Location

Dar es Salaam, Pwani, Iringa, Mwanza, Dodoma, Kilimanjaro, Lindi, Arusha, Rukwa, Ruvuma, Kigoma, Tanga, Mara,Morogoro, Kagera, Tabora, Singida and Mbeya regions.

Background

The Vesico Vaginal Fistula (VVF) is common among poor young women living with poor or limited access to quality maternity care. It is an abnormal communication or hole between the bladder and the vagina through which urine leaks uncontrollably. Prolonged and usually obstructed labour causes death (necrosis) of the vaginal wall, bladder, and urethra, which have been compressed by the head of the foetus (baby) against the pubic bone of the woman. Sometimes, the hole develops between the vagina and the rectum (Rectal Vagina Fistula- RVF), leading to major hygiene problems as both urine and faeces leak uncontrollably through the vagina. Due to limited resources and lack of awareness, many affected women are unable to seek treatment or solutions to the problem. Affected women face isolation by the community and suffer from both physical and psychological damage. There is social stigma attached to the disease. It is clear that in most rural areas, the majority is unaware that VVF is a condition that can be treated. Many relate it to witchcraft, misfortune or being cursed.

Goal

The goal of the national fistula program is to build an effective, comprehensive strategy to address fistula in the context of maternal mortality and morbidity.

Donors

Royal Netherlands Embassy, International Federation of Gynecology and Obstetrics (FIGO) UK, UNFPA and Ministry of Health and Social Welfare.

Project Objectives

• To build capacity of local health care providers to be able to effectively treat and prevent fistula.

• To ensure girls and women are able to access high quality fistula care in an efficient manner and return to a life of dignity following treatment.

• To significantly increase public awareness and understanding of fistula and maternal mortality and morbidity in order to mobilize action for prevention, treatment and reintegration.

• To increase understanding of fistula at the family, community and health systems levels in order and develop strategies to prevent fistula.

• To build a partnership among government, non-governmental actors, professionals, the media and others to address fistula.

Achievements:

• Improved skills of health care providers to treat fistula.27 doctors have been trained in Fistula surgery and provide fistula treatment in 30 hospitals in all regions of mainland. The service is also linked to the AMREF’s Flying doctors clinical outreach services.

• An efficient referral system for fistula patients has been established, including case identification, counseling and logistic and financial support to enhance easy access to treatment. This has drastically increased the number of fistula cases that have been repaired.

• Public awareness on fistula and health needs for the poor has increased. Fistula is now known as a public health concern and an important factor of maternal morbidity and mortality.

• The program is promoting new strategies to assist fistula patients to reintegrate into the society after treatment through destigmatization campaigns, inclusion in social activities, public awareness on fistula treatment and engagement in Income Generating Activities (IGA).

• Effective institutional arrangements have been put in place, for management of the fistula.

	Case study
	With a very sad face, Winifrida Kabomboya (60) from Kumwerulo village of Kibondo District in Kigoma region of Tanzania tells her most painful experience in life which resulted from VVF problem. Winifrida encountered fistula problem on her first born delivery in 1961. This was a result of prolonged labor. “I stayed in labor pains for four days before I went to Bukoba for caesarean section” Said Winifrida Winifrida started leaking urine one week after the delivery. This situation made her lovely husband to abandon her. “My lovely husband could not tolerate the leakage situation as I was always stinking,” she sadly said. Winifrida is not the only woman in Kibondo district facing VVF problem. There is a good number of women in Kibondo region suffering from VVF and have been either abandoned or divorced by their spouses. Most of women suffering from fistula in Kibondo district, including Winifrida currently have a hope of returning to their normal life situation as long as they can now receive the Fistula repairs done by AMREF specialist in Kibondo District Hospital. AMREF in Tanzania through fistula programme does outreach services in remote areas for Fistula repairs. This serves most of women who cannot afford to travel to big Hospitals for the repair.

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