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Fifteen shipments of inner condoms from five suppliers haven’t gone to clinics because of broken equipment at the South African Bureau of Standards, writes Tian Johnson.
Fifteen million inner condoms (formerly known as female condoms) from five suppliers have been stuck at the South African Bureau of Standards (SABS) since September because of broken equipment at the quality regulator's condom-checking laboratory in Tshwane.
That's more than half of the total number of inner condoms that the National Health Department distributed across the country in 2022 (just over 27 million, according to that year's annual report).
The National Department of Health hasn't had any reports of inner condom shortages yet, says spokesperson Foster Mohale. Kopano Klaas heads the civil society monitoring group Stop Stockouts and hasn’t seen such alerts either.
The trouble could still be coming, though, since it's unlikely that more inner condoms will be ordered for South Africa until the backlog is cleared.
How condom testing works
The SABS's acting chief executive officer, Sadhvir Bisoon, says their condom-checking system should be up and running again by the end of 2023.
But even then, 15% of each shipment must first be sent through a complex series of tests before the backlog is cleared.
That amounts to 65,000 inner condoms in total.
Condoms and packaging are, for instance, measured and checked for visual defects and holes. Then, laboratory experts put the condoms through a range of stress tests to check their durability. A machine also inflates the condoms to see at which point they burst.
It's this specialised bursting instrument that's faulty, and Bisoon says it’s difficult to find people who have the skills to fix it.
Without the bursting equipment, the whole process of approving inner condoms is compromised because samples have to pass all the tests before they can be sent to clinics and hospitals.
Failing one of these tests will result in the whole shipment being rejected.
READ | 80% of SA women believe the female condom 'puts them in charge'
This is not the first time this year that logistical failures at the SABS have put people's health at risk.
In April, Gauteng experienced a serious shortage of all condoms, according to the province's Health MEC Nomanomantu Nkomo-Ralehoko. In response to questions posed in the provincial legislature, she wrote that condom suppliers were waiting for the SABS to approve its samples before ordering more.
The shortage was followed by a slight increase in cases of male urethritis syndrome (MUS) in Gauteng. MUS is an infection of the urethra and penis which can be caused by a sexually transmitted infection.
We urge Bisoon and his team to show the kind of accountable leadership that’s required to keep the health system running smoothly.
What happens now?
Fortunately, male condoms are tested using a different type of machine, so people shouldn't have trouble getting hold of them. But inner condoms are an important tool that the receptive partner can use against unplanned pregnancies and sexually transmitted infections (STIs) without relying on their partner.
Women have told researchers that inner condoms make it easier for them to negotiate for protected sex because their male partners consider these devices to be “her's to use". Inner condoms are also more inclusive than their traditional male counterparts because they can be used for anal sex and by people who can't use a male condom because of an injury or erectile dysfunction.
In the same month that the SABS noticed the broken machine, our fellow activists launched the The HIV Prevention Choice Manifesto for Women and Girls in Africa. It demands that governments offer a range of HIV prevention tools so people can choose the one that works best for them.
We absolutely agree that women and girls must have full control over their health and their bodies and that our leaders should budget and plan their organisations to make sure people have the choices they deserve.
It's also concerning that people's choices are being curtailed as South Africa heads into the summer holidays, a time when festivities can make it more difficult for people to stick to their chronic medication, such as antiretrovirals.
South Africa has the biggest government-funded inner condom project in the world. The programme turned 25 years old this year thanks to its consistent and supportive programming that kicked off with the Female Health Company's condoms in 1998.
But condoms only work when people can get hold of them, and if people use them.
Poor planning on the part of clinic managers has, in the past, hamstrung South Africa’s inner condom project. Still, even the best clinic manager and provincial condom focal person can only do what the system enables them to do.
This 15-million inner condom incident should serve as a reminder that a health system is only as strong as the leadership, workforce and institutions that make it work.
The SABS is one of them.
- Tian Johnson is the founder and strategist of the health advocacy non-profit African Alliance. Click here to sign up for their newsletter.
Additional reporting by Joan van Dyk.
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