NgoJulayi 9, 2020, MI-akerere University, iSikole SezeMpilo Yomphakathi yenze inhlolovo ethile ngesimo se-EMS nokunakekelwa kwezikhungo zezempilo e-Uganda. Bathola ukuthi ezingeni elingezansi kuzwelonke, ikakhulukazi bekushoda imishini yama-ambulensi, njengama-ambulensi, ama-spinal board, kanye nokuntuleka kwabaqeqeshi abaqeqeshiwe.

Bangu-16 kuphela (30.8%) kuphela abahlinzeki bangaphambi kwesibhedlela abahloliwe abanezimoto eziphuthumayo ezijwayelekile ezine-ambulensi edingekayo imishini, imithi, kanye nabasebenzi ukuphendula esimweni esiphuthumayo kahle. Lokhu yilokho iMakerere University yakuqondayo ngemuva kocwaningo lwayo kulo lonke elase-Uganda. Lokhu kusho ukuthi cishe ama-70% we ama-ambulensi e-Uganda abanawo amandla okunakekelwa kwezempilo ezindaweni zangaphambi kwesibhedlela.

Emuva kwalolucwaningo, babike ukuthi uMnyango Wezempilo (MoH) uyasiqaphela isidingo sokuthuthukisa izinsizakalo zama-ambulensi. Lolu cwaningo luhlose ukuthola isimo sezinsizakalo zezokwelashwa eziphuthumayo (i-EMS) nokunakekelwa kwezikhungo zezempilo e-Uganda. Benze lokhu kuhlola okulandelayo emazingeni kazwelonke nakazwelonke, becubungula umthamo we-EMS ezikhungweni zangaphambi kwesibhedlela kanye nezinsiza kusebenza besebenzisa ithuluzi le-World Health Organisation (WHO) Emergency Care Systems Test (ECSSA).

Ngenkathi kwenziwa izifundo ezimbalwa ukuhlola ukunakekelwa kwangaphambi kwesibhedlela eKampala [7,8,9], akukho cwaningo olubonakala lwenziwe ukuhlola isimo se-EMS nokunakekelwa kwempilo yezikhungo e-Uganda ezingeni likazwelonke.

 

Inhloso yocwaningo kanye nezisekelo: iqhaza labachwepheshe nemishini ye-ambulensi e-Uganda EMS

Njengohlelo losizo oluphuthumayo lwezempilo (i-EMS), nezinsizakalo zama-ambulensi e-Uganda kufanele zihlele zonke izici zokunakekelwa ezihlinzekelwa ezigulini ezibhedlela zangaphambi kwesibhedlela noma ezibhedlela. Abezimo eziphuthumayo nama-EMTs (futhi abasesimweni sabashayeli be-ambulensi), kufanele baphathe iziguli ngemishini ethile ye-ambulensi. Inhloso kufanele kube ukuthuthuka kwemiphumela ezigulini ezinezimo ezibucayi, njengezokubelethisa, izimo eziphuthumayo zezokwelapha, ukulimala kanzima, nezinye izifo ezinzima ezibucayi isikhathi.

Ukunakekelwa kwangaphambi kwesibhedlela akuyona inkambu kuphela emkhakheni wezempilo, kuyilapho kungase kubandakanye eminye imikhakha efana namaphoyisa kanye nomnyango wezomlilo. Ngaphezu kokunakekelwa kwangaphambi kwesibhedlela, imiphumela yesiguli ithintwa kakhulu ukunakekelwa okuphuthumayo okulethwa esikhungweni sezempilo esitholayo [4]. Ukusinda nokwelulama kwesiguli kuncike ekubeni khona kwabasebenzi bezokwelapha abaqeqeshwe ngokufanele, kanye nokuba khona kwemishini edingekayo ye-ambulensi, njengezihlakala, Umgogodla amabhodi, uhlelo lwe-oxygen nokunye, imithi, kanye nempahla emizuzwini namahora alandela ukufika kwesiguli esigula kakhulu esikhungweni sezempilo [5].

