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22 June 2011 Addis Ababa Access for All
ALLEGORICA
A fictional case study
Getachew Bekele
Marie Stopes International
Allegorica Map and Flag
22 June 2011 Addis Ababa Access for All
22 June 2011 Addis Ababa Access for All
Total Population 2010 was 20.2 million
• 3 million live in the capital city• 50% of the population live in rural areas• 10% of the population live in the mountainous north-east• ~4%* live in the desert
*census data for this nomadic group is weak• ~50% of the population are under the age of 20
TFR = 5.3 CPR = 20.9 (all methods)
Demographic Data
22 June 2011 Addis Ababa Access For All
Method mix
68%1%
18%
5%
4%
2% 1% 2%
Pill
IUD
Injections
Condom
Female sterilization
Male sterilization
Implants
Other modern methods
Any traditional method
The population of 20 million is served by:• 822 doctors• 13,292 nurses and midwives• 9,430 community health workers
Who are permitted to provide the following:• Doctors: All FP services including LTPM• Nurses: OCP, condoms, EmC• CHW: OCP, condoms
22 June 2011 Addis Ababa Access for All
Health Workforce
Point of health-service delivery
54%22.8% 23.2%
Public sectorPrivate sector
Non-formal Formal
• One warehouse per district plus one central warehouse
• District stores at each district hospital
• Five 10-tonne trucks at central warehouse
• One 5-tonne truck and one pickup truck at each district warehouse
22 June 2011 Addis Ababa Access for All
Supply chain
22 June 2011 Access for All
Parliamentarians accuse donors of holding the country to ransom
The Hon. Paul Mwembe and Hon. Henry Chabele both went on record today in accusing donors of fixing very tough conditions on the use of aid money in the Health Sector. Mwembe said “....they [the donors] want us to buy family planning devices and other unnecessary consumables whereas what we need are more nurses and maternity hospitals.......they have no right to impose restrictions on what we can buy with the money”
Recent headlines
Civil Society groups lambast lack of support to non-governmental groupsA number of civil society organisations meeting at the Coastal resort of Tiliminga today accused the State of systematically withdrawing support from many NGO’s in the past year resulting in a lack of services (particularly much needed Maternal, Child Health and Reproductive Health Services). Many NGO’s rely on sourcing contraceptives and other essential MCH commodities from the Central Warehouse in order that they can provide services in their clinics. However changes in procedures means that they have now got to source their commodities from the nearest District Hospital – and many of these have refused citing that they do not have enough supplies for the public system.
Recent headlines
Up to 50% of “Morning After” pill on the market are fakesThe Bureau of Standards today issued a warning that many of the “morning after” pills for sale in the private market – particularly small pharmacies – were of dubious quality and some even complete fakes. Customers were being advised to check the packaging and ensure that they are satisfied that the product is genuine. Members of the public are advised to report suspicious products to the Bureau of Standards. Emergency contraception is available free from all public health hospitals and family planning clinics and these are certified high quality products.
Recent headlines
22 June 2011 Access for All
Recent headlines
Central warehouse admits complete stockout of most popular contraceptiveToday a spokesman for the Central Medical Stores admitted that they had completely run out of injectable contraceptives (depo-provera) and that new stocks are still “months” away. Service providers were having to encourage women to switch methods until the situation can be resolved but the alternative – the contraceptive pill – were also in short supply. A spokesperson for the Ministry of Health blamed the stockout on high demand but also said that the last tender for injectable contraceptives was cancelled due to “irregularities” in the awards procedure.
Private Doctors stopped from providing some contraceptivesPressure from religious groups has meant that private practices are under fire for providing long-term contraception to unmarried women – some as young as 16 – and has resulted in the authorities looking closely at the licences of some practitioners. A spokesperson for the Organisation of Private Practitioners said that it was imperative that unmarried women and vulnerable young women be able to access reproductive health care – especially when they were being refused services in the free public sector purely on the grounds of their marital status or age.
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Government Decree; Contraceptives FreeIn a bold statement today the Minister of Health – the Hon. Mary Kivaria – announced that all contraceptives – including condoms – would be absolutely free at public sector service delivery points and that even the “registration” fee of 30 cents would be waived for returning family planning acceptors. Dr Kivaria went on to say “It is vital that everyone who wants to plan their families are not barred from doing so because they are poor – it is in the country’s interest that women in particular can have control over their reproductive life”. Most observers applauded this decision but some private sector organisations who sell contraceptives feared that their sales would fall in the coming months.
Recent headlines
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