Amazwe amaningi anomthetho wokulawula ugwayi obeka inani elincane kakhuluibhokisi likagwayiezingafakwa ephaketheni elilodwa.
Emazweni amaningi alawula lokhu, usayizi omncane wephakethe likagwayi ungama-20, isibonelo e-United States (Ikhodi Yemithetho Kahulumeni Isihloko 21 Sec. 1140.16) kanye namazwe angamalungu e-European Union (Isiqondiso Semikhiqizo Kagwayi se-EU, 2014/40/EU). Isiqondiso se-EU sibeke inani elincane kakhuluibhokisi likagwayiiphakethe ngalinye ukuze kwandiswe izindleko zikagwayi kusengaphambili futhi ngaleyo ndlela kubenze bangabi shibhile kubantu abasha 1. Ngokuphambene nalokho, kuncane kakhulu umthethonqubo mayelana nosayizi wephakethe eliphezulu, ohlukahluka emhlabeni wonke phakathi kukagwayi abayi-10 no-50 iphakethe ngalinye. Amaphakethe angama-25 alethwa e-Australia ngawo-1970, kanti amaphakethe angama-30, 35, 40 no-50 angena kancane kancane emakethe eminyakeni engamashumi amabili eyalandela 2. E-Ireland, osayizi bephakethe abangaphezu kwama-20 bakhule kancane kancane kusuka ku-0% wokuthengisa ngo-2009 kuya ku-23% ngo-2018 3. E-United Kingdom, amaphakethe angama-23 no-24 alethwa ngemuva kokwethulwa kokupakisha okucacile (okujwayelekile). Ifunda kulokhu okuhlangenwe nakho, iNew Zealand yayala osayizi ababili bephakethe elijwayelekile (20 no-25) njengengxenye yomthetho wayo wokupakisha okucacile 4.
Ukutholakala kosayizi bephakethe obukhulu kuno-20ibhokisi le- ugwayikuyathakazelisa kakhulu ngenxa yobufakazi obukhulayo bendima yobukhulu bengxenye ekusetshenzisweni kweminye imikhiqizo.
Ukusetshenziswa kokudla kuyanda lapho abantu benikezwa ubukhulu obukhulu, uma kuqhathaniswa nobukhulu obuncane, besabelo, kanye nokubuyekezwa okuhlelekile kweCochrane okuthola umphumela omncane kuya ophakathi wobukhulu besabelo ekudleni nasekuphuzweni kweziphuzo ezibandayo 5. Ukubuyekezwa kuphinde kwahlola ubufakazi bomphumela wobukhulu besabelo ekuphuzweni kukagwayi. Izifundo ezintathu kuphela ezihlangabezane nemigomo yokufakwa, zonke zigxile kuibhokisi le- ugwayiubude, kungekho zifundo ezihlola umthelela ekusetshenzisweni kosayizi wephakethe likagwayi. Ukuntuleka kobufakazi bokuhlola kuyakhathaza, ngoba ukwanda kokutholakala kosayizi wephakethe elikhulu kungalimaza intuthuko empilweni yomphakathi etholakala ngezinye izinqubomgomo zokulawula ugwayi.
Kuze kube manje, impumelelo yezinqubomgomo zokulawula ugwayi emazweni amaningi ibangelwe kakhulu ukunciphisa ukuthathwa kogwayi ngokungenelela okusekelwe emananini kunokukhuthaza ukuyeka, kanti amazinga okuyeka ahlale engaguquki ngokuhamba kwesikhathi 6. Le nselele igcizelela isidingo sezinqubomgomo ezikhuthaza ukuyeka. Ukunciphisa inani likagwayi ngosuku ababhemayo abaluphuzayo kungaba yisisekelo esibalulekile semizamo yokuyeka ngempumelelo, futhi ngenkathi ukwenyusa amanani mhlawumbe kuyindlela ephumelela kakhulu, ezinye izinqubomgomo zokulawula ugwayi nazo bezibalulekile ekwehliseni ukusetshenziswa 7. Izitayela zokubhema zikhombisile ukuthi ababhemayo bangaqala futhi baqhubeka nokunciphisa ukusetshenziswa emazweni amaningi. Isibonelo, eminyakeni lapho izinqubomgomo zokungabhemi zazamukelwa khona ezindaweni zokusebenza, ababhemayo babenamathuba amaningi okuyeka ukubhema ezindaweni zokusebenza ezingenayo intuthu uma kuqhathaniswa nalezo ezivumela ukubhema 8. Izinombolo ezibikiwe zaibhokisi le- ugwayiUkubhema ngosuku kuye kwehla futhi ngokuhamba kwesikhathi e-Australia, e-United Kingdom nakwamanye amazwe amaningi (2002–07) 9.
