Usizo lwamazwe angaphandle ngokuyisisekelo luye lwalungisa isimo sempilo yomphakathi e-Saharan engaphansi kwe-Afrika. Phakathi namashumi amathathu eminyaka adlule, ukuthutheleka okukhulu kwemithombo yemali evela kwabanikeli beminikelo, izinhlangano ezihlukene, kanye nezinhlangano zokusiza ngasese, kuye kwanciphisa ngokuphawulekayo ukufa nokugula okubangelwa yizifo ezintathu zezwekazi zezifo ezibulalayo: iHIV/AIDS, umalaleveva, nesifo sofuba. Isilinganiso sokutshala imali esivela kubantu abanikela ngezimali, izinhlangano ezihlukene, nezinhlangano zezezimali zokusiza ngegazi, kanye nemali yembulunga yonke yokulwa nengculaza (PAFAR) kuye kwaphumela emashumini amashumini ezigidini ezinkulungwane zezigidi zezigidi zezigidi zezigidi zezigidi zezigidi zemali ezwe: iHIV, ukuvikelwa kwemali. Ukuphila okungaphindwayo.

Naphezu kwale mpumelelo ephawulekayo, indima yosizo lwangaphandle empilweni yase-Afrika ayiyona into elula futhi ayigujwa yonke indawo. Ukudalwa kwezinhlelo ezinkulu, eziqondene nezifo kusungula izinhlelo eziyinkimbinkimbi, ezivame ukubhekiselwa kuzo ngokuthi "zimile ngokuqonde ngqo" impikiswano. Abagxeki baphikisa ngokuthi ukugeleza okukhulu kosizo kungadala ukuncika, ukujikijela phambili kwendawo, futhi kululaza izimiso zempilo zomphakathi ezintengantengayo ezihloselwe ukusekela. Izinselele zokonakala, ukubusa okubuthakathaka, nokulawula okunamandla, kanye nezithiyo zokufinyelela imiphakathi ekude nomphakathi ocebesekujuleni kuye kwanciphisa imingcele yemiphumela yosizo. Njengoba umphakathi wembulunga yonke ubheka ikusasa, ukugxila kusuka esibonelweni sokusiza abanikelayo, ukusekelana, ukulawulwa, nokulawulwa kwendawo yendawo. Ukulwa nezifo okuthathela kwezifo ezindaweni ezithelelayo kuyintuthuko, ukuhlasela kwembulunga yonke.

Umlando: Ukusuka E - Alma Ata Kuya Enhlekeleleni Yengculaza

Inkathi yanamuhla yosizo lwembulunga yonke lwezempilo e-Afrika yaqala ukuma inqubo ekupheleni kwekhulu lama-20. ISimemezelo sonyaka ka-1978 u-Alma Ata, esabeka umgomo onamandla we "Ukuphila Kwabo Bonke Ngonyaka ka 2000," samisa ukunakekelwa kwempilo okuyinhloko njengesu eliyinhloko. Nokho, izinhlelo zezomnotho nezinhlelo zokulungisa ukwakheka zoma 1980 no 1990 zazenza buthaka kakhulu izimiso zezempilo zomphakathi kulo lonke izwekazi. Ohulumeni baphoqeleka ukuba banciphise ukusetshenziswa kwezempilo, ukuqeqeshwa, neholo, kwakha incithazo elashiya izimiso zezempilo zisengozini futhi zingekho ngaphansi kwemithombo.

Ukuqhuma kobhadane lwesandulela-ngculaza ngawo-1990 kwadalula izinga eligcwele lalokhu kuwohloka. Emazweni anjengeBotswana, iZimbabwe, ne-South Africa, isilinganiso sokuphila kwabantu nakwezomnotho sehla ngeminyaka engu-20 noma ngaphezulu. Inani labantu nezomnotho laba yinhlekelele. Isikali salenkinga sanqoba izakhiwo zempilo zomphakathi ezibuthakathaka. Zazingekho izindlela zokwelapha e-Afrika; imithi elwa nengculaza eyayiguqula isigwebo sokufa yaba isifo esingamahlala njalo eNtshona yayingenakufiki emalini ezindaweni zohulumeni neziguli zase-Afrika.

