Governments Must Be Held Accountable to Family Planning Commitments
By: Racheal Boma, Member of White Ribbon Alliance Tanzania
Tanzania exemplifies the progress a country can make when its government is committed to improving maternal health through family planning, as well as the consequences of unfulfilled promises.
In the 1990s the percentage of women in Tanzania using contraceptives increased dramatically and the number of children per woman decreased steadily. This dramatic change was attributed to the governments strong commitment to family planning. However, today, less than one third of women of reproductive age in Tanzania use contraceptives. The contraceptive prevalence rate (CPR) is surprisingly low compared to the percentage increase that was experienced in the 1990s.
The Government of Tanzania is falling short of meeting the country’s contraceptive needs. In 2007-2008 6.4 billion Tanzanian shillings (Tshs) were needed for contraceptive procurement and only Tshs 4.3 billion was allocated, and of that only Tshs 2 billion was actually released. Unfortunately, the gap has continued to widen. In 2011-2012, a mere Tshs 1.2 billion was allocated for family planning, while the actual demand required Tshs 37.9 billion. This underfunding has had a big effect on family planning service provision.
Funding is not the only issue. I actually believe that even with the reduced government funding, family planning access and availability could be improved if existing plans were better implemented and managed.
In the Tanzania Health Policy, the government commits to provide free maternal health services including family planning services, “the government in collaboration with the non-profit private sector and national organizations will continue to provide service without requiring payment to: pregnant women, users of family planning methods, and children under the age of 5”.
Unfortunately, the situation in the health facilities is very different. There is a huge shortage of family planning services especially in the rural Tanzania. Where family planning services are available, clients still have to pay fees for the services.
The shortage can be prevented with improved transparency, accountability and community monitoring of the family services provided at the health facility.
In early 2011, Care International implemented the process of community scorecards in four districts in Mwanza region in order to monitor family planning service provision in 4 dispensaries. It became clear during this process that the dispensaries did not know the annual amount budgeted for provision of family planning services at the dispensary. This meant that they could not follow up to demand for supplies.
With the community’s involvement in monitoring family planning services at the dispensary, both the service users (community) and the service providers (dispensary staff) were able to realize the challenges surrounding low rates of contraceptive use. The attitudes of service providers and the irregular supply of family planning commodities were identified as major barriers. In order to address these concerns, meetings were held with the community, staff and local decision makers to discuss challenges and potential solutions.
Community monitoring of family planning service could play a huge role in improving service delivery. Community members must be empowered with information from the health facility on the availability of supplies and funding and the dispensary staff must be transparent with information and knowledgeable of government allocations. Together, they will be a very powerful weapon to promote better uptake of family planning services with improved service delivery.
I look forward to the outcomes of the London Summit on Family Planning and to ensuring that citizens of Tanzania are aware of our government’s commitment.