The World Health Organisation (WHO) says cases of infertility are still too high in Africa, and the developing world generally. It notes that one in every four couples faces the infertility problem. Tanzania is no exception. It’s one of the countries in the so-called ‘African Infertility Belt’ that also includes Uganda.
In trying to get to the bottom of the problem, ‘The Citizen’ Health Reporter Syriacus Buguzi talks to Dr Rasha Kelej, CEO of Merck Foundation, an organisation advocating measures to control infertility in East Africa:
I have read about your role in building healthcare capacity in Tanzania, but one thing that stands out is what Merck Foundation is doing to deal with infertility. Why infertility? And what’s the situation in Tanzania?
In many parts of Africa, there is still stigma against those who suffer infertility, and women are the ones mainly blamed. They suffer discrimination, abuse and physiological and physical violence from their husbands and in-laws. This is despite the fact that 50 per cent of the causes of infertility are due to male factor.
According to WHO, infertility has a high incidence in developing countries; almost one in every four couple has infertility. Around 85 per cent of infertility cases are due to untreated infectious diseases, which result from unsafe abortion, unsafe delivery, female genital mutation, child marriage, and STDs.
Hence, awareness about prevention and management is very critical, and this is one of the main pillars of our ‘Merck More Than a Mother’ strategy.
As a scientist and advocate in this aspect, what are the main reasons women are infertile in Tanzania?
As mentioned earlier, there can be many reasons for infertility in women, but women’s infertility is not the only reason for the failure in conceiving in couples, male factors contribute about around 50 per cent of the causes. Therefore, we call upon all men to support their wives and share the journey of the family building together. Fertility is a shared responsibility.
What does your campaign involve? For how long has it been advocated in Tanzania and who, specifically in the country, has benefitted from it?
In some cultures, women still suffer discrimination, stigma, and ostracism. An inability to have a child or to become pregnant can result in being greatly isolated, disinherited or assaulted. This often results in divorce or physical and psychological violence.
‘Merck More Than a Mother’ initiative aims to empower such infertile women through access to information, education, health, and change of mindset. Through this programme, we want to give every woman the respect and help she deserves to live a fulfilling life, with or without a child. If given an opportunity every woman can become a productive part of the society, as the name suggests a woman can be ‘More Than a Mother.’
In Tanzania, we started our programme at the end of 2017. So, we will be able to share the stories of infertile women in Tanzania and bring positive change in their lives in 2018. But this is just the beginning we have a long way to go.
We are also providing clinical and practical training to seven embryologists and a fertility specialist from Tanzania out of more than 40 from across Africa and Asia.
At some point, Merck Foundation announced it was establishing East Africa’s first ever public hospital to offer in vitro fertilisation (IVF). How far has this initiative gone and how are women in Tanzania set to benefit from this?
Merck Foundation is committed to building professional fertility care capacity as in many African countries where there are no embryologists or fertility specialists. The foundation is creating history in these countries by training the first fertility specialists such as in Gambia, Sierra Leone, Liberia, guinea and Chad and Niger.
We also partnered with Uganda’s ministry of Health to train personnel at their first public IVF clinic, which is built to provide services for entire East Africa, including Tanzania. We will also do the initiative in Tanzania, and are going to offer a unique clinical and technical training for the first public IVF in Tanzania like we did in Ethiopia. Merck Foundation is making history in many countries in Africa through our ‘Merck More Than a Mother’ campaign.
There have been complaints that here in East Africa, the cost of treatment for infertility in private hospitals is too high and that most patients cannot afford. Apart from the initiatives you are investing in to solve this, what’s your advice to public health authorities in Tanzania on how they can help low-income families to deal with infertility?
Yes, currently the cost of treatment for fertility is very high, and this is due to the massive gap in demand and supply of fertility care in Africa. In East Africa, there are very few skilled embryologists, and fertility specialists and most of them are in the private sector, and the demand for fertility treatment is very high, much more than supply, which leads to increase in the cost of fertility treatment.
The ‘Merck More Than a Mother’ initiative has collaborated with Asian fertility experts to create a platform for stand alone embryologists in Sub-Saharan Africa. Through our ‘Merck Embryology and Fertility Specialists Training Programme,’ healthcare providers from Sub-Saharan Africa, including Tanzania are experiencing hands-on training in India, Indonesia, and in Russia and China in the future.
So far, seven candidates from Tanzania have benefitted, and we’re going to train more doctors in embryology.
What areas of science and technology has the organisation invested in, in Tanzania? And how is this positively impacting lives?
At Merck Foundation, we strive to improve the health and well-being of people through science and technology. It’s the core ideology of Merck and Merck Foundation.
In Tanzania, through our ‘Merck Oncology Fellowship Programme,’ we have trained the first medical oncologist from Tanzania, Dr Cristina Malichewe at The Tata Memorial Hospital, India. Every day, she is impacting her patients’ lives, and through her, we are transforming people’s lives in Tanzania. We are planning to train another four doctors through a one-year and two-year medical oncology fellowship programme in India and Malaysia.
Through the Merck Diabetes and Hypertension awards, we are granting a one-year postgraduate diploma in Preventive Cardiovascular Medicine or Diabetes Management in, United Kingdom. So far, two medical practitioners have been awarded from Tanzania.
As informed earlier, we’re going to train more embryologists and fertility specialists to establish the first public IVF in Tanzania. So, again, this is just the beginning of our programmes in Tanzania.
How different are you from other organisations that work with the government in boosting healthcare capacity?
At Merck Foundation, we know that everything starts with the community, where everyone can lead a healthy and fulfilling life. I strongly believe that building capacity is the right strategy to improving access to quality and equitable healthcare since the lack of professional skills is a critical challenge in Tanzania.
We also want to raise awareness by building advocacy and supporting policymakers to define policies and regulations that improve access to quality and equitable healthcare solutions.
I am pleased that I am the CEO of Merck Foundation. They believe in playing an important role in building capacity. I have a special passion for this vision, and as a pharmacist and most in importantly as an African woman who believes in the enormous potential of Africa and African people.