APPENDIX A: FC+ PLANNED AND ACTUAL SUPPORTED SITES, FY 17/18
Country/Site Sector Planned Actual FY 17/18 FY 17/18
T: Treatment & Prevention P: Prevention-only Bangladesh: 15 sites 7T, 4P 7T, 8P Ad-Din Dhaka Private T T Ad-Din Khulna Private T T Kumudini Hospital Private T T LAMB Hospital FBO T T Bangabandhu Sheikh Mujib Medical Government T T University Dr. Muttalib Community Hospital Private T T Mamm's Institute of Fistula & Women's Private T T Health Ad-Din Jashohor Private - P Hope Foundation Hospital NGO - P Gaibandha District Hospital Government - P Jhalakathi District Hospital Government - P Rangpur District Hospital Government P P Satkhira District Hospital Government P P Bhola District Hospital Government P P Ranagmati District Hospital Government P P 200 community clinics supported for 4Q Government checklist roll out DRC: 4 sites 5T 4T St. Joseph’s Hospital/Satellite Maternity FBO T T Kinshasa Panzi Hospital FBO T T HEAL Africa FBO T T Beniker Hospital FBO - T Imagerie Des Grands-Lacs Private T Support suspended Maternité Sans Risque Kindu Private T Support suspended Mozambique: 3 sites 2T 3T Hospital Central Maputo Government T T Clinica Cruz Azul Government T T Nampula Central Hospital Government - T WA/Niger: 9 sites 3T, 6P 3T, 6P Centre de Santé Mère / Enfant (CSME) Government T T Maradi Centre National de Référence des Government T T Fistules Obstétricales (CNRFO),Niamey Centre de Santé Mère /Enfant (CSME) Government T T Tahoua Madarounfa District Hospital, Maradi Government P P Guidan Roumji District Hospital, Maradi Government P P Bouza District Hospital Government P P Illela District Hospital Government P P Mayahi District Hospital Government P P Dakoro District Hospital Government P P Nigeria: 741 sites 14T, 770P 14T, 682P General Hospital, Ningi Government T T General Hospital, Ogoja Government T T National Fistula Center, Abakaliki Government T T
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Country/Site Sector Planned Actual FY 17/18 FY 17/18
T: Treatment & Prevention P: Prevention-only Laure VVF Center Government T T National Fistula Center, Babbar Ruga, Government T T Katsina Gesse VVF Center, Birnin Kebbi Government T T Sobi Specialist Hospital, Ilorin Government T T Maryam Abatcha Women and Children’s Government T T Hospital, Sokoto Maryam Abatcha Women and Children’s Government T T Hospital, Yobe Faridat General Hospital, Gusau Government T T University College Hospital, Ibadan Government T T Adeoyo General Hospital, Ibadan Government T T Gambo Sawaba General Hospital, Kofar Government T T Gayan, Zaria, Kaduna State Wesley Guilds Hospital, Osun State Government - T Prevention only sites Government 270P 18223 Former TSHIP sites Government 500P 500P Uganda: 20 sites 5T, 13P 6T, 14P Kitovu Mission Hospital FBO T T Kamuli Mission Hospital FBO T T Kisiizi Mission Hospital FBO - T Hoima Regional Referral Hospital Government T T Masaka Regional Referral Hospital Government P P Jinja Regional Referral Hospital Government T T Bwera General Hospital Government P P Kiyumba HC IV Government P P Kyanamukaka HC IV Government P P Kalungu HC III Government P P Karambi HC III Government P P Kigorobya HC IV Government P P Azur HC IV FBO P P Buseruka HCIII Government P P Kikuube HCIV Government P P Buraru HCIII Government P P Rwesande HCIV FBO P P Kagando Hospital FBO T P Lukolo HCIII Government P P Kagadi General Hospital Government - T USAID Supported, Non Fistula Care Plus 12T, 217P IntraHealth (Mali) 4T, 44P JHPIEGO (Guinea) 4T Jinnah Post Graduate Medical Center 1T (Pakistan) Pathfinder (Ethiopia) NA PROSANI (DRC) 1T MCSP (Rwanda) 2T, 173P TOTAL USAID supported FC+ = 36T, 793P = 37T, 710P= 6 Countries 829 sites 747 sites TOTAL USAID supported, bilateral (non FC+) = 12T, 217P= 6 Countries 229 sites TOTAL USAID supported, All Projects = 49T, 927P = 11 countries 976 sites
23 In Nigeria, 76 prevention-only sites were identified as being supported by both FC+ and by JHPIEGO, at the mission’s request FC+ ended support to those sites and added sites in Cross River and Osun States.
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APPENDIX B: FC+ PARTNERSHIPS, BY COUNTRY, FY 17/1824
Country Partners Nature of Partnership Bangladesh Government of Bangladesh
Ministry of Health and Family Endorsement and dissemination of National Welfare (MOHFW) Fistula Strategy and National Action Plan, participation in National Task Force on Obstetric Fistula, Vouchers Directorate General of Health National Task Force and Action Plan Services (DGHS) development, Government M7edical College and District Hospitals, partograph use, C- Section, strengthening HMIS, surgical training Directorate General of Family FP integration, community outreach Planning (DGFP) Ministry of Social Welfare (MOSW) Reintegration, WDI and Ministry of Women and Children’s Affairs (MCWC)
Quality Improvement Secretariat Establishment of Technical Committee on (QIS), Health Economics Unit, Fistula Ministry of Health Obstetrical and Gynecological Society of Partograph use, C-Section, and safer surgery Bangladesh (OGSB) practice UNFPA National Task Force, strengthening HMIS, policy, Increase treatment capacity, Surgical training, safer surgery agenda NGO Health Delivery Service Program Community outreach and fistula/POP (NHSDP) screening Direct Relief Drugs and disposable surgical supplies Hope Foundation Hospital Strengthening HMIS and FP services Save The Children (MaMoni) BMMMS implementation ICDDRB BMMMS implementation DRC Ministry of Health Fistula prevention and treatment Coordination SMNEA (Health of the Mother, Newborn, Child and Adolescent) Task Force Dissemination of SMNEA standards and guidelines Access to Primary Health Care Project Fistula prevention and treatment, (ASSP) (DFID) Community outreach PROSANI Plus (Projet de Santé Intégré), Fistula prevention and treatment Integrated Health Project (IHP), USAID UNFPA Fistula prevention and treatment Direct Relief Drugs and disposable surgical supplies WA/Niger Ministry of Health Coordination, strategy Centre National de Référence des Fistules Training, treatment and research Obstétricales (CRNFO) Agir pour la Planification Familiale (AgirPF) Fistula prevention, coordination UNFPA Fistula prevention and treatment REF Fistula treatment, community outreach Health and Development International (HDI) Community outreach Community committees Community outreach Mozambique Focus Fistula Fistula prevention and treatment MISAU (Ministry of Health) Fistula prevention and treatment UNFPA Fistula prevention and treatment
24 This list reflects partnerships in FY 17/18. This list does not include supported sites or other fistula projects supported by USAID bilateral funds.
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Country Partners Nature of Partnership Nigeria Federal Ministry of Health (Fistula Desk Coordination Office) UNFPA Coordination with ongoing activities Médecins Sans Frontières (MSF) Referral and coordination Media, CBOs, Women’s Groups, Ward Community outreach Development Committees, Religious Leaders, Transport Unions. Traditional Rulers Population Council Barriers to treatment National Obstetric Fistula Working Group National fistula prevalence study Daughters of Virtue and Empowerment Community outreach Network (DOVENET) Gender Development Organization in Nigeria Community outreach (GEDON) Center for Community Excellence (CENCEX) Community outreach Federation of Muslim Women's Associations Community outreach in Nigeria (FOMWAN) KYI Community outreach Institute of Social Works of Nigeria (ISOWN) Community outreach Radio Nigeria (FRCN) Public-private partnerships Uni-Gold Medical supplies Direct Relief Drugs and disposable surgical supplies Sun of Hope Foundation Public-private partnerships Islamic Medical Association of Nigeria Public-private partnerships Uganda Ministry of Health(MoH) including all FC+ Fistula prevention and treatment, National supported public facilities technical working groups PPFP integration into National Program Review of National RH Policy guidelines Ministry of Education, Sports, Science and Capacity building for midwifery tutors Technology Possible collaborative partnership to support adolescent/youth reproductive health programming for the youth in school. District Health Offices (Masaka, Kasese, Fistula prevention and treatment Kalungu, Hoima, Jinja, Kamuli) interventions; Quality improvement in facilities TERREWODE Social reintegration, particularly with WDI/Persistent fistula-related disorder AMREF Fistula prevention and treatment Population Council Barriers to treatment Direct Relief Drugs and medical supplies UNFPA Fistula prevention and treatment Uganda Health Marketing Group FP Commodities Village Health Teams, Religious groups, Community outreach and sensitizations Women’s groups Parliament of Uganda –Uganda Women Advocacy on maternal health issues including Parliamentary Association, National fistula; Community outreaches and (Members of parliament), District and mobilization for prevention and treatment local political leaders, the media JPHIEGO Postpartum FP programming including capacity building of health workers, Ministry of Gender, Labour and Social Integrating gender into advocacy for obstetric Development prevention Private Not-For-Profit hospitals and health Fistula prevention and treatment facilities Radio stations Public-private partnerships; Promoting fistula awareness Private Education Development Network Implementation of youth-focused (PEDN) interventions Uganda Village project Fistula prevention and treatment
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Country Partners Nature of Partnership Clinton Health Access Initiative (CHAI) RH Logistics and supplies management, NXT cascade in 4 districts (Kasese, Kalungu, Jinja and Kamuli) FHI 360 Communications initiative USAID RHITES South West Fistula treatment, follow-up/reintegration USAID RHITES East Central Fistula treatment, follow-up/reintegration Advocacy For Better Health (ABH) Advocacy for fistula management American College of Obstetrics and Essential training of medical officers in safe Gynecology (ACOG) surgery
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APPENDIX C: FC+ PARTNERSHIPS WITH FAITH-BASED ORGANIZATIONS (FBOS)
Country FBO FC+ Objective(s) Key Activities Populations Served Timeframe Mechanism/Funding Amount Bangladesh LAMB Hospital 4 Fistula prevention Fistula clients, December 2013 Subaward and treatment health workers - present services, surgeon training DRC St. Joseph 2,4 Fistula prevention 100 fistula clients in December 2013 Subaward: $895,989 Hospital and treatment FY 17/18, Women - present services, of reproductive age Community in district, health meetings at workers Paikongila, Kikwit in Bandundu Province, Surgeon training Heal Africa 2,4 Networking with 150 fistula clients in December 2013 Subaward: $695,255 Hospital five religious FY 17/18, Women – present associations, ten of reproductive age schools and three in district, health community workers meetings with NEHEMIAH club at HEAL Africa, fistula prevention and treatment services, outreach activities Panzi Hospital 2,4 Panzi General 200 fistula clients in December 2013 Subaward: $986,196 Reference Hospital FY 17/18, Women – present networks with of reproductive age BADILIKA project, a in district, Health local radio SEVEN, workers five religious associations, ten schools and eetings with Maison Dorcas, fistula and POP prevention and treatment services, outreach activities
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Country FBO FC+ Objective(s) Key Activities Populations Served Timeframe Mechanism/Funding Amount Beniker 2,4 Fistula prevention 80 fistula clients in April 2018 - Professional Services Hospital and treatment FY 17/18 present Agreement (PSA) services Nigeria Federation of 2 Community Religious leaders, April 2017 - Professional Service Muslim outreach, clients Men and women of present Agreement (PSA) Women's mobilization, reproductive age, $40,425.33 Associations in awareness creation fistula clients Nigeria and information (FOMWAN) dissemination Islamic Medical 4 Fistula prevention Fistula clients, July 2016 - Public-private partnership Association of and treatment Health workers present Nigeria services Uganda Hoima Diocese 2 Women of January 2013 - Project funds (Catholic) reproductive age, present men, youth in Mid- western Uganda Bunyoro Kitara 2 Women of January 2013 - Project funds Diocese reproductive age, present Conduct regional (Anglican) men, youth in Mid- joint advocacy western Uganda meetings Masaka 2 Women of January 2013 - Project funds with religious Diocese reproductive age, present leaders for (Catholic) men, youth in Mid respective district, Central Uganda creation of fistula West Buganda 2 Women of January 2013 - Project funds awareness, SRH, Diocese reproductive age, present and fistula referral (Anglican) men, youth in Mid Central Uganda Masaka District 2 Women of January 2013 - Project funds Muslim Council reproductive age, present men, youth in Mid Central Uganda Kamuli Mission 2,4,5 Fistula treatment, Women of January 2016 - Sub award Hospital prevention and reproductive age in present Project funds surgeon training; East Central Capacity building Uganda, fistula on clients, men; institutionalization Health workers; of the partograph/ Fistula clients; EMNOC; Integration of FP
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Country FBO FC+ Objective(s) Key Activities Populations Served Timeframe Mechanism/Funding Amount information, Patients and clients counselling and attending MCH referral in MCH and services fistula treatment; Support for IPC; Data for decision making, data quality assessment Kitovu Mission 2,4,5 Fistula treatment, Women of January 2016 - Sub award Hospital prevention and reproductive age in present Project funds surgeon training; East Central Capacity building Uganda, fistula on clients, men; institutionalization Health workers; of the partograph/ Fistula clients; EMNOC; Patients and clients Integration of FP attending MCH information, services counselling and referral in MCH and fistula treatment; Support for IPC; Data for decision making, data quality assessment Kagando 4 Capacity building Health workers; December Project funds Mission on Women on 2013 - present Hospital institutionalization maternity wards for of the partograph delivery and /EMNOC; immediate Integration of FP postpartum care; information, Patients and clients counselling and attending MCH/FP referral in MCH and services fistula treatment; Support for IPC Building capacity of seven lower level health facilities (HSD) for scaling up institutionalization
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Country FBO FC+ Objective(s) Key Activities Populations Served Timeframe Mechanism/Funding Amount of the partograph /EMNOC Kisiizi Mission 4 Fistula treatment, Women of January 2018 - Sub award Hospital prevention and reproductive age in present Project funds surgeon training South Western Uganda, fistula clients
Azur Christian 4 Capacity building Health workers; December 2013 Project funds HC IV on Women on - present institutionalization maternity wards for of the partograph/ delivery and EMNOC; immediate Integration of FP postpartum care; information, Patients and clients counselling and attending MCH/FP referral in MCH and services fistula treatment; Support for IPC
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APPENDIX D: NUMBER OF USAID-SUPPORTED FISTULA REPAIR SURGERIES BY COUNTRY, SITE AND YEAR
Pre-FC Fistula Care Fistula Care Plus TOTALS
FY05- FY FY FY FY FY FY FY FY FY Grand FY 16/17 FY 17/18 Pre-FC FC FC+ FY07 07/08 08/09 09/10 10/11 11/12 12/13 13/14 14/15 15/16 Total
FY05- FY08- FY14- FY05- Country/Site Total Total Total Total Total Total Total Total Total Total Total Total FY07 FY13 FY18 FY18 Africa Mercy Benin NS NS 110 21 20 NS NS NS NS NS NS NS NS 151 NS 151 Ghana 63 NS NS NS NS NS NS NS NS NS NS NS 63 NS NS 63 Liberia NS 59 NS NS NS NS NS NS NS NS NS NS NS 59 NS 59 Togo NS NS NS 97 NS NS NS NS NS NS NS NS NS 97 NS 97 Total 63 59 110 118 20 NS NS NS NS NS NS NS 63 307 NS 370 Bangladesh Ad-Din Dhaka NS NS NS 34 50 53 42 15 22 19 10 15 NS 179 81 260 Ad-Din Jessore NS NS NS 2 1 25 48 0 21 0 NS NS NS 76 21 97 Ad-Din Khulna NS NS NS NS NS NS NS NS 37 6 4 26 NS NS 73 73 BSMMU NS NS NS NS NS NS NS NS 18 30 23 25 NS NS 96 96 Dr.Muttalib NS NS NS NS NS NS NS NS 30 26 22 12 NS NS 90 90 Kumudini 53 57 49 37 25 33 48 26 85 28 33 34 53 249 206 508 Hospital LAMB Hospital 116 52 81 70 74 73 129 67 87 89 83 67 116 479 393 988 Mamm's Institute NS NS NS NS NS NS NS NS 70 75 68 88 NS NS 301 301 Memorial Christian Hospital 63 13 1 NS NS NS NS NS NS NS NS NS 63 14 NS 77 (MCH) Total 232 122 131 143 150 184 267 108 370 273 243 267 232 997 1261 2490 DRC
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Pre-FC Fistula Care Fistula Care Plus TOTALS
FY05- FY FY FY FY FY FY FY FY FY Grand FY 16/17 FY 17/18 Pre-FC FC FC+ FY07 07/08 08/09 09/10 10/11 11/12 12/13 13/14 14/15 15/16 Total
FY05- FY08- FY14- FY05- Country/Site Total Total Total Total Total Total Total Total Total Total Total Total FY07 FY13 FY18 FY18 HEAL Africa 268 200 214 210 163 288 264 NS 44 183 128 147 268 1339 502 2,109 Hospital Imagerie Des NS NS NS NS 38 78 89 NS 40 127 75 NS NS 205 242 447 Grands-Lacs Maternité Esengo NS NS NS NS NS NS 27 NS NS NS NS NS NS 27 NS 27 de Kisenso Maternite Sans NS NS NS NS 35 151 82 NS 68 226 46 NS NS 268 340 608 Risque Kindu Mutombo NS NS NS NS 104 80 119 NS NS NS NS NS NS 303 NS 303 Beniker NS NS NS NS 80 NS NS 80 80 Panzi Hospital 371 134 268 262 180 500 567 NS 105 223 157 200 371 1911 685 2,967 St. Joseph NS NS NS NS 45 124 208 NS 128 241 141 133 NS 377 643 1,020 DRC Bilaterals Project AXxes NS 361 442 514 NS NS NS NS NS NS NS NS NS 1317 NS 1,317 PS Kabongo NS NS NS NS NS 50 NS NS NS NS NS NS NS 50 NS 50 PS Katako NS NS NS NS NS 87 NS NS NS NS NS NS NS 87 NS 87 Kombe PS HGR Katana NS NS NS NS NS NS 50 NS NS NS NS NS NS 50 NS 50 PS Kaziba NS NS NS NS NS 152 135 60 158 240 207 44 NS 287 709 996 PS Lodja NS NS NS NS NS 82 NS NS NS NS NS NS NS 82 NS 82 PS Luiza NS NS NS NS NS 28 NS NS NS NS NS NS NS 28 NS 28 PS Malemba Kulu NS NS NS NS NS 60 NS NS NS NS NS NS NS 60 NS 60 PS Tshikaji NS NS NS NS NS 49 NS NS NS NS NS NS NS 49 NS 49 PS Uvira NS NS NS NS NS 13 37 NS NS NS NS NS NS 50 NS 50 Total 639 695 924 986 565 1742 1,578 60 543 1240 754 604 639 6490 3201 10330 Ethiopia
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Pre-FC Fistula Care Fistula Care Plus TOTALS
FY05- FY FY FY FY FY FY FY FY FY Grand FY 16/17 FY 17/18 Pre-FC FC FC+ FY07 07/08 08/09 09/10 10/11 11/12 12/13 13/14 14/15 15/16 Total
FY05- FY08- FY14- FY05- Country/Site Total Total Total Total Total Total Total Total Total Total Total Total FY07 FY13 FY18 FY18 Arba Minch NS NS NS 27 NS NS NS NS NS NS NS NS NS 27 NA 27 Hospital Bahir Dar Fistula 564 596 297 383 307 392 NS NS NS NS NS NS 564 1975 NA 2,539 Center Mekelle Center NS NA 166 177 195 198 NS NS NS NS NS NS NS 736 NA 736 Ethiopia
Bilateral Pathfinder Project NS NS NS NS NS NS NS NS NS NS NS 366 NS NS 366 366 Total 564 596 463 587 502 590 NS NS NS NS NS 366 564 2,738 366 3,668 Guinea Ignace Deen 193 63 49 20 NS NS 0 NS NS NS NS NS 193 132 NS 325 Jean Paul II NS 36 88 126 144 185 90 NS NS NS NS 11 NS 669 NS 669 Kissidougou 298 130 148 132 193 189 173 NS 15 49 122 111 298 965 297 1560 Labe NS NS 31 114 122 123 132 NS 5 37 69 43 NS 522 154 676 Boke NS NS NS NS NS NS NS NS NS 6 24 19 NS NS 49 49 Faranah NS NS NS NS NS NS NS NS NS NS NS 10 NS NS NS 10 Kindia NS NS NS NS NS NS NS NS NS NS 27 28 NS NS 55 55 Mercy Ships NS NS NS NS NS NS 25 NS NS NS NS NS NS 25 NS 25 training repairs Total 491 229 316 392 459 497 420 NS 20 92 242 222 491 2,313 555 3369 Mali Gao Regional NS NS 46 40 91 53 NS NS NS NS NS NS NS 230 NA 230 Hospital Kayes Hospital NS NS NS NS NS NS 70 NS NS NS NS NS NS 70 NA 70 Mopti NS NS NS NS NS NS 20 NS NS NS NS NS NS 20 NA 20 Sikasso NS NS NS NS NS NS 140 NS NS NS NS NS NS 140 NA 140
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Pre-FC Fistula Care Fistula Care Plus TOTALS
FY05- FY FY FY FY FY FY FY FY FY Grand FY 16/17 FY 17/18 Pre-FC FC FC+ FY07 07/08 08/09 09/10 10/11 11/12 12/13 13/14 14/15 15/16 Total
FY05- FY08- FY14- FY05- Country/Site Total Total Total Total Total Total Total Total Total Total Total Total FY07 FY13 FY18 FY18 Mali Bilateral IntraHealth NS NS NS NS NS NS NS 47 381 244 181 190 NS NS 1043 1043 Total NS NS 46 40 91 53 230 47 381 244 181 190 NS 460 1043 1503 Mozambique Hospital Central NS NS NS NS NS NS NS NS NS NS NS 16 NS NS 16 16 Maputo Nampula NS NS NS NS NS NS NS NS NS NS NS 47 NS NS 47 47 Clinic Azul NS NS NS NS NS NS NS NS NS NS NS 39 NS NS 39 39 Total NS NS NS NS NS NS NS NS NS NS NS 102 NS NS 102 102 Niger Dosso Regional NS 17 15 22 41 21 13 NS NS NS NS NS NS 129 NS 129 Hospital Lamorde Hospital 27 70 84 129 173 110 92 NS NS NS NS NS 27 658 NS 685 (Niamey) Maradi Regional Hospital (now NS 123 59 63 67 45 65 0 55 9 19 14 NS 422 97 519 CSME Maradi) National Maternity Center, NS NS NS NS NS NS 80 NS NS NS NS NS NS 80 NS 80 Niamey National Obstetric Fistula Center, NS NS NS NS NS NS NS 105 144 245 134 71 NS NS 699 699 Niamey (now CNRFO) Tahoua (now NS NS NS 6 52 33 44 22 28 54 49 65 NS 135 218 353 CSME Tahoua) Tera District NS 3 NS NS NS NS NS NS NS NS NS NS NS 3 NS 3 Hospital Zinder NS NS NS NS NS NS 79 NS NS NS NS NS NS 79 NS 79 Total 27 213 158 220 333 209 373 127 227 308 202 150 27 1,506 1014 2,547
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Pre-FC Fistula Care Fistula Care Plus TOTALS
FY05- FY FY FY FY FY FY FY FY FY Grand FY 16/17 FY 17/18 Pre-FC FC FC+ FY07 07/08 08/09 09/10 10/11 11/12 12/13 13/14 14/15 15/16 Total
FY05- FY08- FY14- FY05- Country/Site Total Total Total Total Total Total Total Total Total Total Total Total FY07 FY13 FY18 FY18 Nigeria National Obstetric Fistula Centre NS NS 189 330 268 277 316 71 283 134 197 188 NS 1,380 873 2253 Abakaliki Babbar Ruga 356 536 331 359 330 416 359 160 309 244 357 279 356 2,331 1349 4036 Hospital (Katsina) Faridat Yakubu General Hospital 180 150 187 115 114 116 126 21 49 95 77 100 180 808 342 1330 (Zamfara) General Hospital Ogoja (Cross NS NS NS NS NS 114 50 14 17 17 63 33 NS 164 144 308 River State) UTH Ibadan NS NS NS NS NS NS 37 18 6 6 20 0 NS 37 50 87 Gesse VVF 102 122 151 207 216 215 152 55 140 171 153 114 102 1,063 633 1798 Center (Kebbi) Laure Fistula Center at Murtala Mohammed 339 473 337 265 379 288 313 122 386 270 293 251 339 2,055 1322 3716 Specialist Hospital (Kano) Maryam Abacha Women’s and 104 156 152 200 137 138 132 93 183 103 186 197 104 915 762 1781 Children’s Hospital (Sokoto) Ningi General NS NS NS NS 63 78 74 NS 131 164 186 156 NS 215 637 852 Hospital (Bauchi) Other NS NS NS 136 NS 43 NS NS NS 20 23 0 NS 179 43 222 Maryam Abacha NS NS NS NS NS NS NS NS NS NS NS 40 NS NS 40 40 (Yobe) Adeoyo GH NS NS NS NS NS NS NS NS 18 18 56 100 NS NS 192 192 Jahun VVF NS NS NS NS NS NS NS NS 79 204 179 NS NS NS 462 462 Center
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Pre-FC Fistula Care Fistula Care Plus TOTALS
FY05- FY FY FY FY FY FY FY FY FY Grand FY 16/17 FY 17/18 Pre-FC FC FC+ FY07 07/08 08/09 09/10 10/11 11/12 12/13 13/14 14/15 15/16 Total
FY05- FY08- FY14- FY05- Country/Site Total Total Total Total Total Total Total Total Total Total Total Total FY07 FY13 FY18 FY18 Sobi General Hospital (Kwara NS NS NS NS NS 35 21 NS 44 13 50 22 NS 56 129 185 State) Family Life VVF NS NS NS NS NS NS NS NS NS 52 NS NS NS NS 52 52 Center Hajiya Gambo Sawaba VVF NS NS NS NS NS NS NS NS NS 72 113 58 NS NS 243 243 Center Wesley Guilds NS NS NS NS NS NS NS NS NS NS NS 22 NS NS 22 22 Total 1,081 1,437 1,347 1,612 1,507 1,720 1,580 554 1645 1583 1953 1560 1,081 9,203 7,295 17,579 Rwanda CHUK 100 36 51 126 109 4 9 NS NS NS NS NS 100 335 NS 435 Kanombe NS NS 14 48 38 55 35 NS NS NS NS NS NS 190 NS 190 Hospital Kibogora NS NS NS NS NS 21 0 NS NS NS NS NS NS 21 NS 21 Ruhengeri 192 47 102 85 131 34 4 NS NS NS NS NS 192 403 NS 595 Rwanda
Bilateral MCSP Project NS NS NS NS NS NS NS NS NS NS NS 249 NS NS 249 249 Total 292 83 167 259 278 114 48 NS NS NS NS 249 292 949 249 1,490 Sierra Leone Aberdeen 272 363 253 166 211 244 115 NS NS NS NS NS 272 1,352 NS 1,624 Total 272 363 253 166 211 244 115 NS NS NS NS NS 272 1,352 NS 1,624 Tanzania Vodafone/CCBRT NS NS NS NS NS NS NS 705 828 1048 885 NS NS NS 3466 3,466 Total NS NS NS NS NS NS NS 705 828 1048 885 NS NS NS 3,466 3,466 Uganda
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Pre-FC Fistula Care Fistula Care Plus TOTALS
FY05- FY FY FY FY FY FY FY FY FY Grand FY 16/17 FY 17/18 Pre-FC FC FC+ FY07 07/08 08/09 09/10 10/11 11/12 12/13 13/14 14/15 15/16 Total
FY05- FY08- FY14- FY05- Country/Site Total Total Total Total Total Total Total Total Total Total Total Total FY07 FY13 FY18 FY18 Hoima RRH NS NS NS NS NS 184 102 63 49 40 44 45 NS 286 241 527 Kagando / Bwera 253 118 85 206 363 143 237 NS NS NS NS NS 253 1152 NS 1405 Kitovu Mission 604 192 183 243 248 190 183 NS 200 204 122 148 604 1239 674 2517 Hospital / Masaka Kamuli Mission NS NS NS NS NS NS NS NS NS 63 22 83 NS NS 168 168 Hospital Mbarara Hospital NS NS NS NS NS NS NS NS NS NS 28 0 NS NS 28 28 Kisiizi Mission NS NS NS NS NS NS NS NS NS NS NS 87 NS NS 87 87 Hospital Kagadi Hospital NS NS NS NS NS NS NS NS NS NS NS 30 NS NS 30 30 Mbale Hospital NS NS NS NS NS NS NS NS NS NS NS 21 NS NS 21 21 Jinja RRH NS NS NS NS NS NS NS NS NS 43 89 51 NS NS 183 183 Total 857 310 268 449 611 517 522 63 249 350 305 465 857 2,677 1432 4,966 Overall Total 4,518 4,107 4,183 4,972 4,727 5,870 5,133 1,664 4,263 5,138 4,765 4,175 4,518 28,992 19,984 53,504 EngenderHealth 3,954 3,150 3,278 3,871 4,225 4,759 4,911 852 2,896 3,606 3,492 3,326 3,954 24,194 14,172 42,320 Supported EH Non-USAID NS NS NS NS NS NS NS NS 20 NS NS NS NS NS 20 20 Supported EH USAID 3,954 3,150 3,278 3,871 4,225 4,759 4,911 852 2,876 3,606 3,492 3,104 3,954 24,194 13,930 42,078 Supported USAID Bilaterals 564 957 905 1,101 502 1,111 222 812 1,367 1,624 1,515 1,071 564 4,798 6,389 11,751 Total USAID- 4,518 4,107 4,183 4,972 4,727 5,870 5,133 1,664 4,243 5,138 4,765 4,175 4,518 28,992 19,985 53,495 Supported NA= Data not available NS= Site not supported
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APPENDIX E: FC/ FC+ PEER REVIEWED PUBLICATIONS25
I. Published
Anastasi E, Romanzi L, Ahmed S, Knuttson AT, Ojengbede O, Grant K; Campaign to End Fistula. Ending fistula within a generation: making the dream a reality. Lancet Glob Health. 2017 Aug;5(8):e747-e748. [COMMENTARY – NO ABSTRACT]
Arrowsmith SD, Ruminjo J, Landry EG. Current practices in treatment of female genital fistula: a cross sectional study. BMC Pregnancy and Childbirth. 2010 Nov 10;10:73.
