UMnyango Wezempilo ubeka inqubomgomo yezwe, ulawula izinsiza zezempilo futhi uqhuba izinhlelo zomphakathi. Izinsiza Zezempilo Zezifunda zixhumanisa ukuhlela ezindaweni zazo. Izikhungo zomphakathi zisebenza kanye nezibhedlela zezithunywa zenkolo, abahlinzeki abazimele, izinsiza zomphakathi nabelaphi bezempilo bendabuko. Abahlinzeki bendabuko nabanye abangekho emthethweni bangasetshenziswa empilweni yangempela, kodwa izinsiza zabo azithathi indawo yokuxilongwa okusemthethweni, ukudluliselwa, ukwelashwa kwezimo eziphuthumayo noma ukulandela imiyalelo kadokotela. I-Rural Health Motivator (RHM) isisebenzi esisekelwe emphakathini esisiza ukuxhumanisa imizi nezindlela zokuvimbela, ukudluliselwa, ukulandela ukwelashwa nokunakekelwa okuqhubekayo. Ama-Community Health Workers enza imisebenzi efanayo yokusebenzisana nomphakathi kwezinye izinhlelo. Uphiko Lwezempilo Yomphakathi luhlinzeka ngokuqwashisa ngezempilo, ukuvimbela, ukwelashwa kweziguli ezingalaliswa nokusebenza emphakathini. Umtholampilo uhlinzeka ngokunakekelwa kweziguli ezingalaliswa; umtholampilo onephiko lokubeletha nawo unganikeza izinsiza zokubeletha, kanti ongenalo unendima yesikhungo encane. Izikhungo zezempilo zinikeza izinsiza ezibanzi, kanti izibhedlela zokudlulisela zezifunda ziphatha amacala adinga isibhedlela, uchwepheshe noma ukulaliswa. Izibhedlela zikazwelonke nezikhethekile zinikeza amazinga aphezulu kakhulu okunakekelwa okudluliselwayo. Indlela yokunakekelwa ebhaliwe ngokuvamile iqala ngosizo lomphakathi noma lwe-RHM, iye emtholampilo noma ePhikweni Lezempilo Yomphakathi, esikhungweni sezempilo, esibhedlela sokudlulisela sesifunda, bese iya esibhedlela sikazwelonke noma esikhethekile uma kudingeka. Udokotela angadlulisela isiguli ngqo esikhungweni esisezingeni eliphezulu uma isimo sidinga ukuhlinzwa, ukuhlolwa uchwepheshe, ukulaliswa, ukuhlolwa okuthuthukile noma ukwelashwa isikhungo sokuqala esingakwazi ukukwenza. Izikhungo zezempilo zinganikeza ukunakekelwa kodokotela nabahlengikazi, amalabhorethri, ama-X-ray, ukuhlinzwa, izifo zabesifazane nezokubelethisa, ukwelashwa kwezingane, izinsiza zeziguli ezilaliswayo nezingalaliswa, amakhemisi, ukwelashwa kwe-HIV, ukwelulekwa nokuhlolwa ngokuzithandela, ukuvimbela ukudluliselwa kwe-HIV kusuka kumama kuya enganeni, ukunakekelwa kwempilo yengqondo, kwamazinyo, i-physiotherapy, ukunakekelwa kwezindlebe, ikhala nomphimbo, amathambo kanye nempilo yezemvelo. Izibalo zezikhungo ezitholakalayo zidinga ukuqashelwa kosuku. Inkomba ye-SARA 2017, esacashunwa njengesisekelo esiphelelwe yisikhathi embikweni Wonyaka ka-2024/25 woMnyango Wezempilo, yabala isibhedlela sikazwelonke sokudlulisela esi-1, izibhedlela zokudlulisela zezifunda ezi-5, izibhedlela ezikhethekile ezi-3, izikhungo zezempilo ezi-5, amaPhiko Ezempilo Yomphakathi ayi-7, imitholampilo engama-31 