Gwamnatin Amurka yanzu tana alƙawarin dubban biliyoyin daloli ga lafiyar duniya ta hanyar amfani da yarjejeniyoyi masu tasowa da aka yiwa lakabi da "Dabarar Lafiya ta Duniya ta Farko ta Amurka." An tsara waɗannan yarjejeniyoyin ne a matsayin hanyar kare Amurkawa daga barazanar kamuwa da cututtuka ta hanyar ƙarfafa sa ido da kuma mayar da martani ga barkewar cutar a ƙasashen waje.
Tun daga farkon shekarar 2026, Ma'aikatar Harkokin Wajen Amurka ta ba da rahoton cewa an riga an amince da yarjejeniyar fahimtar juna tsakanin kasashen biyu kan harkokin kiwon lafiya a duniya guda 16. sanya hannu wanda ke wakiltar sama da dala biliyan 11 a cikin alkawuran Amurka, inda jami'ai suka nuna cewa an tsara wasu yarjejeniyoyi da dama - wani ma'auni wanda ke sa rashin dabarun da aka tsara a sarari ya zama da wahala a tabbatar.
Domin fahimtar abin da ke faruwa, da kuma dalilin da ya sa hakan ke ci gaba da faruwa duk da cewa kula da lafiyar Amurka a gida yana ci gaba da tabarbarewa, yana da kyau a raba tambayoyi biyu waɗanda galibi ba a cika ganinsu ba: menene wannan dabarar a zahiri, da kuma dalilin da yasa Amurka ke ci gaba da bin ta.
Fara da "me." Tsarin Lafiya na Duniya na Farko na Amurka wani tsari ne na aiki wanda ya fito bayan da Amurka ta janye daga Hukumar Lafiya ta Duniya kuma tana buƙatar hanyar ci gaba da aiki a duniya ba tare da shugabancin WHO ba.
Maimakon yin aiki ta hanyar cibiyoyi masu haɗin gwiwa da dama, Amurka yanzu tana sanya hannu kan takardun shaida na kiwon lafiya na shekaru biyar tare da ƙasashe masu ƙarancin kuɗi da matsakaitan kuɗi, galibi a yankin kudu da hamadar Sahara. Waɗannan yarjejeniyoyin sun haɗa shirye-shirye na dogon lokaci kan cutar kanjamau/AIDS, zazzabin cizon sauro, tarin fuka, da sa ido a cikin manyan yarjejeniyoyin gwamnati da gwamnati, waɗanda galibi suka ƙunshi ɗaruruwan miliyoyin - ko biliyoyin - daloli.
A taƙaice, wannan ci gaba ne fiye da rushewa; abin da ya canza shi ne tsarin. Ƙungiyoyin da ba na gwamnati ba da masu shiga tsakani na ɓangarori daban-daban ana mayar da su gefe. Ana tura kuɗaɗe kai tsaye ga gwamnatocin abokan hulɗa. Ana jaddada saka hannun jari tare da "dogara da kai" ta hanyar magana. Kuma an tsara dukkan kasuwancin a matsayin kariyar kai ta ƙasa: dakatar da barkewar cutar a ƙasashen waje kafin su isa gabar tekun Amurka.
A matsayin martanin gudanarwa ga janyewar WHO, wannan yana da ma'ana. Amurka har yanzu tana son samun damar samun bayanan sirri game da cututtuka, ƙarfin dakin gwaje-gwaje, da kuma alamun gargaɗi da wuri. Har yanzu tana son yin tasiri kan kasuwannin sayayya da ma'aikatun lafiya a ƙasashe masu mahimmanci. Yarjejeniyoyi tsakanin ƙasashen biyu ita ce hanya mafi sauƙi don kiyaye waɗannan hanyoyin ba tare da komawa Geneva ba.
Abin da ya ɓace shi ne dabarun da aka saba amfani da shi a ma'anar kalmar. Babu fifiko ga jama'a game da barazanar. Babu wani bayani game da waɗanne cututtuka ne suka fi muhimmanci ga Amurkawa. Babu matsayi na ƙasashe ta hanyar haɗari maimakon buƙata. Babu wani kwatancen gaske tsakanin kashe kuɗi a ƙasashen waje da madadin saka hannun jari a cikin sa ido na cikin gida, tantance tashoshin jiragen ruwa, ko juriyar tsarin lafiya. Madadin haka, kusan duk wani kuɗaɗen kiwon lafiya na duniya za a iya tabbatar da shi bayan gaskiyar a matsayin "kare Amurkawa."
Wannan ya kawo mu ga "dalilin." Me yasa Washington ke ci gaba da faɗaɗa kashe kuɗin kiwon lafiya a duniya yayin da kula da lafiyar Amurka a gida ya zama irin wannan matsala?