 

I-EMS e-Uganda: imishini yama-ambulensi kanye nabaqeqeshiwe abaqeqeshiwe - usayizi weSampula kanye nendlela yokwenza isampula

Uhlelo lokunakekelwa kwezempilo e-Uganda luhlelwe lwaba izigaba ezintathu eziyinhloko:

• izibhedlela zokudlulisela kuzwelonke
• izibhedlela zokudlulisa zezifunda
• izibhedlela ezijwayelekile (zesifunda)

Ngaphakathi esifundeni, kunezikhungo zezempilo ezinamakhono ahlukahlukene:

Isikhungo Sezempilo I no-II: indawo eyisisekelo yokunakekelwa kwezempilo. Ayizifanele izimo ezibucayi zokwelashwa [11];

Isikhungo Sempilo II no IV: izinsizakalo zezokwelapha eziphelele kunazo zonke.

INyuvesi yase Makerere ithole uhlaka lokuyisampula lwazo zonke izikhungo zezempilo e-Uganda kwa-MoH futhi yahlukanisa uhlu lwezifunda zezempilo. Izifunda beziphinde zahlanganiswa zaba izifunda ezi-4 ze-Uganda [12] (okusho, iNyakatho, iMpumalanga, iNtshonalanga kanye neCentral) ukuze kuqinisekiswe ukuthi isifunda ngasinye siyaphathwa ngokwesampula. Ngaphakathi kwesifunda ngasinye sokuphatha i-geo-management, ithimba lokufunda likhethe ngokungahleliwe isifunda esisodwa sezempilo (umdwebo 1 - ngezansi).

 

Bafaka ngamabomu ezinye izifunda ezengeziwe zezempilo: Isifunda sezempilo i-Arua eNtshonalanga yeNayile njengoba siphethe iningi lababaleki, elingathinta ukufinyelela kanye nokutholakala kwe-EMS. Okunye yisifunda sezempilo iKaramoja njengoba inomlando wokungqubuzana futhi phambilini ibikade incishwe amathuba ngenxa yokutholwa okungekuhle kuyo yonke imisebenzi yezenhlalo. Eyesithathu yisifunda saseKalangala esakhiwa iziqhingi ezingama-84 ngakho-ke sinezinselelo ezihlukile zokufinyelela kwezokuhamba.

Ithimba labaphenyi baseMakerere University lafaka onke ama-HC ezifundeni zezempilo ezikhethiwe ngobunikazi (okungukuthi, abaphethwe nguhulumeni, izinhlangano ezizimele ezingezona inzuzo / ezingezona ezikahulumeni (i-PNFP / NGO), kanye nama-HCs ezimele azenzele inzuzo. Esigabeni ngasinye sezempilo, bakhetha ngezikhathi ezithile izikhungo zezempilo ezimbili ezizimele zokwenza inzuzo (ie. 2 HC IV kanye ne-1 HC III), izikhungo zezempilo ze-1 PNFP / NGO (okusho ukuthi, i-4 HC IV kanye ne-2 HC III), kanye nezine eziphethwe nguhulumeni Izikhungo zezempilo (ie, 2 HC IV kanye no-4 HC III). Lapho i-pc yensiza yangasese noma i-PNFP / NGO HC III noma i-HC IV ingatholakali ezifundeni zezempilo ezikhethiwe, bagcwalisa ama-slot nge-HC III ephethwe nguhulumeni noma i-HC IV.

Isu labo lokusampula liholele kusayizi wesampula equkethe izibhedlela eziyisikhombisa zokudluliselwa kwezifunda, izibhedlela ezingama-7 (zesifunda) ezijwayelekile, ezingama-24 i-HC IV kanye ne-30 HC III. Ngaphezu kwalokho iSifunda saseKampala sithathwe njengesifunda esikhethekile ngenxa yesimo saso njengedolobha elikhulu elinenqwaba yezisetshenziswa zezempilo. Kuma-RRH amathathu (okusho, iRubaga, iNsambya, neNaguru) edolobheni, enye i-RRH (Naguru) yengezwe kwisampula yokufunda.

