekayo zempilo zasemaphandleni ngokuzimpikiswa ngesuba, ukukhomba okungakhokhwazwa ngengxubeza, futhi abakhokhi abakhokhi abakhokhi bezindawo eziphambili abambalwa bebhuntwayo.

Izinselele Eziqhubekayo Zokuthola Ukunakekelwa Kwempilo Emaphandleni

Izinkinga abantu basemaphandleni ababhekene nazo azizintsha, kodwa ziye zabhebhethekiswa ukushintsha kwenani labantu, ukucindezela kwezomnotho, kanye nomphakathi wempilo njengobhadane lweCOVID-19. Ukuqonda lezinselele kubalulekile ekuqapheleni ukusabela kwezimiso okuye kwasungulwa ababusi.

Izivalo Zempilo Nokuqina

Kusukela ngo-2010, izibhedlela zasemaphandleni ezingaphezu kuka-130 ziye zavalwa e-United States, ngokwemininingwane evela kuCecil G. Sheps Center for Health Service Research eYunivesithi yaseNyakatho Carolina. Lokhu kuvala kushiya izakhamuzi ngaphandle kwezinkonzo zesimo esiphuthumayo, imibhede evalelweyo, noma imishini yokucwaninga namakhono okuveza izithombe. Kulezo ezisele, isibhedlela esiseduze kungaba ihora noma ngaphezulu, okungabulala uma kuhlaselwa isifo senhliziyo, unhlangothi, noma inhlekelele enzima. Izikhulu ziye zasabela ngokwenza izinhlelo zikahulumeni ezinikeza izinhlelo zokuvula izakhiwo ezinzima nokuhlola ezinye izithombe ezingezinye izibhedlela eziphuthumayo [[[FLT:]] nezibhedlela zasemaphandleni, ezithola iMedictationmentation ekhubazekayo ezingeniselwe izinkonzo ezilinganiselwe.

Ukuswelakala Kwezisebenzi Ezindaweni Zasemaphandleni

Indlala yochwepheshe bezempilo emadolobheni ikhulu. IHealth Resources and Service Administration (HRSA) ibhekisela ezinkulungwaneni ze-Health Professional Shortage Areates (HPS) emaphandleni. Izindawo zasemaphandle zinodokotela abangu-13,5 kubantu abahlala ezindaweni ezingu-10 000, uma kuqhathaniswa no-30,9 emadolobheni. Izikweletuzelo zidlulela kodokotela: imiphakathi yasemaphandleni futhi ayinawo amazinyo, abanakekela impilo, abahle, abahle bezethembisi bezifundo zezemisebenzi yezemisebenzi, futhi zilinganiselwe amathuba ezisebenzi ezingosini ezingosini ezingozakwabo kanye nezingane ezingafuni ukuzikhethela ukuqeqeshelwa amabhulovolo ezikoleni ezisezweni ezivamile zezelelwa ezifunda emapulazini ezikoleni ezisezweni ezisezweni ezivamile, ezikhona ezinkoleni ezise zihlala ezingeni eliphezulu kakhulu.

Izinto Zokuhamba Nezithiyo Zendawo

Ngisho noma kukhona izinkonzo, ukuya kuzo kungavimbela. Izakhamuzi zasemaphandleni ngokuvamile azinakho izinto zokuhamba zomphakathi ezithembekile, futhi amabanga eziya emotweni eseduze zingadlula ngamakhilomitha angu-30 ukudlula ngenye indlela. Lomthwalo wehlela kakhulu emisha yasebekhulile, abafinyele kakhulu, futhi lezo ezinezimo ezingamahlala njalo ezidinga ukuvakashelwa njalo. Ngokwesibonelo, isiguli esinesifo sikashukela esisezweni esikude kungase kudingeke sihambe amakhilomitha angu-60 ukuze sihlolwe, silahlekelwe umsebenzi futhi silahlekelwe izindleko zikaphethi. Ezinye izikhulu zikahulumeni ziye zafaka izinhlelo zokuhamba ezisemzingeni eliphansi , njengezihamba ngemoto ezihambayo, izinkonzo ezingezizodwa ezivamile, ezokuthutha abantu, namasethuthilo awe ezindaweni zokunakekela umphakathi ezisiza abantu ngokuqondile. Ezinye izigaba zezentengo zamazwe eziye zakhampane kanye neziko ezikhokhwale ezikhombayo.

