Ethiopia

Ethiopia is a landlocked country in the Horn of Africa, where an estimated 2.9 million women give birth each year. