Technical Briefs

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.

Five Years of Fistula Care Plus: Looking Back at Key Achievements and the Way Forward to End Fistula (English and French PDF, 2476 KB) EngenderHealth. Fistula Care Plus (FC+) is a global project initiated in 2013 by the US Agency for
International Development (USAID) and implemented by EngenderHealth. FC+ builds on and enhances the work undertaken by USAID’s previous Fistula Care project (2007–2013), also led by EngenderHealth. Achievements from the first five years of project implementation (December 2013–December 2018) in Bangladesh, DRC, Mozambique, Niger, Nigeria, Togo, and Uganda are summarized in this brief.

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.

Fistula Care Plus in Uganda: Success Stories (English, PDF, 3439 KB), EngenderHealth. A compilation of success stories from clients, clinicians, and others involved with the Fistula Care Plus project in Uganda.

Improving Quality of Life for Women with Incurable Fistula: A Fistula Care Plus and  TERREWODE Research Partnership in Uganda (English, PDF, 1300 KB) EngenderHealth and TERREWODE. EngenderHealth’s Fistula Care Plus (FC+) project
partnered with a Ugandan organization, the Association for the Rehabilitation and Re-orientation of Women for
Development (TERREWODE), to conduct research on the social reintegration needs of these women and evaluate
the effects of interventions responding to these needs.

Communities and Health Workers Improving Maternal Health Together in Jinja District, Uganda (English PDF 1658 KB, French PDF 1711 KB) EngenderHealth, 2019. In June 2016, Fistula Care Plus introduced the site walk-through (SWT) model in Jinja, Uganda. An SWT is a one-day event that aims to gather the views of community representatives and health providers on challenges and opportunities for increasing access to services at the health facility in order to inform strategies for strengthening linkages between the health facility and the catchment population. The experience of utilizing the SWT model within FC+ Uganda is highlighted in this brief.

Engaging Religious Leaders in Support of Maternal Health in Uganda (English PDF, 1858 KB, French PDF, 1.68 MB) EngenderHealth, 2019. To increase awareness, the FC+ project leveraged existing communication strengths by engaging religious leaders and fostering their support for maternal health and family planning services. This brief documents the FC+ program experience, focusing on the religious leaders’ perspectives and key lessons learned.

Empowering Youth through Social and Financial Life Skills and Healthy Behaviors: Lessons from a Ugandan Pilot (English PDF 1386 KB, French PDF 1370 KB) EngenderHealth, 2019. FC+’s Aflateen PLUS youth engagement strategy paired an integrated curriculum with dual strategies for in- and out-of school youth. This approach could be replicated in Uganda and other low-resource settings to support youth in developing life skills and planning a healthy future.

Caesarean Section Provision and Capacity in Health Facilities in Tanzania (English, PDF, 1015 KB) EngenderHealth and the London School of Hygiene and Tropical Medicine, December 2018. Based on findings from an analysis of caesarean section data in Tanzania, this policy brief outlines recommendations to improve the capacity to provide safe caesarean sections in the country’s health facilities.

The Labor and Delivery Quality of Care Short Observational Index: A User Guide How to Apply an Innovative Tool for Observation-Based Assessment of Facility-Based Care for Mothers and Newborns. Vandana Tripathi, 2016. This guide provides information on why and how to use a validated short observational index to assess quality of labor, delivery, immediate postpartum, and newborn care at health facilities that offer maternity services in low- and middle-income countries. This guide may be used by individuals and teams involved in measuring and monitoring maternal and newborn care, including ministry of health (MOH) supervisors at the regional, district, and facility levels.

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.

Is It Feasible to Implement a Cesarean Indication Classification System? Findings from Five Countries (English, PDF, 3952 KB) EngenderHealth, September 2016 The Fistula Care Project at EngenderHealth, predecessor to the current Fistula Care Plus Project, conducted a study in 2009 and 2010 to assess the feasibility of using an indications-based cesarean section classification system. This brief describes key findings of the study and implications for tracking cesarean section trends.

Iatrogenic Fistula: An Urgent Quality of Care Challenge (English, PDF, 5 MB) EngenderHealth, August 2016
Evidence is emerging that maternal morbidity is related to quality of care challenges: Iatrogenic causes appear to contribute significantly to the burden of genital fistula in low-income countries.The Fistula Care Plus (FC+) project has sought to raise awareness about this important issue, documenting current trends and perceptions related to iatrogenic fistula and identifying actions that partners can take to address the problem. 