Ngaphezu kwalokho, bafaka namaphoyisa njengabahlinzeki bezokunakekelwa kwasesibhedlela ngoba imvamisa bangaba ngabaphenduli bokuqala ezenzakalweni eziyingozi futhi bahlinzeke izithuthi kulabo abahlukunyezwayo. Lolu cwaningo luwucwaningo lukazwelonke oluhlanganisa izingxenye 7 zezempilo, izifunda ezingama-38 (umdwebo 2) [13], izikhungo zezempilo eziyi-111, kanye nabahlinzeki bezokunakekelwa kwangaphambi kwezibhedlela abangama-52. Kuzo zonke izifunda ezingama-38, abacwaningi baxoxisana nesikhulu esisodwa sesifunda, imvamisa isikhulu sezeMpilo sesifunda ezithatha izinqumo ezithinta izifunda, kanye nabasebenzi abasemqoka abangama-202 ababambe iqhaza ekunakekelweni kwezempilo kwe-EMS.

 

Okokusebenza kwe-ambulensi kanye nabaqeqeshiwe abaswele e-Uganda: ukuqoqwa kwemininingwane

Abaphenyi base Makerere University bavumelanise ithuluzi lokuhlola i-WHO Emergency Care Systems [14] elakhiwe nguTeri Reynolds nabanye [10]. Lokhu kubasizile ukuthi bakwazi ukuqoqa imininingwane kuma-EMS emazingeni aphambi esibhedlela nasesikhungweni sezempilo. Ithuluzi laliqukethe uhlu lokuhlola kanye nemibuzo yemibuzo ehlelwe kahle, ehlola izinsika eziyisithupha zohlelo lwezempilo: ubuholi kanye nokubusa; ezezimali; imininingwane; abasebenzi bezempilo; imikhiqizo yezokwelapha; kanye nokulethwa kwezidingo. Baphinde babuyekeza nemibiko evela ocwaningweni olwenziwe ngaphambilini lwe-EMS e-Uganda [7,8,9] futhi bagcwalisa izikhala ngemininingwane yokubonga ubuso obukhethekile obunolwazi ukuze babhekane nengxoxo nesikhulu esiphezulu se-MOH.

 

 

I-EMS e-Uganda: Imiphumela yokubuka konke ngemishini yama-ambulensi kanye nabaqeqeshiwe abaqeqeshiwe

Ithebula elilandelayo lifingqa imiphumela etholakala emikhakheni eyehlukene kumazinga kazwelonke nakazwelonke. Imiphumela eminingi enemininingwane ekuxhumeni ekugcineni kwendatshana.

 

Imininingwane ku-EMS e-Uganda: ingxoxo

I-Uganda kwaba nokuntuleka okukhulu kwenqubomgomo kazwelonke, imihlahlandlela, kanye nezindinganiso emkhakheni wezokwelapha ophuthumayo. Lokhu kushoda kuboniswa kunoma yimuphi umkhakha womkhakha wezokunakekelwa kwempilo: uxhaso; imikhiqizo yezokwelapha, kanye nokuxhumanisa.

Izindawo eziphuthumayo ezikhungweni zezempilo zingenayo imishini ye-ambulensi eyisisekelo nemithi yokuqapha nokwelapha izimo zempilo eziphuthumayo ezahlukahlukene. Lokhu kushoda okukhulu kwemishini nemithi kwabonwa kuwo wonke amazinga ohlelo lwezempilo. Noma kunjalo, izikhungo zezempilo ezizimele nama-ambulensi ayehlome kangcono kunalezo zikahulumeni. Ukutholakala okulinganiselwe nokusebenza kwemishini ye-ambulensi yokuphendula izimo zezokwelapha eziphuthumayo kwakusho ukuthi iziguli zithola ukunakekelwa okulinganiselwe esigabeni sangaphambi kwesibhedlela, bese zithunyelwa ezikhungweni zezempilo ezazikuhlomele kangcono ukuphatha imicimbi yazo ebihlukumezeka.