Ukusabela enkingeni yengculaza kwaphawula ukushintshwa kwe-paradigm ekusizeni impilo yangaphandle. Ngo-2001] i-United Nations General Assembly yaba neSici Session Esikhethekile ku-HIV/AIDS (UNGASS), imemezela umqedazwe wembulunga yonke. Ngo-2002, i-Global Fund yaqala njengendlela yezimali esunguliwe yokuxhasa izimali zemali eklanyelwe ukuhlanganisa imithombo yemali futhi iqondise ekulweni nengculaza, i-TB, nomalaleveva. Kwabe sekuthi ngo-200, uMongameli uGeorge W. Bush wamemezela i-PEFAR, izigidi eziyizinkulungwane ezingu-5, iminyaka emihlanu, ukuthatha isinyathelo sezempilo kunazo zonke emlandweni owaba yinqubo yempilo enikezelwe ekuguleni kwesifo esisodwa. Le zinhlelo nje zazingasungula izinhlelo ezintsha zokulwa kwemisebe yezidakamizwa, futhi zisakaza izinhlelo ezisebenzayo ezingokwezinkonzo zikahulumeni.

Izifo Ezinkulu, Izimali Ezinkulu: Ithonya Losizo

Ingxenye enkulu yosizo lwezempilo lwakwamanye amazwe e - Afrika iye yathunyelwa ezifweni ezintathu ezithathelwanayo.

I - HIV/AIDS: Kusukela Ekuqothulweni Kwesizwe Kuya Esimweni Esingamahlalakhona

Ekupheleni konyaka ka-2022, ngenxa yomsebenzi we-PEPFAR ne-Global Fund, abantu abangaphezu kwezigidi ezingu - 20 babethola ukwelashwa okusindisa ukuphila ngo 2003.

Ithonya lalesisikali sendlela yokwelapha liyashaqisa. Izinhlelo zengculaza ezihlobene nokufa e-Afrika engaphansi kwe-Saharan ziye zehla ngamaphesenti angaphezu kuka-60 kusukela ekuphakameni konyaka ka-2004. Ukungenwa kweHIV okusha kuye kwancipha ngenkathi engaphezulu kuka-50%. Ukubekwa kokuvinjelwa kukaMama-ukuya ku-Diam-Kuya-MNsana (PTTC) izinhlelo zempumelelo enkulu yezempilo yomphakathi, ukunciphisa izifo ezintsha phakathi kwabantwana abangaphezu kuka-80%. I-UNAIDS "959-95" izinhloso zokuqinisekisa ukuthi abantu abaphila ngeHIV bayazi isimo sabo, 95% kulabo abahlolwayo bayaselashwa empathweni, futhi u-9% walabo abaphethwe yimithwalo yemithwalo yendle. I-Stovo, kuhlanganise namazwe ayizi-Etina, anezinhloso kakade, i-Rwanda, nalezi zindawo eziphambili.

Izinqubo ezixhaswe ngezindlela ezisekelayo ezisetshenziswa usizo lwangaphandle ziye zaba yisihluthulelo sale mpumelelo. Ukusakazwa kobudoda, okunciphisa ukudluliselwa kwesandulela-HIV kufinyelela ku-60%, kuye kwalinganiswa ngokuphawulekayo emazweni aphakeme. Izinhlelo zokufinyelela abantu abayinhloko, njengezisebenzi ezisebenza ngobulili, amadoda ahlanganyela ubulili namadoda, nabantu abafaka izidakamizwa, baye bathuthuka kakhulu. Naphezu kwale ntuthuko, izinselele eziphawulekayo ziyaqhubeka. Izinga lokukhula phakathi kwamantombazane nabesifazane abasebasha eNingizimu Afrika kuhlala kunesimo esinzima. IStigma nobandlululo luyaqhubeka ukuvimbela ukufinyelela izinkonzo eziyinhloko zabantu. Futhi kunengozi eyandayo yokukhathala ngenxa yesimo esiphuthumayo, isilinganiso esithatha isikhathi eside.

