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treatment EQUAL
September 2009Magazine for the Treatment Action Campaign
Igciwane lesandulela ngculaza kanye nesifo sofuba amandla azo Awashoni phansi
Ukuchazwa kwesiteleka sodokotela | Konke mayelana nomkhankaso we-TAC we-Resources for Health | Ukusokwa: Yikuphi esidinga ukukwazi
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Issue 29 - September 2009IsiZulu
amakhasi 2–6
Postal Address: PO Box 2069, Cape Town
8001.
Physical Address: Westminister House,
122 Longmarket Street, 3rd Floor, Cape
Town 8000.
Phone: 0861 END HIV
Fax: +27 21 422 1720
Website: www.tac.org.za
Provincial and District TAC offices
Western Cape Province: 021 447 2593
Khayelitsha District: 021 364 5489
Ekurhuleni District: 011 873 4130
Limpopo Province: 015 291 5448
Elim District: 015 556 3341
Mpumalanga Province: 013 755 2298
Eastern Cape Province: 043 743 7143
Lusikisiki District: 039 253 1951
Queenstown District: 045 838 1364
Kwazulu-Natal Province: 031 304 3673
Pietermaritzburg District: 033 394 0845
Ilembe District: 032 552 5160
Equal Treatment is published by the Treatment Action Campaign.
Umhleli: UMarcus Low
Umsizi womhleli: UMara Kardas-Nelson
Umhleli wezithombe: UMara Kardas-Nelson
Umhleli wekhophi: UCathy Goudie
Isithombe Esikwikhava: Amalungu e-TAC amashela Izinsiza zezeMpilo kwingqungquthela ye-IAS, eKapa, mhla ziyi-19 kuJulayi ka-2009. Isithombe sithathwe nguSamantha Reinders.
Ababenegalelo: UNonkosi Khumalo, uCatherine Tomlinson, uPoppy Riddle, uRebecca Hodes, uElizabeth Sutcliffe, uOlivia Adams, uJessica Vernon, uPouya Gharavi, uLynn Elharake, uNathan Geffen, uZapiro, uNicoli Nattrass, noGregg Gonsalves.
Abathathe izithombe: Samantha Reinders, David Goldblatt, Geoffrey York/The Globe and Mail, Oupa Nkosi/The Mail & Guardian, Eugene Arries, Adam Malapa, Francesco Zizola / Noor, couresty MSF, Campaign Against Arms Trade, Tandeka Vinjwa.
Kubongwa ngokukhethekile: UVeloshnee Govender, I-ARASA, ne-Openly Positive Trust.
Ohambisa amakhophi: UKagiso Seleka
Ukuma kwephephabhuku: Abakwa-Designs4development, ku-www.d4d.co.za
Ukuphrintwa: Abakwa-CTP Book Printers
Ihumushwe yi: Takalani Translation Services
I-TAC izinikele ekuhlinzekeni abantu abanegciwane lesandulela ngculaza, imindeni yabo kanye nababanakekelayo imininingwane ekuyiyonayona emayelana nemithi esindisa izimpilo kanye nokwelashwa. I-TAC kanye nabaholi bayo izimele ayisebenzisani nezimboni zosokhemisi kanye nalezo zimboni zeminye imithi engasetshenziswa futhi ayinazo izinhloso
zezezimali kuzo.
OKUQUKETHWE
amakhasi 7–9
amakhasi 10–21
amakhasi 22–27
Isiteleka sodokotelaIsiteleka sodokotela sesibe undabuzekwayo ezinyangeni ezisanda kudlula. Ziveza ukuthi bemayelana nani nokuthi sihlangane kanjani nenkinga yezinsiza jikelele.
Inkinga yezomnotho kanye nezempiloIqale eMelika, kodwa inkinga yesimo somnotho isizwakala emhlabeni wonke. Sibheka ukuthi kuhambisana kanjani konke nokuthi kusho ukuthini ekunakekelweni kwezempilo.
Izinsiza zezempilo Ukubona ukuthi kunenkinga yezinsiza yenye into, kodwa ukulungisa leyo nkinga ngendlela efanele kuyenye into. Sibheka kabanzi ukuthi umkhankaso we-TAC we-Resources for Health campaign ukuthi ungani, nokuthi uSello Mokhalipi wabagqugquzela kanjani abantu basesifundazweni sase-Free State nokuthi kungani sekunezwi lokuphendukela ukufakwa kwemali kokuqondene negciwane lengculaza akuwenzi umqondo.
ezesayensi kanye nezincwadi ezigabeni zokugcina zalo mbhalo sibheka ukusoka njengengxenye enkulu yendlela yokuvimbela igciwane lesandulela ngculaza, uNathan Geffen usinika ulwazi lwakamuva ngokuphathelene nesifo sofuba, bese sihlaziya nezinye izincwadi okumele uzifunde zezempilo.
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Seside isikhathi kukhalwa emiphakathini, yomibili esemaphandleni kanye naleyo esemadolobheni mayelana nesimo sohlelo lomphakathi lwezokunakekela kwezempilo eNingizimu Afrika. Lezi zindaba azivezi konke ngokungasebenzi ngendlela efanele ukwehluleka kukahulumeni ukwenza izinsiza zibe khona kanye nokwaba imali ngendlela efanele. lokhu kungengameli ngendlela efanele sekuholele kwizimo ezifana nokushoda kwemishanguzo yegciwane lengculaza okwenzeka esifundazweni sase-Free State ngo-2008-2009.
Isibonelo sakamuva nje salokhu yisesibhedlela sase-Edendale ePietermaritzburg, esimise izinhlelo zaso zokwelapha ngoMeyi walo nyaka ngenxa yokuthi uhlelo lwezokwelapha lwegciwane lesandulela ngculaza kanye nesifo sengculaza lungenabo abasebenzi abanele noma indawo yokukwazi ukubhekana nezinye iziguli. UNgqongqoshe wezeMpilo esifundazweni saKwaZulu-Natali uDkt Sibongiseni usesuse esikhundleni umphathi wesifunda wezempilo uMay Zuma-Mkhonza ngenxa yokuhluleka ukwengamela isimo sokukhishwa kwemishanguzo yegciwane legculaza esibhedlela sase-Edendale futhi okokwelapha sekuqalile ukukhishwa futhi ngosizo lwabafake izimali baphesheya.
Kwi-National Strategic Plan (NSP) 2007–2011, uhulumeni waseNingizimu Afrika wazibophezela ekwehliseni ukutheleleka ngegciwane lesandulela ngculaza ngama-50% kanye nokufaka kuhlelo okungenani ama-80% abantu bakithi abadinga imishanguzo yesifo sengculaza kungakashayi u-2011. Ngokwezinga lamanje lokuqalisa, sikude kakhulu nokufinyelela kulokhu esikuphokophele. Izibalo zakamuva zikhomba ukuthi kunabantu abangaphezu kwama-630,000 abakwimishanguzo yesifo sengculaza uma kuqhathaniswa nezigidi ezingama-1.4 ngokwesikuphokophele.
Uma sibheka kwisabiwomali sezifundazwe segciwane lesandulela ngculaza kanye nesifo sengculaza, kulula ukubala ukuthi angeke kube nemali eyanele yokufaka abanye abantu kuhlelo lokwelapha, kungabalwa ukubhekana nezindleko zalabo asebebele bethatha imishanguzo yesifo sengculaza. Isabiwomali saseLimpopo sivumela iziguli eziyizi-50,582 kwimishanguzo yesifo sengculaza. Kodwa, ngokwezibalo zoMnyango wezeMpilo, sekuvele kunabantu abangama-49,421 kwimishanguzo yesifo sengculaza futhi isibalo uma sesiphelele sikhipha iziguli eziyi-1,161 kuphela ezintsha nezizokwazi ukuhlinzekwa kulo nyaka wezezimali. Noma kunjalo, ziyizi-22,000 kuphela iziguli ezaqaliswa kwimishanguzo yesifo sengculaza
Okuphathelene nomhleli kuphela kwisifundazwe ngonyaka odlule, kungenzeka ukuthi eziningi zizodinga ukwelashwa kulo nyaka. Ngoba kunemali eyanela iziguli ezingaphansi kancane kwe-1,500 ukuthi ziqale ukwelashwa, ezingaphezu kwezi-20,000 ezingeke zikwazi ukuthola lawa maphilisi asemqoka nasindisa impilo. Ukungengameli ngamabomu izimali kuchaza ukuthi izinkulungwane zabantu baseNingizimu Afrika abangakwazi ukuya ekunakekelweni kwezikhungo ezingekho ngaphansi kukahulumeni zizosala ngaphandle kokwelashwa.
Esinye isibonelo senzeka ngoMeyi ka-2009 lapho uNgqongqoshe wesifundazwe wezeMpilo eGauteng, akhipha izwi lokuxolisa komama ebebengakwazi ukuthola ubisi oluyimpuphu lwabantwana babo. Lokhu kwenzeka ngenxa yokuthi abahlinzeka ngale nsiza babengakhokhelwe, akwaholelela ekutheni izibhedlela kanye nemitholampilo eGauteng zingalethelwa ubisi. Lokhu kwakungekona okokuqala, njengoba i-TAC kanye ne-AIDS Law Project (ALP) babika imibiko efanayo ngo-2008 ngenxa yokushoda esifundazweni saseMpumalanga. Ingozi yokuthelela abantwana inkulu komama abancelisa abantwana babo.
I-TAC isibambe imihlangano, amamashi kanye nezivimbelo ezindaweni ezifana nezifundazwe zase-Free State kanye naseGauteng ukuze ikhombise ukuhambisani nokwehluleka ukuhlela. Ukuhlela akukaze kwenziwe ngeqiniso ngokuphathelene nezidingo noma umthwalo wesifo, futhi akukaze kuholele ekwabiweni kwezinsiza ngendlela efanele.
Lena akuyona inkinga yaseNIngizimu Afrika kuphela. Izibonelo zamazwe angabeli ngendlela efanele ezempilo imali kungabonakala kwizinto abanye ohulumeni abakhetha ukuzenza zokutakula amabhizinisi amakhulu kunokuthi kunyuswe imali kwezenhlalakahle. Ezempilo yinto enhle emphakathini nayo edingayo ukutakulwa. Izoba miningi imiphumela engemihle okuhlanganiswa kuyo nokulahleka kwezinye izimpilo, uma ezempilo kanye nohlelo lokunakekelwa kwezempilo kungabiwela imali ngendlela efanele. ukwehlisa izindleko manje kuzokhokhwa yizimpilo esikhathini esizayo.
UNonkosi Khumalo, usihlalo
we-TAC
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Ibhalwe nguCatherine Tomlinson
Ukushoda kakhulu futhi kwezisebenzi zezempilo kungezinye zezingqinamba ezinkulu ekwenzeni ngcono ukunakekela kwezempilo eNingizimu Afrika kanye nasekufinyeleleni kokuphokophelwe mayelana nokwelashwa kwegciwane lesandulela ngculaza kanye nokuvimbela ukutheleleka okubhalwe kwi-National Strategic Plan (NSP).
yokuntuleka kwabasebenziUkungakwazi kweNingizimu Afrika ukuheha abasebenzi bezempilo kwizikhungo zikahulumeni – kanye – nokuzigcina zilapho
Ukudluliselwa kwemisebenziUkuze kubhekanwe nenkinga yezisebenzi uhulumeni kumele athathe isinyathelo sokunyusa inani labasebenzi bezempilo eNingizimu Afrika. Lokhu kungenziwa ngokudluliselwa komsebenzi osuka kodokotela uye kubahlengikazi uphinde ususwe kubahlengikazi uye kubasebenzi bezempilo abasebenzela emphakathini, kanye nokuheha bese kugcinwa odokotela kanye nabahlengikazi abasha.
Ukususwa kwemisebenzi kodokotela iye kubahlengikazi isuswe kubahlengikazi iye kwizisebenzi zezempilo ezisebenza emphakathini kunconywa i-World Health Organisation (WHO) emazweni lapho kushoda khona izisebenzi zezempilo njengaseNingizimu Afrika. Ukudlulisela umsebenzi kuzokwehlisa umthwalo kwizisebenzi zezempilo bese kunyusa inani leziguli ezithola ukwelashwa.
Ukususwa komsebenzi kodokotela uye kubahlengikazi kuzovumela abahlengikazi ukuthi baqalise iziguli ezintsha kwimithi yokwelapha. Ukuqalisa okwenziwa abahlengikazi kwegciwane lesandulela ngculaza kufakiwe kwi-National Strategic Plan (2007-2011) ukuze kunyuswe ukufi nyelela kokokwelapha. Kodwa lokhu bekungakenziwa uMnyango wezeMpilo.
Ukudluliselwa komsebenzi kumele kwenziwe futhi ukusuka kubahlengikazi ukuya kwizisebenzi zezempilo ezisebenzela emphakathini. Izisebenzi zezempilo ezisebenzela emphakathini zingeza imisebenzi efana nohlolela igciwane lesandulela ngculaza, ukubheka ukuthathwa ngesikhathi nangendlela efanele kwemithi, kanye nokubheka ukuthi iziguli ziphindele yini kwizikhungo zezempilo ngezinsuku ezifanele kanye nokuhlola isisindo somzimba kanye nezimpawu ezibalulekile kwisiguli. Izisebenzi zezempilo ezisebenza emphakathini zingathuthukisa futhi ukuthi kutholakale
okokwelapha ngokwenza okokwelapha kutholakale ezindaweni ezisemaphandleni.
ODokotelakanye nenkinga
Isiteleka sodokotela esaqala ngoMashi ka-2009, sagqamisa izizathu zamazinga aphansi ezwe okuheha kanye nokugcina odokotela. Ukusombulula lezi zingqinamba kubalulekile ekusombululeni inkinga yokushoda kwezisebenzi.
Odokotela baseNingizimu Afrika bafuna izimo zokusebenzela ezingcono. Bafuna nokukhokhelwa kahle kanye nokwenziwa ngcono kwamathuba okudlulela phambili ngokomsebenzo nge-Occupational Specific Dispensation, noma i-OSD (bheka ikhasi 6).
Ucwaningo oluzimele olwenziwa yi-South African Medical Association (SAMA) lwathola ukuthi odokotela babekhokhelwa imali encane kunaleyo okumele ngabe bakhokhelwa yona ngama-50% kanye nama-75%. Lesi sibalo sisetshenziselwe njengesokuqhathanisa odokotela abatelekile abafuna ukunyuselwa amaholo. Bacela nokwenziwa ngcono kwezimo zokusebenza. Okubakhathazayo kuhlanganisa ukusebenza amahora amade, ukungakhokhelwa isikhathi esengenziwe (overtime), ukungabikho kwezinto kanye namathuluzi okusebenzela ayisisekelo, ukungenganyelwa ngendlela efanele kanye nokungabiwa ngendlela efanele kwezinsisa uMnyango wezeMpilo.
Inkinga yokushoda kwezisebenzi kwizikhungo zokunakekela zezempilo zikahulumeni kwenziwa kubi nakakhulu ukukwabelwa ngokungalingani kwezinsiza phakathi kwezikhungo zikahulumeni kanye nalezo ezizimele. Kuphinde kwenziwe kubi nakakhulu ukuthuthela kwamanye amazwe, kanye nezifo eziwubhubhane okuyigciwane lesandulela ngculaza kanye nesifo sengculaza nesifo sofuba.
Ukushoda kwezisebenzi kusho ukuthi odokotela kwizikhungo zikahulumeni basebenza amahora amade kakhulu. Babheka inani eliya likhula nekunzima ukulengamela leziguli. Lokhu kunomthelela ongemuhle kwikhwalithi yokunakekela odokotela abangakwazi ukukuhlinzeka isiguli ngasinye. Umphumela walokhu ukuthi, ngemuva kokuqeda ukufunda besebenza okuyiminyaka emibili kanye nonyaka owodwa wokusebenzela umphakathi, odokotela abaningi abafisi
ukuhlala kwizikhungo zikahulumeni.
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Kungani sinodokotela abambalwa kangaka kwizikhungo zikahulumeni?Minyaka yonke bayi-1 200 abafundi abathola iziqu zobudokotela eNingizimu Afrika- abangama- 50% kubona bathuthela kwamanye amazwe.
Bangama-600 odokotela abasele – ama-75% abo aya kwizikhungo ezingekho ngaphansi kukahulumeni (private sector).
Bayi-150 odokotela abasele – ama-75% abo aya eNtshonalanga Kapa, EGauteng kanye nakwezinye izindawo ezisemadolobheni.
Lokhu kushiya 35odokotela abangama-35 kuphela abasalela ukusebenzela izindawo ezisemakhaya kuzo
zonke izindawo ezisemaphandleni kuleli.
* Le mininingwane yenziwe i-Health Systems Trust kanye ne-frica Health Placements
• Kuqikelelwa ukuthi babili kokuthathu odokotela baseNingizimu afrika abasebenza kwizikhungo ezingekho ngaphansi kukahulumeni, abasebenzela abantu abangama-14% esizwe.
• Uhlelo lwezempilo olungaphansi kukahulumeni selulahlekelwe abasebenzi kusukela ekupheleni kweminyaka yawo-1990. Njengamanje kunezikhala eziyi-11,000 zodokotela kwizikhungo zezempilo zikahulumeni.
• Eminyakeni edlule eyi-11, nangaphandle kokunyuka kakhulu kokudingeka kwezinsiza zezempilo zomphakathi, futhi nangale komthwalo wesifo sofuba kanye negciwane lesandulela ngculaza, inani labasebenzi kwizikhungo zezempilo zomphakathi azikaze zinyuke.