Izinsizakalo zama-ambulensi zazikhathazwa yimishini engeyinhle, ukuxhumana nokuxhumana. Okungenani i-50% yabahlinzeki be-EMS okwaxoxwa nabo babike ukuthi abakaze bazise izikhungo zezempilo ngaphambi kokudlulisela izimo eziphuthumayo lapho. Ukuthi izibhedlela, kubandakanya izibhedlela zesifunda, zazingenayo i-EMS engama-24 ha ngosuku. Ngempela, ababukeli nezihlobo ngokuvamile yizo kuphela ezisiza iziguli ngokwelashwa. Futhi izimoto ezihamba ngamaphoyisa zaziyindlela ejwayelekile (yabahlinzeki abangama-36 kwabangu-52) yokuhambisa iziguli ezidinga ukunakekelwa okuphuthumayo.

Ucwaningo luchaze i-ambulensi njengemoto ephuthumayo enikezela ukuthutha nokunakekelwa okuphuthumayo ngenkathi isesibhedlela sangaphambi kwesibhedlela, bekuchaza ukuthi iningi labanikezeli bezibhedlela zangaphambi kwesibhedlela belingenawo ama-ambulensi, kepha bebehlinzeka ngezinto zokuhamba eziphuthumayo. Ngaphezu kwalokho, kuwo wonke amazinga, kwakukhona ubufakazi bezimali ezinganele ze-EMS.

Imikhawulo yalolu cwaningo ngamaphutha wokulinganisa kusuka ekuthembeleni kumibiko yokuzenzakalelayo yeminye imiphumela (isib. Ukusetshenziswa kwedatha ekuhleleni). Kodwa-ke, iningi lemiphumela ebalulekile (ukutholakala kanye nokusebenza kwemikhiqizo yezokwelapha) ocwaningweni lalinganiswa ngokubhekwa okuqondile. Ukutholwa kwabaphenyi kuqinisa labo abavela kwezinye izifundo besebenzisa indlela efanayo eyathola ukuntuleka kobuholi, umthetho kanye nokuxhaswa kwemali njengezithiyo ezibalulekile ekuthuthukisweni kwe-EMS emazweni asathuthuka [16].

Lowo obikwe kule ndatshana kwakuyinhlolovo kazwelonke ngakho-ke lokho okutholakele kungabhekelelwa kulo lonke elase-Uganda. Okutholakele kungabuye kwenziwe kwamanye amazwe anengeniso ephansi naphakathi e-Afrika angenazinhlelo ze-EMS [1] futhi angakwazi, ngakho-ke, ukusetshenziselwa ukuqondisa imizamo ehlose ukwenza ngcono izinhlelo ze-EMS kulezi zilungiselelo.

 

Ekuphetheni…

I-Uganda inezinhlelo eziningi zezikhungo zezempilo iziguli ezingaya kuzo ukuze zithole ukwelashwa. Kodwa-ke, kusukela kokutholakale ngaphezulu abaningi bangabuza ukuthi 'Ingabe i-Uganda inayo i-EMS?'. Kufanele sisho ukuthi lolu cwaningo lwenziwe ngesikhathi lapho kwakungekho nqubomgomo ye-EMS, azikho izindinganiso, nokuxhumana kabi kakhulu emazingeni kazwelonke nakwezwelonke.

