Kupwelelera umoyo mu Malaŵi

Wupu wa vyaumoyo ku Malaŵi na ivyo uli navyo vikukwana yayi kuti uleke kusuzga ŵanthu, kusazgapo ŵana awo ŵakufwa na matenda ghanandi, comenecomene HIV/AIDS, maleriya na TB.

## Mbili

Malaŵi wali na ndondomeko ya munkhwala ya vigaŵa vitatu. Ndipouli, ndondomeko ya umoyo wa ŵanthu yikulembeka mu mabuku agho ghakuyana waka na ndondomeko ya umoyo wa ŵanthu ku vyaru vya kumanjiliro gha dazi. Vinthu ivi vikuchitika chifukwa cha kuchepa kwa ŵanthu, kusoŵa maluso ghakukhumbikwa, ŵanthu ŵanandi chomene, kuchepa kwa vinthu vyakwendeskera vinthu, vimbundi, kuleka kujipeleka pa vya ndyali, kusoŵa ndalama zakukwana, kuleka kuŵika vyakukhumbikwa pakunozga bajeti, kweniso ŵanthu awo ŵalije chikanga.

Kuyana na lipoti la wupu wa vyaumoyo wa pa caru cose (World Health Organization Report), Malawi wali pa nambara 185 pa vyaru 190. Tingaŵa na cithuzithuzi ciwemi ca ndyali para tikumanya kuti ndyali panji kuti kulije. Ku malo agha kulije munkhwala wakovwira para kwacitika ngozi, moto, panji para kwacitika vigeŵenga. Para ŵanthu ŵakukhumbikwira wovwiri uwu, ŵakweneraso kulipira. Vipatala vichoko waka vya ŵanthu ŵekha mu misumba yikuru ya Blantyre na Lilongwe ndivyo vili na magalimoto ghachoko waka agho ghakuŵa nga ni magalimoto gha munkhwala.

Mu Epulero 2012, pulezidenti wa boma uyu wakafwa na nthenda ya mtima cifukwa ca kupeleŵera munkhwala mu gulu la ŵadokotala ŵa pulezidenti kweniso ku chipatala uko wakalutanga. Mu 2016, ku Malawi kukaŵa dokotala yumoza pera uyo wakaŵa dokotala wa mtima. Kafukufuku munyake uyo wakachitika sonosono apa, wakulongora kuti ŵalwari awo ŵakulwara matenda agho ghakukhumba vinjeru na vinthu vinyake, nga ni matenda gha mtima panji matenda gha mu wongo, ŵakusuzgika chomene na matenda agha. Mu Malaŵi mulije wupu wakupeleka wovwiri wa vya munkhwala.

Malaŵi ndiyo yili pasi chomene pa vyaru vinyake ivyo vilije nkhondo, kweni vichali na maofesi gha munkhwala ghachoko chomene. Ku caru cose palije ndondomeko yakulongosolera ndopa. Mankhwala ghanandi agho ghakupelekeka mu vipatala ku vyaru vya kumanjiliro gha dazi ghalipo yayi. Pa misika ya vyakurya pali munkhwala uwo uli kukanizgika pa caru cose.

Pansipa pali ndondomeko ya mmene dongosolo la zaumoyo likugwirira ntchito monga momwe linafalitsidwira ndi dipatimenti ya boma la Malawi yoyang'anira zaumoyo.

## Ntchito zaumoyo
Ntchito zaumoyo mu Malawi zikupelekeka na boma, maboma gha private for profit (PFP), na private not for profit (PNFP). Unduna wa vyaumoyo (MOH) ndiwo ukuwona vya umoyo wa ŵanthu mu Malawi.

63% ya maofesi gha boma ghakupeleka wovwiri wa vyaumoyo, 37% ghakupeleka wovwiri wa Christian Health Association of Malawi (CHAM), ndipo ŵanthu ŵachoko waka ndiwo ŵakupokera wovwiri wa vyaumoyo kwizira mu wupu wa private. Ŵadokotala na mawupu ghanyake ghakupeleka wovwiri na munkhwala kwa munthu payekha.

## Vinthu vya boma
Wupu wa boma ukupeleka wovwiri wa munkhwala kwawanangwa ndipo uli na magulu ghatatu. Pali ndondomeko ya ŵanthu awo ŵakutumika ku maofesi agha.

Maofesi gha boma agho ghakupeleka mauteŵeti gha boma ni Unduna wa vya Umoyo (MOH), mawupu gha vigaŵa, gha matawuni, na gha misumba, Unduna wa vya Vyankhondo, na Unduna wa Vyamukati na wa Wovwiri wa Ŵanthu (Police and Prisons). Maofesi agha ghakukolerana na Unduna wa vya Umoyo na Umoyo.

Ŵalwari ŵakunjira mu wupu uwu para ŵafika pa chigaŵa chakwamba ndipo para ŵakukhumbikwira ŵakuluta ku chigaŵa chinyake. Ndipouli, vinthu vya munkhwala na vya ŵanthu vikwenda mwakupambana. Vinthu ivyo vilipo sono ni vichoko chomene ndipo pakwamba vikupelekeka ku malo ghapachanya chomene.

