{"id":38518,"date":"2019-11-23T09:45:35","date_gmt":"2019-11-23T06:45:35","guid":{"rendered":"https:\/\/bilimvegelecek.com.tr\/?p=38518"},"modified":"2019-11-23T10:53:52","modified_gmt":"2019-11-23T07:53:52","slug":"neoliberal-donusumun-bagisiklama-hizmetlerine-etkileri-ve-sonuclari-2","status":"publish","type":"post","link":"https:\/\/bilimvegelecek.com.tr\/index.php\/2019\/11\/23\/neoliberal-donusumun-bagisiklama-hizmetlerine-etkileri-ve-sonuclari-2","title":{"rendered":"Neoliberal d\u00f6n\u00fc\u015f\u00fcm\u00fcn ba\u011f\u0131\u015f\u0131klama hizmetlerine etkileri ve sonu\u00e7lar\u0131"},"content":{"rendered":"

A\u015f\u0131lanmama ve a\u015f\u0131 yapt\u0131rmaya ili\u015fkin teredd\u00fct, a\u015f\u0131latmama, k\u00fcreselle\u015fmeci politik \u00fcstyap\u0131n\u0131n, neoliberal hegemonyan\u0131n bilime ve sa\u011fl\u0131k hakk\u0131na ili\u015fkin kabul ve ifadeleriyle, sa\u011fl\u0131k hizmetlerine y\u00f6nelik bi\u00e7imlendirici kararlar\u0131yla ili\u015fkilidir.
\n<\/em><\/p>\n

Ba\u011f\u0131\u015f\u0131klama hizmetleri, temel sa\u011fl\u0131k hizmetlerinin kavramsalla\u015ft\u0131r\u0131l\u0131p tan\u0131mland\u0131\u011f\u0131, \u00fclkemiz dahil 160 \u00fclkenin karar ve yakla\u015f\u0131mlar\u0131n\u0131 kabul etti\u011fi, 1978 Alma Ata Konferans\u0131nda h\u00fck\u00fcmetlerin halklar\u0131na sunmakla y\u00fck\u00fcml\u00fc oldu\u011fu ilan edilen sekiz hizmetten biridir. Ayn\u0131 \u015fekilde, \u00f6nlenebilir \u00e7ocuk \u00f6l\u00fcmlerine kar\u015f\u0131 Birle\u015fmi\u015f Milletler \u00c7ocuklara Yard\u0131m Fonu (UNICEF) taraf\u0131ndan lanse edilen \u00e7ocuk ya\u015fatma devriminin yedi bile\u015feninden biri Geni\u015fletilmi\u015f Ba\u011f\u0131\u015f\u0131klama Program\u0131d\u0131r (GBP).<\/p>\n

Neoliberalizmin y\u00fckseli\u015fi ile birlikte \u201c\u00e7ocuklara verilen s\u00f6zler\u201d tutulmad\u0131, yerine getiril(e)medi, sa\u011fl\u0131k hizmetleri ticarile\u015ftirildi, sa\u011fl\u0131k hizmetlerinin hak sahibi kullan\u0131c\u0131lar\u0131 tercih sahibi m\u00fc\u015fterilere d\u00f6n\u00fc\u015ft\u00fcr\u00fcld\u00fc. Toplumun sa\u011fl\u0131\u011f\u0131n\u0131 g\u00f6zeten, toplum ba\u011f\u0131\u015f\u0131kl\u0131\u011f\u0131n\u0131 (a\u015f\u0131lama yoluyla ba\u011f\u0131\u015f\u0131k k\u0131larak toplumun hastal\u0131\u011f\u0131n yay\u0131lmas\u0131na kar\u015f\u0131 diren\u00e7 g\u00f6sterip, hen\u00fcz a\u015f\u0131lanma ya\u015f\u0131na gelmemi\u015fleri, hastal\u0131klar\u0131 nedeniyle a\u015f\u0131lanamayacak durumda olanlar\u0131 korumas\u0131n\u0131) hedefleyen ba\u011f\u0131\u015f\u0131klama hizmetleri bireylerin tercihlerine g\u00f6re yararlanacaklar\u0131 a\u015f\u0131lamalara d\u00f6n\u00fc\u015ft\u00fc.<\/p>\n

Ticarile\u015fme-piyasala\u015fma, hizmet sunmada zaaf, g\u00fcvensizlik, teredd\u00fct<\/strong><\/p>\n

T\u00fcrkiye\u2019nin yak\u0131n tarihinin yol haritas\u0131, 24 Ocak 1980 kararlar\u0131 ve Ba\u011f\u0131ms\u0131z Sosyal Bilimciler taraf\u0131ndan \u201cFarkl\u0131 H\u00fck\u00fcmetler, Tek Siyaset\u201d olarak tan\u0131mlanan IMF ile yap\u0131lan 1998 Yak\u0131n \u0130zleme Anla\u015fmas\u0131 ile \u00e7izilmi\u015f durumdad\u0131r. Ulus devletin \u201ck\u00fcresel sisteme\u201d entegrasyonu, Yeni D\u00fcnya D\u00fczeni uyar\u0131nca, devletin toplumsal ya\u015fam ve d\u00fczenlemelerde toplum yarar\u0131n\u0131 g\u00f6zetici rol\u00fcn\u00fc yeni akt\u00f6rlerle payla\u015fma (\u00c7okuluslu \u015firketler, h\u00fck\u00fcmet d\u0131\u015f\u0131 \u00f6rg\u00fctler, medya kartelleri, ara\u015ft\u0131rma ve d\u00fc\u015f\u00fcnce kurulu\u015flar\u0131, hatta baz\u0131 devletlerin y\u0131ll\u0131k GSMH\u2019s\u0131ndan daha fazla \u015fahsi serveti bulunan bireyler ve yat\u0131r\u0131mc\u0131 konsorsiyumlar) tercihi (\u00d6zt\u00fcrk F, D\u0130B, 2018) devletin yeniden yap\u0131lanmas\u0131nda ve sa\u011fl\u0131k hizmetlerinde d\u00f6n\u00fc\u015f\u00fcm program\u0131 ile sa\u011fl\u0131k hizmetleri-yurtta\u015f ili\u015fkileri ve alg\u0131s\u0131nda dramatik sonu\u00e7lara yol a\u00e7m\u0131\u015ft\u0131r.<\/p>\n

