EngenderHealth, Inc.

Ending Fistula: Safe Birth, Safe Surgery in West Africa

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To learn more about – or provide significant funding to – this project, please contact Lever for Change.

Project Summary

Globally, 1-2 million women and girls suffer from fistula, resulting in constant leakage of urine and/or feces from an abnormal opening caused by preventable conditions, such as obstructed labor and errors during cesarean sections. Women with fistula are stigmatized by their communities, ostracized by their families, and unable to work or care for their children. The occurrence of fistula is symptomatic of a failure to meet a woman’s needs and reflects the many conditions women suffer while giving birth.We will work towards ending fistula in Ghana, Guinea, and Nigeria by improving access to quality health services and building sustainable health and community systems to prevent and treat fistula. We will work to ensure that health systems meet the needs of women and girls, and that those with fistula are treated, rejoin communities, and live lives free from stigma. Project success will establish a model for ending fistula worldwide.

Problem Statement

Maternal mortality and morbidity rates, while declining, remain unacceptably high. Low quality maternal care, especially during labor and delivery, causes severe injury for millions of women and girls. Fistula, an abnormal hole that results in chronic leakage of urine and/or feces, is among the most devastating. Women and girls who develop fistula face stigma and isolation from their families and communities and are unable to maintain their livelihoods or care for their children. Although fistula is treatable, many affected do not seek care due to shame, lack of awareness about available treatment, and other barriers like transportation. Fistula is a sign of health system failures to meet women's and girls’ needs and symptomatic of broader gender inequality. It is most commonly caused by inadequately treated prolonged/obstructed labor and errors during cesarean sections and other surgeries. Elimination efforts to date have focused on prolonged/obstructed labor causes, but as cesarean surgeries have increased dramatically in recent years, an increasing proportion of fistula is caused by surgical error. Current efforts are unable to keep up with repair of new fistula cases, let alone address the backlog of existing cases. It is time for an integrated, systems-based approach to ending fistula that tackles the multiple contributing factors that cause fistula, hinder treatment, and leave women and girls to live with its devastating consequences. Comprehensively addressing the three types of delays that cause fistula—delays in seeking, reaching, and receiving high-quality healthcare during labor—is the most effective way to prevent fistula in West Africa.

Solution Overview

We will make significant progress towards ending fistula in West Africa by strengthening health and community systems in Ghana, Guinea, and Nigeria. Building on past evidence and experience, our solution brings together best-in-class healthcare provider training methodologies, public-private sector partnerships with some of the largest private businesses in the region – telecommunications companies, and mobile phone technology to create a supportive ecosystem to prevent, identify, refer, and treat fistula. We will address the three delays that contribute to fistula by establishing and strengthening community systems for screening, referral, and transport; training providers to improve surgical safety and quality; and strengthening national/teaching hospital capacity to repair fistula. Indicators to measure achievements include the number of: people informed about risks related to prolonged/obstructed labor, clinicians trained in strategies to address prolonged/obstructed labor in a timely manner, sites achieving safe surgery practice management, and communities utilizing screening and referral systems to reach care. We will have deep impact in our implementation countries, resulting in a 75% reduction in new fistula cases over five years, improved health and well-being of women and girls, and strengthened health system capacity. Our project will lay the groundwork for ending fistula in the region and beyond by 2030. Success will be achieved when fistula occurs rarely and is a temporary medical condition that is quickly treated instead of a debilitating, life-defining illness. Women and girls affected by fistula will directly benefit from this work and systematic changes will benefit all women and girls, their families, and their communities.

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