Izinga Eliphakeme Lezifo Ezingamahlalakhona Nezici Ezingavumelani Nempilo

Abantu basemaphandleni bavame ukuba badala, bampofu kakhulu, futhi banamazinga aphakeme ezifweni ezingapheli njengesifo senhliziyo, isifo sikashukela, kanye nesifo samahlalakhona esiphazamisa amaphaphu (COPD). Ngaphezu kwalokho, izakhamuzi zasemaphandleni zisengozini kakhulu yokuhileleka ekuziphatheni okuphakeme kezempilo njengokubhema futhi zingafundile kakhulu. Lezi zici zihlanganisa ukubangela imiphumela engcono yempilo kanye nezinga eliphakeme lokufa. Izikhungo zezifo ezisezifweni ezingcono kakhulu. Izinhlelo zivame ukuveza ukuthi amaMelika asemaphandleni afa ngezimbangela ezingenakuvinjelwa kakhulu kunabantu basedolobheni. Izikhulu zezokuqondisa ziye zasabela ngokuqondisa iminyango yempilo ehlolwa ukuvimbela nokuphatha, kuhlanganise nezikhungo zomphakathi ezikhungo zezempilo ezikhubazekayo, izikhungo zesikole eziphezulu, nezokuzimo zezifo ezingapheli. Lezi zinhlelo zitholakala ngezindleko zemali eziphambili ze-CD, nalezo ze-Drune.

Izindlela Ezikahle Zokuxoxa Nabalawuli Ziyasiza Ekuthuthukiseni Indlela Abazothola Ngayo Amaphuzu

Abalawuli banamathuluzi amaningi ezimiso abawasebenzisayo. Kuye ngokwesimo sezwe sezombangazwe, amandla emali, nemisebenzi ephambili, baye baphishekela izinhlobonhlobo zalamacebo alandelayo.

Ukunwebeka Kwemizila Yezindiza

ITelehealth yaqhuma phakathi nobhadane lwe-COVOVAD-19, futhi abaholi abaningi bombuso bahamba ngokushesha ukuze benze isikhashana esiqinile. I-Telehealth ivumela iziguli ukuba zithintane nochwepheshe abaqhele ngamakhulu amakhilomitha zingashiyanga imizi yazo. Ohulumeni baye bathuthukisa lendlela yokuhamba:

  • ukwandisa ukufinyelela kolwembu olubanzi lwe-Internet ngamahhovisi abanzi ezwe, ubudlelwano bomphakathi, kanye nezimali zikahulumeni ezisetshenziswa kuhulumeni ezisuka kuyi-Infrapluctive Investruction and Jobs Act.
  • Izimiso zesifundazwe seMedicaid ukuhlanganisa ukuhambela kwe-telehealth ukuze kuhlanganiswe izinkonzo eziningi, kuhlanganise nempilo yengqondo, ukuphatha izifo ezingapheli, nokugoma.
  • [ Imithetho ephoqayo edinga abakhonzi bomshuwalense ukubuyisela i-telehealth ngokulinganayo nokuhambelana.
  • Ukuhlanganisa ezikhungweni ze-telehealth [ okuvumela imithola-mpilo yasemaphandleni ukuba ixhumane nezikhungo zezokwelapha zemfundo ukuze ithole ukuhlola okukude emasimini njenge-cardiology, i-smatology, ne-iology.

Ngokwesibonelo, isifundazwe sase-Arkansas, ngaphansi koMbusi uAsa Hutchinson, samisa i-Arkansas Telehealth Network, ehlanganisa izindawo zasemaphandleni ezingaphezu kuka-400 nochwepheshe eYunivesithi yase-Arkansas yezesayensi yezokwelapha. Ngokufanayo, uMbusi waseVirginia uRalph Northam wasayina uhlelo lwesikhulu esakha amabutho anwetshwayo ezwe lonke, aholela ekubeni athole umthetho wemvume waphakade we-telehealth. Lezi zinyathelo ziye zanciphisa kakhulu imithwalo yokuhamba futhi zalinda izikhathi zeziguli zasemaphandleni.

