Why inadequate contraceptive forecasting capacity?

By AJAAT

The State of the World’s Children Report of 2008, in the National Road Map Strategic Plan, 2008-2015, affirms that spacing interval between pregnancies could reduce 20-25% of all maternal deaths.

Additional statistics reveal that about one third of 536,000 maternal deaths each year could be averted if women had access to reliable family planning methods and at least one third of the 190 million unintentional pregnancies could be avoided with availability of FP methods.

It is believed that nearly 50 million women who resort to abortion, of which, 19 million are performed under unsafe conditions, could be prevented had the women been accessible to reliable reproductive health services.

Statistics prove that an estimated 68,000 women that die every year as a result of unsafe abortions and the millions more who suffer infections and complications such as infertility as a consequence of these abortions could be saved had there been sufficient supplies of reproductive health commodities.

In spite of their importance, sufficient evidence exists to suggest that there is limited supply of reproductive commodities in those countries.

While some 200 million women in resource-constrained countries would have liked to have an interval of two years before giving another birth, such wishes are hard to come-by because of these women not having access to modern contraception.

The World Health Organization (WHO), 1997 report states that over 99% of 585,000 women death during pregnancy or immediately after giving birth or after an induced abortion occur in low-income countries yearly where unsafe abortion is named as the major contributor to maternal mortality.

Abortion is a procedure performed either by a person lacking the necessary skills or in an environment lacking minimal medical standards or both – is a major contributor to maternal mortality.

The WHO 1994 report states that unsafe abortions are responsible for 50000–100000 preventable deaths each year world-wide and in addition there are millions of women who are suffering from chronic morbidities and disabilities as a consequence of unsafe abortions.

Roke and Rogerson (2008), defining What Are Essential Reproductive Health Supplies; showed that despite large efforts in enhancing the supplies of reproductive commodities in the Pacific region, end-users still reported receiving them inconsistently besides the goods being unsuitable and lacking quality.

The United Nations Population Fund (UNFPA), statement on RHCS Challenges in 19^th October, 2000, shows that not only have poor countries left the task of funding for these commodities to development partners, but also that international donor support has been declining.

There are numerous reasons that are attributable to the situation of reproductive health commodities being insufficient. One is that of funding.  Donor support in the commodities dropped from $560 million in 1995 to $460 million in 2003.

The Global Programme to Enhance Reproductive Health Commodity Security reveals the same trend between 2007 and 2013, the amount needed was $750,000,000 only $208,528,277 was receives while $170,041,267 was pledged and still $371,430,456 was needed.

Because of such shortage, ‘Tracking Donor Support’ notes that donor support would nearly need to double if the current unmet need is to be met by 2015.

But equally important is the question of supply of the commodities, which is dependent on a number of things, including forecasting, financing, procurement, and distribution capacities.

The Reproductive Health Supply Chain report states that for each of the goods to be well-forecasted, well-financed, well-procured, and well-distributed, good data are needed on consumption on how much is required of those commodities and on stock status to how much is left.

To have the right consumption data and the right knowledge on the stock status, it requires effective systems of collecting and storing information, which in a word may be referred to as effective Logistics Management Information System to facilitate better forecasting of future needs.

Accurate determination of funding requirements, improved establishment of the right quantities to be ordered and procured and enhancing management of distribution so as to avoid shortages.

Why should resources allocated for contraceptive be limited? Is it because contraceptives are not prioritized in our development plan? Why is there inadequate forecasting capacity? Why is it that the coordination system is not well organized?

The emerging question is: could the situation be the same for the reproductive health commodities such as EMOC drugs (Oxytocin, Ferrous/Zinc Sulphate, Ergometrine, Misoprostol, SP for pregnant women) and vaccines for children under Expanded Programme for Immunization (EPI), including BCG, TT, Measles, and Low Osmolarity ORS, as it is for FP commodities; COC, POP, Implants, IUCD, Injectables, and condoms?