enezinsiza zokubeletha, imitholampilo engama-203 engenazo, imitholampilo ekhethekile engama-65 nezibhedlela ezizimele eziyi-7. Kwamenyezelwa ukuhlolwa okusha kwe-SARA, ngakho lezi zibalo akufanele zithathwe njengesamba sezwe samanje. Inqubomgomo yomphakathi neNqubomgomo Kazwelonke Yezempilo zithi izinsiza ezibalulekile zezempilo yomphakathi nezokwelashwa kufanele zifinyeleleke ezakhamuzini nokuthi ukungakwazi ukukhokha akufanele kuvimbele ukufinyelela ekunakekelweni okuyisisekelo. Isigaba 60(8) soMthethosisekelo sithi uMbuso kufanele uqinisekise izinsiza zezempilo eziyisisekelo. Uhlelo olubhaliwe alubonisi uhlelo olulodwa lomshwalense wezempilo olulingana nolomhlaba wonke. Izindleko, ibanga, imigwaqo nezinye izingqalasizinda, ukushoda kwabasebenzi, ukutholakala kwemithi nokuminyana ezikhungweni zokudlulisela kusenganquma ukuthi umuntu uthola ukunakekelwa ngokushesha kangakanani. Ngo-2024, i-WHO yabika i-Universal Health Coverage Index engu-58% ne-Service Availability Index engu-63%. Ukushoda kwabasebenzi bezempilo kwabikwa kungu-10,531. Ngonyaka wezimali woMnyango Wezempilo ka-2024/25, izikhundla ezingu-3,765 kwezingu-4,272 ezazivunyiwe zazigcwalisiwe, kwasala ezingu-507 zingenamuntu. Ukuvimbela kuhlanganisa Uhlelo Olwandisiwe Lokugoma lwaseSwatini, oluhlanganisa imigomo evamile yezingane nomgomo we-HPV wamantombazane aneminyaka engu-9 kuya ku-14. Ukumbozwa okubikiwe kuka-2024/25 kwakuhlanganisa u-80% we-BCG no-80.4% we-DPT. Izinsiza ze-HIV zihlanganisa ukuzihlola, ukuqala ukwelashwa ngemva kokuhlolwa, ukusoka kwamadoda ngokuzithandela, ukuvimbela ngaphambi kokuchayeka kanye nokwelashwa ngama-antiretroviral okuholwa abahlengikazi. Imiyalelo yemithi yama-antiretroviral yezinyanga eziningi ingamboza izinyanga ezingafika kweziyisithupha ezimweni ezifanele. Esibalweni se-WHO sango-2022 sabantu abaneminyaka engu-15 nangaphezulu, kwalinganiselwa ukuthi u-94% uyazi isimo sawo se-HIV, u-97% walabo bantu uthola ukwelashwa ngama-antiretroviral, kwathi u-96% walabo abelashwayo wayenegciwane elingatholakali ekuhlolweni kwegazi. Isilinganiso sangoDisemba 2024 sabala abantu abangu-226,596 abaphila ne-HIV, abangu-219,797 kubo okwakulinganiselwa ukuthi bayasazi isimo sabo. I-HIV iseyinkinga enkulu yezempilo, kanti nesifo sofuba siwumthwalo omkhulu. I-WHO yabika izigameko ezintsha zesifo sofuba ezingu-348 kubantu abayi-100,000 ngo-2021. ISwatini isebenzisa ukwelashwa kokuvimbela isifo sofuba kubantu abaphila ne-HIV, ngezinga elibikiwe elihlosiwe noma lokumbozwa okungenani elingu-70%, kanye nezinsiza zesifo sofuba esingazweli emithini, ukuhlolwa kwe-GeneXpert nokwelashwa ezingeni lesifunda noma lesikhungo. Izifo ezithathelwana ngocansi nesifo sokusha kwesibindi kohlobo B kubhekwa ekunakekelweni kwangaphambi kokubeletha. Umgomo womthamo wokuqala we-hepatitis B lapho