Indima Yosizo Lwakwamanye Amazwe Ekuthuthukeni Kwempilo Yasemaphandleni

Imisebenzi yosizo lwamazwe angaphandle njengenjini ebucayi yezemfundo eziqhubekekayo zezempilo emaphandleni angaphansi kwezindawo eziphansi neziphakathi ezifikayo. Leminikelo yezezimali nezobuchwepheshe — evela ezinhlangano zikahulumeni (njenge-USAID, DFID, ne-GIZ), izinhlangano eziningi (njenge-World Bank ne World Health Organization), kanye nezisekelo ezizimele (kuhlanganise i-Bill & Melinda Gates Foundation) — ngokuvamile zihlasela izindawo lapho imali yomphakathi esetshenziselwa impilo ihlala ingaphansi kwe R5 000 ngonyaka. Ezindaweni ezinjalo ezizungezile, imithombo yangaphandle ingasho umehluko phakathi kwedolobha elingenamthola mpilo nezisebenzi zezempilo eziqeqeshiwe izisebenzi zezempilo zomphakathi eziqeshiwe umphakathi.

Isilinganiso salokhu kusekela sikhulu. NgokweNhlangano yezentengiselwano Cotóoperation nentuthuko, usizo lwezentengiselwano zezempilo olungokomthetho lufinyelele ngaphezu kwamaRandi ayizigidi eziyizinkulungwane ezingu-40 ngonyaka eminyakeni yamuva, futhi kunesilinganiso esiphawulekayo esiqondiswe ekuqiniseni izimiso zokunakekela eziyinhloko ezindaweni zasemaphandleni. Lokhu kuhlanganiswa kwenhloko - dolobha nobuchwepheshe kudala amathuba okwakha izakhiwo, izisebenzi zesitimela, nokusungula izinxulumani ezingokobuchwepheshe ebezingafinyelelwa ngokwezimali ohulumeni bendawo abadukile.

Intuthuko Yezakhiwo

Enye yemiphumela ebonakalayo kakhulu yosizo lwakwamanye amazwe ukwakhiwa nokuvuselelwa kwezindawo zempilo ezingokoqobo. Emaphandleni angaphansi kwe-Saharan Afrika ne-South Asia, izinhlelo zokusiza ziye zaxhasa izinkulungwane zezikhungo eziyinhloko zezempilo, izindlu zokubeletha, nezindawo zomthola-khaya ezihamba-hamba. Ngalé kokumisa izakhiwo, izakhiwo zezakhiwo ezivamile zezakhiwo zezakhiwo zemvelo — ukufaka izisekelo ze-weawer ezuleni eliqinile lokuqinisekisa ugesi wokuthambisa i-firiji, ukubhola izimbobo zokuvuleka kwamanzi ahlanzekile, nokwakha izindlu zangasese ukuze kuhlangane nezindinganiso zenhlanzeko. Ngokwesibonelo, i-World Bank’s International Development Association ixhasa izakhiwo zempilo zasemaphandleni emazweni anjenge-Ethiopiat kanye ne-Bangladesh, ukuhlanganisa ukwakhiwa kwemithola-mthola-mthola-mcol, ukuvuse-mhlala-mhlala-mgangathweni owe, ukufakwa komgobonda okuthembekile nokukhucucucu.

Izinhlangano zosizo ngezinye izikhathi zitshala imali ekuthuthukiseni umgwaqo noma zinikeze izisebenzi zezempilo izithuthuthu namabhayisikili ukuze zifinyelele emaphandleni aqhelile. E-Nepal, umsebenzi osekelwa i-Asian Development Bank wakha amabhuloho anciphisa isikhathi sokuhamba ezikhungweni zezempilo ngamahora ambalwa. Lentuthuko engokomzimba ithonya ngokuqondile ukuthi owesifazane okhulelwe angafinyelela yini esikhungweni sokubeletha noma ukuthi umntwana one-nyumoniya uthola ukwelashwa ngenkathi efanele.

Amakhambi Okwelapha Nobuchwepheshe

Usizo lwangaphandle luqinisa lonke uxhaxha lwemithi edingekayo, imithi yokugoma, nemishini. Izinhlelo ezinjenge-Global Fund to Friend AIDS, Isifo sofuba nomalaleveva zisakaza izigidi zamanethathane alele, imithi elwa namagciwane, kanye nokuxilonga ezimbonini zasemaphandleni unyaka ngamunye. Usizo futhi lusekela ama-schinding àwing significist — izithako ezinesiqandisi kanye nezinqonqongo — ezibaluleke kakhulu ekugonyeni okumelwe kugcinwe emazingeni aqondile. Emazweni anjengeMalawi, ukutshala isambar àgradegrade (amagallery) iziqamu ezidayo ezidayo ezincishisiwe ngokuphawulekayo zinciphe kakhulu emitholaneni engu-67grid.

