KAMPALA, 15. June: USAID (Amerikas Danida) no longer funds the procurement of condoms yet the Ugandan government has not released funds to buy them.
A walk into the numerous washrooms (toiletter) of most corporate premises in Kampala will reveal almost one identical thing – a box of condoms placed strategically for any user to pick. When you see these condoms in the morning, be sure they will not be there by evening.
In addition to its role as a crucial and reliable family planning method, the condom is one of the major strategies in the fight against HIV/AIDS and other sexually transmitted diseases.
Yet, if the Government does not urgently release funds for the importation of condoms, there will be no condoms in the country by October, says the United Nations Population Fund deputy country representative, Hassan Mohtashami.
In the past, procurement and distribution of condoms was done by social marketing organisations such as PSI and Marie Stopes with funds from development partners; KFW and USAID. The ministry of health also procured condoms using funds from USAID.
But, with the 2005 Paris Declaration on Aid Effectiveness, which charges countries with the responsibility of owning and funding reproductive health commodities supplies, this trend is changing.
KFW, USAID and other development partners are no longer funding the procurement of condoms and other reproductive health methods, yet the Government has not put in place a budget to procure condoms.
– There is an urgent need for a specific budget on condom programming in the Ministry of Health (MOH) in addition to mobilisation of resources to meet the current condom stock gaps, Dr. Mohtashami said revently.
Uganda has one of the highest fertility rates in the world. Every woman has an average of seven children. Yet family planning is low.
The contraception prevalence rate (the number of married women using a family planning method) is only 24 per cent. On the other hand, HIV prevalence is going up from 6,4 to 7,1 per cent, according to UNAIDS. The condom is both preventive for HIV and unwanted pregnancy.
Using the ABC (Abstinence, Be faithful, use Condoms) approach, Uganda was able to reduce its HIV prevalence rate from about 30 per cent in the 1980s to 15 per cent in the early 1990s and to about 6 per cent in 2002.
However, with the current rise in the HIV prevalence rate, the future looks gloomy, if the Government does not make the issue of condom supplies a priority.
Development partners in the distribution of condoms have requested the Government to come up with long-term sustainable measures to ensure an adequate and reliable supply of condoms to the population.
Ugandas total condom requirement is about 120 million condoms per year and 10 million condoms are needed per month to meet the basic need for HIV prevention in the country.
In a “good” year, according to the MOH, actual supplies would be 120 million condoms. But the past years have seen rapidly diminishing supplies of and capacity for distributing condoms.
Mohtashami says the Government has not been procuring condoms and yet it procures other contraceptives.
For the public sector, condoms were traditionally supplied by the health ministry with funds from USAID and for the social marketing organisations such as PSI and Marie Stopes, condoms were procured with funds from KFW, a development partner.
With the Paris Declaration, USAID and KFW have since stopped funding condom supplies, leaving a huge gap.
Condoms supplied by social marketing organisations currently cost between sh500 and sh1.000 a packet of three, but the price is likely to shoot up when these condoms run out and the importation is left to the profit-oriented private sector.
This will impact negatively on the HIV/AIDS fight and also increase the number of women dying from abortions.
Dr. Ismail Ndifuna, the national programme officer in charge of reproductive health at the UNFPA country office, says in accordance with the Paris Declaration on aid effectiveness, UNFPA is supposed to promote programmes that are government-owned and led.
He says UNFPA will accordingly align its support to the sector in accordance with this principle. In this regard, UNFPA would like to support capacity building systems development and offer technical assistance to the sector and only procure condoms as a provider of last resort.
– We are not seeing adequate government commitment to condom programming. When there is an epidemic, the health ministry quickly puts in place measures to arrest the situation. We would like to see this happening with condoms, Ndifuna says.
Dr. Anthony Mbonye, the assistant commissioner of reproductive health at the ministry, says basing on the current situation, it is imperative that the Government mobilises resources to procure an extra 40 million condoms for the remaining part of 2008 and 120 million required for 2009.
Dr. Moses Muwonge, the national reproductive health commodity security coordinator at the ministry says: – Procurement planning needs to take care of a total of 160 million condoms for the remaining part of 2008 and 2009.
This is estimated to cost 6,4 million US dollar inclusive of procurement, clearing, post-shipment, warehousing and distribution.”
In 2004, there was a condom crisis after a public outcry that Engabu condoms were of poor quality. The Government withdrew the consignment and halted their distribution.
Muwonge says the country has mainly two funders; UNFPA and USAID who only provide 60 million condoms out of the the 120 condoms required per year. He said because of the current gap, UNFPA has procured 20 million more condoms.
– If UNFPA had not added the 20 million condoms, the available stock would have taken us up to June. We now need 40 million condoms to take us up to the end of the year, otherwise we shall have no condoms in October, says Muwonge.
Muwonge argues that the Government would not be able to avert the crisis even if it got funds to procure condoms for the remaining part of the year, because the four months that are remaining up to October are not enough to complete the procurement and shipment process.
He adds that the procurement process through the Government systems takes about nine months while the process takes six months if it is done by other development partners.
Kilder: The New Vision (Uganda) og The Push Journal
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