PAtel

Infertility Carein

South Africa

Malika Patel FCOG(SA) M Med O&G

Reproductive Medicine UnitGroote Schuur HospitalUniversity of Cape Town

Cape Town

Workshop Objectives1. Inventory and discussion of aspects of biomedical

infertility care including • Socio-cultural, political and economic barriers• Counselling, patient staff interaction, privacy• Ethical concerns at political and clinical level• Infertility care and HIV

2. Discussion of research initiatives to infertility• Study and address treatment barriers• Support assess and follow up accessible infertility

care in poor resource countries

OUTLINE

• Demographics of South Africa• What doesn’t work for us…..• What works for us……• Solutions!

DEMOGRAPHICS

Population 50 586 757

Black African 79%

Urban 52%

Fertility Clinics

• Cape4 clinics : 1 in Eastern Cape• Gauteng8 clinics• KZN 3 clinics• North West1 clinic

• Academic InstitutionsGSH

University of Cape Town

Tygerberg Hospital University of Stellenbosch

Infertility Care South AfricaMagnitude of Problem:• Poorly documented • Prevalence*• Impact *• Burden of Disease*

Health Politics• Fertility policy• Fertility regulations• Fertility guidelines• Package of care • Medical insurance cover

Public Health Sector• Level 1 care*• Level 2 care• Level 3 care*• Regional differences• 1 Reproductive Medicine Unit

Private Health Sector• Specialist care• Sub-specialist care• 14-16 ART centres• No ART monitoring*• No medical insurance cover for ART

Research: QoL• Hospital Study • 170 women & partners• Describe QoL in women• Describe QoL in male

partners and compare this to women

• Evaluate sociodemographic variables and compare them to QoL

• Correlate instruments

• Household Survey• 2000 households• Low socioeconomic

area• Prevalence• Evaluate infertility• Evaluate Disability• Compare QoL

Research• Instruments2 Generic QoL Questionnaires

WHOQoL-BrefEQ5D

2 Disease Specific QuestionnairesFertiQolSCC

• Data Collection• Data Analysis

Preliminary findings: FERTIQOLDOMAIN MEDIAN IQREMOTIONALFemale

Male

58.3

79.2

41.7 – 75

58.3 – 91.7

MIND/BODYFemale

Male

79.2

91.67

54.16 – 91.7

66.7 – 100

RELATIONALFemale

Male

75

87.5

58.3 – 87.5

75 – 95.8

SOCIALFemale

Male

79.2

83.3

60 – 91.7

70.8 – 95.8

SCC Q - COMMUNITY 1 2 3 4 5 MEAN NNeg relatnship neighboursFemales

Males

69

28

38

12

15

4

39

5

9

2

2.3

1.8

170

51

Less RespectedFemales

Males

67

28

38

12

14

3

34

6

17

2

2.4

1.8

170

51

Excluded from social gatheringsFemales

Males

147

43

10

4

6

3

4

1

3

-

1.3

1.2

170

51

JokeFemales

Males

84

36

33

7

21

3

20

3

11

2

2.0

1.6

170

51

GossipFemales

Males

65

26

30

8

22

9

31

5

20

2

2.4

1.9

170

50

Preliminary findings: SCC part 2 Medical Conditions

Women n=154VARIABLE MEAN STD. DEVIATION

Not falling pregnant 3.5 0.9

Cancer of womb 3.6 0.8

HIV 3.4 1.0

Depression 3.1 0.9

Blindness 3.2 1.0

Deafness 3.0 1.0

Doctor:30 patients per day

http://www.hst.org.za/uploads/files/cahp9_07.pdf

Clinical Load at Primary Health Center Level

Nurse:40 patients per day

= one every 16 mins = one every 12 mins

Integrated Health Care: South Africa

GSH Model

• 3 Dr’s - 1 Subspecialist2 Subspeciality trainees

• 2 Registrars• Medicines at cheapest rate available• Hospital based billing system

Reproductive Medicine Society

• SASREG• Data monitoring• 6% of estimated

optimal ART coverage (1 500 cycles per million people)

The Solution

SOLUTION

SPECIALISTS

POLICY MAKERS

PATIENTS

HCW-shift from mortality to morbidity-earlier intervention-willing to listen-new health care system

-attitude adjustment -identify correct patient -appropriate investigation -appropriate referral

-education-media/posters-involvement of male-support groups

THANK YOU