BACKGROUND: Background: Maternal outcomes in most countries of the developed world are good. However, in many developing/resource-poor countries, maternal outcomes are bleaker: Every year, more than 500,000 women die in childbirth, mostly in resource-poor countries. Those who survive often suffer from severe and long-term morbidities. One of the most devastating injuries is obstetric fistula, occurring most often in south Asia and sub- Saharan Africa. Fistula treatment and care are available in many countries across Africa and Asia, but there is a lack of reliable data around clinical factors associated with the success of fistula repair surgery. Most published research has been retrospective. While these studies have provided useful information about the care and treatment of fistula, they are limited by the design. This study was designed to identify practices in care that could lead to the design of prospective and randomized controlled trials. METHODS: Self-administered questionnaires were completed by 40 surgeons known to provide fistula treatment services in Africa and Asia at private and government hospitals. The questionnaire was divided into three parts to address the following issues: prophylactic use of antibiotics before, during, and after fistula surgery; urethral catheter management; and management practices for patients with urinary incontinence following fistula repair. RESULTS: The results provide a glimpse into current practices in fistula treatment and care across a wide swath of geographic, economic, and organizational considerations. There is consensus in treatment in some areas (routine use of prophylactic antibiotics, limited bed rest until the catheter is removed, nonsurgical treatment for postsurgical incontinence), while there are wide variations in practice in other areas (duration of catheter use, surgical treatments for postsurgical incontinence). These findings are based on a small sample and do not allow for recommending changes in clinical care, but they point to issues for possible clinical trial research that would contribute to more efficient and effective fistula care. CONCLUSIONS: The findings from the survey allowed us to consider clinical practices most influential in the cost, efficacy, and safety of fistula treatment. These considerations led us to formulate recommendations for eight randomized controlled trials on the following subjects: 1) Efficacy/safety of short-term catheterization; 2) efficacy of surgical and nonsurgical therapies for urinary incontinence; 3) technical measures during fistula repair to reduce the incidence of post-surgery incontinence; 4) identification of predictive factors for "incurable fistula"; 5) usefulness of urodynamic studies in the management of urinary incontinence; 6) incidence and significance of multi-drug resistant bacteria in the fistula population; 7) primary management of small, new fistulas by catheter drainage; and 8) antibiotic prophylaxis in fistula repair.
Arrowsmith SD, Barone MA, Ruminjo J. Outcomes in obstetric fistula care: a literature review. Current Opinion in Obstetrics and Gynecology. 2013 Oct;25(5):399-403.
PURPOSE OF REVIEW: To highlight the lack of consistency in the terminology and indicators related to obstetric fistula care and to put forward a call for consensus. RECENT FINDINGS: Recent studies show at least some degree of statistical correlation between outcome and the following clinical factors: degree of scarring/fibrosis, fistula location, fistula size, damage to the urethra, presence of circumferential fistula, bladder capacity, and prior attempt at fistula repair. SUMMARY: Consensus about basic definitions of clinical success does not yet exist. Opinions vary widely about the prognostic parameters for success or failure. Commonly agreed upon definitions and outcome measures will help ensure that site reviews are accurate and conducted fairly. To properly compare technical innovations with existing methods, agreement must be reached on definitions of success. Standardized
25 This summarizes all peer-reviewed publications throughout the life of both the FC and FC+ projects, as of September 2018.
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indicators for mortality and morbidity associated with fistula repair will improve the evidence base and contribute to quality of care.
Barone M, Widmer M, Arrowsmith S, Ruminjo J, Seuc A, Landry E, Hamidou Barry T, Danladi D, Djangnikpo L, Gbawuru-Mansaray T, Harou I, Lewis A, Muleta M, Nembunzu D, Olupot R, Sunday-Adeoye I, Wakasiaka WK, Landoulsi S, Delamou A, Were L, Frajzyngier V, Beattie K, A Gülmezoglu AM. 7 day bladder catheterization is not inferior to 14 day catheterization following repair of female genital fistula: a randomized controlled, non- inferiority trial. Lancet. 2015 Jul 4;386(9988):56-62.
BACKGROUND: Duration of bladder catheterization after female genital fistula repair varies widely. We aimed to establish whether 7 day bladder catheterization was not inferior to 14 days in terms of incidence of fistula repair breakdown among women with simple fistula. METHODS: We conducted a non-inferiority randomized controlled trial at eight hospitals in eight African countries. Women with a simple fistula that was closed after surgery and that remained closed until postoperative day 7 were eligible. Participants were randomized in a 1:1 ratio to 7 or 14-day bladder catheterization. The primary outcome was fistula repair breakdown, based on dye test results, any time after day 7 after catheter removal up to 3 months post-surgery. Secondary outcomes included: repair breakdowns at 7 days after catheter removal or thereafter, urinary retention on day 1, 3 and/or 7 after catheter removal; infections and febrile episodes potentially related to the treatment; catheter blockage; prolonged hospitalization; and residual incontinence at 3 months. The trial is registered with ClinicalTrials.gov, Identifier NCT01428830. FINDINGS: 524 participants were randomized and followed up between January 2012 and August 2013; 261 in the 7-day group and 263 in the 14-day group. The analysis population included 250 participants in the 7-day group and 251 in the 14-day group. There was no significant difference in the rate of fistula repair breakdown between the groups (risk difference 0.8%; 95% CI -2.8-4.5). There were no significant differences in the secondary outcomes between the groups. INTERPRETATION: 7 day bladder catheterization after repair of simple fistula was non-inferior to 14 day catheterization. It is safe and effective for managing women following repair of simple fistula without a significant increased risk of repair breakdown, urinary retention or residual incontinence through 3 months after surgery.
Barone MA, Frajzyngier V, Arrowsmith S, Ruminjo J, Seuc A, Landry E, Beattie K, Barry TH, Lewis A, Muleta M, Nembunzu D, Olupot R, Sunday-Adeoye I, Wakasiaka WK, Widmer M, Gülmezoglu AM. Non-inferiority of short-term urethral catheterization following fistula repair surgery: study protocol for a randomized controlled trial. BMC Womens Health. 2012 Mar 20;12:5.
BACKGROUND: A vaginal fistula is a devastating condition, affecting an estimated 2 million girls and women across Africa and Asia. There are numerous challenges associated with providing fistula repair services in developing countries, including limited availability of operating rooms, equipment, surgeons with specialized skills, and funding from local or international donors to support surgeries and subsequent post-operative care. Finding ways of providing services in a more efficient and cost-effective manner, without compromising surgical outcomes and the overall health of the patient, is paramount. Shortening the duration of urethral catheterization following fistula repair surgery would increase treatment capacity, lower costs of services, and potentially lower risk of healthcare- associated infections among fistula patients. There is a lack of empirical evidence supporting any particular length of time for urethral catheterization following fistula repair surgery. This study will examine whether short-term (7 day) urethral catheterization is not worse by more than a minimal relevant difference to longer-term (14 day) urethral catheterization in terms of incidence of fistula repair breakdown among women with simple fistula presenting at study sites for fistula repair service. METHODS/DESIGN: This study is a facility-based, multicenter, non-inferiority randomized controlled trial (RCT) comparing the new proposed short-term (7 day) urethral catheterization to longer-term (14 day) urethral catheterization in terms of predicting fistula repair breakdown. The primary outcome is fistula repair breakdown up to three months following fistula repair surgery as assessed by a urinary dye test. Secondary outcomes will include repair breakdown one week following catheter removal, intermittent catheterization due to urinary retention and the occurrence of septic or febrile episodes, prolonged hospitalization for medical reasons, catheter blockage, and self-reported residual incontinence. This trial will be conducted among 512 women with simple fistula presenting at 8 study sites for fistula repair surgery over the
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course of 24 months at each site. DISCUSSION: If no major safety issues are identified, the data from this trial may facilitate adoption of short-term urethral catheterization following repair of simple fistula in sub-Saharan Africa and Asia. TRIAL REGISTRATION: ClinicalTrials.gov Identifier NCT01428830.
Barone MA, Frajzyngier V, Ruminjo J, Asiimwe F, Barry TH, Bello A, Danladi D, Ganda SO, Idris S, Inoussa M, Lynch M, Mussell F, Podder DC. Determinants of postoperative outcomes of female genital fistula repair surgery. Obstetrics and Gynecology. 2012 Sep;120(3):524-31.
OBJECTIVE: To determine predictors of fistula repair outcomes 3 months postsurgery. METHODS: We conducted a multicountry prospective cohort study between 2007 and 2010. Outcomes, measured 3 months postsurgery, included fistula closure and residual incontinence in women with a closed fistula. Potential predictors included patient and fistula characteristics and context of repair. Multivariable generalized estimating equation models were used to generate adjusted risk ratios (RRs) and 95% confidence intervals (CIs). RESULTS: Women who returned for follow-up 3-month postsurgery were included in predictors of closure analyses (n=1,274). Small bladder size (adjusted RR 1.57, 95% CI 1.39-1.79), prior repair (adjusted RR 1.40, 95% CI 1.11-1.76), severe vaginal scarring (adjusted RR 1.56, 95% CI 1.20-2.04), partial urethral involvement (adjusted RR 1.36, 95% CI 1.11-1.66), and complete urethral destruction or circumferential defect (adjusted RR 1.72, 95% CI 1.33-2.23) predicted failed fistula closure. Women with a closed fistula at 3-month follow-up were included in predictors of residual incontinence analyses (n=1,041). Prior repair (adjusted RR 1.37, 95% CI 1.13-1.65), severe vaginal scarring (adjusted RR 1.35, 95% CI 1.10-1.67), partial urethral involvement (adjusted RR 1.78, 95% CI 1.27-2.48), and complete urethral destruction or circumferential defect (adjusted RR 2.06, 95% CI 1.51-2.81) were significantly associated with residual incontinence. CONCLUSION: The prognosis for genital fistula closure is related to preoperative bladder size, previous repair, vaginal scarring, and urethral involvement.
Bedwell C, Levin K, Pett C, Lavender DT. A realist review of the partograph: when and how does it work for labour monitoring? BMC Pregnancy and Childbirth. 2017 Jan 13;17(1):31.
BACKGROUND: The partograph (or partogram) is recommended by the World Health Organisation (WHO), for monitoring labour wellbeing and progress. Concerns about limitations in the way the partograph is used in the clinical context and the potential impact on its effectiveness have led to this realist systematic review of partograph use. METHODS: This review aimed to answer two key questions, 1) What is it about the partograph that works (or does not work); for whom does it work; and in what circumstances? 2) What are the essential inputs required for the partograph to work? A comprehensive search strategy encompassed key databases; including papers of varying methodologies. Papers were selected for inclusion if the focus of the paper was the partograph and related to context, mechanism or outcome. Ninety five papers were included for data synthesis. Two authors completed data extraction and synthesis. RESULTS: The evidence synthesis relates the evidence to identified theories of health worker acceptability, health system support, effective referral systems, human resources and health worker competence, highlighting barriers and facilitators. CONCLUSIONS: This first comprehensive realist synthesis of the partograph, provides the international community of maternity clinicians with a picture of potential issues and solutions related to successful labour recording and management, which is also translatable to other monitoring approaches. Brazier E, Fiorentino R, Barry MS, Diallo M. The value of building health promotion capacities within communities: Evidence from a maternal health intervention in Guinea. Health Policy and Planning. 2015 Sep;30(7):885-94.
BACKGROUND: This paper presents results from a community-level intervention that promoted use of maternal health services as a means of preventing obstetric fistula. Implemented in the Republic of Guinea, the intervention aimed to build the capacity of community-level committees to heighten awareness about maternal health risks and to promote use of professional maternal health services. METHODS: Data were collected through a population-based survey. A total of 2,335 women of reproductive age were interviewed, including 878 with a live birth or stillbirth since the launch of the intervention. An index of community capacity was created to explore the
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effect of living in a community with strong community-level resources and support for maternal health. Other composite variables were created to measure the content of women’s antenatal counseling and their individual exposure to maternal health promotion activities at the community level. Multivariate logistic regression was used to explore the effect of community capacity and individual exposure variables on women’s use of antenatal care (> 4 visits), institutional delivery, and care for complications. RESULTS: Women living in communities with a high score on the community capacity index were more than twice as likely as women in communities with low score to attend at least four ANC visits, to deliver in a health facility, and to seek care for perceived complications. CONCLUSIONS: Building the capacity of community-level cadres to promote maternity care-seeking by women in their villages is an important complement to facility-level interventions to increase the availability, quality, and utilization of essential health services.
Brazier E, Fiorentino R, Barry S, Kasse Y, Millimono S. Rethinking how to promote maternity care-seeking: factors associated with institutional delivery in Guinea. Health Care for Women International. 2014 Sep;35(7- 9):878-95.
This paper presents findings from a study on women’s delivery care-seeking in two regions of Guinea. We explored exposure to interventions promoting birth preparedness and complication readiness among women with recent live births and stillbirths. Using multivariate regression models, we identified factors associated with women’s knowledge and practices related to birth preparedness, as well as their use of health facilities during childbirth. We found that women’s knowledge about preparations for any birth (normal or complicated) was positively associated with increased preparation for birth, which itself was associated with institutional delivery. Knowledge about obstetric risks and danger signs, was not associated with birth preparation or with institutional delivery. The study findings highlight the importance of focusing on preparation for all births—and not simply obstetric emergencies— in interventions aimed at increasing women’s use of skilled maternity care.
Cavallaro FL, Pembe AB, Campbell O, Hanson C, Tripathi V, Wong KL, Radovich E, Benova L. Caesarean section provision and readiness in Tanzania: analysis of cross-sectional surveys of women and health facilities over time. BMJ Open. 2018 Oct 4;8(9):e024216.
OBJECTIVES: To describe trends in caesarean sections and facilities performing caesareans over time in Tanzania and examine the readiness of such facilities in terms of infrastructure, equipment and staffing. DESIGN: Nationally representative, repeated cross-sectional surveys of women and health facilities. SETTING: Tanzania. PARTICIPANTS: Women of reproductive age and health facility staff. MAIN OUTCOME MEASURES: Population-based caesarean rate, absolute annual number of caesareans, percentage of facilities reporting to perform caesareans and three readiness indicators for safe caesarean care: availability of consistent electricity, 24 hour schedule for caesarean and anaesthesia providers, and availability of all general anaesthesia equipment. RESULTS: The caesarean rate in Tanzania increased threefold from 2% in 1996 to 6% in 2015-16, while the total number of births increased by 60%. As a result, the absolute number of caesareans increased almost fivefold to 120 000 caesareans per year. The main mechanism sustaining the increase in caesareans was the doubling of median caesarean volume among public hospitals, from 17 caesareans per month in 2006 to 35 in 2014-15. The number of facilities performing caesareans increased only modestly over the same period. Less than half (43%) of caesareans in Tanzania in 2014-15 were performed in facilities meeting the three readiness indicators. Consistent electricity was widely available, and 24 hour schedules for caesarean and (less systematically) anaesthesia providers were observed in most facilities; however, the availability of all general anaesthesia equipment was the least commonly reported indicator, present in only 44% of all facilities (34% of public hospitals). CONCLUSIONS: Given the rising trend in numbers of caesareans, urgent improvements in the availability of general anaesthesia equipment and trained anaesthesia staff should be made to ensure the safety of caesareans. Initial efforts should focus on improving anaesthesia provision in public and faith-based organization hospitals, which together perform more than 90% of all caesareans in Tanzania.
Delamou A, Delvaux T, El Ayadi AM, Tripathi V, Camara BS, Beavogui AH, Romanzi L, Cole B, Bouedouno P, Diallo M, Barry TH, Camara M, Diallo K, Leveque A, Zhang WH, De Brouwere V. Fistula recurrence, pregnancy, and childbirth following successful closure of female genital fistula in Guinea: a longitudinal study. Lancet Glob Health. 2017 Nov;5(11):e1152-e1160.
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Background: Female genital fistula is a devastating maternal complication of delivery in developing countries. We sought to analyse the incidence and proportion of fistula recurrence, residual urinary incontinence, and pregnancy after successful fistula closure in Guinea, and describe the delivery-associated maternal and child health outcomes. Methods: We did a longitudinal study in women discharged with a closed fistula from three repair hospitals supported by EngenderHealth in Guinea. We recruited women retrospectively (via medical record review) and prospectively at hospital discharge. We used Kaplan-Meier methods to analyse the cumulative incidence, incidence proportion, and incidence ratio of fistula recurrence, associated outcomes, and pregnancy after successful fistula closure. The primary outcome was recurrence of fistula following discharge from repair hospital in all eligible women who consented to inclusion and could provide follow-up data. Findings: 481 women eligible for analysis were identified retrospectively (from Jan 1, 2012, to Dec 31, 2014; 348 women) or prospectively (Jan 1 to June 20, 2015; 133 women), and followed up until June 30, 2016. Median follow-up was 28·0 months (IQR 14·6–36·6). 73 recurrent fistulas occurred, corresponding to a cumulative incidence of 71 per 1000 person-years (95% CI 56·5– 89·3) and an incidence proportion of 18·4% (14·8–22·8). In 447 women who were continent at hospital discharge, we recorded 24 cases of post-repair residual urinary incontinence, equivalent to a cumulative incidence of 23·1 per 1000 person-years (14·0–36·2), and corresponding to 10·3% (5·2–19·6). In 305 women at risk of pregnancy, the cumulative incidence of pregnancy was 106·0 per 1000 person-years, corresponding to 28·4% (22·8–35·0) of these women. Of 50 women who had delivered by the time of follow-up, only nine delivered by elective caesarean section. There were 12 stillbirths, seven delivery-related fistula recurrences, and one maternal death. Interpretation: Recurrence of female genital fistula and adverse pregnancy-related maternal and child health outcomes were frequent in women after fistula repair in Guinea. Interventions are needed to safeguard the health of women after fistula repair.
Delamou A, Utz B, Delvaux T, Beavogui AH, Shahabuddin A, Koivogui A, Levêque A, Zhang WH, De Brouwere V. Pregnancy and childbirth after repair of obstetric fistula in sub-Saharan Africa: Scoping Review. Tropical Medicine & International Health. 2016 Nov;21(11):1348-1365.
OBJECTIVE: To synthesise the evidence on pregnancy and childbirth after repair of obstetric fistula in sub-Saharan Africa and to identify the existing knowledge gaps. METHODS: A scoping review of studies reporting on pregnancy and childbirth in women who underwent repair for obstetric fistula in sub-Saharan Africa was conducted. We searched relevant articles published between 1 January 1970 and 31 March 2016, without methodological or language restrictions, in electronic databases, general Internet sources and grey literature. RESULTS: A total of 16 studies were included in the narrative synthesis. The findings indicate that many women in sub-Saharan Africa still desire to become pregnant after the repair of their obstetric fistula. The overall proportion of pregnancies after repair estimated in 11 studies was 17.4% (ranging from 2.5% to 40%). Among the 459 deliveries for which the mode of delivery was reported, 208 women (45.3%) delivered by elective caesarean section (CS), 176 women (38.4%) by emergency CS and 75 women (16.3%) by vaginal delivery. Recurrence of fistula was a common maternal complication in included studies while abortions/miscarriage, stillbirths and neonatal deaths were frequent foetal consequences. Vaginal delivery and emergency cesarean section were associated with increased risk of stillbirth, recurrence of the fistula or even maternal death. CONCLUSION: Women who get pregnant after repair of obstetric fistula carry a high risk for pregnancy complications. However, the current evidence does not provide precise estimates of the incidence of pregnancy and pregnancy outcomes post-repair. Therefore, studies clearly assessing these outcomes with the appropriate study designs are needed.
Delamou, A., Delvaux, T., Utz, B., Camara, B. S., Beavogui, A. H., Cole, B., Levin, K., Diallo, M., Millimono, S., Barry, T. H., El Ayadi, A. M., Zhang, W.-H. and De Brouwere, V. Factors associated with loss to follow-up in women undergoing repair for obstetric fistula in Guinea. Tropical Medicine & International Health. 2015 Nov;20(11):1454-1461.
Objectives: To analyse the trend of loss to follow-up over time and identify factors associated with women being lost to follow-up after discharge in three fistula repair hospitals in Guinea. Methods: This retrospective cohort
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study used data extracted from medical records of fistula repairs conducted from 1 January 2007 to 30 September 2013. A woman was considered lost to follow-up if she did not return within 4 months post-discharge. Factors associated with loss to follow-up were identified using a subsample of the data covering the period 2010–2013. Results: Over the study period, the proportion of loss to follow-up was 21.5% (448/2080) and varied across repair hospitals and over time with an increase from 2% in 2009 to 52% in 2013. After adjusting for other variables in a multivariate logistic regression model, women who underwent surgery at Labe hospital and at Kissidougou hospital were more likely to be lost to follow-up than women operated at Jean Paul II hospital (OR: 50.6; 95% CI: 24.9– 102.8) and (OR: 11.5; 95% CI: 6.1–22.0), respectively. Women with their fistula closed at hospital discharge (OR: 3.2; 95% CI: 2.1–4.8) and women admitted for repair in years 2011–2013 showed higher loss to follow-up as compared to 2010. Finally, loss to follow-up increased by 2‰ for each additional kilometre of distance a client lived from the repair hospital (OR: 1.002; 95% CI: 1.001–1.003). Conclusion: Reimbursement of transport was the likely reason for change over time of LTFU. Reducing geographical barriers to care for women with fistula could sustain fistula care positive outcomes.
Delamou, A., Diallo, M., Beavogui, A. H., Delvaux, T., Millimono, S., Kourouma, M., Beattie, K., Barone, M., Barry, T. H., Khogali, M., Edginton, M., Hinderaker, S. G., Ruminjo, J., Zhang, W.-H. and De Brouwere, V. Good clinical outcomes from a 7-year holistic programme of fistula repair in Guinea. Tropical Medicine & International Health. 2015 20: 813–819.
OBJECTIVES: Female genital fistula remains a public health concern in developing countries. From January 2007 to September 2013, the Fistula Care project, managed by EngenderHealth in partnership with the Ministry of Health and supported by USAID, integrated fistula repair services in the maternity wards of general hospitals in Guinea. The objective of this article was to present and discuss the clinical outcomes of 7 years of work involving 2116 women repaired in three hospitals across the country. METHODS: This was a retrospective cohort study using data abstracted from medical records for fistula repairs conducted from 2007 to 2013. The study data were reviewed during the period April to August 2014. RESULTS: The majority of the 2116 women who underwent surgical repair had vesicovaginal fistula (n = 2045, 97%) and 3% had rectovaginal fistula or a combination of both. Overall 1748 (83%) had a closed fistula and were continent of urine immediately after surgery. At discharge, 1795 women (85%) had a closed fistula and 1680 (79%) were dry, meaning they no longer leaked urine and/or faeces. One hundred and fifteen (5%) remained with residual incontinence despite fistula closure. Follow-up at 3 months was completed by 1663 (79%) women of whom 1405 (84.5%) had their fistula closed and 80% were continent. Twenty-one per cent were lost to follow-up. CONCLUSION: Routine programmatic repair for obstetric fistula in low resources settings can yield good outcomes. However, more efforts are needed to address loss to follow-up, sustain the results and prevent the occurrence and/or recurrence of fistula.
Delamou, A, Samadari, G, Camara BS, Traore P, Diallo F, Millimono S, Wane D, Toliver M, Laffe K, Verani F. Prevalence and correlates of intimate partner violence among family planning clients in Conakry, Guinea. BMC Research Notes. 2015 8:814
Intimate partner violence (IPV) is a global public health problem that affects women’s physical, mental, sexual and reproductive health. Very little data on IPV experience and FP use is available in resource-poor settings, such as in West Africa. The aim of this study was to describe the prevalence, patterns and correlates of IPV among clients of an adult Family Planning clinic in Conakry, Guinea. The study data was collected for four months (March to June 2014) from women’s family planning charts and from an IPV screening form at the Adult Family Planning and Reproductive Health Clinic of “Association Guinéenne pour le Bien-Etre Familial”, a non-profit organization in Conakry, Guinea. 232 women out of 245 women who attended the clinic for services during the study period were screened for IPV and were included in this study. Of the 232 women screened, 213 (92 %) experienced IPV in one form or another at some point in their lifetime. 169 women reported psychological violence (79.3 %), 145 reported sexual violence (68.1 %) and 103 reported physical violence (48.4 %). Nearly a quarter of women reported joint occurrence of the three forms of violence (24 %).Half of the IPV positive women were current users of family planning (51.2 %) and of these, 77.9 % preferred injectable contraceptives. The odds of experiencing IPV was higher in women with secondary or vocational level of education than those with higher level of education (AOR: 8.4; 95 % CI 1.2–58.5). Women residing in other communes of Conakry (AOR: 5.6; 95 % CI 1.4–22.9) and those
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preferring injectable FP methods (AOR: 4.5; 95 % CI 1.2–16.8) were more likely to experience lifetime IPV. IPV is prevalent among family planning clients in Conakry, Guinea where nine out of ten women screened in the AGBEF adult clinic reported having experienced one or another type of IPV. A holistic approach that includes promotion of women’s rights and gender equality, existence of laws and policies is needed to prevent and respond to IPV, effective implementation of policies and laws, and access to quality IPV services in Guinea and countries with higher rates of IPV.
