Program Background

EngenderHealth began its work on fistula in 2001, conducting research in collaboration with the Women’s Dignity Project in Tanzania and Uganda. In 2003, with support from the United Nations Population Fund (UNFPA), we conducted the first-ever international assessments of the availability of, and need for, fistula services in nine countries. EngenderHealth subsequently became the managing partner of a five-year project supported by the Bill & Melinda Gates Foundation to raise awareness of fistula and increase access to services, in collaboration with the Women’s Dignity Project and UNFPA.

In 2004, USAID began to provide support for fistula services through projects managed by EngenderHealth. The initial scope of work was primarily focused on training surgeons in fistula surgery and on strengthening the capacity of sites to provide quality fistula surgery. In September 2007, USAID awarded a five-year Associate Cooperative Agreement to create the Fistula Care project. With this award, the scope of work was expanded to include a focus on prevention activities. The project grew from five sites in two countries in 2004 to more than 38 treatment sites and 38 prevention only sites in 10 countries in 2013.

Fistula Care Highlights (2007-2013)

Fistula Care was a USAID fistula repair and prevention project managed by EngenderHealth that began in 2007 and ended in 2013. Fistula Care worked in Bangladesh, the Democratic Republic of the Congo, Ethiopia, Guinea, Mali, Niger, Nigeria, Rwanda, Sierra Leone, and Uganda, as well as Benin, Ghana, Liberia, and Togo through Mercy Ships. See below for highlights from the Fistula Care project.

Fistula Repair

Between 2005 and September 2013, 33,402 fistula repair surgeries were supported with funding from USAID, over 23,000 of which were supported by Fistula Care. During 2013, Fistula Care worked with partners in ten countries in a total of 76 facilities. Of these, 38 hospitals provide fistula repair surgery.

Support for Training

Between 2007 and September 2013, Fistula Care trained nearly 33,000 people in areas related to fistula prevention, fistula repair and advocacy for fistula care. Many of these people were community volunteers who learned about fistula, its prevention, and the availability of services. Fistula Care country programs have provided training for 244 surgeons in fistula repair. Over 3,887 nurses and other medical staff have received training in pre and post-operative care and fistula counseling, and over 2,341 health care workers have been trained in obstetric care.

Fistula Care Research

Fistula Care carried out research to help to answer some of the most pressing clinical research questions in the field of obstetric and traumatic fistula. For more information about the studies, please visit the Fistula Care research archive.

Developing Resources

Fistula Care introduced new tools, including counseling curriculums for clients suffering from obstetric and traumatic fistula, as well as a training curriculum developed in partnership with ECSA for nurses and midwives. Fistula Care has also introduced many other resources, including supervision and monitoring tools for training and for service delivery, a knowledge assessment tool for trainees, data collection forms, and an online database for Fistula Care colleagues around the world. A module in informed and voluntary decision-making, among other resources, were under development.

Preventing Fistula

Fistula Care focused on four interventions to prevent new cases of fistula from occurring. These include family planning, the correct use of the partograph, immediate catheterization to prevent or treat small fistulas among women who experience obstructed labor, and strengthening cesarean section service delivery.