In addition to these central sites a further 10 rural facilities were visited, none of which had any supplies. Although the survey represents a small subset of facilities, the lack of product availability is consistent with those presented in the ACQUIRE baseline. If anything, it appears that since the baseline, the situation has deteriorated with almost no stock available.
One of the key components of contraceptive security is that women have a choice of methods when considering family planning, In the sites visited, the method mix and therefore choice was either very limited (one method) or non existent (no products) . Service providers did indicate that when a method was stocked out or not provided at the site, clients were referred to pharmacies. However, it was unclear whether the referrals were converted or if they did not access private sites.
Recognizing product availability problems ACQUIRE is undertaking important steps to prepare and empower family medical doctors and midwives to provide family planning counseling in the pilot districts where their project is working. Previous USAID projects, notably Pathfinder International’s, have had modest success in receiving temporary waivers to allow non-obstetrician/gynecologists to provide selected contraceptive methods. We understand ACQUIRE is providing the training, equipment upgrades and other assistance necessary for primary health care level facilities in their project area to provide family planning counseling and, as permitted, services. However, without access to commodities or the ability to prescribe pills, rural clients in these pilot communities are still forced to incur the additional costs of time and money to travel to the CRH for services. Away from their communities they are more prone to the demands for unofficial fees for diagnostic tests, screenings and post service check ups in addition to the cost of an IUD insertion or pill prescription.