Ukuthunyelwa kobuchwepheshe kungomunye umkhakha. Ukuthatha isinyathelo nge-Telemicine okuxhaswe yizinhlangano zosizo kuvumela izisebenzi zezempilo zasemaphandleni ukuba zithintane nochwepheshe ngomakhalekhukhwini noma ngemishini exhumene. ENdiya, i-Aoglya Setu plat kanye nezinhlelo ezifanayo ziye zandisa amakhono okuxilonga akude. U-Aid ithenga nezinto ezibalulekile njengemishini ye-ultrasound, izibonakude, nezithiyo zokubulala izinambuzane, okwenza izindawo zasemaphandleni zikwazi ukunikeza izinkonzo ezazikhona ngaphambili ezibhedlela zasedolobheni.

Ukuqeqesha Nokwakha Isakhiwo Sasedolobheni

Isisekelo esingokomzimba sodwa asinakuthuthukisa imiphumela yezempilo ngaphandle kwezisebenzi ezinekhono. Usizo lwangaphandle lunikezela izimali ezinkulu ekuqeqesheni izisebenzi zezempilo zomphakathi, abahlengikazi, ababelethisi, nochwepheshe bokucwaninga. Izinhlelo zivame ukuhlanganisa izikhokhelo zabafundi basemaphandleni ababopha ukubuyela ezindaweni zabo ngemva kokuphothula. African Centre for Disease Control and Prevention , esekelwa ohulumeni abanikela ngeminikelo eminingi, iqhuba imishini yokuqeqeshela izikhulu zezifo eziphethe izikhulu zasemaphandleni.

Ukuzigcina kuyinselele engapheli. Ukubekwa kwezindawo zasemaphandleni kuvame ukungabi nazindlu, ukufundiswa kwezingane, namathuba obuchwepheshe. Imisebenzi yosizo ikhuluma ngalokhu ngokwakha izindawo zokuhlala, ukunikeza izindleko zobunzima, nokumisa imfundo eqhubekayo ngebanga lokufunda. ERwanda, ubuhlobo phakathi kukahulumeni ne-Clinton Health Access Inict iqeqeshe amakhulu ezisebenzi zezempilo eziqeqeshelwe ukuhlanganisa ukuphatha ukugula kobuntwana, kanti inani lezentengiselwano lingaphezu kuka-80% ngemva kweminyaka emihlanu. Imizamo enjalo yokwakha iqinisekisa ukuthi ukutshala izimali ngezitini kanye nodaka kugcinwa, ukunakekelwa okuphakeme kwezentengiselwa.

Imiphumela Emihle Yosizo Lwakwamanye Amazwe Empilweni Yasemaphandleni

Uma luhlelwa kahle, usizo lwangaphandle luveza intuthuko ekwazi ukuvela ezikhombini zempilo nokuzimela kwesimiso. Imiphumela elandelayo ifakazelwa kaningi ekuhlolweni kwezinhlelo ezinkulu zama-scale 93:

  • Ukufa kwabantwana nokubeletha okuncishisiwe: Imikhankaso yokugoma exhaswe, ukuqeqeshelwa ukubeletha, nokunakekela okuphuthumayo kuye kwanezela ekuncipheni kwamanani okufa angaphansi kuka-8855 ezindaweni zasemaphandleni. Ngokwesibonelo, phakathi kuka 2000 no-2020, ukufa okungaphansi kuka-695 e-Afrika engaphansi kwe-620, kwancipha cishe ngengxenye, ukuthambekela okuhlobene kakhulu nosizo olukhulisiwe lwempilo.
  • Ukuhlanganiswa okunwetshiwe kokugoma:, i-GVI, i-Vaccine Alliance — exhaswe ohulumeni abanikelayo nezisekelo — kuye kwasiza ukufinyelela izingane ezingaphezu kwezigidi ezingu-80 emiphakathini yasemaphandleni ezinemijovo elwa nezifo ezinjenge-polio, isimungumungwane, ne-nyumonia. Lokhu kuye kwaholela ekunqanda uvendleni kweveva ezindaweni ezisezindaweni ezivamile.
  • Kungcono ukuhlola izifo nokusabela kobhadane: ukutshala izimali zosizo eziminyangweni zokucwaninga nasezimisweni zokubika kwenza izakhiwo zezempilo zasemaphandleni zikwazi ukuzwa ukuqubuka kwekholera, i-Ebola, noma isimungumungwane zisheshe zivimbele ukusakazeka kakhulu. Phakathi nomqedazwe weCOVID 2016, usizo oluxhaswe kakhulu, ukuhlolwa nokuhanjiswa komjovo ezindaweni ezikude zamazwe amaningi.
  • Izimiso zempilo eziqinisweyo: Izisebenzi zivame ukusekela amarekhodi obuchwepheshe namathuluzi okwaziswa angokoqobo e-octronic. ETanzania, isimiso sezwe sezempilo eUSAID àbacked sisiza abaphathi besifunda ukuba balandele amasheya emithi nemiqulu yeziguli, okuholela ekutholeni inzuzo engcono kakhulu.
  • Ukuqaphela impilo okukhulisweyo: ukuguqula imikhankaso yokuxhumana nokuziphatha, kuxhaswe yizinhlangano zosizo, kuye kwakhuthaza ukugeza izandla, inqubo ephephile yobulili, nokusiza ekukhulelweni. Amadrama e-radio, imiyalezo ehamba ngeminxeba, kanye nezingxoxo zomphakathi — konke kusekelwe yizimali zangaphandle — kufinyelela imiphakathi engakwazi ukufunda nokubhala kakhulu.

Lenzuzo yakha umjikelezo omuhle: Izingane ezinempilo ziya esikoleni njalo, abantu abadala balondoloza umkhiqizo, futhi imikhaya ilondoloza imali ebingalahleka ngenye indlela ngenxa yezindleko zezokwelapha.

Izinselele Nokugxeka

Naphezu kwalezi mpumelelo, usizo lwezinye izindawo lokunakekela impilo yasemaphandleni lubhekene nokugxekwa okuphikelelayo nezithiyo ezisebenzayo.

Ukwethembela Emithonjeni Yangaphandle

Inkinga evamile iwukuthi lapho uhulumeni wendawo uncike ekuxhaseni imali esetshenziswayo ukuze kusetshenziswe izindleko eziphindelelayo — iholo, ukuthengwa kwezidakamizwa, imitholampilo — ngaphandle kokwakha imithombo egciniwe yemali yasekhaya. Uma abanikelayo beshintsha izinto eziza kuqala noma benciphisa imali, izimiso zezempilo zingaphela. Ngokwesibonelo, lapho i - Global Fund ibhekene nezikhala ezingokwezimali ngo - 2011, amanye amazwe kumelwe anqande ukubhalisa imitholampilo yasemaphandleni izinyanga eziningana.

Ukudunyazwa Kwezidingo Zendawo

Ngezinye izikhathi abanikela ngeminikelo bangaphandle bafaka phambili ukungenela okubonisa izithakazelo zabo zezombangazwe noma ezingokwezimo esikhundleni sezidingo ezithile zempilo zemiphakathi yasemaphandleni. Izinhlelo ezimisiwe ezigxile ezifweni ezikodwa (njengesandulela-ngculaza noma umalaleveva) zingaphazamisa ukuhlelwa kwezindawo zokunakekela, ziphambukisa izisebenzi nempahla ezikuzo ezibaluleke kakhulu. E-Uganda, izikhungo zezempilo ezihlangene ngezinye izikhathi ziye zaphelelwa imithi eyisisekelo kuyilapho izimali zomlutha zinesifo somthako ngenxa yokuthi inzuzo yemali ingu - 066969. Ukuthatha igalelo lomsebenzi akunele ezinyathelo ezindleleni eziningi, kuholela ezimbonini ezakhiwe kodwa ezilawulwa ngaphansi kwezingako ngenxa yokusetshenziswa kwazo ngenxa yokuntula izinkonzo ezingokwesiko noma amahora afanelekile okusetshenziswayo.

Ukonakala Nokungaqondisiwi

Usizo olukhulu lungaheha inkohlakalo, ikakhulukazi ezimisweni ezinokulawula okubuthakathaka nokwengamele. Izimali eziphawulwe ngokwakhiwa kwemitholampilo yasemaphandleni zingase zihogelwe ngezivumelwano ezinyusiwe noma izisebenzi zezipoki. Uphenyo luka-2018 lweNhlangano yeZwe Lezempilo luthole ukuthi amaphesenti angu-30 ezinto zezokwelapha kwamanye amazwe alahleka ngenxa yokwebiwa noma ukuqedwa kwempatho ephansi. Izimiso zokuthola imali kanye nokuzihlolela ngokwazo — ngokuvamile ezifunwa yizisebenzi ezinikelayo — ziye zancitshiswa kodwa aziziqedanga lezi zinkinga. Ukusebenza kwezinhlangano zendawo ezigadishiwe kungathuthukisa ukulandisa kodwa kudinga isakhiwo sokuphatha okungalinganiswa.

