
Muri impuguke mu buzima mpuzamahanga kandi mufite amakenga n’ingamba zo gukoresha Abajyanama b’Ubuzima, mwaba mwanga agahimbazamusyi gashingiye ku musaruro kandi mwaba mutizera uruhare rw’abaturage ? Kanda ahanditse «Rwanda» kugira umenye uko ibintu bihagaze!
Muri Kanama 2013, igihe nasuraga i Burundi, nagize amahirwe yo gutahura umushinga-fatizo w’ agahimbazamusyi gashingiye ku musaruro mu baturage . Ibyagezweho n’umuryango witwa ADHbyari gushira amakenga nari mfite kugeza icyo gihe, birumvikana nk’abandi bose, ku birebana n’ingamba zo gukoresha Abajyanama b’Ubuzima. Nari nzi ko uwo mugambi wo gushyiraho Abajyanama b’Ubuzima wari warashyizwe mu bikorwa ku rwego rusange rw’igihugu cyose mu gihugu gituranye n’u Burundi, ari cyo u Rwanda. Nakoresheje amahirwe y’ubusabe bwa vuba aha mu rwego rw’umushinga wa « Integrated Health System Strengthening Project» ugamije kubaka ubushobozi bw’imikorere ya Guverinoma y’u Rwanda na Guverinoma ya Leta Zunze Ubumwe za Amerika (ushyirwa mu bikorwa n’umuryango witwa Management Sciences for Health) kugira ngo menye byinshi kuri uwo mugambi w’Abajyanama b’Ubuzima. Nyuma yaho narushijeho kwemera no kunyurwa: nta gushidikanya, aho twerekeza haratanga icyizere.
Ibyo u Rwanda rwagezeho mu birebana n’agahimbazamusyi gashingiye ku musaruro mu baturage byakozwe mu byiciro bibiri. Igerageza rya mbere- kuva mu mwaka wa 2006 –: Agahimbazamusyi k’Abajyanama b’Ubuzima kavaga ku ngengo y’imali y’iguhugu kagezwa ku bajyanama kanyujijwe mu nzego z’ibanze za leta, gusa ntibyagenze neza nk’uko byari byifujwe. Nk’uko Dr Claude Sekabaraga yabinyibukije, nkaba naramusanze i Kigali, amafaranga yoherezwaga ntiyageraga ku bagenerwabikorwa ndetse rimwe na rimwe yakoreshwaga n’inzego z’ibanze zegerejwe abaturage mu gutera inkunga ibindi bikorwa (ibikorwa-remezo…) byasaga n’aho byihutirwa kurusha ibindi. Igerageza rya kabiri- kuva mu mwaka wa 2009- Hashingiwe kubwumvikane n’amategeko agenga imikoreshereze y’inkunga “ Ikigega cy’isi gishinzwe kurwanya Sida, Igituntu na Marariya, hemejwe ko agahimbazamusyi k’Abajyanama b’Ubuzima katazongera kunyuzwa mu nzego z’ubuyobozi ahubwo kazajya kanyuzwa ku Kigo Nderabuzima bahuriyeho.
Umwihariko w’u Rwanda ari nacyo gishya ,ushingiye mu kubumbira hamwe Abajyanama b’ubuzima mu itsinda rikorera hamwe ariryo Koperative bisabwe na Ministeri y’Ubuzima. Cathy Mugeni, uyobora kuva mu ikubitiro, iyi Porogaramu muri Ministeri y’Ubuzima i Kigali, adusobanurira ko aya mahitamo cyane cyane yaterwaga n’imiterere ya politiki y’igihugu : amakoperative y’Abajyanama b’Ubuzima ni uburyo bw’urwego ruboneye kurusha izindi rutuma ibikorwa by’ubukungu cyangwa bibyara inyungu biterwa inkunga y’amafaranga ku buryo bworoshye, hiyongereyeho gushyigikira ibikorwa bisanzwe by’Ubuzima rusange – Uburyo bwa koperative buhuza kurushaho n’intego y’igihugu y’inzira yo kwihaza no kwigenga mu by’imari aho guhora igihugu gihanze amaso inkunga y’amahanga mu rwego rwo guteza imbere Ubuzima bw’abaturage.
