Bangladesh – Fistula Care Plus

Our Work in Bangladesh

Bangladesh is one of the most densely populated countries in the world. Situated on the Bay of Bengal in South Asia, Bangladesh has a population of more than 150 million that continues to grow. Frequent natural disasters stretch its infrastructure. Bangladesh’s population growth has slowed in recent decades because of the availability and uptake of family planning services. Although maternal mortality has been halved in the past 15 years, there is still roughly one Bangladeshi maternal death every hour, and many births in Bangladesh occur at home, without skilled birth attendants.

USAID-supported fistula services in Bangladesh began in July 2005 through the previous Fistula Care project and now continue through Fistula Care Plus in thirteen hospitals. In addition to the four private hospitals supported under the previous project, FC+ also worked with seven private hospitals and three public sector institutions. The FC+ project has established the University Fistula Center at the Bangabandhu Sheikh Mujib Medical University- the apex institute for clinical learning in Bangladesh.

Supported Sites

Community mobilization Sites:

Brac
NGO Health Service Delivery Project (NHSDP)Supported Sites

Ad-din Hospital/Dhaka is located in the capital city and is one of the not for profit projects of the Ad-din Foundation, dedicated to serving the health needs of women and children. Created by the founder of the business conglomerate Akij Group. Ad-din Hospital’s fistula treatment work is just one piece of its broad portfolio for maternal health. The hospital admits more than 14,000 gynecology and obstetrics patients annually. Most are thought to be middle-income or lower-middle-income patients. The Ad-din Hospital established a low-cost ambulance service in 2008 after recognizing that many women in Dhaka were failing to access emergency obstetric care. Using mobile phones and a global positioning system (GPS) tracking, Ad-din manages a fleet of 66 ambulances stationed throughout the city.

Ad-din Hospital/Jessore is located in Jessore 300 km from Dhaka. It has 130 beds for women and children. Ad-din Hospital,Jessore offers similar inpatient and outpatient services as Ad-din Hospital Dhaka. Ad-dinJessore is linked with a micro-credit based health service delivery network in their adjacent communities..

Ad-din Hospital/Khulna is located in Khulna, in the sounthern parts of our country. It was established in 2013 with 250 beds. Ad-din Hospital, Khulna offers similar inpatient and outpatient services as the Ad-din Hospital Dhaka.

Kumudini Hospital was established by the late R.P. Shaha in 1938 as a modest 20-bed hospital at Mirzapur, Tangail, 70 km north of Dhaka. Since then, it has grown to be one of the largest private hospitals in Bangladesh with 750 beds. The hospital is a part of the Kumudini Welfare Trust, which also runs a medical college, a nursing school, a trade training school, a village outreach program, a handicrafts center, and other public welfare initiatives. These projects are funded through Kumudini Welfare Trust’s income-generating projects.

LAMB Hospital is part of a faith-based integrated health and development project located at Parbatipur, Dinajpur, 350 km from Dhaka. It has been working in the Dinajpur and Rangpur areas of northwest Bangladesh for nearly 30 years. Started in 1983, LAMB Hospital is now a 150-bed general hospital. Much of LAMB’s work takes place in the community, and their safe motherhood program includes training of traditional birth attendants and community-based skilled birth attendants as well providing technical assistance to community-run safe delivery units.

Bangabandhu Sheikh Mujib Medical University (BSMMU) is the premier Postgraduate Medical Institution of the country. It bears the heritage to Institute of Postgraduate Medical Research (IPGMR) which was established in December 1965. In the year 1998 the Government converted IPGMR into a Medical University for expanding the facilities for higher medical education and research in the country. The university has strong link with other professional bodies at home and abroad. Besides education, the university plays a vital role of promoting research activities in various discipline of medicine. BSMMU is the busiest clinical center in Bangladesh with over thousand students doing specialty training in Obstetrics and Gynaecology, Urology, General Surgery, Physical Medicine and other disciplines. The university offers MD, PhD, MS, MPhil, MDS, Diploma and training for fellowship of the College of Physicians and Surgeons (FCPS) courses. University Fistula Center, BSMMU was established in January 2015, with support of Fistula Care Plus project of EngenderHealth Bangladesh. The goal of University Fistula Center (UFC) is to strengthen health system capacity for fistula prevention, detection, treatment and reintegration in Bangladesh.

MAMM’s Institute of Fistula and Women’s Health (MIFWOH) was established in December 2012 with the dedicated initiative of Prof Sayeba Akhter. However, MIFWOH started its operation since 2010 using the facilities of TAQWA Specialized Hospital. Later, in December 2012 the hospital was shifted to its present site. This Dhaka based hospital is primarily dedicated for the treatments of patients with Obstetric Fistula (OF). MIFWOH consists of 22 beds and is managed by 20-25 staff including medical doctors, gynaecologists, urologists, anesthetists, nurses and other auxiliary staff. The services include both in and out-patient service to women suffering from obstetric complications, especially the obstetric injuries such as OF, female genital prolapse, perineal tear, vaginal stenosis, etc; and other birth related complications. This hospital however intends to broaden its reach and focus in the future. In addition to providing free medical services to poor women of Bangladesh, it is also training the doctors and nurses on specialized gynaecological surgeries and supporting poor women with specialized health problems. Till now, a total of 257 operations were carried out and the overall success rate is 90%.