Data for Decision Making in Fistula Treatment Services A Supplemental Module for Facilitative Supervision EngenderHealth 2014.  One of the four program results of the Fistula Care project is specifically targeted on the use of data:
“Gather, analyze, and report data to improve the quality of performance of fistula services.” Other ongoing activities in support of this result include conducting research studies and strengthening the capacity of our partners in the use of data for decision making. The use of data for decision making is an integral part of Fistula Care’s and EngenderHealth’s shared approach to quality improvement.

Improving Partograph Use in Uganda through Coaching and Mentoring (English, PDF, 1.82 MB; French, PDF, 1.4 MB) EngenderHealth, August 2013
Since 2010, Fistula Care has collaborated with the Reproductive Health Department of the Ugandan Ministry of Health to strengthen partograph use. This technical brief describes the challenges and achievements of developing and implementing a new approach to support partograph use in five facilities across three districts and makes recommendations for future partograph programming at the national, district, and facility levels.

Creating an Enabling Environment for Fistula Prevention and Treatment in Uganda (English, PDF, 14 KB; French, PDF, 2.1 MB) EngenderHealth, March 2013
The Fistula Technical Working Group was established by the Ugandan Ministry of Health’s Clinical Services Department to ensure equitable access to health care for women with fistula, promote prevention strategies, maximize the efficient use of resources, eliminate duplication of effort, and foster a community of providers. This brief describes three important achievements of the Uganda Ministry of Health and the Fistula Technical Working Group: building an information base for obstetric fistula to better plan for and manage prevention, treatment, and reintegration services; integrating fistula services into the Uganda health system; and establishing standards, guidelines, and protocols to guide services.

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.

Community-Based Screening for Obstetric Fistula in Ebonyi State, Nigeria  (English, PDF, 981 KB; French, PDF, 1.25 MB) EngenderHealth, March 2012
In 2007, the Mother and Child Care Initiative (MCCI) was launched in Ebonyi State, under the leadership and support of the governor’s wife, the Honorable Mrs. Josephine Elechi. In 2008, prior to the construction of a new obstetric fistula center in the state, MCCI coordinated with local governments to deploy a specialized medical team to conduct community-based screening for obstetric fistula throughout Ebonyi State, in order to estimate the potential backlog of women needing fistula repair surgery. This technical brief describes the planning process for the community screening and the results of this effort.

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.

Integrating Fistula Treatment and Prevention: The Launch of a Maternity Unit in Sierra Leone (English, PDF, 2.3 MB; French, PDF, 1.6 MB)
EngenderHealth, January 2012
The Aberdeen Women’s Centre maternity unit began offering delivery services in May 2010. Today, its dedicated staff provide hundreds with women high-quality maternity services each year. This brief details the challenges of opening a maternity centre, and the factors that have led to the success of the clinic today.

Making Mobile Phones Work for Women with Fistula: The M-PESA Experience in Kenya and Tanzania (English, PDF, 2.2 MB; French, PDF, 666 KB)
EngenderHealth, March 2011
This brief discusses the work of the Freedom from Fistula Foundation in Kenya and Comprehensive Community Based Rehabilitation in Tanzania. Both programs use an innovative combination of mobile banking and community education to provide free fistula treatment to women who need it.

Beyond Repair: Involving Communities in Fistula Prevention and Reintegration–Experience from Kissidougou, Guinea (English, PDF, 1.96 MB; French, PDF, 3.3 MB) EngenderHealth, September 2010
This brief discusses engaging local government and community members in treatment, reintegration and prevention of fistula.

A Collaborative Network to Improve Access to Fistula Treatment in Nigeria (English, PDF, 3.38 MB; French, PDF 600 KB) EngenderHealth, August 2010
This brief describes the pooled effort strategy that the Nigeria team has been leading to expand access to fistula repair services.

Fistula Pre-Repair Center Model in the Amhara Region of Ethiopia (English, PDF, 467 KB; French, PDF 639 KB) EngenderHealth, November 2009
This brief provides readers with an overview of USAID support to three pre-repair centers in the Amhara Region which are part of a partnership with the Amahara Regional Health Bureau and the Bahir Dar Hamlin Fistula Hospital.