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.