Dr. Muttalib community Hospital and Park Laboratory established in 1981 in Bijoynagar, Dhaka. It consists of 22 beds and is managed by 25-30 staff including medical doctors, gynecologists, urologists, anesthetists, nurses and other auxiliary staff. The services include general surgery, both in and out-patient service to women suffering from obstetric complications, especially the obstetric injuries such as OF, female genital prolapse, perineal tear, vaginal stenosis, etc; and other birth related complications.

HOPE Hospital is a 40-bed, 24-hour hospital in the district of Cox’s Bazar, Bangladesh. This hospital is the pillar of HOPE’s work, where they conduct all of our services services, surgeries, specialized care, research and education. The hospital boasts the following departments: Outpatient, In-Patient, Children’s Ward, Maternity Ward, Laboratory, X-Ray, Labor and Delivery, Emergency Room, Pathology, Physiotherapy, Operation Theater, Pharmacy, Rehabilitation Unit, and Medicine Unit. HOPE hospital is located in the outskirts of Cox’s Bazar, about a 30-minute bus ride from the city. It is a major health care center in the Cox’s Bazar district with a catchment area of over 2000,000 people.

Jhalakathi District Hospital is a hospital located in Jhalokati District Town situated in the south-central part of Bangladesh in the Barisal Division. It is a government district hospital with about 100 beds. Jhalakathi District Hospital will be focused on fistula prevention, partograph use and catheterization services.

Habiganj District Hospital is located in Habiganj District Town situated in the north eastern part of Bangladesh in the Sylhet Division. It is a government district hospital with about 100 beds. Habiganj District Hospital will be focused on fistula prevention, partograph use and catheterization services.

BRAC, an international development organisation based in Bangladesh, is the largest non-governmental development organisation in the world as of June 2015. Established by Sir Fazle Hasan Abed in 1972 after the independence of Bangladesh, BRAC is present in all 64 districts of Bangladesh as well as other countries in Asia, Africa, and the Americas. BRAC employs over 100,000 people, roughly 70 percent of whom are women, reaching more than 126 million people. The organisation is 70-80% self-funded through a number of commercial enterprises, including a dairy and food project and a chain of retail handicraft stores called Aarong. BRAC maintains offices in 14 countries throughout the world, including BRAC USA and BRAC UK. BRAC started providing public healthcare in 1972 with an initial focus on curative care through paramedics and a self-financing health insurance scheme. The programme went on to offer integrated health care services, its key achievements including the reduction of child mortality rates through campaign for oral rehydration in the 80s and taking immunisation from 2% to 70% in Bangladesh. In 2007, BRAC launched two projects focused on bettering maternal, neonatal, and child mortality, namely, Manoshi in certain urban regions and Improving Maternal, Neonatal and Child Survival (IMNCS) in certain rural regions. The programmes cover Dhaka, 7 other city corporations, and 14 of Bangladesh’s 64 districts. From 2007–10, Manoshi’s operations led to a decline in home deliveries from 86% to 25%, and a maternal mortality ratio of 141 (per 100,000 births) compared to the national average of 194. Similarly, in IMNCS areas, hospital delivery doubled to 30% from 15%, and maternal mortality declined to 157 (per 100,000 births). In 2014 BRAC’s community healthcare workers reached 1.6 million women with between one and four prenatal care check ups. They also attended deliveries, and provided birthing huts as an alternative to childbirth at home.

USAID-DFID NGO Health Service Delivery Project (NHSDP) is the largest USAID and DFID co-funded investment in Bangladesh. This project supports the delivery of a primary health care essential service package (ESP) through the nationwide Smiling Sun or ‘Surjer Hashi’ network of 26 local NGOs with 334 static clinics, 9,018 satellite clinics and 6,666 community service providers (CSP). USAID-DFID NHSDP serves approximately 23 million people (about 15% of the total population) of Bangladesh through this massive network.

Bangladesh Resources and Publications

Community-Based Fistula Diagnosis Events: An Innovative Approach to Fistula Screening and Identification in Bangladesh (English PDF, 628 KB) EngenderHealth. Identifying and treating existing fistula cases within Bangladesh is difficult, despite the availability of treatment. Women with fistula often live in isolation and in remote areas, and even when screening activities identify suspected fistula cases challenges such appropriate clinical diagnosis and transportation to a treatment facility pose barriers to care. To address these barriers, the Fistula Care Plus (FC+) project developed a structured approach for fistula case identification, confirmation, and referral that can be implemented closer to the homes of clients: the community-based fistula diagnosis event (CFDE).

