As the most populous nation in Africa, Nigeria makes up 3% of the world’s population, yet it accounts for 14% of all maternal deaths. In its vast rural areas, health facilities are scarce and often undersupplied, and where services do exist, cultural and social pressures can limit women’s ability to use them.
Since the Fistula Care project began in 2007, we have focused on preventing and treating obstetric fistula in Nigeria. To do so, we train doctors and nurses to perform fistula repair surgery, and we partner with hospitals and health centers to improve or introduce emergency obstetric care so that laboring women who reach a hospital in time will not develop fistula. In addition, we support health facilities in building awareness about fistula prevention, maternal health, and family planning services. Under the previous Fistula Care project from 2007 to 2013, we trained more than 450 Nigerian nurses and doctors to perform fistula repair surgery, and we supported 10,284 fistula repair surgeries.
Our work continues to strengthen fistula prevention and treatment in Nigeria through the Fistula Care Plus project by expanding our efforts to build community awareness and increasing our focus on the integration of family planning services with fistula and maternal health care.
In addition to supporting over 200 prevention-focused facilities, including many taken on from the former USAID Targeted States High Impact Project (TSHIP), FC+ works with hospitals to prevent and repair fistula and to train health professionals about fistula case management. Supported hospitals over the life of the project included:
- National Obstetric Fistula Center, Babbar Ruga, Katsina State
- Gesse VVF Center, Birnin Kebbi, Kebbi State
- Faridat Yakubu General Hospital, Zamfara State
- Laure Fistula Center at Murtala Mohammed Specialist Hospital, Kano State
- Maryam Abatcha Women and Children’s Hospital (MAWCH), Sokoto State
- National Obstetric Fistula Center, Abakaliki, Ebonyi State
- National Obstetric Fistula Center, Bauchi State
- Ogoja General Hospital, Cross River State
- Sobi Specialist Hospital, Ilorin, Kwara State
- University College Hospital at the University of Ibadan, Oyo State
- Jahun VVF Center, Jigawa State
- Adeoyo General Hospital, Ibadan, Oyo State
At a Glance: FC+ Nigeria
• 7,295 surgical fistula repairs completed; 81% closed at discharge
• 34 fistula surgeons and 1,317 other healthcare workers trained in fistula prevention and treatment
• 1,166,080 family planning (FP) counseling sessions and 643,595 couple-years of protection delivered at project supported health facilities
• 792,934 individuals reached through in-person community outreach; 1,181 community volunteers and educators trained
Fistula Care Plus: Nigeria- Strengthening Health Systems to Prevent and Treat Fistula EngenderHealth’s USAID-supported fistula prevention and repair efforts in Nigeria began in July 2005 and continued under the Fistula Care and FC+ projects until September 2018. In Nigeria, FC+ partnered with the Federal Ministry of Health (FMOH), Federal Ministry of Women’s Affairs and Social Development (FMWASD), corresponding state ministries, and hospitals throughout the country to support fistula repairs and prevent fistula by supporting voluntary family planning (FP), clinical capacity building, and community outreach and education. FC+ helped build health system capacity for safe surgery (including routine fistula repair), develop and implement national policy and guidance on the use of urethral catheterization for fistula prevention and treatment, increase community awareness, integrate FP within fistula and maternal health services, and pilot efforts to meet the reintegration needs of women who have undergone fistula repair. FC+ supported 16 health facilities for fistula treatment and prevention services and 768 facilities providing prevention-only services. In total, FC+ supported fistula services in 14 of Nigeria’s 36 states (Akwa Ibom, Bauchi, Cross River, Ebonyi, Kaduna, Kano, Katsina, Kebbi, Kwara, Osun, Oyo, Sokoto, Yobe, and Zamfara) and provided ad hoc support to facilities in 2 additional states (Jigawa and Niger).
FC+ End of Project Report Summary Operating in seven countries—Bangladesh (2013-2020), the Democratic Republic of Congo (DRC: 2014 -2021), Mozambique (2017-2021), Niger (2013-2021), Nigeria (2014-2018), Togo (2014), and Uganda (2014-2019) — FC+ focused on five objectives:
1. Strengthening the enabling environment to institutionalize fistula services in the public and private sectors.
2. Enhancing community understanding and practices to prevent fistula, improve access to treatment, reduce stigma and
3. Reducing transportation, communications, and financial barriers to care.
4. Strengthening provider and health facility capacity to provide and sustain quality services.
5. Strengthening the evidence base to improve fistula care and scale up application of standard M&E indicators for prevention and treatment.
