Increase investment in quality healthcare to end obstetric fistula

Dr. Meshack Ndirangu Country Director Amref Health Africa in Kenya during highlights of the effects of Covid-19 among youth's in Kenya. [Wilberforce Okwiri, Standard]

The World Health Organisation estimates that Kenya records 3,000 new cases of obstetric fistula, a chronic disability that has severe physical, psychological, social, and economic consequences on women. Despite obstetric fistula being both preventable and treatable, only about 1,000 fistula surgeries (less than 50 per cent of the cases) are done annually in Kenya.

Due to the increased cost of living, only about 7.5 per cent of the girls and women can access fistula-related medical care, including surgery, estimated to cost Sh7,200.

Furthermore, less than 10 per cent of all health facilities in Kenya can offer basic emergency obstetric care, and only 6 per cent offer comprehensive emergency obstetric care.

These figures are an indication that Kenya is in dire need of medical personnel trained in fistula care, including prevention, repair, and reintegration back into society.

Suffice to note, this significant percentage of women and girls not only live with the debilitating experiences of constant leaking of urine and/or feces through the vagina but also suffer the indignity of severe stigma and isolation associated with both the consequences of fistula and the misconceptions about the cause.

The 'fistula belt' is therefore synonymous with counties with high levels of poverty, insufficient infrastructure, lack of specialised workforce, poorly developed referral networks and over-reliance on donor support for fistula care. The obvious lack of attention to this means that a significant percentage of women and girls live with the debilitating consequences of fistula and the indignity of severe stigma and isolation.

Fistula, an injury caused by long, painful obstructed labour and described as the leading cause of disability during childbirth, calls for a multi-pronged approach that entails, strengthening of primary healthcare, expansion of fistula treatment networks and post-repair support through multi-sectoral partnership, political goodwill and action for the patients.

To its credit, to address maternal mortality and morbidity, the government has in place strategies, policies, and guidelines aimed at ending fistula by 2030. With devolution of health functions, the implementation of these policies lie squarely on the shoulders of the county leadership.

Indeed, studies have established that regional fistula treatment networks have proved effective in increasing awareness and access to fistula care services, reducing stigma and enhancing post-operative follow-up and reintegration support. However, such networks only thrive in the backdrop of implementation frameworks that strengthen a people-centered approach to healthcare.

Governors and other health stakeholders should take note of this year's World Fistula Day theme, 'End fistula now: Invest in quality healthcare, empower communities!' This is a call to action.

A call of change of focus to 'the triangle that moves mountains in healthcare': One, political goodwill for county and supra county-level policy, legislative, and resource mobilisation frameworks. Two, quality healthcare by appointing knowledgeable and experienced technocrats to the health management teams and, three, empowerment of communities through public participation and support from civil societies.

We hope such interventions will leave a long-lasting mark on these women by rebuilding their dignity and re-integration into societies.

Dr Wekesa, an obstetrician, gynecologist, and health systems strengthening expert is Chief of Party, USAID Imarisha Project at Amref Health Africa in Kenya. Dr Ndirang'u is the Country Director at Amref Health Africa in Kenya

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