Implementation of a Surgical Safety Toolkit in Bangladesh: Program Learning from Routine Client Tracker Data (English PDF, 923 KB) EngenderHealth. While there are existing programs to expand access to surgical repair in many countries with fistula burdens, assuring and improving the quality of these services remains an important need. High-quality data about fistula services are also needed to better manage coverage of surgical care and improve clinical decision-making. In 2016, in response to identified gaps in clinical records, challenges in understanding clinical data trends, and clinical staff requests at project-supported facilities, FC+ developed and introduced the Surgical Safety Toolkit (SST) — a set of clinical trackers and quality assurance checklists designed to support the provision of surgical care for fistula and pelvic organ prolapse in low-resource settings.

Bangladesh Fistula Mission Partnership: Leveraging Assets from the United States Agency for International Development and the Department of Defense to Address a Health Care Crisis in a Developing Nation. Military Medicine, 2020. USAID and the Department of Defense (DOD) developed a novel Interagency Agreement leveraging the surgical skills of military health professionals to scale-up the ongoing fistula care program. The military team supported the surgical repair of 40 pelvic fistulae and perineal tears and provided operative management for an additional 25 patients with pelvic organ prolapse.

Development and Implementation of the 4Q Checklist for Fistula Screening and Referral in Bangladesh (English PDF, 2587, French PDF 2,796KB) EngenderHealth, 2019. The 4Q Checklist is a tool with four fistula screening questions adapted from a fistula diagnosis job aid developed by EngenderHealth and IntraHealth during the prior USAID-fundedFistula Care Project. FC+ modified the job aid to add content related to fistula screening, referral for diagnosis and treatment, and follow-up support.

Prevalence of Obstetric Fistula and Pelvic Organ Prolapse in Bangladesh: Summary of the 2016 National Estimates EngenderHealth and Measure Evaluation, 2018. The Bangladesh Maternal Mortality and Health Care Survey (BMMS) in 2016 aimed to measure national levels of obstetric fistula and pelvic organ prolapse. Partners conducted a complementary study—the Maternal Morbidity Validation Study (MMVS)—to gather information on the validity of the self-reported OF and POP that can then be used to adjust the national level estimate from the BMMS data.

What to measure and why? Experience developing monitoring indicators for an emerging maternal health issue: the case of obstetric fistula. Journal of Health Informatics in Developing Countries. 2015 9(1): 14-22. Carrie Ngongo, Evelyn Landry, Karen Levin, Simon Ndizeye, Iretioluwa Sutton, and Vandana Tripathi recounts the process of developing, refining, and using standardized monitoring indicators as part of a fistula prevention and repair project in fourteen countries—Bangladesh, Benin, Democratic Republic of the Congo, Ethiopia, Ghana, Guinea, Liberia, Mali, Niger, Nigeria, Rwanda, Sierra Leone, Togo, and Uganda.

Assessing the quality of record keeping for cesarean deliveries: results from a multicenter retrospective record review in five low-income countries. BMC Pregnancy and Childbirth. 2014, 14:139
Evelyn Landry, Celia Pett, Renee Fiorentino, Joseph Ruminjo, and Cristina Mattison reviewed a sample of year 2008 cesarean section (CS) records from nine facilities in Bangladesh, Guinea, Mali, Niger, and Uganda. Female Genital Fistula: changing etiologic landscape and policy implications for Bangladesh. A presentation by Dr. Abu Jamil Faisel at the Global Maternal and Newborn Health Conference in Mexico City, Mexico in October 2015.

Living with Obstetric Fistula: Qualitative Research Findings from Bangladesh and the Democratic Republic of the Congo (English, PDF, 1 MB; French, PDF, 750 KB) EngenderHealth, August 2012
What are the social consequences of fistula? What affects how women with fistula are treated? Fistula Care is pleased to announce its latest technical brief, which provides insights into the experiences of women with fistula in Bangladesh and the Democratic Republic of the Congo. This qualitative research examines the lives of women suffering from fistula in two very different sociocultural contexts, including the physical and social consequences associated with the condition and women’s attempts to obtain care.

Low-Cost Ambulance Network to Improve Access to Maternity Services in Dhaka, Bangladesh (English, PDF, 736 KB; French, PDF, 781 KB)
EngenderHealth, March 2012
Transportation to skilled maternity care is critical. In 2008, the Ad-din Hospital recognized that many women in Dhaka were unable to access emergency obstetric care and established a low-cost ambulance service. This technical brief describes how Ad-din uses mobile phones and global positioning system (GPS) tracking to manage a fleet of 66 ambulances stationed throughout the city.

Increasing Access to Maternity Services in Rural Bangladesh: Sustainable Facility-Community Links (English, PDF, 1.1 MB; French, PDF, 1.2 MB)
EngenderHealth, March 2012
The Ad-din Hospital for Women and Children and the LAMB Project in Bangladesh have established community-level services for women in rural, underserved communities. This technical brief describes their noteworthy programs, which ensure community ownership and sustainability. One program is integrated into a microfinance program to enable financial independence; the other empowers community members to truly own and manage its services.

See other clinical and training resources for Bangladesh.

For more research from Bangladesh and other FC+ countries, visit our Resources section.

Our Work in Bangladesh

Supported Sites

Fistula Prevention and Treatment Sites

Community mobilization Sites:

Bangladesh Resources and Publications