Africa, Development & Aid, Gender, Headlines, Health, Human Rights, Poverty & SDGs, Women's Health

HEALTH-AFRICA: Family Planning: Expand Role For Private Sector

Joyce Mulama

NAIROBI, Aug 6 2009 (IPS) - Dwindling donor support in the face of rising contraceptive demand, combined with diminishing government budgets could make already widespread shortfalls in the provision of contraceptives worse. African reproductive health experts are suggesting that the private sector could be the key to filling the gap.

Research by the East, Central and Southern African Health Community (ECSA) confirms that governments are heavily dependent on donor funds to supply contraceptives.

"Donor programmes on contraceptives may not be sustainable when they shift focus to other emerging public sector needs, or delay to replenish contraceptive supply leading to stock-outs," said George Gahungu, the director of the National Reproductive Health Programme within the ministry of health in Burundi.

A contraceptive stock-out occurred in the country two years ago when one of the key donors failed to replenish stock of various family planning methods on time. "It is bad when a woman comes to a clinic and leaves without her preferred method. This poses risks of unintended pregnancies and unsafe abortions," Gahugu observed.

Burundi’s contraceptive prevalence rate – the proportion of women of reproductive age (or their partners) who are using contraceptive methods – is among the lowest in the world standing at 12 percent, according to the United Nations Population Fund.

At a meeting of reproductive health specialists from East, Central and Southern Africa in late July, it was underscored that governments need to create enabling environments to foster private sector participation in family planning.

According to USAID, many countries in these regions have restrictive legal and policy environments that have impeded expansion of private sector reproductive health services.

Family planning not exactly a gold mine

But aside from that, it emerged that the private sector does not consider family planning a lucrative market. In most of Africa, FP is either provided free or at subsidised cost in public health facilities. "The private sector is reluctant to provide FP services in large scale because it is not an emergency and majority of people cannot afford the fee in private institutions," Dr Wasunna Owino, from USAID's Health Policy Initiative, told IPS.

Solomon Orero, a private reproductive health practitioner agreed. "Apart from consultation fees, I have to recover costs of purchasing commodities. Long term FP methods require a lot of work including a sterile environment, surgical equipment. I have to charge for all these including my time."

He added: "For example, most of the private practitioners providing Norplant will not charge less than 3000 Kenyan shillings (about 40 dollars). For coils and inter uterine devices we charge between 1000 – 2000 Ksh (about 13-26 dollars). Very few can afford these services, and therefore many private sector practitioners opt to concentrate on other health services – like curative – more than family planning."

Social franchising

A profitable role for the private sector providing services in rural areas – where close to 80 percent of the regions' population resides – poses an even a greater challenge given the high poverty levels. Such scenarios, participants at the ECSA meeting heard, call for a public-private partnership to increase access.

Marie Stopes – Kenya’s (MS-K) social franchising model was cited as one that has successfully taken FP services to hard-to- reach areas, improving uptake. The model, started in the country in 2004, extends sexual and reproductive health services through existing private sector providers.

The organisation identified private providers in communities where contraceptive prevalence was low and trained them in highly effective long-term family planning methods. They were then certified as members of a franchise network called Amua, which was monitored regularly to ensure they met quality standards.

Providers that did not have basic equipment necessary for the services were supplied with it at a subsidised rate, and committed to offer services at a reasonable fee agreed upon with the community. The service providers were then linked to community-based distributors of contraceptives for the purposes of demand creation within the communities.

"Providers are seeing an increase in client numbers because we use the mass media to direct the clients to where the services are being offered. Since we trained providers on cross-service skills, they are able to offer other services to clients besides FP.

"The providers are realising revenue because from one client they are able to get fee for different services. The relationship with government has increased given that some of the skills trainers are from public sector since it is a public – private partnership," Walter Odhiambo, deputy country director of MS-K said.

Too much of a good thing?

While demand creation for family planning is crucial, Martha Rimoy, a principal nursing officer in Tanzania, warned against consequences in her country. "We are creating demand and we are not ready to address supply. We need to constantly ensure supply matches demand at every level," she observed, citing a shortage of contraceptives in her country for the past six months.

Elsewhere, demand for contraceptives is being suppressed by religious groups which are fighting against promotion of modern family planning methods. In Burundi for example, there are areas where churches are engaged in counter campaigns against family planning, according to Gahungu.

"We have cases where women are coming back to remove IUDs and Norplants, saying the priests are against such methods." This, he says, is jeopardising the war against maternal mortality, which is already high, currently standing at 1,000 deaths per 100,000 live births, United Nations Population Fund statistics state.