\"\"
Hi\u00e7 a\u015f\u0131lanmam\u0131\u015f \u00e7ocuk say\u0131s\u0131nda art\u0131\u015f 17.248 ki\u015fiyi bulmu\u015ftur. Bu art\u0131\u015f 2008 sonu\u00e7lar\u0131na g\u00f6re % 81 d\u00fczeyindedir.<\/figcaption><\/figure>\n

Bu s\u00fcre\u00e7te sa\u011fl\u0131k hizmetlerinde kamusal y\u00fck\u00fcml\u00fcl\u00fc\u011f\u00fcn bireysel tercihlere-sorumlulu\u011fa transferi ba\u011f\u0131\u015f\u0131klama hizmetlerini de etkilemi\u015ftir. Ulusal A\u015f\u0131 Kampanyas\u0131 ile 1985\u2019te devlet eliyle fark\u0131ndal\u0131\u011f\u0131 ve gereksinim duygusu yarat\u0131lan ve ciddi bir politik isteklilik ile kar\u015f\u0131lanan ba\u011f\u0131\u015f\u0131klama hizmetleri, s\u00fcre\u00e7 i\u00e7inde bireysel sorumluluk (performans hedefi) \u00fczerinden hizmet sunan sa\u011fl\u0131k \u00e7al\u0131\u015fanlar\u0131 ile bu hizmetlere gereksinimi oldu\u011funun fark\u0131nda da olmayabilen, etkili sa\u011fl\u0131k e\u011fitiminden yoksun b\u0131rak\u0131lm\u0131\u015f, sa\u011fl\u0131k okuryazarl\u0131\u011f\u0131 kamu spotlar\u0131 arac\u0131l\u0131\u011f\u0131yla geli\u015ftirilebilece\u011fi varsay\u0131lan bireyler (aile hekimlerinin listelerinde yer alanlar) aras\u0131ndaki ili\u015fkiye evrilmi\u015f ve sa\u011fl\u0131k \u00e7al\u0131\u015fan\u0131 ile vatanda\u015f aras\u0131ndaki g\u00fcven ili\u015fkisi zedelenmi\u015ftir. Bu evrim kendili\u011finden olmam\u0131\u015f, k\u00fcreselle\u015fmenin ve neoliberal hegemonyan\u0131n\/ politik \u00fcstyap\u0131n\u0131n a\u015fa\u011f\u0131daki m\u00fcdahalelerinden etkilenmi\u015ftir.<\/p>\n

a) Sa\u011fl\u0131k Ocaklar\u0131nda g\u00f6revli ebeler, sorumlu olduklar\u0131 2500-3000 ki\u015filik bir co\u011frafyan\u0131n i\u00e7inde gezici hizmetle topluma; do\u011fuma yard\u0131m, evde bak\u0131m, ba\u011f\u0131\u015f\u0131klama, gebe-bebek ve 15-49 ya\u015f kad\u0131n izleme hizmetleri sunar, g\u00fcven sa\u011flard\u0131. Sa\u011fl\u0131k Ocaklar\u0131 kapat\u0131l\u0131p ba\u015fvuruya dayal\u0131, listedeki bireylere hizmet sunmakla y\u00fck\u00fcml\u00fc Aile Sa\u011fl\u0131\u011f\u0131 Merkezlerine ge\u00e7i\u015f ile birlikte, sa\u011fl\u0131k hizmeti sunucular\u0131 ile kullan\u0131c\u0131lar\u0131 aras\u0131ndaki ili\u015fkinin, \u201cne yap\u0131lmas\u0131 gerekiyorsa bilen ve yapan\u201d babac\u0131l sa\u011fl\u0131k \u00e7al\u0131\u015fan\u0131-kullan\u0131c\u0131 ili\u015fkisinden bireyin m\u00fc\u015fteri oldu\u011fu ticari ili\u015fkiye, ard\u0131ndan \u00fc\u00e7\u00fcnc\u00fcl ki\u015fi (avukat, yarg\u0131\u00e7-tazminat) ya da kurumlar\u0131n (sa\u011fl\u0131k bakanl\u0131\u011f\u0131-negatif performans, Aile ve Sosyal Politikalar Bakanl\u0131\u011f\u0131 (ASPB)-sa\u011fl\u0131k tedbiri) m\u00fcdahil oldu\u011fu, karar alma sorumlulu\u011fundan ka\u00e7\u0131nma (hekim i\u00e7in; onam alma, a\u015f\u0131 reddi imzalatma- kurum i\u00e7in; yarg\u0131ya ba\u015fvurma, birey i\u00e7in sorumluluk \u00fcstlenmeden ka\u00e7\u0131nma, teredd\u00fct ) ili\u015fkisine d\u00f6n\u00fc\u015fm\u00fc\u015f, hizmet sunmada zaaf ortaya \u00e7\u0131km\u0131\u015ft\u0131r.<\/p>\n

