South Africa: New report sheds light on the causes of contraceptive shortages
29 August 2024, Johannesburg—As Women’s Month 2024 draws to a close, the Stop Stockouts Project (SSP), in partnership with Ritshize, releases its most recent report, ‘Contraceptive Supply Chain: Stockouts and their Causes’, on the availability and accessibility of medicines at public health facilities in South Africa.
Previous findings from the SSP revealed that contraceptives were the most prevalent stockouts in the country. This report sought to investigate the relationship between supply chain and contraceptive stockouts. Whilst medicines stockouts are widespread across South Africa, this report focuses on the Eastern Cape, KwaZulu-Natal and the North West provinces between April 2022 and June 2023. The report details healthcare users' experiences accessing contraceptives and includes interviews with public health facility managers to establish the causes of poor access and mitigation measures in place. Between April 2022 and June 2023, SSP, together with the Ritshidze project, surveyed public health users to assess their experiences with accessing contraceptives.
In the Eastern Cape and KwaZulu-Natal provinces, almost all women and girls who were surveyed did not receive the contraceptives they requested. The survey also examined the availability of various types of contraceptives. Throughout the monitoring period, injectable contraception was reported as the least accessible, followed by external condoms and the implant.
Facility managers were interviewed about the measures implemented to address stockouts. Whilst most managers in the Eastern Cape and KwaZulu-Natal reported having received guidance on responding to contraceptive stockouts, managers in the North-West Province said they had not received such advice. However, the survey showed that healthcare providers made efforts to ensure that healthcare users did not leave facilities without medicines. Healthcare providers offered healthcare users alternative medicines or referred them to facilities with stock. The survey also highlighted the unavailability of termination of pregnancy services. Most of the surveyed facility managers in all three provinces reported that they referred healthcare users seeking these services to other facilities.
Our findings are that poor national procurement planning continues to be the main driver of contraceptive stockouts and shortages. At the provincial level, causes of stockouts included budgetary limitations, dependence on manual paper-based systems and poor management of stock controls. The report recommends that the national and provincial health departments urgently address the use of manual data systems for payment and stock management.
Access to contraceptives is a crucial component of the enjoyment of the right to sexual and reproductive health rights as well as the right to bodily autonomy. Contraceptives enable women and adolescent girls to exercise their right to decide whether to be pregnant, the number and spacing of their children, and to have pleasurable and safe sexual experiences without the risk of unintended pregnancies. Moreover, contraception enhances socioeconomic opportunities for women and opens up more educational opportunities for adolescent girls. Failure to ensure access to contraceptives, therefore, violates various constitutionally guaranteed rights.
More about the Stop Stockouts Project
Established in 2013, the Stop Stockouts Project is a consortium of five civil society organisations: Doctors Without Borders (MSF), Rural Doctors Association of South Africa (RuDASA), Rural Health Advocacy Project (RHAP), SECTION27, and the Treatment Action Campaign (TAC). Its aim is to monitor and report on medicine and vaccine shortages and stockouts at primary healthcare facilities.
** More about the Ritshidze project
Ritshidze is a project being implemented by organisations representing people living with HIV—including the Treatment Action Campaign (TAC), the National Association of People Living with HIV (NAPWA), Positive Action Campaign, Positive Women’s Network (PWN) and the South African Network of Religious Leaders Living with and affected by HIV/AIDS (SANERELA+)—in alliance with Health Global Access Project (Health GAP), the Foundation for AIDS Research (amfAR), and Georgetown University’s O’Neill Institute for National and Global Health Law. Ritshidze works towards improving the quality of HIV and TB services provided in the public health sector through a community-led clinic monitoring system which is being rolled out in hundreds of primary healthcare facilities across the country.
Read more about our activities in South Africa
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About Doctors Without Borders (MSF)
Doctors Without Borders (MSF) is a global network of principled medical and other professionals who specialise in medical humanitarian work, driven by our common humanity and guided by medical ethics. We strive to bring emergency medical care to people caught in conflicts, crises, and disasters in more than 70 countries worldwide.
In South Africa, the organisation is recognised as one of the pioneers of providing Antiretroviral Treatment (ART) in the public sector and started the first HIV programmes in South Africa in 1999. Until today, the focus of MSF’s interventions in the country has primarily been on developing new testing and treatment strategies for HIV/AIDS and TB in Eshowe (Kwa-Zulu Natal) and Khayelitsha (Western Cape).
In Tshwane, we run a migration project, and we offer medical and psychosocial care to migrants, refugees, and asylum seekers, who struggle to access public health services under South Africa’s increasingly restrictive.
Previously we offered free, high-quality, confidential medical care to survivors of SGBV in Rustenburg.
To learn more about our work in South Africa, please visit this page on our website (www.msf.org.za). To support MSF’s work:
- SMS “JOIN” to 42110 to donate R30 Once-off
- Visit https://www.msf.org.za/donate