In 2019, with funding secured through Amref UK, two projects started in Uganda and Tanzania that aimed to reduce the medical, social, and economic burden that women living with fistula suffer.
Amref has started a second 3-year phase of work helping local health authorities in Tanzania and Uganda to build networks and capacities to provide holistic obstetric fistula care.
What is obstetric fistula?
Obstetric fistula is a serious pregnancy-related condition that is often the result of poor management or lack of management during labour. It results in a hole between the birth canal and bladder and/or rectum, which causes abnormal leakage of urine or faeces.
Delays in reaching medical help
Fistula is a medical condition but it most impacts the poorest women in low-resource regions where women in labour are more likely to encounter delays in reaching a health facility with the necessary services and treatment.
Severe social consequences
Individuals with fistula are frequently ostracized from their community because of the continuous odour of urine or faeces that they live with. Fistula survivors commonly face severe medical, social, psychological, and economic consequences as a result.
Both projects incorporated international best practices into their design, while also adapting their approaches to the unique requirements of the communities where we work. The work takes place through three intervention areas: life-changing restorative surgery; psychosocial support; and livelihood opportunities.
Through the first phases of our Tanzania and Uganda projects, we were able to reach 567 women and girls like Mpejiwa with holistic fistula treatment and care. Covid-19 presented both operational and programmatic challenges, reducing the availability of key government technical staff and medical professionals, restricting gatherings and movement, and increasing the cost of some activities. As a result, the number of women reached with the programme fell short of the target of 650.
However, in the face of this challenge our project teams in Tanzania and Uganda rallied to embrace community-level networks of traditional and administrative leaders, local health facilities, human resources for health, and grassroots women’s organisations.
By connecting and sharing the responsibility of getting treatment and care to women and girls with the community we quickly re-gained momentum. We will carry this momentum into a new intervention phase and we have increased our ambitions to reach 504 women and girls in Arua, Uganda and 249 in Mwanza and Geita in Tanzania.
In the new phase, each project will continue to adapt its approach according to the realities they encounter. Our work in phase one has identified some commonalities, particularly the success of community health workers and fistula ambassadors trained to provide fistula information, dispel misconceptions about fistula and identify new cases.
We will also be investing in the training of surgeons, doctors, and nurses to develop the necessary specialised knowledge and skill to treat fistula. Finally, our projects will also help to strengthen the intake of fistula survivors in local organisations like village savings and loan association (VSLAs). The collective impact of these efforts aims to establish a permanent infrastructure within communities that will over time improve the health and socio-economic status of women who have suffered from obstetric fistula.