Abanikazi Bezimali Abasekela Abaphi

Ukuze kuxazululwe ukuntuleka kwemisebenzi, ababusi baye babeka izimali zikahulumeni eziqinile ezithathelwe izinhlelo zokubuthwa nokugcinwa. Lezi zihlanganisa:

  • Inkokhelo nezinhlelo zemfundo zinikezwa ngeminyango kahulumeni yempilo noma yemfundo ephakeme. Ngokwesibonelo, iTexas Physician Education Loan Refunger Program inikeza odokotela abakhonza emaphandleni eHPS aMadola angu-2060 000 (R160 000).
  • Izindawo zokuhlala ezivunyiweyo zase sifundeni ezibhedlela nasemitholampilo yasemaphandleni, ikhuthaza odokotela abasha ukuba bahlale endaweni ngemva kokuqeqeshwa.
  • Izikweleti zokweleta kanye nobhonasi kubanakekeli abaprakthiza ezindaweni zasemaphandleni iminyaka emincane.
  • Ukuvaleka kwe-Licenfire nama-compact aphakathi kwezwe okwenza kube lula ngabaphathi ukuba basebenzise imigqa yombuso, okubalulekile emiphakathini yomngcele nasemiphakathini ye-telemedicine. I- Interstame Medical Licenfisure Convention ivumelana nezindawo eziningi, ilandela inqubo yokuvala izinzwa kodokotela abafisa ukuyisebenzisa ezizweni eziningi.

I- “Mo HealthNet” yohlelo lwe-Mike Parson, ngaphansi koMbusi, yandisa inzuzo ekhokhelwa abanakekela abaholayo kakhulu ezindaweni zasemaphandleni, yenza kube ngcono kakhulu ukwamukela iziguli ze-Medicaid. i-Dakota yaseNyakatho Doug Burgum, ngaphansi koMbusi uDoug, yasungula uhlelo lokukhokha imali ekhokhelwa izisebenzi zempilo ekhokhelwayo enikeza intethelelo engenisa amaR350 000 entengozelo ezisebenzi zezempilo ezisebenza ezingokwengqondo eziqhuba izilinganiso ezingaphansi kwezinga eliphezulu zasemaphandleni.

Ukuhlola Izimiso Zezempilo Zasemaphandleni

Ngaphandle kokugcina izibhedlela zivuliwe, ababusi baxhasa izakhiwo ezintsha kanye neziphelelwe isikhathi. Lokhu kuhlanganisa inzuzo yemali yokuthuthukisa imishini, ukwandisa izakhiwo, nobuchwepheshe. Isifunda saseCalifornia, ngaphansi koMbusi Gavin Newsom, bagunyaza izibhedlela eziyizigidi ezingu-200 “ISibhedlela iLoan Program" yokusiza izibhedlela zasemaphandleni ezilwayo zigwema ukuva ukuvalwa. Ngaphezu kwalokho, ababusi abaningi baye basekela iSibhedlela sikahulumeni i-Emetergatency [RET] (H) imodeliyo, evumela izibhedlela ezincane ukuba ziguqulelwe ngaphandle kwemisebenzi ephuthumayo, ukwamukela izindleko ezikhungokwandisiwe. Izizwe ziye zashukumisela ngokushesha kulamazwe ama-Medicareckies.

Ababusi abaningana baye basekela futhi ukwakhiwa kwezikhungo zempilo zasemaphandleni, lapho abacwaningi nabasebenza emtholampilo bebambisana khona ekuxazululeni okuvumelana nezidingo zendawo. Ngokwesibonelo, i - University of Nebraska Medical Center of Liral Health Innovation Hub ithola izimali zikahulumeni ukuze ihlole izingqapheli ezintsha zokuthutha izinkonzo, kuhlanganise nemitholampilo ehambayo, iziguli ezisiza umphakathi, kanye nokuhlola iziguli ezisezindaweni ezikude.