Amsar farko ita ce tattalin arzikin siyasa. Gyaran kula da lafiyar Amurka yana nufin fuskantar manyan muradun cikin gida: asibitoci, kamfanonin inshora, farashin magunguna, tsarin lasisin jihohi, ƙungiyoyin ƙwararru, da siyasa ta haƙƙin mallaka. Ana jayayya kan kowace hanya. Kowace gyara tana samar da masu asara a bayyane. Akasin haka, kashe kuɗin kiwon lafiya na duniya, galibi yana waje da faɗan rarrabawa na cikin gida. Ana ware shi a hankali, ana gudanar da shi ta hanyar gwamnati, kuma an tabbatar da shi a matsayin kuɗin agaji ko na tsaro. A siyasance, yana da sauƙi a kashe kuɗi.
Na biyu, shirye-shiryen kiwon lafiya na duniya na Amurka suna aiki a matsayin kayan aikin manufofin ƙasashen waje kamar yadda ake yi wa harkokin kiwon lafiya. Shekaru da dama, tallafin cutar kanjamau/AIDS da zazzabin cizon sauro ya ƙarfafa dangantakar diflomasiyya, ya ci gaba da kasancewa a Amurka a cikin ƙasashe masu rauni, kuma ya tsara ƙa'idodin saye da ƙa'idoji. Wannan tunanin bai ɓace ba lokacin da Amurka ta bar WHO. Kawai ta koma cikin tsarin haɗin gwiwa. Yarjejeniyar Lafiya yanzu tana aiki a matsayin kayan tasiri a yankunan da Washington ba ta son miƙa ƙasa ga China, EU, ko masu ba da gudummawa na Gulf.
Na uku, kashe kuɗin kiwon lafiya a ƙasashen waje yana bawa jami'an Amurka damar fitar da haɗari maimakon cibiyoyin gyara. Ya fi sauƙi a yi iƙirarin cewa ya kamata a dakatar da barkewar cutar "a can" fiye da gyara gazawar sa ido a cikin gida, gurguwar ƙa'idoji, ko ƙuntatawa ga iyawar asibiti. Zuba jari a ƙasashen waje yana jin kamar rigakafi ne da fasaha. Gyaran cikin gida yana jin kamar siyasa ce, jinkirin, kuma an ɗora masa laifi. An tsara ɗaya a matsayin hangen nesa; ɗayan kuma a matsayin gazawa.
Na huɗu, sake fasalin sunan Amurka First yana nuna daidaitawar tsarin mulki, ba bayyananniyar akida ba. Da zarar Amurka ta fice daga shugabancin WHO, hukumomi har yanzu suna buƙatar samun bayanai, ƙwayoyin cuta, ƙa'idodi, da abokan hulɗa. Maimakon yin shawarwari a fili kan hulɗar fasaha, sun sake gina tsare-tsare iri ɗaya a ɓangarorin biyu. Sakamakon shine hanyar sadarwa ta yau ta yarjejeniyoyi - ba dabarar da ta dace ba fiye da hanyar magance matsalar da aka tsara don ci gaba da gudanar da shirye-shiryen da ke akwai a ƙarƙashin sabbin ƙuntatawa.
A ƙarshe, gazawa a ƙasashen waje ba a iya ganinta a siyasance ta yadda gazawar cikin gida ba ta da yawa. Idan shirin zazzabin cizon sauro da Amurka ke bayarwa bai yi kyau ba a Malawi, farashin zai yi yawa kuma alhakin zai yi rauni. Idan manufofin kiwon lafiya na cikin gida suka gaza, masu jefa ƙuri'a za su lura nan take. Ƙoƙarin ba su daidaita ba.
Babu ɗaya daga cikin waɗannan da ke nuna cewa kashe kuɗi a fannin kiwon lafiya a duniya ba shi da ma'ana ko kuma rashin da'a. Wasu daga cikinsu suna ceton rayuka da ƙarancin farashi. Wasu kuma suna rage haɗari na gaske. Amma hakan yana nufin cewa dorewar manyan alkawuran kiwon lafiya a ƙasashen waje tare da matsalolin cikin gida ba abin mamaki ba ne. Wannan sakamako ne da ake iya faɗi game da tattalin arzikin siyasa guda biyu daban-daban.
Matsalar da ke tattare da Tsarin Lafiya na Duniya na Farko na Amurka ba wai Amurka tana aiki a ƙasashen waje ba ce. Washington ta naɗa shirye-shirye masu faɗi, waɗanda suka dogara da hanya a cikin alamar ƙasa ba tare da yin aikin da dabarun ke buƙata ba: ayyana manyan manufofi, yin ciniki, buga ma'auni, da kuma bayyana dalilin da yasa waɗannan jarin suka fi sauran zaɓuɓɓuka masu yiwuwa.
Har sai hakan ta faru, "Amurka First Global Health" za ta ci gaba da kasancewa kamar yadda take a yanzu: taken da aka makala ga manyan bincike, waɗanda hukumomi ke ci gaba da yi, kuma an keɓe shi daga binciken da manufofin kiwon lafiya na cikin gida ba za su taɓa tserewa ba.
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Roger Bate ɗan'uwan Brownstone ne, Babban ɗan'uwa a Cibiyar Shari'a da Tattalin Arziki ta Duniya (Jan 2023-present), Memba na Kwamitin Yaki da Cutar Malaria (Satumba 2000-present), kuma Fellow a Cibiyar Harkokin Tattalin Arziki (Janairu 2000-yanzu).
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