Message from the government of Uganda.

Abstract

Infertility is a major challenge in Uganda with an estimated 5 000 000 people facing infertility, mainly handled by the private centers in urban areas. This means that the patients in the rural centers do not have access to treatment. The World Health Organization (WHO) Report of 2002 puts the prevalence of infertility to be the most concentrated in Sub-Saharan Africa. Of all couples attempting a pregnancy, in any given year, approximately 10–15% fail and require serious medical help. Whereas Malaria, HIV etc. are considered top priority, apparently the policy makers have not been provided with the right facts and information regarding the devastating effects of infertility on the emotional and social wellbeing of the population. In my preparation, I invited health practitioners in Uganda from both public and private health facilities to provide updates on prevalence of infertility to help me in putting my case. They were not able to provide any data from Uganda. This is my first challenge as a government voice. However, they have cooperated and came up with the suggestions and recommendations on which we can be able to build. Management of infertility is included in the national policy guidelines and service standards for sexual and reproductive health and rights, but unfortunately the policy guidelines and objectives are not yet integrated in existing sexual and reproductive health services at all levels. Where gynecological clinics exist, which is mainly at referral centers, they are poorly facilitated and there are no specific facilities for infertile patients. There is no national program for the management of infertility. This puts our country to poor access to the management of infertility. Levels of technology are still low, i.e. equipments, laboratory support, technical trained staff, drugs and medication. There are two private centers that provide advanced assisted conception at a price only affordable by very few (,10%) of infertile couples. The key issues to address in Africa are (i) training, (ii) staffing, (iii) establishing specialized centers and integrating services in already established health units at all levels and (iv) providing affordable or free services. The most important recommendations of our government will include the development of the prevention of infertility as a public health issue, gender awareness, making assisted reproduction techniques affordable and accessible to many. Supporting the vital role of education and information, to develop statistical data to guide policy and creating ethical guidelines on religious and moral issues. International organizations and the pharmaceutical industry should work together with governments and relevant institutions to document data on infertility. These data will inform the governments about the magnitude of the problem. The WHO and the European Society for Human Reproduction and Embryology can guide healthcare systems of developing countries. It is time to break the silence, to get information about the disease in Africa. Patient organizations such as Joyce Fertility Support Centre Uganda are mobilizing couples and advising them to seek partnership with health providers, government and the media advocating for Advanced Reproductive Technology as a treatment. Low cost IVF might be an answer to this long time of suffering. In order to be well coordinated, countries should build corresponding structures to roll out the project, such as community sensitization, healthcare providers networking, ethical guidelines and government coordinating. Uganda government policy has decentralized services at District levels. In the Ministry of Health strategic planning, we have health centers from Village, Parish, sub-county up to District. All these institutions will have to document infertility cases. The Joyce Fertility Support Center Uganda will be invited to work with the government in documenting the infertility prevalence in the country. When infertility is handled, it is evident that many diseases will be managed including safe obstetrical care. We also plan to continue emphasizing prevention of diseases that cause infertility. These will run concurrently with HIV/AIDS prevention. Fertility treatment is rather expensive in the world and more threatening in the developing world where resources are scarce; priority is often given to the more obvious life-threatening diseases. Thus leaving fertility treatment on the back burner, yet infertility is a silent killer both emotionally and socially. Our aim is to create awareness and empower and sensitize the population regarding fertility issues with the help of patients’ organizations. I am looking forward to a future proposal which improve the health of communities faced by infertility and I am also calling for a united front by all forces in this Arusha meeting to uphold to the objectives which will lead to important goals of this meeting to become a reality.