This column is a contribution by Advance Family Planning (AFP), a coalition of 10 local Non-Governmental Organizations (NGOs) advocating for family planning access to Tanzania. The project’s thrust is to contribute towards strengthening investments in family planning as a way towards attaining national and Millennium Development Goals (MDGs) 4 and 5 in Acceleration of the Reduction of Maternal, Newborn and Child Mortality.

Tanzania’s elapsed national and MDGS

By AJAAT

Tanzania is one of the 189 nations, which endorsed the Millennium Development Goals (MDGs), in September 2000 as part of the internationally agreed-upon development goals at the General Assembly of the United Nations.

The MDGs initiative calls upon developed and developing countries to work in partnership towards a world with less poverty, hunger and disease, greater survival prospects for mothers and infants, guaranteeing basic education for children, equal opportunities for women, and a healthier environment in support of the Agenda 21 principles of sustainable development.

Family planning can contribute governments around the world are focused on combating poverty and achieving a range of health and development goals, such as those outlined in the United Nations and Millennium Development Goals (MDGs).

Although Africa has just 12% of the global population, it accounts half of all maternal deaths and half the deaths of children under five and to attain the MDGs 4 and 5 on maternal and child health are lagging far behind target.

The MDGs provide a framework of time-bound targets by which progress can be measured and commitment of all nations tracked. Statistical experts selected indicators to be used to assess progress over the period from 1990 to 2015, when targets are expected to be met.

The Tanzania Millennium Development Goals Report mid-way evaluation covering achievements in 2000 to 2008 report the Maternal Mortality Rate (MMR) is unlikely to be achieved by 2015.

MDG goal 5 is to improve maternal health with two targets; 5A to reduce by three quarters between 1990 and 2015, the MMR and it has two indicators for monitoring progress are 5.1 maternal mortality ratio and 5.2 Proportion of births attended by skilled health personnel.

The report conducted by the Poverty Eradication and Economic Empowerment Division at the Ministry of Finance highlighted the MMR target to have 133 per 100,000 live births is unlikely to be attain to met the target.

Computed as percentage passage time thus 2012 the equivalent to 22 years time that has elapsed, MMR according to Tanzania Demographic and Health Survey (TDHS) 2010 report shows it ranks 454 per 100,000 live births.

Maternal mortality rate remains high in Tanzania. About 7,000 women die every year due to pregnancy related complications. Other causes include underweight about 10 per cent of women in child bearing age, anemia 58% as well as long distances to health centres.

Indicator two for proportion of births attended by skilled health personnel is unlikely to be achieved has is shows insignificant improvements in both Tanzania Mainland and Zanzibar.

Births attended by skilled health personnel targeted to be 90% by 2015, computed percentage to passage time is beyond the 2008 expected of 77.1% to the time over and done.

The MDG 5B goal is to achieve universal access to reproductive health by 2015, the indicators are contraceptive prevalence rate (CPR), adolescent birth rate, antenatal care coverage at least one visit to at least four visits and unmet need for family planning.

Thus to attain the goal of reducing to 170 Maternal Mortality Rate and increasing the percentage of births attended by skilled health staff to 90 per cent as required by the MDG Goal more efforts are required.

The government has introduced new policy documents and guidelines in place to guide and mobilizing additional resources to support implementation through community participation at all levels by different stake holders to boost its responsibilities’.

Such policies are the Reproductive and Child Health (RCH) Policy guideline (2003), National Package of Essential RCH Interventions, RCHS strategy: 2005-2010, Adolescent Health and Development Strategy: 2004-2008 and the Adolescent Friendly Service Standards.

Others guidelines are the Road Map for Accelerating the Reduction of Maternal, Newborn and Child Morbidity and Mortality: 2008 -2015 and the National Plan of Action: 2001-2015 to accelerate the elimination of FGM and harmful traditional practices.

