Fistula Care Promotes Family Planning Integration to Prevent Fistula in Rwanda

Family planning is a key element in improving maternal health services and preventing obstetric fistula. The Fistula Care Project, the Rwandan Ministry of Health, and the Rwanda Medical Association recently hosted an important stakeholders’ meeting to discuss family planning integration. The meeting, which took place December 7 and 8, 2009, at the Serena Hotel in Kigali, was attended by representatives of more than 70 regional and district health providers, local and international nongovernmental organizations, and other donor agencies working in maternal and reproductive health. The meeting focused on fistula prevention through the integration of family planning into fistula treatment and other maternal health services. The goal of the meeting was two-fold: to engage policy makers, health care officials, and leaders at the district and national levels in the issue of fistula in Rwanda, and to stimulate thinking among stakeholders about the value of family planning in fistula prevention and the role that they can play in facilitating integrated fistula services.

The opening speech was delivered by the Permanent Secretary of the Ministry of Health, Dr. Agnes Binagwaho, who expressed the view that the meeting participants’ engagement would be critical to developing a national strategy to eradicate fistula in Rwanda. Speeches were also given by the USAID Rwanda Representative, Nancy Godfrey, and the Vice President of EngenderHealth, Dr. Isaiah Ndong. The first day of the meeting focused primarily on engaging stakeholders in dialogue about the issue of fistula in Rwanda through presentations and open discussions about fistula statistics, causes, and prevention mechanisms. The day concluded with a reception to celebrate the opening of EngenderHealth’s office in Kigali. The reception included a welcoming speech from Dr. Ndong, a presentation of the EngenderHealth Rwanda staff, and traditional Rwandan music and dance.

The second day of the meeting concerned the integration of family planning with fistula care services. A particular emphasis was placed on the Levels of Family Planning Integration, which enable a site to integrate services according to its capacity. At one end of the spectrum, facilities could provide only family planning counseling and referrals, while at the next level, facilities would counsel, refer, and offer pills, condoms, and cycle beads. At the highest level of family planning integration, facilities would counsel, refer, and offer all contraceptive methods, including surgical methods such as vasectomy and female sterilization. The stakeholders participated in small-group work to generate achievable recommendations to the Ministry of Health for developing a strategic plan to integrate family planning with fistula and other maternal health services.

The Fistula Care Project is currently working with three sites in Rwanda to treat and prevent fistula: Centre Hospitalier Universitaire de Kigali (CHUK), Kanombe Hospital, and Ruhengeri Hospital. Fistula Care will work with these sites and two to three additional facilities to improve fistula prevention and strengthen family planning service delivery. The project is also working with the National Fistula Technical Working Group, through the Division for Safe Motherhood, to develop a comprehensive strategy for fistula management in Rwanda.