### Kupwelelela kwkwamba
Vipatala vikovwira ŵanthu ŵanandi chomene mu Malawi. Vinthu ivi ni maofesi gha munthavi, maofesi gha munthavi na ghambura munthavi, malo ghakupwelelera ŵalwari, maofesi gha munthavi, na maofesi gha munthavi. Pa chigaŵa chakwamba (chigaŵa chachitatu), vipatala vili na vipatala vyakugonerapo, vipatala vyakugonerapo para mwana wababika, vipatala vyakugonerapo, ndipo vingapeleka wovwiri wa ŵalwari ŵakufumira kuwaro, wovwiri wakulera ŵana, na wovwiri wakulera ŵana.

Usange mulwari wali na suzgo likuru chomene, ŵakuchimbilira ku chipatala chinyake.

### Kupwelelela kwachiŵili
Chipatala ichi chili na vipatala 26 ivyo vili mu vigaŵa vyose vya Malawi. Vipatala ivi vili na vinthu vyakukhumbikwa kuti vipelekenge wovwiri wakuyana waka na wa ku chipatala cha vipatala vyakwambilira (ivyo vyayowoyeka pachanya apa).

### Kupwelelera ŵalwari
Chipatala chimoza pa vipatala vinayi vikuruvikuru ivyo vili mu misumba yikuruvikuru ndicho chikupeleka wovwiri wapachanya. Vipatala ivi vikupambana na vipatala vinyake chifukwa vili na maofesi ghakupambanapambana..

## Bajeti ya vyaumoyo

Mwakuyana na ivyo Wupu wa vyaumoyo wa pa caru cose ukayowoya vya Malawi, ndalama izo ŵanthu ŵakugwiliskira nchito pa vyaumoyo zakwera comene. Kufuma mu 2002 kufika mu 2011, ndalama izo boma likugwiliskira ntchito pa umoyo wa ŵanthu (PPP int.) zikukwera kufuma pa $27.2 kufika pa $77.0 ndipo ndalama izo boma likugwiliskira ntchito pa umoyo wa ŵanthu (PPP int.) zikukwera kufuma pa $16.4 kufika pa $56.5. Kafukufuku uyu wakulongora kuti boma la Malawi likuŵika mtima comene pa nkhani ya cipatala. Kweniso vikulongora kuti boma la Malawi likuŵika mtima comene pa vya umoyo. Kufuma mu 2002 m'paka mu 2011, chiŵelengero cha ndalama izo boma likupeleka ku vya umoyo chikakwera kufuma pa 13% kufika pa 18.5%.

Ndalama zinandi izo boma likupeleka ku vyakupwelelera umoyo wa ŵanthu ku Malawi, vikukolerana na kuchepa kwa wovwiri wa vyakupwelelera umoyo wa ŵanthu ŵakufuma ku vyaru vinyake. Mu 2009, ndalama zakufumira ku vyaru vinyake zikaŵa na 97.4% ya ndalama zose izo ŵanthu ŵakagwiliskiranga ntchito pa vya umoyo. Mu 2017 89% ya ndopa za ku Malawi zikapelekeka kwizira mu ŵanthu awo ŵakapeleka ndalama.

## Awo ŵakugwira ntchito zaumoyo
Pa lipoti la vyaumoyo la Malawi, ilo likalembeka kaumaliro mu Meyi 2013, wupu wa vyaumoyo pa caru cose ukati pa ŵanthu 10,000, pakaŵa ŵadokotala 0.2 pera na ŵasilikari 3.4 pera. Ku Malaŵi kulije ŵantchito ŵanandi awo ŵakugwira ntchito za munkhwala. Kweniso, ŵantchito ŵa munkhwala awo ŵalipo mbakugaŵikana mwambura kwenelera. Vinthu vinyake ivyo vikupangiska kuti paŵe suzgo ili ni maofesi gha munkhwala agho ghakusambizga ŵanthu vya munkhwala.

Mu vyaka vya m'ma 1990, Malawi wakaleka kusambizga ŵantchito ŵakovwira ŵanesi na ŵantchito ŵakovwira ŵadokotala. Mu 2001, sukulu iyi yikambiraso kuti ŵanthu ŵanandi ŵasambire vya munkhwala.

Mu 2005, Malawi yikamba kufiska pulogiramu yake ya wovwiri wa ŵanthu iyo yikulaŵiska comene pa kusazgirako ŵantchito awo ŵali kusambizgika vya munkhwala, kusazgirako malipiro gha awo ŵakugwira nchito mu vipatala, na kuŵakhozga.

Mu 2017, mu charu ichi mukaŵa ŵadokotala pafupifupi 200, ndipo 10 pera ndiwo ŵakaŵa mu vipatala. Vipatala vinandi vikuŵavya dokotala wa munkhwala, ndipo mu myezi yinkhondi na umoza vikumazga munkhwala wose uwo ŵapika..
Nurse with neonate.jpg|Nurse with neonate.
Clinic visit.jpg|A clinic visit. 
Ophthalmology Rotation.jpg|Ophtalmology rotation.
Doctor's discussing a patient.jpg|Discussion of a patient.