Ukwandisa IMedicaid Nokunciphisa Ukungasheshi

Imali yomshuwalense wezempilo iwukungangeni okuyinhloko. Izinga elingakhokhwa ezindaweni zasemaphandleni livame ukuphakama kunezindawo zasemadolobheni, futhi izakhamuzi zasemaphandleni zisengozini kakhulu ukuphakanyiswa. I-ffordhable Care Act ye-Medicaid Act iwukwanda kwe-Medicaid ithuluzi eliyinhloko lokunciphisa inani lababusi abangaqiniseki. Kusukela ku-2024, amazwe angamashumi amane ne-Origidi eColumbia aye andisa i-Medicaid. Izikhulu zasemazwe ezandisa intuthuko ezomnotho zasemaphandleni nemvume yokuthola isineke ukuze zivimbele ukunakekelwa. Ngokwesibonelo, ngemva kokuba u-Montanam Midid ekhuliswe ngaphansi koMpulcock ka 2016, izibhedlela zikahulumeni zasemaphandleni zabona ukuncitshiswa kwezindleko ezilinganayo ezikwe-25% ezinteleni ezincishisiwe. Izikhulu zikahulumeni zasemaphandleni ziye zabika ezibhekene phambili ezimweni zasemaphandleni ezibhekene ngokuncitshiswa kwezinye zasemaphandleni.

Ngalé kwe-Medicaid, ababusi baye basebenza futhi ukubhalisa izakhamuzi zasemaphandleni ezimakethe zempilo nokukhuthaza amapulani abiza imali eshonelwe. Izivumelwano ezisekelwe kuhulumeni, njengalezo zaseColorado nase Minnesota, ziye zalungisa imikhankaso yokufinyelela izilaleli zasemaphandleni, zilungiselela imikhumbi yemikhumbi ehamba phambili kanye nezinqubo zokuzidayisa ezilula.

Izimodeli ezintsha kanye nomngane wombuso

Abaholi abasebenzi bodwa. banobuhlobo obuqinile nohulumeni kahulumeni kanye nengxenye ezimele ekuklameni izinhlelo eziqinile nezingantengantengi.

Izinhlangano Ezinesibopho Sokunakekela Emaphandleni

Abanye ababusi baye bakhuthaza ukwakhiwa kwezinhlangano zokunakekela ezinombuzo [zokuvikela] [i-ACOS] [i-AFLT] [i-AFLT:1] ezivumela imitholampilo emincane nezibhedlela ukuba zingene ezinhlanganweni ezivuzwayo zokugcina iziguli ziphilile kunokuba zinikeze nje ukwelashwa. Laba -ACOS basebenzisa abaqondisi bokunakekela abadinga usizo, ulwazi lwe-alytics, kanye nokusiza iziguli ukuba zilawule izifo ezingapheli futhi zinciphise ukuhlaziywa. Izwe lase-Iowao, ngaphansi koMbusi u-Io Kim Reynolders, linikeza usizo lwezobuchwepheshe ukuba izakhiwo zasemaphandleni zikwazi ukwakha i-ACOS, okuphumela ezindlekweni eziphansi nezingcono ze-mediactritives zokwanuals.

Izisebenzi Zezempilo Zomphakathi Nontanga

Iqaphela ukuthi ukwethembana kubalulekile emiphakathini emincane, ababusi abaningi baye baxhasa ukuqeqeshwa nokusetshenziswa kwezisebenzi zezempilo zomphakathi (CHWs) ezivame ukuba izakhamuzi zezindawo ezifanayo ezikhonzayo. I-CHWs inikeza imfundo yempilo, iziguli zisiza ekuqondiseni inqubo, futhi ihlanganisa nezinkonzo zezenhlalakahle. Izifunda eziningi, kuhlanganise neNtshona Virginia naseKentucky, ziye zakha izinhlelo zokuqinisekisa nokubuyisela imbuyiselo ye-CHWs phakathi kwezinhlelo zazo ze-Médicaid. Lendlela iye yaphumelela ekulawuleni i-transport, diabetes, ne-mian ezindaweni zasemaphandleni.

Ubudlelwane Nezizwe Zesizwe

Ezifundeni ezinabantu abavelele bamaMelika Omdabu, ababusi baye basebenza nohulumeni besizwe ukuhlanganisa izinkonzo zokunakekela impilo emingceleni ephethe imingcele. I-Indian Health Service (IHS) ikhonza amalungu amaningi esizwe, kodwa imithombo yayo ayinele. Ohulumeni baye bangena ezivumelwaneni zokuthenga, izibopho zemininingwane, kanye nemithola ezokwelapha ehlangene ukuze bakhokhe i-Alaska, ngaphansi koMbusi uMike Dunleavy, obambisana nezinhlangano zesizwe zezempilo zokwandisa i-teleheath kanye nezingathathi ezikhethekile zokungena ezifundeni ezinkulu, izifunda zesifundazwe ezingenamgwaqo.