• Umgomo woMnyango wezeMpilo wokungaqashi kulezo zikhala zomsebenzi okuhamba noma kuthathe kuzo umhlalaphansi odokotela nakho sekwenze buthakathaka kanakhulu uhlelo lwezempilo. Kwengeza nakumthwalo wodokotela basele kwizikhungo
zikahulumeni.
Umthombo: Health Systems Trust, ‘South African Health Review’ (2006) p.475; ‘A Roadmap for the Reform of the South African Health System’, Draft final report, (8 November 2008) p.19-20.
Ukuntuleka kwezinsiza kanye nokushoda kwezisebenzi zezempilo kuphetha ngezinga elingelihle lokunakekelwa kweziguli. Lapha iziguli ze-cholera zelashwa ngokungatheni emnyango eMusina. Isihtombe sithathwe u-Oupa Nkosi/i-The Mail & Guardian.
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Isiteleka sodokotela
Ngo-Ephreli ka-2009 odokotela baqala ukutelekela
amaholo angcono kanye nezimo zokusebenzela
ezingcono. Mhla zinga-25 ku-Ephreli ka-2009 iNkantolo
yaBasebenzi yanquma ukuthi leso siteleka sasingekho
emthethweni. Noma kunjalo, odokotela baqhubeka
nokwesabisa ngokuthi bazoteleka uma abukufunayo
kungenziwa.
Okwamanje akukho emthethweni ukuthi odokotela
bateleke ngoba asikho isivumelwano esikhona phakathi
kodokotela kanye nohulumeni mayelana namazinga
amancane okuhlinzeka ngezinsiza ngesikhathi
kutelekiwe. Uhulumeni uthatha konke ukuhlinzekwa
ngezidingo zezempilo njengokusemqoka, okwenza
kungabi semthethweni ukuteleka ngaphansi kwe-Labour
Relations Act 66 ka-1995 (LRA). ISigaba 65 (1) (d) se-LRA
sivimbela ukuteleka kanye nokuvalelwa ngaphandle
kwimisebenzi esemqoka kanye neyokulungisa izinto.
UMthetho uchaza imisebenzi esemqoka njengaleyo,
uma ingaphazamiseka, ingabeka izimpilo engozini
noma impilo yesizwe sonke engozini noma ingxenye
yaso, imisebenzi yasePhalamende kanye nophiko
lwamaphoyisa aseNingizimu Afrika.
Ukuze odokotela baseNingizimu Afrika bakwazi genela isiteleka ngokusemthethweni kumele bafinyelele kwisivumelwano nomqashi wabo mayelana ngezinga elincane lomsebenzi ongenziwa ngesikhathi kutelekiwe. Lezi zinga elincane lizokwenza isiqiniseko sokuthi isiteleka asibeki engcupheni izimpilo zabantu, ukuphepha komuntu noma impilo yesizwe. Odokotela abasebenzela isikhungo zikahulumeni kumele baxoxisane ngesivumelwano sikazwelonke noMnyango weMisebenzi yoMphakathi kanye Nokwenganyelwa kwayo. Lo Mnyango yiwona ongumqashi wazo zonke izisebenzi ezikumacandelo okusebenzela umphakathi. Ngezinhloso ezithile, ezihlanganisa ukuxoxisana ngamaholo . noma isiphi isivumelwano sezinga elincane kakhulu lokuhlinzeka ngezinsiza okuzovunyelwana ngalo kumele ligunyazwe iKomidi Lemisebenzi Esemqoka (Essential Service Committee). Uhulumeni awuzange uvume imizamo edlule yokufinyelela kwisivumelwano esifana nalesi. Noma kunjalo ngesikhathi sesiteleka imitholampilo kanye nezibhedlela eziningi azizange zivalwe zazebenza ngabasebenzi abambalwa. Ukwenqaba ukufinyelela kwizinga elincane kakhulu lokuhlinzeka ngezinsiza kungukwephula ilungelo lodokotela lokwenziwa komsebenzi ngendlela
efanelekile.
Odokotela bagcwala imigwaqo ekuqaleni kwalo nyaka, befuna ukukhushulelwa amaholo kanye nezimo ezingcono zokusebenza. Isithombe sithathwe nguSamantha Reinders.
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Mhla zingama-22 ku-Ephreli ka-2009 i-Equal Treatment yabuza imibuzo udokotela okunyaka wesibili wokusebenza efunda u-Colwyn Poole, osebenza esibhedlela esisedolobheni eNingizimu Afrika. Wachaza izimo ezingezinhle zokusebenza waphinde wezwakalisa nokuthi lezi zimo ezingezinhle zenza ukuthi odokotela bangasafuna ukusebenza kwizikhungo zomphakathi ngemuva kokuqeda ukusebenza isikhathi
abasinqunyelwe.
Athini amahora asetshenzwa odokotela asebethole iziqu abafunda umsebenzi wehola?
Ngenxa yokuntuleka kwabasebenzi, odokotela abafunda besebenza bayingxenye enkulu yazo zonke izikhungo zokusebenzela umphkathi ezweni lonke. Futhi izibhedlela ingxenye yazo enkulu yezisebenzi okuyilabodokotela angeke zikwazi ukusebenza ngaphandle kwabo. Ukuhlolwa kwamahora okusebenza okwenziwa odokotela abasebenza befunda abayi-14 kwakhombisa ukuthi basebenza amahora amaningi kakhulu kunalawo abekwe yi-Health Professionals Council of South Africa (HPCSA) kwi-‘Handbook of Internship Training’ (2008).
Odokotela abafunda besebenza bajwayele ukuqala ukusebenza ngo-07h30 bese beqeda i-call shift emahoreni angama-24 hours ngemuva kwalokho. Ekupheleni kwe-call odokotela abafunda besebenza isikhathi esiningi abakwazi ukuya ekhaya. Babe sebeqala umsebenzi wosuku olulandelayo ngaphandle kokuphumula. Odokotela abafunda besebenza baba-on call (ukulindela ukubizwa) amahora angama-30 ukuya kwangama-36 alandelanayo. Ngalesi sikhathi udokotela ofunda esebenza kanye nodokotela omfundisa umsebenzi banesikhathi esincane ngesinye isikhathi abasitholi nesikhathi sokudla, sokulala noma esokusebenzisa igumbi lokugeza. Ngemuva kwamahora alinganiselwa kuma-20, ukuthatha izinqumo kanye
nokunakekelwa kweziguli kungalimala kakhulu.
Banxeshezelwa kanjani ngokusebenza isikhathi eseqile odokotela abafunda besebenza?
Odokotela abaningi abafunda besebenza badlula ngale kwemihlahlandlela ebekwe kwi-HPCSA yesingakhathi esengeziwe okubekwe kwaba ngamohora angama-80 ngenyanga. Iningi lodokotela abafunda besebenza bafaka isicelo samahora angama-80 esikhathi esengeziwe. Kodokotela abayi-14 abebehlolwa, bonke bayawadlula amahora esikhathi esengeziwe esingamahora angama-80 ngamahora angama-20 kanye nangamahora angama-40. Odokotela abafunda
Izimo Zokusebenza zoDokotelabesebenza abanxephezelwa nganoma isiphi isikhathi esingaphezu kokusebenza amahora
engeziwe adlula kumahora angama-80.
Lingakanani inani leziguli ezibonwa odokotela abafunda besebenza?
Ngokwemihlahlandlela ye-HPCSA odokotela abafunda besebenza akumele babone iziguli ezingaphezu kwezingama-25 ngesikhathi. Ama-‘In-patients’ iziguli ezigula kakhulu ezidinga ukulaliswa ukuze zihlolwe, zibhekwe, zelashwe bese zihlolwa ngokukhethekile. Kodwa kucwaningo lodokotela abafunda besebenza abayi-14, ngamunye babika ukuthi babona iziguli ezingama-35 ukuya kwezingama-42 ezilalisiwe ngesikhathi. Odokotela abafunda besebenza babona ukuthi kuyisidingo ukuthi basheshe bafike bese bephuza ukuhamba ukuze bakwazi ukumelana nenani
leziguli.
Uyini umthelela ekunakekelweni kanye nakwisithunzi seziguli?
Izimo ezingezinhle zokusebenza zingadala ubudlelwane obushayisanayo phakathi kodokotela kanye neziguli. Odokotela bangangawuthakaseli umsebenzi abawenzayo bese lokho kungabe kusaholela kwikhwalithi enhle yokunakekela. Lokhu kungaba nomthelela kwisithunzi sesiguli. “Yikuphi ukunakekela okungahlinzekwa odokotela ngalawa mahora asetshenzwayo?” kwabuza uPoole. Odokotela abaningi abancane bezwa ukuthi, uma kubhekwa izimo zokusebenza , ‘isithunzi sesiguli yinto yokuqala eyasala ekungeneni kwesibhedlela
ngasinye’.
Ingabe odokotela banokuxhaswa okwenele?
Ukubuza imibuzo kuveze ukuthi odokotela bakhathazekile ngezokuvikelela ezindaweni zokuhlala odokotela abasafunda, abanye sebeke bashaywa futhi bagqekezelwa nezindlu zabo.
Okunye futhi ukuthi, ezibhedlela azikho izindawo ezihlanzekile nezivikelekile lapho odokotela bengaphumula khona uma besebenza amahora amade. Isikhathi esiningi bathola ukuthi kumagumbi odokotela abalindele ukubizwa (on-call rooms), okuyizindawo ezakhelwe ukuthi odokotela baphumule kuzo, azihlanziwe, azikhiyiwe noma zigqekeziwe. Akubikhona kudla noma okokubamba umoya okutholwa odokotela abafunda besebenza ngesikhathi sabo somsebenzi. Izindlu zangasese zabasebenzi isikhathi esiningi zisetshenziswa njengezindawo zokubhema. Azigcinwa zisesimweni esifanele, futhi azinazo izinto zokukhiya iminyango, okubeka engcupheni ezokuphepha.
UColwyn Poole, udokotela ofunda esebenza esikhungweni somphakathi, welapha usana esibhedlela saseGoli. Odokotela abafunda besebenza bakha ingxenye enkulu yabo bonke odokotela abakwizikhungo ezisebenzela umphakathi ezweni lonke. Izithombe zithathwe ngu-Eugene Arries.
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Iyini i-OSD?
Odokotela bateleka befuna ukuqaliswa kwe-Occupational Specific Dispensation, noma i-OSD. Lolu hlelo lokwethula uhlelo lwamaholo olubuyekeziwe oluhlukile kumsebenzi ngamunye kumkhakha wokusebenzela umphakathi. I-OSD yethulwa ngo-2007 njengengxenye yendlela yokuqeda isiteleka sezisebenzi ezisebenzela umphakathi esasike saba khona ngokuthi kulungiswe amaholo bese kwakhiwa nezindlela zokuthuthuka kwimisebenzi eyenziwayo. Kwakuhloswe ngayo ukuthi kugcinwe izisebenzi zezempilo kwizikhungo ezisebenzela umphakathi.
Ngo-2007 i-OSD yaqaliswa kubahlengikazi neyayingahlelwe kahle ngokwesabiwomali futhi yangaqaliswa ngendlela efanele, okwaholela kwizindleko eziningi kwizinsiza zezempilo. Imizamo yoMnyango wezeMpilo yokuphinde iqoqe imali engaphezulu ye-OSD eyakhokhelwa abahlengikazi yaholela ekungabonini ngasolinye nabahlengikazi. I—OSD kwakumele iqaliswe kodokotela, odokotela bamazinyo, osokhemisi kanye nezinye izisebenzi zezimo eziphuthumayo ngoJulayi ka-2008.
Ngemuva konyaka isiphakamiso sokugcina sikahulumeni se-OSD sodokotela sasayindwa zingama-30 kuJuni ka-2009. I-SAMA ayizange isemukele lesi siphakamiso ngemuva kokuvota kodokotela abamelwe yi-SAMA. Ama-91% odokotela ababebambe iqhaza kwinhlolovo abahambisananga nalesi siphakamiso. Mhla zingama-24 kuJulayi i-Health Sector Council (PHSDSBC) yahlangana nezinyunyana ukuze kudingidwe isiphakamiso. Mhla ziyi-11 ku-Agasti izinyunyana zasemukela isiphakamiso. Isivumelwano se-OSD semukelwa kuchaziwe kodwa ukuthi amazinga amaholo athile kumele aphinde ahlaziywe kungekapheli
isikhathi eside. Ngesikhathi sokushicilela izingxoxo mayela nalokhu okwakuchaziwe bezingekafiki
esivumelwaneni.
Iyini i-SAMA?
I-South African Medical Association (SAMA) inhlangano engekho ngaphansi kukahulumeni yodokotela abasebenza kwizikhungo ezisebenzela umphakathi kanye nakulezo ezizimele. Imele odokotela abaningi eNingizimu Afrika futhi isebenzisana ne-COSATU. Ihlanganisa futhi ne-Junior Doctors Association (i-Judasa), i-Rural Doctors Association (i-Rudasa) kanye ne-Registrar Association. I-SAMA imele odokotela kumkhandlu wokuxoxisana ngamaholo (Bargaining Council), okuyinkundla lapho odokotela bexoxisana khona ngokukhokhelwa kwabo ngendlela
efanele kanye nezimo zokusebenza ezingcono.
Yini i-UDF?
Ekupheleni kuka-Ephreli ka-2009 i-United Doctors Forum (UDF) yakhiwa odokotela abaphuma kwi-SAMA. Amalungu e-UDF akhalaza ngokuthi i-SAMA, eyayimele odokotela abasenza kwizikhungo ezisebenzela umphakathi kanye nakwizikhungo ezizimele, yayingasamele abakufunayo. I-UDF yabuye yakhalaza ngokuthi i-SAMA yayingenzi imizamo ngendlela yokufuna ukunyuselwa kodokotela amaholo ngama-50%. Njengamanje i-UDF ayimelelekile kumkhandlu wokuxoxisana nge-OSD. Le nyunyana ithi imele iningi lodokotela abasebenza kwizikhungo zomphakathi futhi seyesabise ngokuteleka uma ingavunyelwa ukuthi ibambe iqhaza kwizingxoxo ze-OSD. Kodwa i-UDF ayivunyelwe ukuthi ibambe iqhaza kumkhandlu wokuxoxisana ngamaholo ngoba ayiyona inyunyana
ebhalisiwe.
Ukubhekana nokushona obekungagwemekaKunzima ukusebenza kwizimo lapho izifo ebezingalapheka zisaba yimbangela yokushona. UPoole usebhekane nokushona okubili okwakungagwemeka futhi okwamphatha kabi ngesikhathi somsebenzi esendulela akuso. Okokuqala okwengane eshone ngenxa yesifo sofuba. Isiguli sathola i-hepatitis ngenxa yephilisi lesifo sofuba esabangela ukopha ebuchosheni. Ngenxa yokuthi igumbi lokunakekela abagula kakhulu laligcwele (Intensive Care Unit), odokotela abakwazanga ukufaka umntwana kwigumbi kusanesikhathi.
Ukushona kwesibili kwakuyilokho kwengane eyatholakala inegciwane lesansulela ngculaza. Umama
wengane wayengakaze athole imishanguzo yesifo sengculaza yokuvikela ukuthi umama angatheleli ingane yakhe, futhi ingane yakhe ubeyincelisa exuba (ubisi oluyimpuphu lwezingane kanye nolwebele). Isiguli noma kwaziwa ukuthi sitholakale sinegciwane lesandulela ngculaza asizange sithole okwelapha ngemuva kwalokho. treatment.
Odokotela abasebancane yibona abathwala umthwalo omkhulu futhi yibona ababhekana nenani elikhulu kakhulu lokushona kwabantu ngenxa yesifo sofuba kanye negciwane lengculaza. Lokhu kushona, ikakhulukazi uma bekungagwemeka kusinda kakhulu
kodokotela abafunda besebenza.
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Sizwa okuningi kulezi zinsuku mayelana ‘nokubheka phansi kwesimo somnotho’, ‘inkinga kwezezimali’ kanye
‘nokwehla kwamandla omnotho’ kulezi zinsuku. Emgwaqweni, emisakazweni, kumaphephandaba kanye nakumathelevishini,
abantu bakhuluma ngakho. Kodwa iyini ngempela le nkinga, futhi isho ukuthini kithina kanye nakwizimpilo zethu?
7
Yini ebangele ukwehla kwamandla omnotho esikhathini samanje?Osomnotho abaningi bayavumelana ukuthi ukwehla kwamandla omnotho kwamanje kubangelwe yinkinga yemalimboleko yasemabhange eMelika ngo-2007. amanye amabhange aseMelika abeboleka izimali abantu abakuthola kunzima ukuthi bazibuyibuyise. La mabhange aqala ukulahlekelwa izimali ngenxa yemalimboleko ayeyikhiphile njengoba abantu babengakwazi ukuyikhokha. Kwaabe sekuba khona ukuthuka ngesimo samabhange, amabhange ayengasakutholi kulula ukuthi abolekane izimali ewoda kanye nezinkampani. Amabhange kanye nezinkampani eziningi zezimboni zabhekana nokucwila kwase kudingeka ukuthi zinikwe noma zibolekwe izimali uhulumeni ukuze zisindiswe. Ngesikhathi esifanayo kwanyuka namanani okudla kanye nowoyela, okwadala enye inkinga kumnotho.