Ukuntuleka Kokulondolozwa Nokulondolozwa Kwezinsimbi Ezinde

Imisebenzi eminingi yezesisekelo elungiselelwe i-locanced iyahluleka phakathi neminyaka embalwa ngenxa yokuthi ayikho indlela yokusebenzisa imali ekhona yokulungisa izindleko. Umthola-mpilo owenziwe ngemali yosizo ungase uswele imali yokubuyisela isikhumulo esiphukile noma ukulungisa uphahla oluvuzayo eminyakeni emibili kamuva. Ukuhlolwa kwamachashaza amanzi asemaphandleni ase-saharan Afrika engaphansi kwe-88 — i-athority yezempilo edingayo — uthola ukuthi i-30-40% yayingasebenzi ngemva kweminyaka emihlanu ngenxa yokuntula izingxenye ezigciniwe kanye nokuqeqeshwa. Izinhlelo zosizo zihlanganisa izimali zokulungisa nokuqeqesha kochwepheshe bendawo phakathi nesigaba sokuklama kweprojekthi, kodwa lomkhuba awukatholakali ndawo yonke.

Amasu Okuqeda Ithonya Elikhulu

Ukuze banqobe lezinselele futhi baqiniseke ukuthi usizo lwakwamanye amazwe luletha intuthuko ehlala njalo ezinhlanganweni zezempilo zasemaphandleni, odokotela nabenzi bezimiso baye basungula izinhlelo eziqinisekisiwe.

Ukuba Umnikazi Nokwenza Ingxenye Komphakathi

Ukuhlanganisa abaholi bendawo, amakomiti ezempilo, kanye nabasebenzisi besikhathi esizayo ekuhleleni nasekuqondiseni kwandisa ukufaneleka nokulandisa. Uma imiphakathi inikela ngezwe, umsebenzi, noma izindleko ezincane, iqala umuzwa wokuba nabaphathi okhuthaza ukusetshenziswa okufanele nokunakekelwa. Democratic Republic of Congo] “Democratic Republic of“ [[FLT Zoons"] ukusondela, okusekelwa yinhlangano yentuthuko yase-Belgium, izihambeli zokuphatha eziyinhloko zamakomiti obuchwepheshe asebenza eduze kwamaqembu obuchwepheshe. Imiphumela iye yabonisa amazinga aphezulu e-Rodemocratic kanye nokuphatha amasheya e-make engcono uma kuqhathaniswa nezimiso ezingaphezulu zezenyuksi.

Ukusondela Okungaqinile Nezimiso Zokusondela

Kunokuba kube nemisebenzi ehlukene, izinhlelo zosizo eziphumelelayo ezitshala isayensi yezempilo yonke — kusukela ezisekelweni zezesisekelo nasezintweni zabantu nakwezezimali. iPudent’s Emergency Plan for AIDS Relation [PEPFAR] ekuqaleni zagxila kakhulu kwi-HIV, kodwa kamuva zaqala ukuqinisa imishini yokuhlola izakhi zemvelo, nokuqeqesha izisebenzi zempilo ebhodini, inzuzo kwezinye izinhlelo zezempilo. Ukutshala izimali emanzini, ukukhuculisa indleko, nokudla okuhambisana nokwakha izakhiwo zezempilo kunciphise izinzuzo zezifo futhi kunciphise umthwalo wezifo.

Ukukwazi Ukubusa Kukahulumeni Wasendaweni Kuyaqinisa

Ukwakha ikhono lezikhulu zezempilo zombuso nezombuso zokuhlela, ukuhlela, nokuphatha izimali kubalulekile ekunikezeni usizo. Lokhu kuhlanganisa ukuqeqeshwa ekuqondiseni imali, ekuhlaziyweni kokwaziswa, nasekutholeni imali. IGavi Igcwele Countryssions[ ibonise ukuthi amazwe anezimiso zokulawula ezinamandla kakhulu zendawo athengwa kakhulu ngemva kokusekela iminikelo. I-Ecticc advisss abasebenzi bezobuchwepheshe bemisebenzi yendawo — kunokuba asebenzise amahhovisi amaprojekthi afanayo — liyisu elivamile lokudlulisela amakhono.