El Ayadi AM, Barageine J, Korn A, Kakaire O, Turan J, Obore S, Byamugisha J, Lester F, Nalubwama H, Mwanje H, Tripathi V, Miller S. Trajectories of Women's Physical and Psychosocial Health Following Obstetric Fistula Repair in Uganda: A Longitudinal Study. Trop Med Int Health. 2018 Oct 29. doi: 10.1111/tmi.13178. [Epub ahead of print]
OBJECTIVES: To explore trajectories of physical and psychosocial health, and their interrelationship, among women completing fistula repair in Uganda for one-year post-surgery. METHODS: We recruited a 60-woman longitudinal cohort at surgical hospitalization from Mulago Hospital in Kampala Uganda (Dec 2014-June 2015) and followed them for one year. We collected survey data on physical and psychosocial health at surgery and at 3, 6, 9, and 12 months via mobile phone. Fistula characteristics were abstracted from medical records. All participants provided written informed consent. We present univariate analysis and linear regression results. RESULTS: Across post-surgical follow-up, most women reported improvements in physical and psychosocial health, largely within the first six months. By 12 months, urinary incontinence had declined from 98% to 33%, and general weakness from 33% to 17%, while excellent to good general health rose from 0% to 60%. Reintegration, self-esteem, and quality of life all increased through six months and remained stable thereafter. Reported stigma reduced, yet some negative self-perception remained at twelve months (mean 17.8). Psychosocial health was significantly impacted by report of physical symptoms; at 12 months, physical symptoms were associated with a 21.9 lower mean reintegration score (95% CI -30.1, -12.4) CONCLUSIONS: Our longitudinal cohort experienced dramatic improvements in physical and psychosocial health after surgery. Continuing fistula-related symptoms and the substantial differences in psychosocial health by physical symptoms supports additional intervention to support women's recovery or more targeted psychosocial support and reintegration services to ensure that those coping with physical or psychosocial challenges are appropriately supported.
El Ayadi A, Nalubwama H, Barageine J, Neilands TB, Obore S, Byamugisha J, Kakaire O, Mwanje H, Korn A, Lester F, Miller S. Development and preliminary validation of a post-fistula repair reintegration instrument among Ugandan women. Reproductive Health. 2017 Sep 2;14(1):109.
BACKGROUND: Obstetric fistula is a debilitating and traumatic birth injury affecting 2-3 million women globally, mostly in sub-Saharan Africa and Asia. Affected women suffer physically, psychologically and socioeconomically. International efforts have increased access to surgical treatment, yet attention to a holistic outcome of post- surgical rehabilitation is nascent. We sought to develop and pilot test a measurement instrument to assess post- surgical family and community reintegration. METHODS: We conducted an exploratory sequential mixed-methods study, beginning with 16 in-depth interviews and four focus group discussions with 17 women who underwent fistula surgery within two previous years to inform measure development. The draft instrument was validated in a longitudinal cohort of 60 women recovering from fistula surgery. Qualitative data were analyzed through thematic analysis. Socio-demographic characteristics were described using one-way frequency tables. We used exploratory factor analysis to determine the latent structure of the scale, then tested the fit of a single higher-order latent factor. We evaluated internal consistency and temporal stability reliability through Raykov's ρ and Pearson's correlation coefficient, respectively. We estimated a series of linear regression models to explore associations between the standardized reintegration measure and validated scales representing theoretically related constructs. RESULTS: Themes central to women's experiences following surgery included resuming mobility, increasing social interaction, improved self-esteem, reduction of internalized stigma, resuming work, meeting their own needs and the needs of dependents, meeting other expected and desired roles, and negotiating larger life issues. We expanded the Return to Normal Living Index to reflect these themes. Exploratory factor analysis suggested a four-factor structure, titled 'Mobility and social engagement', 'Meeting family needs', 'Comfort with relationships', and 'General life satisfaction', and goodness of fit statistics supported a higher-order latent variable
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of 'Reintegration.' Reintegration score correlated significantly with quality of life, depression, self-esteem, stigma, and social support in theoretically expected directions. CONCLUSION: As more women undergo surgical treatment for obstetric fistula, attention to the post-repair period is imperative. This preliminary validation of a reintegration instrument represents a first step toward improving measurement of post-surgical reintegration and has important implications for the evidence base of post-surgical reintegration epidemiology and the development and evaluation of fistula programming.
Frajzyngier V, Ruminjo J, Asiimwe F, Barry TH, Bello A, Danladi D, Ganda SO, Idris S, Inoussa M, Lynch M, Mussell F, Podder DC, Barone MA. Factors influencing choice of surgical route of repair of genitourinary fistula, and the influence of route of repair on surgical outcomes: findings from a prospective cohort study. BJOG. 2012 Oct;119(11):1344-53.
OBJECTIVE: The abdominal route of genitourinary fistula repair may be associated with longer-term hospitalisation, hospital-associated infection and increased resource requirements. We examined: (1) the factors influencing the route of repair; (2) the influence of the route of repair on fistula closure 3 months following surgery; and (3) whether the influence of the route of repair on repair outcome varied by whether or not women met the published indications for abdominal repair. DESIGN: Prospective cohort study. SETTING: Eleven health facilities in sub-Saharan Africa and Asia. POPULATION: The 1274 women with genitourinary fistula presenting for surgical repair services. METHODS: Risk ratios (RRs) and 95% confidence intervals (95% CIs) were generated using log- binomial and Poisson (log-link) regression. Multivariable regression and propensity score matching were employed to adjust for confounding. MAIN OUTCOME MEASURES: Abdominal route of repair and fistula closure at 3 months following fistula repair surgery. RESULTS: Published indications for abdominal route of repair (extensive scarring or tissue loss, genital infibulation, ureteric involvement, trigonal, supratrigonal, vesico-uterine or intracervical location or other abdominal pathology) predicted the abdominal route [adjusted risk ratio (ARR), 15.56; 95% CI, 2.12-114.00]. A vaginal route of repair was associated with increased risk of failed closure (ARR, 1.41; 95% CI, 1.05- 1.88); stratified analyses suggested elevated risk among women meeting indications for the abdominal route. CONCLUSIONS: Additional studies powered to test effect modification hypotheses are warranted to confirm whether the abdominal route of repair is beneficial for certain women.
Frajzyngier V, Ruminjo J, Barone MA. Factors influencing urinary fistula repair outcomes in developing countries: a systematic review. American Journal of Obstetrics & Gynecology. 2012 Oct;207(4):248-58.
We reviewed literature examining predictors of urinary fistula repair outcomes in developing country settings, including fistula and patient characteristics, and perioperative factors. We searched Medline for articles published between January 1970 and December 2010, excluding articles that were (1) case reports, cases series or contained 20 or fewer subjects; (2) focused on fistula in developed countries; and (3) did not include a statistical analysis of the association between facility or individual-level factors and surgical outcomes. Twenty articles were included; 17 were observational studies. Surgical outcomes included fistula closure, residual incontinence after closure, and any incontinence (dry vs wet). Scarring and urethral involvement were associated with poor prognosis across all outcomes. Results from randomized controlled trials examining prophylactic antibiotic use and repair outcomes were inconclusive. Few observational studies examining perioperative interventions accounted for confounding by fistula severity. We conclude that a unified, standardized evidence-base for informing clinical practice is lacking.
Frajzyngier V, Li G, Larson E, Ruminjo J, Barone MA. Development and comparison of prognostic scoring systems for surgical closure of genitourinary fistula. American Journal of Obstetrics & Gynecology. 2013 Feb;208(2):112.e1-11.
OBJECTIVE: The purpose of this study was to test the diagnostic performance of 5 existing classification systems (developed by Lawson, Tafesse, Goh, Waaldijk, and the World Health Organization) and a prognostic scoring system that was derived empirically from our data to predict fistula closure 3 months after surgery. STUDY DESIGN: Women with genitourinary fistula (n = 1274) who received surgical repair services at 11 health facilities in sub- Saharan Africa and Asia were enrolled in a prospective cohort study. Using one-half of the sample, we created
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multivariate generalized estimating equation models to obtain weighted prognostic scores for components of each existing classification system and the empirically derived scoring system. With the second one-half, we developed receiver operating characteristic curves using the prognostic scores and calculated areas under the curves (AUCs) and 95% confidence intervals (CIs) for each system. RESULTS: Among existing systems, the scoring systems that represented the World Health Organization, Goh, and Tafesse classifications had the highest predictive accuracy: AUC, 0.63 (95% CI, 0.57-0.68); AUC, 0.62 (95% CI, 0.57-0.68), and AUC, 0.60 (95% CI, 0.55-0.65), respectively. The empirically derived prognostic score achieved similar predictive accuracy (AUC, 0.62; 95% CI, 0.56-0.67); it included significant predictors of closure that are found in the other classification systems, but contained fewer, nonoverlapping components. The differences in AUCs were not statistically significant. CONCLUSION: The prognostic values of existing urinary fistula classification systems and the empirically derived score were poor to fair. Further evaluation of the validity and reliability of existing classification systems to predict fistula closure is warranted; consideration should be given to a prognostic score that is evidence-based, simple, and easy to use.
Keya KT, Sripad P, Nwala E, Warren CE. "Poverty is the big thing": exploring financial, transportation, and opportunity costs associated with fistula management and repair in Nigeria and Uganda. Int J Equity Health. 2018 Jun 1;17(1):70. Background: Women living with obstetric fistula often live in poverty and in remote areas far from hospitals that offer surgical repair. These women and their families incur a range of costs, some of which include: management of their condition, lost productivity and time, and transport to facilities – all of which prevent them from accessing fistula repair. This study explores, through women, community, and provider lenses, the financial, transport, and opportunity cost barriers and enablers to seeking repair services. Methods: A qualitative approach was applied in Kano and Ebonyi, Nigeria and Hoima and Masaka, Uganda. The study team conducted in-depth interviews (IDIs) with women affected by fistula (n=52) – including those awaiting repair, living with fistula and post-repair, their spouses and other family members (n=17), and health service providers involved in fistula repair and counseling (n=38). Focus group discussions (FGDs) with male and female community stakeholders (n=8) and post-repair clients (n=6) were also conducted. Results: Women’s experiences indicate that costs associated with the obstetric fistula condition reflect a combined set of costs associated with delivery, repair, transport, forgone income, and companion expenses that altogether is often catastrophic. Medical and non-medical ancillary costs such as food, medications, and water are not borne evenly across fistula care centers or camps due to funding shortages. In Uganda, most women spent Ugandan Shilling 10,000 to 90,000 (US$3.00-US$25.00) for a single trip to the camp for two people, while Nigerian women (Kano) spent Naira 250 to 2000 (US$0.80-US$6.41) for transportation. Factors influencing the cost of fistula care access include education and vocational skills of women and their family, community-based savings mechanisms, available resources in repair centers, client counselling, and subsidized care and transport. Conclusions: The concentration of women in poverty and the catastrophic costs associated with fistula repair speak to an inability to prioritize accessing fistula treatment over household expenditures. Findings recommend innovative approaches to financial assistance, transport, information of the available repair centers, rehabilitation, and reintegration in overcoming cost barriers.
Landry E, Pett C, Forentino R, Ruminjo J, Mattison C. 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 Apr 12;14:139.
BACKGROUND: Reliable, timely information is the foundation of decision making for functioning health systems; the quality of decision making rests on quality data. Routine monitoring, reporting, and review of cesarean section (CS) indications, decision-to-delivery intervals, and partograph use are important elements of quality improvement for maternity services. METHODS: In 2009 and 2010, a sample of CS delivery records from calendar year 2008 was reviewed at nine facilities in Bangladesh, Guinea, Mali, Niger, and Uganda. Data from patient records and hospital registers were collected on key aspects of care (e.g., timing of key events, indications, partograph use, maternal and fetal outcomes). Qualitative interviews were conducted with key informants at all study sites. RESULTS: A total of 2,941 records were reviewed. Fifty-seven key informant interviews were conducted to learn about record- keeping practices. Patient record-keeping systems were of varying quality across study sites: at five sites, more than 20% of records could not be located. Across all sites, patient files were missing key aspects of CS delivery care: timing of key events (e.g., examination, decision to perform CS), administration of prophylactic antibiotics,
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maternal complications, and maternal and fetal outcomes. Rates of partograph use were disappointingly low at six sites: 0 to 23.9% of patient files at these sites had a completed partograph on file, and among those found, 2.1% to 65.1% were completed correctly. Information on fetal outcomes was missing in up to 40% of patient files. CONCLUSIONS: Deficits in CS patient record data quality across a broad range of health facilities in low-resource settings in four sub-Saharan Africa countries and Bangladesh indicate an urgent need to improve record keeping.
Landry E, Frajzyngier V, Ruminjo J, Asiimwe F, Barry TH, Bello A, Danladi D, Ganda SO, Idris S, Inoussa M, Kanoma B, Lynch M, Mussell F, Podder DC, Wali A, Mielke E, Barone MA. Profiles and experiences of women undergoing genital fistula repair: findings from five countries. Global Public Health. 2013;8(8):926-42.
This article presents data from 1354 women from five countries who participated in a prospective cohort study conducted between 2007 and 2010. Women undergoing surgery for fistula repair were interviewed at the time of admission, discharge, and at a 3-month follow-up visit. While women's experiences differed across countries, a similar picture emerges across countries: women married young, most were married at the time of admission, had little education, and for many, the fistula occurred after the first pregnancy. Median age at the time of fistula occurrence was 20.0 years (interquartile range 17.3-26.8). Half of the women attended some antenatal care (ANC); among those who attended ANC, less than 50% recalled being told about signs of pregnancy complications. At follow-up, most women (even those who were not dry) reported improvements in many aspects of social life, however, reported improvements varied by repair outcome. Prevention and treatment programmes need to recognise the supportive role that husbands, partners, and families play as women prepare for safe delivery. Effective treatment and support programmes are needed for women who remain incontinent after surgery.
Longombe AO, Claude KM, Ruminjo J. Fistula and traumatic genital injury from sexual violence in a conflict setting in Eastern Congo: case studies. Reproductive Health Matters. 2008 May;16(31):132-41.
The Eastern region of the Democratic Republic of Congo (DRC) is currently undergoing a brutal war. Armed groups from the DRC and neighbouring countries are committing atrocities and systematically using sexual violence as a weapon of war to humiliate, intimidate and dominate women, girls, their men and communities. Armed combatants take advantage with impunity, knowing they will not be held to account or pursued by police or judicial authorities. A particularly inhumane public health problem has emerged: traumatic gynaecological fistula and genital injury from brutal sexual violence and gang-rape, along with enormous psychosocial and emotional burdens. Many of the women who survive find themselves pregnant or infected with STIs/HIV with no access to treatment. This report was compiled at the Doctors on Call for Service/Heal Africa Hospital in Goma, Eastern Congo, from the cases of 4,715 women and girls who suffered sexual violence between April 2003 and June 2006, of whom 702 had genital fistula. It presents the personal experiences of seven survivors whose injuries were severe and long-term, with life-changing effects. The paper recommends a coordinated effort amongst key stakeholders to secure peace and stability, an increase in humanitarian assistance and the rebuilding of the infrastructure, human and physical resources, and medical, educational and judicial systems.
Mallick L, Tripathi V. The association between female genital fistula symptoms and gender-based violence: A multicountry secondary analysis of household survey data. Trop Med Int Health. 2018 Jan;23(1):106-119.
OBJECTIVE: The Demographic and Health Surveys (DHS), which include standardised questions on female genital fistula symptoms, provide a unique opportunity to evaluate the epidemiology of fistula. This study sought to examine associations between self-reported fistulasymptoms and experience of gender-based violence (GBV) among women interviewed in DHS surveys. METHODS: This study used data from thirteen DHS surveys with standardised fistula and domestic violence modules. Data from the most recent survey in each country were pooled, weighting each survey equally. Multivariable logistic regressions controlled for maternal and demographic factors. RESULTS: Prevalence of fistula symptoms in this sample of 95 625 women ranges from 0.3% to 1.8% by country. The majority of women reporting fistula symptoms (56%) have ever experienced physical violence, and more than one-quarter have ever experienced sexual violence (27%), compared with 38% and 13% among women with no
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symptoms, respectively. Similarly, 16% of women with fistula symptoms report recently experiencing sexual violence-twice the percentage among women not reporting symptoms (8%). Women whose first experience of sexual violence was from a non-partner have almost four times the odds of reporting fistula symptoms compared with women who never experienced sexual violence. These associations indicate a need to investigate temporal and causal relationships between violence and fistula. CONCLUSIONS: The increased risk of physical and sexual violence among women with fistula symptoms suggests that fistula programmes should incorporate GBV into provider training and services.
Ngongo C, Levin K, Landry E, Sutton I, Ndizeye S. What to measure and why? Experience developing and using novel monitoring indicators in maternal health: the case of obstetric fistula. Journal of Health Informatics in Developing Countries. 2015 9(1): 14-22.
The field of obstetric fistula has historically lacked common definitions for measuring outcomes. This paper recounts the process of developing, refining, and using standardized monitoring indicators and approaches as part of a fistula prevention and repair project working in fourteen countries. The process included the development and refinement of clinical indicators, the introduction of standardizing data collection and reporting at partner health facilities, building capacity to use data for decision making locally, nationally, and within the project, institutionalizing data review meetings and partner health facilities, and supporting the introduction of fistula treatment indicators into national Health Management Information Systems to enable continued measurement and support for fistula treatment services. As monitoring in the field of obstetric fistula continues to become more standardized and routine, the multi-country scope of the project enabled a wide-ranging effort through which indicators for a “new” maternal health content area were developed and applied. This experience provides lessons for other initiatives seeking to strengthen monitoring and reporting related to novel or emerging topics in maternal health services.
Ngongo C, Christie K, Holden J, Ford C, Pett C. Striving for excellence: nurturing midwives' skills in Freetown, Sierra Leone. Midwifery. 2013 Oct;29(10):1230-4.
Midwives provide critical, life-saving care to women and babies. Effective midwives must be clinically competent, with the required knowledge, skills, and attitudes to provide quality care. Their success depends on an environment of supportive supervision, continuing education, enabling policies, and access to equipment and referral facilities. In Freetown, Sierra Leone, the Aberdeen Women's Centre launched a maternity unit with an emphasis on striving for excellence and providing ongoing professional development to its staff midwives. Its success was built upon fostering a sense of responsibility and teamwork, providing necessary resources, conforming to evidence-based standards, and building partnerships. An explicit philosophy of care was crucial for guiding clinical decision making. In its first two years of operation, the Aberdeen Women's Centre assisted 2076 births with two maternal deaths and 92 perinatal deaths. In-service education and supportive supervision facilitated the midwives' professional growth, leading to capable future leaders who are providing exemplary care to delivering mothers and their newborns in Freetown.
Raassen TJ, Ngongo CJ, Mahendeka MM. Iatrogenic genitourinary fistula: an 18-year retrospective review of 805 injuries. International Urogynecology Journal. 2014 Dec;25(12):1699-706.
INTRODUCTION: Genitourinary fistula poses a public health challenge in areas where women have inadequate access to quality emergency obstetric care. Fistulas typically develop during prolonged, obstructed labor, but clinicians can also inadvertently cause a fistula when performing obstetric or gynecological surgery. METHODS: This retrospective study analyzes 805 iatrogenic fistulas from a series of 5,959 women undergoing genitourinary fistula repair in 11 countries between 1994 and 2012. Injuries fall into three categories: ureteric, vault, and vesico- [utero]/-cervico-vaginal. This analysis considers the frequency and characteristics of each type of fistula and the risk factors associated with iatrogenic fistula development. RESULTS: In this large series, 13.2% of genitourinary fistula repairs were for injuries caused by clinician error. A range of cadres conducted procedures resulting in
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iatrogenic fistula. Four out of five iatrogenic fistulas developed following surgery for obstetric complications: cesarean section, ruptured uterus repair, or hysterectomy for ruptured uterus. Others developed during gynecological procedures, most commonly hysterectomy. Vesico-[utero]/-cervico-vaginal fistulas were the most common (43.6%), followed by ureteric injuries (33.9%) and vault fistulas (22.5%). One quarter of women with iatrogenic fistulas had previously undergone a laparotomy, nearly always a cesarean section. Among these women, one quarter had undergone more than one previous cesarean section. CONCLUSIONS: Women with previous cesarean sections are at increased risk for iatrogenic injury. Work environments must be adequate to reduce surgical error. Training must emphasize the importance of optimal surgical techniques, obstetric decision-making, and alternative ways to deliver dead babies. Iatrogenic fistulas should be recognized as a distinct genitourinary fistula category.
Ruminjo JK, Frajzyngier V, Bashir Abdullahi M, Asiimwe F, Hamidou Barry T, Bello A, Danladi D, Oumarou Ganda S, Idris S, Inoussa M, Lynch M, Mussell F, Chandra Podder D, Wali A, Barone MA. Clinical procedures and practices used in the perioperative treatment of female genital fistula during a prospective cohort study. BMC Pregnancy Childbirth. 2014 Jul 5;14:220.
BACKGROUND: Treatment and care for female genital fistula have become increasingly available over the last decade in countries across Africa and South Asia. Before the International Federation of Gynaecology and Obstetrics (FIGO) and partners published a global fistula training manual in 2011 there was no internationally recognized, standardized training curriculum, including perioperative care. The community of fistula care practitioners and advocates lacks data about the prevalence of various perioperative clinical procedures and practices and their potential programmatic implications are lacking. METHODS: Data presented here are from a prospective cohort study conducted between September 2007 and September 2010 at 11 fistula repair facilities supported by Fistula Care in five countries. Clinical procedures and practices used in the routine perioperative management of over 1300 women are described. RESULTS: More than two dozen clinical procedures and practices were tabulated. Some of them were commonly used at all sites (e.g., vaginal route of repair, 95.3% of cases); others were rare (e.g., flaps/grafts, 3.4%) or varied widely depending on site (e.g. for women with urinary fistula, the inter-quartile range for median duration of post-repair bladder catheterization was 14 to 29 days). CONCLUSIONS: These findings show a wide range of clinical procedures and practices with different program implications for safety, efficacy, and cost-effectiveness. The variability indicates the need for further research so as to strengthen the evidence base for fistula treatment in developing countries.
Ruminjo R, Landry E, Beattie K, Isah A, Faisel AJ, Millimono S. Mortality risk associated with surgical treatment of female genital fistula. International Journal of Gynecology and Obstetrics. 2014 Apr 18. pii: S0020- 7292(14)00194-5.
OBJECTIVE: Most surgeries proceed without incident, but all major surgeries have inherent risks for adverse events, including death. Some deaths are attributable to the condition requiring surgery, concurrent morbidity, or the surgery itself. For fistula treatment, published literature on mortality risk is extremely limited. This article describes the mortality risk associated with surgical treatment of female genital fistula and the contributory and contextual factors. METHODS: Confidential inquiries and clinical audits were conducted at 14 fistula repair sites in seven resource-poor countries. Data collection included interviews with key personnel involved in the clinical management of the deceased and a review of hospital records and client files following an audit protocol. RESULTS: Thirty deaths occurred from 26,060 fistula repair surgeries from 2005 to 2013, 21 attributable to surgery; the case fatality was 0.08 per 100 procedures. The causes of death for nearly half of the cases were various manifestations of sepsis and inflammation. CONCLUSIONS: This case fatality rate for fistula repair surgery is in the same range as comparable gynecologic operations in high-resource settings. Clinical and systemic issues should be addressed to minimize chances of recurrence, improve perioperative care and follow-up, assure prudent referral or deferral of difficult cases, and maintain better records.
Ruminjo J. 2007. Obstetric fistula and the challenge to maternal health care systems. IPPF Medical Bulletin 41(4):3-4. [COMMENTARY – NO ABSTRACT]
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Tripathi V, Elneil S, Romanzi L. Demand and capacity to integrate pelvic organ prolapse and genital fistula services in low-resource settings. Int Urogynecol J. 2018 Feb 6. [Epub ahead of print]
INTRODUCTION AND HYPOTHESIS: There is a need for expanded access to safe surgical care in low- and middle-income countries (LMICs) as illustrated by the report of the 2015 Lancet Commission on Global Surgery. Packages of closely-related surgical procedures may create platforms of capacity that maximize impact in LMIC. Pelvic organ prolapse (POP) and genital fistula care provide an example. Although POP affects many more women in LMICs than fistula, donor support for fistula treatment in LMICs has been underway for decades, whereas treatment for POP is usually limited to hysterectomy-based surgical treatment, occurring with little to no donor support. This capacity-building discrepancy has resulted in POP care that is often non-adherent to international standards and in non-integration of POP and fistula services, despite clear areas of similarity and overlap. The objective of this study was to assess the feasibility and potential value of integrating POP services at fistula centers. METHODS: Fistula repair sites supported by the Fistula Care Plus project were surveyed on current demand for and capacity to provide POP, in addition to perceptions about integrating POP and fistula repair services. RESULTS: Respondents from 26 hospitals in sub-Saharan Africa and South Asia completed the survey. Most fistula centers (92%) reported demand for POP services, but many cannot meet this demand. Responses indicated a wide variation in assessment and grading practices for POP; approaches to lower urinary tract symptom evaluation; and surgical skills with regard to compartment-based POP, and urinary and rectal incontinence. Fistula surgeons identified integration synergies but also potential conflicts. CONCLUSIONS: Integration of genital fistula and POP services may enhance the quality of POP care while increasing the sustainability of fistula care.
Tripathi V. A literature review of quantitative indicators to measure the quality of labor and delivery care. International Journal of Gynecology and Obstetrics. 2016 Feb:132(2): 139-45.
BACKGROUND: Strengthening measurement of the quality of labor and delivery (L&D) care in low-resource countries requires an understanding of existing approaches. OBJECTIVES: To identify quantitative indicators of L&D care quality and assess gaps in indicators. SEARCH STRATEGY: PubMed, CINAHL Plus, and Embase databases were searched for research published in English between January 1, 1990, and October 31, 2013, using structured terms. SELECTION CRITERIA: Studies describing indicators for L&D care quality assessment were included. Those whose abstracts contained inclusion criteria underwent full-text review. DATA COLLECTION AND ANALYSIS: Study characteristics, including indicator selection and data sources, were extracted via a standard spreadsheet. MAIN RESULTS: The structured search identified 1224 studies. After abstract and full-text review, 477 were included in the analysis. Most studies selected indicators by using literature review, clinical guidelines, or expert panels. Few indicators were empirically validated; most studies relied on medical record review to measure indicators. CONCLUSIONS: Many quantitative indicators have been used to measure L&D care quality, but few have been validated beyond expert opinion. There has been limited use of clinical observation in quality assessment of care processes. The findings suggest the need for validated, efficient consensus indicators of the quality of L&D care processes, particularly in low-resource countries.
Tripathi V, Stanton C, Strobino D, Bartlett L. Development and Validation of an Index to Measure the Quality of Facility-Based Labor and Delivery Care Processes in Sub-Saharan Africa. PLoS ONE. 2015. 10(6): e0129491.
BACKGROUND: High quality care is crucial in ensuring that women and newborns receive interventions that may prevent and treat birth-related complications. As facility deliveries increase in developing countries, there are concerns about service quality. Observation is the gold standard for clinical quality assessment, but existing observation-based measures of obstetric quality of care are lengthy and difficult to administer. There is a lack of consensus on quality indicators for routine intrapartum and immediate postpartum care, including essential newborn care. This study identified key dimensions of the quality of the process of intrapartum and immediate postpartum care (QoPIIPC) in facility deliveries and developed a quality assessment measure representing these dimensions. METHODS & FINDINGS: Global maternal and neonatal care experts identified key dimensions of
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QoPIIPC through a modified Delphi process. Experts also rated indicators of these dimensions from a comprehensive delivery observation checklist used in quality surveys in sub-Saharan African countries. Potential QoPIIPC indices were developed from combinations of highly-rated indicators. Face, content, and criterion validation of these indices was conducted using data from observations of 1,145 deliveries in Kenya, Madagascar, and Tanzania (including Zanzibar). A best-performing index was selected, composed of 20 indicators of intrapartum/immediate postpartum care, including essential newborn care. This index represented most dimensions of QoPIIPC and effectively discriminated between poorly and well-performed deliveries. CONCLUSIONS: As facility deliveries increase and the global community pays greater attention to the role of care quality in achieving further maternal and newborn mortality reduction, the QoPIIPC index may be a valuable measure. This index complements and addresses gaps in currently used quality assessment tools. Further evaluation of index usability and reliability is needed. The availability of a streamlined, comprehensive, and validated index may enable ongoing and efficient observation-based assessment of care quality during labor and delivery in sub-Saharan Africa, facilitating targeted quality improvement.