Osomonotho abaningi baphinde bathi futhi imbabgela yokuba khona kwalokhu kwehla amandla omnotho ukuthi okulumeni abazange bengamele ukusebenza kwamabhange ngokwanele. Ukwengamela ngabe kwavimba amabhange ekuthini azibandakanye ekwenziweni komsebenzi ngendlela eyingozi, efana nokuboleka izimali abantu abangeke bakwazi ukukhokha. Enye inkinga enkulu ehlanganiswa nokwengamela ukuthi abantu abaningi kanye namabhizinisi amaningi ayesezikweletini. Lokhu
sezomnotho kanye nezempilokwesimo
Ukubhekaphansi
Ibhalwe nguPoppy Riddle
Kuyini ukubheka
phansi kwesimo somnotho?
Igama elijwayelekile lokubheka phansi komnotho ukwehla kwamandla
omnotho. Ngokujwayelekile izwe lithathwa njengelehlelwe amandla emali uma i-Gross
Domestic Product (GDP) ishona phansi izinyanga eziyisithupha noma ngaphezulu kulandelana.
I- GDP inani eliphelele lezimpahla kanye nemisebenzi eyenziwe ngaphakathi kwemingcele yaleso sizwe ngonyaka.
Izibonelo zezimpahla zihlanganisa ukudla, izimoto kanye namakhompuyutha. Izibonelo zemisebenzi zihlanganisa ukulungiswa kwezinto eziphathelene namapayipi (plumbing), ukufundisa kanye nokokuzithokozisa. Kaphandle kwe GDP eshona phansi, osomnotho abaningi baphinde bachaze ukwehla kwamandla omnotho njengokukhuphuka ngo-1.5% kokuntula imisebenzi ngonyaka owodwa.
Yizwe noma isifunda kwezomnotho kwehla ngaphezu kwezinyanga eziyisithupha. IN
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kusho ukuthi kwakunemali encane emhlabeni kunaleyo
abantu ababecabanga ukuthi ikhona.
Kusho ukuthini lokhu kubheka phansi komnotho kumazwe asathuthuka?Ukwehla kwamandla omnotho sekusabalale kakhulu
emhlabeni ngenxa ye-globalisation. I-‘Globalisation’ ichaza
ukuthi amasiko, iminotho, ezopolitiki, ezobuchwephezhe
kanye nemiphakathi emhlabeni seyihlangene.
Njengomphumela we-globalisation, ukwehla kwamandla
omnotho okwaqala eMelika kanye naseYurophu,
sekusabalalele nakwamanye amazwe ahlanganisa neNingizimu
Afrika. Ngokwe-Congress of South African Trade
Unions (COSATU), i-GDP yezwe uma isihlangene yehle
ngama-6.4% kwikwata yokuqala ka-2009, okubi kakhulu
kunokwehla kwama-1.8% kwekwata yesine ka-2008.
Isimo ngokomhlaba salokwehla kwamandla omnotho
sizobanga izinkinga ezintathu ezinkulu kumazwe asathuthuka:
1. Imali eyenziwa amakhaya izokwehla.Ukwentula imisebenzi kuzonyuka, bese kuthi kulabo abazobe
besasebenza, maningi amathuba okuthi kungehla amaholo.
Abantu bazoba nemali encane abangayisebenzisa. Ngakho
uhulumeni uzoqoqa imali yentela encane futhi kungenzeka
ehlise ukusebenzisa imali kwimisebenzi yomphakathi efana
nokunakekela kwezempilo, ezemfundo kanye nezezindlu.
2. Ukuhwebelana kanye nokutshalwa kwezimali emazweni asathuthukayo kuzokwehla njengoba ukuhwebelana kwamazwe omhlaba kanye nokutshalwa kwezimali kwehla.Ngokwe-South African Institute of International Aff airs
(SAIIA), amazwe asathuthuka kulindeleke ukuthi alahlekelwe
izigidingezigidi (billions) ezingaphezu kwama-$750 ama-
dollar aseMelika kwezokuhwebelana kanye nemali etshaliwe
ngo-2009. ngaphezu kwalokho, i-Afrika emaphakathi
kulindeleke ukuthi kube yiyona azoshaywa kakhulu yilokhu
kubheka phansi kwesimo somnotho – ukulahlekelwa kayo
kwemali okulindelekile kulinganiselwa kwizigidingezigidi
ezingama-$50 zama-dollar aseMelika. Lokhu kuzoholela
kwizinga eliphezulu lokuntula imisebenzi kanye nemali
encane yamakhaya kanye nohulumeni.
I-Afrika emaphakathi isengcupheni kakhulu ngoba incike
kakhulu ekuhwebelaleni ngezinto (commodities). Ama-
commodity izinto ezifana nezinto ezingakalungiselelwa ukuthi
zingasetshenziswa (raw materials) isb. uwoyela insimbi kanye
nemikhiqizo yezolimo efana novolo. Umphumela walokhu
ukuthi kuncane ukufunwa kwezinto ezingakalungiselelwa
ukusetshenziswa emazweni asethuthukile. Amazwe
afana neBotswana, encike kakhulu ekuhwebeni kwayo
ngamadayimane, ukwehla kwamandla omnotho kuyisimo
esibi kakhulu.
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3. Ukuxhaswa ngamazwe aphasheya kuzokwehla.Amazwe amaningi asathuthuka ancike kakhulu kumxhaso ovela ngaphandle (phesheya). Isibonelo, eRwanda kanye nase-Ethiopia, ingaphezu kwama-50% emali yonke esetshenziswa uhulumeni yesabiwomali sezempilo iqhamuka kwabanikela ngemali abaqhamuka ngaphandle. Kulindeleke
ukuthi ukwehla kwamandla omnotho emhlabeni
kudale ukuthi amazwe athuthukayo anikele ngezimali
ezincane zomxhaso. I-Th e Global Fund yokulwa nesifo sengculaza, isifo sofuba kanye nomalaleveva kuyimanje sesibhekene nezinkinga zokukhipha izimali. I-Global Fund inikezwa izimali amazwe amaningi ehlukene, abantu kanye nezinhlangano futhi sekubonakala sengathi kunegebe lezimali okungenani lezigidingezigidi (billion) ezingama-$3.9 zonyaka ozayo. Kubantu abayizigidi ezi-3 emazweni asathuthuka abathola imishanguzo yesifo sengculaza, abayizigidi ezi-2 kubo bathola ukuxhaswa ngezezimali yi-Global Fund. Ukwehla kweminikelo kwi-Global Fund kuzobanga-ke imiphumela engemihle kwizinhlelo zezempilo. Eziningi zezinhlelo kanye nezinhlangano zezinhlelo ezifanayo zibhekene nokwehlisa ukusetshenziswa kwemali ngenxa yokubheka phansi kwesimo
somnotho emhlabeni.
Kusho ukuthini konke lokhu ezimpilweni zethu?Izinga eliphansi jikelele lezempiloNgokwe-Bhange loMhlaba (World Bank), ukwehla kwamandla omnotho okudlule kubange ukwehla kwimpilo yabantu jikelele emazweni asathuthuka. Ziningi izizathu zalokhu. Emazweni angenazo izinsiza zezempilo zomphakathi, abantu abanemali encane yokuyisebenzisa ekuvakasheleni udokotela noma ukuthenga imithi ngalesi sikhathi sokwehla kwamadla omnotho. Kungenzeka bangakwazi ukukhokhela izinto zokuhamba zokuya emitholampilo noma ezibhedlela. Imbala nasemazweni lapho uhulumeni enika izimali ngokuphelele izinhlelo zezokwelapha, abantu basazikhokhela imali yamaphilisi kanye nezinye izimali zezokwelashwa. Kwamanye amazwe (isibonelo iTanzania), izikhungo zezempilo zisakhokhisa imali yokuzisebenzisa. Ngokunyuka kokuntuleka kwemisebenzi, abantu abampofu maningi amathuba okuthi bathinteke kakhulu. Ukungakwazi ukubhekana nezindleko kungenzeka kubenze bangafuni ukunakekelwa kwezempilo, okungengeza ekwenzeni kubi isimo sezempilo. Ukwehla kwizabiwomali zezempilo kanye nakwimali yomxhaso yaphesheya kuzophinde kubange izinkinga – ezifana nokushoda
kwamaphilisi kanye nezinsiza kusebenza.
UkungondlekiUkwehla kwamandla omnotho maningi amthuba okuthi kungabanga ukusabalala kokungondleki emazweni asathuthuthuka. Njengoba amakhaya eshaywa ukwentuleka kwemisebenzi kanye nokwehla kwemali engenayo, abantu bazoba nemali encane abazoyisebenzisa kukudla, ikakhulukazi kukudla okunempilo okufana nezithelo kanye nemifi no. Lokhu kungaphetha ekwehleni kwezisindo zomzimba okusabalele kanye nokungondleki okukhulu ikakhulukazi ezinganeni. Abantu abaphila nengciwane lesandulela ngculaza abaphinde bangondleki futhi maningi amathuba okuthi bangathola izifo ezingosomathuba bese beshesha ukuba nesifo sengculaza. Njengoba imishanguzo yegciwane lengculaza isikhathi esiningi idinga ukuthathwa nokudla, abantu abangenayo imali yokuthenga ukudla bazokuthola kunzima ukuthi bathathe imithi yabo ngendlela nangesikhathi esifanele. Ukuthatha imithi ngendlela kanye nangesikhathi
esifanele kubalulekile uma abantu bezohlala bephilile.
Ukumiswa kwezinhlelo zokwelapha zegciwane lesandulela ngculaza kanye nesifo sengculazaEmhlabeni wonke, imishanguzo yesifo sengculaza igcina abantu abayizigidi ezi-3.4 bephila futhi bephilile. Kodwa ngokweBhange loMhlaba, abaphindwe kabili kuleso sibalo badinga ukwelashwa ngokushesha ukuze baphile. Ukwehla kwezabiwomali zezempilo kanye nokuxhaswa ngezimali abaphesheya kungenza kube nzima ukuthi laba bantu bafi nyelele kwimithi yokwelapha.
Ngaphezu kwalokho, ukwehliswa kwezabiwomali kanye nokwehla ekuxhasweni okuvela ngaphandle kungashiya abantu emazweni ayi-15 asathuthuka besengozini enkulu yokunqamuka kokuthola imithi. Ukuyeka ukuthola imithi kuyingozi ngoba:
• Uma imithi inqamuka, abantu basheshe bagule futhi bashone, beshiya izingane ziyizintandane futhi kuphuca umphakathi abasebenzi bawo.
• Abantu abayeka imithi babayingozi enkulu yokudlulisela izifo.
• Ukuthatha imithi okuphazamisekile kwenza imishanguzo yesifo sengculaza ingasebenzi kahle.
Ukubheka phansi kwesimo somnotho kungaphinde kwenze ukuthi inani lokutheleleka ngegciwane lesandulela ngculaza kunyuke ngoba: 1) imitholampilo kungenzeka ishodelwe amakhondomu; 2) ukungondleki kanye nokuphazamiseka kokuthatha imithi kungenza abantu abanegciwane lesandulela ngculaza ukuthi babeyingozi enkulu yokudlulisela izifo; futhi 3) kungenzeka kube nemali encane ekhona yezinhlelo
zokufundisa ukuvimbela ukutheleleka.
Imithombo: Congress of South African Trade Unions (COSATU) Central Executive Committee media statement, 4 June 2009; The World Bank “Averting a Human Crisis During the Global Downturn” (2009); The South African Institute of International Affairs (SAIIA) “The Implications of the Global Economic Recession on Civil Society Advocacy, Aid and Policy Implementation” (2009) • Article reviewed by Veloshnee Govender, lecturer, Health Economics Unit, School of Public Health, University of Cape Town
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Ukulungiselelwa komkhankasoEkulungiseleleni ukwethula umkhankaso we-TAC
we-Resources for Health, abasebenzi abaphuma
kwizinhlangano eziyisithupha ezikwizifunda eziqhuba
kahle kakhulu (Ekurhuleni, iGert Sibande, iKhayelitsha,
iLusikisiki, iMopani, uMgungundlovu) zahlanganisa
ulwazi mayelana nesimo mayelana nokukhishwa
kwemishanguzo yesifo sengculaza emiphakathini
yabo. Bathola izinto ezazithusa kakhulu. Ohlu olude
lokulinda ukuthola imishanguzo yesifo sengculaza,
ukushoda okukhulu kobisi lwezingane oluyimpuphu
kanye namanye amaphilisi adingekayo, kanye
ukuntuleka kwezisebenzi zezempilo emitholampilo
kwakuyikhokonke okulimaza impilo yemiphakathi.
Emitholampilo eminingi, kwakungekho ngisho imithi
eyisisekelo yezinhlungu kanye nokukhwehlela.
Lokhu okwatholakala kwabhalwa kwincwadi yohlu
lwezikhalazo eyayihanjiswa ezindaweni eziningi
abasebenzi be-TAC. Imihlangano yokukhuluma
ngokutholakele kanye nokucobelelana ngolwazi
yabanjwa ukuze kudingidwe okutholakele kucwaningo
bese kunqunywa ukuthi izokwenziwa kanjani
imikhankaso yezifundazwe.
Ukwethulwa komkhankaso: kungani kube seNtshonalanga Kapa?
I-International AIDS Society (IAS) Conference on
Pathogenesis, Treatment and Prevention yesihlanu
yabanjelwa eKapa, ukusukela mhla ziyi-19 kuJulayi.
Kulolu suku, i-TAC yethula umkhankaso we-
Resources for Health. I-TAC kanye neziningi
ezinye izinhlangano ezisebenzisana nayo
zamasha enkabeni yedolobha laseKapa ukuze
ikhombise uhulumeni, umphakathi kanye
nabantu ababethamele ingqungquthela
Izinsiza zezempilo
I-TAC yaba nomnyakazo oqonde ngqo wonyaka eKapa ngoJulayi ka-2009 wokwethula umkhankaso we-Resources for Health.
ukuthi ukulwa kwethu nokufinyelela ekunakekelweni
kwezempilo okuhlanganisa konke kuse kude ukuphela.
Kuyabonakala ukuthi, noma isimo seKhayelitsha
siyibeka njengendawo yokuthola imishanguzo
yesifo sengculaza ehamba phambili, ucwaningo
lwasendaweni lwe-TAC lukhomba ukuthi izinkinga
ezibhekene nemitholampilo eminingi kulo lonke elakuleli
iyatholakala naseKhayelitsha futhi nakwimiphakathi
eseduze. Imitholampilo eminingi inohlu lwabantu
abalindile abangaphezu kakhulu kwekhulu, nokuthi
ukuqaliswa kweziguli ezintsha kwehle kakhulu
ezinganeni ezintathu zokugcina zika-2008 – ubufakazi
bokuthi ukukhishwa kwemishanguzo yesifo sengculaza
kuyehla naseNtshonalanga Kapa. Ucwaningo lukhomba
ukuthi, eKhayelitsha abantu abaningi baqaliswa
kwimishanguzo yesifo sengculaza sebenamasosha
omzimba angaphansi kwangama-50. IKhayelitsha
iphinde ihlushwe ukushoda kwamakhondomu
okuqhubekayo, futhi abeluleki abaningi abakaholelwa
kusukela ngoNovemba ka-2008. abanye-ke sebeze
bashiya imitholampilo, okusho ukuthi iziguli ezizohloela
igciwane lesandulela mgculaza isikhathi esiningi
zibuyiselwa emuva.
Umyalelo womthetho wokumisa ukukhishwa kwemishanguzo yesifo sengculaza esifundazweni sase-Free State: Uphawu lwezinto ezisazokwenzekaNgoNovemba, kwamiselwa umyalelo womthetho wokumiswa kokuqaliswa kweziguli ezintsha kwimishanguzo yesifo sengculaza esifundazweni sase-Free State. Lokhu kwakuchaza ukuthi azikho iziguli ezintsha ezazizoqaliswa kuze kube kuphinde kwakhishwa esinye isaziso. I-TAC yaqala ukuthola
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Ibhalwe nguRebecca Hodes
Kulo mbhalo siyabheka ukuthi umkhankaso umyaelana nani, kanye nezinkinga zokufi nyelela kukunakekela kwezempilo ezasenza ukuthi sifune ushintsho.
izikhalazo kodokotela kanye neziguli ababethukuthele ababetshelwe uMnyango wezeMpilo ukuthi okwaleso sikhathi azikho iziguli ezintsha ezizothola ukwelashwa. Iziguli eziningi ezazikuhlelo, okuhlanganisa nezingane, izigaba zazo zemishanguzo yesifo sengculaza zaphazamiseka ngenxa yokushoda kwamaphilisi emitholampilo.
I-TAC yagqugquzela ukuba lo myalelo uyekiswe, kodwa wathatha izinyanga ezine. I-HIV Clinicians Society iqikelela ukuthi abanye abantu abangamashumi amathathu ngosuku abashona ngesifo sengculaza ngenxa yokuthi bengakwazi ukuthola imishanguzo yesifo
sengculaza.