This column is a contribution by Advance Family Planning (AFP), a coalition of 10 local Non-Governmental Organizations (NGOs) advocating for family planning access to Tanzania. The project’s thrust is to contribute towards strengthening investments in family planning as a way towards attaining national and Millennium Development Goals (MDGs) 4 and 5 in Acceleration of the Reduction of Maternal, Newborn and Child Mortality.

Journalists Group Discussion at HAPCA (2008) Training

AJAAT builds capacity for journalists on HIV and AIDS Prevention and Control Act (HAPCA)-2008, Gender and Human Rights for MARPs

Journalists following up AFP training at UMATI, Dar es Salaam

Tanzania to Integrate Reproductive Health, Family Planning and HIV/AIDS

By AJAAT

Efforts are under way in Tanzania to integrate reproductive health, family planning and HIV/AIDS services to provide better, more comprehensive care and treatment at lower cost.

Speaking to journalists in Dar es Salaam recently, the Representative of Voice of America (VOA), Mwamoyo Hamza said often these services are offered at different facilities  by different providers, making it more time- consuming and expensive for women, who need family planning as well as HIV/AIDS services.

“Supporters say that integrating these services would help reduce vulnerability to HIV, reduce sexually transmitted infections, and provide information to men and women about preventing HIV and reproductive health as well as planning their families”, he added.

The process could help Tanzania achieve three of the Millennium Development Goals, which are reducing poverty, child deaths and improving maternal deaths. However, integration was not without challenges.

Mwamoyo said these include country’s lack of health professionals, resources to cross-train reproductive health and HIV/AIDS service providers. Currently, integration was being tried through various projects in Tanzania.” One question was whether these attempts have been successful enough to scale it up to a national level?”,  he asked.

Speaking in Dar es Salaam recently, Alisa Cameron, USAID/Tanzania Health Team Leader said the Global Health Initiative through the United States was investing US dollars 63 billion over six years to help partner countries strengthening their systems which would improve health outcomes.

She said there was a particular focus on bolstering the health of women, newborns and children by combating infectious diseases and providing quality health services. She added that for every US dollar invested in health systems, the Global Health Initiative (GHI) aims to maximize the health impact on citizens.

“In Tanzania the GHI builds on over four decades of partnership between the US government and the Republic of Tanzania. It represents an opportunity to contribute further to Tanzania’s development goals in health. The vision was to improve the health of all Tanzanians and especially the health of the most vulnerable groups of women, girls, newborns and children under the age of five” Lisa said.

The GHI was launched by President Barack Obama on May5, 2009. The GHI was a model that builds on the Bush Administration’s successful record in global health, notably as the President’s Emergence Plan for AIDS Relief (PEPFAR) and the President’s Malaria Initiative.

Mass Media in Tanzania Promote Family Planning as an Economic Agenda

Advocacy Case Study

In December 2011, six media houses declared their firm support to family planning efforts. The committed from a predominantly private media houses is significant in terms of strengthening and expanding coverage of family planning issues as part of promoting policy dialogue and public education on the issues. The media houses namely;- Mwananchi Communications Ltd, New Habari (2006) Ltd., Tanzania Standard Newspapers and the Guardian Limited in print media while in electronic media were Sahara Communications Limited and Tanzania Broadcasting. Those are among the major media houses in the country with broad geographical reach, broad readership and listenership countrywide. All the six media houses committed to allocate space and air time as well to appoint two journalists in each institution to be focal persons for FP news coverage.

Background – Engaging the Media, an opportunity for sustaining advocacy

Historically, Tanzania’s mass media have been integral in promoting development through public education, leadership sensitization and mass mobilization. The mass media, especially radio and television has been the main source of information including that on family planning.[1] The DHS has shown that about 50% of women and 61% of men in the reproductive age (15-49) get family planning information and messages from radio, while television is the source of this kind of information to 19% women and 32% men. Media’s role in disseminating family planning information offers a great opportunity to engage leaders and the public in general in dialogue on pertinent issues around family planning services. These may range from access to contraceptives, method choice, and resources for improved family planning, to policy issues critical in creating enabling environment for service delivery. Therefore as agents of change, mass media’s participation in strengthening family planning advocacy is critical in Tanzania’s setting, and their contribution is undoubtedly invaluable. The fact that 95% of media houses are privately-owned makes their commitment to the family planning agenda a remarkable gesture that ought to be acknowledged.