Tunçalp O, Tripathi V, Landry E, Stanton CK, Ahmed S. Measuring the incidence and prevalence of obstetric fistula: approaches, needs, and recommendations. Bulletin of the World Health Organization. 2015 Jan; 93(1):60-62. [COMMENTARY - NO ABSTRACT]
Tunçalp Ö, Isah A, Landry E, Stanton CK. Community-based screening for obstetric fistula in Nigeria: a novel approach. BMC Pregnancy Childbirth. 2014 Jan 24;14:44.
BACKGROUND: Obstetric fistula continues to have devastating effects on the physical, social, and economic lives of thousands of women in many low-resource settings. Governments require credible estimates of the backlog of existing cases requiring care to effectively plan for the treatment of fistula cases. Our study aims to quantify the backlog of obstetric fistula cases within two states via community-based screenings and to assess the questions in the Demographic Health Survey (DHS) fistula module. METHODS: The screening sites, all lower level health facilities, were selected based on their geographic coverage, prior relationships with the communities and availability of fistula surgery facilities in the state. This cross-sectional study included women who presented for fistula screenings at study facilities based on their perceived fistula-like symptoms. Research assistants administered the pre-screening questionnaire. Nurse-midwives then conducted a medical exam. Univariate and bivariate analyses are presented. RESULTS: A total of 268 women attended the screenings. Based on the pre- screening interview, the backlog of fistula cases reported was 75 (28% of women screened). The backlog identified after the medical exam was 26 fistula cases (29.5% of women screened) in Kebbi State sites and 12 cases in Cross River State sites (6.7%). Verification assessment showed that the DHS questionnaire had 92% sensitivity, 83% specificity with 47% positive predictive value and 98% negative predictive value for identifying women afflicted by fistula among women who came for the screenings. CONCLUSIONS: This methodology, involving effective, locally appropriate messaging and community outreach followed up with medical examination by nurse-midwives at lower level facilities, is challenging, but represents a promising approach to identify the backlog of women needing surgery and to link them with surgical facilities.
II. In press/under review/in draft
Tripathi V, Romanzi L, Langer A, Wegner MN. Cesarean sections: preventing mortality yet causing morbidity? Under review at BMJ Open. [COMMENTARY – NO ABSTRACT]
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APPENDIX F: FC/FC+ PUBLICATION READERSHIP METRICS*
PUB TITLE VIEWS JOURNAL YEAR Obstetric fistula and the challenge to maternal health care systems n/a* IPPF Medical Bulletin 2007 Fistula and traumatic genital injury from sexual violence in a conflict setting in Eastern Congo: case studies n/a Reproductive Health Matters 2008 Current practices in treatment of female genital fistula: a cross BMC Pregnancy and sectional study 8623 Childbirth 2010 Determinants of postoperative outcomes of female genital fistula repair surgery. n/a Obstetrics and Gynecology 2012 Factors influencing choice of surgical route of repair of genitourinary fistula, and the influence of route of repair on surgical outcomes: findings from a prospective cohort study n/a BJOG 2012 Factors influencing urinary fistula repair outcomes in American Journal of developing countries: a systematic review n/a Obstetrics and Gynecology 2012 Non-inferiority of short-term urethral catheterization following fistula repair surgery: study protocol for a randomized controlled trial 5046 BMC Women's Health 2012 Development and comparison of prognostic scoring systems American Journal of for surgical closure of genitourinary fistula. n/a Obstetrics and Gynecology 2013 Current Opinion in Obstetrics Outcomes in obstetric fistula care: a literature review n/a and Gynecology 2013 Profiles and experiences of women undergoing genital fistula repair: findings from five countries 1280 Global Public Health 2013 Striving for excellence: nurturing midwives' skills in Freetown, Sierra Leone. n/a Midwifery 2013 Assessing the quality of record keeping for cesarean deliveries: results from a multicenter retrospective record BMC Pregnancy and review in five low-income countries. 2176 Childbirth 2014 Clinical Procedures and Practices Used in the Perioperative Treatment of Female Genital Fistula during a Prospective BMC Pregnancy and Cohort Study. 2312 Childbirth 2014 Community-based screening for obstetric fistula in Nigeria: a BMC Pregnancy and novel approach 3409 Childbirth 2014 Iatrogenic genitourinary fistulas: An 18-year retrospective International Journal of review of 801 iatrogenic injuries n/a Urogynecology 2014 Rethinking how to promote care seeking: Factors associated Health Care for Women with institutional delivery in Guinea 1274 International 2014 Measuring the incidence and prevalence of obstetric fistula: Bulletin of the World Health approaches, needs, and recommendations n/a Organization 2014 Mortality risk associated with surgical treatment of female International Journal of genital fistula. 228*** Gynecology and Obstetrics 2014 The value of building health promotion capacities within communities: Evidence from a maternal health intervention in Guinea. n/a Health Policy and Planning 2014 A literature review of quantitative indicators to measure the International Journal of quality of labor and delivery care** n/a Gynecology and Obstetrics 2015 Breakdown of simple female genital fistula repair after 7 day versus 14 day postoperative bladder catheterisation: a randomised, controlled, open-label, non-inferiority trial n/a The Lancet 2015 Development and validation of an index to measure facility- based labor and delivery care processes in sub-Saharan Africa** 9261 PLOS ONE 2015 Prevalence and correlates of intimate partner violence among family planning clients in Conakry, Guinea. 540 BMC Research Notes 2015
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PUB TITLE VIEWS JOURNAL YEAR Factors associated with loss to follow-up in women undergoing Tropical Medicine and repair for obstetric fistula in Guinea n/a International Health 2015 Good clinical outcomes from a 7-year holistic programme of Tropical Medicine and fistula repair in Guinea. n/a International Health 2015 What to measure and why. Experience developing monitoring indicators for an emerging maternal health issue: the case of Journal of Health Informatics obstetric fistula" n/a in Developing Countries 2015 Pregnancy and childbirth after repair of obstetric fistula in sub- Tropical Medicine and Saharan Africa: Scoping Review n/a International Health 2016 A realist review of the partograph: when and how does it work BMC Pregnancy and for labour monitoring? 7488 Childbirth 2017 Development and preliminary validation of a post-fistula repair reintegration instrument among Ugandan women. 853 Reproductive Health 2017 Fistula recurrence, pregnancy, and childbirth following successful closure of female genital fistula in Guinea: a longitudinal study. (epublication; full publication to follow in late 2017) n/a Lancet Global Health 2017 Ending fistula within a generation: making the dream a reality. n/a Lancet Global Health 2017 The association between female genital fistula symptoms and Tropical Medicine and gender-based violence: A multicountry secondary analysis of International Health household survey data. n/a 2018 Demand and capacity to integrate pelvic organ prolapse and International Journal of genital fistula services in low-resource settings. n/a Urogynecology 2018 Poverty is the big thing": exploring financial, transportation, Int J Equity Health and opportunity costs associated with fistula management and repair in Nigeria and Uganda.**** 971 2018 Caesarean section provision and readiness in Tanzania: BMJ Open analysis of cross-sectional surveys of women and health facilities over time.***** 238 2018 Trajectories of Women's Physical and Psychosocial Health Tropical Medicine and Following Obstetric Fistula Repair in Uganda: A Longitudinal International Health Study. [Epub ahead of print]**** n/a 2018 TOTAL 43,699 * n/a indicates that the journal does not provide readership metrics ** Published through the Maternal and Child Health Integration Program/Maternal and Child Survival Program. *** Due to a change in web platform, updated metrics are no longer available. This number reflects views through late 2014. **** Accepted during FY2018; published after close of fiscal year.
Updated 11/6/2018.
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APPENDIX G: HUMAN RESOURCES FOR HEALTH CESAREAN SECTION SESSION INVITATION
Please join a brown bag lunch session at the Fourth Global Forum on Human Resources for Health (HRH) Strengthening the Surgical, Obstetric, and Anesthesia Workforce to Ensure the Safety and Quality of Cesarean Section Services in Low-resource Settings Thursday, 16 November 2017 | 12:30 – 13:30 Session Room – Dodder B | Royal Dublin Society
Cesarean section is one of the most commonly provided surgeries in low and middle-income countries (LMIC). This essential procedure requires an adequate health workforce. HRH gaps contribute to unsafe, poor quality, and inequitably distributed cesarean section services in LMICs. Iatrogenic fistula, often the result of low quality cesarean section service delivery, now represents a substantial proportion of fistula cases in South Asia and sub-Saharan Africa. The workforce issues affecting cesarean care are a microcosm of HRH challenges in low-resource settings.
The Fistula Care Plus project and Maternal Health Task Force hosted a global technical consultation with safe surgery and safe motherhood experts in July 2017. Participants reviewed flashpoints in cesarean provision affecting safety and quality, and developed a consensus action agenda to respond to these challenges.
This session will share the HRH-focused findings and recommendations from this consultation and identify strategies for action. Participants will: Understand trends in cesarean section provision in LMICs, including health worker distribution and cadre. Describe contributors to unsafe health system environments for cesarean section, particularly related to the surgical, obstetric, and anesthesia workforce. Define key actions to strengthen HRH that will improve the safety and quality of cesarean services and identify steps through which HRH stakeholders can promote these actions.
The session will be moderated by Loveday Penn-Kekana, London School of Hygiene and Tropical Medicine (LSHTM). Panelists include: Lenka Benova, LSHTM Lina Roa, Program in Global Surgery and Social Change, Harvard Medical School Vandana Tripathi, Fistula Care Plus project, EngenderHealth Read the full consultation report: https://fistulacare.org/resources/program-reports/cesarean-section-technical-consultation/
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APPENDIX H: HRH FORUM PRESENTATIONS
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APPENDIX I: CESAREAN SECTION TECHNICAL CONSULTATION DISSEMINATION PRESENTATION
Fistula Care Plus (FC+) Project Overview
• Goal: Strengthen health system Current Countries: Bangladesh, capacity for fistula prevention, Democratic Republic of the Congo, detection, treatment, and Niger, Nigeria, Uganda; reintegration; 2013–2018 EngenderHealth also addresses fistula in Guinea • Through USAID funding, FC+ and its predecessor projects at EngenderHealth have supported >35,400 surgical fistula repairs and trained >26,000 health care workers
#csectionsafety
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Additional Evidence from the Literature
• Wright et al., 2016, Ethiopia – Review of 2,593 fistula cases at Hamlin Hospital (2011–2015) – 24.6% of women had high bladder fistula, “which predominantly occurs following surgery, specifically C/S or emergency hysterectomy….” • Onsrud et al., 2011, DRC – Review of 597 fistula cases at Panzi Hospital (2005–2007) – Of 229 women with fistula who had cesarean delivery, 24% of cases were considered iatrogenic in origin • Benfield et al., 2015, DRC – Survey of 202 fistula clients at HEAL Africa Hospital (2009–2012) – 74% of women with fistula reported to a hospital or health center during early labor
#csectionsafety Global survey data on C/S in LMIC
• https://tinyurl.com/LMICCSAnalysis
Who, where, and why? Lenka Beňová, Francesca L. Cavallaro, Oona M.R. Campbell
#csectionsafety
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APPENDIX J: FCOP WEBINAR ANNOUNCEMENT
Please join the Fistula Community of Practice (FCoP) on November 9, 2017 at 9:30 am Eastern Standard Time for a webinar sharing highlights from a recent technical consultation on cesarean section safety and quality in low-resource settings.
Cesarean section provision has expanded rapidly in low/middle-income countries (LMIC). 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 LMIC fistula incidence.
The Fistula Care Plus Project and 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 LMIC, at global institutions, and in the US. Following presentations of global cesarean section trends, participants discussed flashpoints in safety and quality (e.g., workforce density, task shifting, clinical decision-making, and patient 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 realization of the potential impacts of universal access to essential obstetric surgery.
Webinar learning objectives:
Understand the key findings of a recent analysis of DHS and SPA data on trends in cesarean section provision in LMIC Describe important contributors to and key health impacts of an unsafe health system environment for cesarean section Describe the key actions in the consensus agenda produced through the consultation Identify opportunities to disseminate the action agenda and support its implementation
Visit our website: www.fistulacare.org
Follow us on Twitter @fistulacare
After registering, you will receive a confirmation email containing information about joining the webinar.
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Webinar Panelists Include:
Lenka Benova
Lenka is a quantitative population health scientist with training in management, economics, Middle East studies and demography. She currently serves as a co-investigator in the Maternal healthcare markets Evaluation Team (MET), leading the SAGE (Secondary data Analysis for Generating new Evidence) team. Within this role, Lenka utilizes secondary data - on both individual and health-facility levels - to describe levels, trends and inequalities in healthcare coverage in order to pinpoint policy priorities. Previously, she headed operations in a start-up company in eldercare in the United States and worked as project coordinator with Médecins Sans Frontières in Nigeria, the West Bank and South Sudan. Lenka’s research focus is on health-seeking behavior in general and reproductive/maternal health in particular.
Vandana Tripathi, MPH, PhD Vandana Tripathi is the Deputy Director of the Fistula Care Plus Project. Before joining EngenderHealth, she worked on research studies related to maternal and newborn health, particularly quality of care measures in Sub-Saharan Africa, through projects at the Johns Hopkins Bloomberg School of Public Health and the Maternal and Child Health Integrated Program. Prior to this, Vandana worked at institutions including HealthRight International, Planned Parenthood of New York City, and the Ford Foundation.
John Varallo, MD, MPH Dr. John Varallo is an Obstetrician/Gynecologist with extensive global public health and clinical experience in over 20 countries in diverse settings. At Jhpiego/MCSP, he is a Senior Technical Advisor providing technical leadership on improving the quality of care in the prevention and management of maternal Annual Report • October 2017 – September 2018 Fistula Care Plus 166
complications, including improving the safety and quality of cesarean section in the organization’s programs.
Mary Nell Wegner, EdM, MPH Mary Nell Wegner is the Executive Director of the Maternal Health Task, overseeing work that spans the MHTF portfolio and includes a number of partners, as well as faculty, staff, and students. Previously, she has worked directly for donors (the Rockefeller Foundation, UNFPA and the Empower Foundation) as well as community-based and nonprofit organizations at both the local and global levels (Jubilee Refugee Camp, The White Mountain Apache Tribal Health Authority, The Women’s Dignity Project, Planned Parenthood of Connecticut, Planned Parenthood of the Rocky Mountains, The Margaret Sanger Center and EngenderHealth).
The webinar will be moderated by Bethany Cole, the Global Projects Manager on the Fistula Care Plus project. Please direct any inquiries about the FCoP or the webinar to [email protected].
The Fistula Care Plus project, in coordination with the U.S. Agency for International Development, manages the FCoP. The purpose of the FCoP is to facilitate collective learning, knowledge sharing, coordination, and technical resource development related to preventive care, detection, treatment, and reintegration support for women and their families and communities and to leverage that within the global conversation and activity around fistula.
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APPENDIX K: IHI POSTER QOC IN TANZANIA
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APPENDIX L: IHI POSTER CESAREAN SECTION CONSULTATION
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APPENDIX M: IHI POSTER SST IMPLEMENTATION
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APPENDIX N: 58TH ANNUAL CONFERENCE OF WEST AFRICAN COLLEGES OF SURGEONS (WACS) PROGRAM
25TH FEB 2018 TO 2ND MARCH 2018 PROGRAMME SCHEDULE
SUN MON TUES WEDS THURS FRI SAT 10:00 – 05:00 08:00 - 09:30 AM 08:00 - 09:30 AM PARALLEL PARALLEL 10:00 - 12:00 PM PM ETHICON Parallel scientific /WAHO/ SCIENTIFIC SCIENTIFIC sessions Jim Nwobodo SESSIONS SESSIONS Prize Contests 09:30 - 10:15 AM Scientific Session
TEA BREAK TEA BREAK TEA BREAK TEA BREAK
10:00 - 12:00 PM 10:30 - 12:30 PM 10:30 - 12:30 10:30 - 12:30 10:00 - 12:00 PM Council PM PM Meeting Departure PARALLEL PARALLEL PARALLEL CONFERMENT OF Opening Ceremony SCIENTIFIC SCIENTIFIC SCIENTIFIC HONORARY SESSIONS SESSIONS SESSIONS FELLOWSHIP ADMISSION OF NEW FELLOWS DIPLOMATES
12:00 - 12:30 PM CLOSING CEREMONY
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Group Photo Exhibitions Refreshment
12:30 – 1:30 PM 12:30 - 1:30 PM 12:30 - 1:30 PM 12:30 - 1:30 PM
Scientific SIR SAMUEL Scientific Scientific Parallel MANUWA Parallel Parallel Sessions Lecture Sessions Sessions
01:30 - 02:30 PM LUNCH BREAK
02:30 - 05:30 PM 02:30 - 5:30 02:30 - 05:30 02:30 - 6:30 PM PM PM
FACULTY BOARD PARALLEL AGM Scientific MEETINGS SCIENTIFIC Session SESSIONS Free papers ACCREDITATION Adjourned MEETING Council Meeting FREE
07:00 – 09:00 PM 07:00 - 11:30 07:00 – 07:00 – PM 09:00 PM 09:00 PM GALA COCKTAIL COCKTAIL COCKTAIL DINNER, Endowment Fund & DANCE
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APPENDIX O: WACS LIST OF FC+ AND CONSULTANT PARTICIPANTS
Noms Fonction Localisation Institution Contacts
Altiné DIOP Program New-York EH/FC+ [email protected] Associate Nazmul Huda Acting Global BANGLADESH EH/FC+ [email protected] Field Manager, FC+ Iyeme Efem Nigeria NIGERIA EH/FC+ [email protected] Country Program Manager Oladosu Professor and NIGERIA Centre for [email protected] Ojengbede Director at Population & Ibadan Reproductive hospital Health College of Medicine University College Hospital, Ibadan AMODU Clinical NIGERIA EH/FC+ [email protected] Associate Félicien BANZE Technical DRC EH/FC+ [email protected] Advisor Prof. Serigne EH Consultant SENEGAL Université [email protected] MAGUEYE Cheik Anta GUEYE DIOP Dr Dolorès Project DRC Hôpital Saint [email protected] NEMBUNZU Manager FC+, Joseph
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APPENDIX P: WEST AFRICA REGIONAL MEETING FOR FISTULA ELIMINATION AGENDA
ENDING FISTULA WITHIN A GENERATION IN WEST AFRICA
REGIONAL TECHNICAL AND RESOURCES MOBILIZATION MEETING
Achieving “Hope, Healing and Dignity for All”
Banjul, March 5-7
The Gambia Coral Beach Hotel & SPA
DAY 1. 5th March 2018
8.00-8.30 Registration
8.30-9.30. Session 1. Opening Session
Welcoming remarks by WAHO representative Welcoming address by UNFPA representative Welcoming remarks by the US Ambassador to Gambia Welcoming remarks by the Minister of Health of Gambia Keynote address by the First Lady of Gambia
9.30-10.40 Session 2. Setting the stage: Regional Context (UNFPA, WACS)
Review of meeting objectives and agenda (5 min) Review of key meeting logistics (5 min) Regional landscape: Prevalence and Incidence of Fistula in the WCA region (30 min): UNFPA The call to end fistula: Previous resolutions/initiatives on fistula eradication in the world and in the region: where are we? What have learned? (30 min): UNFPA
10.40-11.00 Coffee Break
11.00-13.00 Session 3. Back to basics (WACS can adjust this session as needed)
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them. Analyze bottlenecks to advocate for Traumatic Fistula support and commitment Discuss the main challenges in ending fistula in the region and introduce the WCAGEOF
13.00-14.00 Lunch
14.00-16.30. Session 4: Round table: Donors and partners response in the fight to end fistula
UNFPA as the global leader in the end fistula campaign (30 min) USAID response: from congressional earmark to zero fistula in Maradi (30 min) Islamic Development Bank partnering to end fistula in West Africa (30 min) WAHO and ECGD regional leadership on campaign to end fistula The Nigerian experience with EngenderHealth The Asian experience in the campaign to end fistula (30 min)
8.30-10.30. Session 6: Harmonizing country strategies: Country presentations
Presentation of countries Strategies (30 min per country as per the template provided)
10.30-11.00 Coffee Break
11.00-12.30 Session 6 (con’t): Harmonizing country strategies: Country presentations
Presentation of countries Strategies (30 min per country as per the template provided) Summary of current status of all countries strategies and recommendations
12.30-13.30 Lunch
13.30-15.30 Session 7. Regional response (UNFPA)
Present and discuss the Regional Strategic Plan/ Proposal on ending fistula (discuss and select key intervention pillars) Resource mobilization and funding plan (UNFPA, USAID) o Timeline and main responsibilities (Group 1) o Budget of the RM plan (Group 2)
15.30-16.00 Coffee Break
16.00-17.00 Session 8: Costing of the regional strategy (Group work) Develop detailed costing of regional proposal (1 group to work on the costing) Roadmap (1 group to work on the Roadmap)
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8.30-9.00: Restitution of the costing and the design of the Roadmap
Presentation and discussion Validation
9.00-10.00: Session 9: Mapping of donors (Who, where, what, How)
8.30-10.30: Session 10: Coordination, Monitoring and Evaluation (WACS, USAID, UNFPA)
Formalization of the regional coordination mechanism Monitoring and Evaluation Plan and key tools: Discuss and select key indicators and expected results Road map until 2020
10.30-11.00 Coffee Break
11.00-12.00. Session 11: Review a draft of “Banjul’s call for action for fistula free West and Central Africa”
12.00-13.00 Session 12: Closing ceremony
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APPENDIX Q: WEST AFRICA REGIONAL MEETING FOR FISTULA ELIMINATION PARTICIPANTS LIST
REGIONAL MEETING TO ACCELERATE STRATEGY FOR OBSTETRIC FISTULA ERADICATION IN THE ECOWAS REGION BANJUL, GAMBIE, 5 - 7 MARS 2018 LIST OF PARTICIPANTS
No. Name/Nom PAYS/COUNTR Position and Contact Details/ Y Fonction et adresse
1. Her Excellency Mrs GAMBIA First Lady Republic of Gambia Fatoumatta Bah Barrow 2. Her excellency C. Patricia GAMBIA US AMBASSADOR in GAMBIA Alsup 3. Ms. Saffie Lowe – Ceesay GAMBIA The minister of health and social welfare of the republic of Gambia 4. Madame BACO CHABI MAMA BENIN Chef Division Formation au Ministère de la Aminatou santé Email : [email protected]
Tél : 00229.96 74 00 82
5. Madame Hermione TOSSOU BENIN Chef de Service Statut juridique de la femme et membre du comité national de lutte contre les FO Ministère des affaires sociales Email : [email protected] 6. Dr MOUSSA DADJOARI BURKINA FASO Tel: 70193199
Email: [email protected]
7. Mme OUEDRAOGO Habibou BURKINA FASO Chargée de missions du Ministre de la Femme, de la Solidarité Nationale et de la Famille [email protected]
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No. Name/Nom PAYS/COUNTR Position and Contact Details/ Y Fonction et adresse
8. Dr KOUADIO Bile Paul Roger COTE D’IVOIRE Médecin Point focal Fistule Obstétricale à la Direction de Coordination du Programme National de Santé de la Mère et de l’Enfant contacts : 225 02 42 91 94/ 225 77 99 04 57
Email : [email protected] 9. Dr KRAFFA Blaise COTE D’IVOIRE Médecin à l’institut Médico-Social du Ministère de la Femme de la Protection de l’Enfant Tél : +225 225 07 89 76 47
Email [email protected] 10. Mr. Bafoday JAWARA THE GAMBIA Programme Manager Reproductive and Child Health Unit Email: [email protected]
11. Gladys Brew GHANA Program manager Maternal and Child Health Email: [email protected] 12. Comfort Ablometi GHANA Principal Gender Officer
Email: [email protected] 13. Dr. Mamady Kourouma GUINEE Health Policy Counselor of the Minister of Health [email protected] Tel: +224 622 938 532 -CONAKRY 14. Pr. Namory Keita GUINEE Président de la Société Africaine de Gynécologie et d’Obstétrique (SAGO) Email : [email protected] 15. Dr. Mamadou Désiré Mary MALI Directeur National Adjoint de la Santé KEITA Tel 76476290 Email: [email protected] 16. Dr Ibrahim SOULEY NIGER Directeur Général de la Santé de la Reproduction, Président du Réseau pour l’Elimination de la Fistule Tel. (00227) 96 88 41 98
[email protected] 17. Mme Chaibou Oumoul Hairi NIGER Ministère de la Promotion de la Femme et de la Protection de l'Enfant [email protected]
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No. Name/Nom PAYS/COUNTR Position and Contact Details/ Y Fonction et adresse
18. Mr. Issoufou Balarabe NIGER Project Officer FC+ Niger
[email protected] 19. Mrs. PETERS- NIGERIA Fistula Programme coordinator OGUNMAYIN OLUSEYE Ministry of Health IDOWU [email protected] +234 8033151819
20. Dr. IYEME EFEM NIGERIA Nigeria country program manager,
Email : [email protected] 21. Prof OLADOSU OJENGBEDE NIGERIA Director center for Population & reproductive health, University college of Ibadan. Email: [email protected]
22. Dr. DEMBO GUIRASSY SENEGAL Ministère de la Santé et de l’Action Sociale
Direction de la Santé de la Mère et de l’Enfant Téléphone : +221 779202836 [email protected]
23. Mme FATOU CELINE BASS SENEGAL Mme Fatou Céline BASSE, joignable 00221 77612 32 10, [email protected] 24. Prof SERIGNE SENEGAL Vice President of WACS MAGUEYE GUEYE [email protected] 25. Dr. INNA RAKYA CAMEROUN Gynécologue Obstétricienne à l’Hôpital Gynéco Obstétrique et Pédiatrique de Douala Email : [email protected] 26. Dr. AISSA ADO BOUWAYE WAHO PO Santé maternelle et néonatale Bobo-Dioulasso, BURKINA FASO Tél: +226 75 75 90 90 Email: [email protected] 27. Ms. ALTINE DIOP NEW YORK Program Associate, FC+ [email protected] 28. Dr. SK. NAZMUL HUDA BANGLADESH Bangladesh Country Manager/West Africa Regional Technical Advisor
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No. Name/Nom PAYS/COUNTR Position and Contact Details/ Y Fonction et adresse
29. Dr. MBAYI KANGUDIE GHANA WA MISSION
+233-30-274-1843
30. Dr. SOSTHENE DOUGROU SENEGAL Technical Specialist, Health System Strengthening UNFPA Regional Office (WCARO)
31. Dr. KUNLE ADENIYI The GAMBIA UNFPA Representative in the Gambia
32. Dr. ZAHLA ASSOUMANA NIGER UNFPA consultant
33. Mr. IDRISSA OUEDRAOGO SENEGAL UNFPA Regional Office (WCARO)
34. Dr. FELICIEN BANZE DRC Clinical Advisor, FC+ DRC [email protected]
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APPENDIX R: WEST AFRICA REGIONAL MEETING FOR FISTULA ELIMINATION - FC+/DRC PRESENTATION
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APPENDIX S: WEST AFRICA REGIONAL MEETING FOR FISTULA ELIMINATION – FC+/NIGERIA PRESENTATION
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APPENDIX T: BANJUL CALL TO ACTION FOR A FISTULA FREE ECOWAS REGION
We, the participants of the regional meeting on intensifying efforts to end fistula in West Africa in a generation, held from March 5 to 7, 2018 at Banjul, in the Republic of The Gambia; attended by HE the First Lady of The Gambia, HE the US Ambassador to the Gambia, representatives of ministries of top 10 highest burden countries, development partners including WAHO, UNFPA, USAID and EngenderHealth represented by regional offices of respective organizations, academics represented by the leadership of West and Central African College of Surgeons,the Africa Society of Gynecologists and Obstetricians, the International Society of obstetric fistula Surgeons proposing this call for action
Considering that to heed the 2003 UN Secretary General’s call for action to end obstetric fistula “within a generation”, our sub-region requires optimized fistula prevention that integrates safe surgery principles within MNCH implementation frameworks, efficient and confidential identification of patients, women and young adolescent rights, partnership, coordination and resource mobilization.