I-TAC yathinta ihhovisi lomgcinimafa kanye noMnyango wezeMpilo wasesifundazweni saseFree State ukuze uzwe ngezizathu zomyalelo womthetho. Satshelwa ukuthi isifundazwe bese siphelelwe imali futhi besingenayo enye indlela ebesingenza ngayo kodwa ukuyeka ukuhlinzeka ngezinsiza zemithi esindisa izimpilo kanye nemithi – okuhlanganiswa kuyo leyo yegciwane lesandulela ngculaza, umfutho ophezulu wegazi kanye nesifo sikashukela. Ukuqalisa iziguli ezintsha eziyi-1,200 kwimishanguzo yesifo sengculaza kwakuzobiza isifundazwe sase-Free State imali elinganiselwa kwizigidi ezingama-R8000 000. Ngemuva kwamasonto ambalwa kuqale umyalelo womthetho wokumiswa kokukhishwa kwemishanguzo yesifo sengculaza i-TAC yezwa ukuthi isifundazwe sinike amaqembu ezepolitiki izigidi ezingama-R30 ukuze alungisele imikhankaso yokhetho.
Okwenzeka esifundazweni saseFree State kwakuwukwephula amalungelo abantu abaphila negciwane lesifo sengculaza kanye nelabanye ababedinga ukunakekelwa kwezempilo okusemqoka abangakutholanga ngalesi sikhathi. Ezimweni eziningi,
kusaqhubeka nokungatholakali. Isifundazwe sase-Free State sinamazinga aphansi kakhulu okutholakala kwemishanguzo yesifo sengculaza ezweni – isibalo simi eduze kwama-26%, ngokwezibalo ezisemthethweni.
I-TAC isizamile ukuthola ukuthi ingabe sifundazwe senza okusemthethweni yini ngokubeka umyalelo womthetho. UMthetho woKwengamelwa kwezimali zoMphakathi uvumele ukukhishwa kwezimali zesimo esiphuthumayo uma izimpilo zabantu zisengozini ngenxa yokungabikho kwezimali zomphakathi. Kucacile ukuthi kwenziwa amaphutha amakhulu nokuthi kwakungekho ukuhlela; umphumela walokho kwaba
ukushona kwabantu.
Izindaba eziphathelene nezimaliUmyalelo womthetho wesifundazwe saseFree State wakhombisa ukuthi ukukhishwa kwemishanguzo yesifo sengculaza kwakunamaphutha kakhulu – ikakhulukazi ngokuphathelene nokuhlelwa kwesabiwomali kanye nokubhekelela. Ukusukela ngaleso sikhathi ukushoda kwemishanguzo yesifo sengculaza sekukhuphukile eMpumalanga Kapa, eLimpopo, KwaZulu-Natali kanye naseGauteng imbala nokuyisifundazwe esinothe kakhulu. Ukushoda kwezinye izinto zezempilo eziyisidingo nakho kwenzeka kakhulu. Izinto ekuyizona eziyimbangela ukungahleli ukusetshenziswa kwemali ngendlela efanele kanye nokumosa imali, akanye nokuthi ukusetshenziswa kwemali uhulumeni
akuqashelisiswa.
Ukubhekwa kokusebenza kwezinhlelo zezempilo sekuthole ukuntengantenga cishe kuzo
INingizimu Afrika isebenza kabi kakhulu kunamanye amazwe asebenzisa imali encane kwezempilo. IZ
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zonke izigaba. Zindawo zombili ezibhedlela kanye nakwizifunda sekukhombise ukungahanjiswa kahle kwezinsiza futhi nokuhluleka ukuhlangabezana nezidingo zezempilo zemiphakathi yazo.
INingizimu Afrika inamakhona kanye nezinto zokwenza ukuthi ifinyelele kokuphokophelwe kwi-National Strategic Plan (NSP) kanye nokwenza izinsiza ezanele zezempilo, kodwa isebenzise lezi zinto ngendlela efanele.
Ngo-Okthoba ka-2009, isabiwomali sezempilo zomphakathi kumele silungiswe. Noma iluphi ushintsho kumele lubhekelele ukuthi okwamanje kushoda ngezigidingezigidi (billion) eR1 ukuze kuqaliswe inani eliphokophelwe labantu abazongena kwimishanguzo yesifo sengculaza ngo-2009, futhi iziphathimandla zezempilo kwizifundazwe ziyehluleka. Umkhankaso we-TAC we-Resources for Health uzolwela ukufinyelela kwimishanguzo yesifo sengculaza
• ngokugcwaliseka kokuphokophelwe kwi-NSP, • ngokuqedwa kohlu lokulinda lokuthola imishanguzo
yesifo sengculaza, • ngokutholakala kwezigaba ezihamba ngazimbili
zokuvimbela ukutheleleka komntwana igciwane lesandulela ngculaza likamama wakhe (PMTCT) kanye
• nokuhlanganiswa kwemithi yokwelapha yesifo
sofuba kanye neyegciwane lesandulela ngculaza.
Amalungelo ezempilo, amalungelo abantu, amalungelo emishanguzo yesifo sengculaza esebenza kakhuluKuyisibophezelo sikahulumeni ukwenza imishanguzo yesifo sengculaza itholakale futhi ifaneleke njengoba kuchazwe kwi- National Strategic Plan (NSP), uhulumeni ozibphezele kuyo. I-NSP iphokophele ukwelapha abantu abangama-80% abadinga imishanguzo yesifo sengculaza kungekashayi u-2011, kanye nokwehlisa ukutheleleka ngesifo sengculaza ngama-50% ngesikhathi esifanayo. Kodwa inkinga ye-NSP ukuqaliswa njengoba kukhonjisiwe ucwaningo lwezifunda eziyisithupha
ze-TAC eziqhuba kahle kakhulu. Lokhu kwathola
ukushoda kwimikhakha yonke yemithi ebalulekile kanye
nakukuntuleka kwezisebenzi zezempilo emitholampilo.
Ukusuka ngoJuni ka-2009, kuneziguli ezilinganiselwa
kwizi-560,000 ezikwimishanguzo yesifo sengculaza
kwizikhungo zezempilo zomphakathi. Kodwa
okungenani liphindwe kabili inani elidinga
ukwelashwa ngokushesha ukuze liphile.
Ezinyangeni ezimbalwa ezedlule, ukukhishwa
kwemishanguzo sekuphelelwe amandla. Amashumi
amakhulu abantu bahlala kuhlu lokulinda, futhi iningi
leziguli zinamasosha omzimba angaphansi kwe-100
ngesikhathi zigcina zifakwe kwimishanguzo yesifo
sengculaza. Lokhu kuchaza ukuthi sebenezimpawu
ezinzima kakhulu futhi sebesesigabeni sesithathu noma
sesine sesifo sengculaza.
Lokhu kuyakhalisa kakhulu ngezobulungiswa futhi
kungukumosa izinsiza zethu zezempilo eziyigugu.
UMthethosisekelo uqinisekisa ukukwazi ukufinyelela
ekunakekelweni kwezempilo okuhlanganisa konke
okuqhubekayo. Uhlu olude lokulinda imishanguzo yesifo
sengculaza kanye nokushoda kwemithi ebalulekile
kwephula leli lungelo. Banikela ngezimpilo kanye
nokuphila kahle kwabantu baseNingizimu Afrika
abatholakale benegciwane lesandulela ngculaza.
Ukuqaliswa sekuhambe isikhathi kwemishanguzo
yesifo sengculaza kubiza kakhulu ngoba ukwelapha
izifo ezingosomathuba kudinga ukunakekelwa
kwezempilo okuningi., okudinga imali kanye nesikhathi
esiningi. Ukuqalisa imishanguzo yesifo sengculaza
kusenesikhathi kuzokwehlisa kokubili ukudlulela
kwisifo sofuba kanye negciwane lesandulela ngculaza
ngokwehlisa inani legciwane egazini kanye nokuqinisa
amasosha omzimba abantu abaphila nengciwane
lesandulela ngculaza. Umbono womphakathi wokuthi
ukuvinjelwa kwegciwane lesandulela ngculaza kanye
nokwelashwa kwegciwane lesandulela ngculaza izinto
ezimbili kumele kushintshe. Ukwenza imishanguzo
yesifo sengculaza itholakale kubo bonke abantu
kuyindlela yokuvimbela igciwane lesandulela ngculaza.
INingizimu Afrika kungaba ibhekene nenkinga
yezomnotho, kodwa amalungelo ezempilo kanye
nawempilo awadayiswa. Umkhankaso we-TAC
we-Resources for Health campaign uzogqugquzela
imiphakathi kulo lonke elaseNingizimu Afrika ukuze
kulwiwe nokutholakala okungcono kwemithi yesifo
sofuba kanye neyegciwane lesandulela ngculaza kulabo
abayidingayo.
Imithombo: J. Berger; ‘A Roadmap for the Reform of the South African Health System’ p. 20; M. Heywood, ‘Key Targets of the NSP for 2009’, (2009) • A. Violari et al., ‘Early Antiretroviral Therapy and Mortality among HIV-Infected Infants’, New England Journal of Medicine, 359: 2233 – 2244 (2008); ‘A Roadmap for the Reform of the South African Health System’, p. 43; N. Ford et al., ‘Rationing ART in Africa’.
Ungqongqoshe wezeMpilo u-Aaron Motsoaledi (kwesokudla) nomongameli we-International AIDS Society uJulio Montaner (kwesokunxele) kanye noNobhala Jikelele we-TAC uVuyiseka Dubula (emuva) ekwethulweni komkhankaso we-Resources for Health eKapa. Isithombe sithathwe nguSamantha Reinders.
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Okuphambili okuphokophelwe ngomkhankaso:1. Ukufuna ukwelashwa kwezingane kusenesikhathi, izindlela okumele zilandelwe
ekwelashweni kanye nasekuhlinzekweni kwemithi eyisidingo ekuvinjelweni kokutheleleka komntwan ayigciwane lesandulela ngculaza likamama wakhe. Okuphokophelwe yi-NSP kuka-2009 ukwenza ukuthi iizkhungo ezingama-85% zifinyelele kumazinga ekhwalithi okuphiwa kwabantwana ukudla. Njengoba ucwaningo kwizifunda lufakazela ukuthi, lokhu okuphokophelwe kuyehluleka ukufezeka ngokusobala. I-Children with HIV Early Antiretroviral Therapy (i-CHER) ucwaningo olwathola ukuthi ukuqalisa abantwana kwimishanguzo yesifo sengculaza uma betholakala benegciwane lesandulela ngculaza kwehlisa amazinga okushona kakhulu. Ukufuna ukwenziwa kokuhlola kwe-polymerase chain reaction (i-PCR) kwegciwane lesandulela ngculaza kanye nokwelashwa kwezingane kusenesikhathi kuzosindisa izinkulungwane zezimpilo, futhi kunyuse nesibalo sezingane ezikwimishanguzo yesifo sengculaza. Lokhu kuzosibeka eduze nokufeza okuphokophelwe yi-NSP. Abantwana abancane kakhulu kanye nezingane esezikhulakhulile kumele zihlolelwe ezikhungwini zokugoma. Omama abayidingayo kumele banikezwe imishanguzo yesifo sengculaza esebenza kakhulu (HAART) kanye nokuhlolwa kwe-PCR kwabantwana babo
abancane.
2. Ukukwelapha kusukela kwinani lamasosha omzimba angama-350, kungabi ukusukela kwangama-200, njengoba kunconywa i-WHO, kanye nokuqedwa kohlu lokulinda bukualiswa kwimishanguzo yesifo sengculaza. Isizathu esiphambili sokuthi abantu bashone ngenxa yesifo sengculaza ingoba imishanguzo yesifo sengculaza ayitholwa yilabo abayidingayo,
kanye nokuqalwa kwayo sekuhambe isikhathi kakhulu.
3. Ukulwela ukuhlanganiswa kokwelashwa kwesifo sofuba kanye negciwane lesandulela ngculaza. Bonke abantu abanesifo sofuba kumele bahlolelwe igciwane lesandulela ngculaza. Imithi yokwelapha kumele itholakale emtholampilo ofanayo ukuze kwenziwe isiqiniseko sokuthi abantu bayakwazi ukuthatha imithi yabo ngendlela efanele kanye nangesikhathi esifanele
ngokwezigaba zayo.
-TAC izimisele ukuzuza lokhu okuphokophelwe:1. Ngokufuna ukwenziwa
kwesabiwomali okusekelwe kwizidingo, ukubhekelela ezezimali ngeso lokhozi kanye nokuba nesibopho ngokusetshenziswa kwezimali kumazinga womabili okuwukuzwelonke kanye
nasesifundazweni.2. Ngokufuna isisombululo
kwinkinga yokuntuleka kwezisebenzi kumkhakha wezempilo.
3. Ngokufundisa analungu e-TAC kanye nomphakathi mayelana nenkinga yamanje ekunakekelweni kwezempilo kanye nokuhlupheka
nokushona okukubangayo. 4. Ukwenza isiqiniseko sokuthi
uhulumeni uhamba phambili ekusombululeni inkinga kumkhakha wezempilo.
5. Ukukhankasela izinsiza zezempilo emhlabeni wonke
jikelele.
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Kungani inkulumo yokuphikisana ingawenzi umqondoIndaba yokuthi sisebenzisa imali eningi kwigciwane lesandulela ngculaza akuwenzi umqondo. Indlela i-World Health Organization (WHO) efaka ngayo imali imishanguzo yegciwane lesandulela ngculaza kuyahambisana nomthwalo isifo esesiwudalile ngenxa yegciwane lesandulela ngculaza. Uma kukhona okungabalulwa ukuthi, ukuphela kwemithi kanye nokwesabela izinhlelo ezithile zezokwelapha e-Afrika kuwubufakazi bokuthi ukufakwa kwemali kumele kunyuke kakhulu. Ukwehliswa kwemali kuzoholela kokunye ukushona kwabantu obekungagwemeka.
Njengoba ukufakwa kwemali kwisifo sengculaza kusolwa ngokwenza uhlelo lwezempilo olushona phezulu emhlabeni okulimaza ezinye izinhlelo zezempilo jikelele, iqiniso ukuthi ukufakwa kwemali kwisifo sengculaza sekwenze uhlelo lwezempilo olukhulu kakhulu emlandweni olusabalala luya emaceleni. Sekuhambe kwadlula ekubhekaneni negciwane lesandulela ngculaza kuphela sekubandakanye nesifo sofuba, i-hepatitis C, isifo ezithathelana ngokocansi kanye nomdlavuza wesibeletho, kanye nokunakekelwa kwezempilo jikelele. Ukwengeza ekwehliseni kanye nasekuvimbeleni ezinye izifo ezifana nesifo sofuba, ukufakwa kwemali kwisifo sengculazi kuphinde kwehlise ngqo amazinga okushona komama kanye nezingane.
Ubufakazi buyakhombisa ukuthi ukufaka imali ekunakekelweni kwezempilo kanye nakwisifo sengculaza kuyahambisana futhi nokuthi ukusetshenziswa kwemali kwezempilo jikelele sekunyukile ngenxa yokubhekana nesifo sengculaza. Abeseka ukuphikisana
Ukuphikisananokufakwa kwezimali
nesifo sengculazakokuphathelene
Nangaphambi kwenkinga yesimo somnotho yamazwe omhlaba, ukuphikisana nokufakwa kwemali kwizinto eziphathelene nesifo sengculaza besekuvele kuqalile. Abaqale lokhu kuphikisana kokufakwa kwezimali kwizinto eziphathelene nesifo sengculaza bathi iningi kakhulu imali esifakwe kwizinto eziphathelene nesifo sengculaza kunalokho okudingekile futhi nokuthi leyo mali ingasetshenziswa kangcono ekuqinisweni jikelele kwezinhlelo zezempilo.
Okushiwo abaphikisana nokufakwa kwezimaliLabo abaxhasa ukuphikisana nokufakwa kwezimali kwizinto ezihambisana nesifo sengculaza bathi ukufakwa kwezimali ngqo kwisifo sengculaza sekwakhe uhlelo lwezempilo olushona phezulu olukhulu kakhulu emlandweni. Nokuthi futhi kudla imali engabe isetshenziselwa ezinye izinto zempilo kanye nokuqinisa izinhlelo zezempilo, ukufakwa kwemali eqondene nesifo sengculaza kusolwa ngokuthi: • kuvule imbobo kumkhakha wezempilo womphakathi, • kubukele phansi ukusebenza ngendlela kukahulumeni, • kususa ukwenganyelwa kukazwelonke ezintweni ezibalulekile okumele
zisetshenziselwe imali • kususe ukubhekwa kwempilo yomama kanye neyabantwana.
nalokhu baphikisana ne-United Nations’ Millennium Development Goals 4 no 5 yokwehlisa ukushona komama kanye nezingane kanye no-Goal 6 wokwehlisa ukutheleleka ngegciwane lesandulela ngculaza, ekubeni kokuthathu lokhu okuphokophelwe kuyahambisana.
Iqiniso ukuthi eNingizimu Afrika bayizigidi ezingama-5.5 abantu abaphila negciwane lesandulela ngculaza. Usuku ngalunye bayi-1,000 abesifazane abansundu abasebancane abatheleleka ngegciwane lesandulela ngculaza. Ziyizi-27,000 izingane esezikwizinga lesine lesifo ezingatholi mithi, nokuthi izinga lokushona kwezingane ngenxa yesifo sengculaza liphezulu ngokuphindwe kane uma kuqhathaniswa nokushona kwabantu abadala ngenxa yesifo sengculaza. Ukukhishwa kwemishanguzo yesifo sengculaza sekwehlise ukushona kwezingane, kwenyusa nokulindeleka kwezinga lempilo kwehlisa nezinga lokutheleleka ngegciwane lesandulela ngculaza.