b) Ba\u011f\u0131\u015f\u0131klama hizmetlerinin hedeflenen d\u00fczeyde yerine getirilememesi durumunda Aile Sa\u011fl\u0131\u011f\u0131 Hekimi ve eleman\u0131na para cezas\u0131 ve ceza puan\u0131 verilmektedir. Bu durumdan ka\u00e7\u0131nmak ve cezaland\u0131r\u0131lmamak i\u00e7in aile hekimi ailenin a\u015f\u0131y\u0131 yapt\u0131rmak istememesini belgelemek durumundad\u0131r. Ayr\u0131ca Sa\u011fl\u0131k Bakanl\u0131\u011f\u0131n\u0131n GBP kapsam\u0131ndaki a\u015f\u0131lar\u0131 yapt\u0131rmayan aileleri ASPB\u2019na ihbar\u0131 sonucunda sa\u011fl\u0131k tedbiri al\u0131nmas\u0131 amac\u0131yla yarg\u0131lanan aileler ve hukuki sonu\u00e7lar\u0131 i\u00e7in Anayasa Mahkemesinin a\u015f\u0131 uygulamas\u0131n\u0131n zorunlu olmad\u0131\u011f\u0131na dair karar\u0131n\u0131 da etkili giri\u015fimlerden biri olarak nitelemek gerekir.<\/p>\n

c) D\u00fcnya\u2019da UNICEF \u00f6nc\u00fcl\u00fc\u011f\u00fcnde toplum yarar\u0131n\u0131 g\u00f6zeten bir yap\u0131lanma olarak ba\u015flayan Geni\u015fletilmi\u015f Ba\u011f\u0131\u015f\u0131klama Program\u0131 (GBP) a\u015f\u0131 \u00fcretiminde tekelle\u015fme ile birlikte piyasas\u0131 gittik\u00e7e geni\u015fleyip b\u00fcy\u00fcyen ticari bir faaliyete evrilmi\u015ftir.<\/p>\n

GBP, UNICEF taraf\u0131ndan, \u00c7ocuk Ya\u015fatma Devriminin bir \u00f6gesi olarak lanse edildi\u011finde hedefteki 6 hastal\u0131\u011fa kar\u015f\u0131 a\u015f\u0131 takvimine g\u00f6re a\u015f\u0131lama maliyeti 2,5 $, a\u015f\u0131 \u00fcreticisi say\u0131s\u0131 80 dolay\u0131nda idi, bug\u00fcnlerde a\u015f\u0131 piyasas\u0131 10\u2019dan daha az \u015firketin belirleyicili\u011finde oldu\u011fu gibi takvimdeki a\u015f\u0131lar\u0131n maliyeti 100 $ dolay\u0131ndad\u0131r.<\/p>\n

d) Sa\u011fl\u0131k Ocaklar\u0131n\u0131n kapat\u0131lmas\u0131yla belirlenmi\u015f co\u011frafi s\u0131n\u0131rlarda ya\u015fayanlar\u0131 hedefleyen topluma dayal\u0131 herkesi kapsay\u0131c\u0131 bir hizmet, toplum sa\u011fl\u0131\u011f\u0131n\u0131 koruma hedefinden, aile hekimleri arac\u0131l\u0131\u011f\u0131yla, co\u011frafi b\u00f6lge ba\u011flam\u0131 olmayan, listelerinde kay\u0131tl\u0131 bireylerin ba\u015fvurular\u0131yla kar\u015f\u0131lanan, bireysel korumay\u0131 hedefleyen, toplumsal korumay\u0131 sa\u011flamada zaaf\u0131 olan bir hizmete d\u00f6n\u00fc\u015fm\u00fc\u015ft\u00fcr.<\/p>\n

Ba\u015fvuruya dayal\u0131 hizmet, \u00fclkemizde ba\u011f\u0131\u015f\u0131klama hizmetlerine daha \u00e7ok gereksinimi olanlar\u0131n hizmetlerden daha az yararlanmas\u0131 ile sonu\u00e7lanm\u0131\u015ft\u0131r. Sa\u011fl\u0131k hizmetlerinden yararlanmada Terslik Kanununda tarif edildi\u011fi gibi, ilkokul ya da daha d\u00fc\u015f\u00fck e\u011fitim alm\u0131\u015flar, yoksullar, k\u0131zlar, do\u011fum s\u0131ras\u0131 4 ya da daha fazla olanlar hi\u00e7bir a\u015f\u0131 ile a\u015f\u0131lanmama ve tam ba\u011f\u0131\u015f\u0131k olma durumu a\u00e7\u0131s\u0131ndan 2013\u2019te 2008\u2019e g\u00f6re daha k\u00f6t\u00fc duruma gerilemi\u015ftir. (Eskiocak M, TTB, 2018)<\/p>\n

