Revised Ending Obstetric Fistula in a Generation
Ogutu, James O.
MetadataShow full item record
The proceedingsin this publication emanate from the International Reproductive Health Conference underthe theme: “EndingObstetric Fistula in aGeneration”. The conference took place between 22nd and 24 th May 2017. The purpose ofthe conferencewasto exchange and documentinformation on how to end obstetric fistula in contemporary society. The conference was meant to provide a forum for sharing information and networking among people involved in fistula prevention,management and to facilitateestablishmentof viable recommendationsforfuturepolicy action programs. One ofthe reasonsforthe conference wasthat obstetric fistula is one ofthemajor concernsfor public health and medical practitioners. Obstetric fistula has been associated with socialstigma and shame. Thisreducesthe number of patientsseeking care. The stigma also affects the economic status of the patients because of poor interaction with the rest of the population. In addition, current report indicate that Kenya has a challenge in dealing with the fistula problem. The number of health facilities that handle fistula repair are too fewand no fistula care centresin the country. Therefore,the cases are usually managed in a few hospitals. There is, therefore, a persisting need to identify alternative strategiestoassistin thepreventionandmanagementofthe fistula problem. The conference was necessitated by the fact that Obstetric fistula has been on the increase due to limited accessto Comprehensive Emergency Obstetric and Newborn Care facilities. Thisisin addition to lack of accessto qualitymaternity care and also the roleofsocial culturalfactors which include early marriages. The main objectives of the conference were to exchange and document information on how to end obstetric fistula in contemporary society,to provide a forumforsharing and networking among people involved in fistula prevention and management, and to facilitate drawing of recommendationsfuture policy action programs. Papers were presented in four thematic areas first, risk factors and complications associated with obstetric fistula quality of care and management of obstetric fistula cases. Second, partnership synergy in prevention and management of obstetric fistula. Third, community empowermentinprevention offistula andfourth accessto information andadvocacy. Health practitioners and health promoters, and other stakeholders were invited to chart the way forward in ending obstetric fistula. Enlightening and stimulating presentations were made from the academia, clinical practitioners, international organizationssuch as Fistula Foundation, Freedomfrom Fistula Foundation Flying doctors, AMREF and United Nations Population Fund, among others. Deliberationsfrom the conference were expected to enhance a healthy networking that can be used to scale up thefight againstfistula. The papers presented in this conference covered many topic including fistula care training, service delivery supervision and monitoring, counseling the obstetric and traumatic fistula patient, clinical management of fistula cases, client centered reproductive health counseling during fistula repair, fistula care informed consent, restoring women's dignity, post fistula treatment, best practices and models in training fistula health care providers, tracking fistula survivors, research and advocacy, vii Health e oductiv epr R and tion opul P aHealthsity of Univ Public er t DepartmenSchoolen ofa tta y K community engagement in prevention and management of fistula, policy and legal framework for prevention andmanagementof obstetric fistula. According toUNFPA ending obstetric fistula isitsfirst priority and key step in achieving SDGs. Together with partners, UNFPA has made progress towards eliminating Obstetric Fistula through prevention, and re-integration. It has managed to gain public awareness and politicalsupport. In addition, UNFPA is involved in sharing of best practices, providing comprehensive support for treatment of Obstetric Fistula and underlying causes e.g. improving reproductive health and rights, ASRH, early marriage, childbearing, equity and accessto RHservices especially EMONC services.UNFPA's efforts also include improving coordination and management mechanisms at global, regional and country level, increasing integration of fistula prevention, and treatment of Fistula into UNFPA country program and into national Reproductive health programmes (includes training of surgeons and other health care workers at a scale, provision of equipment like obstetric kits, funding ofservicesin some counties e.g. performing surgery in a camp). Other efforts include supporting national level plan of action to end obstetric fistula, training health workers at a scale and innovation of e-Learning module with support fromJHPIEGOandWHO. Some of the interventions that have been implemented to end obstetric fistula include service provision through outreaches, organising special medical camps and regular outreach visits. Other interventions include knowledge development, skills transfer on prevention e.g. use