Whereas ECOWAS countries share the highest burden of maternal mortality and morbidity in the world. Obstetric Fistula, a devastating chronic obstetric morbidity prevails as a sentinel indicator of massive global inequity in relation to the health and well-being of women and girls. The countries in the ECOWAS region need a clear road map with specific milestones to achieve a fistula-free generation.
Considering the highest level of political commitment demonstrated at the state leaderships, The ECOWAS First Ladies summit in Niamey, development partners, academicians, and professional organization for the much- deserved continuing improvement of the quality of life of women in West and Central African region for prevention, care and rehabilitation with regard to obstetric fistula.
Considering that an effective leadership and investments by the governments and concerted efforts of many stakeholders along with the women health professionals across the region can significantly catalyze better outcomes in women’s health..
We call on civil societies, professional bodies, women health professionals, development partners and other stakeholders to maintain and enhance capacity and integrated systems strengthening of national health systems, in partnership with academic institutions for prevention, case identification, surgical and non-surgical clinical management, reintegration and rehabilitation of the women with fistula in the region. Fundamental to the success of these collaborations is the promotion of data for decision making, research and knowledge management
We call on the ECOWAS leadership to support a resolution by the Assembly of Health Ministers for a continuing strong political commitment, domestic investment and resource mobilization for collective actions to make West Africa free from Fistula in a generation.
Done at Banjul, this 7th day of third Month 2018 Signed (list of participants provided)
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APPENDIX U: COSECSA/GIEESC EH/FC+ SPONSORED EVENT
East and Southern African Conversation on the Eradication of Obstetric Fistula December 6, 2017 COSECSA 2017 AGM, WHO GIEESC 2017
THE VISION
We are all here today in attendance of the Annual General Meeting 2017 of the College of Surgeons of East, Central and Southern Africa (COSECSA) and the 2017 meeting of the World Health Organization Global Initiative for Emergency and Essential Surgical Care (WHO GIEESC). Both of these organizations are active collaborators in the emerging “Safe Surgery” community of practice that supports surgical ecosystems that we all know are crucial to fistula prevention and to fistula treatment. There are no better contemporary women’s health indicators of gaps in surgical ecosystems than the persistence of eradicable obstetric fistula and the emerging threat of iatrogenic fistula caused by obstetric and gynecologic surgical systems weaknesses.
EngenderHealth’s Fistula Care Plus project is pleased sponsor tonight’s conversation to explore the possibility of collaboration between the safe surgery and fistula communities in order to accelerate the achievement of the UN Secretary General’s 2016 call to action to “End Fistula Within a Generation”.
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The formula for eradication is:
Prevent incident cases + Treat prevalent cases = Eradication
The UNSG’s challenge calls into sharp focus the eradication of classic obstetric fistula 100 years ago in Western Europe, North America and the UK. In these regions, obstetric fistula was eradicated without dedicated public health programming, in a pre-antibiotic era when life expectancy, literacy, empowerment of women and girls, maternal mortality, transportation and communication systems were, arguably, more severe than currently exists today in regions where prolonged/obstructed labor continues to challenge the prevention side of the eradication formula. Over the past decades, UNFPA, USAID, Fistula Foundation and other dedicated treatment partners have done much to address capacity and systems strengthening for surgical fistula treatment. UNFPA’s “End Fistula” campaign set the vision of eradication through a prevention/treatment/post-treatment reintegration platform. This campaign includes a list of 92 partner organizations and 26 supporting governments and other institutions. The global maternal/child health (MCH) community continues to face gaps in obstetric intervention access and quality that substantively impede MCH impact on mortality and morbidity prevention.
In 2015 we witnessed the launch of the Safe Surgery community of practice with the World Health Assembly call to action in resolution 68/15: Strengthening emergency and essential surgical care and anaesthesia as a component of universal health coverage, the publication of the proceeds of Lancet Comission on Global Surgery, and the publication of WHO’s DCP3 Essential Surgery textbook. The safe surgery movement engages a “Surgery Anesthesia Obstetrics” platform that includes 10 obstetric and gynecologic surgical procedures among the list of 44 Essential Surgeries, fistula surgery and cesarean section among them.
This evening, let us consider alliances across the public, private and academic sectors to close the surgical care gaps that, without specific actions, guarantee fistula will persist in low- and middle- income countries.
ORGANIZATIONS
Tonight we begin this conversation with the following organizations represented: USAID UNFPA – ESARO, Mozambique, Kenya, DRC, New York HQ WHO GIEESC COSECSA WACS (West African College of Surgeons) ECSACOG (ECSA College of Obstetrics and Gynaecology) Focus Fistula Mozambique RCOG Global Health ACOG Global Health Annual Report • October 2017 – September 2018 Fistula Care Plus 189
PGSCC ISOFS (International Society of Obstetric Fistula Surgeons) Fistula Foundation EngenderHealth Fistula Care Plus
AGENDA Introductions and organizational ideas Existing partnerships within safe surgery and fistula COPs Gaps & next steps
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APPENDIX V: PARTICIPANT LIST FOR FC+ DINNER SIDE EVENT
Name Organization(s) email Denis Robson Fistula Foundation, Johnson [email protected] and Johnson, WAHA Amir Modan UNFPA Mozambique [email protected] Achu Lordfred UNFPA DRC [email protected] Muna Abdullah UNFPA ESARO [email protected] Andrea Wagner UNFPA Mozambique [email protected] Rene Kiamba Johnson and Johnson [email protected] Berhanu T. Taye ACOG Global Women’s [email protected] Health Susan Raine ACOG Global Women’s [email protected] Health, Baylor University Mpunga Mafu Michel EH FC+ [email protected] Samo Manhiga AMREF Health Africa [email protected]; [email protected] SK Nazmul Huda EH FC+ [email protected] Farhana Akhter EH FC+ [email protected] Sohier Elneil RCOG Global Health [email protected] Igor Vaz Focus Fistula Mozambique [email protected] Baruga Evariste COSECSA [email protected] Byamugisha Josaphat ECSACOG [email protected] Bellington Vwalika ECSACOG [email protected] Barageine Justus Kafunjo ECSACOG, ISOFS, Makerere [email protected] University (Uganda), Save the Mothers (East Africa)
Kee Park Harvard Program in Global [email protected] Surgery and Social Change Fred Kirya ISOFS, UNFPA Uganda [email protected] Obonyo John Hyacinth Minister of Health, Uganda [email protected]
Serigne M. Gueye WACS, EH FC+ consultant [email protected]
Walt Johnson WHO GIEESC [email protected] Rachel Davis WHO Global Surgery Fellow Lauri Romanzi EH FC+ [email protected]; [email protected] Bethany Cole EH FC+ [email protected]
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APPENDIX W: SURVEY FOR COSECSA/GIEESC FC+ EVENT
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APPENDIX X: WHO GIEESC BIENNIAL MEETING AGENDA
The 7th WHO Global Initiative for Emergency and Essential Surgical Care Biennial Meeting
December 7, 2017 12:00 to 17:00 Joaquim Chissano International Conference Centre Maputo, Mozambique In conjunction with COSECSA and AMC
DESCRIPTION The WHO Emergency and the Essential Surgical Care Programme welcomes the members of the WHO Global Initiative for Emergency and Essential Surgical Care (GIEESC), representatives of Member States and other surgical stakeholders to its biennial meeting in Maputo, Mozambique. This meeting will take place in conjunction with the 18th Annual College of Surgeons of East, Central and Southern Africa (COSECSA) Meeting and the Associação Moçambicana de Cirurgia (AMC).
Two years have elapsed since the passage of the resolution WHA68.15 on "strengthening of emergency and essential surgical care and anaesthesia as a component of universal health coverage." During the last GIEESC meeting on December 2015 in Geneva, a roadmap towards implementation of this resolution was drafted. At recent WHA 70, a two-year report was presented and a Decision Point passed calling for continued reporting every 2 years until 2030. A WHO Global Action Plan was initiated.
Please join us in Maputo to hear global public health leaders, policymakers, champions of global surgery, and others discuss the many exciting developments and efforts to bring safe, affordable, and timely surgical care and anaesthesia to all. Annual Report • October 2017 – September 2018 Fistula Care Plus 194
Register for the event HERE or copy and paste: http://TinyURL.com/MaputoSurgery
CONTACT E-mail: [email protected] Twitter: #WHO #globalsurgery #GIEESC
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APPENDIX Y: FC+ BARRIER REDUCTION INTERVENTION STUDY DISSEMINATION PRESENTATION – NIGERIA
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APPENDIX Z: FC+ BARRIER REDUCTION INTERVENTION STUDY DISSEMINATION PRESENTATION – UGANDA
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APPENDIX AA: HSR SESSION APPLICATION 26
Overview for conference program
Health system challenges contribute to poor-quality, inequitably-distributed surgical obstetric care in low- resource settings. Increasing iatrogenic fistula from unsafe cesarean section demonstrates the impact of these gaps. Panelists will present evidence regarding the systems contexts and pressures affecting cesarean care and the recommendations of a global consultation to examine these challenges.
Summary of the session content: include purpose/objective, technical content, target audience and significance for the selected thematic area and/or field-building dimension; learning objectives
Accessible, affordable, acceptable, and quality maternal, newborn, and essential surgical care is fundamental to achieving the Sustainable Development Goals. Cesarean section is at the nexus of these three healthcare domains; it is one of the most commonly performed surgeries in low-resource settings and has been identified as one of three bellwether procedures by the global surgery movement. Safe cesarean requires a strong health system, particularly a functioning surgical ecosystem. The volume of cesarean procedures has increased rapidly in low- and middle-income countries (LMIC), without accompanying investments in the health system elements necessary to meet minimum safety and quality standards. Coverage with this essential maternal and newborn health procedure is extremely inequitably distributed and “too much” and “too little” can exist in the same country, or even same health facility. Iatrogenic fistula resulting from Cesarean section now accounts for a substantial proportion of fistula cases in South Asia and sub-Saharan Africa and should be seen as a sentinel indicator of health system dysfunction.
The Fistula Care Plus Project and the Maternal Health Task Force hosted a technical consultation with experts from the safe surgery and safe motherhood communities of practice. Participants presented clinical, survey, and programmatic evidence regarding health systems flashpoints affecting service safety and quality. These findings illustrated contributors to unsafe cesarean care; for example: The absolute numbers of cesarean sections have increased several-fold in many settings, even when the total number of births has declined; in overwhelmed hospitals, clinicians conduct Cesarean section completely alone, without nursing or anesthesia support; referral systems do not adequately link women or medical information between levels of care. Through iterative discussion, participants developed a consensus action agenda to address these health systems challenges.
The session will share the research findings and the consensus recommendations from this technical consultation. The session’s intended participants are health systems researchers, safe surgery and safe motherhood program implementers, and health equity advocates. The session learning objectives are to enable participants to:
Understand the context of cesarean section procedures in LMIC settings, particularly trends in service volume, facility readiness, and notable disparities in coverage. Describe important contributors to an unsafe health system environment for cesarean care and illustrate their maternal and newborn health
26 This is the original panel session submission, which was replaced by a satellite session application (subsequently accepted) in March 2018. Annual Report • October 2017 – September 2018 Fistula Care Plus 206
impacts Define key health system strengthening actions that will improve the safety and quality of Cesarean services.
Summary of the session’s planned process: include short description of any presentations or inputs, moderation/ management approach of the session, role of contributors, and description of how the 90 minutes will be used
This 90-minute session will be in a panel format, with a presentation portion followed by discussion among participants.
The presentation component (60 minutes) will include four presentations covering the objectives above, sharing information on:
- Evidence regarding maternal morbidity resulting from unsafe cesarean section. This will be guided by data from fistula treatment programs as well as clinical research examining cesarean section decision making and record keeping. (Presentation 1)
- Trends in the volume of these procedures, access disparities, and facility readiness to deliver these services. This will be guided by a multi-country analysis of Demographic Health Survey and Service Provision Assessment data. (Presentation 2)
- Case studies of health system flashpoints affecting Cesarean section quality and safety, e.g., workforce density, task shifting, infrastructure for infection prevention and anesthesia, surveillance and HMIS gaps, and challenges in alignment between public and private sectors. (Presentation 3)
The consensus action agenda identified by participants in a global technical consultation on Cesarean section safety and quality, and concrete tactics to advance this agenda. (Presentation 4)
The discussion component (30 minutes) will ask participants to:
- Provide feedback on the action agenda
- Offer recommendations for an ongoing research agenda to address cesarean safety and quality in LMIC
- Identify how they can advance the action agenda in their roles as policymakers, advocates, or program implementers.
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APPENDIX BB: FIGO SESSION SUMMARY
Title of Session: Cesarean Section Safety in Low-Resource Settings: Ensuring Quality in a Context of Rapidly Increasing Volume
Relevant Conference Theme: AB 2 Clinical Obstetrics: AB 2.3 Operative Obstetrics Chairperson: Dr. Vandana Tripathi, Fistula Care Plus Project at EngenderHealth Sponsoring Organization: EngenderHealth Individual Presentation Titles and Panelists 1. Cesarean section provision in low-resource settings: Who, where, why – global trends from DHS and SPA data Dr. Francesca Cavallaro, London School of Hygiene and Tropical Medicine 2. Preventing obstetric and iatrogenic fistula: The role of a safe surgery ecosystem Dr. Lauri Romanzi, Fistula Care Plus Project at EngenderHealth) 3. The right procedure for the right person: Clinical decision making for operative delivery Dr. Fernando Althabe, Institute for Clinical Effectiveness and Health Policy 4. The surgical, obstetric, and anesthesia (SAO) workforce: Global challenges and solutions from Ethiopia and Tanzania Dr. John Varallo, Jhpiego
Abstract: Objective: Cesarean section provision has expanded rapidly in low/middle-income countries (LMIC). Evidence indicates that many cesarean procedures are performed in unsafe settings. For example, iatrogenic fistula resulting from cesarean section now accounts for a substantial proportion of LMIC fistula incidence. This session will present trends in global cesarean section care, evidence regarding issues affecting cesarean care, and recommendations for action. .
Method: The Fistula Care Plus Project and Maternal Health Task Force convened a consultation to understand contributors to unsafe environments for cesarean section, describe knowledge gaps, and identify key actions to improve cesarean section safety and quality. Participants included clinicians and researchers in LMIC, at global institutions, and in the US. Discussions centered on global trends in cesarean volume and distribution, flashpoints in safety and quality (e.g., workforce density, task-shifting, clinical decision-making, and patient rights), and prioritizing responsive actions. Highlights from these proceedings will be presented during the session.
Results: Trends in the context of LMIC cesarean section procedures, particularly in service volume, facility readiness, and disparities in coverage illustrate health system pressures contributing to unsafe cesarean section. Severe health system gaps (e.g., staffing and infrastructure) contribute to an unsafe environment for cesarean care and underpin adverse maternal and newborn health outcomes. For example, in overwhelmed hospitals, clinicians may Annual Report • October 2017 – September 2018 Fistula Care Plus 208
conduct an average of six cesarean sections per day or conduct cesareans completely alone, without nursing or anesthesia support. Inadequate clinical guidance and varying facility contexts contribute to cesarean section decision-making driven by factors other than medical need. A consensus agenda to address these challenges requires that surgical, anesthesia, and obstetrics (SAO) actors build bridges between maternal health/safe surgery communities; establish accreditation criteria for cesarean section facilities; expand the SAO workforce; create evidence- based guidelines for labor management and decision-making; and increase demand for quality maternity care without over-intervention. Programs to strengthen surgical obstetric care in sub- Saharan Africa provide illustrative examples for implementing this action agenda.
Conclusion: The potential impact of universal access to essential obstetric surgery is enormous, yet surgery to address maternal/newborn complications is contributing to preventable morbidity. The action agenda presented at this session requires dissemination and innovative implementation by partners across the maternal health.
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APPENDIX CC: ACOG ETOO27 PRESENTATION
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. APPENDIX DD: BANGLADESH MATERNAL MORBIDITY VERIFICATION STUDY DISSEMINATION PRESENTATION
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APPENDIX EE: FC+ SUPPORTED TREATMENT SITES MEETING TO DISCUSS DATA
Q1 Q2 Q3 Q4 Total Number of Country/Site Meetings in FY 17/18 Fistula Care Plus Total: 34 treatment sites28 56% met at least twice 94% met at least once Bangladesh: 7 treatment sites 100% met at least twice 100% met at least once Ad-Din Dhaka 1 1 1 1 4 Ad-Din Khulna 1 1 1 1 4 Kumudini Hospital 1 1 1 1 4 LAMB Hospital 1 1 1 1 4 Bangabandhu Sheikh Mujib Medical 1 1 1 1 4 University Dr. Muttalib Community Hospital 1 1 1 1 4 Mamm's Institute of Fistula & Women's 1 1 1 1 4 Health DRC: 4 treatment sites 100% met at least twice 100% met at least once St. Joseph’s Hospital/Satellite 1 1 0 0 2 Maternity Kinshasa Panzi Hospital 1 1 1 0 3 HEAL Africa 1 1 1 0 3 Beniker - - 1 1 2 WA/Niger: 3 treatment sites 100% met at least twice 100% met at least once Centre de Santé Mère / Enfant (CSME) 1 1 1 0 3 Maradi Centre National de Référence des 1 1 1 0 3 Fistules Obstétricales (CNRFO),Niamey Centre de Santé Mère /Enfant (CSME) 1 1 1 0 3 Tahoua Nigeria: 14 treatment sites 36% met at least twice 100% met at least once General Hospital, Ningi 0 1 0 0 1 General Hospital, Ogoja 0 1 0 0 1 National Fistula Center, Abakaliki 1 1 0 0 2 Laure VVF Center 1 1 0 0 2 National Fistula Center, Babbar Ruga, 1 1 1 1 4 Katsina Gesse VVF Center, Birnin Kebbi 0 1 0 0 1 Sobi Specialist Hospital, Ilorin 0 1 0 0 1 Maryam Abatcha Women and 1 1 1 1 4 Children’s Hospital, Sokoto Maryam Abatcha Women and 0 1 0 0 1 Children’s Hospital, Yobe Faridat General Hospital, Gusau 1 1 0 0 2
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Q1 Q2 Q3 Q4 Total Number of Country/Site Meetings in FY 17/18 University College Hospital, Ibadan 0 1 0 0 1 Jahun VVF Center, Jigawa State 0 1 0 0 1 Adeoyo General Hospital, Ibadan 0 1 0 0 1 Wesley Guilds Hospital 0 1 0 0 1 Uganda: 6 treatment sites 0% met at least twice 67% met at least once Kitovu Mission Hospital 0 0 0 1 1 Hoima Regional Referral Hospital 0 1 0 0 1 Kamuli Mission Hospital 0 0 0 1 1 Kagadi General Hospital 0 0 0 0 0 Kisiizi Mission Hospital 0 0 0 0 0 Jinja Regional Referral Hospital 0 0 1 0 1 NS: not supported during this quarter
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APPENDIX FF: AFLATEEN PRESENTATION FOR USAID/WASHINGTON BROWN BAG
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APPENDIX GG: SDI PARTNERS MEETING AGENDA “Excellence in Implementation: What it Takes to Deliver Service Delivery-Oriented Family Planning High Impact Practices (HIPs)”
Wednesday, April 25, 2018: 8:30am – 4:30pm E2A Offices, 1250 23rd Street NW, Suite 475, Washington, DC 20037 Objectives
• Provide USAID/Office of Population and Reproductive Health Front Office Updates.
• Discuss SDI partner contributions to implementing family planning service delivery “High Impact Practices” and other evidence-based promising practices, both globally and in the countries where we work. • Foster an environment of sharing and learning about challenges and lessons learned implementation Time Session Presenters 8:30- Registration and Breakfast 9:00 9:00- Welcome & Introductions Maureen Norton, 9:15 USAID/SDI Gary Cook, USAID/SDI 9:15- PRH Front Office Updates Shyami de Silva, USAID 9:30 • USAID / Department of State Joint Strategic Plan: Key Goals and Priorities and what it Means for Partnership 9:30 – Partner Session: Working with Drug Shops and 10:25 Pharmacies to Offer Family Planning Shops Plus 10:25- Partner Session: Immediate Postpartum Family Planning 11:20 MCSP, PAC-FP, E2A 11:20- BREAK 11:35
11:40- Partner Session: Mobile Clinical Outreach for SIFPO2 IPPF, SIFPO2 MSI 12:35 Family Planning 12:35- Annual Report • October 2017 – September 2018 Fistula Care Plus 229
1:25 Lunch and Networking 1:25- Partner Session: Local Capacity Building APC, Fistula Care Plus 2:20
2:30- E2A, SIFPO2 PSI Partner Session: Consideration for Scale Up 3:15
3:15- 3:25 BREAK 3:25- Group Discussion: The Art and Science of Facilitators: Jennifer Mason, 4:15 Implementation: Conclusions, Key Recommendations, USAID/SDI, and Tabitha Next Steps Sripipatana 4:15- Marguerite Farrell, 4:30 Wrap-Up & AOB USAID/SDI
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APPENDIX HH: FC+ SDI PARTNER MEETING PRESENTATION
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APPENDIX II: FCOP SBA SURVEY WEBINAR PRESENTATION
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APPENDIX JJ: 2017 GLOBAL SURVEY OF INTRAPARTUM AND POSTPARTUM CLINICAL PRACTICES
Executive Summary Bladder care is an important part of intrapartum care, with clinical guidelines recommending that patients void every two to four hours throughout labor, and that providers use urinary catheters for two weeks on patients who experience prolonged/obstructed labor (P/OL) to prevent obstetric fistula. (East, Central, and Southern African Health Community (ECSA-HC) and Fistula Care/EngenderHealth, 2012) (Lewis & De Bernis, 2006). Despite these recommendations, little is known about current knowledge and practices among skilled birth attendants (SBAs) regarding intrapartum and postpartum bladder care and UC to manage P/OL. To fill this gap and assist in building the evidence base for UC in relation to fistula prevention/treatment, the Fistula Care Plus Project (FC+) conducted a key informant survey of skilled birth attendants (SBAs) to better understand how maternity providers in low- and middle-income countries (LMICs) provide intrapartum and postpartum bladder care and manage P/OL. This survey was designed based on existing L&D clinical guidelines and nursing/midwifery training curricula and administered online using Survey Monkey in French and English, from May-Oct, 2017. A purposive/snowball sampling approach was employed. Eligibility criteria for participating in the survey included being a SBA, who has attended a live birth within the past three years, and practices in a LMIC. Survey data were analyzed using Stata v12 to generate descriptive summaries of KI characteristics, knowledge, and practices. Chi-square tests of independence were conducted to test for significant disparities by region, facility type, and geography. Respondents (n=222) were primarily midwives (61%) and OB-GYNs (15%); 56% in the Africa region and 39% in South-East Asia. A majority practice many of the recommended practices related to intrapartum/postpartum bladder care and P/OL management. Most reported using a partograph to monitor labor (99%), monitoring voiding frequency for postpartum patients (95%), and utilizing UC after P/OL (94%). While there was some variation in how respondents define P/OL, they generally had a strong understanding of the criteria to identify P/OL and its’ potential outcomes. Despite this, the survey reveals the lack of facility protocols in place for SBAs on providing intrapartum and postpartum bladder care and management of P/OL, as well as notable difference in in-service training, utilization of clinical practices, and availability of supplies between regions, facility types, and geography. The findings reveal a strong foundation for improvements and standardization in intrapartum/postpartum bladder care and P/OL management. While variations in practices expose where SBA training can be strengthened to promote widespread adoption of quality and effective intra-/post-partum practices, SBA reports indicate that UC after P/OL is feasible and acceptable, meaning that its systematic practice can be scaled-up to prevent obstetric fistula and other sequelae of P/OL in low-resource settings. However, SBAs, particularly midwives, must be supported with facility protocols, in-service training, and consistent availability of supplies, especially in the Africa region and public facilities in accordance with the updated 2018 World Health Organization (WHO) document: WHO recommendations: Intrapartum care for a positive birth experience (WHO, 2018). Annual Report • October 2017 – September 2018 Fistula Care Plus 238
APPENDIX KK: C-SECTION PRESENTATION FOR USAID BROWN BAG
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APPENDIX LL: ETOO USAID PRESENTATION
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APPENDIX MM: FC+ FIGO 2018 PLANNED PRESENCE
I. Engenderhealth Panel
Title: Cesarean section safety in low-resource settings: Ensuring quality in a context of rapidly increasing volume Date/Time/Location: October 19, 10:30 – 12:00 pm, Room 202A Chairperson: Dr. Vandana Tripathi, Fistula Care Plus (FC+) Project at EngenderHealth Presentations and panelists: 1. Cesarean section provision in low-resource settings: Who, where, why – global trends from DHS and SPA data Dr. Francesca Cavallaro, London School of Hygiene and Tropical Medicine 2. Preventing obstetric and iatrogenic fistula: The role of a safe surgery ecosystem Dr. Lauri Romanzi, FC+ Project at EngenderHealth) 3. The right procedure for the right person: Clinical decision making for operative delivery/The surgical, obstetric, and anesthesia (SAO) workforce: Global challenges and solutions from Ethiopia and Tanzania Dr. John Varallo, Jhpiego
II. Free Communication Session (FCS) Presentations
Abstract Title Session Time FCS Presentation Presenter ID Location Time
Monday, October 15 FCS 5.623 Causes of juxta-cervical fistula and difficulties during repair: 49 cases 8:30–10:00 am Stage 5 8:40-8:50 am Bilkis Begum FCS 5.625 Delivery experience of 159 obstetric fistula cases, treated in a tertiary 8:30–10:00 am Stage 5 8:50-9:00 am SK Nazmul center in Bangladesh Huda
FCS 5.629 Feasibility of task shifting in primary screening of obstetric fistula 8:30–10:00 am Stage 5 9:10-9:20 am Paul clients by midwives – Lessons learnt from a fistula treatment site, Uganda Kaduyu
FCS Advancing fistula data management through using electronic 2:30–4:00 pm Stage 6 3:50-4:00 pm Hassan
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12.849 database to inform decision making in Uganda. Experience from Kanakulya Fistula Care Plus supported treatment sites FCS A Safe Surgery Toolkit for elective genital fistula and prolapse repair 4:00–5:30 pm Stage 3 4:30-4:40 pm Lauri 15.415 surgery in Bangladesh Romanzi FCS Challenges faced by women after repair of genital tract fistula: An 4:00– 5:30 pm Stage 6 4:40-4:50 pm Christine 18.857 observational study in Kongolo and Kabalo, Democratic Republic of Amisi Congo Tuesday, October 16 FCS Frequency and management of non-obstetric fistula in the 8:30--10:00 am Stage 5 8:40–8:50 am Michel 23.631 Democratic Republic of Congo: Experience from Fistula Care Plus Mpunga project FCS Identification of risk factors of failed closure of genitourinary fistulae 8:30–10:00 am Stage 5 9:10-9:20am Tahsin 23.634 and residual incontinence Islam FCS Assessment of the standardization of training and surgical care using 8:30–10:00 am Stage 6 9:20–9:30 am Namala 24.751 the FIGO Competency-Based Fistula Surgery Training Manual in a specialized Angella hospital Clare FCS Improving capacity for cesarean section provision in Uganda: Results 2:30–4:00 pm Stage 3 2:40–2:50 pm Vandana 33.233 from the ACOG structured operative obstetrics training pilot Tripathi FCS Health systems strengthening for improved maternal health services 4:00–5:30 pm Stage 5 4.30–4:40 pm Molly 41.783 uptake - A case of rural Uganda Tumusiime FCS Improved service delivery through clinical data use among health 4:00–5:30 pm Stage 6 4:50-5:00 pm Babafemi 42.882 workers in selected fistula centers in Nigeria Dare Wednesday, October 17 FCS Improving contraceptive method mix through rights based 8:30–10:00 am Stage 4 9:50–10:00 am Lucy Asaba 46.546 multidimensional approaches in Fistula Care Plus supported sites in Uganda** Thursday, October 18 FCS Community-based organizations: A strategy to mobilize fistula clients 4:00 – 5:30 pm Stage 6 4:40 – 4:50 pm Iyeme 90.862 for care in Nigeria Efem FCS Women’s third trauma: Caesarean-section when women present with 4:00 – 5:30 pm Stage 1 4:50 – 5:00 pm Kenny 85.354 fistula and stillbirth? Raha **Winner, FIGO Ipas Best Paper Award (see below) Annual Report • October 2017 – September 2018 Fistula Care Plus 249
III. FIGO Ipas Best Papers from Low-Resource Countries Awards
Session Date/Time/Location: October 19, 8:30 – 10:00 am, Room 211
Presenter: Lucy Asaba | Presentation Time: 9:06 – 9:15 am
Presentation Title: Improving contraceptive method mix through rights-based multidimensional approaches in Uganda
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APPENDIX NN: USAID BRIEFING ON FC+/POPULATION COUNCIL BARRIER INTERVENTION STUDY
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APPENDIX OO: WIF TERREWODE STUDY PRELIMINARY FINDINGS SUMMARY
Changes in health satisfaction, psychosocial status and quality of life [Tool II] TERREWODE/FC+ WIF Study
Elly Arnoff & Vandana Tripathi, August 2018
Introduction TERREWODE provided an individualized social reintegration intervention to 30 women with “women with incurable fistula” (WIF) in Uganda in 2017. Participants were interviewed after the intervention to understand their perspectives on its usefulness, effects, and the remaining challenges they face as WIF (reported elsewhere by TERREWODE study team members). Three standardized tools to measure health/psychosocial status and quality of life (QoL) were also administered before an after the intervention. These tools are the SRQ-20, WHO QoL-BREF, and the modified King’s Health Questionnaire. FC+ study team members analyzed changes in scores on these measures before and after the intervention. The aims of this analysis were to 1) systematically assess the impact of this intervention on participants’ quality of life and 2) recommend measures that are appropriate for this population for comparable assessment of interventions for WIF across settings. This summary presents the findings for aim 1. A. SRQ-20 The 20-item Self-Reporting Questionnaire (SRQ–20) is a psychometric instrument to assess levels of general distress. Each item in the instrument is answered with either yes or no, and the measure is scaled from zero to twenty, with higher scores indicating higher levels of general distress. The conventional cut- off point for psychological distress with this instrument is a total score of eight or more. Before the intervention, all 30 participants had a SRQ-20 of over eight, indicating that all participants were psychologically distressed. After the intervention, there was a significant reduction in the proportion of participants whose scores indicated psychologically distress (p=0.0003). Of the 30 participants, eleven (37%) had a score of less than eight after the intervention, a statistically significant reduction. Table 1 shows the differences in SRQ-20 mean scores before and after the intervention. The total mean score reduced from 16 to 9 from before to after the intervention (p<0.0001).