Mu by’ukuri nari mfite amatsiko yo kumenya uyu mugambi wo kwiyambaza Abajyanama b’Ubuzima mu baturage aho bakorera. Ku bw’amahirwe, igihe nasuraga u Rwanda cyahuriranye n’icy’intumwa za Minisiteri y’Ubuzima ya Lesotho. Nashoboye rero kujyana n’izo ntumwa ku Kigo Nderabuzima cya Gikomero.(1)
Amasomo nungutse
Abajyanama b’Ubuzima bagomba kumenywa nka bamwe mu bagize inzego zose z’Ubuzima. Umugambi w’Abajyanama b’Ubuzima wakoze amakosa igihe kirekire bitewe no gutatanya ingufu zawo (Buri Porogaramu uhereye hejuru ugana hasi yari ifite Abajyanama bayo b’Ubuzima bwite) ; na none kandi, wakekwaga kuba indiri y’abaganga bigiye munsi y’igiti, umuntu atamenya ibyo bakora cyangwa bagakora ibyo bishakiye, igihe bahawe imiti. Sinshobora guhamya no kuvuga kuri buri rwego, ariko ibyo nabonye mu Rwanda, ibyo nabwiwe n’abantu banyuranye bampaye amakuru n’ibyo nabonye ahandi (ugereranije cyane cyane n’ibyo nabonye muri Niger) byanyemeje ko kwirengagiza Abajyanama b’Ubuzima, ni ukwivutsa umusemburo nyakuri wafasha mu kugera ku ntego z’Ubuzima zinyuranye kandi ziduhenda cyane, by’umwihariko intego zivugwa mu Migambi y’Ikinyagihumbi igamije Iterambere ya 4, 5 n’uwa 6. Dr Michel Gasana, Umuyobozi mu rwego rw’igihugu wa Gahunda yo Kurwanya Igituntu, yansobanuriye ko Abajyanama b’Ubuzima bagira uruhare rukomeye mu kurwanya igituntu ku rwego rw’igihugu. Na none kandi bafite uruhare mu mivurire n’imikoreshereze y’imiti. Ku Kigo Nderabuzima cya Gikomero, Abajyanama b’Ubuzima batweretse ibikorwa byabo binyuranye byinshi, cyane cyane : kwita ku ndwara z’abana ku buryo bukomatanjiye (umuriro, impiswi, umusonga) ku rwego rw’abaturage, guteza imbere imikoreshereze ya za serivisi zo kuboneza urubyaro, gutanga uburyo bwo kuboneza urubyaro, n’imiti ivura igituntu, ibiganiro bigamije guhindura imyifatire, na gahunda y’imirire ishingiye ku baturage) ; byose bigira ingaruka nziza zihambaye. Twanashoboye gushima imihurize n’imikoreshereze inoze cyane y’ibikoresho bitandukanye biyambaza.
Nk’umwe mu mpuguke zinyuranye mu « rwego rw’ubuzima», muri iyi myaka ishize nibanze ku bigo by’ubuzima n’amavuriro. Impungenge za mbere zabaye kuzubakira ubushobozi kugira ngo zishobore gutanga urwunge rwa serivisi zabyo. Ibi byarantangaje kuko ku Kigo Nderabuzima cya Gikomero nasanze hari imikoranire yateye imbere ku buryo buhebuje hagati y’ibikorwa by’amavuriro n’Abajyanama b’Ubuzima.Niba Abajyanama b’Ubuzima batanga zimwe muri serivisi (urugero kuvura impiswi bakoresheje imyungu ivura umwuma ya Zinc, kuvura umusonga), igice kinini cy’uruhare rwabo kibanda ku guteza imbere imikoreshereze n’imikoranire n’Ikigo Nderabuzima (na none kandi bahora bakoranira hafi n’Ikigo Nderabuzima hamwe na Ministeri y’Ubuzima hakoreshejwe za telefone zigendanwa zituma batanga amakuru ku buryo bwihuse mu rwego rwo kurengera ubuzima bw’abaturage).
Akarusho k’ingenzi k’Abajyanama b’Ubuzima ni uko baba batuye mu Mudugugu umwe n’abagenerwabikorwa babo. Kandi bakunze kugirirwa icyizere n’abaturage kandi bagahabwa ikaze muri buri rugo, nta kibazo. Nyuma yaho, twasuye, mu kandi Karere, Ibitaro byta Rutongo. Mu cyumba cy’abana, twabajije umubyeyi wari ufite umwana urwaye bwacye. Yatubwiye inzira yanyuzemo: Uko yabonye ko umwana we yahinduye imyifatire, kugana Umujyanama w’Ubuzima, icyemezo cyo kujyana bombi ku Kigo Nderabuzima (n’ubwo ibipimo ku ifishi y’umwana byari mu ibara « ry’icyatsi kibisi ») kandi ko nyuma yo gusuzuma umwana ku Kigo Nderabuzima bagasanga afite imirire mibi ikabije, uwo mwana bamwohereje mu bitaro (bakoresheje imbangukiragurabara/ingobyi y’abarwayi).
