Planning for Sustainable Access to Technology: An Essential Element of Safe Abortion Care

Abstract

Uterine evacuation services in the public clinic were going well. After a long and concerted effort, systems for providing manual vacuum aspiration (MVA) services to the abortion and post-abortion care patients were in place. Doctors and midwives were trained, and an international donor had provided several MVA instruments. The clinic managers were pleased to be providing the improved services in accordance with new national protocols prescribing that sharp curettage services be replaced with MVA. The clinic staff worked with members of the local community to explain that MVA procedures are simple and safe and that women could now gain access to care more quickly, as they would no longer need to travel to the operating theatre of the regional hospital.

Within months, community health workers were referring more women to the clinic, and the number of MVA procedures performed had increased. The clinic was saving money, and fees for patients were lower. But then, the MVA kits began to age. After they were used for a large number of procedures, it was clear that replacement instruments would be needed. The clinic manager requested replacements but was informed by the procurement officer that MVA was not included on the "essential equipment" list and, thus, additional authorisation would be necessary. The clinic manager then learned that the current district health budget also did not provide for purchase of new instruments and any expenditure would need to wait until the following year. Because a sustainable system for obtaining MVA instruments was not in place, the clinic was forced to suspend the service and lose the significant improvements that had been made in care for the clinic's patients.

Key Words: Manual vacuum aspiration, logistics, supply chain, abortion technology