Scaling up Investment towards a birth injury that can be prevented
International Day to End Obstetric Fistula (IDEOF) is set aside on 23rd May to recognize the suffering of women living with Female Genital Fistula. On this day, we recognize Government, stakeholders, and healthcare workers efforts towards a global goal of ending fistula by 2030. This year’s theme is “End Fistula Now: Invest in Quality Healthcare, Empower Communities!”
To mark this year’s IDEOF celebrations, the Ministry of Health in partnership with Tharaka Nithi County, Beyond Zero, UNFPA, M-PESA Foundation, AMREF and Flying Doctors Society of Africa have launched a free medical and fistula treatment at the Chuka County Referral Hospital from 21st to 27th May 2022. The camp, targets to offer free fistula repair surgery to 50 women, a number that is a drop in the ocean compared to the number of women living with fistula; an estimated backlog of over 300,000 fistula cases as per the last UNFPA report released in 2014.
Dr. Anthony Wanjala, a fistula Surgeon explains that “Fistula condition most often occurs as a result of prolonged and obstructed labour but can also be caused by surgical trauma or accidents, some forms of Female Genital Mutilation (FGM), sexual violence, cervical cancer and poverty that lead to malnutrition thus stunted growth” Most women living with fistula hide away in shame. The mental health emanations of fistula in women have been previously documented to include stigma, social isolation, divorce, psychological distress as well as depression in severe cases. Tanya Nduati, CEO of Flying Doctors Society of Africa highlights an important factor for the community to take cognizant of; the mental state of fistula survivors. Fistula does not just affect the women physically but also mentally and there is a collective need by all partners in the fistula space to help the women reintegrate back to society well after their recovery.
In Kenya, statistics from (WHO) indicate that 100,000 new fistula cases are recorded annually and that, 3 to 4 women for every 1,000 deliveries stand a chance to develop fistula. Female Genital Fistula (FGF) affects women and girls across the continent, mainly from poor backgrounds with little or no access to healthcare. It manifests itself as an abnormal communication between the urinary bladder or rectum and birth canal, which leads to uncontrolled, continuous leakage of urine and/or faecal matter, uncontrolled gas from the birth canal and foul smell. Obstructed labour with a risk of fistula, accounts for 6% of all maternal deaths and prenatal loss if left untreated. It is not only as a maternal public health concern but also a development and human rights issue, granting the right to a healthy and dignified life of women and girls.
The Kenyan Constitution under Article 43 (1) of the Bill of Rights guarantees women access to health care, promoting health care issues including reproductive health care. The Government has put in efforts to improve maternal health under the Sustainable Development Goal (SDG) 3, SDG 5 on achieving gender equality and empowering all women and girls, and partly SDG 1 to end poverty in all its manifestations by 2030. Mr. Anders Thomsen, UNFPA Representative in Kenya, notes that Government efforts to scale up access to skilled birth attendance through UHC, Linda Mama, and Her Excellency the First Lady’s Beyond Zero medical safari have led to significant improvements in maternal health outcomes in the country. The National Strategic Framework on Female Genital Fistula in Kenya and Female Genital Fistula Training Manual for Health Workers have also been developed to achieve the vision of “A Fistula free Kenyan Nation.”
“Progress has however been slow in ensuring that treatment of fistula is integrated in the routine surgical procedures within the health facilities, including the allocation of budgetary resources towards elimination of fistula,” says Mr. Thomsen.
Fistula can be prevented through investment in quality emergency obstetric care services and advocacy. It is also treatable by equipping medical facilities and training fistula surgeons and Community Health Workers (CHW). However, the cost of a fistula repair is often too high and ranges between Kshs. 50,000 to Kshs 450,000 depending on the nature of facility whether, public or private hospital.
Angella Langat, the Coordinator of Beyond Zero in her remarks stated that “The national framework provides for fistula repairs as a routine service but the uptake of NHIF is still low as the women are not able to pay the monthly NHIF fee of Ksh. 500.” She further noted that concerted efforts of partners through rotational camps continue to act as a stop gap to allow access for treatment. Inclusion of women into the NHIF scheme can however reduce the economic burden to the women.
The government’s obligation is to intensify actions against FGF and set maternal preventive health standards in ending the occurrence of fistula. Partners, including private sector stakeholders, can support to strengthen these efforts by supplementing the Governments interventions through advocacy and resource mobilization to build the capacity of level 4 and 5 health facilities to manage fistula patients routinely among other prevention, treatment and reintegration measures.
This collaboration supplements Government interventions in creating awareness on fistula, providing access to medical service and financially investing in building medical capacity of healthcare workers across the country towards eliminating Female Genital Fistula and other maternal morbidity by 2030. Together lets end fistula now by investing in quality healthcare system and empower communities!
Clara Mihadi is Marketing and Fundraising professional at The Flying Doctors Society of Africa
