“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
“Integrating Physical Rehabilitation to Strengthen Fistula and Maternity Care” – September 30, 2020. The USAID-funded Fistula Care Plus project, with partners Panzi Foundation and Mama, LLC, hosted a webinar to discuss the impact of integrating physical rehabilitation in fistula and maternity care. Maternal morbidities such as pelvic organ prolapse and obstetric fistula affect women’s ability to carry out daily tasks and participate fully in society. Surgical treatment is often required to fully repair these conditions. However, for many women, physical therapy (or physiotherapy-informed treatment) can make a profound impact on the severity of symptoms and quality of life. Despite this impact and the low cost of physical therapy relative to many other interventions, these services are often a missing piece in health care, particularly in low-resource settings. During the webinar, a new and innovative resource, Implementing Physical Rehabilitation Services into Comprehensive Fistula and Maternity Care: A Training Guide for Health Workers, was presented by physiotherapists from Mama, LLC. The training guide is a practical tool for health care workers to introduce physical rehabilitation services into comprehensive fistula and maternity care. Case studies were also provided on the successful integration of physiotherapy at the Panzi General Reference Hospital in Bukavu, DRC.
“Innovative Solutions to Reduce Barriers to Fistula Care” – April 9, 2020. The USAID-funded Fistula Care Plus (FC+) project, with partners Population Council and Viamo, to discuss learnings from an intervention to improve access to fistula care in Nigeria and Uganda. Despite the expansion of fistula treatment programs in several affected countries, many women lack information about or access to fistula diagnosis and treatment. 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 socio-cultural barriers to care-seeking. 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.
The FC+ project, led by EngenderHealth, recently completed a research-to-action collaboration in partnership with the Population Council to identify and address hurdles to fistula diagnosis and repair in Nigeria and Uganda. The research documented the process of developing and implementing an innovative fistula screening and referral hotline using Interactive Voice Recognition (IVR) technology and described the service usage results and stakeholder perspectives associated with the hotline.
During the virtual panel, guest panelists from the FC+ project, Population Council, Viamo, and USAID, shared lessons learned for the sustainable scale-up and integration of digital health solutions for health screening and treatment programs, as well as for interventions to address stigmatized and neglected conditions. Using multiple communication pathways, strong links to community health systems, and an innovative digital health solution developed in partnership with Viamo that targets stigma and literacy barriers, FC+ increased access to fistula screening and referral. The intervention responded to highly gendered barriers to health information and care and helped hundreds of underserved women access free fistula screening, diagnosis, and treatment services.
“A Global Survey of Skilled Birth Attendants on Intra- and Post-Partum Bladder Care and Management of Prolonged/Obstructed Labor” – April 10, 2018. In 2017, the USAID-funded Fistula Care Plus project of EngenderHealth conducted a key informant survey of skilled-birth attendants (SBAs) to better understand the range of intra-partum and post-partum clinical practices in low- and middle-income countries (LMICs). The survey examined SBAs’ training, knowledge, practices, and facility environment as they relate to intrapartum and postpartum bladder care and management of prolonged/obstructed labor. During this webinar, presenters Vandana Tripathi, Elly Arnoff, and Sheena Currie shared the findings from this global SBA survey and discussed programmatic and research implications, particularly for midwifery training and practice.
“Webinar on Cesarean Section Safety and Quality in Low-Resource Settings: Highlights from a Global Technical Consultation”- November 9, 2017. Cesarean section provision has expanded rapidly in low- and middle-income countries (LMICs). While this includes needed growth in emergency obstetric and newborn care, evidence indicates that many cesarean sections are performed in settings where minimum standards for care quality and surgical safety cannot be met. Iatrogenic fistula resulting from cesarean section now accounts for a substantial proportion of fistula incidence in LMICs.
The Fistula Care Plus project and the Maternal Health Task Force recently convened a consultation to understand the causes of and potential solutions to this challenge. Participants included clinicians and researchers in LMICs, at global institutions, and in the United States. Following presentations of global cesarean section trends, participants discussed flashpoints in safety and quality (e.g., workforce density, task shifting, clinical decision making, and client rights). The proceedings showcased evidence of severe gaps (e.g., staffing, infrastructure, protocols) undermining cesarean section care quality and surgical safety and public health impacts of cesarean section underuse and overuse. Participants identified a consensus agenda to respond to these challenges through action across the maternal, newborn, and safe surgery communities. Implementation of this agenda is essential for realizing the potential impacts of universal access to essential obstetric surgery.