Ngokusho kokutholwe yiNyuvesi yase Makerere, ngakho-ke, kubonakala kunengqondo ukuphetha ngokuthi, eqinisweni bekungekho-EMS, kepha izakhi ezimbalwa ezibalulekile endaweni ezingakhiwa kabusha njengesiqalo sokusungulwa kohlelo. Lokhu kungachaza isizathu semishini ye-ambulensi kanye nokuntuleka kwabasebenzi abaqeqeshiwe. Kodwa-ke, bekukhona inqubo eqhubekayo yokuqamba izinqubomgomo nemihlahlandlela yokusungulwa kwe-EMS.

 

IZINDAWO ZOLWAZI

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8. Mehmood A, Paichadze N, Bayiga E, et al. Ukuthuthukiswa kanye nokuhlolwa kwezindiza okusheshayo kwe-thuluzi lokunakekelwa kwangaphambi kwesibhedlela eKampala, e-Uganda. Ukuvimbela Ukulimala. 594; 2016: A22.
9. Balikuddembe JK, Ardalan A, Khorasani-Zavareh D, Nejati A, Raza O. Ubuthakathaka kanye nezindlela ezithinta ukunakekelwa okuphuthumayo kwabaphambi kwezisulu zezingozi zomgwaqo endaweni enkulu yedolobha laseKampala: isifundo esiphambanayo. BMC Emerg Med. 2017; 17 (1): 29.
10. Reynolds TA, Sawe H, Rubiano AM, Do Shin S, Wallis L, Mock CN. Ukuqinisa izinhlelo zezempilo ukuhlinzeka ukunakekelwa okuphuthumayo. Izinto eziza kuqala Ukulawulwa Kwezifo: Ukwenza ngcono Impilo kanye Nokwehlisa Ubumpofu uhlelo lwesi-3: IBhange Lwamazwe Ngamazwe Lokwakha kabusha Nentuthuko / IBhange Lomhlaba; 2017.
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AUTHORS

Albert Ningwa: UMnyango Wezokulawulwa Kwezifo Nezempilo Yezemvelo, Makerere University School of Public Health, Kampala, Uganda

UKennedy Muni: UMnyango we-Epidemiology, University of Washington, Seattle, WA, USA

UFrederick Oporia: UMnyango Wezokulawulwa Kwezifo Nezempilo Yezemvelo, Makerere University School of Public Health, Kampala, Uganda

UJoseph Kalanzi: UMnyango Wezimo Eziphuthumayo Wezempilo, Umnyango Wezempilo, eKampala, e-Uganda

U-Esther Bayiga Zziwa: UMnyango Wezokulawulwa Kwezifo Nezempilo Yezemvelo, Makerere University School of Public Health, Kampala, Uganda

UClaire Biribawa: UMnyango Wezokulawulwa Kwezifo Nezempilo Yezemvelo, Makerere University School of Public Health, Kampala, Uganda

U-Olive Kobusingye: UMnyango Wezokulawulwa Kwezifo Nezempilo Yezemvelo, Makerere University School of Public Health, Kampala, Uganda

 

 

FUNDA OKWENGEZIWE

I-EMS e-Uganda - Isevisi Yama-ambulensi ase-Uganda: Lapho uPastor Ehlangana Nomhlatshelo

I-Uganda Yokukhulelwa Nge-Boda-Boda, Amatekisi Esithuthuthu Asetshenziswa Njengama-Ambulense Wezithuthuthu

E-Uganda: Ama-ambulensi amasha angama-38 Ekuhambeleni KukaPapa uFrancis

 

 

IMITHOMBO

I-BMS: I-BioMed Central - Isimo sezimo eziphuthumayo zezokwelashwa nokunakekelwa kwezempilo okunempilo e-Uganda: okutholakele ocwaningweni lukaNational Cross-Sectional Survey

Ukubuyekeza KontangaIsimo sezimo eziphuthumayo zezokwelashwa nokunakekelwa kwezikhungo zezempilo e-Uganda: okutholakele kuCwaningo Lwezempilo Lwezizwe

Isikole seKholeji Yomphakathi Yezempilo Yezesayensi Yezempilo, University of Makerere

 

I-WHO: ukunakekelwa okuphuthumayo