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Tushen Ci gaban Siyasa
Duk ayyukan kula da lafiyar jama'a suna da farashi da fa'idodi, kuma yawanci ana auna su a hankali bisa ga shaidar da aka yi a baya, wanda aka ƙara ta hanyar ra'ayin ƙwararru inda irin wannan shaidar ta iyakance. Irin wannan ƙima mai kyau yana da mahimmanci musamman inda mummunan tasirin sa baki ya haɗa da haƙƙin haƙƙin ɗan adam da sakamako na dogon lokaci ta hanyar talauci.
Martani ga annoba misali ne bayyananne. Duniya ta fito daga taron na Covid-19, wanda yakamata ya ba da kyakkyawan misali, yayin da aka sanya sabbin tsauraran matakai kan yawan jama'a, yayin da wasu kasashe ke ba da kyawawan kwatancen ta hanyar guje wa yawancin waɗannan hane-hane.
WHO ta kira irin waɗannan matakan Kiwon Lafiyar Jama'a da Matakan Zamantakewa (PHSM), kuma tana amfani da kalmar da ba ta dace ba (NPI). Ko da mun ɗauka cewa ƙasashe za su ci gaba da samun cikakken ikon mallakar manufofinsu na ƙasa, shawarwarin WHO suna da mahimmanci, idan kawai saboda ikon al'ada ko tsara abubuwan da ake tsammani. A cikin 2021, WHO ta kafa wani PHSM Working Group wanda a halin yanzu yana tasowa a tsarin bincike akan tasirin PHSM. A matsayin wani ɓangare na wannan ƙaddamarwa, ana sa ran WHO za ta sake nazarin shawarwarin su akan PHSM sosai don yin la'akari da darussan daga Covid-19. Ana sa ran kammala wannan tsari nan da shekarar 2030.
Don haka yana da ban sha'awa cewa WHO, ba tare da samar da wani kwatancen farashi da fa'ida daga Covid-19 ba, ta kammala taron 2023 tare da masu ruwa da tsaki na kiwon lafiyar jama'a daga kasashe 21 tare da kira zuwa aiki a kan dukkan ƙasashe "don sanya PHSM a matsayin muhimmin matakan kariya tare da alluran rigakafi da hanyoyin warkewa don annoba da shirye-shiryen cutar da kuma mayar da martani." Tare da Membobin Kasashe waɗanda za su kada kuri'a a ƙarshen Mayu don ba da shawarwarin WHO a cikin Dokokin Kiwon Lafiya ta Duniya (IHR) yadda ya kamata dauri, "Ayyukan bin shawarwarin Babban Darakta kafin a ba su, mutum zai yi tsammanin waɗannan shawarwarin za su kasance bisa cikakken nazari na gaskiya da ke tabbatar da ƙaddamar da su."
IHR Benchmarks
A cikin 2019, WHO ta bayyana 'asowar don Dokokin Kiwon Lafiya ta Duniya (IHR),' waɗanda basu haɗa da PHSM ba. Kodayake ana ci gaba da sake fasalin IHR, an sabunta ma'auni a cikin 2024 kamar yadda 'ma'auni don ƙarfafa ƙarfin gaggawa na lafiya.' Sabuntawa ya haɗa da sabbin ma'auni akan PHSM, waɗanda WHO ta bayyana don "taka muhimmiyar rawa a cikin matakai daban-daban na gaggawa na kiwon lafiya tare da ba da gudummawa don rage nauyi kan tsarin kiwon lafiya ta yadda mahimman ayyukan kiwon lafiya za su iya ci gaba da haɓaka da kuma tura magunguna masu inganci tare da haɓaka tasirin su don kare lafiyar al'umma."
A cikin sabuwar takardar, an ce PHSM ya kasance "daga sa ido, gano lamba, saka abin rufe fuska da nisantar da jama'a zuwa matakan zamantakewa, kamar hana taron jama'a da gyara makarantu da bude kasuwanni da rufewa." An haɗa sabon ma'auni akan PHSM. Misali, don saduwa da matakin “bayyani na iya aiki,” yanzu ana sa ran Jihohi su “bita da daidaita manufofin PHSM da aiwatarwa bisa la’akari da lokaci da kuma kimanta bayanai na yau da kullun” da kuma “kafa dukkan hanyoyin gwamnati tare da ingantaccen tsarin mulki da umarni don aiwatar da PHSM masu dacewa.”