The Strategy – Working with media structures to move the FP agenda

The Approach

The Association of Journalists Against AIDS in Tanzania (AJAAT) is one of the implementing partners of the Advance Family Planning (AFP) project in Tanzania that works with a number of local NGOs that formed the FP Coalition in November 2010. AFP’s lead partner – the Human Development Trust (HDT) coordinates the coalition with 11 member organisations including AJAAT. Using the Spitfire approach, AJAAT identified key media houses that are likely to support family planning, conducted a rapid assessment of media houses’ interest in FP issues, developed a policy brief on the significance of supporting these issues and shared results as part of soliciting media support to FP.

Key Activities: Soliciting Media Commitment to FP

The Association of Journalists Against AIDS in Tanzania (AJAAT) is one of the implementing partners of Advance Family Planning (AFP) Project in Tanzania. Between July and December 2011, AJAAT conducted four activities namely; an Assessment of Media House’s Interest in Supporting Family Planning Services in Tanzania, One – to- One Meeting with Managers from selected six national Media Houses and then disseminated and share findings of the report and finally a one day orientation workshop with media editors through the Editors’ Forum concerning family planning coverage and status in Tanzania.

A.     RAPID MEDIA ASSESSMENT FOR MEDIA HOUSES’ INTERESTED IN SUPPORTING FP

The assessment, explores the private sector playing its role in the provision of social services as outline in the Public Private Partnership Act, 2010 and the implementation of Corporate Social Responsibility policies. The rapid assessment main objective intended to set up the following; 

1. Gather information from media on the family planning coverage status; 

2. Capacity, interest and commitment from the media; and lastly

3. Challenges on family planning issues from the media.

The assessment was conducted using standard structured questionnaires with both closed-ended and open-ended questions to collect the desired information from respondents. The questionnaires were distributed to respondents to respond the questions privately and freely. Respondents were purposely selected; Media managers’ who hold positions of considerable influence in decision making were targeted.

B.     ONE – TO – ONE MEETINGS WITH MANAGERS OF THE SURVEYED MEDIA HOUSES

AJAAT started the process by preparing a policy brief, which pointed out the importance of family planning to support social and economical development in Tanzania. The aim was to enlighten the media houses on the importance of family planning advocacy.

One AJAAT staff visited one of the media houses to discuss how there media will support AFP partners in family planning advocacy, where awareness message in the policy brief were circulated. The media houses visited were; Sahara Corporation (Star Tv) and Tanzania Broadcasting Corporation (TBC) in the electronic media. In the print media were Swahili and English dailies newspapers from New Habari (2006) Ltd,. (Mtanzania and The African); Mwananchi

Communications (Mwananchi and The Citizen), The Guardian Ltd,. (Nipashe and The Guardian) and the Tanzania Standard Newspapers (The Daily News and Habarileo). All 12 media managers respond positively to support family planning coverage by providing space and air time. They also agreed to give priority in family planning news and features in their daily coverage’s.

C.      WORKSHOP ON SHARING MEDIA HOUSES ASSESSMENT REPORT

AJAAT organized a one day Media Meeting to disseminate the assessment report by inviting managers from the media surveyed; Sahara Corporation, Tanzania Broadcasting Corporation (TBC), New Habari (2006) Ltd,. Mwananchi Communications, The Guardian Ltd, and Tanzania Standard Newspapers.

D.     EDITOR’S FORUM ORIENTATION WORKSHOP ON FAMILY PLANNING

The Editors started arriving at the Lion Hotel, Sinza and 38 participants’ attendant the workshop, 30 were editors and senior journalists with four facilitators. Zacharia Ssebuyoya, ANAT programme coordinator was invited as amoung AFP lead implementing partner while Dr. Hellen Mrina from Medical Women of Tanzania Association (MEWATA) and Dr. Namala Mkopi from Paediatric Association of Tanzania (PAT) were two medical experts facilitate the workshop who come from AFP coalition.