Bilimsel bilgi ve de\u011ferler sisteminin yerini, \u201cyar\u0131-bilimsel, yar\u0131-hurafe, \u00e7o\u011funlukla bilgi k\u0131r\u0131nt\u0131s\u0131 \u015feklinde, dolayl\u0131 yollardan edinilmi\u015f kanaatlerin, reddiyeci, negatif bir tavra d\u00f6n\u00fc\u015fmesi ile bilmeme, bilememe, \u00f6ng\u00f6rememenin, tepkisel bir \u015fekilde, yok saymaya, bir \u00e7e\u015fit sald\u0131rgan kadercili\u011fe d\u00f6n\u00fc\u015fmesi alm\u0131\u015ft\u0131r.\u201d (Ergur A, TTB, 2014)
\nYa da s\u0131n\u0131rl\u0131 ve y\u00f6nlendirilmi\u015f bilgileri ile bilin\u00e7li olarak hareket ettiklerini d\u00fc\u015f\u00fcnen, \u00e7o\u011funlukla kendileri i\u00e7in yararl\u0131 olan\u0131n ay\u0131rd\u0131na da varamayan baz\u0131 t\u00fcketiciler \u00e7ocuklar\u0131n\u0131 kendi annelik uygulamalar\u0131n\u0131n merkezine yerle\u015ftirmi\u015f, tercihlerinin ba\u015fkalar\u0131 i\u00e7in potansiyel sonu\u00e7lar\u0131n\u0131 g\u00f6remez hale gelmi\u015f, yeni nesil a\u015f\u0131r\u0131 bilgili ve kayg\u0131l\u0131 ebeveynler olu\u015fmu\u015ftur. (Reich JA, Gender &Society, 2014)<\/p>\n

G\u00fcven duyaca\u011f\u0131 sa\u011fl\u0131k \u00e7al\u0131\u015fan\u0131ndan s\u00fcrekli ve g\u00fcvenilir bilgi sa\u011flayamayan, t\u00fcketici haline getirilen hizmet kullan\u0131c\u0131s\u0131, internet ve sosyal medya ve televizyon arac\u0131l\u0131\u011f\u0131yla elde etti\u011fi s\u0131n\u0131rl\u0131 ve y\u00f6nlendirilmi\u015f\/\u00e7arp\u0131t\u0131lm\u0131\u015f bilgisi ve kontrol\u00fc ele ald\u0131\u011f\u0131 duygusuyla bebek ve \u00e7ocuk \u00f6l\u00fcmlerinin, hastalanmalar\u0131n\u0131n \u00f6n\u00fcne ge\u00e7ilmesini sa\u011flayan (1989\u2019da 5,5 milyon \u00e7ocuk \u00f6l\u00fcm\u00fcnden 2017\u2019de 100.000 dolay\u0131nda \u00e7ocuk \u00f6l\u00fcm\u00fcne azalma) ba\u011f\u0131\u015f\u0131klama hizmetlerine kar\u015f\u0131 g\u00fcvensizlik, teredd\u00fct ve reddin arac\u0131 olmaktad\u0131r.<\/p>\n

\u201cBeklenen influenza pandemisi (domuz gribi salg\u0131n\u0131), neoliberal hegemonyan\u0131n sa\u011fl\u0131k ortam\u0131nda de\u011ferleri sarsmakta oldu\u011fu bir d\u00f6nemde ortaya \u00e7\u0131kt\u0131. Neoliberalizm \u00f6l\u00fcm\u00fc, ya\u015fam\u0131, sa\u011fl\u0131\u011f\u0131, sa\u011fl\u0131k hizmetlerini, bilimi, biliminsan\u0131n\u0131, de\u011ferleri kendine g\u00f6re bi\u00e7imlerken, bildiklerimize inanc\u0131m\u0131z\u0131 sorgulat\u0131rken, kavramlar\u0131 bildi\u011fimizden farkl\u0131 tan\u0131mlarken, T\u00fcrkiye\u2019de Pandemi y\u00f6netim s\u00fcreci sa\u011fl\u0131k alan\u0131nda neoliberal d\u00f6n\u00fc\u015f\u00fcm\u00fcn uygulama-\u00e7at\u0131\u015fma alan\u0131na d\u00f6n\u00fc\u015ft\u00fc. Pandemik tehdide kar\u015f\u0131 al\u0131nacak \u00f6nlemlerin y\u00fck\u00fcml\u00fcl\u00fc\u011f\u00fc kamusal \u00f6rg\u00fctlenmeden bireysel sorumlulu\u011fa aktar\u0131ld\u0131. \u0130nsanl\u0131\u011f\u0131n ortak birikimi olan bilim ve teknoloji, insan ya\u015fam\u0131 \u00fczerinden sermayenin kazan\u00e7 f\u0131rsat\u0131na d\u00f6n\u00fc\u015ft\u00fcr\u00fcld\u00fc, de\u011ferlere g\u00fcven sars\u0131ld\u0131, bilimin sesi siyaset ve dogma kar\u015f\u0131s\u0131nda yitikle\u015fti.\u201d (Eskiocak M, TTB, 2014)
\ne) Bireyleri a\u015f\u0131 uygulayarak diren\u00e7li k\u0131lma sorumlulu\u011fu devletten\/ Sa\u011fl\u0131k Bakanl\u0131\u011f\u0131ndan bireysel tercihe transfer edilmi\u015ftir.<\/p>\n