Imiphumela Emikhulu Nezinselele Ezisasele

Izimiso ezisetshenziswa ababusi ziye zaveza intuthuko engokoqobo, kodwa izikhala eziphawulekayo ziyaqhubeka. Ukuhlola ithonya langempela kudinga ukubheka izikhombo eziningi.

Izindaba Eziye Zaphumelela

  • Ukusetshenziswa kwe-tempelth ezindaweni zasemaphandleni kuye kwanyuka ngamaphesenti angaphezu kwangu-3 000 kwezinye izindawo kusukela ngo-2020, enamanani okwaneliseka kwesineke angaphezu kwa 90%. Iziguli zasemaphandle zibika ukuthi zalondoloza isikhathi nemali, futhi zinamathela kangcono ekulandeleni ukunakekela.
  • Izinhlelo zokukhokha imali ebolekiswayo yesizwe zifake amakhulukhulu ezisebenzi emiphakathi engaphansi kwe-oyile. Ngokwesibonelo, i-Virginia State Loan Reatement Program ihambise izimboni eziyinhloko ezingaphezu kuka- 150 emaphandleni e-HPS kusukela ekuqaleni kwayo.
  • Ukunciphisa ekulalisweni ezibhedlela okungavinjelwa ezizweni ezinezinhlelo zezisebenzi zezempilo zomphakathi eziqinile kanye nezi-ACOS.
  • Ukuvalwa kwesibhedlela kuye kwanciphisa [ emibhalweni efake imali yokuzinza nokuguqula i-REH. Ngokwe-Sheps Center, izinga lokuvala liye lehla ukusuka kwi-avareji yaminyaka yonke engu-15 kuya ku-9 eminyakeni emibili ngemva kokusungulwa kwegama le REH.

Izithiyo Ezisalokhu Zikhona

Naphezu kwalezi nzuzo, izakhamuzi eziningi zasemaphandleni zisabhekene nezinkinga ezinkulu zokufinyelela. Ukuswelakala kwezisebenzi kuyaqhubeka[; uhulumeni ulinganisela ukuthi kudingeka ezinye izikhungo eziyinhloko ezingu-200,000 ukuze kuqedwe iHPSA iziqu emaphandleni asemaphandleni. [[[FLT]] Brutradbactic ukufinyelela [[[FLT:]] incict: nakuba i-Infrabliclactmentmentmentmentmentmentmental Acts inikezela ngezigidi ezingu-65 (izigidi ezingu-65) zezigidi zezigidi zezigidi ze-Acrobox, izindawo eziningi zasemaphandleni zihlala zingasasebenzi noma zingena ezingenisweni ezingaphansi kwe-mgangatho. [[FUFUF], futhi inciphiswa kakhulu yezigidi zezinga], izifunda ezingekho emaphandleni ezin.[10]

Indima Yezimiso Nemithombo Yengcebo

Ohulumeni abanakuxazulula ukunakekelwa kwempilo yasemaphandleni kuphela. Izimiso ze-Federal zinquma izindlela ezinkulu zokulungisa isimo sikahulumeni.

  • [ Amazinga entengo ne-Medicaid ayimbuyiselo [: Amazinga aphakeme abagcini basemaphandleni athuthukisa ukuzinza okungokwezimali. Izikhungo zeMedicare & Medicaid Services (CMS) ziye zasungula ukulungisa okuningi okukhokhelwayo ezindaweni zasemaphandleni, kodwa abalawuli baye basekela ukwanda okwengeziwe.
  • Imisebenzi nokubonisa : Izinhlelo ezinjenge HRSA Federal Office yezinhlelo ze-milral Health Policy ezinikezayo[ inikeza izimali zokuxhasa iteleheath, izisebenzi, nentuthuko yezakhiwo. Ababusi abaningi baye basebenzisa lezi ziphakamiso ezinyathelo ezithathwayo ezinhlalweni zembewu.
  • [ Ukuvumelana nemithetho: Imishini yetelehealth, izisebenzi zasesibhedlela, kanye nomkhuba wenqubo iye yaba yimbi kakhulu. Ohulumeni baye basebenza ne-CMS kanye nezishaya-mthetho zikahulumeni ukwenza ukuba i-trapedial propatialties zihlale njalo.