The Workshops Outcome

1.       Media Managers and Editors react on the facts that because planning a family and deciding on the number of children and spacing impacts on individual economic situation; for those with more children, they endure greater burden in sustaining their families.

2.       At government level – it is critical for governments to plan well to meet the education, health and other needs of its population. The government doesn’t have sufficient resources for a growing population well equipped to fuel the economic engine.

3.      That the percentage of the labour forces in the population and how does this play out with dependency ratio? Governments see individuals as economic units – consume and produce – how big is this labour force and whether it is capable of promoting economic development.

4.      In the media, FP is almost a non-issue/agenda both as an issue for coverage, and for programming in media institutions. Media houses do not have family planning services and media managers have not seriously thought about this.

5.      The gender ratio in the media – fewer women than men; and the employers’ bias towards pregnant employees and those caring for children (seen sometimes as an opportunity loss – viewed as not as hardworking as male colleagues); FP as an issue of individual right – the media has a role in promoting the concept.

6.      Getting an interesting angle for FP issues – remains a challenge. The impacts on the narrow or inadequate coverage of FP issues.

7.      Media campaigns are critical in strengthening visibility of FP issues.

8.      Deteriorating mothers’ health due to frequent childbirth leads to declining family welfare and national economic growth.

9.      Big families – big money – secure future! Such attitudes and beliefs contribute to communities shying away from the use of contraceptives.

10.   The media managers’ request on the AFP coalition on-line internet hub as family planning archive to gather easy information’s and updated report concerning family planning status in Tanzania as well as the global ones.

Lessons Learnt and Next Steps

Why is FP not an agenda in the media when its contribution to reduction of maternal mortality rate and infant mortality rate is known?

It was highlighted that the media history – for many years media practitioners’ understanding on FP/RH and population issues has been skewed towards seeing these issues as externally-driven with foreign interests “harmful” to Tanzanians; the exception of the foreign actors wanting to exploit us and media structure – big names make news – as a guiding principle.

Media Assessment report Key findings;-

1. Workplace perceptions, policy implications and actions of the Media Houses on the subject.

Ø      None had guidelines for family planning in the workplace;

Ø      Only one Media House 7% – Mwananchi Communication - had a plan develop one or include family planning in existing policies.

Ø      Three Media Houses 21% – TBC, Mwananchi Communication, and Tanzania Standard Newspapers - consider family planning;

Ø      All of the rest 79% did not have policies considering family planning;

Ø      One 7% was not sure about the answer;

Ø      There was no particular type of contraceptives prescribed regarding family planning in workplace

2. Areas of interventions

1. Conduct media campaigns for family planning to increase awareness and expand networks of family planning stakeholders engaging the Media in family planning;

2. Media people have indicated their need for support from experts on family planning so they can work with them and collaborate with decision makers in order to properly align policies and practices.

WHAT SHOULD BE DONE?

Editors’ recommend that:-

Ø  Media should sensitize the society to see FP as an opportunity. (Packing the messages).

Ø   Increase FP coverage (make it an economic agenda).

Ø  Empower journalists with FP knowledge.

Ø  Experts in FP needed to be more accessible to journalists.

Ø  Harmonize information (operation system in media). – News story – Information for public knowledge.

Ø  Frequent survey should be done on the use of nets and its preventive ability.

Ø  Editors’ Forum should select a topic for discussion on AFP with view to building knowledge on these issues.

Ø  Editors from media outside the surveyed asked to be presented in the campaign and promise to provide space and air time for family planning coverage in the media.

Acknowledgements

Six media houses managers from the surveyed media houses as well as the editors through the Tanzania Editors Forum.

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[1] Tanzania Demographic and Health Survey 2010