Duk da haka, takardar ta kuma yarda cewa PHSM na iya haifar da "sakamako mara kyau ga lafiya da jin dadin mutane, al'ummomi da tattalin arziki, kamar ta hanyar karuwar kadaici, rashin abinci, hadarin tashin hankali na gida da rage yawan kudin shiga da kuma yawan aiki" [watau karuwar talauci]. Saboda haka, an gabatar da wani sabon ma'auni: "Kare rayuwa, ci gaba da kasuwanci da ci gaba da ilimi da tsarin ilmantarwa yana nan kuma yana aiki a lokacin gaggawar lafiya." A halin yanzu da alama ana sa ran rugujewa musamman ga makaranta a lokacin gaggawar lafiya kamar yadda aka nuna a cikin maƙasudai da suka haɗa da "manufofin madadin hanyoyin isar da abincin makaranta da sauran alaƙar makaranta da kariyar zamantakewar makaranta lokacin da makarantu ke rufe saboda gaggawa." Duk da yake ana iya samun tushe a cikin yarda da illolin Covid-19, wannan ma'auni kuma yana kwatanta girman abin da ya faru na Covid-19 a yanzu ya tsara ra'ayin yadda martanin cutar ya kasance. Babu wata annoba ko gaggawa ta lafiya da aka taɓa magance ta hanyar tsawaita tsawaita wa tattalin arziƙi ko ilimi.
Bugu da ƙari, maƙasudin matakan kula da kan iyaka a yanzu suna tsammanin Jihohi za su "ɓullo da ko sabunta dokoki (da suka dace da tantancewa, keɓewa, gwaji, gano lamba, da sauransu) don ba da damar aiwatar da matakan da suka shafi balaguron ƙasa." Don saduwa da ma'auni na "bayyanar da iya aiki", dole ne Jihohi su kafa "rakunan keɓewa don ware da keɓe waɗanda ake zargi da kamuwa da cutar mutum ko dabba."
Sakamakon Bincike
Waɗannan sabbin ma'auni suna nuna ban mamaki ficewa daga jagororin WHO kafin Covid-2019. An gabatar da mafi cikakkun bayanai irin waɗannan shawarwarin a cikin XNUMX Daftarin aiki bisa tsarin bita na matakan da ba na magunguna ba don cutar mura. Duk da SARS-CoV-2 da ke yaduwa iri ɗaya zuwa mura, an yi watsi da waɗannan ƙa'idodin tun daga 2020. Misali, takaddar 2019 ta bayyana cewa rufe kan iyaka, ko keɓe masu tuntuɓar lafiya ko matafiya "ba a ba da shawarar a kowane hali ba." An ba da shawarar keɓe marasa lafiya da ya zama na son rai lura cewa rufe wuraren aiki ko da kwanaki 7-10 na iya cutar da masu karamin karfi.
Kafin 2020, mafi yawan tattaunawa akan PHSM yanzu wanda WHO ta gabatar ba a taɓa aiwatar da shi da yawa ba kuma bayanai akan tasirin su ya yi ƙasa sosai. Misali, bita na 2019 ya ba da shawarar sanya abin rufe fuska yayin bayyanar cututtuka da tuntuɓar wasu, har ma da "shawarar sharadi" sanya abin rufe fuska lokacin da asymptomatic yayin bala'in annoba kawai ya dogara da "lalacewar injiniya." Hakika, biyu meta-nazari na gwaje-gwajen da aka sarrafa bazuwar (RCTs) na abin rufe fuska da aka buga a cikin 2020 ba a sami raguwa mai yawa a cikin watsa mura ko rashin lafiya mai kama da mura ba.