Fistula Care Plus: Key Achievements and the Way Forward to End Fistula (English PDF, French PDF) Fistula Care Plus (FC+) was a global project initiated by the United States Agency for International Development (USAID) and implemented by EngenderHealth from December 2013 to March 2021. Building on work undertaken by the previous Fistula Care project (2007 to 2013), FC+ supported activities in 1,171 facilities (54 fistula treatment sites and prevention sites and 1,117 prevention-only sites) in Bangladesh, Democratic Republic of Congo (DRC), Mozambique, Niger, Nigeria, Togo, and Uganda. The data presented in this brief covers these time periods
Fistula Care Plus: Summary of Repair Case Profiles and Outcomes FC+ collected routine client data on surgical and nonsurgical fistula repairs at all project-supported fistula treatment sites through 1.) aggregate facility data, reported on a quarterly basis by treatment sites and entered into a project-developed DHIS2 platform for data storage and analysis and 2.) individual client data collected at a subset of 27 project-supported facilities in four countries. Through these mechanisms, FC+ and project-supported facilities were able to routinely monitor and act upon identified clinical trends at the facility, country, and global levels. This brief summarizes routine, aggregated, and anonymous global and country project data on demand for and provision of fistula repair services and illustrates client profiles including the causes of clients’ fistula, fistula types, surgical outcomes, and family planning (FP) preferences and uptake.
Use of interactive voice response technology to address barriers to fistula care in Nigeria and Uganda. (Fistula Care Plus and Population Council, 2020). The use of digital health technologies has expanded across low-resource settings, including in programs seeking to improve maternal health care seeking and service usage. However, there has been limited use of these technologies for screening and referral within maternal health, and many interventions have relied on SMS tools, which may have limited impact in settings with low female literacy. Digital health technologies have the potential to increase access to care for chronic maternal morbidities, such as obstetric fistula, and for women facing stigma, geographic isolation, and other sociocultural barriers to care seeking. This study documented the process of developing and implementing an innovative fistula screening and referral hotline using interactive voice response (IVR) technology, and described the service usage results and stakeholder perspectives associated with the hotline
Barriers to Fistula Repair in Nigeria: A Formative Study (English, PDF, 364 KB) September 2016. Population Council and EngenderHealth. A formative research study was conducted in Nigeria, building on the results of a systematic review to better understand the barriers and enabling factors for fistula repair care delivery and access. Understanding how Nigerian women living with fistula decide to seek care, identify and reach medical centers, and receive adequate and appropriate care is integral and continues to influence the design of a larger implementation pilot.
Quantitative Analysis of a Retrospective Review of Fistula Cases in Nigeria: Study Report (English, PDF, 567 KB) September 2016. Elly Arnoff, Karen Levin, Ringpon Gwamzhi, Adamu Isah, Vandana Tripathi for EngenderHealth
Qualitative Research on Communication Needs and Channels: Study Report (English, PDF, 681 KB) August 2016. Vandana Tripathi, Caitlin Donaghy, and Anna Wadsworth for EngenderHealth. The Fistula Care Plus (FC+) project conducted an Assessment of Communication Needs for Obstetric Fistula Programming in Nigeria study in early 2016. The study involved in-depth interviews and focus group discussions with a variety of key informants at federal, state, local government authority (LGA), and community levels in each of the focus states. Additionally, the study reviewed existing patient records from FC+ supported fistula treatment sites. The qualitative findings are summarized in one report, and the results from the record review are provided in a second report. Findings from these studies are informing FC+ communications efforts in Nigeria related to fistula prevention, treatment and social reintegration services.
Community-based screening for obstetric fistula in Nigeria: a novel approach. BMC Pregnancy and Childbirth, 2014. Ozge Tuncalp, Adamu Isah, Evelyn Landry, Cynthia Stanton aim to quantify the backlog of obstetric fistula cases within two states in Nigeria via community-based screenings and to assess the questions in the Demographic Health Survey (DHS) fistula module.
For more learnings from Nigeria and other FC+ countries, visit our Resources section.