Ukukhishwa kwemishanguzo yesifo sengculaza sekuqinise uhlelo lwezempilo:• ngokunika amandla iziguli kanye nezisebenzi
zezempilo; • ngokuqinisa izinhlaka zokuhambisa izinsiza
zezokwelapha;• ngokufaka izinsiza ezibaluleke kakhulu kumakhemisi
kanye nasekutholakaleni kwezifo;• ngokuvimbela ukutheleleka okusha ngegciwane
lesandulela ngculaza;• ngokwehlisa izifo ezingosomathuba;
• ukwehlisa amazinga ezifo kanye nokushona.
Isisombululo: Ukuqinisa izinhlelo zezempilo ekubhekaneni negciwane lesandulela ngculazangesikhathi isimo sokunikelelwa ngezimali kwaphesheya sishintsha futhi nokufakwa kwezimali kwizinhlangano ezingekho ngaphansi kukahulumeni (NGO) kuya kuncipha futhi kubheke kakhulu ekuqiniseni izinhlelo zezempilo, kubalulekile ukubona ukuthi ukufakwa kwezimali ekuqiniseni izinhlelo zezempilo jikelele akunayo into eyenza uhulumeni abe nesibophezelo. Ukwenza izinhlelo ezingcono zezempilo ukuze kubhekwane nesifo sengculaza kwenza umqondo ophelele ngenxa yezinhlelo ezinamandla esezivele zakhiwe uhulumeni kanye nezishoshovu ekubhekaneni nobhubhane lwegciwane lesandulela ngculaza.
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Iyini i-Global Fund?I-Global Fund yokulwa nesifo sengculaza, isifo sofuba kanye nomalaleveva isikhungo samazwe omhlaba sokuhlinzeka ngezimali esifaka izimali kwizinhlelo eziningi zezempilo. Ukuze kube yimanje, sesifake izigidingezigidi (billion) ezingama- $15.6 kumazwe ayi-140 axhasa inhlelo ezinabile zokuvinjelwa, ukwelashwa kanye nokunakekela. Ukusukela mhla lu-1 kuJulayi ka-2009, bayizigidi eziyi-2.3 abantu abathola imishanguzo yesifo sengculaza ngenxa ye-Global Fund. Kodwa-ke, isikhwana okwamanje isikhwama sibhekene nokushoda kwezimali okuzoholela ekuncishisweni kwezinhlelo zokuxhasa.
Le-Equal Treatment yenziwe yaphinde yahanjiswa ezindaweni ezehlukene ngenxa yokuxhaswa ngokwezezimali okuvela kwi-Global Fund.
• Izinhlelo zezempilo ezishona phezulu (Vertical health programmes) kuchaza imizamo ekuhloswe ngayo ukubhekana nesifo esithile ngqo. Misa isifo sofuba, isibonelo, uhlelo lwezempilo olushona phezulu okuhloswe ngalo ukulwa nesifo sofuba.
• Izinhlelo zezempilo ezisabalala ziye emaceleni (Horizontal health programmes) zibhekana nokuqinisa uhlelo lwezempilo selulonke, kunokuthi zibheke isifo esithile ngqo.
Igciwane lesandulela ngculaza kanye nesifo sengculaza sekube nomthelela obanga usizi ekushoneni kwabantwana abancane emhlabeni wonke. Le-graph ikhombisa ukuthi ukwethulwa kwezinhlelo zemishanguzo yesifo sengculaza (ART) kanye nokuvimbela kokutheleleka komntwana yigciwane lesandulela ngculaza likamama wakhe (PMTCT)sekwehlise kangakanani ukushona kwabantwana. IKhayelitsha iyisibonelo esihle sokuthi ukusetshenziswa kwemishanguso yesifo sengculaza kanye nezinhlelo zokuvimbela ukutheleleka komntwana igciwane lesandulela ngculaza likamama wakhe kwehlisa kakhulu amazinga okushona kwezingane. Lokhu kukhombisa kokubili ukuthi isifo sengculaza sinomthelela omkhulu ezimpilweni zabantwana nokuthi ukufakwa kwezimali kwisifo sengculaza kusemqoka ekushintsheni lezi zinkomba ezingezinhle.
N. Nattrass and G. Gonsalves. ‘Economics and the Backlash against AIDS-specific Funding.’ Presentation to UNAIDS/the World Bank. 21 April 2009.
Imithombo: Natrass, N and Gonsalves, G. “Economics and the Backlash against AIDS-specific funding”, Paper for the WHO/World Bank/UNAIDS Economics Reference Group (2009); Dubula, V. “South African politics post election, what do they mean for women and access to quality health”, Women’s leadership training, Booysens Hotel, Johannesburg 2009; Lynch, S and Hodes, R. “The Current Donor Landscape”.
Ukufakwa kwezimali kwigciwane lesandulela ngculaza kanye nesifo sengculaza sekusize ekuqiniseni izinhlelo zezempilo ezindaweni eziningi emhlabeni, kuhlinzeka imali edingeka kakhulu yezisebenzi zezempilo kanye nokudingekayo kwezokwelashwa. Isithombe sithathwe ngu-© Francesco Zizola / i-Noor, ngezilokotho ze-MSF.
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Ukushona kwabantwana abancane (akukho i-PMTCT futhi akukho i-ART)
Ukushona kwabantwana abancane (akukho i-PMTCT futhi akukho i- ART)
Ukushona kwabantwana abancane (akukho i-PMTCT futhi akukho i-ART)
Ukushona kwabantwana abancane eKhayelitsha
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NgeSonto mhla ziyi-19 kuJulayi ka-2009 balinganiselwa
kwizi-2000 amalungu e-TAC kanye nezinhlangano
ezisebenzisana nayo ahlanganela eKapa ukuze
kumashwe kuyiwe e-convention centre yedolobha
lapho okwakubanjelwe khona i-International AIDS
Conference on Pathogenesis, Treatment and Prevention
yesi-5. Ukuhamba kwezimoto kwama-nse ngesikhathi
abamashayo begcwele imigwaqo, befuna ukuthi
uhulumeni afeze akuphokophele ekwelapheni kanye
nasekuvinjelweni kwegciwane lesandulela ngculaza
kanye nesifo sofuba okubekwe kwi-National Strategic
Plan (NSP).
I-TAC yaxhunywa amaqabane aphuma kwi-South African
Medical Association, i-Democratic Nursing Association
of South Africa, i-Congress of South African Trade
Unions, kanye ne-AIDS and Rights Alliance of Southern
Africa. UNgqongqoshe wezeMpilo waseNingizimu Afrika
u-Dokotela Aaron Motsoaledi, usihlalo waseNingizimu
Afrika we-International AIDS Society (IAS) uDokotela
Jerry Coovadia, kanye noMongameli we-IAS uDokotela
Julio Montaner nabo bahlanganyela. UVuyiseka Dubula,
uNobhala Jikelele we-TAC, wafunda uhlu lwezikhalazo
lomkhankaso olwasayindwa uMotsoaledi ngemuva
kokucela esakhe isikibha esibhalwe ukuthi-HIV positive.
Wezwakalisa ukweseka uhlu lwezikhalazo wabe esethi
‘okuningi’ kwizikhalazo kuzoba yingxenye yomgomo
kahulumeni, wase ecela ukuthi i-TAC isebenzisane
nohulumeni ekwenziweni kwalo msebenzi. UNonkosi
Khumalo, uSihlalo we-TAC, wemukela iziphakamiso
zikaNgqongqoshe wezeMpilo kodwa wabe esexwayisa
ukuthi uma okukhathaza i-TAC kungabhekwa, amalungu
e_TAC azobuya azoshaya itoyitoyi.
Ezinye izinto ezenzeka ngesikhathi esifanayo ezweni lonke ukwethula umkhankaso kumahhovisi ezifunda e-TAC:
• EMopani, eLimpopo alinganiselwa kuma-900 amaqabane amasha esuka eNkantolo kaMantshi eya kwihhovisi lesifunda saseMopani soMnyango wezeMpilo. Uphiko lwentsha lwe-ANC kanye nenhlangano zomphakathi i-Fair Shate kanye neNtshuxeko zanika imiyalezo yokweseka ngesikhathi kuvulwa. Uhlu lwezikhalazo lwe-TAC lwemukelwa omele isifunda oqhamuka kuMnyango wezeMpilo kwisifunda saseMopani.
• E-O.R. Tambo, eMpumalanga Kapa angaphezu kwama-500 amalungu e-TAC amasha ehla kwimigwaqo yaseMthatha ukuze ahambise uhlu lwezikhalazo kuMnyango wezeMpilo. Lokhu kwenzeka ngelanga kugujwa usuku lokuzalwa lukababa u-Nelson Mandela lweminyaka engama- 91 ngesikhathi kunikelwe ngemizuzu engama-67 ukuze kuhlonishwe owayenguMongameli.
• Ekurhuleni, eGauteng aqikelelwa kwi-1000 amalungu e-TAC kanye nesebenzisa nabo amasha aya ehhovisi leMeya ukuze ahambise uhlu lwezikhalazo befuna izinsiza zezempilo. Ikhansela u-Ndolosi wemukela
uhlu lwezikhalazo emele iMeya. Kwakukhona nezintatheli ezivela kumaphephandaba kanye nakwimisakazo eyehlukene emikhulu.
• EMgungundlovu, KwaZulu-Natali balinganiselwa kuma- 600 abantu abamasha besuka e-Market Square beya kwiSishayamthetho. Ukwengeza kumkhankaso we- Resources for Health, imashi futhi yayihlangene nohlu lokulinda kanye nokuphela kwemishanguzo yesifo sengculaza esibhedlela sase-Edendale. Kwabanjwa umlindelo walabo abashona besalindele ukuthola imishanguzo yesifo sengculaza e-Edendale.
• EGert Sibande, eMpumalanga alinganiselwa kuma-520 amalungu amasha esuka enkundleni yezemidlalo eMpumalanga eya kuMnyango wezeMpilo. Uhlu lwezikhalazo lwemukelwa uMqondisi wezeMpilo kwisifunda. Ngemuva kwemashi i-TAC yathola izimemo ezintathu kwizibhedlela ezintathu ngaphambilini ezaziphikisana nokusebenza kwesifunda.
Ukuze uzibandakanye nomkhankaso we-Resources for Health we-TAC thinta igatsha eliseduzane nawe. Imininingwane yokuxhumana ikwikhasi lokuqukethwe
laleli phephabhuku.
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Ngesikhathi esebenza njengekhansela lokulungiselela ukukhishwa kwemithi, uSello Mokhalipi wabona i-emali eyayivela ehhovi si likaNgqongqoshe wesifundazwe sase-Free State eyayiyalela izikhungo ezikhipha imishanguzo yesifo sengculaza ukuthi ingabe isaqalisa iziguli ezintsha ngoNovemba ka-2008. USello wabe esebona ukuthi isifundazwe siphelelwa imishanguzo yesifo sengculaza futhi ngemuva kokwenza uphenyo wathola ukuthi iziguli bezibekwe kuhlu lwabalindele ukuthola imishanguzo yesifo sengculaza kusukela ngo-Agasti ka-2008.
Yingaleso sikhathi-ke lapho uSello anquma khona ukuthi axhumane nehhovisi likazwelonke le-Treatment Action Campaign (TAC) eKapa. Wayeseqalile ukugqugquzela umphakathi mayelana nokuphela kwemishanguzo yesifo sengculaza e-Free State.
Ngasekupheleni kukaNovemba, wabhala incwadi eya kuNgqongqoshe wesifundazwe wase-Free State uMnu. Sakiwo Belot, ekhalaza ngokuphela kwemishanguzo yesifo sengculaza. Ihhovisi likaNgqongqoshe wesifundazwe alizange liphendule. Noma kunjalo, ngoJanuwari ka-2009 uSello waphinde wabhala enye incwadi, kulokhu ecela ukuba nomhlangano ukuze kudingidwe lolu daba. Lo mzamo wokuxhumana nawo awuzange uthele zithelo.
Mhla ziyi-10 kuFebhruwari ka-2009, uSello wahlela imashi eya endlini kaNgqongqoshe wesifundazwe eBloemfontein. Kwakukhona kuyo nosihlalo we-TAC, uNonkosi Khumalo, kanye nezinye izishoshovu ezivele esifundazweni saseGauyeng. Ngosizo lwe-TAC uSello waphinde wahlela umhlangano wezinhlangano zezishoshovu ezehlukene ngoMashi, okwakukhona kuwo nowayenguNgqongqoshe wezeMpilo kuzwelonke uBarbara Hogan. Okwaphuma kulo mhlangano kwaba ukuthi i-TAC kanye nezinhlangano esebenzisana nazo babe umbimbi, uSello wabe esekhethwa njengosihlalo walo.
USello waphinde wahlela ukuvimbela ehholo ledolobha laseBloemfontein okwenzeka mhla zingama-16 kuMashi ka-2009. Umyalelo wezomthetho wokumisa ukukhishwa kwemishanguzo yesifo sengculaza esifundazweni saseFree State wasuswa ngemuva kwamaviki ambalwa ngemuva kokuvimbela.
Okwenziwa uSello kwaba negalelo ngqo ekususweni komyalelo wezomthetho esifandazweni saseFree State. Waziza i-TAC ngenkinga noma yayingasebenzi kwisifundazwe, futhi wenza inkinga yabonakala kakhulu ngokugqugquzela abantu bendawo kanye nokusiza ngokwaziswa kwabezindaba.
USello Mokhalipi kanyenokuphela kwemishanguzo yesifo sengculaza
esifundazweni sase-Free StateIbhalwe nguOlivia Adams
USello Mokhalipi wayesebenza njengekhansela lokulungiselela ukukhishwa kwemithi esufundazweni sase-Free State ngesikhathi ebona i-emali ephuma kwihhovisi likaNgongqoshe wesifundazwe iyalela izikhungo ezikhipha imishanguzo yesifo sengculaza ukuthi zingabe zisaqalisa iziguli ezintsha ukusukela ngoNovemba ka-2008. Wanquma ukuthathela lokhu isinyathelo. Kungekudala ngemuva kwalokho, ukuphela kwemishanguzo yesifo sengculaza esifundazweni sase-Free State kwaba yindaba esematheni ezweni lonke.
USello uke wahamba esifundazweni saseFree State okwesikhashana kodwa manje usebuyele futhi usazibandakanya ne-TAC kanye neFree State HIV Coalition. Siyambonga ngokusebenza kwakhe kanzima, ukubakhona kwe-TAC esifundazweni saseFree State akuhlehleli emuva futhi negatsha elisavula amaphiko alo lisaqhubeka nokukhula. (Ukuze uthole eminye imiphumela yokuphela kwemithi esifundazweni saseFree
State, bheka ikhasi 11).
Izindaba ezivela kwisifundazwe sase-Free State
U-Isaac Makamole uthathwe lapha nomndeni wakhe. U-Isaac akakwazanga ukuthola imishanguzo yesifo sengculaza ngesikhathi sesikhathi somthetho sokumiswa kokukhishwa kwemisganguzo yesifo sengculaza esifundazweni sase-Free State. Wayegula kakhulu ngaphandle kwemithi yakhe kwaze kwadingeka ukuthi anikwe i-oxygen esibhedlela esisendaweni. Isithombe sithathwe ngu-Geoffrey York/i-The Globe and Mail.
Izinyanga eziningi, u-Evelyn Mapota wayengakwazi ukuthola imishanguzo yesifo sengculaza yendodakazi yakhe ngesikhathi somthetho sokumiswa kokukhishwa kwemishanguzo yesifo sengculaza esifundazweni sase-Free State. Waphindiselwa emuva kaningi yizibhedlela zikahulumeni, futhi walekhu etshelwa ukuthi “aphinde abuye ngesonto elizayo.” Isithombe sithathwe nguGeoffrey York/ i-The Globe and Mail.
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Ngaphandle kwemali ayanele, izethembiso zokufinyelela kwezokwelapha ziyizeleze, futhi imiphakathi yethu izoqhubeka nokuqedwa izifo ebezingagwemeka nezelaphekayo.
Kubantu abanegciwane lesandulela ngculaza e-Afrika, umthelela wesimo somnotho ucacile: ngokombiko wakamuva webhange lomhlaba, ezinyangeni eziyi-12 ezizayo ama-70% abanatu ayisigidi esi-1.9 abathola imishanguzo yesifo sengculaza bangabona ukuthola kwabo okokwelapha kuba sengcupheni ngenxa yesimo somnotho esingesihle.
Ngaphandle kokuzibophezela komhlaba wonke mayelana nokutholakala kwezokwelapha kungakafiki u-2010, kubantu abayizigidi eziyi-3.9 base-Afrika abanegciwane lesandulela ngculaza abasadinga ezokwelapha, amathuba okuthi bathole imishanguzo yesifo sengculaza iya ngokushabalala. Isimo sibi ngokulinganayo ngokuphathelene nempilo yomama kanye nabantwana. Kwizwekazi lase-Afrika lonke, izinga lokushona komama liqikelelwa ukuthi lehle okungenani kuma-5% kunamazinga ango-1990. Kodwa i-Millennium Development Goal ifuna ukuba amazinga ebephansi ngama-75% kunamazinga ango-1990 ngo-2015.
