A karshen Mayu 2024, Majalisar Lafiya ta Duniya za ta kada kuri'a kan ko za a yi amfani da na'urorin Hukumar Lafiya ta Duniya (WHO) guda biyu: wani sabon salo. Yarjejeniyar annoba da kuma gyara ga Dokokin Kiwon Lafiya na Kasa (IHRs). An tsara waɗannan manufofin don daidaitawa da daidaita shirye-shiryen balaguron balaguro na ƙasa, tare da haɓaka sauran shirye-shiryen shirye-shiryen rigakafin cutar kamar na Bankin Duniya. Asusun Cutar Cutar, Hukumar Lafiya Ta Duniyar Cibiyar Kula da Cututtuka ta Duniya (IPSN), da kuma Dandalin Ma'auni na Likita (MCP).
An sami ƙididdiga masu yawa game da farashin tallafawa waɗannan kayan rigakafin cutar, shirye-shirye, da martani (PPPR) da kuma yadda za'a iya samun kuɗin waɗannan kuɗin. Misali, da G20 Babban Mataki mai zaman kansa (HLIP) yana ba da shawarar zuba jari a matakin duniya da na ƙasa na dalar Amurka biliyan 171 a cikin shekaru biyar, tare da adadin da ba a bayyana ba a kowace shekara bayan haka. The Kiyasin bankin duniya cewa za a buƙaci ƙarin dalar Amurka 10.3 zuwa dala biliyan 11.5 don haɓaka Kiwon lafiya ɗaya a matsayin na'ura ga PPPR.
Wani rahoto mai tasiri da ya rubuta McKinsey & Kamfanin an kiyasta PPPR zai kashe ko'ina daga dalar Amurka biliyan 85 zuwa dala biliyan 130 sama da shekaru biyu, tare da farashin shekara bayan dalar Amurka biliyan 20 zuwa dala biliyan 50. The WHO da Bankin Duniya kiyasin cewa zuba jari na PPPR yana buƙatar dalar Amurka biliyan 31.1 a shekara, gami da dalar Amurka biliyan 10.5 a cikin taimakon raya ƙasa (ODA). HLIP ba ta haɗa da ayyuka masu alaƙa da PPPR da yawa a cikin ainihin ƙididdiganta ba, kamar magance juriya na ƙwayoyin cuta (AMR), ƙarfafa tsarin kiwon lafiya, da abubuwa na kera hanyoyin magance magunguna. Idan an haɗa waɗannan farashin, to farashin PPPR ya kai kusan kwata na dala tiriliyan a cikin shekaru biyar na farkon wannan yunƙurin, tare da ƙarin saka hannun jari da ake buƙata don kula da iya aiki daga baya.
GYARA yayi bitar waɗannan ƙididdiga da kuma ƙarin shaidu da kayan da Sakatariyar WHO ta bayar don tallafawa Ƙungiyar Tattaunawa ta Duniya (INB) don Yarjejeniyar Cutar Cutar da Rukunin Ayyuka na Dokokin Kiwon Lafiya ta Duniya (IHRWG). Bincikenmu ya mayar da hankali kan ƙarfin ƙimancin farashi da kuma ko shawarwarin kuɗi masu alaƙa sun dace da samun dacewar dawowa kan saka hannun jari don tallafawa shirin shirye-shiryen bala'i na yanzu.
Abubuwan damuwa guda hudu sun fito daga binciken REPPARE.
Ƙididdigar PPPR ba ta da aminci
Amincewar kididdigar PPPR tana da rauni, tunda akwai ƙarancin ingantattun ƙididdiga masu tsada don shirye-shiryen bala'in cutar a halin yanzu a matakin gida da na duniya saboda rashin kulawa, rashin bayar da rahoto, da ma'anoni marasa daidaituwa game da ainihin abin da ke tattare da shirye-shiryen cutar. Don rama wannan rashin shaidar, manyan takardun PPPR sun dogara da ƙaramin samfurin nazarin shari'ar, jerin jerin nazarin ilimi, abubuwan da suka dace daga bayanan marasa inganci, da kuma amfani da ƙididdiga marasa kyau da McKinsey & Company ya bayar.
