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April 14, 2008
Photo by Richard Lord

This article is based on information from a series of Ipas workshops held in Africa and Asia during the past year.

In many areas of the developing world, shortages of basic medical supplies are common. These shortages pose devastating consequences for communities and reproductive health care is no exception. Without a reliable supply of contraceptives, couples aren’t able to choose when and if they want to have children. Unless instruments are available and ready for use, women who need medical care after miscarriages or unsafe abortions are unable to receive it. Additionally, women who are determined to end their pregnancies will go to potentially dangerous providers if safe and qualified providers do not have the means to provide services.

One of Ipas’s goals is to  create and share strategies for creating a “sustainable supply” of manual vacuum aspirators (MVAs) and related instruments that are used to treat complications of unsafe abortion and to enable women to receive safe first-trimester abortions. The World Health Organization recognizes the use of MVAs as a preferred method of providing safe abortion care. In addition to being safe and effective, MVAs are portable, inexpensive and do not require electricity. Health-care providers in developing countries can sterilize and re-use MVA instruments; however, instruments eventually need to be replaced. Creating a “sustainable supply,” where these instruments can be re-ordered and safely delivered to health facilities, allows women to receive proper care.

“The idea of a sustainable supply of MVAs is simple,” says Marian Abernathy, Ipas Senior Advisor for Training and Service Delivery Improvement, and a key presenter at all the workshops. “A health facility’s MVA supply is sustainable when, after the program has been set up, clinicians have MVA instruments whenever they need them. But creating a sustainable MVA supply throughout the developing world is often difficult.”

Ironically, donated equipment – or at least an overreliance on donated equipment – prevents sustainable supplies from forming, according to Abernathy. Many health facilities receive their initial supply of MVAs as donations after clinicians are trained and when facilities begin providing MVA services. However, after this point, there is often no plan to replace used, broken or lost instruments. Government and donor-agency budgets and priorities can change, and with competing needs, resupplying existing facilities often becomes a low priority.

Also, unless health facilities develop reliable means of ordering MVA equipment when they need it, they can become dependent upon donations. Facilities that have relied on donations may not include the costs of MVA in their budgets, or they may not develop the systems to order instruments when they are needed. Results from one study found that 23 countries received donations following training, but only six were able to develop systems to order and receive MVAs in the future.

This inability to order MVAs, in turn, has serious consequences for women. A 2005 survey found that in one country, 98 percent of clinics had no system or budget for re-supply and that 70 percent of the existing MVAs were in poor condition. A practical solution to this problem, says Ipas Director of Product Promotion and Development Denise Harrison, is the use of commercial distributors.

“Distributors are intermediaries who purchase medical supplies, including MVAs from manufacturers, and who then market and sell them to health-care facilities and providers,” Harrison explains. “They complete a ‘supply loop’ that starts with the manufacturers, moves to distributors, and then goes to facilities and providers who purchase and use the MVAs.”

Within this system, donations or samples can still play an important role in establishing health facilities, but distributors provide the majority of MVAs to running facilities (although Ipas manufactures MVAs and sells them to distributors, it does not profit from MVA sales).

Because distributors are locally based, they are experts at reaching their customers. Distributors know the names, locations and contact information of local health-care providers and administrators, as well as the languages and messages that will be most effective to reach those providers. Although distributors do work for a profit, their ultimate goals of creating a sustainable market and of reaching the broadest possible audience, overlaps with the goal of governments and donor agencies of increasing women’s access to safe and effective equipment.

Ipas is hosting a series of web-based seminars on sustainability. For more information, e-mail marinn@ipas.org.

This article is the first in a two-part series. The second will illustrate the difficult task of forecasting program needs and will highlight improvements in various programs around the world.

For more information, contact:
Kirsten Sherk
Senior Associate, Media Relations
e-mail: sherkk@ipas.org
phone: 919.960.5612
fax: 919.929.0258