A\u015f\u0131 konusunda Sa\u011fl\u0131k Bakan\u0131 Recep Akda\u011f ile ayn\u0131 g\u00f6r\u00fc\u015fte olmad\u0131\u011f\u0131n\u0131 belirten Erdo\u011fan, \u201cBu konuda Sa\u011fl\u0131k Bakan\u0131m ile ayn\u0131 d\u00fc\u015f\u00fcnm\u00fcyorum. Kimseyi icbar edemeyiz. Bu konuda vatanda\u015f\u0131m kendi iste\u011fine ba\u011fl\u0131 olarak b\u00f6yle bir yolu tercih ederse, eyvallah… Ama etmiyorsa, \u2018muhakkak yapt\u0131rman\u0131z gerekir\u2019 diye b\u00f6yle bir kampanyan\u0131n s\u00fcrd\u00fcr\u00fclmesi do\u011fru de\u011fildir, yanl\u0131\u015ft\u0131r. Bu konuda e\u011fer ebeveyn kalk\u0131p da \u2018ben bunu istiyorum\u2019 diyorsa bu olmal\u0131d\u0131r. \u00c7\u00fcnk\u00fc otoriteler de g\u00f6r\u00fcyorsunuz, de\u011fi\u015fik kanaatler belirtiyor. Kimisi (olmal\u0131d\u0131r) kimisi (olmamal\u0131d\u0131r) diyor. \u00d6yle ise yapaca\u011f\u0131m\u0131z \u015fey, siyasi irade olarak bunu iste\u011fe ba\u011fl\u0131 hale getirmektir. Yar\u0131n bunun faturas\u0131n\u0131 siyasi iradeye kesmesin. Cebren bu i\u015f olmaz, iste\u011fe ba\u011fl\u0131 olur. \u0130ste\u011fe ba\u011fl\u0131 olarak haz\u0131rl\u0131klar\u0131m\u0131z\u0131 yapt\u0131k, altyap\u0131m\u0131z haz\u0131rd\u0131r, a\u015f\u0131 vard\u0131r. A\u015f\u0131, arzu edene, isteyene yap\u0131l\u0131yor, yapt\u0131r\u0131l\u0131yor \u00fccretsiz olarak. Bizim g\u00f6revimiz de bu.\u201d dedi.
\n(CNN T\u00fcrk, 2009)<\/p>\n

f) Sa\u011fl\u0131k Ocaklar\u0131n\u0131n kald\u0131r\u0131lmas\u0131yla yurtta\u015flar\u0131n ya\u015fad\u0131klar\u0131 yerde evlerinde ziyaretlerini yapan, bebek ve gebeleri, kad\u0131nlar\u0131 izleyen, kimi sa\u011fl\u0131k hizmetlerini sunan (tansiyon \u00f6l\u00e7\u00fcm\u00fc, enjeksiyon, pansuman\u2026) Sa\u011fl\u0131k Evi ebelerinin hizmet s\u00fcrecinden \u00e7ekilmesi, birinci basamak hizmetlerinin temel \u00f6zelliklerinden birisi olan s\u00fcreklili\u011fin, hizmetlere eri\u015febilmenin zaafa u\u011framas\u0131, politik \u00fcstyap\u0131n\u0131n, medyan\u0131n aktar\u0131p geli\u015fimine katk\u0131da bulundu\u011fu teredd\u00fct gittik\u00e7e a\u015f\u0131lara kar\u015f\u0131, ba\u011f\u0131\u015f\u0131klama hedefleyenlere kar\u015f\u0131 g\u00fcvensizlik olu\u015fmas\u0131 ile sonu\u00e7lanm\u0131\u015ft\u0131r.<\/p>\n

T\u00fcm \u00fclkelerde temel sa\u011fl\u0131k hizmetlerinin ve bireye y\u00f6nelik koruyucu ve tedavi edici hizmetlerin ilk adresi Birinci Basamak Sa\u011fl\u0131k Hizmetleridir. Etkin ve g\u00fc\u00e7l\u00fc bir birinci basamak hizmet sunumu, bireylerin, ailelerin ve toplumun s\u00fcreklilik i\u00e7inde, yak\u0131n, daha g\u00fc\u00e7l\u00fc bir g\u00fcven ili\u015fkisi i\u00e7inde hizmet almalar\u0131n\u0131 sa\u011flar. Bu temel bilgiden yola \u00e7\u0131karak, pandeminin izlem ve y\u00f6netiminde birinci basamak sisteminin daha etkin katk\u0131s\u0131n\u0131n sa\u011flanmas\u0131 gereklili\u011fine vurgu yapmak istiyoruz. (TTB, 2014)<\/p>\n

\"\"
T\u00fcrkiye\u2019de k\u0131zam\u0131k salg\u0131n\u0131 2010 Aral\u0131k\u2019tan beri s\u00fcren ve 2016\u2019daki 12 ayl\u0131k dola\u015f\u0131m\u0131n durduruldu\u011fu (salg\u0131n olmadan ge\u00e7en bir y\u0131l) d\u00f6nemin ard\u0131ndan tekrar ba\u015flad\u0131.<\/figcaption><\/figure>\n

Sonu\u00e7lar: A\u015f\u0131lanamama, a\u015f\u0131 kar\u015f\u0131tl\u0131\u011f\u0131 ve salg\u0131nlar<\/strong><\/p>\n

1) T\u00fcrkiye N\u00fcfus ve Sa\u011fl\u0131k Ara\u015ft\u0131rmas\u0131 2013 verilerine g\u00f6re hi\u00e7bir a\u015f\u0131 yapt\u0131rmam\u0131\u015f olma durumu 13-26 ayl\u0131k \u00e7ocuklarda 2008\u2019de 20 bin dolay\u0131nda (% 1,6) iken 2013\u2019te 37 binlere (% 2,9) \u00e7\u0131km\u0131\u015ft\u0131r.<\/p>\n