A yau, muna da ɗimbin shaida kan tasirin PHSM yayin zamanin Covid. Duk da haka, da wuya a sami ƙarin rashin jituwa game da inganci. A Rahoton kungiyar Royal Society ya kammala cewa kulle-kulle da umarnin abin rufe fuska sun rage watsawa kuma an danganta su da tasirin su. A halin yanzu, a meta-bincike An kiyasta matsakaicin kulle-kulle a Turai da Arewacin Amurka don rage yawan mace-macen Covid da kashi uku kawai a cikin gajeren lokaci (a high kudin) da kuma updated Binciken Cochrane har yanzu ba a sami wata shaida game da tasirin abin rufe fuska a cikin saitunan al'umma (ba da izinin abin rufe fuska) a cikin RCTs. Ƙananan matakin ƙuntatawa a cikin ƙasashen Nordic yana da alaƙa da wasu daga cikin mafi ƙanƙanta duk-dalili na mace-mace a cikin duniya tsakanin 2020 da 2022, gami da Sweden wacce ba ta taɓa yin amfani da kulle-kulle na gabaɗaya ko umarnin rufe fuska ba.
Sabbin Shawarwari
Duk da sauye-sauyen shaida na tasiri da cutarwa, da kuma ci gaba na shekaru 7 na aikin WHO, WHO ta fara sake duba shawarwari kan PHSM. The bugu na farko na sabon shirin da WHO ta kaddamar da Shirye-shirye da Juriya ga Barazana (PRET), mai taken 'Shirye-shiryen cututtukan cututtukan cututtukan numfashi,' suna ba da shawarar "hanyar yin taka tsantsan don rigakafin kamuwa da cuta da wuri" wanda "zai ceci rayuka" kuma ya gaya wa masu tsara manufofin su " kasance a shirye su yi amfani da PHSM mai tsauri, amma na ɗan lokaci kaɗan, don rage rashin lafiya da sauran rayuwa. sakamakon zamantakewa da tattalin arziki." Waɗannan shawarwarin ba a kafa su kan kowane tsarin nazari na sabbin shaidu ba, kamar yadda aka yi ƙoƙari a cikin jagorar mura ta 2019, amma galibi akan “darussan da aka koya” waɗanda ba a tsara su ba, na kwamitocin da WHO ta kira.
Sigar 2023 na WHO'sSarrafa Annoba'littafin hannu, fara buga a 2018 da nufin sanar da ma'aikatan hukumar ta WHO da ma'aikatun lafiya, yana misalta wannan rashin hujja-tushe. Kwatanta bugu biyu na takarda ɗaya yana nuna alamar daidaitawar PHSM-zamanin Covid-19. Misali, sigar da ta gabata ta ba da shawarar marasa lafiya su sanya abin rufe fuska yayin bala'i mai tsanani a matsayin "matsananciyar ma'auni." Littafin Jagoran da aka sake fasalin yanzu yana ba da shawarar rufe kowa da kowa, mara lafiya ko lafiya, ba kawai lokacin annoba mai tsanani ba har ma da mura na yanayi. Rufe fuska a fili ba a la'akari da "matsananciyar ma'auni" amma an daidaita shi kuma an kwatanta shi da kama da wanke hannu.
A wani wuri, sigar 2018 ta 'Sarrafa Cututtuka' ta ce:
Mun kuma ga cewa yawancin matakan tsare al'ada ba su da inganci. Don haka ya kamata a sake duba su bisa hasashen da mutane ke yi na samun ‘yancin walwala, gami da ‘yancin walwala. Matakan kamar keɓewa, alal misali, da zarar an ɗauke su a matsayin gaskiya, ba za su zama abin karɓa ba ga yawancin jama'a a yau.
Buga na 2023 ya sake fasalin wannan zuwa:
Mun kuma ga cewa da yawa matakan hana al'ada suna da ƙalubale don aiwatarwa da dorewa. Matakan kamar keɓewa na iya yin saɓani da tsammanin mutane na samun ƙarin 'yanci, gami da 'yancin motsi. Fasahar dijital don gano tuntuɓar juna ta zama gama gari a cikin martani ga Covid-19. Waɗannan, duk da haka, suna zuwa tare da keɓantawa, tsaro da damuwa na ɗabi'a. Ya kamata a sake nazarin matakan ƙullawa tare da haɗin gwiwar al'ummomin da suke tasiri.
Hukumar ta WHO ba ta la'akari da keɓe marasa inganci kuma ba za a yarda da ita ba, amma kawai "ƙalubalanta don sanyawa da ci gaba" saboda yana iya yin hannun riga da tsammanin mutane.