ISEBENZISE IMALI ENINGI KWEZEMPILOKUNGANI KUMELE I-AFRIKA
Ekuqaleni kwe-World Economic Forum (WEF) on Africa eyayibanjelwe eKapa kusukela mhla ziyi-10 – 12 kuJuni ka-2009, imbumba yezishoshovu zegciwane lesandulela ngculaza kanye nesifo sofuba zafuna ukuthi abaholi besifundazwe baqinisekise ilungelo lezempilo, baqinisekise ukuthi kufakwa izimali njengento esemqoka, futhi bathole ezinye izinsiza ezidingekayo ezizotholakala emhlabeni wonke ukuze kuvinjelwe, kwelashwe futhi kunakekelwe isifo sofuba kanye negciwane lesandulela ngculaza.
Ukufunwa kwezinsiza zokulwa negciwane lesandulela ngculaza kanye nesifo sofuba e-Afrika akulona ihaba. Ukubakhona kwezinsiza ngeyona yinto ezonquma ukuthi izigidi zabantu zizophila noma zizoshona yini. Isifo sofuba isona esihamba phambili njengesizathu sokushona kwabantu emazweni amaningi kwisifunda, ikakhulukazi abantu abaphila negciwane lesandulela ngculaza. Sibulala abantu abangaphezu kwesigamu sesigidi e-Afrika njalo ngonyaka. Konke ukushona kwabantu okuhlobene negciwane lesandulela ngculaza kwizwekazi kuqikelelwa kwisibalo esiyi-1.5 yezigidi
ngonyaka.
Sebenzisa manje, wonge kamuvaUkwehlukela ukutshala imali eyanele ekwengameleni isifo sofuba kanye negciwane lesandulela ngculaza kukhombisa ukungabi nandaba nezimpilo zabantu abanalezi zifo. Futhi kuphinde kuthwalise umthwalo izwekazi ngenxa yemiphumela ngokwezenhlalo kanye nezomnotho ngenxa yokungenganyelwa kwalolu bhubhane. Umbiko ka-2007 weBhange loMhlaba uqikelela izindleko zezomnotho zokungelashwa kwesifo sofuba kuma-$519 ezigidigidi, okungokuphindwe ngama-25 kwinani lokwengamela isifo sofuba
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ngendlela efanele esikhathini esifanayo. Ucwaningo olumbalwa selufakazele ngokungengabazeke ukuthi ukuqalisa imishanguzo yesifo sengculaza kwinani eliphezulu lamasosha omzimba kwehlisa amazinga okudluliseka kakhulu. Ngendlela efanayo, ukukwazi ukufinyelela kwezokwelapha emhlabeni wonke nakho kuyindlela yokuvimbela okungagcina sekongele ohulumeni igidi ngezigidi zama-dollar.
Ngesikhathi izinsiza zezomnotho ziya zincipha, kubaluleke kakhulu kunakuqala ukuthi abaholi kwisifunda benze isiqiniseko sokuthi izinto abazibeka phambili zihlangabezana nezidingo zabantu ababasebenzelayo. Ngo-2001, abaholi bamazwe ase-Afrika kwiSimemezelo sase-Abuja (Abuja Declaration) bathi: ‘ Sikholwa ngokuphelele ukuthi ukuvimbela ukusabalala kanye nokuhlehlisa ubhubhane oluyigciwane lesandulela ngculaza, isifo sofuba kanye nezinye izifo ezithathelanayo kumele kube yinto esiyibeka phambili kwikwata yokuqala kweminyaka eyikhulu yama-21’.
Kuningi okunye ukuzibophezela kwesifunda kanye namazwe aphesheya okuphinde kwazakalisa lesi sitatimende futhi kwabona ukubaluleka kokunyusa imali ukuze kuliwe negciwane lesandulela ngculaza kanye nesifo sofuba e-Afrika. Kodwa ambalwa kakhulu amazwi kulawa asephenduke ukwenziwa kokuthile. Futhi, inkulumo ‘yongoti’ emhlabeni wonke manje isiqalile ukuphendukela ukufakwa kwezimali ngqo kwigciwane lesandulela ngculaza, bathi sense buthakathaka uhlelo lwezempilo. Le mpikiswano iyenzeka noma ngale kokuthi izigidi
zabantu ziyaphila namhlanje ngenxa yezigidi ngezigidi zama-dollar izatshalwa kwimishanguzo yegciwane lesandulela ngculaza kanye nakwizinhlelo zezempilo (bona ikhasi lesi-4 ngokuphathelene nenye impikiswano mayelana nokufakwa kwemali kwisifo sengculaza).
Siyala ukuthi kubuyelwe emuvakule nqubekela phambili eseyenziwe. Izishoshovu kwisifunda zizobe ziqaphe ngeso lokhozi abaholi ngokuphathelene nokuzinikela kwabo kumalungelo abantu abanegciwane lesandulela ngculaza kanye nesifo sofuba, futhi zizofuna ukuxhaswa ekwenzeni isiqiniseko sokuthi lawa malungelo avikelekile.
Ikusasa lezwekazi limnyama uma ezempilo zalo zingavikelekile, futhi impilo yezwekazi angeke ivikeleke ngaphandle kokuthi sibhekane nezinselele zegciwane lesandulela ngculaza kanye nesifo sofuba. Inkulu inqubekela phambili eseyenziwe ngokuphathelene nalolu bhubhane lolubili- kodwa sikude nokunqoba impi, futhi abathelelekayo
bayaqhubeka nokwanda.
Kwi-WEF, i-TAC kanye ne-AIDS and Rights Alliance for Southern Africa (ARASA) bafuna ukuthi abaholi babone bese bephendula kwisimo samanje sezinkinga kwezempilo:
Ngokugcina isibophezelo esisasebenza, esihlanganisa: • ISimemezelo sase-Abuja sika-2001, lapho abaholi bamazwe ase-Afrika
bathembisa khona ukubekela ama-15% esabiwo zimali zikazwelonke kwezempilo;
• Izivumelwano zamazwe omhlaba zokufaka ama-0.7% ezimali zentela eziqoqwe amazwe anothile kwi-Overseas Development Assistance (ODA); kanye
• Nesithembiso sokuqinisekisa ukufinyelela ekuvinjweni, ekwelashweni kanye nasekunakekelweni ngkuphathelene negciwane lesandulela
ngculaza kanye nesifo sofuba.
I-TAC kanye ne-ARASA yaphinde yafuna abaholi ukuthi bavale igebe sezinsiza zezokwelapha ngoku-:
• Ngakhuthazi imigomo yesikhwama sezwe enika umkhawulo ekusetshenziselweni imali kwezenhlalakahle kumazwe anganothile;
• Zibophezela ukukhipha ama-15% emali yentela eqoqwe amazwe aphakathi nendawo kanye nanganothile ngokwezezimali (okungahlanganisi izimali zesibonelelo sikahulumeni) kwezempilo;
• Qinisekisa ukuthi u-15% we-ODA, noma u-0.1% wemali yentela eqoqwe amazwe anothile, inikezwa ezempilo;
• Ukwethula kokusetshenziswa kwentela yamazwe omhlaba, njengoba lokhu kusanda kuphakanyiswa yiFrance, engakhipha izigidingezigidi (billion) ezingama-$30 – $60 ngaphezulu ngonyaka ngamunye kwezempilo zamazwe omhlaba; futhi
• Ukuthuthukisa ukwenza izinto ngendlela ebonakalayo kanye nokuba nesibopho ngokuphathelene nendlela izinsiza zezempilo ezikhishwa futhi ziphinde zisetshenziswe ngayo, okuhlanganisa ukuphuma
kwezimali okungekho emthethweni kumazwe anganothile.
Izishoshovu zase-Afrika zicela abaholi kwi-2009 World Economic Forum on Africa ukuthi babeke phambili ukunikwa imali kwezempilo kanye nokuvalwa kwezikhala kwizinsiza ukuze kuqinisekiswe ukufinyelela ekunakekelweni emhlabeni wonke ngokuphathelene negciwane lesandulela ngculaza kanye nesifo sofuba. Izithombe zithathwe nguSamantha Reinders.
Umbhalo uthathwe kumbiko wesithangami sezindaba we-RASA.
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Ngesikhathi sokubhala lo mbiko, uhulumeni waseMelika bese ubeke imali eyizigidingezigidi (billion) ezingama-$830.2 yezimpi zase-Iraq nase-Afghanistan. Ezinye izigidingezigidi (billion) ezingama-$77.1 seziceliwe ukuze kufakwe imali kulokhu kungqubuzana, okubeka imali uma isiyonke kwizigidingezigidi (billion) ezingama-$907.3 kusukela ngo-2001.
Uma kuqhathaniswa nemali esetshenziselwa isifo sengculaza yiqembu le-G8 lamazwe anothile, i-European Commission kanye nabanye abanikelayo akwakuyizigidingezigidi (billion) eziyi-$6.6 ngo-2007. Ngo-2006, yayingaphansi ngezigidi mgrzigidi eziyi: $5.6. Umphumela, ngokwe-Joint United Nations Programme on HIV/AIDS (UNAIDS), siyizigidingezigidi (billion) eziyi-$8.1 igebe elisele ngokwezezimali kwizinhlelo ezisemqoka zegciwane lesandulela ngculaza kanye nesifo sengculaza
emhlabeni wonke jikelele.
INingizimu Afrika ingelinye lamazwe ayi-15 okubhekwenwe nawo kwi-United States government’s President’s Emergency Plan for AIDS Relief (PEPFAR). Imali ye-PEPFAR eNingizimu Afrika ibiyizigidi ezingama-$397.8 kuphela ngo-2007. izwe laseMelika liphinde lihlinzeke ngokuxhasa imizamo yomhlaba wonke ngokuphathelene negciwane lesandulela ngculaza kanye nesifo sengculaza
ngokufaka kwalo imali kwiSikhwama Samazwe Omhlaba (Global Fund) ukuze kuliwe nesifo sengculaza , isifo sofuba kanye neNomalaleveva. I-Global Fund seyiphumelelise izibonelelo ezinhlanu zegciwane lesandulela ngculaza kanye nesifo sengculaza (okuhlanganisa nezibonelelo zegciwane lesandulela ngculaza kanye nesifo sofuba) zeNingizimu Afrika, uma sezihlangene ziyizigidi ezingama-$228.7 ama-dollar kwimali
okunisekisiwe ukuthi izonikezwa.
Kuleli, ukuhlinzekwa ngemali kokuphathelene negciwane lesandulela ngculaza kanye nesifo sengculaza kutholakala ikakhulukazi kwisabiwomali zikazwelonke sezempilo. Ngo-2007 kwakuqikelelwa ukuthi isabiwomali ngokuphathelene negciwane lesandulela gculaza kanye nesifo sengculaza sikazwelonke siyizigidingezigidi (billion) eziyi-R3.4
(okungalinganiswa nezigidi ezingama-$480).
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ezingama-$907.3
eziyi-$6.6 $5.6.
ezingama-$397.8
eziyi-$8.1 ezingama-$228.7
ezingama-$480)
eziyi-R3.4
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Lapho kuya khona
$iMali$Umbiko ohlanganiswe nguPouya Gharavi kanye noLynn Elharake.
Izimpi zase-Iraq nase-Afghanistan
Uthathwe ku-: http://www.nationalpriorities.org/cost_of_war_counter_notes; http://www.plusnews.org/Report.aspx?ReportId=79150; http://www.kff.org
Izithombe zithathw
e ngabakwa-C
ampaign
Against A
rms Trade
Ibhola leNdebe yoMhlaba lika-2010 eNingizimu Afrika
Imithombo: http://www.sa2010.gov.za/en/funding; http://www.sa2010.gov.za/en/printpdf/524; http://www.gcis.gov.za/docs/publications/yearbook/2009/chapter12.pdf; “How Much Does It Cost to Provide Antiretroviral Therapy for HIV/AIDS in Africa?”, Center for International Health and Development Boston University.
INingizimu Afrika isebenzisa izigidingezigidi (billion) eziyi-R8.4 ukwakha izinkundla zemidlalo ezinhlanu ezintsha kanye nokulungisa ezinye ezinhlanu zemidlalo yamanqamu yeNdebe yoMhlaba ka-2010, ngokwabalungiselela le midlalo. Imali yonke efakwe uhulumeni kwingqalasizinda kanye nezinkundla zemidlalo iyizigidingezigidi (billion) eziyi-R17.4.
Uma kuqhathaniswa, nesabiwomali jikelele soMnyango wezeMpilo kazwelonke sika-2008/09 esasiyizigidingezigidi (billion) eziyi-R15.1.
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eziyi-R17.4.
eziyi-R15.1.
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Ukukhankasela ukhetho uma kuqhathaniswa nezimpilo
Ekuqaleni kwalo nyalo isifundazwe sase-Free State siphasise umthetho wokunikeza imali eyizigidi ezingama-R30 kumaqembu ezepolitiki ukuze ayisebenzise kwimikhankaso yawo yezokhetho. Ongoti bakuchaza njengento engekho emthethweni futhi engahambisani nomthethosisekelo. Uhulumeni kazwelonke kuphela onganika amaqembu ezepolitiki izimali.
Lesi simemezelo senziwa ngemuva kokuba isifundazwe sase-Free State sesiyekile ukufaka iziguli ezintsha kwimishanguzo yesifo sengculaza ngoNovemba ka-2008-okwabikwa ukuthi kungenxa yokuthi isifundazwe
sasingenayo imali eyanele yokuthenga imithi. Isikhathi esanikwa umthetho sokuthi kuyekwe ukukhishwa kwemishanguzo yesifo sengculaza kwadlula nezimpilo ezingama-30 ngosuku, ngokwesibalo esiqikelelwayo esiphuma kwi-South African HIV Clinicians Society.
Ngesikhathi imali itholakala kumaqembu ezepolitiki, yayigodliwe kwiziguli. Kwakuzobiza isifundazwe sase-Free State igidi eziyi-R800,000 kuphela ukuqhubeka nezokwelapha ngesikhathi sezinyanga ezine zesikhathi esanikwa umthetho sokumisa ukukhishwa kwemishanguzo
yesifo sengculaza.
Uhulumeni waseMelika usebenzisa imali engaphezu
kwezigidingezigidi zezigidi (trillion) ezingama-$7.76
kwimizamo yokwehlisa umthelela wesimo esibi
sezomnotho.
Loku kusetshenziswa kwemali kuvela ngesikhathi lapho
abanikelayo bamazwe omhlaba kanye nohulumeni base-
afrika sebememezele ukuthi makhulu amathuba okuthi
behlise isabiwomali sezempilo ngenxa yale nkinga. Ongoti
bezempilo bayesaba ukuthi ukunyuka kokungasebenzi
kanye nobumpofu kuzosho ukuba phansi kokuqinisekiswa
kokudla kanye nomsoco ongekho ezingeni elifanele,
okuzophinde kushonise phansi futhi uhlelo lokunakekela
lwezempilo oluntengantengayo.
Imali yokutakula
Imali ye-Global Fund yoKulwa nesifo sengculaza, isifo sofuba kanye nomalaleveva esanda kumenyezelwa okungenani iyizigidingezigidi (billion) ezingama-$4 ngaphansi kwemali eyidingayo ukuze iqhubeke ngokuhlinzeka ngemali imisebenzi eyisidingo ngo-2010. umbimbi lwe-Global Fund lukholelwa ukuthi liyizigidingezigidi (billion) ezingama-$10.7 igebe lokuqaliswa kwe-Global Plan lokuMisa isifo sofuba sisodwa.
[Lokhu kushoda kwenza ukudingeka nakakhulu kwemali esikhathini esizayo.] Uhulumeni waseNingizimu Afrika ama-R400 ekwelapheni isiguli esinesifo sofuba esijwayelekile, kodwa uma umuntu esengenwa uhlobo lwesifo sofuba esingalapheki ngeminye imithi yokwelapha isifo sofuba,
imali ebiza ukwelapha iyanyuka ifinyelele kwizi-R24,000.
Ngesikhathi iNingizimu Afrika itshale izigidingezigidi (billion) ezingama-R17.4 kwibhola leNdebe yoMhlaba ka-2010, izwe lisebenzisa izigidingezigidi (billion) ezingama-R3.4 kuphela kwigciwane lesandulela ngculaza kanye nesifo sengculaza.
Inkundla yezemidlalo yeNdebe yoMhlaba ka-2010, eGreen Point, eKapa, ziyi-17 kuAgasti ka-2008. Isithombe sithathwe ngu-David Goldblatt.
IZIN
SIZA
ZEZ
EMPI
LO
ezingama-$7.76
ezingama-R30
eziyi-R800,000
ezingama-$4
ezingama-$10.7
22
Kuyini ukusokwa kwezempilo kwabesilisa?Ukusokwa kwabantu besilisa ukuhlinza okwenziwayo ukususa ijwabu kwisitho sangasese somunty wesilisa. Lokhu bekwenziwela izizathu zezenkolo kanye nesamasiko izinkulingwane zeminyaka. Ukusokwa kwabantu besilisa kumele kuhlukaniswe nokusokwa kwabantu besifazane okubizwa phecelezi nge-female genital mutilation (FGM), okusenziwa emazweni amaningi. I-FGM yenzeka uma kusikwa ingxenye yesitho sangasese somuntu wesifazane okuhlanganisa ubhontshisi wakhe kanye nezindebe zesitho sangasese ezingaphakathi. I-FGM iyagxekwa njengendlela njengokuhlukumezwa kwamalungelo abantu futhi inomthelela ongemuhle empilweni yabantu besifazane, kwisithunzi kanye nasekuzimeleni kwabo.