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Table 1. Differences in SRQ-20 before and after intervention Pre-test Post-test Paired t test Mean/ Mean/ Mean S Propo Range IQR Prport Range IQR 95% CI P value difference D rtion ion
Total score (0-20) 16 12-20 14-18 9 4-15 6-12 7 3.9 5.6-8.4 <0.0001
Changes in the proportions of women answering yes to individual SRQ-20 items before and after the intervention were also evaluated. Despite the demonstrated reduction in the total score and in the proportion of psychological distressed cases from before to after the intervention, there were four individual items in the SRQ-20 that did not show any significant improvement (p>.05). These items were: 8) Do you have trouble thinking clearly? 12) Do you find it difficult to make decisions? 17) Has the thought of ending your life been on your mind? 20) Are you easily tired? B. WHO QoL BREF The WHO QoL BREF begins with two stand-alone questions related to overall quality of life and health satisfaction. Respondents answer using a five-point Likert scale, with higher scores denoting higher quality of life or greater satisfaction. Table 2 shows the differences before and after the intervention in the mean scores for these two questions. Participants’ responses to overall quality of life significantly improved by 0.7 from before to after the intervention (p=0.0003). The improvement was even greater for health satisfaction, with a significant increase in mean score of 1.3 (p<0.0001). Table 2. Differences in WHO QoL BREF stand-alone questions before and after intervention Pre-test Post-test Paired t test IQ IQ Mean Mean Range Mean Range SD 95% CI P value R R difference How would you rate -1.1 - - 2.0 1-4 1-3 2.7 2-4 2-3 -0.7 1.0 0.0003 your quality of life? 0.4 How satisfied are you -1.5 - - 1.7 1-3 1-2 3.0 2-4 3-3 -1.3 0.7 <0.0001 with your health? 1.0
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The WHO QoL BREF also consists of questions related four quality of life domains: physical health, psychological, social relationships, and environment. The domain scores are scaled from zero to 100 with higher scores denoting a higher quality of life. For each domain, the participants’ mean scores significantly increased (p<0.001) from before to after the intervention. The physical health domain showed the largest increase in mean score (23), followed by the social relationships and environment domains (18), and then the psychological domain (14). These changes are illustrated in Figure 1.
Changes in the mean scores for individual items were also evaluated; scores on the following individual items did not significantly improve: Physical: To what extent do you feel that physical pain prevents you from doing what you need to do? Psychological: How satisfied are you with your abilities? How often do you have negative feelings, such as blue mood, despair, anxiety, depression? Social relationships: How satisfied are you with your sex life? Environment: How healthy is your physical environment? How available to you is the information that you need in your day-to-day life? C. Modified King’s Health Questionnaire A modified version of the King’s Health Questionnaire, with question language changed to ask specific about fistula, was also administered to WIF participants in the TERREWODE intervention. Similar to WHO QoL BREF, the King’s Health Questionnaire begins with two stand-alone questions. Respondents answer using a five-point Likert scale for the first question and a four-point scale for the second question. Responses are then transformed to a zero to 100 scale. However, unlike the WHO instrument, lower scores indicate a higher quality of life. Table 3 reports mean scores for these two questions, as well as for
Figure 1. WHO QoL BREF pre- and post-test mean scores by domain 100 80 49 60 45 43 41 30 40 27 23 26 23 14 18 18 20 0 Physical health Psychological Social relationships Environment
pre-test mean score post-test mean score Difference the total raw score of the instrument’s additional 18 questions. For the health perception question, participants’ mean score significantly decreased by 22.5 from before to after the intervention (p<0.0001) and for the question on how much fistula affects their life, the mean score significantly decreased by 12.2 (p<0.0001). Additionally, the mean total raw score for the additional 18 other questions significantly reduced by 18 (p<0.0001).
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Figure 2. King's Health Questionnaire pre- and post-test mean scores by domain 98 98 96 100 91 86 88 80 66 63 68 62 63 54 60 48 43 32 36 31 32 33 40 31 25 20 0 Role limitations Physical Social Personal Emotions Sleep/Energy Severity limitations relationships measures
pre-test mean score post-test mean score Difference
Table 3. Differences in King’s Health Questionnaire before and after intervention Pre-test Post-test Paired t test Mean 95% Mean Range IQR Mean Range IQR SD P value difference CI How would you 50- 75- 50- 15.9- describe your health at 78.3 55.8 25-75 22.5 17.8 <0.0001 100 100 75 29.1 the present? How much do you think your fistula 100- 100- 67- 67- 6.1- 100 87.8 12.2 16.3 0.0003 condition affects your 100 100 100 100 18.3 life? 62- 40- 14.8- Total Raw KHQ Score 65.5 60-72 47.5 32-62 18 8.5 <0.0001 68 52 21.2
The King’s Health Questionnaire also consists of seven domains: role limitations, physical, social limitations, personal relationships, emotions, sleep/energy, and severity measures. The domain scores are scaled from zero to 100 with lower scores denoting a higher quality of life. Figure 2 illustrates the pre- and post-test scores, and their difference by domain. In each domain, the participants’ mean scores significantly increased from before to after the intervention (p<0.01).The largest differences in scores were within the social limitations (43) and physical (36) domains, with the severity measures domain having the least improvement (25). Discussion These standardized instruments have been validated and applied in a variety of settings, including in sub- Saharan Africa. Changes in the scores on these instruments indicate that the TERREWODE intervention was associated with significant positive changes in participants’ perception of and satisfaction with their health, psychosocial status, and impact of their fistula condition on their quality of life. While many of the practical ramifications of incurable fistula cannot be eliminated, it appears that individualized, comprehensive interventions can significant mitigate the impact of this condition on women’s quality of Annual Report • October 2017 – September 2018 Fistula Care Plus 260
life. Such interventions may be useful in other settings with a fistula burden; the use of standardized measures across settings will enable comparison of such interventions across programs and populations. As the burden of administering multiple assessment tools may be inappropriate in routine, non-research settings, it may be more feasible to use a single tool. Recommendations regarding measures will be reported in a separate analysis summary.
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APPENDIX PP: INVITATION TO HEALTH SYSTEMS RESEARCH CONFERENCE PANEL ON CESAREAN SECTION SAFETY IN LOW-RESOURCE SETTINGS
The Fistula Care Plus Project invites you to an exciting panel event at the 5th Global Symposium on Health Systems Research in Liverpool:
Cesarean section safety in low-resource settings: Addressing health system challenges that jeopardize maternal and newborn health Tuesday, 9 October; 15:00 – 17:00 Room 11A Arena and Convention Centre (ACC), Liverpool Health system challenges contribute to poor quality, inequitably distributed surgical obstetric care in low- resource settings. Increasing iatrogenic fistula from unsafe cesarean sections demonstrates the impact of these gaps. Panelists will present evidence regarding the systems contexts and pressures affecting cesarean care and the recommendations of a global consultation to examine these challenges.
Session panelists include: Dr. Lenka Benova, London School of Hygiene and Tropical Medicine Dr. Lina Roa, Program in Global Surgery and Social Change, Harvard Medical School Dr. Vandana Tripathi, Deputy Director, Fistula Care Plus Project, EngenderHealth
Presentations will include:
Evidence regarding maternal morbidity resulting from unsafe cesarean section. Trends in the volume of these procedures, access disparities, and facility readiness to deliver these services. Case studies of health system flashpoints affecting cesarean section quality and safety, e.g., workforce density and task shifting. The consensus action agenda identified by participants in a global technical consultation on cesarean section safety and quality, and concrete tactics to advance this agenda.
More information about the global consultation is available at: https://fistulacare.org/resources/program-reports/cesarean-section-technical-consultation/
Refreshments will be served. All are welcome!
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APPENDIX QQ: BARRIER INTERVENTION STUDY KNOWLEDGE PRODUCTS PIPELINE Fistula Treatment Barriers Collaboration*
I. Published:
Manuscripts: Keya KT, Sripad P, Nwala E, Warren CE. "Poverty is the big thing": exploring financial, transportation, and opportunity costs associated with fistula management and repair in Nigeria and Uganda. Int J Equity Health. 2018 Jun 1;17(1):70. doi: 10.1186/s12939-018-0777-1. https://equityhealthj.biomedcentral.com/articles/10.1186/s12939-018-0777-1 Baker Z, Bellows B, Bach R, Warren C. Barriers to obstetric fistula treatment in low-income countries: a systematic review. Trop Med Int Health. 2017 Aug;22(8):938-959. doi: 10.1111/tmi.12893. Epub 2017 Jul 20. Review. https://onlinelibrary.wiley.com/doi/abs/10.1111/tmi.12893
Technical briefs: Barriers to fistula repair in Nigeria: A formative study. September 2016. Washington, DC: Population Council. http://www.popcouncil.org/uploads/pdfs/2016RH_FistulaBarriersNigeria.pdf Barriers to fistula repair in Uganda: A formative study. August 2016. Washington, DC: Population Council. http://www.popcouncil.org/uploads/pdfs/2016RH_FistulaBarriersUganda.pdf Reducing barriers to accessing fistula repair: Establishing a baseline in Ebonyi. September 2017. Washington, DC: Population Council. http://www.popcouncil.org/uploads/pdfs/2017RH_FistulaRepairEbonyi_brief.pdf Reducing barriers to accessing fistula repair: Establishing a baseline in Katsina. September 2017. Washington, DC: Population Council. http://www.popcouncil.org/uploads/pdfs/2017RH_FistulaRepairKatsina_brief.pdf Reducing barriers to accessing fistula repair: Establishing a baseline in Uganda. September 2017. Washington, DC: Population Council. http://www.popcouncil.org/uploads/pdfs/2017RH_FistulaRepairUganda_brief.pdf
Research reports: Warren CE, Agbonkhese R, Ishaku SM. Formative research on assessing barriers to fistula care and treatment in Nigeria. January 2016. Washington, DC: Population Council. http://www.popcouncil.org/uploads/pdfs/2016RH_FistulaCare_Nigeria.pdf Research report: Sripad P, Warren CE. Formative research on factors influencing access to fistula care and treatment in Uganda. January 2016. Washington, DC: Population Council. http://www.popcouncil.org/uploads/pdfs/2016RH_FistulaCare_Uganda.pdf Research report: Bellows B, Bach R, Baker Z, Warren CE. Barriers to obstetric fistula treatment in low-income countries: A systematic review. December 2014. Washington, DC: Population Council. http://www.popcouncil.org/uploads/pdfs/2014RH_ObstetricFistulaTreatmentSystematicReview.pdf
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II. In process/planned:
Manuscripts: Removing barriers to fistula care: Applying appreciative inquiry to improve access to screening and treatment in Nigeria and Uganda. Status: In draft form, undergoing revisions
Exploring the awareness of obstetric fistula onset and availability of fistula care services in eastern and northern Nigeria. Status: final internal PC review Study Protocol. Status: In draft form, undergoing revisions Developing a composite multidimensional measure of barriers to fistula treatment in Nigeria and Uganda. Status: data analysis, drafting Book chapters: Exploring care users and provider experiences and perceptions of fistula service delivery models. Status: Data analysis, outline development
Research report: Evaluation of an intervention to address barriers to fistula treatment in Nigeria and Uganda. Status: Will be completed following endline data collection and analysis in September 2018.
Technical briefs:** Evaluation of an intervention to address barriers to fistula treatment in Nigeria. Status: Will be completed based on endline research report. Evaluation of an intervention to address barriers to fistula treatment in Uganda. Status: Will be completed based on endline research report.
*This inventory excludes presentations and panels at technical forums and conferences. ** If inadequate Population Council LOE/subaward resources remain, these may be completed by FC+ staff
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APPENDIX RR: FY 17/18 FC+ COUNTRY REPAIR DATA VISUALIZATIONS
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SS: FC+ ANNUAL PARTOGRAPH MONITORING: FY 14/15
Indicator Indicator
A (Mean B Score) (% Correct Action) file? roughoutlabor) th (Quantitative)
- throughoutlabor) throughoutlabor) throughoutlabor) 12. Actions 12. Taken? 6. Partograph6. from a 11. Cross 11. Action line? B. B. A. -at A. admission or - B. 7. Contractions7. (1/2hrly Number recordsreviewed referringfacility in patient 10. Maternal 10. Pulse (EITHER 9. Maternal 9. Blood Pressure (EITHER-A.at admission or 8. Fetal 8. Heart Rate(1/2 hrly 5. Partograph5. patientin file? 0: No, 0: No, not 0: No, 0: No, 0: No, 0: No, 0: No, 0: No, Maximum Maximum not in in file; not not not not not appropriat file 1: Yes, in recorded; recorded; recorded; recorded; crossed; e actions = 5 = 100% 1: Yes, file; 1: Yes, 1: Yes, 1: Yes, 1: Yes, 1: not taken; in file N/A: not Recorded Recorded Recorded Recorded crossed 1:Yes, referred; appropriat DK: source e actions cannot be taken determined Bangladesh 175 0.45 n/a 0.41 0.41 0.41 0.38 0.10 0.10 2.05 100.00% LAMB 25 1.00 n/a 0.88 0.88 0.88 0.88 0.04 0.04 4.52 100.00% din Dhaka 25 1.00 n/a 0.84 0.84 0.84 0.84 0.00 0.00 4.36 n/a din Jessore 25 0.32 n/a 0.32 0.32 0.32 0.28 0.32 0.32 1.56 100.00% din Khulna 25 0.32 n/a 0.32 0.32 0.32 0.24 0.32 0.32 1.52 100.00% BSMMU 25 0.00 n/a 0.00 0.00 0.00 0.00 0.00 0.00 0.00 n/a Kumudini 25 0.48 n/a 0.48 0.48 0.48 0.44 0.04 0.04 2.36 100.00% Muttalib 25 0.00 n/a 0.00 0.00 0.00 0.00 0.00 0.00 0.00 n/a Niger 50 1.00 0.70 0.88 1.00 1.00 1.00 0.00 0.00 4.88 n/a CSME Maradi 25 1.00 0.92 0.76 1.00 1.00 1.00 0.00 0.00 4.76 n/a CSME Tahoua 25 1.00 0.48 1.00 1.00 1.00 1.00 0.00 0.00 5.00 n/a
• October 2017 – September 2018 Fistula Care Plus 269
Indicator Indicator
A (Mean B Score) (% Correct Action)
file? roughoutlabor) th (Quantitative)
- throughoutlabor) throughoutlabor) throughoutlabor) 12. Actions 12. Taken? 6. Partograph6. from a 11. Cross 11. Action line? B. B. A. -at A. admission or - B. 7. Contractions7. (1/2hrly Number recordsreviewed referringfacility in patient 10. Maternal 10. Pulse (EITHER 9. Maternal 9. Blood Pressure (EITHER-A.at admission or 8. Fetal 8. Heart hrlyRate(1/2 5. Partograph5. patientin file? Facility nameFacility 0: No, 0: No, not 0: No, 0: No, 0: No, 0: No, 0: No, 0: No, Maximum Maximum not in in file; not not not not not appropriat file 1: Yes, in recorded; recorded; recorded; recorded; crossed; e actions = 5 = 100% 1: Yes, file; 1: Yes, 1: Yes, 1: Yes, 1: Yes, 1: not taken; in file N/A: not Recorded Recorded Recorded Recorded crossed 1:Yes, referred; appropriat DK: source e actions cannot be taken determined Nigeria 276 0.17 0.00 0.00 0.01 0.00 0.00 0.00 0.00 0.18 0.00% Takai Clinic, Kano 23 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 n/a Kumbotso, Kano 23 1.00 n/a 0.04 0.13 0.00 0.00 0.04 0.00 1.17 0.00% Maryam Abatcha, Kano 23 1.00 n/a 0.00 0.00 0.00 0.00 0.00 0.00 1.00 n/a Ungwa Uku, Kano 23 0.00 n/a 0.00 0.00 0.00 0.00 0.00 0.00 0.00 n/a Miga, Jigawa 23 0.00 n/a 0.00 0.00 0.00 0.00 0.00 0.00 0.00 n/a Aujara, Jahun, Jigawa 23 0.00 n/a 0.00 0.00 0.00 0.00 0.00 0.00 0.00 n/a Dutse, Jigawa 23 0.00 n/a 0.00 0.00 0.00 0.00 0.00 0.00 0.00 n/a Gwaram Cottage, Jigawa 23 0.00 n/a 0.00 0.00 0.00 0.00 0.00 0.00 0.00 n/a GH Ningi, Bauchi 23 0.00 n/a 0.00 0.00 0.00 0.00 0.00 0.00 0.00 n/a Low Cost PHC, Bauchi 23 0.00 n/a 0.00 0.00 0.00 0.00 0.00 0.00 0.00 n/a Warji Town Mat, Bauchi 23 0.00 n/a 0.00 0.00 0.00 0.00 0.00 0.00 0.00 n/a Gadarmaiwa, Ningi, Bauchi 23 0.00 n/a 0.00 0.00 0.00 0.00 0.00 0.00 0.00 n/a
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Indicator Indicator
A (Mean B Score) (% Correct Action)
file? roughoutlabor) th (Quantitative)
- throughoutlabor) throughoutlabor) throughoutlabor) 12. Actions 12. Taken? 6. Partograph6. from a 11. Cross 11. Action line? B. B. A. -at A. admission or - B. 7. Contractions7. (1/2hrly Number recordsreviewed referringfacility in patient 10. Maternal 10. Pulse (EITHER 9. Maternal 9. Blood Pressure (EITHER-A.at admission or 8. Fetal 8. Heart hrlyRate(1/2 5. Partograph5. patientin file? Facility nameFacility 0: No, 0: No, not 0: No, 0: No, 0: No, 0: No, 0: No, 0: No, Maximum Maximum not in in file; not not not not not appropriat file 1: Yes, in recorded; recorded; recorded; recorded; crossed; e actions = 5 = 100% 1: Yes, file; 1: Yes, 1: Yes, 1: Yes, 1: Yes, 1: not taken; in file N/A: not Recorded Recorded Recorded Recorded crossed 1:Yes, referred; appropriat DK: source e actions cannot be taken determined Uganda 175 0.86 0.02 0.62 0.62 0.35 0.39 0.07 0.07 0.57 92.31% Karambi HCIII 25 1.00 0.00 0.60 0.60 0.56 0.52 0.00 0.00 3.28 n/a Bwera 25 1.00 0.00 0.56 0.60 0.24 0.40 0.04 0.00 2.80 0.00% Hoima 25 1.00 0.12 0.96 0.96 0.24 0.12 0.08 0.08 3.28 100.00% Kitovu 25 1.00 0.00 0.68 0.68 0.28 0.24 0.12 0.12 2.88 100.00% Masaka RRH 25 1.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 1.00 n/a Kalungu HCIII 25 0.00 0.00 0.72 0.72 0.44 0.72 0.00 0.00 2.60 n/a Kagando 25 1.00 0.00 0.84 0.76 0.68 0.72 0.28 0.28 4.00 100.00% FC+ TOTAL 676 0.62 0.24 0.48 0.51 0.44 0.44 0.05 0.04 1.92 0.95
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APPENDIX TT: FC+ ANNUAL PARTOGRAPH MONITORING: FY 15/16
Indicator A Indicator B
(Mean (% Correct at admission or or admission at - Score) Action) eart Rate (1/2 hrly hrly (1/2 Rate eart
- at admission or B. - B. or admission - at - throughout labor) labor) -throughout Facility name Facility reviewed records Number patient in Partograph 5. file? a from Partograph 6. patient in facility referring file? 1/2hrly ( Contractions 7. labor) throughout Fetal8.H labor) throughout Pressure Blood Maternal 9. A. (EITHER B. Pulse(EITHER 10.Maternal A. labor) throughout line? Action 11.Cross Taken? 12. Actions (Quantitative) 0: No, not 0: No, not in 0: No, not 0: No, not 0: No, not 0: No, not 0: No, not 0: No, Maximum Maximum = in file file; recorded; recorded; recorded; recorded; crossed; 1: appropriate 1: Yes, in 1: Yes, in 1: Yes, 1: Yes, 1: Yes, 1: Yes, crossed actions not = 5 100% file file; Recorded Recorded Recorded Recorded taken; N/A: not 1:Yes, referred; appropriate DK: source actions cannot be taken determined Bangladesh 136 0.59 n/a 0.56 0.81 0.98 0.98 0.34 0.34 3.92 100.00% LAMB 25 1.00 0.92 1.00 1.00 1.00 1.00 1.00 4.92 100.00% Ad-din Dhaka 25 0.92 0.88 0.92 0.88 0.88 0.00 0.00 4.48 n/a Ad-din Khulna 11 1.00 1.00 1.00 1.00 1.00 1.00 1.00 5.00 100.00% BSMMU 25 0.00 0.00 1.00 1.00 1.00 0.00 0.00 3.00 n/a Kumudini 25 0.60 0.56 0.96 1.00 1.00 0.04 0.04 4.12 100.00% Muttalib 25 0.00 0.00 0.00 1.00 1.00 0.00 0.00 2.00 n/a Niger 50 1.00 0.00 0.50 0.50 1.00 1.00 0.00 0.00 4.00 n/a CSME Maradi 25 1.00 0.40 0.40 1.00 1.00 0.00 0.00 3.80 n/a CSME Tahoua 25 1.00 0.60 0.60 1.00 1.00 0.00 0.00 4.20 n/a Uganda 397 0.51 0.00 0.71 0.68 0.39 0.35 0.12 0.09 2.59 78.43% Karambi HCIII 25 0.00 0.80 0.80 0.28 0.28 0.00 0.00 1.36 n/a Annual Report • October 2017 – September 2018 Fistula Care Plus 272
Indicator A Indicator B
(Mean (% Correct at admission or or admission at - Score) Action) eart Rate (1/2 hrly hrly (1/2 Rate eart
- at admission or B. - B. or admission - at - throughout labor) labor) -throughout Facility name Facility reviewed records Number patient in Partograph 5. file? a from Partograph 6. patient in facility referring file? 1/2hrly ( Contractions 7. labor) throughout Fetal8.H labor) throughout Pressure Blood Maternal 9. A. (EITHER B. Pulse(EITHER 10.Maternal A. labor) throughout line? Action 11.Cross Taken? 12. Actions (Quantitative) 0: No, not 0: No, not in 0: No, not 0: No, not 0: No, not 0: No, not 0: No, not 0: No, Maximum Maximum = in file file; recorded; recorded; recorded; recorded; crossed; 1: appropriate 1: Yes, in 1: Yes, in 1: Yes, 1: Yes, 1: Yes, 1: Yes, crossed actions not = 5 100% file file; Recorded Recorded Recorded Recorded taken; N/A: not 1:Yes, referred; appropriate DK: source actions cannot be taken determined Bwera 25 0.88 0.48 0.44 0.20 0.20 0.16 0.16 2.20 100.00% Hoima 25 0.64 0.56 0.56 0.08 0.08 0.04 0.04 1.92 100.00% Kiyumba HCIV 25 0.00 0.92 0.96 0.68 0.64 0.32 0.32 3.20 100.00% Jinja 25 0.96 0.28 0.24 0.12 0.12 0.08 0.08 1.72 100.00% Kamuli 25 1.00 0.76 0.60 0.52 0.44 0.08 0.00 3.32 0.00% Kigorobya HCIV 25 0.00 0.96 0.92 0.68 0.64 0.28 0.24 3.20 85.71% Kyanamukaaka 25 0.00 1.00 1.00 0.52 0.56 0.08 0.08 3.08 100.00% HCIV Buraru HCIII 22 0.00 0.88 0.88 0.72 0.16 0.28 0.28 2.64 100.00% Azur HCIV 25 1.00 0.68 0.72 0.04 0.00 0.24 0.12 2.44 50.00% Buseruka HCIII 25 0.00 0.96 0.84 0.56 0.52 0.28 0.20 2.88 71.43% Kikuube HCIV 25 0.48 0.92 0.88 0.64 0.68 0.00 0.00 3.60 n/a Kitovu 25 1.00 0.68 0.68 0.32 0.48 0.00 0.00 3.16 n/a Masaka RRH 25 1.00 0.92 0.88 0.44 0.24 0.04 0.04 3.48 n/a Kalungu HCIII 0 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 n/a
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Indicator A Indicator B
(Mean (% Correct at admission or or admission at - Score) Action) eart Rate (1/2 hrly hrly (1/2 Rate eart
