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HEALTH-KENYA: Contraceptives: Stock-Outs Threaten Family Planning

Joyce Mulama

NAIROBI, May 15 2009 (IPS) - Kenya's new national plan for reducing maternal mortality recognises the importance of a steady supply of contraceptives across the country. In principle, contraceptives are already available for free or heavily-subsidised at government clinics and hospitals, but for women who rely on public health system, the reality is somewhat different.

The country has been rocked by massive stock-outs of some critical contraceptive methods in recent years. Health officers say because of the shortages in public facilities, many women cannot afford to purchase the birth control commodities which are expensive from private drug stores and therefore end up getting pregnant.

"Most clients come asking for Implanon (a contraceptive inserted under the skin of a woman’s upper arm) but they cannot get what they are asking for," Mohammed Salat Dagane, a provincial nursing officer in Kenya's North Eastern Province told IPS, "What will stop them from becoming pregnant? The pregnancy rate in this region is high."

Karen Owuor, his counterpart in the western province of Nyanza had the same story. "Majority of our clients prefer injectable or surgical contraceptives but these are not accessible in most of our facilities. Even though they are available in the market, not many people can afford them so they either have to wait until they are supplied to the hospitals or get pregnant," she said.

Kenya's last Demographic Health Survey (KDHS) in 2003 found that 24 percent of women who do not want another child within the next two years are not using contraception due to unavailability. The lack of access to family planning commodities, particularly surgical and injectable contraceptives, is a major contributor to the figure, coupled with a lack of awareness on methods available.

According to Josephine Kibaru, head of the Family Health Department within the ministry of health, the stock-outs have been largely due to insufficient funds to purchase the commodities. Bureaucratic obstacles between different ministries – specifically enormous difficulties and delays in securing the release of funds to the health ministry by the treasury – have been criticised.

The government drug supply body, the Kenya Medical Supplies Agency (KEMSA), has also been faulted for failing to deliver promptly contraceptives to government health facilities.

"If a woman comes and misses contraceptives of their choice at our hospitals, even if they are brought later, it will not make a difference. The next time she comes it will be when a traditional birth attendant sends her to us dying from complications of an unplanned pregnancy," Kibaru said.

The KDHS puts the maternal mortality rate (MMR) at 414 deaths per 100,000 live births, far in excess of the U.N. target of 147 deaths per every 100,000 live births by the year 2015. Two-thirds of these due to birth-related complications and the remainder to unsafe abortions.

The National Contraceptive Commodities Security Strategy 2007-2012, published by the health ministry, puts the government on the spot for its low budgetary allocation for family planning.

Even though the past three years have seen authorities allocate about 6.7 million dollars for procurement of family planning commodities, an estimated 20 million dollars needed annually to ensure adequate supply.

Family planning in Kenya was previously supported exclusively by donors – who are expected to finance the deficit this year. The donor community has also been partly blamed for the stock-outs.

"We need partners to deliver their pledges on time. There is no need of them giving us funds two months after the stock-outs. We need to ensure uninterrupted supply of contraceptives to all people that need them whenever and wherever they need them," Kigen Bartilol, deputy head of the Division of Reproductive Health in the health ministry told IPS.

Increased funds have to go hand in hand with prompt delivery of services. Health experts at the launch of the national plan on Apr. 16 called on KEMSA to include contraceptives in its essential drug kits when delivering medicines to health facilities across the country.

"Family planning commodities are as important as medicines for other diseases. We want KEMSA to include in the kits contraceptives that are equivalent to the specific needs of every region. By this we will not be working on assumption but on actual requirements and figures, ensuring that everyone is catered for on time," Kibaru said.

But the lack of qualified personnel to administer the commodities still remains a challenge. "For example surgical contraceptives must be managed by skilled health care providers, and these are lacking especially in low level institutions like dispensaries and health centres which are closer to communities," Monica Agutu, head of Kisumu Medical and Education Trust, a community organisation, said in an interview with IPS from Kisumu, western Kenya.

She added, "A woman will think twice before travelling miles away to a provincial or district hospital where she may be able to access these services. Before she knows it, she will be pregnant. If it is unplanned, no one will stop her from procuring an abortion; if it goes sour, another death."