Eri\u015filmedi\u011fi i\u00e7in a\u015f\u0131lanamayanlar, a\u015f\u0131 yapan birimlere uzakta ya\u015fayanlar, ya\u015fam bi\u00e7imleri ve yapt\u0131klar\u0131 i\u015f nedeniyle hareket halinde olanlar, s\u0131\u011f\u0131nmac\u0131lar, a\u015f\u0131 yapt\u0131rmay\u0131 ret edenler, a\u015f\u0131 yapt\u0131rmaya t\u0131bbi engeli olanlar, aile hekimlerinde kayd\u0131 bulunmayanlar (T.C. Kimli\u011fi olamayanlar) bu say\u0131ya dahildir. A\u015f\u0131lanmayanlar dezavantajl\u0131 gruplard\u0131r, ba\u011f\u0131\u015f\u0131klama hizmetlerinin temel sa\u011fl\u0131k hizmeti yakla\u015f\u0131m\u0131yla sunulmamas\u0131n\u0131n ma\u011fdurlar\u0131 gibi g\u00f6r\u00fcnmektedir.<\/p>\n

– Hi\u00e7 a\u015f\u0131lanmam\u0131\u015f \u00e7ocuk say\u0131s\u0131nda art\u0131\u015f 17.248 ki\u015fiyi bulmu\u015ftur. Bu art\u0131\u015f 2008 sonu\u00e7lar\u0131na g\u00f6re % 81 d\u00fczeyindedir.<\/p>\n

– A\u015f\u0131lanmama k\u0131z \u00e7ocuklar\u0131 i\u00e7in gittik\u00e7e artan bir e\u015fitsizlik \u00f6gesi olarak g\u00f6r\u00fcnmektedir. A\u015f\u0131lanmama a\u00e7\u0131s\u0131ndan kad\u0131n\/erkek oran\u0131 2008-2013 aras\u0131nda % 28 artm\u0131\u015ft\u0131r. K\u0131z \u00e7ocuklarda a\u015f\u0131lanmama, son 5 y\u0131l i\u00e7in % 86,4 ile erkeklere g\u00f6re (% 45,5) yakla\u015f\u0131k 2 kat artm\u0131\u015ft\u0131r.<\/p>\n

– Do\u011furganl\u0131\u011f\u0131n te\u015fvik edildi\u011fi bu d\u00f6nemde 4-5 \u00e7ocuklu ailelerin \u00e7ocuklar\u0131n\u0131n a\u015f\u0131lanmamas\u0131nda art\u0131\u015f tek \u00e7ocuklulara g\u00f6re % 153,4; 2-3 \u00e7ocuklulara g\u00f6re % 65,9\u2019dur. 2008-2013 d\u00f6neminde hi\u00e7 a\u015f\u0131 olmam\u0131\u015flar\u0131n s\u0131kl\u0131\u011f\u0131nda art\u0131\u015f 4-5 \u00e7ocuklu ailelerin \u00e7ocuklar\u0131 i\u00e7in % 176,5 olmu\u015ftur.<\/p>\n

– Hi\u00e7 a\u015f\u0131 olmam\u0131\u015flar\u0131n s\u0131kl\u0131\u011f\u0131 kentte % 93,7, k\u0131rda % 25 artm\u0131\u015ft\u0131r. Bu art\u0131\u015f a\u015f\u0131lanmama a\u00e7\u0131s\u0131ndan k\u0131r\/kent e\u015fitsizli\u011fini azaltm\u0131\u015ft\u0131r. Kentte gezici hizmetin ortadan kalkmas\u0131 dezavantajl\u0131lar\u0131n a\u015f\u0131lanmas\u0131n\u0131 olumsuz etkilemi\u015ftir.<\/p>\n

– Hi\u00e7 a\u015f\u0131 olmam\u0131\u015flar\u0131n s\u0131kl\u0131\u011f\u0131 bat\u0131da % 193,7 artarken t\u00fcm b\u00f6lgelerde azalma sa\u011flanm\u0131\u015ft\u0131r. Bu art\u0131\u015f, a\u015f\u0131lanmama a\u00e7\u0131s\u0131ndan do\u011fu\/bat\u0131 e\u015fitsizli\u011fini azaltm\u0131\u015ft\u0131r.<\/p>\n

Hi\u00e7 a\u015f\u0131lanmam\u0131\u015flar\u0131n s\u0131kl\u0131\u011f\u0131nda art\u0131\u015f en \u00e7ok hanehalk\u0131 refah d\u00fczeyi orta olarak s\u0131n\u0131flanan kesimde (% 666,7), azalma ise en vars\u0131l kesimde (-% 100) olmu\u015ftur. Hi\u00e7 a\u015f\u0131lanmam\u0131\u015f olma neredeyse t\u00fcm\u00fcyle vars\u0131l olmayanlar\u0131n sorunu gibi g\u00f6r\u00fcnmektedir.<\/p>\n