- at admission or B. - B. or admission - at - throughout labor) labor) -throughout Facility name Facility reviewed records Number patient in Partograph 5. file? a from Partograph 6. patient in facility referring file? 1/2hrly ( Contractions 7. labor) throughout Fetal8.H labor) throughout Pressure Blood Maternal 9. A. (EITHER B. Pulse(EITHER 10.Maternal A. labor) throughout line? Action 11.Cross Taken? 12. Actions (Quantitative) 0: No, not 0: No, not in 0: No, not 0: No, not 0: No, not 0: No, not 0: No, not 0: No, Maximum Maximum = in file file; recorded; recorded; recorded; recorded; crossed; 1: appropriate 1: Yes, in 1: Yes, in 1: Yes, 1: Yes, 1: Yes, 1: Yes, crossed actions not = 5 100% file file; Recorded Recorded Recorded Recorded taken; N/A: not 1:Yes, referred; appropriate DK: source actions cannot be taken determined Rwesande HCIV 25 0.72 0.56 0.52 0.36 0.36 0.04 0.00 2.52 0.00% Kagando 25 1.00 0.68 0.68 0.44 0.48 0.12 0.04 3.28 33.33% DRC 75 0.74 0.00 0.48 0.35 0.72 0.72 0.01 0.01 3.01 100.00% Heal Africa 25 1 0.44 0.24 0.92 0.92 0.00 0.00 3.52 n/a St. Joseph 25 0.96 0.72 0.72 1.00 1.00 0.04 0.04 4.40 100% Esengo 25 1 0.76 0.44 0.96 0.96 0.00 0.00 4.12 n/a MSRK 0 0 0.00 0.00 0.00 0.00 0.00 0.00 0.00 n/a FC+ TOTAL 658 0.71 0.56 0.59 0.77 0.76 0.12 0.11 3.38 0.94
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APPENDIX UU: FC+ ANNUAL PARTOGRAPH MONITORING: FY 16/17
Indicator A Indicator B (Mean Score) (% Correct Action)
-at admissionor Heart Rate(1/2 hrly
-at admissionor B.- -throughout labor) Facility nameFacility Number recordsreviewed Partograph5. patientin file? Partograph6. from a referringfacility in patient file? Contractions7. ( 1/2hrly throughoutlabor) Fetal 8. throughoutlabor) Maternal 9. Blood Pressure (EITHERA. B. Maternal 10. Pulse (EITHER A. throughoutlabor) Cross 11. Action line? Actions 12. Taken? (Quantitative) 0: No, not 0: No, not in file; 0: No, not 0: No, not 0: No, not 0: No, not 0: No, not 0: No, Maximum = 5 Maximum = in file 1: Yes, in file; recorded; recorded; recorded; recorded; crossed; 1: appropriate 1: Yes, in N/A: not 1: Yes, 1: Yes, 1: Yes, 1: Yes, crossed actions not 100% file referred; Recorded Recorded Recorded Recorded taken; DK: source 1:Yes, cannot be appropriate determined actions taken Bangladesh 150 0.57 n/a 0.55 0.82 0.99 0.93 0.03 0.03 3.86 100.00% LAMB 25 1.00 n/a 0.96 0.96 1.00 1.00 0.16 0.16 4.92 100.00% Ad-din Dhaka 25 1.00 n/a 1.00 1.00 1.00 1.00 0.00 0.00 5.00 n/a Ad-din Khulna 25 0.64 n/a 0.64 0.92 0.92 0.60 0.00 0.00 3.72 n/a BSMMU 25 0.00 n/a 0.00 1.00 1.00 1.00 0.00 0.00 3.00 n/a Kumudini 25 0.76 n/a 0.72 1.00 1.00 1.00 0.00 0.00 4.48 n/a Muttalib 25 0.00 n/a 0.00 0.04 1.00 1.00 0.00 0.00 2.04 n/a Niger 25 0.84 0.00 0.32 0.72 0.80 0.80 0.00 0.00 3.48 n/a CSME Maradi NA NA NA NA NA NA NA NA NA NA NA CSME Tahoua 25 0.84 0.00 0.32 0.72 0.80 0.80 0.00 0.00 3.48 n/a Uganda 409 0.94 0.01 0.83 0.80 0.55 0.52 0.05 0.02 3.60 45.45% Karambi HCIII 25 1.00 0 0.72 0.68 0.32 0.48 0.00 0.00 2.48 n/a Annual Report • October 2017 – September 2018 Fistula Care Plus 275
Indicator A Indicator B (Mean Score) (% Correct Action)
-at admissionor Heart Rate(1/2 hrly
-at admissionor B.- -throughout labor) Facility nameFacility Number recordsreviewed Partograph5. patientin file? Partograph6. from a referringfacility in patient file? Contractions7. ( 1/2hrly throughoutlabor) Fetal 8. throughoutlabor) Maternal 9. Blood Pressure (EITHERA. B. Maternal 10. Pulse (EITHER A. throughoutlabor) Cross 11. Action line? Actions 12. Taken? (Quantitative) 0: No, not 0: No, not in file; 0: No, not 0: No, not 0: No, not 0: No, not 0: No, not 0: No, Maximum = 5 Maximum = in file 1: Yes, in file; recorded; recorded; recorded; recorded; crossed; 1: appropriate 1: Yes, in N/A: not 1: Yes, 1: Yes, 1: Yes, 1: Yes, crossed actions not 100% file referred; Recorded Recorded Recorded Recorded taken; DK: source 1:Yes, cannot be appropriate determined actions taken Bwera 25 1.00 n/a 0.76 0.76 0.40 0.32 0.12 0.04 3.24 33.33% Hoima 25 0.96 0.08 0.72 0.76 0.32 0.20 0.12 0.04 2.96 33.33% Kiyumba HCIV 25 1.00 0.00 1.00 0.96 0.48 0.60 0.24 0.12 4.04 50.00% Jinja 25 0.96 0.05 0.68 0.64 0.40 0.36 0.04 0.04 3.04 100.00% Kamuli 25 1.00 0.00 0.96 0.96 0.72 0.76 0.08 0.04 4.40 50.00% Kigorobya HCIV 25 1.00 n/a 0.92 0.64 0.68 0.72 0.00 0.00 3.96 n/a Kyanamukaaka HCIV 25 1.00 0.00 0.96 0.96 0.88 0.84 0.04 0.00 4.64 0.00% Buraru HCIII 20 1.00 n/a 1.00 1.00 0.85 0.80 0.00 0.00 4.65 n/a Azur HCIV 25 0.96 n/a 0.76 0.68 0.08 0.04 0.00 0.00 2.52 n/a Buseruka HCIII 16 1 n/a 0.94 0.94 0.88 0.81 0.00 0.00 4.57 n/a Kikuube HCIV 23 1.00 n/a 0.96 0.96 0.61 0.52 0.00 0.00 4.05 n/a Kitovu 25 0.96 0.04 0.72 0.68 0.36 0.28 0.04 0.00 3.00 0.00% Masaka RRH 25 0.64 0.00 0.60 0.60 0.16 0.04 0.00 0.00 2.04 n/a Rwesande HCIV 25 1.00 n/a 0.76 0.72 0.72 0.56 0.00 0.00 3.76 n/a Lukolo HCIII 25 0.52 n/a 1.00 1.00 0.96 0.92 0.08 0.04 4.40 n/a Annual Report • October 2017 – September 2018 Fistula Care Plus 276
Indicator A Indicator B (Mean Score) (% Correct Action)
-at admissionor Heart Rate(1/2 hrly
-at admissionor B.- -throughout labor) Facility nameFacility Number recordsreviewed Partograph5. patientin file? Partograph6. from a referringfacility in patient file? Contractions7. ( 1/2hrly throughoutlabor) Fetal 8. throughoutlabor) Maternal 9. Blood Pressure (EITHERA. B. Maternal 10. Pulse (EITHER A. throughoutlabor) Cross 11. Action line? Actions 12. Taken? (Quantitative) 0: No, not 0: No, not in file; 0: No, not 0: No, not 0: No, not 0: No, not 0: No, not 0: No, Maximum = 5 Maximum = in file 1: Yes, in file; recorded; recorded; recorded; recorded; crossed; 1: appropriate 1: Yes, in N/A: not 1: Yes, 1: Yes, 1: Yes, 1: Yes, crossed actions not 100% file referred; Recorded Recorded Recorded Recorded taken; DK: source 1:Yes, cannot be appropriate determined actions taken Kagando 25 1.00 0.00 0.72 0.72 0.52 0.52 0.12 0.08 3.48 66.67% DRC 124 0.73 0.00 0.46 0.44 0.72 0.66 0.07 0.05 2.85 69.44% Heal Africa 25 0.64 n/a 0.52 0.52 0.68 0.68 0.20 0.08 3.04 0.4 St. Joseph 25 0.8 n/a 0.32 0.36 0.68 0.72 0.04 0.04 2.60 1 IGL 25 0.64 n/a 0.64 0.64 0.76 0.44 0.08 0.08 2.56 1 Esengo 25 1 n/a 0.76 0.44 0.96 0.96 0.00 0.00 4.12 n/a MSRK 24 0.58 n/a 0.08 0.25 0.50 0.50 0.04 0.00 1.91 0 FC+ TOTAL 708 0.77 0.54 0.70 0.76 0.73 0.04 0.03 3.45 0.67
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APPENDIX VV: FC+ ANNUAL PARTOGRAPH MONITORING: FY 17/18
-
- Indicator A Indicator B
- (Mean Score) (% Correct
Action) ilityin
-at t t labor)
Facility nameFacility Number records reviewed Partograph5. in patientfile? Partograph6. from a referringfac patientfile? Contractions7. ( throughout1/2hrly labor) Fetal 8. Heart Rate hrly (1/2 throughout labor) Maternal 9. Blood Pressure(EITHER A. at admissionor B. throughoutlabor) Maternal 10. Pulse (EITHERA. admissionor B. throughou Cross 11. Action line? Actions 12. Taken? (Quantitative) 0: No, not 0: No, not in file; 0: No, not 0: No, not 0: No, not 0: No, not 0: No, not 0: No, Maximum = 5 Maximum in file 1: Yes, in file; recorded; recorded; recorded; recorded; crossed; 1: appropriate 1: Yes, in N/A: not 1: Yes, 1: Yes, 1: Yes, 1: Yes, crossed actions not = 100% file referred; Recorded Recorded Recorded Recorded taken; DK: source 1:Yes, cannot be appropriate determined actions taken Bangladesh 149 0.54 n/a 0.56 0.56 0.81 0.78 0.09 0.83 3.25 n/a LAMB 25 1.00 n/a 0.92 1.00 1.00 1.00 0.00 1.00 4.92 n/a Ad-din Dhaka 24 0.96 n/a 0.96 0.96 0.96 0.96 0.00 1.00 4.80 n/a Ad-din Khulna 25 0.76 n/a 0.52 0.44 0.52 0.28 0.56 0.00 2.52 0.00% BSMMU 25 0.00 n/a 0.08 0.40 0.40 0.44 0.00 1.00 1.32 n/a Kumudini 25 0.52 n/a 0.88 0.52 1.00 1.00 0.00 1.00 3.92 n/a Muttalib 25 0.00 n/a 0.00 0.04 1.00 1.00 0.00 1.00 2.04 n/a Uganda 450 0.99 0.01 0.80 0.79 0.66 0.60 0.07 0.05 3.79 69.84% Karambi HCIII 25 1.00 0 0.96 0.88 0.92 0.92 0.00 0.00 3.72 n/a Bwera 25 1.00 n/a 0.88 0.88 0.88 0.88 0.12 0.12 4.52 100.00% Hoima 25 0.96 0.08 0.68 0.68 0.52 0.52 0.24 0.20 3.36 83.33% Kiyumba HCIV 25 1.00 n/a 0.96 0.92 0.88 0.76 0.16 0.16 4.52 100.00%
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-
- Indicator A Indicator B
- (Mean Score) (% Correct
Action) ilityin
-at t labor) t
Facility nameFacility Number records reviewed Partograph5. in patientfile? Partograph6. from a referringfac patientfile? Contractions7. ( throughout1/2hrly labor) Fetal 8. Heart Rate hrly (1/2 throughout labor) Maternal 9. Blood Pressure(EITHER A. at admissionor B. throughoutlabor) Maternal 10. Pulse (EITHERA. admissionor B. throughou Cross 11. Action line? Actions 12. Taken? (Quantitative) 0: No, not 0: No, not in file; 0: No, not 0: No, not 0: No, not 0: No, not 0: No, not 0: No, Maximum = 5 Maximum in file 1: Yes, in file; recorded; recorded; recorded; recorded; crossed; 1: appropriate 1: Yes, in N/A: not 1: Yes, 1: Yes, 1: Yes, 1: Yes, crossed actions not = 100% file referred; Recorded Recorded Recorded Recorded taken; DK: source 1:Yes, cannot be appropriate determined actions taken Jinja 25 1.00 n/a 0.56 0.52 0.20 0.16 0.04 0.00 2.44 0.00% Kamuli 25 1.00 n/a 0.80 0.80 0.88 0.84 0.10 0.08 4.32 80.00% Kalungu 25 1.00 n/a 0.96 0.88 0.80 0.80 0.00 0.00 4.44 n/a Kigorobya HCIV 25 1.00 n/a 0.72 0.68 0.64 0.36 0.04 0.04 3.40 n/a Kyanamukaaka HCIV 25 1.00 n/a 1.00 1.00 0.76 0.88 0.04 0.04 4.64 100.00% Buraru HCIII 25 1.00 n/a 1.00 1.00 1.00 0.76 0.08 0.00 4.76 0.00% Azur HCIV 25 1.00 n/a 0.76 0.76 0.32 0.08 0.08 0.04 2.92 50.00% Buseruka HCIII 25 1 n/a 0.92 0.92 0.80 0.80 0.00 0.00 4.44 n/a Kikuube HCIV 25 0.92 n/a 0.84 0.84 0.32 0.16 0.04 0.04 3.08 100.00% Kitovu 25 0.96 0.04 0.68 0.68 0.48 0.28 0.00 0.00 3.08 n/a Masaka RRH 25 1.00 0.00 0.28 0.32 0.16 0.20 0.08 0.00 1.96 0.00% Rwesande HCIV 25 1.00 n/a 0.84 0.84 0.84 0.84 0.16 0.12 4.36 75.00% Lukolo HCIII 25 1.00 n/a 0.96 1.00 0.92 0.96 0.00 0.00 4.84 n/a Kagando 25 1.00 0.00 0.64 0.68 0.60 0.56 0.08 0.04 3.48 50.00% DRC 75 0.81 0.00 0.55 0.56 0.84 0.84 0.01 0.47 3.40 100.00% Heal Africa 25 1 n/a 0.40 0.44 0.88 0.88 0.00 0.32 3.60 n/a
Annual Report • October 2017 – September 2018 Fistula Care Plus 279
-
- Indicator A Indicator B
- (Mean Score) (% Correct
Action) ilityin
-at t labor) t
Facility nameFacility Number records reviewed Partograph5. in patientfile? Partograph6. from a referringfac patientfile? Contractions7. ( throughout1/2hrly labor) Fetal 8. Heart Rate hrly (1/2 throughout labor) Maternal 9. Blood Pressure(EITHER A. at admissionor B. throughoutlabor) Maternal 10. Pulse (EITHERA. admissionor B. throughou Cross 11. Action line? Actions 12. Taken? (Quantitative) 0: No, not 0: No, not in file; 0: No, not 0: No, not 0: No, not 0: No, not 0: No, not 0: No, Maximum = 5 Maximum in file 1: Yes, in file; recorded; recorded; recorded; recorded; crossed; 1: appropriate 1: Yes, in N/A: not 1: Yes, 1: Yes, 1: Yes, 1: Yes, crossed actions not = 100% file referred; Recorded Recorded Recorded Recorded taken; DK: source 1:Yes, cannot be appropriate determined actions taken St. Joseph 25 0.72 n/a 0.64 0.64 0.64 0.64 0.04 0.08 2.68 100% Panzi 25 0.72 n/a 0.60 0.60 1.00 1.00 0.00 1.00 3.92 n/a FC+ TOTAL 674 0.78 0.64 0.64 0.77 0.74 0.06 0.45 3.48 n/a
Annual Report • October 2017 – September 2018 Fistula Care Plus 280
APPENDIX WW: FC+ PLANNED PRESENCE AT ISOFS 2018
2018 ISOFS Conference – Submitted Abstracts Submitting Title Lead Author Other Authors country Bangladesh Experience of using Community Radio for Fistula Nitta Biswas SK Nazmul Huda Communication in Bangladesh Bangladesh Report of a Prevalence survey on Female Genital Lucky Ghose SK Nazmul Huda, Vandana Tripathi Fistula in a large district in Bangladesh Bangladesh Surgical Safety Toolkit based Quality Monitoring of Israt Jahan SK Nazmul Huda Fistula Surgery in Bangladesh Lauri Romanzi Bangladesh Media Leaders Workshop on Fistula Ashifur Nazmul Huda, Nitta Biswas Communication: An Innovation for capacity Rahman building of Bangladesh Press Bangladesh Why has the Caesarean Rate Increased Dramatically Nazmul Huda John Richards2, Labin Rahman3 in Bangladesh? Bangladesh Rehabilitation and reintegration of Fistula Clients Sheikh Fazlul Haque, Sk Nazmul Huda through Micro credit linked services Mohiuddin
Bangladesh Contribution of Ad-din Micro-credit program in Fazlul Haque Sheikh Mohiuddin, Sk Nazmul Huda Fistula case identification, referral and community based rehabilitation
Bangladesh Female Genital Fistula Repair Performance of Ad- Nahid Farzana Yesmin, Sheela Podder, Lucky Ghose din Hospitals 2013-2018 Yesmin
Bangladesh Human resource development for Prevention and Saleha Sk Nazmul Huda, Sharmeen Mahmud care of Fistula: Begum Experience of University Fistula Center, BSMMU Chowdhury Bangladesh Doctors beyond the wall of the hospital: Shuily Saleha Begum Chowdhury, Farhana Alam Reflections of Community Based Actions of Chowdhury University Fistula Center, BSMMU
Annual Report • October 2017 – September 2018 Fistula Care Plus 281
Submitting Title Lead Author Other Authors country Bangladesh Experience of Partnership with Fistula Program in Farhana Alam Saleha Begum Chowdhury, Sharmeen Mahmud Bangladesh: University Fistula Center, BSMMU Bangladesh Fistula Champions leading local actions for Ending Ashorjo Shampad Karmaker, Sk Nazmul Huda Fistula in Bangladesh Karmaker
Bangladesh Fistula Communication by Print and Electronic Sebika Nitta Biswas, Sk Nazmul Huda Media in Bangladesh Debnath as facilitated by Bangladesh Health Reporters Forum Bangladesh Community Radio Supporting Maternal and Child Selim Abdullah al Mahmood, Nitta Biswas, Sk Nazmul Huda Health and Preventing obstetric Fistula in an area Shahriar impacted by climate change Bangladesh Iatrogenic Fistula: Types, Causes and Post-repair Bilkis Begum outcome – 70 Cases Chowdhury Bangladesh Baseline knowledge of female genital fistula Stacy Saha Bea Ambauen-Berger, symptoms, causes and treatment among a rural Shirajum Munira population in Northern Bangladesh Bangladesh Preliminary analysis of quality of life (QOL) before Stacy Saha Bea Ambauen-Berger, and after surgery for female genital fistula. A Shirajum Munira prospective cohort study Bangladesh Incidence and characteristics of surgical fistula Bea Stacy Saha, Alison Seadon patients at LAMB hospital from 2011 to 2017 Ambauen- Berger Bangladesh Fistula Program Management using DHIS2: Masum Salah Sk Nazmul Huda Experience of Fistula Care Plus Project in Uddin Bangladesh DRC Facteurs de risques et prise en charge de la fistule Dolores Michel Mpunga, Felicien Banze, B. Tena Tena, obstétricale compliquée de calcul vésical à l’hôpital Nembunzu Vandana Tripathi Saint Joseph de Kinshasa RD Congo DRC Childbirth injuries encountered on outreach in Justin Paluku Esther KAHAMBU KITAMBALA, Eugénie remote RDCongo Lussy KAMABU MUKEKULU
Annual Report • October 2017 – September 2018 Fistula Care Plus 282
Submitting Title Lead Author Other Authors country DRC The Mobile Surgical Outreach Model for women Kenny Raha AMISI NOTIA1, L. KEYSER3, J. MCKINNEY 3, M. with genital fistula in the Democratic Republic of BERG4, D. MUKWEGE1,2 Congo* DRC Frequency and management of non-obstetric fistula Alexandre Michel Mpunga2, Félicien Banze2, Dolores Nembunzu3, in the Democratic Republic of Congo: experience Delamou Kenny Raha4, Justin Paluku5, Rachel Kinja4, Esther from Fistula Care Plus project Kitambala5, Brian Tena-Tena Aussak3, Ruth Bulu Bobina5, Notia A4, Mukuliboy Anne3, Altine Diop6, Vandana Tripathi6, Lauri Romanzi6 DRC Challenges faced by women after repair of genital Christine Aline Philibert 2, Mukwege Mukengere Denis1 tract fistula: An observational study in Tanganyika Amisi Notia1, Province, Democratic Republic of Congo
DRC IMPLEMENTING PHYSIOTHERAPY SERVICES Laura Keyser Mc Kinney J., Amisi Ch., Mukwege D., Kinja Rachel INTO FISTULA CARE AT PANZI HOSPITAL, BUKAVU, DRC* Guinea Stakeholders perceptions on women’s health after Alexandre Alexandre Delamou1, Thérèse Delvaux2, Aissatou obstetric fistula repair : results from a qualitative Delamou Diallo1, Moussa Soka Douno1, Moustapha Diallo3, study in Guinea Vincent De Brouwere2, Altine Diop4, Vandana Tripathi4, Lauri Romanzi4 Niger Fistula Prevention Awareness Activities of Ibrahim Diop Ndeye Altine2, Mounkaila, Habsatou Traore3, Community Volunteers in Niger Souley Tripathi Vandana
Uganda Improving fistula data reporting through Hassan Paul Kaduyu, Elly Arnoff, Rose Mukisa, Vandana collaboration, learning and adaptation of fistula Kanakulya Tripathi tools and indicators in Uganda
Uganda Assessment of health worker knowledge in fistula Hassan C. Ndwiga, P. Sripad, E. Arnoff, R. Mukisa, S. Warren, management in Uganda Kanakulya J. Barageine Uganda Facilitating Data for Decision Making to improve Hassan Carol Kyozira, Paul Kaduyu, Rose Mukisa Health Management Information Systems reporting Kanakulya at four supported sites in Uganda
Annual Report • October 2017 – September 2018 Fistula Care Plus 283
Submitting Title Lead Author Other Authors country Uganda Building the capacity of teachers to facilitate Molly Dr. Paul Kaduyu, Hassan Kanakulya, Dr. Rose Mukisa, sexual reproductive information increases their Tumusiime confidence levels – the case of in school Aflateen plus Clubs, Uganda.
Uganda Establishing Depression Levels among Women Paul Kaduyu, Rose Mukisa, Veronica Ibanda Seeking Pelvic Floor Disorder Treatment at Fistula Care Plus Supported Sites in Uganda.
Uganda Increasing opportunities for obstetric fistula case Molly Paul Kaduyu detection and treatment by using multifactorial Tumusiime Hassan Kanakulya approaches – the case of Kalungu district –Uganda. Rose Mukisa
Uganda Using a communication strategy to empower Molly Paul Kaduyu youths make responsible social, economic, and Tumusiime Hassan Kanakulya sexual and reproductive health decision. Rose Mukisa
Uganda (Pop Enhancing primary health care providers’ capacity Pooja Sripad, George Odwe and Charlotte Warren Council) in screening and referral of women with fistula. Charity Ndwiga Global Improving quality of life for women with incurable Vandana Uganda & TERREWODE teams fistula in Uganda Tripathi Global The association between female genital fistula Vandana Lindsay Mallick symptoms and gender-based violence Tripathi Global Bladder care and management of Vandana Elly Arnoff prolonged/obstructed labor for obstetric fistula: A Tripathi global survey of intrapartum and postpartum clinical practices
Annual Report • October 2017 – September 2018 Fistula Care Plus 284
APPENDIX XX: PARLIAMENTARY PRESENTATION ON UGANDA COSTING STUDY
Annual Report • October 2017 – September 2018 Fistula Care Plus 285
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Annual Report • October 2017 – September 2018 Fistula Care Plus 287
Annual Report • October 2017 – September 2018 Fistula Care Plus 288
APPENDIX YY: FC+ CORE INDICATORS: ANNUAL ACHIEVEMENTS
Note: Benchmarks for FY 15/16 are the approved benchmarks based on approved country workplans. Benchmarks for FY 17/18 are drawn from the original project approved FC+ PMP. Blanks indicate indicators/years for which benchmarks have not been finalized.
Goal: To strengthen health system capacity for fistula prevention, detection, treatment, and reintegration in priority countries in Sub-Saharan Africa and South Asia.
Indicator 1: Number of countries supported by Fistula Care Plus (FC+)
Definition: # of countries in which FC+ is supporting fistula repair sites and other activities to strengthen fistula-related policy, community capacity, and services
Additional description/context: FC+ will support countries to strengthen capacity for obstetric fistula prevention, detection, repair, and reintegration of affected women.
Data source and collection: Collected quarterly from project reports by FC+ staff
Benchmark Values29
Year Target Actual Notes
FY2013/14 5 5
FY2014/15 5 6 FC+ supported activities in Togo through the USAID/WARP mission
FY2015/16 6 6 FC+ supported activities in Togo through the USAID/WARP mission
FY2016/17 6 5 FC+ supported activities in Togo ended in FY 15/16.
FY2017/18 6 6 FC+ support to Mozambique initiated in FY17/18.
29 Benchmarks are aggregated for all indicators unless otherwise stated. Annual Report • October 2017 – September 2018 Fistula Care Plus 289
FY2018/19 5 Support to Nigeria ended in FY17/18. Planned countries are: Bangladesh, DRC, Mozambique, Niger, Uganda
Indicator 2: Number of sites supported by FC+ for fistula repair and prevention
Definition: # of facilities to which FC+ is providing support for fistula repair services.
Additional description/context: FC+ will support facilities to provide fistula repair services. The majority of these sites will also provide some level of prevention care. Support can include: provider training and clinical mentoring, equipment, and/or other site strengthening activities such as quality improvement (QI) and management capacity building. Support to clients at these sites can include: transport costs to hospitals for surgery, temporary shelter, costs for repair, post-operative hospitalization costs, pre and post operative counseling. and client rehabilitation services during post-operative recovery. Supported sites will provide data to FC+ on clinical indicators including numbers of clients seeking and requiring fistula repair services, the number of repairs performed, and the outcomes for those clients. Supported sites may also be engaged in fistula prevention activities, as defined in indicator 3. However, in reporting, sites will be disaggregated into prevention-only sites and repair/prevention sites. Sites that provide both are reported via indicator 2.
Data source and collection: Collected quarterly from project reports by FC+ project staff and in-country partners
Benchmark Values
Year Target Actual Notes
FY2013/14 26 25
FY2014/15 32 31
FY2015/16 34 37
FY2016/17 36 33
FY2017/18 36 37
FY2018/19 25
Annual Report • October 2017 – September 2018 Fistula Care Plus 290
Indicator 3: Number of prevention-only sites supported by FC+
Definition: # of facilities to which FC+ is providing support only for fistula prevention services.
Additional description: FC+ will support facility sites to provide services that prevent fistula. Support can include: include provider training and clinical mentoring, equipment, minor renovation or rehabilitation of facilities, other site strengthening activities such as quality improvement (QI) and management capacity building; and/or community outreach for awareness, screening, detection, and referral activities. FC+ will focus prevention interventions in three areas: a. Emergency obstetric services (EmOC) with immediate interventions to help prevent fistula. We will track three key immediate term interventions which will be a focus of strengthening at selected sites:
Correct use of the partograph to manage labors Availability of C-section services Routine use of catheterization for women who had prolonged/obstructed labor. b. Family Planning (FP) services as a medium term fistula prevention intervention
c. Screening, detection, and referral of women needing fistula treatment to repair sites.
As noted above, facilities will be classified as either prevention-only or repair/prevention sites. Repair sites may also be engaged in any or all of the prevention activities outlined here.