Sakamakon haka, ƙididdigar farashi na farko sun dogara ne akan rahotanni guda uku kawai waɗanda ke nuna kansu kuma ba a bincika su ba, suna ƙirƙirar shaidar madauwari da tushe. Misali, HLIP ya dogara da rahoton WHO da Bankin Duniya na 2021 da ba a samu yanzu ba da rahoton daga. McKinsey & Kamfanin don ƙididdige kididdigar kuɗaɗen su na PPPR. Rahoton WHO na 2021 da Bankin Duniya ya dogara da kiyasin McKinsey iri ɗaya. Duk da haka, a cikin wani aiki na dabaru, sabunta rahoton WHO da Bankin Duniya, sake dubawa kuma sake sakewa a cikin 2022, sannan ya kawo rahoton HLIP don tabbatar da kiyasin farashin su.
Wannan hujjar madauwari tana haifar da ra'ayi na ƙarya game da tsattsauran ra'ayi na kimiyya, tabbatarwa, da yarjejeniya. Mafi damuwa, yana haifar da yuwuwar "rashin son rai," wanda aka nuna ta gaskiyar cewa lokacin da aka karkatar da shi zuwa kimanta na shekara-shekara na PPPR, duk rahotannin guda uku sun haɗu a kusa da wani abin mamaki mai kama da farashin PPPR na dalar Amurka biliyan 31.1 zuwa dalar Amurka biliyan 35.7 (watau dalar Amurka biliyan 31.1; WHO/Bankin Duniya - dalar Amurka biliyan 34.2; dala biliyan 35.7 HLIP.XNUMX). Yawancin lokaci, irin wannan ƙananan rata tsakanin karatun masu zaman kansu zai ba da shawarar babban matakin dogaro a cikin ƙididdiga da aka bayar. Duk da haka, a wannan yanayin, idan aka yi la'akari da yanayin asalin tushen tushen da aka yi amfani da su da kuma ƙayyadaddun hanyoyin da aka tsara, aminci da daidaito suna lalacewa. Sakamakon haka, akwai buƙatu ƙarara don ƙarin ƙaƙƙarfan ƙididdiga na asali na PPPR da kuma farashin da aka ƙera don cike giɓin da aka gano.
Hujja mara gamsarwa don ƙimar PPPR don Kuɗi
Da'awar da aka yi game da ƙimar PPPR don kuɗi da komawa kan zuba jari ba su da tabbas sosai. Samfuran saka hannun jari da aka yi amfani da su don tabbatar da PPPR sun yi amfani da matsala, ɗanyen ruwa, ko ginshiƙan da ba a bayyana ba don kwatantawa yayin da aka kasa yin nazarin tasiri mai fa'ida akan tattalin arziki da sauran nauyin cututtuka. Misali, takaddun sun ɗauka daidai gwargwado cewa matakan PPPR na iya hana 100% na tasirin tattalin arziƙin da ke da alaƙa da barkewar “covid-like” (ko da yake HLIP ta yi shingen fare ta hanyar ba da shawarar cewa zai iya zama kawai 75%). Wannan yana da shakku sosai, tunda hanawa da ƙunsar zoonoses yana da ƙalubale sosai kuma har ma da ƙananan annoba za su haifar da wani tasiri.
Haka kuma, kuma ƙari game da batun, samfuran sun yi amfani da Covid-19 azaman tushen kwatancen su, duk da haka sun kasa rarraba tasirin kai tsaye sakamakon bullar SARS-CoV-2 (asibiti, jiyya, asarar kuɗi saboda rashin lafiya) daga tasirin kai tsaye sakamakon martanin manufofin jama'a wanda ya haifar da mummunan tasirin tattalin arziki (kullewa, hana zirga-zirga, takunkumin allura, da dai sauransu).
