| SAPLER Population Trust | |
| Splendidly Alive People Within Limited Environmental Resources | |
Part XIV: Other Organisations
The report looks at: The Planned Parenthood Association of SA (PPASA), The Association of Voluntary Sterilisation in SA (AVSSA), the new organization, Steriplan, Marie Stopes International and the Progressive PHC Network (PPHCN).
Planned Parenthood Association of SA (PPASA)
This organization grew out of the original family planning association of SA, which for years provided an excellent family planning service in the main urban areas to those who came to them.
In recent years the nature of the organization has changed. In Johannesburg none of the previous personnel have remained.
They now state that their aim is mainly to serve youth and address matters of sexual reproductive health.
From the Annual Report 1994:
Mission Statement: PPASA wishes to reach the youth so that they can make informed choices about matters of planned parenthood, reproductive health and responsible sexuality.
"We will achieve this by involving and challenging the media, Government and other policy and opinion makers to ensure that comprehensive reproductive health services and education are provided for all."
"We recognize and will promote the inextricable links between the world's population, the environment and the allocation of natural resources, so that all can work together towards achieving a balance between human numbers, human needs and the natural environment."
President's Report: (Dr Malefetsane Ngatane)
"Most teenagers continue to be vulnerable to unwanted pregnancies and unsafe abortions ... I am somewhat concerned that the debate on abortion has been largely based on moral and ethical grounds and not on facts ...
"I am delighted that my colleagues Dr Rees and Dr McIntyre have initiated the Reproductive Health Research Unit at Baragwanath. One of the Unit's first priority, September 14, 1998s first priorities is to conduct a study into abortion."
Introduction: "...If these issues are not urgently addressed the spread of STDs will escalate and the ultimate quality of life among those who had been marginalised by apartheid will not improve."
National Report: Priority areas:
PPASA participated in many conferences over the year.
"...In the coming year, we plan to develop the PPASA into an efficient organisation and to consolidate our position as a leader in sexuality and reproductive health."
PPASA'S Programme
Pilot Projects: "...These projects, targeted mainly at young people, were:
Sexuality and AIDS education programme for primary and secondary schools
Youth Information Centres
Community Based Distribution of contraceptives
Orange Farm: "The community centre in Orange Farm is now complete. This centre is a model of a development partnership between the community of Orange Farm and the PPASA.
"PPASA employs six part-time community health workers in the area. They make house visits and educate members of the community about contraceptives and STDs including HIV/AIDS.
Maputaland: "The PPASA outreach in this area emphasises the promotion of birth spacing, breast feeding, prevention of unwanted pregnancies and STDs, especially HIV/AIDS. These objectives are achieved through family planning motivational courses for Community Health Workers.
Inhlangwini: "This area has a population of about 200 000 people. Apart from the mobile clinic that visits the community twice a month, there are no other health facilities in the area. The PPASA and the Institute for Natural Resources run a joint project whose objectives are to improve the economic infrastructure in the community as well as reproductive health. The PPASA project is implemented by 15 Community Helpers (Abasizi)."
SAPLER is not able to comment further on PPASA as we have not been sent, any data on which we could make a valid assessment.
Association for Voluntary Sterilisation of SA (AVSSA)
AVSSA's chairman is Pohl de Villiers, but unlike Dr de Villiers's own set-up in Paarl, the association seems not to have thrived elsewhere.
They have had huge publicity campaigns, such as the TV ad with the hyenas (many kids) and the lions (few kids). This has led to an increased wish to use sterilisation - but doctors are not keen, state services are patchy, and the association's own services are too expensive.
The Johannesburg branch of this association has now closed down.
From the Cape Town branch Margaret Moss writes:
"Regarding AVSSA's outreach it is impossible to give numbers and costs of outreach. A large part of our budget has gone into posters, pamphlets and more recently videos, TV and radio advertising. No evaluation of the impact of these has been carried out.
"Top-up is simply a term coined by AVSSA whereby remuneration offered by the state to private practitioners per case for sterilisations performed is increased by AVSSA to a more attractive rate - although still way below the Medical Aid recommended rates. This does not apply to full-time doctors employed by the state."
SteriPlan is a new organization formed by Diana Darvell to meet the unmet need for free sterilisation in Johannesburg. It is privately funded.
This organization has managed to get the South Rand Hospital to let them use their theatre on one Monday morning a month for sterilisations. The hospital charges a nominal fee of R500 for a morning.
Ironically, it is the Transvaal Province sterilisation doctor, Dr Duys, who does the sterilisations. (See Part XV)
So a provincial doctor does sterilisations in a state hospital, but it has had to be arranged privately.
SteriPlan has a three month waiting list. The total cost per morning is R1450 for 9 patients = R161 per patient. But the patient herself pays nothing.
Transport: the patient gets herself there, or is brought by a friend or an employer.
The scheme is advertised in clinics.
This organization is named after Marie Stopes, who was the pioneer birth control advocate in Britain. The organization is known world wide and has a very high reputation for effectiveness, caring and honesty.
They have, however, had great difficulty in getting started in South Africa, to the extent of being told, "We will fight you all the way."
Anne Halsted, their local representative, says, "Even the British government can't do all its own family planning - they contract out to us - so how does South Africa expect to cope?"
How Marie Stopes has managed to keep going in developing areas of the world is by becoming "sustainable" - in the economic sense. Their policy has been to start in a major centre and to charge for their services. When this is well established they move out to rural areas where people can't afford to pay the full amount.
A few years ago the European Community expressed interest in giving them about R5m to get going in Johannesburg. Anne Halsted worked out the costs of starting a Jhb clinic. She then took the proposal to the Khagiso Trust who were vetting donations at that time. After a long wait the trust turned down the proposal - on the grounds that it was not community-oriented enough.
When I heard about this proposal I also felt it was wrong. I felt that Jhb had enough family planning already. I did not then know of the lack of sterilisation services in Alex and in the Northern suburbs of Jhb.
After the New South Africa was in place, Marie Stopes again made a proposal, this time to the British Overseas Development Agency, this time for over one million pounds. The ODA was interested, but again there was hesitation because of local resistance.
Anne Halsted now says that their Mozambique schemes will get off the ground before anything big is started here.
This is a tragedy.
When I heard about the second proposal I phoned Tim Black in England. We then knew just how chaotic Lebowa was and how valuable a few fp mobiles would be. He at first stuck to the Marie Stopes principle of becoming economically viable first - but when we returned from our homelands survey, Anne phoned me and said that the organization had agreed to letting half the money being used for rural mobiles. She even came round to discuss where these could best be situated.
But the problem of local resistance remains.
In the meantime, according to the Star, the ODA has given a few million rand to Baragwanath Hospital, "to do research into abortion".
Anne Halsted has now started a successful sterilisation and vasectomy service in central Jhb. The clients pay the full price of the service - but it is less than they would have to pay a private doctor.
National Progressive Primary Health Care Network (NPPHCN)
This is a loose collection of anyone connected with primary health care (both meanings) who are not part of the government. Marie Stopes International and SAPLER both belong to this network.
From a family planning point of view the members fall into three groups:
1. Those who want nothing to do with it, including Catholics, some Greens, some people working in areas with negative chiefs - and some who simply say that their funders wouldn't like it.
2. Those who have not up to now done anything in this area but who are willing to consider our SAPLER-nompilo idea.
An example of this is Hlatlolanang Health and Nutrition Education Centre, near Jane Furse Hospital in Lebowa.
3. Those who already do family planning, such as the outstanding Ithuseng self-help project, where lay workers hand out contraceptive pills.