Umalaleveva: Ukulwa Isikhathi Eside Nombulali Wasendulo

Umalaleveva ulokhu ungenye yezimbangela eziphambili zokufa kwabantwana abangaphansi kweminyaka emihlanu e-Afrika. Emashumini amaningi eminyaka, ukulwa nesifo kwakunzima kakhulu. Ukuqubuka kobudlelwane be-roll Back Malalearia ngo-1998 kanye nokusungulwa kwe-Global Fund ne-U.S. uMongameli we-Malaria Initivery (PMI) yawushintsha kakhulu umhlaba wezezimali. Ukusetshenziswa kwembulunga yonke ekulawuleni umalaleveva kuye kwasindisa ukuphila okulinganiselwa ezigidi ezingu-11,7 kusukela ngo-20000.

[[FLT:] Impatho enkulu exhaswe usizo lwangaphandle ihlelwe kahle futhi iphumelela kakhulu.

  • [FLT]]][FLT]][FLT]][[FLT]] I-Incaticide (TTNS) I-infect (TNS): [[FFOTN]] Inethi enkulu] inetshena lokuvinjelwa. [[12] Imivumbo ibonisa ukuthi izakhiwo ezingaphezulu kwezingu-Saharani ezikhuphukelelwe kakhulu manje, ukwanda okuphawulekayo [[FFT:] [FT6] [FT:] [FT] [5] [5] [5] ngaphezu] izipheshalome zemivu engcono kakhulu] [impaza engcono kakhulu] [impaphekelele, i-fucunyu] izizuzo ezingcono kakhulu] [ingeni elingcono kakhulu] [ezi ezingcono kakhulu] [f] [f] [f] [f]

    Imiphumela iye yaba mikhulu. INhlangano Yezwe Yezempilo ilinganisela ukuthi amazinga okufa kukamalaleveva e-Afrika ancipha ngama-50% kusukela ngo 2000, amazwe amaningana asengcupheni yokususwa. Nokho, intuthuko iye yaphela eminyakeni yamuva. Ukuvela nokusakazeka kwezibulala zinambuzane ezibulala izinambuzane ezibulala imilaliso nokumelana nezidakamizwa ezifweni ezilwa namagciwane kuyizinsongo ezingathi sína. Ngo-2021, i-WHOOM ivumela ukugonywa kokuqala komalaleveva, i-RTS,/AS01, futhi manje incishintshwa emazweni asebenza ezindizayo. Umjovo wokugodi oshizayo, R1/Matrix-M, futhi ivunyelwe. Ukufakwa kwalezizinto zokugoma, kanye nokuvinjelwa okuqinile, kuzoba inseleleka ka-RTS, futhi kunezinsi ezisethi ezilandelayo.

    Isifo Sofuba: I - pandemic Endala Kakhulu Nenselele Ye - MDR - TB

    I-TB iyisifo esithathelwanayo esibulala kakhulu emhlabeni, esibulala abantu abangaphezu kwezigidi ezingu-5 ngonyaka. Nakuba ivame ukumbozwa yigciwane lesandulela-ngculaza nomalaleveva, i-TB ihlala iyinkinga enkulu e - Afrika, ebangela amaphesenti angaba ngu 25 abantu abaphethwe yimbulunga yonke. Ukuhlangana kwezifo ze-TB negciwane lesandulela-HIV kubulala kakhulu; i-TB iyimbangela ephambili yokufa kwabantu abanegciwane lesandulela-HIV.

    Usizo lwe-Fotrut luye lwaba lubalulekile ekumelaneni ne-TB e-Afrika. INgxowa-mali yembulunga yonke ingumphaka wezinhlelo ze TB enkulu kakhulu, inikeza izimali eziningi kakhulu emhlabeni wonke ukuze ixilonge, ukwelashwa, nokuvinjelwa. INhlangano yempilo yeZwe Lonke Yokuhlola Ngokuqondisisa, i-Short-course (DOTS), kanye nolandela kuyo, i-Stop TB Strategy, inikeza uhlelo lwezinhlelo zesizwe. Isilinganiso esikhulu se-GeneXerbert, esingacustom semishini yokuhlola i-TBPracle, engacubungela i-TB futhi ikwazi ukumelana nokwenqaba phakathi namahora amabili, iye yaba yinqubo enkulu, isekelwe kakhulu ngosizo.