Ganin cewa mafi girman farashin Covid-19 yana da alaƙa da matakan mayar da martani na zamantakewa kamar su kulle-kulle, rahotannin suna haifar da ƙima na kuɗi na ƙarya da kuma babban koma baya kan saka hannun jari. Wata hujja ta daban ita ce mafi girman ƙimar kuɗi zai haifar da dacewa da cikakken bita na matakan mayar da martani da aka yi amfani da su yayin Covid-19 don tantance ingancinsu da farashi da fa'ida.
Yayin da ake yawan amfani da dawo da saka hannun jari a cikin kamfanoni masu zaman kansu, amfani da shi a lafiyar jama'a ya fi ƙalubalanci tunda fa'idodin samun kuɗi ba mai sauƙi ba ne kuma ana iya haɗa fa'idodi da yawa waɗanda ba na kasafin kuɗi ba. Manufar dawowa kan zuba jari ita ce fassara fa'idodin zuba jari zuwa ma'auni guda ɗaya da aka bayyana a cikin sharuddan kuɗi, don haka za a iya kwatanta "darajarsa" kai tsaye tare da farashinsa. Duk da haka, game da takardun PPPR da aka yi nazari, waɗannan ƙalubalen sun kara ta'azzara ta hanyar hangen nesa na dogon lokaci da kuma rashin amincewa da cewa yanayin yanayi zai canza ba makawa, kamar sauya nauyin lafiyar duniya da sababbin ci gaban fasaha.
Wani Barazana Mai Kuɗi da Ba'a taɓa taɓa yin irinsa ba don ɗaukar Tallafin Lafiya na Duniya
Ko da ƙididdigar PPPR daidai ne, suna wakiltar babban canji a manufofin kiwon lafiya na duniya kuma zai zama ko'ina daga 25% zuwa 55% na halin yanzu na ODA da ake kashewa don lafiya. A halin yanzu, tsarin PPPR da alama ya daidaita akan ƙididdiga da aka bayar WHO da Bankin Duniya, wanda ya kiyasta buƙatar kusan dala biliyan 31.5 a cikin jimlar kuɗin shekara-shekara don PPPR, gami da dalar Amurka biliyan 26.4 a cikin jarin PPPR na shekara-shekara ta ƙasashe masu karamin karfi (LMICs) da dalar Amurka biliyan 4.7 da ake buƙata a cikin sabon tallafin ODA don haɓaka ƙoƙarin duniya. Waɗannan ƙididdiga sun ɗauka cewa kashi 25% na ODA ɗin da ake da su sun riga sun rufe ƙoƙarin PPPR na duniya kuma LMICs za su buƙaci dalar Amurka biliyan 7 kawai a cikin ƙarin ODA don cike gibin kasafin kuɗin ƙasa. Don haka, jimillar kiyasin abin da ake bukata na ODA na PPPR zai zama dalar Amurka biliyan 3.5 + dalar Amurka biliyan 7 = dalar Amurka biliyan 10.5.
Wannan yana wakiltar saka hannun jari mara daidaituwa don nauyin cutar da ba a san shi ba a nan gaba. Misali, idan aka kwatanta da halin da ake ciki a halin yanzu a cikin tallafin tarin fuka, inda tallafin masu ba da gudummawa ya kai dalar Amurka biliyan 1.1, amma ga cuta mai yawan mace-mace na shekara-shekara 1.3 miliyan mutane. Dangane da manufofin jama'a, wannan ya saba wa al'adun gargajiya a cikin lafiyar jama'a, wanda zai auna duk wata fa'ida ta rigakafin cutar da sauran nauyin cututtuka da bukatun kuɗaɗen lafiya.