Zimwe mu ngufu zikomeye nabonye i Makamba mu Burundi n’ibyo nabonye mu Rwanda, ni ishingwa ry’urwego ruhuriweho n’Abajyanama b’Ubuzima bose ku Kigo Nderabuzima kimwe. Ku ruhande rumwe, iyi mikorere izakuraho ikibazo cyahozeho cyo gutatanya ingamba zitangwa n’Abajyanama b’Ubuzima (Kuko buri porogaramu ifiite abayo). Ibi bizoroshya ku buryo bushimishije ihuzabikorwa hamwe n’Ikigo Nderabuzima; nk’urugero, ibi bizatuma ingamba zateganyijwe zigerwaho ku buryo bwihuse. By’umwihariko, ishyirwaho ry’ishyirahamwe cyangwa rya koperative bizatuma urwego rw’Abajyanama b’Ubuzima ruva ku rwego mpuzamikorere y’inzego (nk’umuhuza wa za Porogaramu) rugana ku rwego rushinzwe ubukangurambaga nyakuri kandi rufata ibyemezo bihuriweho – Dukurikije uko tubyumva, iyi ni yo ntego nyakuri y’ibikorwa bishingiye ku baturage.
Kugira ngo ibi bigerweho, ni ngombwa gushyiraho intego n’uburyo byo gufatira hamwe ibyemezo. Icyo tubitekerezaho ni uko agahimbazamusyi gashingiye ku musaruro mu baturage, bitewe n’uko kagizwe n’amafaranga yoherezwa mu nzego (ishyirahamwe cyangwa koperative) bibyara icyo gikorwa. Kuko niba agahimbazamusyi gashingiye ku musaruro mu baturage gateganya ko urwego ruhuruweho rugomba guhemba buri Mujyanama w’Ubuzima kubera umusanzu we bwite, igihembo gitangwa na Ministeri y’Ubuzima ni kinini ku buryo bushimishije kugira ngo buri tsinda rishobore gushyira iruhande igice kimwe cy’amafaranga binjiza. Bakoresheje ayo mafaranga, bashobora gutangira ibikorwa by’ishoramari.
Ku Kigo Nderabuzima cya Gikomero, Madamu Concessa Kiberinka, Umujyanama w’Ubuzima akaba n’umucungamari wa Koperative y’Abajyanama b’Ubuzima, yatweretse ibikorwa by’ubukungu binyuranye Koperative yabo yakoraga : Ubworozi bw’ingurube, urutoke, ishoramari mu bwubatsi bw’amazu,… Na none kandi yatubwiye undi mushinga bateganyaga mu gihe kizaza: Kubaka ibagiro ry’inyama z’ingurube! Mu mashuri y’ubucungamari, ibi babyita gutera intambwe nyongeragaciro k’ibikorwa byabo…
Namubajije niba bidashoboka ko iterambere rya Koperative yabo y’ubukungu bitazatuma umushinga wabo umungwa na ruswa, kandi intego yayo ya mbere ari uguteza imbere (1°) ubuzima. Ibi bishobora gutuma twibaza ko abandi bantu bazashaka kuba Abajyanama b’Ubuzima bazaba bakuruwe n’indonke n’irari ry’inyungu y’amafaranga. Yansobanuriye ko buri mudugugudu uhitamo Abajyanama b’Ubuzima binyuze mu buryo bwa demokarasi kandi ko ingingo zigenderwaho zikurikizwa ari ukwitangira umudugugudu, ubunyanyamuganyo, ubushobozi bwo kwizerwa n’ingo no kuzisura… (2) Biraruhije gusobanura, ariko mu biganiro twagiranye n’Abajyanama b’Ubuzima, byagaragaye ko barangwaga n’izi ndangagaciro zose.
Ivuka n’Iterambere ry’ubu buryo
Dore rwose uburyo bw’imikorere bwatekerejwe neza kandi bufite urwego ruteye neza bwavutse : Abajyanama b’Ubuzima, batoranywa ku buryo bwa demokarasi, bikozwe n’abaturage, bahugurirwa gutanga urwunge rwa serivisi zikomatanyije zinoze, bakora no ku buryo buhuza ibikorwa byabo kandi bagenzurwa n’Ikigo Nderabuzima, bishyira hamwe ku rwego rw’aho batuye muri Koperative, nayo kandi ikaba iterwa inkunga n’igihembo gishingiye ku
musaruro, kandi ikaba yiyemeje gutangiza ibikorwa bibyara inyungu z’ubukungu, ibi kandi byose bikaba bikorerwa mu rwego rwa politiki
nkangurambaga ihanitse.
Icyitonderwa no Gushimira:
(1) Turashimira Health Development Performance n’Ishuri Rikuru ry’Ubuzima Rusange rya Kigali kuko bemeye kugira uruhare muri urwo rugendo!
(2) amakoperative arimo 2/3 by’abagore ; nk’umugabo, mbona ari icyemezo gishingiye ubushishozi buhanitse, kandi ibi ntibitangaje mu Rwanda).
Translation: Dr Candide Tran Ngoc & Francoise Kayirangwa