Hi\u00e7 a\u015f\u0131lanmam\u0131\u015flar\u0131n s\u0131kl\u0131\u011f\u0131nda art\u0131\u015f en \u00e7ok ilkokulu bitirmemi\u015f\/ e\u011fitimi olmayan kesimdedir (% 187,5). Lise ve \u00fczeri e\u011fitim alm\u0131\u015flar ile e\u011fitimi olmayanlar aras\u0131ndaki e\u015fitsizlik % 187,5 artm\u0131\u015ft\u0131r. Hi\u00e7 a\u015f\u0131lanmam\u0131\u015f olma neredeyse t\u00fcm\u00fcyle lise ve \u00fczeri e\u011fitim almam\u0131\u015flar\u0131n sorunu gibi g\u00f6r\u00fcnmektedir.<\/p>\n

– Tam a\u015f\u0131l\u0131 olu\u015fta (bir ya\u015f\u0131n\u0131 doldurdu\u011funda yap\u0131lm\u0131\u015f olmas\u0131 gereken t\u00fcm a\u015f\u0131lar\u0131n yap\u0131lm\u0131\u015f olmas\u0131) Geni\u015fletilmi\u015f Ba\u011f\u0131\u015f\u0131klama Program\u0131 hedefine uzakl\u0131k 2008\u2019de % 9,5 iken 2013\u2019te % 15,9\u2019a y\u00fckselmi\u015ftir. Bebeklerimizi a\u015f\u0131 ile \u00f6nlenebilir hastal\u0131klara kar\u015f\u0131 diren\u00e7li k\u0131lmada ba\u015far\u0131 2008\u2019e g\u00f6re % 8 azalm\u0131\u015f, tam a\u015f\u0131l\u0131 olmayan \u00e7ocuk say\u0131s\u0131nda art\u0131\u015f 88.270 ki\u015fi olmu\u015ftur.<\/p>\n

2) T\u00fcrkiye\u2019de k\u0131zam\u0131k salg\u0131n\u0131 2010 Aral\u0131k\u2019tan beri s\u00fcren ve 2016\u2019daki 12 ayl\u0131k dola\u015f\u0131m\u0131n durduruldu\u011fu (salg\u0131n olmadan ge\u00e7en bir y\u0131l) d\u00f6nemin ard\u0131ndan tekrar ba\u015flam\u0131\u015ft\u0131r. A\u015f\u0131lanmay\u0131 reddedenler salg\u0131nda hastalanma riski alt\u0131ndad\u0131r. Salg\u0131n\u0131n boyutunun daha da b\u00fcy\u00fcmesi ve olumsuz sonu\u00e7lar\u0131n\u0131n (\u00f6l\u00fcm, sa\u011f\u0131rl\u0131k, k\u00f6rl\u00fck, SSPE\u2026) yay\u0131lmas\u0131 riskini art\u0131rmaktad\u0131rlar. Ne var ki salg\u0131n\u0131n a\u015f\u0131lanmay\u0131 reddedenlerle a\u00e7\u0131klanmas\u0131 yetersiz kalmaktad\u0131r. K\u0131zam\u0131k a\u015f\u0131lamas\u0131n\u0131n toplum ba\u011f\u0131\u015f\u0131kl\u0131\u011f\u0131 i\u00e7in \u00f6nerilen d\u00fczeyde (% 95 ve \u00fczeri) oldu\u011fu il say\u0131s\u0131 1. doz i\u00e7in 67, 2. doz i\u00e7in yaln\u0131zca 8\u2019dir.<\/p>\n

3) K\u0131zam\u0131k salg\u0131n\u0131nda hastalananlar\u0131n a\u015f\u0131 durumu verilerine g\u00f6re hastalar temel olarak a\u015f\u0131s\u0131z \u00e7ocuklard\u0131r.<\/p>\n

DS\u00d6 Avrupa b\u00f6lgesi ayl\u0131k bildirim verilerinden elde edilen bilgilere g\u00f6re 2013 ve 2015 k\u0131zam\u0131k salg\u0131n\u0131nda hastalananlar\u0131n a\u015f\u0131 durumu verilerine g\u00f6re hastalar temel olarak a\u015f\u0131s\u0131z \u00e7ocuklard\u0131r. Bu durum salg\u0131n y\u00f6netimi ile ilgili kayg\u0131 verici uyar\u0131lar vermektedir.<\/p>\n

Tablo 1.<\/strong>T\u00fcrkiye\u2019de Laboratuvar ile Do\u011frulanm\u0131\u015f K\u0131zam\u0131k Hastal\u0131\u011f\u0131n\u0131n Y\u0131llara G\u00f6re Da\u011f\u0131l\u0131m\u0131<\/p>\n\n\n\n\n
Y\u0131l<\/strong><\/td>\n2018*<\/strong><\/td>\n2017<\/strong><\/td>\n2016<\/strong><\/td>\n2015<\/strong><\/td>\n2014<\/strong><\/td>\n2013<\/strong><\/td>\n2012<\/strong><\/td>\n2011<\/strong><\/td>\n2010<\/strong><\/td>\n<\/tr>\n
Olgu say\u0131s\u0131<\/td>\n50<\/td>\n48<\/td>\n9<\/td>\n342<\/td>\n569<\/td>\n7397<\/td>\n343<\/td>\n105<\/td>\n15<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

