School of Health and Related Research - ScHARR, The University of Sheffield, Sheffield, UK.
Medical Research Council - MRC The Gambia Unit, Fajara, The Gambia.
BMC Health Serv Res. 2022 Sep 7;22(1):1127. doi: 10.1186/s12913-022-08514-0.
Infertility is a long-standing reproductive health issue, which affects both men and women worldwide and it is especially problematic in the Global South. In sub-Saharan Africa, understanding the current availability of diagnostic and treatment services for infertility is important because this could guide health systems to improve access to fertility care for all. Yet, few studies have explicitly started from a health system perspective to grasp the availability and integration of infertility services in sub-Saharan Africa. This quantitative study, the first in The Gambia, West Africa, examines the availability of infertility services in public and private facilities as part of a wider endeavour to improve fertility care policy and practice in the country.
A cross-sectional survey using Qualtrics was administered to 38 health facilities. The survey was carried out between March and August 2021 and involved closed-ended questions. Data analysis consisted of descriptive statistics and t-tests performed using SPSS version 26.
A total of 25 facilities (66%) offered infertility services, of which 13 (52%) were public and 12 (47%) private. Although the availability of screening tests was similar between health institutions, most diagnostic and treatment services were available only in the private sector. Treatment services included: (i) ovarian stimulation (n = 16, 42%); (ii) reversal of tubal ligation and/or blockage (tuboplasty) (n = 4, 11%); and (iii) intrauterine insemination (n = 3, 8%). Assisted reproductive technologies such as IVF and ICSI were not available in public or private sectors. The Gambian health management information system lacked a dedicated space to capture data on infertility. Reported barriers to integration of infertility services in existing reproductive health services included a lack of specialised training, an absence of national guidance on infertility management, and a shortage of appropriate equipment, supplies, and medication.
The availability of infertility services in The Gambia follows a trajectory that is similar to other SSA countries in which services are mostly obtainable through the private sector. Yet, access to private care is expensive and geographically restricted, which exacerbates inequalities in accessing fertility care for all. Improving the provision of infertility services in the public sector requires systematically capturing data on infertility and investing in the provision of a full-range fertility care package.
不孕不育是一个长期存在的生殖健康问题，影响着全球的男性和女性，在撒哈拉以南非洲尤其成问题。在撒哈拉以南非洲，了解当前不孕不育的诊断和治疗服务的可及性很重要，因为这可以指导卫生系统改善所有人获得生育保健的机会。然而，很少有研究从卫生系统的角度出发，了解撒哈拉以南非洲不孕不育服务的可及性和整合情况。这项在西非冈比亚进行的定量研究是此类研究中的首例，旨在改善该国的生育保健政策和实践。
采用问卷调查的方式，对 38 家卫生机构进行了横断面调查。调查于 2021 年 3 月至 8 月进行，采用封闭式问题。数据分析包括使用 SPSS 版本 26 进行描述性统计和 t 检验。
共有 25 家（66%）机构提供不孕不育服务，其中 13 家（52%）为公立机构，12 家（47%）为私立机构。尽管卫生机构的筛查检测可及性相似，但大多数诊断和治疗服务仅在私立部门提供。治疗服务包括：（i）卵巢刺激（n=16，42%）；（ii）输卵管结扎和/或阻塞的逆转（输卵管成形术）（n=4，11%）；（iii）宫腔内人工授精（n=3，8%）。体外受精和卵胞浆内单精子注射等辅助生殖技术在公立和私立部门均不可用。冈比亚卫生管理信息系统缺乏专门用于记录不孕不育数据的空间。在现有的生殖健康服务中整合不孕不育服务的报告障碍包括缺乏专门培训、缺乏国家不孕不育管理指南以及缺乏适当的设备、用品和药物。
冈比亚的不孕不育服务可及性遵循与其他撒哈拉以南非洲国家类似的轨迹，这些国家的服务主要通过私立部门获得。然而，获得私人护理的费用昂贵且地域受限，这加剧了所有人获得生育保健服务的不平等。要改善公共部门不孕不育服务的提供，需要系统地收集不孕不育数据，并投资提供全面的生育保健套餐。