    Inselele enkulu kakhulu ekusabeleni kwe TB ukwanda kweminye imidansi ye-Drug Diffant TB. Ukwelapha i-MDR-TB kuthatha isikhathi eside, kubiza, futhi kunobuthi, okudinga izinyanga zemijovo yansuku zonke nemithi eminingi. Kuze kube muva nje, isilinganiso se-MDR-TB sasiphansi kakhulu. Ukuthuthukiswa nokusetshenziswa kwemithi emifushane, yonke imilaliso yezidakamizwa, njenge-BPAL, ifuna ukwelashwa okushintshwa, kodwa ukufinyelela kule mithi emisha kuhlala kulinganiselwe emazweni amaningi ase-Afrika ngenxa yokungabhaliswa. Igebe elikhulu phakathi kwabantu abaqalayo nenani eliye latholwa futhi abelashwa enye inkinga enkulu. Inkinga eyanda kakhulu.

    Izinselele Nezimpikiswano: Olunye Uhlangothi Losizo

    Kukho konke ukuphumelela kwayo, isibonelo esivelele sosizo lwangaphandle lwezifo ezithathelwanayo e - Afrika siye sabhekana nokugxekwa okungathi sína nokuqhubekayo.

    Ingxoxo eqonde dindilizi

    Isimiso esiyisisekelo siphathelene nokwakheka kwezindlela zempilo zembulunga yonke. "Izinhlelo eziqhamile" njenge-PEPFAR ne-Global Fund ziqondene nezifo, ezinemifudlana enikezelwe ngokwezimali, inikeza amaketanga, kanye nezakhiwo zokuphatha. "Izinhlelo ezimhlophe" zihlose ukuqinisa izimiso zempilo zonke. Abagxeki, kuhlanganise nezibalo zempilo ezivelele njengoLaurie Garrett, baye baphikisa ukuthi izinhlelo ezinkulu zezokuhla ze-tektha zezwe zingasonta izinto eziza kuqala zesizwe futhi zidala izimiso ezihlobisa imithombo esetshenziselwa ukunikeza inzuzo engokwempilo eyisisekelo. Abasekeli baphikisa ukuthi izinhlelo ezimile zifeza impumelelo, imiphumela esheshayo, eqinisweni, ziqinisa izimiso zezempilo ngokwakha izakhiwo nokuqeqesha izisebenzi. Iqiniso inselele ukuklalwa ngokuqonde phezulu.

    Ukuncika Nokuzinza

    Ukwesaba okuphikelelayo ukuthi usizo lwakwamanye amazwe lubangela ukuncika. Kwenzekani uma amapheya noma i-Global Fund esekela ukusekela kwawo? Ukuxhasa kwezezimali zasekhaya nempilo emazweni amaningi ase-Afrika kuhlala kuphansi kakhulu, ngaphansi kakhulu kwe-Abuja Declaration ye-15% ye-GDP. Abanye ohulumeni baye bephuza ukuthatha izindleko zezinhlelo, belindele abanikeli ukuba baqhubeke ngokungenasiphelo. Ukuguqula izimali ezisemfashinini ukuze basekele ubunikazi kuse ekhaya kubucayi, futhi ngokuvamile akuxazululeki. Umbono "Obaiory," isimiso esiyinhloko se-Intectrio on Aid Effectiveived, ngokuvamile kuye kwabonakala kunzima ukuzisebenzisa lapho abanikeli besekela ukulawula okuphawulekayo ekusekeleni imali kanye nezinto eziza kuqala.