Ngokusokwa kwezempilo sichaza ukususwa kwejwabu odokotela ngaphansi kwezimo zenhlanzeko kanye nomuthi ngumuntu okuqeqeshelwe lokhu esebenzisa amathuluzi ezempilo kanye
nezindlela ezemukeleke emsebenzini wokuba udokotela.
Izinzuzo zezempilo zokusokwaUkusokwa kunciphisa ingozi yokuthola igciwane lesandulela ngculaza ngama-50-60% kubantu besilisa abaya ocansini nabantu besifazane. Lokhu sekukhonjiswe ngokucacile kucwaningo oluthathu. Lolu cwaningo, lonke olwenziwe e-Afrika, kwahlukaniswa iqembu lamavolontiya angamadoda atholakale engenalo igciwane lesandulela ngculaza aba ngamaqembu amabili, iqembu elilodwa elabe selisokwa. Kulona loluthathu ucwaningo amadoda ayesokiwe ayesengozini encane yokutheleleka ngengciwane lesandulela ngculaza. (Ubufakazi obukhona njengamanje kuphathelene kuphela namadoda aya ocansini nabantu besifazane. Okwamanje, asikazi noma ukusoka kuhlinzeka ngokuvikeleka kumadoda aya ocansini namanye amadoda na.)
kanye nokuvinjelwa kwegciwaneUkusokwa kwabesilisa
lesandulela ngculazaUbufakazi bezesayensi bukhulu: emphakathini onabantu abaningi abanegciwane lesandulela ngculaza, ukuthi kunezinzuzo ezicacile zezempilo ekusokweni kwabantu besilisa. Lezi zinzuzo zishiya ngamalengiso ingozi engaba khona uma lokhu kwenziwe ngendlela efanele. Kodwa, kunemibuzo ephathelene nenkambo yokulunga kanye nokwenzekayo okumele kucatshangwe ngayo uma kubekwa uhlelo lwezempilo lomphakathi lokusoka.
Ucwaningo lwamanje luphinde lukhombe nokuthi nokuthi:• Amadoda asokiwe asemathubeni amancane okuthi
angatheleleka nge-herpes (i-herpes simplex ewuhlobo lwegciwane lesi-2). Amadoda asokiwe aphinde abukeke esemathubeni amancane okuthi athole ezinye izifo ezithathelana ngokocansi, ezifana nezilonda ezithweni zangasese kanye ne-gonorrhoea.
• Amadoda asokiwe asemathubeni amancane okuthi umdlavuza wesitho sangasese sabantu besilisa uma kuqhathaniswa namadoda angasokiwe.
• Abafana abasokiwe basemathubeni amancane okuthi bathole izifo ezihlasela umgudu womchamo.
• Abalingani besifazane bamadoda asokiwe kubonakala sengathi baba semathubeni amancane okuba sengozini yomdlavuza wesibeletho. Amadoda asokiwe asemathubeni amancane okuthi atheleleke noma athelele abalingani bawo nge-human papilloma virus (HPV). Ezinye izinhlobo ze-HPV zihlanganiswa nomdlavuza wesibeletho.
Ucwaningo olwenziwe phambilini kubukeka sengathi lukhomba ukuthi abalingani besifazane bamadoda asokiwe anegciwane lesandulela ngculaza kungenzeka babe semathubeni amancane okutheleleka ngegciwane lesandulela ngculaza kunabalingani besifazane bamadoda angasokiwe anegciwane lesandulela ngculaza. Okusha, okungathembelwa kukho nakakhulu okutholakele, kukhomba ukuthi lokhu akunjalo, nokuthi bobabili basemathubeni alinganayo okutheleleka. Noma kunjalo kulindeleke ukuthi abantu besifazane bazuze kwizinhlelo zokusoka ngoba ukusoka kuhlinzeka ngokuvikeleka okuthile kumadoda futhi kumele kuholele ekwehleni kwezinga lokubakhona kwegciwane lesandulela ngculaza jikelele.
INhlangano yezeMpilo yoMhlaba (WHO) incoma ukusokwa abezempilo kwamadoda
njengengxenye ebalulekile kwimizamo
yokuvimbela igciwane lesandulela ngculaza.
Izingozi zezempilo zokusokaUkunga nezinkinga ngemuva kokuhlinzwa kuyenzeka kodwa
kungamaphesenti amancane kwabasokwe abezempilo ngoba
kuwuhlelo lwezokuhlinza lwabezempilo. Iningi lezehlakalo kulezi zinkinga ngemuva kokuhlinzwa ziyaxazululwa. Ezehlakalweni ezingavamile kuyenzeka kushone abantu.
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very low
iphansi
iphezulu
Ukuzinikela ekusokweni kuhlelo lwezempilo lomphakathi kuyithuba lokweluleka kanye nokuhlolela amadoda igciwane lesandulela ngculaza. Ngenxa yengozi yokuthi ukusokwa kungabonakala njengelayisensi yokuya kucansi olungaphephile, kubalulekile ukuthi ukweluleka kube okuhle kakhulu futhi okuhambisana nenqubo efanayo.
Abafana kanye nabantu besilisa abasebancane abaningi bayasokwa eNingizimu Afrika njengengxenye yomgubho wezenkolo kanye nemigubho yesintu. Loku kusokwa kumbalwa ukuthi kwenziwe ongoti kwezempilo futhi isikhathi esiningi kwenziwa ngapahnsi kwezimo ezingenayo inhlanzeko. Akuvamisile ukuthi kwenziwe kufakwe imithi futhi sekube khona imibiko eminingi yokungakwazi ukwenza lo msebenzi okuholela ekuthini abafana balaliswe esibhedlela. Akucacile ukuthi ingabe izinzuzo zezempilo zishiya ngamalengiso yini ingozi kubafana abasokwe ngale ndlela.
Ukusokwa kwamadoda ngokwesiko kanye nokwezenkolo kumele
kuvumeleke, kodwa uhulumeni kumele enze isiqiniseko sokuthi
kwenziwa ngokuphepha futhi ngangokuhambisana nemithetho
engokusoka. Kumele kwenziwe kusetshenziswe izinto zokusika
ezihlanzekile kanye nangabantu abaqeqeshwe ngendlela efanele.
Noma ukusoka kuwukuhlinza okuphephiphile, izimo zokungahambi kahle kwezinto zingenzeka. Ukusoka kumele-ke kuhlinzekwe kwizikhungo zokuhlinza zikahulumeni ezihambisana namazinga emulekekile. UMnyango weZempilo kumele wenze isiqiniseko sokuthi lezi zindawo ziyakhiwa kwizifunda lapho
zingekho khona okwamanje.
Ukusokwa abezempilo ngokuzinikela kumele kuhlinzekwe mahhala kwizikhungo zezempilo ezweni lonke. Kumele kuhlinzekwe ndawonye nezinga eliphezulu lezokweluleka kanye nokuhlolelwa igciwane lesandulela ngculaza.
Original factsheet by Nathan Geffen with assistance from Mark Heywood. Adapted for Equal Treatment by Marcus Low. Sources: World Health Organization information package on Male Circumcision for HIV Prevention. (www.who.int/hiv/topics/malecircumcision/en/) • Auvert et al. 2005. Randomized, controlled intervention trial of male circumcision for reduction of HIV infection risk: the ANRS 1265 Trial. PLoS Med. 2005 Nov;2(11):e298. Epub 2005 Oct 25.• Bailey et al. 2007. Lancet. Feb 24;369(9562):643-56. Malecircumcision for HIV prevention in young men in Kisumu, Kenya: a randomised controlled trial.• Gray et al. 2007. Lancet. Feb 24;369(9562):657-66. Male circumcision for HIV prevention in men in Rakai, Uganda: a randomised trial.• Siegfried et al. 2009. Cochrane Database Syst Rev. 2009 Apr 15;(2):CD003362. Male circumcision for prevention of heterosexual acquisition of HIV in men.
Ing
ozi yokuth
eleleka ig
ciwan
e lesan
du
lela ng
culaza em
adod
eniAkukho
khondomu futhi awusokiwe
Akukho khondomu futhi
usokiwe
Usokiwe futhi usebenzisa ikhondomu
ngendlela efanele
iphezulu kakhulu
• Amanye amadoda asokiwe athi ukusebenza kwawo ngokuphathelene nezocansi kwehlile, noma imizwa yezitho zabo zangasese yehlile ngemuva kokusokwa. Kodwa, amanye amadoda abika ukuthi kwenyukile ukweneliseka kwawo ngemuva kokusokwa.
• Ngesikhathi isitho sangasese somuntu wesilisa sisaphola ngemuva kokusokwa (okuthatha isikhathi esilinganiselwa kumasonto ayisithupha), ingozi yokudluliseleka kwegciwane elisuka kumuntu wesilisa otholakele enegciwane lesandulela ngculaza ukuya kumuntu wesifazane otholakale engenalo igciwane lesandulela ngculaza ongumlingani wakhe kungaba bephezulu kunalokho kwamadoda angasokiwe. Lokhu kukhombisa ukuthi kubaluleke kakngakanani ukweluleka
amadoda ukuthi angayi ocansini ngalesi sikhathi.
Yini elungile ngokusoka? Ukusoka uma sekwenziwe akukwazi ukuphinde kubuyiselwe emuva. Kushintsha ngendlela engeke iphinde iguqulwe umzimba womuntu wesilisa, kubanga ubuhlungu okwesikhashana futhi, okungenani ezikhathini ezimbalwa, kwehlisa imizwa kwisitho sangasese.
Lokhu kuvusa eminye imibuzo: Ingabe kuyinto elungile yini ukugqugquzela ukusokwa? Ingabe kuyinto efanele yini ukusoka izingane okungenzeka zizisole ngokuthi zasokwa? Izinzuzo zezempilo zicacile kodwa kusengxompikiswano mayelana nale mibizo.
UMthetho weZingane waseNingizimu Afrika unengxenye ephathelene nokusokwa kwabesilisa engavumi ukusokwa kwabesilisa abangaphansi kweminyaka eyi-16 ngaphandle uma:
• kwenziwela izizathu zezenkolo futhi kwenziwa ngendlela yenqubo yaleyo nkolo futhi nangendlela okumele kuqhutshwe ngayo; noma
• kwenziwela izizathu zezempilo ngokululekwa isisebenzi sezempilo.
Sincoma ukuthi izingane ezingaphansi kweminyaka eyi-16 kanye nezingasencane kakhulu kumele zisokwe ngemuva kokululekwa ngendlela efanele kanye nokuvumelana nazo. Ezinganeni ezingaphezu kweminyaka eyi-16, umthetho ufuna ukuthi zivume
zinolwazi nokuthi zelulekwe ngendlela efanele.
Ukusoka kuhlelo lwezempilo lukahulumeniAmadoda aya ocansini nabantu besifazane ahlala esengozini enkulu yokuthola igciwane lesandulela ngculaza uma engasebenzizi ikhondomu uma eya ocansini. Noma ingozi ithe ukwehla, zonke izindlela zokuzivikela kumele kutshekwe nokuzisebenzisa. Ukusoka kumele kugqugquzelwe ngendlela yokuthi ingaholeli ekutheni amadoda acabange ukuthi angaya ocansini olungaphephile ngemuva kokuba esokiwe.
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Iphilisi elisha lesifo sofuba libukeka lithembisaIphilisi elisha lesifo sofuba elibizwa nge-TMC207 lisahlolwa ukuthi liyasebenza yini okwamanje, futhi okwamanje imiphumela isabukeka ithembisa. I-TMC207 yaqhathaniswa ne-placebo lapho okwakwenziwa khona ucwaningo kungachazwanga ukuthi iziphi iziguli ezinikwe amaphili okuyiwonawona kwinani elincane leziguli ezinesifo sofuba esingalapheki kalula ngemithi yesifo sofuba (MDR-TB) ezibhedlela zaseNingizimu Afrika elalithathiwe.
Iziguli eziyi-10 kwezingama-21 ezathatha i-TMC207 zatholakala zingasenaso isifo sofuba uma kuqhathaniswa nezi-2 kwezingama-23 ezathatha i-placebo. Lokhu kusho ukuthi i-TMC207 yasebenza kahle kakhulu ekwelapheni isifo sofuba esingalapheki kalula ngemithi yesifo sofuba kulokhu kuhlola. Kodwa kwaba khona nokungaphathi kahle umzimba okuthile okwenzeka. Iziguli
Ibhalwe nguNathan Geffen
Sicela wazi ukuthi: Zonke iziguli ezazibandakanya kulolu cwaningo lwezempilo oluchazwe kulo mbhalo zakwenza lokhu zingaphoqiwe. Ucwaningo lavunywa amakomidi okulungileyo kanye noMkhandlu woKwengamela wezeMpilo. Lolu cwaningo lwezempilo lwavunywa ama-ethics committees kanye ne-Medicines Control Council. Akumele uphoqwe ukuthi ube yingxenye yocwaningo lwezempilo futhi akumele wenziwe ingxenye yocwaningo ngaphandle kokwazi.
eziningi ezathatha i-TMC207 zaba nokucanuzelelwa inhliziyo kuneziguli ezathatha i-placebo. Noma kunjalo, iziguli eziningi zakwazi ukubekezelela i-TMC207.
Uma kusekelwa kule miphumela, i-TMC207 ibukeka ithembisa. Kodwa lolu kwawukuhlola ukusebenza kwayo okuncane futhi okusesekuqaleni. Kusenziwa okunye ukuhlola. Kungathatha eminye iminyaka emibili ngaphambi kokuthi sisho ngokuzethemba ukuthi ukuthi ingabe leli philisi liphephile futhi lisebenza ngendlela efane le yini noma cha. Okwamanje, i-TMC207 kumele inikwe abantu abanesifo sofuba ezingalapheki kalula ngemithi yesifo sofuba lapho abantu abanesifo sofuba esingalapheki kalula ngemithi yesifo sofuba bengenakho okunye abangakusebenzisa.
Ama-Steroid asebenza ngendlela efanele ukwelapha i-TB IRISEzinye zeziguli eziqala imishanguzo yesifo sengculaza zinamasosha omzimba aphansi kakhulu zingaba nesifo esiyingozi kakhulu esibizwa nge-immune reconstitution syndrome (IRIS). Noma ngabe zilashwa, iziguli ezine-IRIS zingaba nezifo ezingosomathuba ezifana nesifo sofuba. Lokhu kwenzeka ngoba amasosha omzimba ayasimama (ngenxa yemishanguzo yesifo sengculaza) bese ephinda elwa nezifo esezivele zikhona emzimbeni.
UDkt Graham Meintjes ungudokotela esibhedlela i-Jooste eKapa. Wenza ucwaningo lokuthola ukuthi iziguli ezine-TB IRIS ziba ngcono yini uma zinikwa i-steroid esibizwa nge-prednisone.
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Iqembu lakhe lathatha iziguli ezingama-55 jikelele ezine-TB IRIS zanikwa i-prednisone kwase kwathi ezingama-54 zaba kwi-placebo. Isikhathi esilinganisiwe esasihlalwa iziguli esibhedlela ezikwi-prednisone kwakuwusuku olulodwa, ngesikhathi iziguli ezikwi-placebo kwakuba izinsuku ezintathu. Uma sekuhlangen konke, inani lezinsuku esibhedlela zazingama-282 kwiqembu le-prednisone uma kuqhathaniswa nezingama-463 zeqembu le-placebo. Zazimbalwa izinto okumele zenziwe esibhedlela kwiqembu le-prednisone (abangama-29 uma kuqhathaniswa nama-38). Uma sekubhekwa konke, iziguli ezikwi-prednisone zenza kangcono kunalezo ezikwi-placebo.
Lolu cwaningo lukhombisa ukuthi i-prednisone kumele inikezwe iziguli ezine-TB IRIS. I-prednisone isivele iyatholakala
ezikhungwini zomphakathi.
Abantu abatholakala bephila negciwane lesandulela ngculaza abanesifo sofuba kumele banikezwe imishanguzo yegciwane lengculaza ngaleso sikhathiI-Salim and Quarraisha Abdool Karim’s research institute, i-CAPRISA, yenza ucwaningo lwezempilo eTh ekwini ukuze kubonakale ukuthi yinini lapho kungcono khona ukufaka iziguli ezinegciwane lengculaza ezinesifo sofuba kwimishanguzo yesifo sengculaza.
Bahlukanisa iguli zabo kungabhekwa okuthile zaba ngamaqembu amabili. Iqembu lokuqala lathola imishanguzo yesifo sengculaza ngaleso sikhathi ndawonye nemithi yesifo sofuba. Iqembu lesibili lanikwa imishanguzo yesifo sengculaza kuphela uma seliqedile ukuthatha imithi yesifo sofuba. Izinga lokushona kwabantu
kwiqembu elanikwa imishanguzo yesifo sengculaza ngaleso sikhathi lalingaphansi kwesigamu salelo leqembu elalindiswa.
Ucwaningo lwabo luphendula umbuzo obalulekile. Lukhomnbisa ukuthi abantu abatholakala benegciwane lesandulela ngculaza kanye nesifo sofuba kumele banikwe imishanguzo yesifo sengculaza ngaleso sikhathi uma sebetholakele ukuthi banesifo sofuba, kanye namaphilisi abo esifo sofuba.