ENgilandi, iziqondiso ze-National Institute for Health and Care Excellence (NICE) (izincomo zezempilo ezisekelwe ebufakazini bukazwelonke) zikhuthaza ababhemayo ukuthi banciphise ukusetshenziswa ngenxa yokuthi kungenzeka bandise amathuba okuyeka. Kodwa-ke, kukhona ukukhathazeka kokuthi ukukhuthaza ukunciphisa kungalimaza ukuyeka kanye nokumelana nokubuyela emuva 10. Ukubuyekezwa okuhlelekile kokungenelela kokuyeka ukubhema kuthole ukuthi ukunciphisa ngaphambi kokuyeka, noma ukuyeka ngokuzumayo, kwakunezinga elifanayo lokuyeka kwababhemayo abahlose ukuyeka 11. Ukuhlolwa okulandelayo kuthole ukuthi ukunciphisa ukuyeka ukubhema kwakungenamandla kakhulu kunokuyeka ukubhema ngokuzumayo 12; noma kunjalo, abalobi basikisela ukuthi iseluleko sokunciphisa ukubhema singase sibe usizo uma sandisa ukuzibandakanya nomqondo wokuthola ukwesekwa. Ukuguqulwa kwemvelo okufana nokuvalaibhokisi le- ugwayiUsayizi wephakethe unamandla okunciphisa ukusetshenziswa ngaphandle kokuqaphela ngokuqaphela. Ngakho-ke kunikeza ithuba lokuletha izinzuzo zokunciphisa ukusetshenziswa ngaphandle kokuba umuntu obhemayo athuthukise izinkolelo zokuzikhulula mayelana nokunciphisa ukulimala ngokunciphisa kuphela. Impumelelo iboniswe yizinqubomgomo zokuvala usayizi omkhulu, kanye nenani elivunyelwe ekuthengisweni okukodwa, kweminye imikhiqizo eyingozi. Isibonelo, ukunciphisa inani lamaphilisi okudambisa ubuhlungu ngephakethe ngalinye kube nenzuzo ekuvimbeleni ukufa ngokuzibulala 13.
Lesi sihloko sihlose ukwakhela phezu kokubuyekezwa kwakamuva kweCochrane 5 lapho kungekho zifundo zokuhlola ezitholakale ngomthelela wobukhulu bephakethe likagwayi ekusetshenzisweni kukagwayi.
Njengoba kungekho bufakazi obuqondile, sithole ukuhlukahluka okukhona ekutholakaleni kwe-ibhokisi le- ugwayi osayizi futhi kwahlanganiswa izincwadi eziphathelene nemibono emibili ebalulekile yobukhulu bephakethe lokumboza:
(i) ukunciphisa usayizi wephakethe kunganciphisa ukusetshenziswa; kanye (ii) ukunciphisa ukusetshenziswa kungandisa ukuyeka. Ukuntuleka kwezifundo zokuhlola ukusekela lezi zicabango akuvimbeli usongo olukhula ngokushesha.ibhokisi le- ugwayiosayizi bephakethe (> 20) bangase babangele impumelelo kwezinye izinqubomgomo zokulawula ugwayi. Siphikisana ngokuthi ukugxila kokulawula mayelana nosayizi wephakethe elincane, ngaphandle kokucatshangelwa okufanele ukuthi kufanele kube nosayizi wephakethe eliphakeme eliphoqelekile, empeleni kudale isikhala esingase sisetshenziswe imboni kagwayi. Ngokusekelwe ebufakazini obungaqondile, siphakamisa umbono wokuthi umthetho kaHulumeni wokunciphisa amaphakethe kagwayi ku-20 ungaba negalelo ezinqubweni zokulawula ugwayi zezwe nezomhlaba wonke ukuze kuncishiswe ukusabalala kokubhema.
Isikhathi sokuthunyelwe: Julayi-25-2024