Bangladesh

Bangladesh is one of the most densely populated countries in the world. Situated on the Bay of Bengal in South Asia, Bangladesh has a population of more than 160 million that continues to grow. Frequent natural disasters stretch its infrastructure. Bangladesh’s population growth has slowed in recent decades because of the availability and uptake of family planning services. Although maternal mortality has been halved in the past 15 years, there is still roughly one Bangladeshi maternal death every hour.

USAID-supported fistula services in Bangladesh began in July 2005. Fistula Care Bangladesh works with four private hospitals to prevent and repair fistula and to link women with rehabilitation and reintegration activities:

Ad-din Hospital, Dhaka
Ad-din Hospital, Jessore
Kumudini Hospital, Mirzapur, Tangail
LAMB Hospital, Parbatipur, Dinajpur
Memorial Christian Hospital, Malumghat, Cox’s Bazar (no longer supported)

Program Results

As of December 2012 (since July 2005):

1,013 fistula repair surgeries supported.
Thirteen doctors and 312 nurses trained on fistula surgery and management from the National Fistula Center.
830 doctors and nurses trained on fistula counseling and safe motherhood.
390 doctors, nurses and community outreach workers, both the government of Bangladesh and nongovernmental organizations received community outreach and advocacy training.

In addition to fistula treatment, each hospital provides a range of maternity services, including antenatal care, family planning services, and deliveries, including cesarean sections. Sites also carry out community outreach activities with fistula prevention messages. Fistula Care serves as the secretariat for the quarterly meetings of the National Fistula Task Force, which developed Bangladesh's National Strategy on Obstetric Fistula.

News and Resources

Program Update: Fistula Care Team Meets with Bangladesh’s Minister of Health and Family Welfare

Picture Book: Preventing Obstetric Fistula (English; Bangla)

Technical Brief: Living with Obstetric Fistula: Qualitative Research Findings from Bangladesh and the Democratic Republic of Congo

Technical Brief: A Low-Cost Ambulance Network to Improve Access to Maternity Services in Dhaka, Bangladesh

Technical Brief: Increasing Access to Maternity Services in Rural Bangladesh: Sustainable Facility-Community Links

Client Education Tools and Provider Resources Developed in Bangladesh

Stories from the Field from Bangladesh

Profile of a Fistula Surgeon in Bangladesh

Supported Sites

Ad-din Hospital/Dhaka is located in the capital city. The hospital is a social enterprise of the business conglomerate Akij Group. A number of development and welfare projects are implemented by Ad-din, including a chain of hospitals, an underprivileged children's home, and income-generating enterprises to support the welfare projects. Ad-din Hospital/Dhaka aims to provide quality preventive and curative care for children and women at low cost. It operates a busy and popular outpatient department for women and children, providing antenatal and postnatal care, family planning, treatment for sexually transmitted infections, obstetric, gynecologic, and surgical services for women, and child health services. Ad-din Hospital also manages a fleet of sixty-six ambulances that facilitate transport for emergencies and women in labor.

Ad-din Hospital/Jessore is a satellite of Dhaka's Ad-din Hospital, located 300 km from Dhaka. It has 130 beds for women and children. Ad-din Hospital/Jessore offers similar inpatient and outpatient services to the Ad-din Hospital in Dhaka. In 2010, 283,510 outpatients and 14,230 inpatients received services at the facility. Ad-din/Jessore operates a network of satellite clinics that offer women antenatal and postnatal care close to home.

Kumudini Hospital was established by R.P. Shaha in 1938 as a modest 20-bed hospital at Mirzapur, Tangail, 70 km north of Dhaka. Since then, it has grown to be one of the largest private hospitals in Bangladesh, with 750 beds. It cares for about 34,000 inpatients and 245,000 outpatients each year, including emergency cases. The hospital is a part of the Kumudini Welfare Trust, which also runs a medical college, a nursing school, a trade training school, a village outreach program, a handicrafts center, and other public welfare initiatives. These projects are funded through Kumudini Welfare Trust's income-generating projects.

LAMB Hospital is part of a faith-based integrated health and development project located at Parbatipur, Dinajpur, 350 km from Dhaka. It has been working in the Dinajpur and Rangpur areas of northwest Bangladesh for nearly 30 years. Started in 1983, LAMB Hospital is now a 150-bed general hospital. It cares for about 8,500 inpatients and 55,000 outpatients each year. Obstetric fistulas are repaired routinely as well as by visiting surgeons during concentrated fistula repair efforts. Much of LAMB’s work takes place in the community. It's safe motherhood program includes training of traditional birth attendants and community-based skilled birth attendants, as well as the provision of technical assistance to community-run safe delivery units.

Memorial Christian Hospital is a 65-bed hospital offering general medical, surgical, and obstetric care in southeastern Bangladesh, 400 km from Dhaka in Malumghat, Cox’s Bazar. It dates from before the Liberation War, when the death of a missionary due to the lack of surgical facilities prompted supporting churches to raise funds for a surgical facility that could serve the local population. Memorial Christian Hospital now serves an outreach area of 10 million people, with a strong emphasis on maternity care. Annually, it treats roughly 66,000 outpatients and 6,500 inpatients. Fistula Care supported Memorial Christian Hospital through December 2008.

Program Activities

Strengthening services

Fistula Care works with the four supported sites to ensure the continued provision of quality fistula repair services. Fistula Care provides refresher trainings for staff on a wide range of subjects, including comprehensive fistula case management, postpartum hemorrhage, fistula counseling, pelvic floor exercises, and facilitative supervision. Fistula Care collaborates with the National Fistula Center of Dhaka Medical College Hospital to organize training for surgeons from Fistula Care-supported programs.

Improving fistula prevention

Fistula Care worked to increase community awareness about the prevention and treatment of fistula within the expanded catchment areas of the fistula repair sites and surrounding districts. A booklet of fistula survivors’ stories was developed to highlight the importance of prevention and to raise awareness about the magnitude of the fistula burden and the solutions needed to reduce maternal mortality and morbidity. Fistula Care is working to strengthen quality services through training providers on emergency obstetrics, infection prevention, and family planning.

Analyzing and reporting data

Fistula Care is ensuring that data about fistula repairs and prevention activities are routinely analyzed and reported. Site staff compile data quarterly, analyzing how each site can improve its performance. Two Bangladesh sites participated in the global prospective study on the determinants of post operative outcomes of fistula repair.

Encouraging a supportive policy environment

Fistula Care serves as the secretariat of the National Task Force on Obstetric Fistula that is led by the Directorate General of Health Services of the Government of Bangladesh. The task force has brought stakeholders together to develop a national strategic vision and a national action plan for prevention, treatment, and rehabilitation of obstetric fistula cases within the framework of the National Maternal Health Strategy.