Ama-social ahlangene angokombuso, njenge- Ukuhlanganisa 1115 Medicaids wavers, ivumela amazwe ukuba ahlole izindlela ezintsha. Ngokwesibonelo, i-Ohio yathola umqalisi wokushayela “amakhaya anempilo” wesibonelo seziguli ezinezimo ezingalapheki emaphandleni, ifaka impilo nendlela yokunakekela eyinhloko yokuziphatha.

Bheka Phambili: Iziqondiso Zesikhathi Esizayo Zohulumeni

Imingcele elandelayo ekutholeni impilo yasemaphandleni iyohlanganisa ukuhlanganiswa okujulile kobuchwepheshe, ukusetshenziswa okunwetshiwe kwabezosizo abangasebenzisi i-physics, nokugxila ekunqandeni impilo yabantu.

  • Umehluko wokuzijwayeza ukukhuliswa kwenqubo kwabahlengikazi ababhaliswe kakhulu (APRNS), odokotela abasiza (PAS), kanye nosokhemisi abakwazi ukuyisebenzisa bephezulu kwephepha-mvume labo, okungandisa ukufinyelela ngaphandle kodokotela.
  • Ukusetshenziswa okukhuliswe kokuhlola iziguli okukude [ nemishini enciphileyo yokulawula izimo ezingamahlalakhona, esekelwa ukutshala izimali kuhulumeni ezisekelweni zezempilo IT.
  • Izikhungo zezempilo eziqinile kakhulu ezisekelwe esikoleni ezinikeza izingane izinkonzo eziyinhloko, impilo engokwengqondo, kanye namazinyo ezindawo zasemaphandleni, ngokuvamile ezixhaswe ngemali ngemiphakamiso kahulumeni.
  • Izinguquko ezisekelwe ekukhokheni okungalinganiyo ezivuzayo kunokuba zikhiqize, zivumela abaqashi basemaphandleni ukuba bafake imali ekuvimbeleni nasekunakekeleni.

Ababusi abaningana bahlola futhi iziphakamiso ze-telehealth enfire, ikhemisi, ngisho nokuhlanganyela imininingwane yezempilo yomphakathi ukuze kubonwe izidingo ezivelayo ezindaweni zasemaphandleni. imo elawulayo [ ihlala ikhona, futhi ababusi basebenzisa amazwi abo ukuhlela ukubusa kwezwe ngeNhlangano yesizwe futhi baqondise ukubusa.

Isiphetho

Ukungenela kwezempilo zasemaphandleni akuyona inkinga eyodwa kodwa ukuqoqwa kwezimpikiswano ezihlangene ezihlanganisa ukuma komhlaba, ezomnotho, izisebenzi, nesimiso. Abalawuli baye baqhubekela phambili ngesu elibanzi lamasu: ukwandisa i-telehealth, ukunikeza izihekelele zemali ezingokwezimali, ukutshala izakhiwo zezezimali, ukunwebela umshuwalense, nokuthuthukisa ukudluliswa kwemishuwalense, nokukhuthaza ukunakekelwa kwemikhakhakha. Nakuba le mizamo iye yaveza intuthuko enenjongo engcono kakhulu, iziguli ezihlangene kakhulu, izimiso zempilo eziqinile zendawo ezihlala phambili zihlala zinde. [[FLT]] Inzuzo yempilo ye-Hub iqokomisa ukuthi abantu basemaphandleni bayaqhubeka bebhekana nemiphumelo engcono, negebeva ezindaweni ezikhona phakathi kwezindawo zokuphila eziphakathi kwezindawo zasemaphandleni, isibopho esiphakathi kwemibuso emishaneni, imisha kanye nomphakathi womphakathi wonke, ukuhlanganiswa kwezindawo eziphambili, kodwa ukuvusekusebenza ngokuvusemuva, kodwa ukuvusekuvuseza inte, ukuvusehlaka.