    Ukubusa Nokonakala

    Izimali eziningi ezithunyelwa ezimisweni ezingaqondi kahle ziyinqubo yokulahla indle nenkohlakalo. Kuye kwabikwa amacala enkohlakalo emalini emali ekhokhelwayo yembulunga yonke nezinye izinhlelo zosizo, lapho kwebiwa khona izidakamizwa, izisebenzi zezipoki zakhokhelwa, futhi izivumelwano zanikezwa izinxulumani zezombangazwe. Nakuba kokubili i-PEPFAR ne-Global Fund iye yaqinisa ukuqondisa kwazo kanye nokuziphendulela, inkohlakalo ihlala iyisithiyo enkulu ekuqinisekiseni ukuthi wonke amadola afinyelela abani abafuna ukuzuza. Izimiso zezempilo ezilula nokunikeza imishini elinganiselwe yokuphatha amaqembu ezombangazwe emazweni amaningi futhi iholele ekunakekeleni inzuzo ephawulekayo yezidakamizwa, njengasezingeni eliphezulu yezezenzweni nemithi esekhona.

    Impahla Nendlela Yokuthola Imithi

    Izindleko eziphakeme zemithi egunyaziwe kwakuyinkinga enkulu enhlekeleleni yengculaza. Ukusungulwa kweNgxoxo yembulunga yonke ngokwengxenye kwakuyisehlolo sesidingo sokunikeza i-Dibraltion. Ukusetshenziswa kwezidakamizwa ezikwaziyo, okwasiza ngo-2001 iDoha Declaration eTRIPS Active and Public Health, izindleko zokusetshenziswa kwemithi ezibizayo ezisukela ku-R3,50 ngonyaka kuya ku-R360 ngonyaka. Lempi iyaqhubeka namuhla ngaphezu kwezidakamizwa ezintsha ze-MDR-TB kanye nesibindi sohlobo C, kanye ne-Priging ye-CHOP ye-CHOVID kanye nemijovoID nezindlela zokwelapha. Ukulwela ukutholakala kwemithi engatheki. Ukulwa kwemithi kusemfa ingundabhreance kusemsebenzi oyinhloko wosizo lwakwamanye amazwe nangaphansi kwe-R3 000 ngonyaka.

    Ikusasa Losizo: Ukushintsha, Ukulingana, Nobunikazi

    Imbulunga yonke yempilo ishintsha ngokushesha. Umqedazwe we-COVOVID-19 wadalula ukuwohloka kwezimiso zezempilo kuyo yonke indawo futhi waqokomisa ukungalingani okujulile kokuthola imithi yokugoma, yokuxilonga, neyokwelapha. Uhlelo olusha losizo lwangaphandle luvela, olugcizelela ukuqina, ukukhiqiza nokusekela kwemali.

    Ukwakha Izimiso Zempilo Ezilinganiswayo Nezokulingana

    Kukhona ukuvumelana okukhulu kokuthi ukugxila kuphela ezifweni ezithile akwanele. Ikusasa losizo lwangaphandle lisekuqiniseni izisekelo zokwakha izimiso zezempilo: izimali, izisebenzi, izinhlelo zokwaziswa, amaketanga, nokuthunyelwa kwenkonzo. Ukushaqeka kokuqubuka kwe-Ebola eNtshona Afrika (204-2016) kanye nobhadane lweCHOVID-19 luye lwandisa lombono. I-World Bank’s Pandemic Fund, eyasungulwa ngo-2022, iyinqubo entsha yezimali ehlukene enikezelwe ukuqinisa ukuvimbela umqedazwe, ukuphenya, ukulungiselela, nokusabela (PPR) emazweni aphansi naphakathi afikayo.

    Ukuthungatha Kwendawo Nohlelo Olwase-Afrika Olusha Lwempilo Yomphakathi

    Enye yentuthuko ebaluleke kakhulu ukusungulwa kwemisebenzi yempilo yendawo e-Afrika. Izwekazi lingenisa amaphesenti angaphezu kwangu-70 emithi yalo kanye no-99% emijovo yalo. I-African Union ibeke umgomo onamandla wokwenza amaphesenti angu-60 emijovo edingekayo kuleli zwekazi ngo-2040. Izindlela ezinjengamaPricenternepy e-Afrikan Vaccine Manufacting (PAVM) kanye nophuhliso lobuchwepheshe be-mRNA yokugoma i-mmuthi odluliselwa eNingizimu Afrika ziyizinyathelo eziqinile zokuncitshiswa komkhiqizo bakwamanye amazwe nokwakha amandla esayensi yendawo.