Umshini Osetshenziswa ELonggradeTerm

Izimali ezisungulwayo zinganciphisa ukuncika. Izibonelo zihlanganisa izimali ezihambelanayo, lapho abanikelayo befanelana khona nezindawo zikahulumeni wendawo zempilo, kanye nemali esekelwe emalini, lapho izakhiwo zithola khona izimali ezengeziwe ezisekelwe ekulinganiseni nasekusebenziseni. I-World Bank’s Results highised Financing program[ eRwanda nase Burundi zasiza ukwandisa amazinga okuthutha nokugoma lapho kufakwa intengo ekhokha imiphumela eqinisekisiwe. Izindlela ezinjalo ezisebenza kahle kanye nezibophelelo zendawo.

Ukuhlola Izenzakalo Ngosizo Olunethonya

Izibonelo ezimbili ezivelele zibonisa ukuthi usizo lwakwamanye amazwe lungatholakala kanjani futhi kufundwa kanjani ezinhlanganweni zezempilo zasemaphandleni.

PHUTHA] eMadolobheni ase-Forka: yaqala ngo-2003, iPEPFAR ifake imali engaphezu kwamaRandi ayizigidi eziyizinkulungwane ezingu-100 emikhakheni yesandulela-ngculaza, eminingi yayo emitholampilo yasemaphandleni. Yakha noma yathuthukisa izinkulungwane zezindawo zezempilo, yaqeqesha amashumi ezinkulungwane zezisebenzi zezempilo, futhi yasungula iminyango yokucwaninga eyasekela ukuhlolwa kwe-COVHOID 7619. Naphezu kokukhathalela konyaka ngezinhlelo ze-injini, ukuthwebula i-PAPFAR ngokuqinisa izimiso zempilo ezisemhlabeni wonke emazweni anjengeKenya, i-Uganda, ne-Zambia — izisebenzi zasemaphandle zokwelapha kanye nokuphathwa kwe-parthmagement ezithuthukile ngaphezu kwezesayensi ye-HIV.

IGavi’s Vaccine Paregoy in Repeal Aquares: IGVI ixhasa ukukhula kwemishini ebandayo yeketanga, ukunikeza amaketanga, kanye nezinkonzo zokudlulisa ukuze ifinyelele izingane emiphakathini esukela “ka-2001. Emazweni anjengeMozambique ne-Nepal, iGvia yasiza ekuthuthukiseni amathuluzi amancane kakhulu ahlukanisa zonke izingane ezidinga ukujovwa. Ukuhlolwa kwe-British Medical Journal kwalinganisela ukuthi ukugonyelwa kwemijova kwavimbela ukufa okungaphezu kwezigidi ezingu-14 emazweni aphansi e-75in engenisa iminyaka eyishumi, nezindawo zasemaphandleni ezibamba ingxenye enkulu kakhulu yenzuzo.

Isiphetho

Usizo lwangaphandle luyithuluzi elibalulekile lokwakha nokusekela isisekelo sezempilo ezindaweni zasemaphandleni lapho izimali zikahulumeni ziphelelwa khona izidingo. Kusukela ekwakheni imitholampilo egunyazwe yizingxenye zelanga kuya ekuqeqesheni ababelethisi abasindisa ukuphila komama, usizo lwangaphandle lunemiphumela engcono yempilo nokuqina kwesimiso. Nokho izinselele zokwethembela, ukuphambuka, ukukhohlakala, nokufuna impumelelo eqhubekayo. Izinhlelo eziphumelela kakhulu ezisemkhakhenikha, zifaka ishende ekulawuleni kwezindawo zomphakathi wendawo, futhi zihlela ukuguqula kancane kancane kancane ukuba abendlu. Uma lezizimiso zithuthukisa ukuklama, ithonya ekunakekeleni impilo yasemaphandleni ingaba namandla amakhulu futhi ihlale ikhona.

Ekugcineni, usizo lwangaphandle alunakuthatha indawo yesimiso sempilo yomphakathi esigunyazwe kahle, esixhaswa ngokufanele. Kodwa phakathi nonyaka — futhi ngokuvamile njengengxenye yalowo mgomo — lunikeza ingcebo, ubuchwepheshe, namandla adingekayo ukuze kulethe ukunakekelwa okufanelekile kwempilo ezakhamuzini zomhlaba ezikude kakhulu. Ukuze ufunde ngokuqhubekayo ngezindlela zosizo eziphumelelayo, bheka imibiko evela kwiNhlangano yezempilo yeZwe Lonke Yezempilo [[FLT:] [Health Systems Profecincence and Financing ne-World Bank Health, Controtion and Population Globaltics Practice [[FLD]].