## Kufika ku maofesi gha munkhwala
Ŵanthu ŵanandi ŵa ku Malawi ŵakusuzgika na suzgo la umoyo. Pa ŵanthu wose awo ŵakukhala mu caru ici, 46% pera ndiwo ŵakukhala kufupi na malo gha cipatala. Nangauli maofesi ghanandi ghakupwelelera umoyo wa ŵanthu ghalije malipiro, kweni kanandi pakukhumbikwira ndalama zinandi kuti munthu walute ku chipatala. Ŵanthu ŵanandi awo ŵakukhumbikwira wovwiri kweni ŵangakwaniska yayi kulipira ndalama zakwendakwenda, ŵakopa yayi. Para munthu wakufumako ku chipatala cha ku mizi wakuluta ku chipatala cha ku chigaŵa panji ku chipatala cha ku chigaŵa wakuluta ku chipatala cha ku msumba, vinthu vikusuzga. Sonosono apa, Medobal Healthcare yikawovwira ŵanthu awo ŵakugwira ntchito mu vyaru vinyake.

## Ivyo boma likucita kuti liŵawovwire
Unduna wa vyaumoyo ukuyowoya mwakudumura ivyo vikukhumbikwa kuti wovwiri wa vyaumoyo uŵe uwemi mu Malawi.

* Vyakovwira vya ŵanakazi na ŵana awo ŵandafike vyaka 5 vyasazgikira

* Kupereka wovwiri wa munkhwala uwemi mu maofesi ghose

* Ntchito zaumoyo ku ŵanthu zikukhozgeka

* Kuŵikapo mtima na urunji pakugwiliskira ntchito makora ndalama

* Kuŵa na mwaŵi wa kupokera wovwiri wa munkhwala

* Kuŵa na ŵanthu ŵanandi ŵakumanya makora ntchito yawo

* Kukhwimiskika kwa kukolerana na ubwezi mu vigaŵa vya umoyo

* Ndalama zose za mu cigaŵa ca vyaumoyo zikasazgikira

Vilato ivi vyafiskika munthowa zakupambanapambana. Mu 2002, Malawi yikalemba ndondomeko ya kuchepeska ukavu iyo yikaŵa na ndondomeko ya vyaumoyo. EHP yikapangika kufuma ku malipoti agho Wupu wa vyaumoyo pa charu chose (World Health Organization) ukapeleka mu 2002. Ntchito yake yikulaŵiska comene pa nkhani 11 izo zikukhwaska comene ŵakavu.

Mu 2004, boma la Malawi, pamoza na ŵanyawo, likanozga pulogiramu ya vilimika vinkhondi na cimoza (POW) iyo yikajintha pa EHP ndipo yikalongozga pakugwiliskira nchito ndondomeko ya umoyo wose (SWAp). Mu 2007, ndondomeko iyi yikasintha na kuŵa ndondomeko ya vyaumoyo, iyo yikamba kugwira nchito mu 2007 m'paka 2011.

Kuwona umo vinthu vikwendera, nga ni ivyo vikuchitika na ndondomeko ya SWAp, nkhwakusuzga comene cifukwa cakuti palije ndondomeko yakulembamo ŵanthu.

Mu chaka cha 2019, Mulara wa Unduna wa vya Umoyo, Bestone Chisamile, wakati: "Kugwiliskira ntchito ndalama mu ŵanthu awo ŵali na umoyo uwemi ni nthowa yakovwira kuti vinthu vyendenge makora pa charu. Ntheura nkhuwonga comene kuti gulu la Medobal likukhumba kovwira maboma gha mu cigaŵa ici kuti ghaŵe na maluso ghakusazgirako luso lawo. Chisamile wakalongosora kuti kukhazikiskika kwa kampani iyi mu Malawi kukung'anamula kuti kupwelelera umoyo wa munthu waliyose ni udindo wa waliyose. Iyo wakati kukhazikiskika kwa Medobal mu Malawi kukovwira vyaru kuti vicitenge vinthu mwaluŵiro kwizira mu ndondomeko yiweme na yakukolerana.

## Kupokera ndalama za Global Health Initiative
Kuchepa kwa ŵantchito ŵa vyaumoyo ku Malawi kukupangiska kuti ndalama za Global Health Initiatives (GHI) zileke kugwiliskirika nchito makora. Kuwonjezeka kwa ntchito zaumoyo, nga nkhulwara HIV/AIDS, kanandi kukupangiska kuti chiŵelengero cha ŵantchito awo ŵakumanya vinandi yayi pa nkhani ya munkhwala chikure. Kuyana na kafukufuku uyo wakalembeka mu 2010, apo Malawi wakapokera ndalama zinandi za GHI kufuma ku Global Fund kuti zikovwire kulimbana na AIDS, TB, na maleriya, pakaŵa kusazgikira kwa ŵasambizgi na ŵantchito pa vigaŵa vyose vya wupu wa vyaumoyo. Ŵanthu ŵanandi awo ŵakugwira ntchito za ku chipatala ŵali kupokera malipiro ghanandi.

## Maukaboni