kuzalwa wawungakafakwa ngesikhathi esibhalwe emithonjeni. Izinsiza zomama nezingane zihlanganisa ukunakekelwa kwangaphambi kokubeletha, ukusizwa ochwepheshe ngesikhathi sokubeletha, ukunakekelwa kwangemva kokubeletha, izinsiza zokubeletha, ukwelashwa kwezingane nokuvimbela ukudluliselwa kwe-HIV kusuka kumama kuya enganeni. UMnyango Wezempilo wabhala ukuzalwa kwezingane ezingu-19,046 nokufa komama abangu-18 ngonyaka wezimali ka-2024/25, kanye nokufa kwezinsana ngaphambi, ngesikhathi noma ngemva nje kokuzalwa okungu-517. I-UNICEF yabika ukufa kwezingane ezingaphansi kweminyaka emihlanu okungu-45.1 kubantwana abayi-1,000 abazalwa bephila ngo-2024. Izinkomba zokunakekelwa kwezingane ezibikiwe zazihlanganisa ukufunwa kokunakekelwa kwezifo zokuphefumula eziyingozi okungu-60%, ukusetshenziswa kwesisombululo sokubuyisela amanzi anosawoti noshukela kuhudo okungu-68%, ukumbozwa komthamo wesithathu we-DTP okungu-84% nokumbozwa komthamo wesibili wesimungumungwane okungu-87%. Ukumbozwa okusebenzayo kwama-antiretroviral okuvimbela ukudluliselwa kusuka kumama kuya enganeni kwabikwa kungaphezu kuka-95%. Ezinye izinkomba zamanje zomama zazingatholakali, ngakho izibalo ezindala noma ezingaphelele akufanele zisetshenziswe njengombono ophelele wesizwe. Izifo ezingatheleleki nazo zidinga ukunakekelwa. Umfutho wegazi ophezulu uphakathi kwezimbangela ezivamile zokugula. Umdlavuza womlomo wesibeletho ungomunye wemidlavuza ehamba phambili ethinta abesifazane, kanti ukucindezeleka, ukukhathazeka nokusebenzisa kabi izidakamizwa yizimo ezivamile zempilo yengqondo. Izinsiza zempilo yengqondo zinikezwa eSibhedlela Sikahulumeni Sezifo Zengqondo, ezingxenyeni zezifunda nasezikhungweni zezempilo ezijwayelekile. Kwabikwa ukuthi izinga lokuzibulala liyakhula, kodwa imininingwane yezempilo yengqondo yezinga labantu isalinganiselwe. Imithi iqondiswa yi-Essential Medicines List 2021 ne-Standard Treatment Guidelines. UMnyango Wezempilo ne-WHO bahlose ukuthuthukisa ukutholakala, ukufinyelela nokukwazi ukuyikhokhela ngemithi yokunakekelwa kwezempilo okuyisisekelo. Ukushoda kwemithi kuseyingozi ohlelweni. Isitatimende songqongqoshe sango-2024 sabika ukuthi izinga lokugcwaliswa kwama-oda emithi lenyukile lisuka cishe ku-30% laya ku-60–70%, kodwa lokhu akusho ukuthi yonke imithi itholakala kuzo zonke izikhungo ngaso sonke isikhathi. Ulwazi olukhona aluqinisekisi uhlu olulodwa lwamanje lwezimali ezikhokhwayo ezweni lonke, isikhathi sokulinda esifanayo noma ukutholakala okuqinisekisiwe kwazo zonke izinsiza. Esimweni esiphuthumayo sezempilo, kungashayelwa i-Emergency Communication Centre ku-977 ngaphandle kwemali yokuxhumana. Izinsiza zezokwelapha zangaphambi kokufika esibhedlela, ama-ambulensi anokweseka impilo okuthuthukile kanye namanethiwekhi okuhlukumezeka nokudlulisela zisiza ukuthuthwa kwabantu