Data source and collection: Collected quarterly from project reports by FC+ staff and in-country partners
Benchmark Values
Year Target Actual Notes
FY2013/14 43 16 Delays in funds release and subaward agreements negatively affected prevention-only site support
FY2014/15 39 749 FC+ has temporarily taken on support of a large number of prevention-only sites in Nigeria following the close of the TSHIP project.
FY2015/16 790 789
Annual Report • October 2017 – September 2018 Fistula Care Plus 291
FY2016/17 791 752 Support to sites in Jigawa State in Nigeria was discontinued during the FY.
FY2017/18 787 710 Expected increases in Nigeria prevention only sites did not occur during the FY.
FY2018/19 17 Support to sites in Nigeria ended in FY17/18.
Objective 1: Strengthened enabling environment to institutionalize fistula prevention, treatment and reintegration in the public and private sectors
Indicator 4: Number of countries receiving support from FC+ where governments or supported facilities have revised/adopted/ initiated/implemented policies or guidelines for fistula prevention or treatment
Definition: # of supported countries or facilities (some private sites may develop their own policies/guidelines) that have revised/adopted, initiated, or are continuing to implement policies in support of fistula prevention and treatment services.
Additional description/context: The FC+ Annual Report will include the name of policy/guideline, location, and status (e.g., under development or review, approved, implemented). Fistula-specific polices or guidelines can be part of broader reproductive and/or maternal health documents. For the purposes of FC+, a policy30 is an official statement by a government or health authority that provides an overall direction for a health issue by defining a vision, values, principles, and objectives, and establishing a broad model of action to achieve that vision. Policies may address financing, coordination among agencies and programs, necessary legislation, organization of services, procurement of material resources, required human resources, quality standards, and/or information systems. A guideline is a statement that provides a framework or course of action through which to implement policy objectives, including recommendations and best practices that ensure quality within services to be provided. This indicator includes countries that have fistula policies/guidelines in place at the start of the project.
30 Adapted from World Health Organization definitions. Available at: http://www.who.int/mental_health/policy/services/1_MHPolicyPlan_Infosheet.pdf. Accessed January 22, 2014. Annual Report • October 2017 – September 2018 Fistula Care Plus 292
Data source and collection: Collected annually from project reports and policy/guideline documents by FC+ staff and in-country partners
Benchmark Values
Year Target Actual Notes
FY2013/14 5 5
FY2014/15 5 5
FY2015/16 6 5
FY2016/17 6 5
FY2017/18 5 5
FY2018/19 4
Indicator 5: Number of countries receiving support from FC+ where governments or supported facilities have addressed WDI, women with TF and/or POP in their fistula and/or broader reproductive/maternal health policies or guidelines
Definition: # of supported countries or facilities (some private sites may develop their own policies/guidelines) that have addressed the needs of WDI, women with TF, and/or women with POP in their relevant policies/guidelines.
Additional description/context: This incorporation can be within fistula-specific documents or broader policies/guidelines on reproductive and/or maternal health services.
Annual report will include the name of policy/guideline, location, and status (e.g., under development or review, approved, implemented). The definitions of policies and guidelines described under indicator 5 will be applied here.
Data source and collection: Collected annually from project reports and policy/guideline documents by FC+ staff and in-country partners
Annual Report • October 2017 – September 2018 Fistula Care Plus 293
Benchmark Values
Year Target Actual Notes
FY2013/14 0 0 Policy efforts related to WDI/TF/POP to begin in FY14/15
FY2014/15 1 2 Nigeria and Uganda have both held national level meetings drafting policy related to treatment and reintegration of WDI
FY2015/16 2 2 Bangladesh and Niger
FY2016/17 2 4 Bangladesh, Niger, Nigeria, and Uganda
FY2017/18 5 5 Bangladesh, DRC, Nigeria, Nigeria and Uganda
FY2018/19 4
Indicator 6: Number of countries receiving support from FC+ in which governments have budget line item for fistula care
Definition: # of supported countries with a specific annual budget allocation to fund fistula prevention, detection, repair, and/or reintegration services.
Additional description/context: This is an annual, rather than aggregated, indicator.
Data source and collection: Collected annually from project reports and key informant interviews by FC+ staff and in-country partners
Benchmark Values
Year Target Actual Notes
FY2013/14 2 2 Budget allocations made in Nigeria and Uganda
FY2014/15 2 2 Budget allocations made in Nigeria and Uganda
Annual Report • October 2017 – September 2018 Fistula Care Plus 294
FY2015/16 3 2 Bangladesh and Nigeria
FY2016/17 3 3 Bangladesh, Niger, Nigeria
FY2017/18 3 3 Bangladesh, Niger, Nigeria
FY2018/19 2
Indicator 7: Number of countries with fistula indicators included in the health management information system (HMIS)
Definition: # of supported countries whose HMIS includes fistula indicators.
Additional description/context: The primary indicator of interest is the number of fistula repairs; however, additional relevant indicators that may be incorporated into HMIS include the number of women identified as needing repair.
Data source and collection: Collected annually from project reports and key informant interviews by FC+ staff and in-country partners
Benchmark Values
Year Target Actual Notes
FY2013/14 4 3 Along with Niger, Nigeria, and Uganda, indicators have also been approved in a 4th country (Bangladesh), but data collection has not yet begun.
FY2014/15 4 3 See FY13/14
FY2015/16 4 4 Bangladesh, Niger, Nigeria, Uganda
FY2016/17 4 4 Bangladesh, Niger, Nigeria, Uganda
FY2017/18 4 4 Bangladesh, Niger, Nigeria, Uganda
FY2018/19 3
Annual Report • October 2017 – September 2018 Fistula Care Plus 295
Indicator 8: Number of public/private partnerships established to address fistula prevention, repair, or reintegration by country
Definition: # of public/private partnerships established to address country-level needs related to fistula prevention, repair, and/or reintegration.
Additional description/context: Partnerships may include the leveraging of private (e.g., corporate) financial resources to fund fistula activities and/or the provision of in-kind support to enable fistula services (e.g., medical equipment, drugs, supplies, human resources).
Data source and collection: Collected semi-annually from project reports by FC+ staff and in-country partners
Benchmark Values
Year Target Actual Notes
FY2013/14 131 3 In addition to the 3 PPPs (Bangladesh, Nigeria, and Uganda), an individual has also donated commodities in Uganda
FY2014/15 2 3 Partnerships for private contribution to fistula activities are active in DRC, Nigeria, and Uganda. Proposals for such partnership are pending in Bangladesh and Niger.
FY2015/16 3 4 Bangladesh, DRC, Nigeria, Uganda
FY2016/17 4 4 Bangladesh, DRC, Nigeria, Uganda
FY2017/18 5 3 DRC, Nigeria, Uganda (with global partners Laborie Inc., Gradian Health Systems, and Bioteque)
FY2018/19 3
31 This will be achieved in Y2 due to the shortened Y1. Annual Report • October 2017 – September 2018 Fistula Care Plus 296
Objective 2: Enhanced community understanding and practices to prevent fistula, improve access to fistula treatment, reduce stigma, and support reintegration of women and girls with fistula
Indicator 9: Number of community volunteers/educators trained in tools and approaches to raise awareness regarding fistulae prevention and repair
Definition: # of community volunteers/educators trained in topics and approaches and approaches, such as social and behavior change communication (SBCC), stigma, gender-based barriers, and male involvement to mobilize communities for fistula prevention, the use of safe motherhood services including family planning and EmOC, and fistula screening/detection/referral for repair.
Additional description/context: Community volunteers/educators are individuals affiliated with or employed by community-based organizations, non-governmental organizations, and/or faith-based organizations. In some countries, they are affiliated with government agencies (e.g., Ethiopia’s Health Development Army); however, while these individuals may liaise with health facilities and providers, their role is restricted to health promotion and they are not formally attached to specific health facilities. These are considered to be distinct from the community health workers discussed in Indicator 18 below.
Data source and collection: Collected quarterly from training reports by FC+ staff and in-country partners
Benchmark Values
Year Target Actual Notes
FY2013/14 227 0 Delays in funds release and subaward approvals negatively affected ability to implement community volunteer/educator trainings in FY13/14
FY2014/15 494 77
FY2015/16 607 679
FY2016/17 725 850
Annual Report • October 2017 – September 2018 Fistula Care Plus 297
FY2017/18 1,423 749 Expected refresher trainings in Niger did not take place due to office closure.
FY2018/19 1,074
Indicator 10: Number of community awareness-raising activities/events conducted by program partners
Definition: # events carried out by program partners to provide information about EmOC availability, fistula prevention, screening and detection, repair, and other safe motherhood issues.
Additional description/context: Events may include community gatherings and broadcast messages.
Data source and collection: Collected quarterly from program monitoring reports by FC+ staff and in- country partners.
Benchmark Values
Year Target Actual Notes
FY2013/14 570 12 Delays in funds release and subaward approvals negatively affected ability to implement community outreach and education in FY13/14.
FY2014/15 586 1,990
FY2015/16 1,695 10,393
FY2016/17 6,130 In person:33,425 Home visits in Niger and Aflateen activities in Uganda resulted in achievements far above Mass media: 659 benchmarks.
FY2017/18 10,666 In person: 17,678
Mass media: 53
FY2018/19 6,064
Annual Report • October 2017 – September 2018 Fistula Care Plus 298
Indicator 11: Number of participants reached through community awareness-raising events/activities conducted by program partners
Definition: # of participants reached through community awareness raising events/activities conducted by program partners.
Additional description/context: Participants may include attendees at events in the community, as well as those listening to/watching broadcast messages. Numbers of persons reached will be estimates for some activities; e.g., radio partners will provide estimates of the listenership for broadcast events.32
Data source and collection: Collected quarterly from program monitoring reports by FC+ staff and in- country partners.
Benchmark Values
Year Target Actual Notes
FY2013/14 155,150 10,745 Delays in funds release and subaward approvals negatively affected ability to implement community outreach and education in FY13/14
FY2014/15 232,100 414,067
FY2015/16 In person: In person: 306,750 2,862,124 Mass media: Mass media: 1,550,000 3,676,406
FY2016/17 In person: In person: Mass media reach numbers were not available 327,000 557,186 in all countries. Mass media: Mass media: 102,150,000 15,289,736
32 FC+ has expanded its definition of the reach of community activities to include the audience for radio broadcasts; not all countries have been able to establish baseline estimates of these audiences yet; these benchmarks may thus be revised based on Y1 experience. Annual Report • October 2017 – September 2018 Fistula Care Plus 299
FY2017/18 In person: In person: 676,000 681,597 Mass media: Mass media: 27,339,750 20,919,065
FY2018/19 In person: 203,000 Mass media: 600,000
Objective 3: Reduced transportation, communication, and financial barriers to accessing preventive care, detection, treatment, and reintegration support
Indicator 12: Number and type of transportation initiatives introduced, enhanced, and/or tested
Definition: # of initiatives introduced enhanced, and/or tested to reduce barriers faced by women in traveling to fistula services, particularly repair, in the catchment areas of FC+ sites.
Additional description/context: Initiatives may include vouchers, support from local transportation networks, and other strategies to enable transportation to fistula services.
Data source and collection: Collected semi-annually from program monitoring and evaluation reports by FC+ staff and in-country partners
Benchmark Values
Year Target Actual Notes
FY2013/14 0 0
FY2014/15 2 0 Delays in approvals/conduct of Pop Council study have negatively impacted ability to move forward with designing and piloting initiatives
Annual Report • October 2017 – September 2018 Fistula Care Plus 300
FY2015/16 2 0 Initiatives planned but not yet implemented, will take place in FY 16/17
FY2016/17 2 2 Nigeria and Uganda
FY2017/18 2 2 Nigeria and Uganda
FY2018/19 0 In the NCE year, active implementation will be over, with a focus instead on documentation of results
Indicator 13: Number and type of communication technologies introduced, enhanced, and/or tested for improving communication with patients and/or providers
Definition: # of initiatives introduced enhanced, and/or tested to improve communication with providers and/or patients engaged through FC+ sites.
Additional description/context: Initiatives may target health behavior and service utilization messages for women, follow-up support and mentoring for trained providers, and/or monitoring of service provision/uptake by patients and providers.
Data source and collection: Collected semi-annually from program monitoring and evaluation reports by FC+ staff and in-country partners
Benchmark Values
Year Target Actual Notes
FY2013/14 0 0
FY2014/15 1 0 Delays in approval and conduct of Pop Council study have negatively impacted ability to design/test new technologies
FY2015/16 2 0 Initiatives developed but will be implemented in FY 16/17
FY2016/17 2 2 Nigeria and Uganda
Annual Report • October 2017 – September 2018 Fistula Care Plus 301
FY2017/18 2 2 Nigeria and Uganda
FY2018/19 0 In the NCE year, active implementation will be over, with a focus instead on documentation of results
Objective 4: Strengthened provider and health facility capacity to provide and sustain quality services for fistula prevention, detection, and treatment
Indicator 14: Number of women requiring fistula repairs
Definition: # of women diagnosed with obstetric fistula at supported repair sites
Additional description/context: This will be a subset of women seeking treatment at repair sites; women will be screened to determine whether their incontinence is due to obstetric fistula. This indicator encompasses all types of fistula, including urinary and RVF together, and RVF alone.33
Data source and collection: Collected quarterly from hospital registers/ client records/program reports by FC+ staff and partner staff
Benchmark Values
Year Target Actual Notes
FY2013/14 2,131 912
FY2014/15 4,000 3,790
FY2015/16 18,000 4,798
33 We have included this indicator in our approved PMP instead of number of women seeking fistula repairs. We know from experience that many women seeking care are often not diagnosed with fistula, but rather have some other condition that results in some incontinence. FC+ will collect information on the number of women seeking care for urinary incontinence as part of our routine clinical monitoring as was done under Fistula Care. If the difference between the number seeking and the number requiring is large then we will know that work needs to be done to improve messages about fistula treatment. We believe for USAID reporting to Congress, the number requiring is more powerful. We are using the term urinary fistula instead of VVF since it more accurately describes the range of typical fistula cases seen at sites. Urinary type fistula includes: vesicovaginal, urethro-vaginal, uretero-vaginal, vesico-uterine. Annual Report • October 2017 – September 2018 Fistula Care Plus 302
FY2016/17 N/A 4,031
FY2017/18 N/A 3,862
FY2018/19 N/A
Indicator 15a: Number of surgical fistula repairs
Definition: # of fistula repair surgeries performed at supported sites.
Additional description/context: This includes all types of fistula repairs, including urinary alone, urinary and RVF together, and RVF alone. Each time a woman has surgery it will be counted; however, it is unlikely that any woman would get more than one repair surgery per quarter. Therefore the quarterly figure for the number of surgeries should therefore equal the number of women getting fistula repair.
Data source and collection: Collected quarterly from hospital registers/ client records/program reports by FC+ staff and partner staff
Benchmark Values
Year Target Actual Notes
FY2013/14 1,30034 852 Delays in funds release and subaward approvals negatively affected ability to support fistula repairs during FY13/14.
FY2014/15 3.830 2,876 Repairs benchmark increased due to requests from Bangladesh and Nigeria missions
FY2015/16 4,121 3,514
FY2016/17 3,780 3,250
34 Release of MCH funds were delayed in Nigeria and Uganda; these two countries account for a large proportion (73%) of the estimated repairs. This benchmark was calculated based on the provision of repairs for two quarters. However, repairs in Uganda were only carried out in the final quarter of the FY.
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FY2017/18 2,950 3,104
FY2018/19 1,224
Indicator 15b: Number of conservative fistula treatments (catheterization)
Definition: # of conservative fistula treatments (catheterization) performed at supported sites.
Note: There is no annual benchmark assigned to this indicator.
Additional description/context: This includes the number of catheterizations performed on an existing fistula, as a conservative approach to fistula repair, provided by supported sites.
Data source and collection: Collected quarterly from hospital registers/ client records/program reports by FC+ staff and partner staff.
Benchmark Values
Year Target Actual Notes
FY2013/14 N/A 4
FY2014/15 N/A 304
FY2015/16 N/A 323
FY2016/17 N/A 294
FY2017/18 N/A 162
FY2018/19 N/A
Indicator 16: Outcomes of fistula repair (percentage closed and dry)
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Definition: Numerator: # of women who received any type of fistula repair surgery (urinary alone, urinary and RVF together, and RVF alone) who when discharged, had a closed fistula and were dry at time of discharge / Denominator: # women who had any type of fistula repair surgery and were discharged X 100
Additional description/context: N/A
Data source and collection: Collected quarterly from hospital registers/ client records/program reports by FC+ staff and partner staff
Benchmark Values
Year Target Actual Notes
FY2013/14 75% 76% Closed and continent data is incomplete for FY13/14 due to new data collection tools. Data presented is what is available for this time period.
FY2014/15 75% 67% 79% of fistulas successfully closed (67% closed and continent, 12% closed and incontinent)
21% not closed
FY2015/16 75% 77% 88% of fistulas successfully closed (77% closed and continent; 11% closed and incontinent)
12% not closed
FY2016/17 75% 78% 89% of fistulas successfully closed (78% closed and continent; 11% closed and incontinent)
11% not closed
FY2017/18 75% 80% 89% of fistulas successfully closed (80% closed and continent; 9% closed and incontinent)
11% not closed
FY2018/19 75%
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Indicator 17: Complications of fistula repair (percent of repairs with complications)
Definition: Numerator: # of women discharged in a quarter whose fistula repair surgeries resulted in a reportable complication / Denominator: total # of women discharged in a quarter following fistula repair surgeries X 100
Additional description/context: Reportable complications can either be major or minor related to the fistula surgery or to anesthesia. As one woman may have more than one complication, the occurrence types of complications will also be disaggregated. Deaths will be monitored separately and reported to USAID annually in a special report. Guidelines regarding complications will be carried over from the Fistula Care Project.
Data source and collection: Collected quarterly from hospital registers/ client records/program reports by FC+ staff and partner staff
Benchmark Values
Year Target Actual Notes
FY2013/14 <20% .4%
FY2014/15 <20% 2.3%
FY2015/16 <20% 2.7%
FY2016/17 <20% 2.1%
FY2017/18 <20% 1.5%
FY2018/19 <20%
Indicator 18: Number of health systems personnel trained, by topic, for fistula and/or POP prevention and treatment (disaggregated by training topic, sex and cadre of provider)
Definition: # of persons attending training in support of fistula services
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Additional description/context: Type of training will be reported by the primary training category. Training in surgical repair is included in this indicator, and will be disaggregated. Training will be reported for specific topics such as counseling, use of the partograph, quality improvement, data-driven management, etc.
Categories of health system personnel trained may include:
Surgeons and other physicians Nurses and midwives Other non-physician clinicians (e.g., clinical officers) Non-clinician counselors Facility managers Community health workers
For the purposes of FC+, community health workers are individuals formally affiliated with the health system and linked to specific health facilities, generally providing health education and services at the community/household level. This may include both unpaid and paid individuals. This term encompasses cadres known by other titles, depending on the country context (e.g., Ethiopia’s Health Extension Workers).
Data source and collection: Collected quarterly from training reports by FC+ staff and partner staff
Benchmark Values
Year Target Actual Notes
FY2013/14 526 403 Delays in funds release and subaward approvals negatively affected ability to implement training in FY13/14
Number revised from FY13/14 report to reflect additional data submitted from countries post-reporting
FY2014/15 929 1,065
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FY2015/16 1,395 1,414
FY2016/17 1,041 1,391
FY2017/18 838 1,289
FY2018/19 439
Indicator 19: Number of supported facilities that have introduced treatment for POP
Definition: # of facilities to which FC+ is providing support that have introduced POP treatment services.
Additional description/context: Support can include: provider training and clinical mentoring, equipment, minor renovation or rehabilitation of facilities, and/or other site-strengthening activities such as quality improvement (QI) and management capacity building. Supported sites will provide data to FC+ on the number of POP treatment services provided. Some POP facilities may also be providing fistula repair and/or prevention services. In that case, those sites will also be reported in Indicator 2 or 3, as appropriate; this will be disaggregated in the report.
Data source and collection: Collected semi-annually from program reports by FC+ staff and partner staff
Benchmark Values
Year Target Actual Notes
FY2013/14 0 0 0
FY2014/15 1 0 9 supported sites providing ongoing POP treatment35
FY2015/16 6 4 10 supported sites providing ongoing POP treatment
35 Reported through FC+ routine M&E; not necessarily introduced or strengthened through FC+ supported fistula/POP integration activities. See indicator 20 for clinical outputs at these sites. Annual Report • October 2017 – September 2018 Fistula Care Plus 308
FY2016/17 N/A 2 15 supported sites providing ongoing POP treatment
FY2017/18 4 N/A 11 supported sites providing ongoing POP treatment
FY2018/19 N/A N/A
Indicator 20: Number of POP treatment services provided
Definition: # of POP treatment services performed at supported sites.
Additional description/context: This includes both conservative treatment (e.g., treatment with a pessary) and all types of surgical treatment (e.g., hysterectomy with pelvic support repair, mesh, etc.). Reports will disaggregate by type of treatment.
Data source and collection: Collected quarterly from hospital registers/ client records/program reports by FC+ staff and partner staff
Benchmark Values
Year Target Actual Notes
FY2013/14 0 NA
FY2014/15 30 1,334
FY2015/16 505 2,681
FY2016/17 N/A 2,884
FY2017/18 400 2,886
FY2018/19 N/A
Indicator 21: Couple-years of protection in sites supported by FC+
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Definition: The estimated protection provided by family planning services, based upon the volume of all contraceptives distributed to clients during the reporting period
Additional description/context: USAID-endorsed conversion factors for each family planning method will be used to calculate CYP.36 All CYP will be credited to the year in which the method was distributed, rather than annualizing CYP.
Data source and collection: Collected semi-annually from facility FP registers by FC+ staff and in- country partners
Benchmark Values
Year Target Actual Notes
FY2013/14 28,430 40,039
FY2014/15 90,500 107,985
FY2015/16 153,261 195,986
FY2016/17 145,496 263,206
FY2017/18 184,755 315,229
FY2018/19 36,500 Support to Nigeria sites ended in FY 17/18
Indicator 22: Number of FP counseling sessions provided to clients
Definition: # of counseling sessions provided to clients at FC+ sites regarding FP methods.
Additional description/context: As a woman may receive more than one FP counseling session in a given quarter, this indicator represents number of service encounters, rather than numbers of individual clients.
Data source and collection: Collected semi-annually from facility FP registers by FC+ staff and in-country partners
36 Office of Sustainable Development, Bureau for Africa, USAID. Health and Family Planning Indicators: A Tool for Results Frameworks Volume I. Accessed: January 20, 2014. Annual Report • October 2017 – September 2018 Fistula Care Plus 310
Benchmark Values
Year Target Actual Notes
FY2013/14 53,698 38,373
FY2014/15 117,800 149,610
FY2015/16 204,532 366,038
FY2016/17 186,232 423,736
FY2017/18 297,200 456,930
FY2018/19 31,010
Indicator 23: Completion of partographs and management of labor according to protocol at sites receiving support for strengthening partograph use
Definition: A two part indicator will be used to assess partograph completeness and management of labor according to protocol.
Part 1: Mean partograph completion score for labor records reviewed during the reporting period. Partograph completion scores will be based on five key items that should be present in all records, whether labor was normal or prolonged. 1 point will be assigned for each item, for score range from 0 to 5. These are selected based on USAID/MCHIP/WHO tools and guidelines. They are:
Existence of partograph in labor & delivery file. Fetal heart rate recorded every half hour on partograph. Contractions plotted every half hour on partograph. Maternal pulse recorded at least every half hour on partograph. Blood pressure recorded at least every four hours on partograph. Part 2: % of partographs with action line reached in which the correction actions were taken.
Additional description/context: This information will be collected during medical monitoring supervision visits using FC+ medical monitoring tool. A systematic sample of up to 25 labor & delivery records for the reference period will be reviewed. Instructions for drawing a systematic sample are
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included in the monitoring tool.). Information from partographs will be abstracted using a standardized form. Data will only be collected from sites where FC is working to strengthen the correct use of the partograph.
Data source and collection: Collected annually from medical monitoring reports by FC+ staff and in- country partners
Benchmark Values
Year Target Actual Notes
FY2013/14 0 NA
FY2014/15 50% of sites receiving a mean 18% of sites receiving a score of 4 on reviewed mean score of 4 on partographs; 60% of reviewed reviewed partographs; 78% of partographs responding reviewed partographs appropriately action if action line responding appropriately reached action if action line reached
FY2015/16 60% of sites receiving a mean 24% of sites receiving a score of 4 on reviewed mean score of 4 on partographs; 60% of reviewed reviewed partographs; 75% of partographs responding reviewed partographs appropriately action if action line responding appropriately reached action if action line reached
FY2016/17 65% of sites receiving a mean 38% of sites receiving a score of 4 on reviewed mean score of 4 on partographs; 65% of reviewed reviewed partographs; 67% of partographs responding reviewed partographs appropriately action if action line responding appropriately reached action if action line reached
FY2017/18 70% of sites receiving a mean 41% of sites receiving a score of 4 on reviewed mean score of 4 on partographs; 70% of reviewed reviewed partographs; 73% of partographs responding reviewed partographs Annual Report • October 2017 – September 2018 Fistula Care Plus 312
appropriately action if action line responding appropriately reached action if action line reached
FY2018/19 70% of sites receiving a mean score of 4 on reviewed partographs; 70% of reviewed partographs responding appropriately action if action line reached
Objective 5: Strengthened evidence base for approaches to improve fistula care and scaled up application of standard monitoring and evaluation indicators for prevention and treatment
Indicator 24: Number of evaluation or research studies completed
Definition: # of evaluation or research studies completed that address fistula care services.
Additional description/context: Studies may include evaluation of models of prevention and repair service delivery, quality assessment and improvement research, evaluation of clinical approaches, and assessment of strategies to reduce barriers to fistula treatment. Annual report will list studies by study name, location, and status (i.e., in development/ ongoing/ complete). Completion will be defined as the submission of a final study report to USAID or the submission of a manuscript documenting study findings for publication.
Data source and collection: Collected annually from program research reports by FC+ staff and research partners
Benchmark Values
Year Target Actual Notes
FY2013/14 0 0
FY2014/15 1 1 Population Council literature review completed
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FY2015/16 2 2 Uganda formative research completed, Nigeria communications assessment completed
FY2016/17 N/A 3 Nigeria formative research completed, DHS analysis of Cesarean Sections in LMIC, UCSF/Makarere study
FY2017/18 4 4 Global SPA survey, Uganda WIF study, DRC non- obstetric fistula study, Aflateen PLUS process documentation
FY2018/19 4 Planned: Uganda treatment barriers implementation research study, Nigeria treatment barriers implementation research study, HMIS process documentation, DRC epidemiological profile of fistula clients
Indicator 25: % of supported sites reviewing fistula monitoring data bi-annually to improve fistula services
Definition: Numerator: # of sites in which fistula monitoring data are reviewed at the facility to assess program progress / Denominator: # of supported sites X 100
Additional description/context: This indicates the proportion of supported FC+ sites with a functioning process for reviewing fistula monitoring data in order to improve services. A functioning review process is defined as a team of staff from the site who meet at least twice a year37, with or without outside assistance (e.g., supervisory teams, FC+ staff) to review and discuss the data and make program decisions to improve fistula services based on these data.
Data source and collection: Collected semi-annually from program monitoring reports by FC+ staff and in- country partners
Benchmark Values
37 The ideal is for these data to be reviewed on a monthly or quarterly basis, depending on service volume at a particular facility. However, experience from the original FC project indicates that this is very difficult, given shortages in human and other resources. FC+ will advocate with partner facilities to strengthen data monitoring and review systems, but has noted that in the approved PMP that bi-annual review is the minimum achievable floor for this indicator. Annual Report • October 2017 – September 2018 Fistula Care Plus 314
Year Target Actual Notes
FY2013/14 40% NA
FY2014/15 45% 55%
FY2015/16 50% 68%
FY2016/17 70% 94%
FY2017/18 75% 56%
FY2018/19 75%
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