Bugu da kari, a cikin 2022, lafiyar duniya ta samu Dalar Amurka biliyan 39.3 a cikin ODA daga gwamnatoci da hukumomi da yawa. Wannan adadin ya karu sosai daga matakan ODA kafin barkewar cutar, kodayake an bayyana karuwar ta hanyar haɓaka kudade don Covid-19 wanda ya zama kashi biyar na jimlar. Idan ODA don lafiya ya kasance mai dorewa akan dalar Amurka biliyan 39, to dalar Amurka biliyan 10.5 zata yi daidai da kashi ɗaya bisa huɗu na ODA masu alaƙa da lafiya. Idan bayan-covid ODA don kiwon lafiya ya koma matakan pre-Covid (kimanin dalar Amurka biliyan 22 a cikin 2018), to PPPR zai ƙunshi fiye da rabin duk kashe kuɗin kiwon lafiya na ODA na duniya.
Ƙididdiga na PPPR yana haifar da Ƙirar Damar da Ba a Gane Ba tare da Yiwuwar Ciwon Lantarki
Kudin da ke sama yana haifar da damuwa mai mahimmanci; wato, sun kasa yin la'akari da gagarumin farashin damar da ke tattare da zuba jarin da WHO, Bankin Duniya, da G20 HLIP suka gabatar. Farashin dama yana da mahimmanci ga kowace manufar kiwon lafiyar jama'a, tun da kiyasin farashi da buƙatun kuɗi na PPPR suna haifar da haɗarin karkatar da ƙarancin albarkatu daga manyan abubuwan kiwon lafiyar duniya da na ƙasa na nauyi mafi girma. Don haka yana da mahimmanci cewa ƙiyasin farashi daidai ne kuma abin dogaro.
Haka kuma, duk wani saka hannun jari ba za a iya ƙaddara shi kaɗai ba amma dole ne a auna shi da fafatawa a fagen kiwon lafiya, zamantakewa, da tattalin arziki, tunda shawarar saka hannun jari don shirye-shiryen bala'i yana da tasiri mai yawa ga lafiyar al'umma. Ba a yi la'akari da waɗannan tunani ba kuma ba a auna su da sauran sanannun abubuwan da suka shafi lafiyar jama'a a duniya.
Shin Zato Mai Kyau ne don Zuba Jari?
Akwai bayyanannen bukatu don ƙaddamar da ingantacciyar tushe na duniya da matakin ƙasa da kimanta farashin shirye-shiryen daidai gwargwado da yuwuwar ciniki na shirin samar da tallafin rigakafin cutar. Don yin haka, ana buƙatar ɗimbin kewayon misalan shari'ar ƙasa da tattara bayanan farko game da kashe kuɗin PPPR na yanzu. Wannan zai fi gano gibi da kama bambancin mahallin da buƙatu. Bugu da ƙari kuma, ingantaccen kimanta ayyukan PPPR na yanki da na duniya na yanzu ya zama dole, tun da shirye-shirye da cibiyoyi masu yawa suna haifar da matsalolin ƙidayar ƙidayar sau biyu da kuma haɗakar hanyoyin kuɗi.
Fahimtar nauyin cututtukan dangi da tasirin tattalin arziki yana da mahimmanci don gano fa'idar tsada da dawowa kan saka hannun jari daga tallafin bala'i, da kuma jagorantar zaɓin ayyukan da ke haɓaka kyakkyawan sakamako na lafiyar jama'a. Rashin yin la'akari da waɗannan batutuwa masu fa'ida yana ɗaukar haɗarin manufofin PPPR masu tsada waɗanda ke haifar da mummunan sakamako.
Idan aka yi la’akari da ƙarancin shaidar da ke tattare da tsadar annobar cutar da kididdigar kuɗi, yana da kyau kada a yi gaggawar shiga cikin sabbin shirye-shiryen cutar har sai an tantance zato da faɗin da'awar dawo da saka hannun jari yadda ya kamata. Waɗannan dole ne su kasance bisa ƙaƙƙarfan shaida, buƙatu da aka sani, da matakan haƙiƙa na haɗari. Kasashe membobi na WHO za su kasance mafi kyawu ta hanyar samun kimomi masu gaskiya waɗanda ke nuna gaskiya da haɗari kafin su tsunduma cikin wannan yunƙuri mara tabbas kuma mai tsada.
