Thirty minutes outside Arusha on the way to Nairobi and then 3km along a dirt road is the Selian Lutheran Hospital. One of 20 Lutheran hospitals across the country, the Selian facility serves the primarily Maasai population in the surrounding area. This morning the PAI team visited the reproductive health (RH) unit of the hospital and learned of the important role it plays in meeting family planning needs despite the ongoing challenge of securing a consistent supply of contraceptive methods.
Ms. Florah Kyara, a nurse in the RH unit, opened a cabinet and showed us the shelf containing all of the contraceptive supplies in stock,
which was less than half full. Selian Hospital offers its clients a range of family planning methods, including condoms, three types of oral contraceptives, injectables, implants, IUDs and male and female sterilization; but only after each new client has received a complete medical examination and counseling about her contraceptive choices.
Today, we found that the hospital was stocked out (out of stock) of
injectables, the most preferred method among women who visit the
clinic, as well as implants. All of these products are supplied for
free to the hospital by the Tanzanian government over three-month
periods, but the district office has told the hospital staff not to
expect any further implant donations, while the current stockout of the
injectable Depo-Provera is expected to last about one month. According
to Ms. Kyara, these injectable stockouts occur about twice a year.
Hospital has other options at its disposal when the government is
unable to provide contraceptive supplies. The hospital will purchase
some products with its own funds and provide them to clients for free,
and currently has a box of socially marketed pills available. Nurses in
the RH unit will also refer women to other family planning providers or
local pharmacies where they can purchase a dose of Depo-Provera for 500
shillings ($0.42) or an implant for 15,000 shillings ($12.50). However,
this can be a severe financial hardship to women in a country where the
per capita annual income is just over $300, while all RH services
provided at Selian Hospital are free of charge.
The fact that
the hospital is currently stocked out of two of its most popular
products is especially unfortunate, given the clients’ strong
preference for long-term methods.
Kyara explained that within the surrounding Maasai culture, people
prefer large families of 6-8 children (Tanzania’s national total
fertility rate is 5.7 children per woman), so few husbands support
their wives’ use of family planning. Women prefer to stop by the
hospital to receive an injection every three months because it can be
combined with other errands and kept secret from their husbands. But
with injectables out of stock, the number of daily family planning
clients has dropped by about one-third, from 15 to 10.
Hospital conducts outreach programs in the surrounding community to
promote accurate knowledge of and support for family planning.
Integrated HIV/AIDS and family planning teams visit nearby villages to
discuss the two issues, while within the RH unit, staff will
periodically devote a month to addressing family planning methods in
classes offered to all women who visit the clinic, including for
antenatal and pediatric care. They also visit a local youth club to
discuss contraceptive methods with young people ages 15-24. These are
critical and promising efforts, but inconsistent supply and periodic
stockouts can reverse much of the progress made in raising awareness.
Although the Tanzanian government is now funding contraceptives from
its own budget, together with direct and health sector support from
international donors, many challenges remain in ensuring that every
woman and man can have access to reproductive health supplies.
Elizabeth Leahy, Research Associate
1. Nurse Florah Kyara shows the Selian
Hospital reproductive health unit’s supply of contraceptives and
condoms, which are distributed to clients for free. Currently, the
hospital is out of stock of both injectables and implants.
Nurse Florah Kyara stands with a group of mothers awaiting reproductive
health care, which at Selian Hospital includes postnatal checkups and
vaccinations for children. One of the women is currently using family
planning, one hoped to start using injectable contraceptives (which
were out of stock at the time of her visit) and the others were not