Did millions go to waste?
Activists say the government may be investing in the wrong female condom
Every year, South Africa distributes tens of millions of female condoms — making the country home to one of the largest female condom programmes in the world — research published in the 2017 South African Health Review (SAHR) shows.
The tenders for these condoms are big business. About three years ago, the department awarded the bulk of the female condom tender to manufacturers of the then new Cupid female condom.
During this period, it also distributed another new female condom, bought under a previous tender called Pleasuremore. The World Health Organisation (WHO) had not approved Pleasuremore.
The health department continued to use Pleasuremore even as a subsequent 2015 tender required all female condoms to be WHO approved. There has been no public explanation for this decision.
The remainder of the tender went to the Female Health Company, producers of the FC2 female condom, which has a long history in South Africa. Both the Cupid and FC2 condoms are WHO-approved.
For as long as South Africa has had a national female condom programme, advocates have always said that for each rand spent on a female condom, a corresponding amount should be spent on promoting its use.
Civil society warned introducing new brands without any social marketing or training by manufacturers for health workers or communities could confuse people. It could also mean that women wouldn’t know enough to ask for newer contraceptives and health workers wouldn’t feel confident enough with their own knowledge to promote them.
Despite this caution, the previous tender went ahead. New research shows activists were right to be worried.
A study published in the SAHR found that although almost every public, private or nonprofit facility surveyed had distributed the FC2 female condom, only about a third could say the same for the Cupid. Many distribution sites surveyed had never seen or heard of Cupid.
What does this mean? Cupid condoms, which cost about R4.30 each, did not get into women’s hands.
We estimate that this translates into R127-million of possibly wasted money on a contraceptive that was effectively “dumped” into the healthcare system without adequate investment — no awareness campaigns, no training, no support.
The health department is likely to be on the verge of awarding the next female condom tender and, if it repeats its past mistakes, we risk spending millions on contraception.
But it’s not too late to avoid this. As part of its new tender, the department must introduce new products such as Cupid while maintaining access to the more wellknown and popular FC2. Companies who successfully bid for the tender must support the roll-out of their products with locally relevant training and support.
Finally, the department should develop a well-functioning stock system. The female condom is one of the few tools we have that can prevent HIV and other sexually transmitted infections as well as unplanned pregnancies. We have to get it right.
The national health department’s response:
The invitation to bid for the tender in question stated new female condom designs similar to those of condoms already approved and marketed could be exempt from requirements such as WHO approval. Pleasuremore suppliers proved this was the case.
All three female condoms distributed within this tender were similar and instructions for use are exactly the same.
National HIV testing training materials have a module for correct condom use and are used to train health workers on the correct use and demonstration of both male and female condoms.
We have received no reports of female condoms expiring on public health facilities’ shelves. In fact, there is always demand for female condoms, which has led to the decision to increase the number procured in the national tender.