quality improvement, for example, after fistula service there is usually a two weeks follow up to assess outcome of operation, development of learning materials and operational research that links FGM and Fistula. Some organizations have focused on advocacy activities, external partnerships and fundraising to supportfistula programmes Effortsmade to tackle the problemof obstetric fistula include the establishment of a number of fistula treatment sites. There are those that offer routine fistula services such as KNH, Gynocare, St Mary's, Jamaa, Kisii, Kisumu, Cherangany. There are also regular fistula Outreaches/camps that are held in different parts of the country. Some of the county hospitals where the camps have been held on a regularbasisincludeKisii,CPGH,Kilifi,Marsabit,Garissa,Moyale,Bomu andKakuma. With regard to the fistula data capture,the firstinclusion of fistulamodule was done in the KDHS 2014. Othersourceswhere fistula data hasbeen captured include KenyaHealth Facility. Assessment/Service availability and Readiness Assessment Mapping (KHFA 2017) which has been done since June 2017 and also theDHIS2(MOH711,705)whichhas beendone sinceMay2016 Some of the challenges in Kenya campaign to end fistula include: shortage of staff trained on management and care of obstetric fistula patients, lack of guidelines on education and practice of obstetric fistula treatment, inadequate equipped health facilities and infrastructure, lack ofrespectful maternity care and broader socio-economic and political challenges. Moreover, there is low male participation in the fistula campaign largely due to the cultural belief that reproductive issues are largely a female issue. Stigma was observed to largely affect fistula survivor reintegration. Early child bearing was also noted to be a significant challenge against efforts aimed at stopping fistula viii tion a en er g a in tula fis tri c e t ob s En di ng occurrence. Implementation of ending of fistula interventions has been faced by a number of challenges that are both internal and external. Internal challenges include lack of in integration of obstetric fistula prevention projectsinto RMNCH/Nutrition programmes. The other challenge isin form of insufficient mediumtolong-termfunding for projectimplementation and development. External challengesthat were reported included remoteness of areastargeted. This implied that the coveragewasnot adequate. Therewas also the problemof high levels of poverty and cultural practices posing challenges in re-integration of fistula patients. Severe shortages of qualified and motivated health workers due to high staff turnover. This means that some medical campslack required health workers. There is also the problem of limited infrastructure of partnering health facilities lack of theatres, equipment etc. Policy related challenges were also reported. These included political classification offacilitiesto higherlevelswhich pose infrastructural challenges.Also noted wasthe fact that Fistula surgery is notlucrative andmanydoctorsshuntraining init. Several lessons were learned from the fistula projects that have been implemented. These included prevention, treatment and social reintegration, in the safe motherhood context with emphasis on prevention. Thiswillhelpsafeonresourcesthatareused toimplement variousprograms. Needs assessments isimportant for both planning and advocacy by use of CHVs to identify mothers, ensure availability of all resources prior to sensitization of patients. This will help plan the interventionsrelevantly. All systems need to work in order to avoid mistrust. Treatment services should be available before public awareness activitiesare undertaken. Supportservicesshould include psychosocial,social and economic components. Migori County, Kenya is a good example. Diverse, multi-sectoral partnerships at all levels ensure a comprehensive and coordinatedresponse. Thiswillhelpreachoutto areaswhere services havenot beenprovided. The conference recommended that screening and treatment of fistula should be integrated into the primary health care programs. Fistula treatmentshould not be done through holding of fistula repair camps only. Asthe fistula camps are held the governmentshould supportthese activities by providing payment ofthe providers on regularsalary atthe facilities where the camps are held. There is need for a needs assessment to establish gaps that advocacy interventions should focus on. Communities shouldbe sensitisedto change their attitude andreintegrate the fistula survivorsintothe community. Health information systems for fistula prevention and management needs to be improved. The tool that has been developed by division offamily health for data collection should be standardised so asto capture data from all partners working on prevention and management of fistula. This should be developed to enable partners learn best practices that can be used for fistula prevention and management. There is need for a holistic approach to train more workers at all levels of care. Obstetric fistula prevention and management strategies should be integrated into both Public health and MBCHB