*\u0130lk 3 ay<\/p>\n

DS\u00d6 Avrupa b\u00f6lgesi veri taban\u0131nda 2018\u2019in ilk 3 ay\u0131nda a\u015f\u0131lanma durumu sunulan 474 olgunun 36\u2019s\u0131 1 ya\u015f\u0131ndan k\u00fc\u00e7\u00fck, 275\u2019i 14; 127\u2019si 5-9; 3\u2019\u00fc 10-14 ya\u015f grubundad\u0131r. Yaln\u0131zca 6\u2019s\u0131 15 ya\u015f\u0131ndan b\u00fcy\u00fckt\u00fcr. 161\u2019i a\u015f\u0131s\u0131z, 188\u2019i tek doz, 125\u2019i 2 doz a\u015f\u0131 ile a\u015f\u0131lanm\u0131\u015ft\u0131r.<\/p>\n

Te\u015fekk\u00fcr<\/strong>: Ele\u015ftirel de\u011ferlendirme ve katk\u0131lar\u0131ndan dolay\u0131 Prof. Dr. Burcu Toku\u00e7 ve Prof. Dr. Mehmet Zencir\u2019e te\u015fekk\u00fcr ederim.<\/p>\n

Kaynaklar<\/strong><\/p>\n

1) \u00d6zt\u00fcrk Feza, D\u0131\u015f \u0130\u015fleri Bakanl\u0131\u011f\u0131, K\u00fcreselle\u015fme-Yeni D\u00fcnya D\u00fczeni http:\/\/www.mfa.gov.tr\/kuresellesme-yeni-dunya-duzeni.tr.mfa, 19.05.2018<\/p>\n

2) Eskiocak M, \u00d6ns\u00f6z, (i\u00e7inde) T\u00fcrk Tabipleri Birli\u011fi Pandem\u0130K Influenza AH1N1V Bilimsel Dan\u0131\u015fma ve \u0130zleme Kurulu Pandemik \u00c7al\u0131\u015fma Raporu, https:\/\/www.ttb.org.tr\/h1n1\/index.php?option=com_content&view=article&id=169:rapor&catid=1:genel, 20.05.2018<\/p>\n

3) Ergur A. Salg\u0131n ve Medya \u0130leti\u015fimi, (i\u00e7inde) T\u00fcrk Tabipleri Birli\u011fi Pandem\u0130K Influenza AH1N1V Bilimsel Dan\u0131\u015fma ve \u0130zleme Kurulu Pandemik \u00c7al\u0131\u015fma Raporu, https:\/\/www.ttb.org.tr\/h1n1\/index.php?option=com_content&view=article&id=169:rapor&catid=1:genel, 20.05.2018<\/p>\n

4) Reich JA. Neoliberal Mothering and Vaccine Refusal: Imagined Gated Communities and the Privilege of Choice. Gender & Society <\/em>2014 28: 679.<\/p>\n

5) TTB, 2014, 22.12.2009, Bas\u0131n A\u00e7\u0131klamas\u0131, T\u00fcrk Tabipleri Birli\u011fi Pandem\u0130K Influenza AH1N1V Bilimsel Dan\u0131\u015fma ve \u0130zleme Kurulu Pandemik \u00c7al\u0131\u015fma Raporu, https:\/\/www.ttb.org.tr\/h1n1\/index.php?option=com_content&view=article&id=169:rapor&catid=1:genel, 20.05.2018<\/p>\n

6) CNN Turk, 2009, Erdo\u011fan domuz gribi a\u015f\u0131s\u0131 olmayacak, https:\/\/www.cnnturk.com\/2009\/turkiye\/11\/03\/erdogan.domuz.gribi.asisi.olmayacak\/550253.0\/index.html, 03.11.2009 Sal\u0131 14:02).<\/p>\n

7) Eskiocak M, A\u015f\u0131lanmama, A\u015f\u0131latmama ve T\u00fcrkiye\u2019de \u201cA\u015f\u0131 Reddi\u201d Tart\u0131\u015fmas\u0131na K\u0131sa Bir Katk\u0131, Toplu ve Hekim, Cilt 33, Say\u0131 3, May\u0131s-Haziran 2018, TTB.<\/p>\n","protected":false},"excerpt":{"rendered":"

A\u015f\u0131lanmama ve a\u015f\u0131 yapt\u0131rmaya ili\u015fkin teredd\u00fct, a\u015f\u0131latmama, k\u00fcreselle\u015fmeci politik \u00fcstyap\u0131n\u0131n, neoliberal hegemonyan\u0131n bilime ve sa\u011fl\u0131k hakk\u0131na ili\u015fkin kabul ve ifadeleriyle, sa\u011fl\u0131k hizmetlerine y\u00f6nelik bi\u00e7imlendirici kararlar\u0131yla ili\u015fkilidir. Ba\u011f\u0131\u015f\u0131klama hizmetleri, temel sa\u011fl\u0131k hizmetlerinin kavramsalla\u015ft\u0131r\u0131l\u0131p tan\u0131mland\u0131\u011f\u0131, \u00fclkemiz dahil 160 \u00fclkenin karar ve yakla\u015f\u0131mlar\u0131n\u0131 kabul etti\u011fi, 1978 Alma Ata Konferans\u0131nda h\u00fck\u00fcmetlerin halklar\u0131na sunmakla y\u00fck\u00fcml\u00fc oldu\u011fu ilan edilen sekiz hizmetten […]<\/p>\n","protected":false},"author":1474,"featured_media":38520,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[19],"tags":[2777,2779,5585,1563,425],"class_list":["post-38518","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-bilim-gundemi","tag-asi","tag-asi-karsitligi","tag-asilanmama","tag-neoliberalizm","tag-saglik"],"acf":[],"aioseo_notices":[],"aioseo_head":"\n\t\t\n\t\n\t\n\t\n\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t