    Izimiso Zezempilo Nezokuxhumana

    Ubuchwepheshe buguqula ukunikezelwa kwempilo. Izinhlelo zezokuhlinzwa kwe-mobile (mHealth) zisebenzisa i-SMS kanye nocingo ukuze zithumele izikhumbuzo zokwelapha, i-data ye-octractal, futhi zinikeze imfundo yempilo. I-Agency ye-International Development (USAID) ne-PEPFAR isebenzise imali eningi kakhulu empilweni yeze-mini. Ukunikeza okudume kakhulu ngenkampani i-Zipline, kuletha igazi, imijovo, nemithi ezindaweni ezikude eRwandayo naseGhana. Imisebenzi yezempilo yomphakathi (CHWS) iqashelwa njengesisekelo se-Topiyase. Izindawo ze-Topiya, nesimiso sayo sezempilo, zibonise ukuthi i-ChylvalProbian, i-octived promistling i-factivesssssswork i-evey engcono kakhulu.

    Ukuhweba Ngezindlu Nokushintshelwa Ezweni

    Umgomo othatha isikhathi eside ukusebenzela amazwe ase-Afrika ukuba asekele izimiso zawo zempilo. Lokhu kudinga ukukhula kwezomnotho, izimiso zentela eziqhubekayo, nentando yezombangazwe. Kugcizelelwa kakhulu "usizo olusebenzisa izimali zasekhaya. IGlobal Fund's cone-paneisence, egunyaza ukuba amazwe andise imali yawo siqu emakhaya empilweni, iyisibonelo sokuthi abanikeli bangayisebenzisa kanjani ukuba abe ngumniniyo. Ingxoxo iyasuswa ku "umfela-repiement" ukuya ku "ubudlelwane bezentengiselwano," lapho ohulumeni nezinhlangano baseAfrika behola khona ekuhleleni izinto eziza kuqala nasekuqondiseni izinhlelo zezokusekela izinhlangano zezizwe ngezizwe.

    Isiphetho

    Usizo lwangaphandle luye lwabangela olunye lwezinguquko eziphawulekayo zempilo yomphakathi emlandweni wanamuhla. Ukulwa nesandulela-ngculaza, umalaleveva, nesifo sofuba e-Afrika kuye kwahlangana ukuze kwakhe izinhlelo ezinkulu, futhi kusindise amashumi ezigidi zabantu. Umgomo wokuqeda lezi zifo njengezisongela impilo yomphakathi ezinkulu ngo-2030, kuyilapho kuseyinselele enkulu, useseduze kakhulu ukuba kube khona kunanini ngaphambili.

    Indlela phambili idinga ukuziphendukela kwemvelo efekthri yosizo lwakwamanye amazwe. Idinga ukubambisana okuvuthiwe, okulinganayo okudlula ukudluliswa nje kwemali. Kudinga ukugxila ekwakheni izikhali eziqinile, izimiso zempilo eziklanywe endaweni ezingasingatha izifo zanamuhla futhi zilungiselele izifo eziza kuqala zakusasa. Isahluko esilandelayo asikho "ukushiya i-Afrika" ngesisa esikhuthazweni sangaphandle, kodwa ngokufaka imali empilweni ehlanganyelweyo. Impumelelo izochazwa ngokushintsha okungenamthezelelwe ekusekeleni inzuzo yosizo emakhaya, kusukela ezimisweni ezimile ukuya ezimisweni ezihlanganisanayo, nakusukela ezimisweni ezithathelwa phambili ezinikezwa iminikelo ukuze ikhiphe izixazulu zendawo. Izigidi zokuphila ziyisivumelwano sokuzuza ngezenzo ezihlanganye, kodwa umsebenzi uphelile.