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Contraceptive roulette at SA’s state clinics

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State clinics and healthcare facilities around South Africa continue to experience a shortage of injectable contraceptives, despite the Health Department claiming it had “enough” stock. According to a Sunday Independent report, women who relied on state-issued contraceptives such as Depo-provera and Provera complained that the supply had been inconsistent since early this year and at times they have had to do without. The department has since explained that the delays were due to a major supplier pulling out of the tender process at the eleventh hour earlier this year, and they have since been scrambling to get the supply up and running again.

The report says glitches in supply have resulted in nurses dispensing alternative forms of birth control such as condoms, implants and intrauterine devices. But the users are concerned that the alternatives might have harmful side-effects.

Deputy director-general of national health insurance in the national Health Department, Dr Anban Pillay, said during the tender process the appointed manufacturer of Provera took a decision to discontinue production, therefore a contract could not be awarded. And the supplier of Depo-provera did not have sufficient stock to meet demands so the department had to import additional stock.

“An alternative supplier (Pfizer) was identified who was willing to supply stock on a quotation basis even though they did not bid for the tender. The supplier currently has Provera stock available,” he said. “There is only one supplier (Bayer) of the Depo-provera product on the market. At the time of tender, the supplier submitted a bid price that was above what we could afford.

“The Health Department and Treasury then entered into negotiations with the company to have the price reduced. In the interim, provinces were buying the product at the previous contract price.

“However, once negotiations were concluded and the contract awarded, the supplier did not have sufficient stock.”

He said orders for contraceptives were done monthly in each province, based on demand. Orders were then delivered to the respective province’s medical depot. Health care facilities place orders with the depot and delivery is facilitated thereafter.

“The responsibility of having sufficient stock rested with the head of pharmaceutical services in each province, said Pillay. “The national department supports provinces through the establishment of monitoring systems for medicine availability.

“Clinics have an IT system called Stock Visibility which uses mobile phone technology to report levels. These reports go to district pharmacists, the provincial office and to the national department. This system is used for ARVS, TB and vaccines but can be used for other medicines. Hospitals are equipped with a system called RX solution, which is used to monitor stock levels.”

The report says women who spoke on the condition of anonymity, said they have had to use contraceptives that they were not comfortable with, while others had to do without it. “Condoms can’t be completely trusted, so when nurses told us Depo-provera was not available, I opted to insert a loop. I prefer the injections because they never caused side-effects. I pray the loop is effective because I don’t want to fall pregnant,” said one.

Another woman, who received injectable contraceptive at an Umlazi clinic, said she was off contraceptives because of the shortage.

Sunday Independent report

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