“Obstructed labor does not end at delivery: Strengthening postpartum care following prolonged/obstructed labor” – June 20, 2017. The USAID-funded Fistula Care Plus project of EngenderHealth convened a breakfast panel discussion cosponsored by Bard Medical on postpartum care following prolonged/obstructed labor (P/OL) at the 31st International Confederation of Midwives (ICM) Triennial Congress in Toronto, Canada. The panel was moderated by Dr. Lauri Romanzi, FC+ Director, and involved the following panelists: 1) Vandana Tripathi, FC+ Deputy Director; 2) Pandora Hardtman, International Midwifery Consultant; 3) Ekpoanwan Esienumoh, Senior Lecturer and Professor of Midwifery at University of Calabar, Nigeria; and 4) Jeffrey M. Smith, Vice President, Jhpiego. Panelists discussed gaps in guidelines for intrapartum and postpartum care, and highlighted practices to prevent and manage morbidity, focusing on bladder care and urinary catheterization, as well as sepsis prevention, recognition, and treatment.
“After Fistula Repair: Understanding Women’s Needs” – April 10, 2017.
The USAID-funded Fistula Care Plus project of EngenderHealth hosted a webinar discussion on understanding women’s needs after fistula repair in Uganda on Monday, April 10, 2017. Genital fistula, whether obstetric, iatrogenic, or from other causes, is a devastating condition with profound health and psychosocial impacts. Surgical repair can restore continence to women who have been living with fistula.
However, most fistula programs are unable to follow women after they are discharged from care; consequently, clients’ success in reintegration and their mental and physical health trajectories are not well understood. In order to better understand the long-term outcomes of fistula repair, Makerere University in Uganda and the University of California, San Francisco recently conducted a one year longitudinal study to develop a measure of postsurgical reintegration success and document physical and mental health changes among repaired clients. During the webinar, presenter Alison El Ayadi reviewed the results from this study, while commentators Moustapha Diallo and Rose Mukisa discussed the implications of these findings for the Fistula Care Plus project. Bethany Cole moderated a discussion with questions from webinar attendants.
To read more about the UCSF and Makerere research, including answers to questions raised during the webinar, visit the FC+ blog.
“Obstetric Fistula and Gender-Based Violence: Examining the Linkages” –Feb 22, 2017.
Reproductive outcomes, including maternal morbidities, have a direct impact on a woman’s vulnerability to intimate partner and sexual violence. A new multi-country analysis of data from the Demographic and Health Surveys (DHS) has found that women reporting symptoms of gynecological fistula are also more likely to report experience of physical and sexual violence. These findings raise important questions about the temporal and causal relationships between fistula and gender-based violence (GBV) and about how programs can better serve women throughout their experiences of seeking health services. During the webinar, moderator Lauri Romanzi and presenters Lindsay Mallick and Vandana Tripathi reviewed the literature on fistula and GBV, presented results from the DHS data analysis, and discussed the research and program implications of these findings.
“Surgical Safety Toolkit Webinar”– February 8, 2017.
EngenderHealth’s Fistula Care Plus (FC+) project has published an important new resource, the FC+ Surgical Safety Toolkit (SST), which will advance safe surgical practices and improve health outcomes for women affected by fistula. The SST consists of an adaptable system of quality assurance tools and safety checklists that aim to standardize surgical care. The toolkit is the first resource available to offer checklists designed for women with fistula, prolapse, and incontinence. The checklists are universal, so they can also be used for any type of surgery offered by health facilities. Available in both French and English, the SST will help surgeons and health care providers improve safety and quality of care around fistula surgery—from admission to care long after discharge from the health facility—to ensure the best possible health outcomes for women. Lauri Romanzi, Project Director of FC+ moderates a webinar to showcase the SST and how to use it.
“A Call to Action to End Iatrogenic Fistula”– Aug 17, 2016.
Evidence is emerging that iatrogenic causes contribute significantly to the burden of genital fistula in low-income countries. Given the preventability and severity of fistula, data on iatrogenic fistula indicate the urgency of improving surgical training, supervision, and facility capacity, particularly amid increasing rates of cesarean section and gynecologic surgery in low-income countries. While data indicate the need for a consistent definition of iatrogenic fistula, people working on these issues have yet to reach a consensus on definitions or a minimum acceptable standard of surgical care in low-income countries. During the webinar, moderator Bethany Cole and presenters Dr. Lauri Romanzi and Dr. Vandana Tripathi aimed to further the global effort to address these important issues.