REPPARE rahoton kudi na annoba
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REPPARE (Sake kimanta Shirye-shiryen Cutar Kwayar cuta Da Ajandar Amsa) ya ƙunshi ƙungiyar darussan da yawa da Jami'ar Leeds ta kira.
Garrett W. Brown
Garrett Wallace Brown shine Shugaban Manufofin Lafiya na Duniya a Jami'ar Leeds. Shi ne Co-Jagoran na Sashen Bincike na Lafiya na Duniya kuma zai zama Darakta na sabuwar Cibiyar Haɗin gwiwar WHO don Tsarin Lafiya da Tsaron Lafiya. Binciken nasa ya mayar da hankali kan gudanar da harkokin kiwon lafiya na duniya, ba da kuɗaɗen kiwon lafiya, ƙarfafa tsarin kiwon lafiya, daidaiton lafiya, da ƙiyasin farashi da yuwuwar bayar da tallafi na shirye-shiryen rigakafin cutar da martani. Ya gudanar da manufofi da haɗin gwiwar bincike a cikin lafiyar duniya fiye da shekaru 25 kuma ya yi aiki tare da kungiyoyi masu zaman kansu, gwamnatoci a Afirka, DHSC, FCDO, Ofishin Majalisar Dinkin Duniya na Birtaniya, WHO, G7, da G20.
David Bell
David Bell likita ne na asibiti da lafiyar jama'a tare da PhD a cikin lafiyar jama'a da asali a cikin likitancin ciki, ƙirar ƙira da cututtukan cututtukan cututtuka. A baya can, ya kasance Darakta na Fasahar Kiwon Lafiya ta Duniya a Asusun Intellectual Ventures Global Good Fund a Amurka, Shugaban Shirin Malaria da Cutar Cutar Kwalara a Gidauniyar Innovative New Diagnostics (FIND) a Geneva, kuma ya yi aiki a kan cututtuka masu yaduwa da daidaita dabarun gano cutar zazzabin cizon sauro a Hukumar Lafiya ta Duniya. Ya yi aiki na tsawon shekaru 20 a fannin kimiyyar halittu da lafiyar jama'a na duniya, tare da wallafe-wallafe sama da 120. David yana zaune a Texas, Amurka.
Blagovesta Tacheva
Blagovesta Tacheva ƙwararren mai bincike ne na REPPARE a Makarantar Siyasa da Nazarin Duniya a Jami'ar Leeds. Tana da PhD a cikin Harkokin Ƙasashen Duniya tare da gwaninta a ƙirar cibiyoyi na duniya, dokokin kasa da kasa, 'yancin ɗan adam, da martanin jin kai. Kwanan nan, ta gudanar da bincike na hadin gwiwa na WHO game da shirye-shiryen cutar sankara da kiyasin farashin mayar da martani da yuwuwar samar da sabbin hanyoyin samar da kudade don saduwa da wani yanki na wannan kiyasin. Matsayinta a cikin ƙungiyar REPPARE shine ta bincika shirye-shiryen cibiyoyi na yanzu waɗanda ke da alaƙa da shirye-shiryen balaguron balaguro da ajandar mayar da martani da kuma tantance dacewarta ta la'akari da nauyin haɗari da aka gano, farashin dama da sadaukarwa ga wakilci / yanke shawara mai adalci.
Jean Merlin von Agris
Jean Merlin von Agris dalibi ne na REPPARE wanda ke samun tallafin PhD a Makarantar Siyasa da Nazarin Duniya a Jami'ar Leeds. Yana da digiri na biyu a fannin raya tattalin arziki tare da sha'awar ci gaban karkara na musamman. Kwanan nan, ya mai da hankali kan yin bincike kan iyaka da tasirin ayyukan da ba na magunguna ba yayin bala'in Covid-19. A cikin aikin REPPARE, Jean zai mai da hankali kan tantance zato da kuma ƙwaƙƙwaran tushen shaida da ke ƙunshe da shirye-shiryen balaguron bala'in duniya da ajandar mayar da martani, tare da mai da hankali musamman kan abubuwan da ke haifar da jin daɗi.
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