Service Delivery

• What constitutes a fistula care service?
• What resources are needed to deliver fistula repair services?
• Does fistula repair surgery require special equipment?
• What do fistula repair services cost?

• Prevention to stop new cases of fistula
• Surgical repair for women who have fistula
• Rehabilitation and reintegration of women into society after surgery

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What resources are needed to deliver fistula repair services?
Fistula repair surgery requires the time and skill of trained medical professionals along with surgical equipment and supplies. In addition, many other resources are needed to make the surgery possible. Vehicles are used to identify and transport women; they require fuel and upkeep. During the hospital stay, clients need food. The hospital itself must be maintained and secure. The work environment must be positive and supportive. The facility must have a functioning referral system. Because of power outages, the hospital may need to maintain and fuel generators. Facilities must sometimes pay to repair operating tables.

Fistula Care invests in human resources to ensure the quality of fistula treatment. Surgeons are trained over time in increasingly complex repairs in order to increase the number of women they can help. Surgical teams learn about infection prevention and quality improvement. Project personnel in the field and at headquarters collect and report data, track spending, and assist with program planning to coordinate the overall effort with transparency.

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Does fistula repair surgery require special equipment?
The equipment needed for fistula repair is often the same as what is needed for other gynecologic procedures. There are, however, some differences: An operating table used by fistula clients might have more tilt; some of the scissors or forceps used may vary or be a bit longer. Generally speaking, however, very few pieces of equipment are unique to fistula surgery.

While most fistula equipment is unspecialized, many hospitals may not have functioning basic equipment. Fistula Care has developed an equipment list that outlines what hospitals need as a standard to perform repairs. When basic equipment is neither available nor functional, Fistula Care helps hospitals procure what they need. Provision of equipment can potentially improve all surgeries, including those that prevent fistula. Though focused on fistula, the Fistula Care project strives to improve the quality of all reproductive health services and to strengthen the overall health system.

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What do fistula repair services cost?

Cost estimates vary widely within and across countries and across different service-delivery components. Fistula Care is conducting research on costs and is developing a standardized tool to estimate the total costs associated with fistula repair.