Global Briefs
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
support reintegration.
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.
FC+ collaborated with partners to challenge and change the environment, work toward a holistic continuum of care, and engage with communities, governments, and other actors to address the health inequities that lead to genital fistula and limit access to care. Selected highlights from this work are described below.
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.
Briefs by Country
Fistula Care Plus: Bangladesh – Strengthening Health Systems to Prevent and Treat Fistula EngenderHealth’s USAID-supported fistula prevention and repair efforts in Bangladesh began in July 2005 and continued under the Fistula Care and FC+ projects, until March 2020. Fistula is a devastating morbidity, with profound social consequences for those
affected. In Bangladesh, FC+ worked to support fistula repairs and prevent fistula by supporting voluntary family planning, clinical capacity building, and community outreach and education. Between December 2013 and March 2020, FC+ supported approximately half of all fistula surgeries in Bangladesh and mobilized national professional groups, government agencies, civil society platforms, and media institutions to engage in and strengthen strategies to prevent and treat fistula. FC+ also brought attention to emerging aspects of fistula care, including the crisis of iatrogenic fistula caused by unsafe surgery. FC+ provided direct support to 8 health facilities providing fistula treatment and prevention services, 9 facilities providing prevention services, 10 upazila (subdistrict) health complexes, and 200 community clinics; this included public, private, and faith-based health facilities.
Fistula Care Plus: Democratic Republic of Congo (DRC)- Strengthening Health Systems to Prevent and Treat Fistula (English PDF, French PDF) USAID-supported fistula prevention and repair efforts in the Democratic Republic of Congo (DRC) began in 2005 and continued under the Fistula Care and FC+ projects, until March 2021. Fistula is a devastating morbidity, with profound social consequences for those affected. In the DRC, FC+ directly supported six health facilities for fistula treatment and prevention services, including private and faith-based health facilities in five provinces: Kinshasa, Lubumbashi, Maniema, North Kivu, and South Kivu. Through these partnerships, FC+ supported fistula repairs and worked to prevent fistula by supporting voluntary family planning (FP), clinical capacity building, and community outreach and education. The project emphasized strengthening systems for safe surgery (including routine fistula repair), community awareness, FP services integration with fistula and maternal health care, and reintegration of women who have undergone fistula repair. The project also supported FP and fistula prevention services at an additional 318 facilities in Ituri and North Kivu provinces.
Fistula Care Plus: Mozambique- Strengthening Health Systems to Prevent and Treat Fistula EngenderHealth’s USAID-supported fistula prevention and repair efforts in Mozambique began in December 2017 and continued until January 2021. Fistula is a devastating morbidity, with profound social consequences for those affected. In Mozambique, FC+ supported fistula repairs and fistula prevention through organizational and clinical capacity building as well as community
outreach and education. The project strengthened systems for providing safe surgery including building capacity for routine fistula repair, increasing community awareness, integrating family planning (FP) services within fistula and maternal healthcare, and training clinicians. FC+ provided support to nine health facilities for fistula prevention and treatment services.
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).
Fistula Care Plus: Uganda- Strengthening Health Systems to Prevent and Treat Fistula EngenderHealth’s USAID-supported fistula prevention and repair efforts in Uganda began in July 2005 and continued under the Fistula Care and FC+ projects, until May 2019. Fistula is a devastating morbidity, with profound social consequences for those affected. In Uganda, FC+ emphasized building capacity for providing safe surgery including routine fistula repair, community awareness, integrating voluntary family planning (FP) services within fistula and maternal healthcare, and piloting efforts to meet the reintegration needs of clients who have undergone fistula repair. The project partnered with six health facilities for fistula treatment and prevention services and 15 facilities providing prevention services; this included public and faith-based health facilities across seven districts in central, east-central, and western Uganda.
Fistula Care Plus: West Africa Region/Niger and Togo- Strengthening Health Systems to Prevent and Treat Fistula (English PDF, French PDF) EngenderHealth began support for fistula services in West Africa with implementation
of a Bill and Melinda Gates Foundation grant in Niger in 2005. USAID-supported fistula services in the region began in 2007 through the Action for West Africa Region Reproductive Health and Child Survival project (AWARE-RH) and Fistula Care project and continued through FC+ until February 2021. Through funding from the USAID West Africa Region Program, FC+ collaborated with partners in Niger, Togo, and the broader West African region to strengthen the enabling environment for the elimination of fistula through facilitating policy dialogues, building clinical capacity for routine fistula repairs, creating awareness to prevent fistula through community outreach and education, and supporting voluntary family planning (FP).
End of Project Webinars
To watch a recording of the two End of Project webinars held on March 8 and March 22, 2021, please go to the following links.
“Fistula Care Plus Learning Agenda: Partnerships, Research, and Action”– March 22, 2021. The final FC+ webinar showcased research conducted by FC+ and partners around the world to improve fistula prevention and care. Panelists described how the project developed a shared research agenda with stakeholders in Africa and Asia, discussed key learning and the potential to transform fistula programming, and shared effective approaches to build research capacity in low-resource settings. All event participants also had the opportunity to share suggested priorities for where further evidence is needed to support the global community in eliminating fistula by 2030.
“Towards a Fistula-Free Future: 15 Years of Breakthroughs and Program Impact”– March 8, 2021. On International Women’s Day 2021, the USAID Fistula Care Plus project recognized key advancements in fistula prevention and treatment across Africa and Asia. Speakers from EngenderHealth, USAID, and partner organizations shared 15 years of lessons learned and breakthroughs achieved in advancing fistula care, and considered new pathways and partnerships for realizing a Fistula-Free Future.