abadinga usizo oluphuthumayo. Ngonyaka wezimali ka-2024/25, uhlelo lwaqopha izingcingo ezingu-427,187, amacala anzima angu-53,778 nokuthuthwa kwabantu abangu-48,101; u-89% wokuthuthwa okubikiwe waphumelela. Ukunakekelwa okuphuthumayo akufanele kubambezeleke kufunwa isikhathi esijwayelekile sokubonana nodokotela noma isikhungo esisezingeni eliphansi lapho isimo sibucayi. Ezinye iziguli zidinga ukwelashwa ngaphandle kweSwatini. I-Phalala Fund ingase isekele izakhamuzi ezifanele zaseSwatini ezingenawo omunye umshwalense wezokwelapha ngemva kokuhlolwa kwezindlela zokwelashwa ezitholakala kuleli. Ukudluliselwa ngudokotela kudlula ekuhlolweni kobuchwepheshe naseBhodini lePhalala. Ukudluliselwa kungase kube seNingizimu Afrika noma eMozambique. Amadokhumenti asekelayo angahlanganisa incwadi yokuhamba, i-visa yezokwelapha, isilinganiso sezindleko, incwadi yokudlulisela, incwadi yesiqinisekiso, isiqinisekiso sesikhathi sokubonana nemininingwane yesibhedlela noma kadokotela. Ngemva kokwelashwa, inqubo ingadinga umbiko wezokwelapha, imithi, izinhlelo zokulandelwa nokuhlela ezokuthutha. Izisebenzi zikahulumeni nabondliwa yizo bangase babe ngaphansi koHlelo Lokudlulisela Ekwelashweni Lwezisebenzi Zikahulumeni, kuye ngemithetho esebenzayo. Ngemva kokuphuma esibhedlela, irekhodi lokwelashwa, imithi enqunyiwe nezikhathi zokulandelwa kunquma ukunakekelwa okuqhubekayo. I-physiotherapy nokuvuselelwa kunganikezwa ngezinsiza zesibhedlela. Ukunakekelwa kwempilo yengqondo kungahlanganisa ukubuyela emphakathini nokulandelwa khona. Ama-RHM nezisebenzi ezisekelwe emphakathini zingasiza ekuqedeni ukudluliselwa, ekulandeleni ukwelashwa nasekulandelweni kwezifo ezingamahlalakhona. Isikhungo esamukela isiguli, uhlelo lokwelashwa nesimo sesiguli kunquma ukuthi yiziphi izinsiza zokulandelwa ezidingekayo.
Ezempilo eSwatini
Ukunakekelwa kwezempilo eSwatini kuhlanganisa izikhungo zomphakathi, zezithunywa zenkolo nezizimele kanye nezinsiza ezisekelwe emphakathini nabelaphi bezempilo bendabuko. Ukunakekelwa kuvame ukuqala ku-Rural Health Motivator noma isisebenzi sezempilo somphakathi, kudlulele emtholampilo noma ePhikweni Lezempilo Yomphakathi, bese kuba esikhungweni sezempilo nesibhedlela sokudlulisela uma icala lidinga amandla engeziwe. Uhlelo luhlanganisa ukuvimbela izifo, izinsiza ze-HIV ne-TB, ukunakekelwa kokubeletha nokwengane, imithi, impilo yengqondo, ukuthuthwa kwezimo eziphuthumayo, ukwelashwa kochwepheshe nokuvuselelwa, kodwa ibanga, ukushoda kwabasebenzi, ukutholakala kwemithi nokuminyana kokudluliselwa kungabambezela ukufinyelela. Izinsiza ezibalulekile zezempilo yomphakathi nezokwelashwa zihloselwe ukutholakala ezakhamuzini, kuyilapho indlela esetshenziswayo nokutholakala kuncike esikhungweni nasendaweni esisebenzela kuyo.
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