Wani sabon sashe kan “infodemics” yana ba da shawara kan yadda ake gudanar da tsammanin mutane. A yanzu ana ƙarfafa jihohi su kafa “tawagar kula da bayanan sirri” wacce za ta “yi watsi da bayanan da ba a sani ba da kuma rashin fahimta wanda zai iya yin mummunan tasiri ga lafiya ga mutane da al’ummomi, tare da mutunta ‘yancin fadin albarkacin baki.” Har ila yau, ba a ba da shaida kan dalilin da ya sa ake buƙatar wannan sabon yanki na shawarwari ba, yadda 'gaskiya' ke yin hukunci a cikin irin waɗannan yanayi masu sarƙaƙƙiya da mabanbantan yanayi, ko kuma yadda za a magance mummunan tasirin da zai iya haifar da musanya musayar bayanai da tattaunawa kan batutuwa masu rikitarwa.
Gudanar da Infodemic a cikin Ayyuka
Tedros Adhanom Ghebreyesus, Darakta-Janar na WHO kwanan nan ya tabbatar wa duniya a cikin wani jawabi:
Bari in bayyana a sarari: WHO ba ta dora komai kan kowa ba yayin bala'in Covid-19. Ba kulle-kulle ba, ba umarnin rufe fuska ba, ba umarnin alluran rigakafi ba. Ba mu da ikon yin hakan, ba ma so, kuma ba ma ƙoƙarin samunsa. Ayyukanmu shine mu tallafa wa gwamnatoci tare da jagora na tushen shaida, shawara da, lokacin da ake buƙata, kayayyaki, don taimaka musu su kare mutanensu.
Wannan ba shine kawai misali na hukumar ta WHO tana ɗaukar dabarun kai tsaye na "gudanar da bayanai" kamar yadda ta ba da shawarar jihohi su yi ba. The sabon daftarin aiki na Yarjejeniyar Cutar Cutar ta ƙunshi sabon sakin layi:
Babu wani abu a cikin Yarjejeniyar Cutar ta WHO da za a fassara shi azaman samar da Sakatariyar Hukumar Lafiya ta Duniya, gami da Babban Darakta na WHO, duk wata hukuma don ba da umurni, yin oda, canza ko kuma ba da izini ga dokokin cikin gida ko manufofin kowace ƙungiya, ko ba da umarni ko kuma aiwatar da kowane buƙatun da ƙungiyoyin ke ɗaukar takamaiman ayyuka, kamar hana ko karɓar matafiya, aiwatar da umarnin rigakafi ko aiwatar da matakan rigakafi ko aiwatar da matakan rigakafi.
Da'awar ta ƙarshe tana da mahimmanci musamman saboda ta yi watsi da gyare-gyaren IHR da aka gabatar da ke tare da yarjejeniyar cutar, ta hanyar da ƙasashe za su ɗauki nauyin bin shawarwarin nan gaba kan PHSM a cikin yarjejeniyar da ta dace ta doka, yayin da Yarjejeniyar Cutar Cutar ba ta haɗa da irin waɗannan shawarwari ba.
WHO ta yi alƙawarin 'taimakawa gwamnatoci da jagorar shaida' amma da alama tana haɓaka shawarwarin PHSM waɗanda suka ci karo da nasu jagora ba tare da wani sabon tushe na shaida ba. Ganin cewa kasashe sun yi kyau ba tare da bin matakan takaitawa sosai ba, da kuma tasirin rage ilimi da lafiyar tattalin arziki na dogon lokaci kan lafiyar dan Adam, ka'idar "kada ku cutar da ita" da alama tana bukatar karin taka tsantsan wajen amfani da irin wadannan manufofi masu tasiri. Manufofin suna buƙatar tushen shaida don tabbatar da ɗaukar su. Idan aka yi la'akari da yanayin barkewar yanayi, sabanin ikirari na WHO, shine ba karuwa, da alama yana da kyau a yi tsammanin mutum ɗaya daga WHO kafin su tura ƙasashe membobinsu shiga cikin haɗarin lafiya da walwalar jama'arsu a gaba lokacin da aka ayyana bala'in cutar amai da gudawa.
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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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