Lokhu kulula kakhulu emitholampilo elapha kokubili isifo sofuba kanye negciwane lesandulela ngculaza. Ngakho uMnyango wezeMpilo kumele usize imitholampilo ukuthi yenze lokhu. Iziguli ezinakho kokubili, igciwane lesandulela ngculaza kanye nesifo sofuba akumele zize ziye emitholampilo emibili eyehlukene. Ukunakekelwa okwehlukene kuyabiza, akusebenzi futhi kwenza ukuphazamiseka. Kuphinde kusho futhi ukuthi zonke iziguli ezinesifo sofuba kumele zihlolelwe igciwane lesandulela ngculaza, futhi zonke iziguli ezinegciwane lesandulela ngculaza azihlolelwe isifo sofuba
Izindaba ngokuphathelene nesifo sofuba esingalapheki ngeminye imithi yesifo sofuba (XDR-TB) eNingizimu Afrika ziyaqhubeka nokukhathaza.
Ucwaningo olwenziwa u-Max O’Donnell esibhedlela saseKing George V eTh ekwini lwakhombisa ukuthi kwiziguli ezingama-25 kwezingama-60 iqembu lakhe elazilaphela i-XDR-TB zashona. Ezinye eziyisithupha zayeka ukuthatha imithi yazo. Ekupheleni kwezinyanga eziyisithupha, zimbalwa kakhulu kunohhafu kulezi ziguli azazaziwa njengezisaphila. Lokhu kwenzeka noma zazinikwa ukunakekelwa kwezempilo okusezingeni eliphezulu kakhulu, okwakuhlanganisa imishanguzo yesifo sengculaza kwiziguli ezazinegciwane lesandulela gculaza. Ziyishumi nambili kuphela iziguli ezelashwa ekupheleni kwesikhathi sokwenziwa kocwaningo.
Lolu cwaningo lukhobisa ukuthi kunzima kangakanani ukelapha i-XDR-TB ngempumelelo.
Kuyakhathaza futhi ukuthi iziguli zazilethwa lapha zisuka kwizikhungo zezempilo ezingama-26 ezehlukene esifundazweni saKwazulu-Natali. Lokhu kusho ukuthi i-XDR-TB isisabalale
kakhulu esifundazweni.
I-placebo iphilisi okungelona. Amaphilisi amasha kujwayelwe ukuthi kuhlolwe ukusebenza kwawo eqhathaniswa namaphili okungewona.
Uhlelo lokuhlola olubizwa nge-double-blinded ilapho udokotela kanye nesiguli bengazi khona ukuthi isiguli sithola i-placebo noma iphilisi ekubhekwa ukusebenza kwalo.
Ukuhlolwa kwezempilo ku-randomised uma isiguli sithathwa kuzenzekela nje (isibonelo ngokupinisa imali) ukuze sithole iphilisi langempela noma i-placebo. Lonke ucwaningo lwezempilo kumele lwenziwe ngokuthatha iziguli okuzenzekelayo.
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I-Bad Science
Ibhalwe nguBen Goldacre
ENingizimu Afrika siyazi ukuthi kuncane kakhulu okwaziwayo ngesayensi nokuthi imisebenzi yayo ingaholela ekuvimbeleni ukushona kwabantu okungavimbeleka. Siyazi ukuthi amavithamini angeke elaphe igciwane lesandulela ngculaza, nokuthi imishanguzo yesifo sengculaza iyona kuphela engacindezela igciwane. Noma kunjalo, owayenguNgqongqoshe wezeMpilo wehluleka ukubona lamaqiniso afakazelwe.
Kwi-Bad Science, udokotela kanye nombhali wezesayensi owaziswayo u-Ben Goldacre uchaza ngolimi okulula ukuluqonda ukuthi singakwenza kanjani kwakhe umqondo lokho okushiwo ngokwesayensi ngabezindaba. Ukubeka ngendlela ekwenza ubone ukuthi abezindaba bazibandakanya kanjani ekwesabiseni, izinkampani zezobudlelwane bomphakathi zihambisa kanjani isayensi mbumbulu ukuze
Izincwadi okucebiswa ukuthi zifundwezihlomulise amakhasimende azo, nokuthi izintatheli eziningi zenza kanjani amaphutha ayisisekelo uma zibhala ngesayensi nempilo.
UGoldacre akasoli abathile kuphela nje, kodwa: ukunikeza mathuluzi okuthi ubone isayensi engeyinhle kanye nokwesatshiswa kwesayensi mbumbulu ngokwakho. Kanjalo-ke, i-Bad Science iyincwadi enika ulwazi kakhulu futhi nencwadi okucebiswa ukuthi ifundwe kakhulu. Ukuba-nje abanye babaholi bethu babeyifundile ngaphambi kokuthi bathole izikhundla.
Qaphela ukuthi incwadi eshicilelwe ngo-2009 iqukethe isahluko ngo-Matthias Rath. Lesi sahluko sasishiyiwe kwezishicilelwe phambilini ngoba u-Rath wathathela izinyathelo zezomthetho u-Goldacre ngenxa yokuphawula okwenziwa uGoldacre kwiphephandaba i--Th e Guardian. Isinqumo senkantolo savuna uGoldacre. Isahluko ngo-Rath siyatholakala mahhala kwikhompuyutha kuleli kheli:: http://www.badscience.net/2009/04/matthias-rath-steal-this-chapter/
I-The Virus, Vitamins and Vegetables Ihlelwe nguKerry Cullinan no-Anso Thom
I-Th e Virus, Vitamins and Vegetables ihlinzeka kabanzi ngomlando weminyaka lapho uhulumeni wayehambisana nokuphikwa kwesifo sengculaza ngaphansi kowayenguMongameli UTh abo Mbeki kanye nalowo owayenguNgqongqoshe wezeMpilo uManto Tshabalala-Msimang. Ihlanganiswe ithimba lezintatheli eziphumelele imiklomelo ku-Health-e News Service, le ncwadi ifake nokuthasiselwe ngabanye, okungabalwa kubo uPregs Govender, uAshraf Coovadia kanye noZackie Achmat.
Ukwethulweni kwencwadi eTh ekwini , owayisekela likaNgqongqoshe wezeMpilo uNozizwe Madlala-Routledge wathi “ilanda isiphetho esibuhlungu esenzekayo uma abaholi bekhetha ukudlala ngezimpilo zabantu ngokushaya indiva ubufakazi kanyae nesayensi nokuthatha amakhambi
angekahlolwa kanye nemicabango engafakezelwe yalabo abanokungaphili kahle emqondweni.”
Njengomlando wokuphika isifo sengculazi, incwadi ikufanelwe ukufundwa. Ukusukela kwi-Virodine ukuya ekulweni isikhathi eside kwe-TAC noMatthias Rath kanye nempumelelo yomkhankaso yokwenza uhulumeni akhiphe imishanguzo yesifo sengculaza (ARV), zonke lezo zinto eziyisisekelo kuyakhulunywa ngazo.
Akuwona wonke kodwa ama-eseyi kulawa amahle ngendlela efanayo. Umbhalo nge-TAC, uma senza isibonelo, ugxila kakhulu kwipolitiki yezobulili engaphakathi kwi-TAC. Noma lesi kuyisihloko esifanelekile ukuthi siphenywe, ofundayo akakhonjiswa ukuthi sibaluleke ngani uma kukhulunywa ngokuphika.
Noma kunjalo, i-Th e Virus, Vitamins and Vegetables iyincwadi ebalulekile kumuntu othanda ukwazi ngegciwane lesandulela ngculaza kanye nesifo sengculaza eNinginzimu Afrika.
Zombili lezi zincwadi zihlaziywe nguMarcus Low.
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Izincwadi eziphuma kwi-Openly Positive I-The Openly Positive Trust (Openly Positive) isiza ukwakha indawo yokuxhasa yabantu abaphila negciwane lesandulela ngculaza ngochungechunge lwezinhlelo zokuxoxa izindaba. Izincwadi zikaDerrick Fine i-Clouds Move (2007) neka-Elaine Maane ethi-Umzala (2009) zizolandelwa izindaba ezimfushane mayelana nabantu abaphila negciwane lesandulela ngculaza eNingizimu afrika kanye nakwizwekazi lase-Afrika. Uma ufuna ukufaka indaba yakho ungathinta abakwa-Openly Positive ku- [email protected] noma ku-www.openlypositive.com
I-Clouds MoveIbhalwe nguDerrick Fine
I-Clouds Move indaba elotshiwe eyake yenzeka ehlabayo neyembula ukuphila nengciwane lesandulela ngculaza eNingizimu Afrika. Lena yindaba ngempilo ka-Derrick Fine echazwa ngamagama, izinkondlo, izithombe kanye nama-cartoon kaZapiro amahle kakhulu. Kanti futhi iyindaba yabantu abaningi abalwelwa ukufi nyelela kwezokwelapha futhi abafuna ukukhanya kwisimo sezepolitiki esimfi liba.
Ngokusebenzisa ukubuyela emuva empilweni yakhe yakuqala, izinselele zokuziveza ukuthi uyindoda
ethandana namanye amadoda, nokudalula kancane kancane kwakhe ukuthi uphila nengciwane lesandulela ngculaza kanye nenjebulo yokuthola uthando, uhambo lwempilo ka-Derrick lugubha impilo bese limema ukubonakala kakhulu kwabantu abaphila negciwane lesandulela ngculaza.
I-Clouds Move isigqugquzela ukuthi sibheke izimpilo zethu, ngezifundo zayo eziwusizo, imibuzo okumele idingidwe kanye nemihlahlandlela yolimi lwethemba ukusiza ukwehlisa isinembekezelo segciwane lesandulela ngculaza. Ungasebenzisa lawa mathuluzi okufunda ngokwakho, kwimihlangano yokucobelelana ngolwazi kanye nakumaqembu okuchasana.
UmzalaIbhalwe nguElaine Maane
Umzala (igama lesiZulu elisho umzala, u-Elaine alisebenzisa ukuchaza igciwane lesandulela ngculaza) ingamazwi okwethula asuka ekujuleni kwenhliziyo kwizinselele zokuphila ngethemba negciwane lesandulela ngculaza, axoxwa ngezinyembezi kanye nokuhleka. U-Elaine wabelana ngendlela ehanjwe ngabaningi bethu abazizizwa beyisiqhingi esikhathini esithile sezimpilo zethu.
Ukusukela ezimpandeni zakhe zaseZambia, indaba ka-Elaine ibheka uhambo lwempilo yakhe njengomama osemncane othola ukuthi unegciwane
lesandulela ngculaza kanye nokulahlekelwa kwakhe umyeni wakhe ngenxa yaleli gciwane. Uhambo lwakhe luzokuthinta ngolwazi lwakhe oluvuselelayo ngesikhathi abelana ngezifundo azifundile ngengomzali ongayedwana, isithandani, kanye nokuba ngowesifazane olokhe ehlushwa ukulahlekelwa amathandayo.
Umzala usenza sikwazi ukumelana nezimo ezibonakala zingeke zanqobeka ukuze sibeke induku yethu ebandla. U-Elaine usigqugquzela ukuthi siphole, sithande bese siyathandwa, nokuthi siphile impilo ngokuphelele ngendlela esingakwazi ukwenza ngayo. Ndawonye kanye naye, sithola ukuthi igciwane lesandulela ngculaza akumele libe isivimbelo sokuthi sifeze amaphupho ethu.
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IZINDABA zegatsha
UOscar Mabela owegatsha laseLimpopo wengamele ukudingidwa kwezigaba zemishanguzo yesifo sengculaza ezitholakala kumkhakha wezempilo kahulumeni e-Lenyenye Y Centre. Isithombe sithathwe ngu-Adam Malapa.
E-Goso Forest, eLusikisiki amalungu egatsha amasha njengenxenye yomkhankaso wawo wamalungelo abantu kanye nokufi nyelela kuhlelo lwezinsiza zokwelapha ezinakho konke. Njengengxenye yomkhankaso, i-TAC seyigqugquzele umphakathi ukuthi uzihlolele njalo igciwane lesandulela ngculaza kanye nesifo sofuba, futhi banika izincwajana ze-Equal Treatment kanye namakhondomu angaphezu kwama-800. Igatsha lizoqhubeka nokuhlinzeka ngokufundisa ngegciwane lesandulela ngculaza kanye nesifo sofuba ezikoleni futhi lihlela ukwakha iqimbu lokuxhasana labasindile abadlwenguliwe. Izithombe zithathwe nguTandeka Vinjwa.
Ama-Creamy Tuna NoodlesUkudla okungadli kakhulu ephaketheni kokufudumeza izisu zomndeni wakho mhla kunetha.
IMINININGWANE YOMSOCO: kuneFiber Eningi • Kunamafutha amancane • Kunama-Saturated Fat amancane • Kune-Calcium Eningi • Kune-Potassium Eningi • Kuphilile naseNhliziyweniLokhu kudla kugcwele amavithamini amaningi, isipinashi kanye nama-bell peppers abomvu. Ukuze uthole i-fi bre eyengeziwe sebenzisa ama-noodles kakolweni. YENZA: ukudla kwabantu abayi-6 ISIKHATHI: imizuzu engama-40 UKULUNGISELELA: Kulula
Yini oyidingayo1 iphakethe lama-instant Chinese noodles (noma ama-noodles ajwauelekile)1 i-tablespoon e-vegetable oil3 ama-clove ka-garlic, aqotshwe amancane1 u-anyanisi ophakathi nendawi, oqotshiwe1 u-bell pepper, oqotshiwe1 i-bunch yesipinashi, esiqotshiwe1 i-teaspoon likasawoti470ml ubisi olungenamafutha2 ama-teaspoon ka-freshly ground pepper2 amakani ka-chunk light tuna (bheka iThiphu), acwengiwe180ml uCheddar cheese ogreyithiwe
Indlela yokwenza 1. Faka ama-noodles ebhodweni. Thela amanzi abilayo bese uyamayeka aze
athambe. Ungawabilisa futhi ngokulandela umyalelo wephakethe kungama-noodles ajwayelekile. Wacwenge amanzi.
2. Shisisa amafutha epanini elikhulu emlilweni ophakathi nendawo. Faka u-anyanisi, u—garlick, u-bell pepper kanye nosawoti bese uyakupheka, ugovuza ngemuva kwesikhathi, kuze kube u-anyanisi uthambile kodwa ungakabi nsundu, okungaba cishe imizuzu emi-5. Faka isipinashi bese usipheka size sithambe, imizuzu emi-4 ukuya kwemi-5. Faka ubisi kanye no-pepper bese ukuyeka ukupheka ngomlilo ophakathi nendawo, ukugovuza njalo. Faka i-tuna kanye noshizi ukugovuze kube khona yonke indawo. Bese ufaka ama-noodles ugovuze. Kususe esitofini bese uphaka.
ITHIPHU: Inhlanzi esethinini iwumthombo omuhle noshibhile wamaphrotheni. Ungasebenzisa inhlanzi esethinini esikhundleni se-tuna kule-recipe.
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Equ
al T
reat
men
t’sCr
ossw
ord
Puzz
le
Across3 When nurses take over some of the functions of doctors it
is called task___
6 Medical circumcision reduces, but does not ... the risk of contracting HIV.
9 According to new research, HIV-positive people with TB must be given ART___
10 From which African country is Elaine Maane?
6
4
2
8
Down1 OSD stands for Occupational Specifi c___
2 Th e chairperson of TAC is Nonkosi___
4 In November 2008, an antiretroviral moratorium was put in place in which province?
5 When a country’s Gross Domestic Product falls for six months or more in a row, that country is considered to be in___
7 Th e book ‘Bad Science’ was written by Dr Ben___
8 In the 2001___ Declaration, African heads of state pledged to devote 15% of national budgets to health.
We will give a R200 Pick n Pay gift voucher to the first crossword drawn from a hat with all the correct answers. The answers can be found in this issue of Equal Treatment.
Last month’s winner will be announced in a future issue.
Fax or post your completed crossword, with your name, address and contact number.Address: Equal Treatment, PO Box 2069, Cape Town 8001 Fax: 021 422 1720
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• UMongameli uRobert Mugabe waseZimbabwe wasebenzisa ama-$250 000 kumcimbi wosuku lwakhe lokuzalwa lweminyaka engama-85, okwakungahlinzeka ngezezimali okokwelapha kwesifo sofuba okuyizi-10 501.
• Inkosi uMswati III waseSwazini unemoto kanokusho ebiza-$500 000, okuyinani lokokwelapha kwesifo sfuba okungama-21 001.
• UMongameli waseMelika u-Barack Obama usesebenzise izi-$700 000 000 000 ekutakuleni ngezezimali abantu baleliya lizwe, okungaphezulu ngokuphindwe kali-100 kwisabiwomali se-President’s Emergency Plan for AIDS Relief (PEPFAR).
• Ukubiza kwempi yaseMelika e-Iraq, eyayiholwa yilowo owayenguMongameli uGeorge Bush kanye nalowo owayeyisekela likaMongamenli u-Dick Cheney, ibalelwa kwizi-$686 880 390 658, okungaphezu ngokuphindwe kayi-140 emalini edingeka ukuze kuvalwe igebe Semali Yamazwe Omhlaba (Global Fund) segciwane lesandulela ngculaza kanye nesifo sofuba.which is more than
140 times the money needed to close the Global Fund’s gap for HIV and TB.
Siboniseni imali yezeMpilo!
Sayinda uhlu lwethu lweziphakamiso bese ubuka ividiyo ethi-‘Lords of the Bling’ ukuze uthole eminye imininingwane emayelana nokuthi imali yethu iyaphi kanye nokuthi kumele isetshenziswe kanjani.Ku-www.arasa.info
