Condom Shortge in Uganda Worries Health Experts

THE low government investment in reproductive health commodities has resulted in an acute condom shortage.
Contraceptives used in controlling unwanted pregnancies include condoms, injectables, pills, interuterine devices and surgical contraception equipment.

But condoms remain the most popular and cheapest means used to check STDs/ HIV and unwanted pregnancies in Uganda. According to Dr. Moses Muwonge, a reproductive health consultant, Uganda had a stock of 12 million condoms in May.

The Government imports about 20 million condoms every month. About 10 million are dispatched by the health ministry every month.

While the previous minimum stock level was six months with 12 months being the maximum, it has since been revised to four and six months, respectively because of the bulkiness of condoms.

The shelf-life of condoms is three to five years. The problem, though, is that after manufacturing, condoms are not shipped immediately.

“Sometimes they spend over 18 months at the National Medical Stores,” says Muwonge. “This reduces their shelf-life.”

Rising demand
Ugandans need over 220 million condoms annually, but only between 80-120 millions are imported.
“It means if all men were to use condoms, each would get a ration of three,” says Muwonge.

“Would this make any impact on fighting unwanted pregnancies and HIV?”
In 1993, the Government imported one million femidoms (female condoms), but only 200,000 were used.

“The remainder (800,000) expired,” says Muwonge. However, when femidoms were recently piloted in four districts, consumption rose to 100,000 in three months.

Budget
Donors fund up to 95% of the reproductive health commodities budget, which could explain the shortage. The health ministry is left guessing when the next consignment will arrive.

“What will happen when donors pull out? Where would people seek refuge?” wonders Dr. Betty Kyaddondo, the head of family health department at Population Secretariat (Pop-sec).

In the 2009/10 budget, sh15b was allocated to reproductive health commodities. Uganda needs about $12m (about sh24b) next year to address her unmet needs.

However, the Government has slashed the health sector budget. This will impact negatively on reproductive health commodities.

The contraceptive funding gap is $3m(about sh6b). The country’s five-year cost strategic plan needs $53m (about sh106b).

The Government spends over 14% of its national budget on health. Donors contribute about 35% while inter-regional NGOs meet 0.4% of the health needs of Ugandans.

Health care support falls
Mwonge says the health care package has fallen from $1.7 to $0.7 per Ugandan. “This means any person seeking medical care from public health units gets only athird of the requirement,” he says.

Uganda loses $101m (over sh202b) in unmet needs for family planning services annually. According to the 2006 Uganda Demographics and Household Survey statistics, the country’s unmet needs for reproductive health commodities stand at 41%, a drop from 52% in 1989

The survey also shows that 41% of married women do not want to have more children, 35% want to wait for two or more years before the next birth.

The United Nations Population Fund estimates that for every dollar spent on reproductive health commodities, the Government saves about $3 (about sh9000) on maternal and newborn care.

Why condoms are vital
Condoms have proved to be an effective tool in reducing teenage pregnancies, considering that over 50% of Uganda’s population is under 24 years.

Charles Zirarema, the Pop-sec chief, warns that teenage pregnancies, STDs/HIV infections will go up if condom stocks run out.

Teenage pregnancy is one of the reasons why Uganda’s maternal mortality is still high (435 deaths per 100,000 live births).

‘High population good’
President Yoweri Museveni is at the forefront of justifying the need for a high population. A high population, he argues, boosts trade.

He says such a population ensures exploitation of the natural and human resources, increased economic growth due to high production and increased profits and markets from increased demand.

However, Zirarema says for economic development to take course, such a population must have high savings and investments pattern.

“We have a crowded city (Kampala) and traffic jams because of high population growth rate,” he says. “While we may not reduce it, we must contain it.”

High population rate
Uganda’s population is about 33 million, according to the 2009 State of the UNFP World Population report. Women make up over 51% of the population with a fertility rate of 6.7 children per woman.

Ray of hope
James Kakooza, the health state minister in-charge of primary health care, says the Government will import new stocks of condoms by the end of this year. He says the shortages should not cause worry.

“Rather, people should test and know their HIV/AIDS. This is a key preventive measure.”

According to Kyaddondo, Uganda faces an uphill task in achieving the Millennium Development Goals 4 and 5 of reducing child mortality and improving maternal health, respectively.