Improving access to ART in low-income settings through knowledge transfer: a case study from Zimbabwe

Abstract

It may be assumed that infertility is not a problem in resource-poor areas where fertility rates are high. However, evidence overwhelmingly shows that childlessness is highly stigmatized in these settings and that women who are unable to bear children suffer significant social and psychological consequences. The World Health Organization has recommended that infertility be considered a global health problem and stated the need for ART to be adapted to low-resource settings. This paper describes a model for improving access to ART in low-resource settings. Experienced ART health professionals from Australia and Italy representing medical science, embryology, nursing and counselling used knowledge transfer to support a clinician, a laboratory scientist and a nurse to establish an ART service in Harare, Zimbabwe. Support and mentorship provided between October 2016 and December 2017 included: hosting the clinician and the embryologist for the new service in established ART clinics for short periods and providing them with dedicated mentorship and training during their stay; funding an experienced embryologist to travel to Zimbabwe (three times) to oversee the setting up of the lab and provide hands-on embryology training; funding a scientist and a nurse to travel to Zimbabwe to troubleshoot and establish protocols for record keeping and psychosocial care; and contributing approximately AUD $15,000 to the purchase of some equipment. By 31 March 2018, the team at IVF Zimbabwe had performed 166 ART procedures, which at time of writing had resulted in 16 births and 4 ongoing pregnancies. This case study demonstrates that with mentorship and modest financial support from ART experts from high-income settings, health professionals in low-income settings can deliver affordable ART with successful outcomes.

IVF and other ART in low- and middle-income countries: a systematic landscape analysis

“…Owing to the lack of local knowledge, guidelines or legislation, clinicians starting an ART clinic often refer to European/American guidelines, organize collaborations and training in European centers, and even use second-hand equipment from European laboratories. A recent case report showed the feasibility of knowledge transfer from high- to low-income settings in the set-up of a fertility clinic in Zimbabwe, resulting in safe and affordable ART with successful outcomes ( Hammarberg et al , 2018 ). Nevertheless, local practices are also implemented, such as extended bed rest and hospitalization in Ghana after embryo transfers ( Gerrits, 2016 ), and egg sharing to reduce costs for patients ( Hörbst, 2016 ).…”

Adding It Up: Investing in Sexual and Reproductive Health 2019

“…194 Even higher prevalence rates are reported in parts of Sub-Saharan Africa. 192,195 In 2012, WHO analyzed 277 health surveys and estimated that 49 million couples worldwide were suffering from infertility, half of whom were in Sub-Saharan Africa and Southern Asia. 196 Factors that contribute to infertility include age and reproductive tract infections, as well as genetic, lifestyle and environmental factors.…”

“…200 International partnerships, including South-South cooperation, can help ensure that clinicians and laboratory scientists in LMICs establish and maintain high-quality services. 195 Launching and expanding these efforts worldwide may require a global initiative, with high-level support and international funding, to transfer knowledge and affordable technologies to LMICs. For now, the key starting points for helping millions of couples affected by infertility are to raise awareness about the issue, reduce the stigma surrounding it, focus on prevention and counsel couples about their options.…”

Hope and Heartache: Unpacking the invisible struggles of involuntary childlessness and Assisted Reproductive Technology (ART) use in Zimbabwe and New Zealand

“…While infertility and assisted reproduction have been on New Zealand's policy agenda since the 1990s (Adams, 2023;Fitzgerald et al, 2019), I have conducted an exhaustive search on the regulation of assisted reproduction in Zimbabwe and have been unable to locate a single policy document or law that specifically addresses infertility and assisted reproduction. Rather, doctors and clinics that provides ART services in Zimbabwe tend to use various guidelines from other countries such as Australia (Chiware et al, 2021;Hammarberg et al, 2018). In Zimbabwe, fertility treatment is only offered in the private sector where it is often beyond the reach of the general population (Hammarberg et al, 2018;Sande and Takawira-Mtwaya, 2022).…”

“…Rather, doctors and clinics that provides ART services in Zimbabwe tend to use various guidelines from other countries such as Australia (Chiware et al, 2021;Hammarberg et al, 2018). In Zimbabwe, fertility treatment is only offered in the private sector where it is often beyond the reach of the general population (Hammarberg et al, 2018;Sande and Takawira-Mtwaya, 2022). In New Zealand, fertility clinics have voluntarily adopted policy around ARTs from the early 1990s (Adams, 2023).…”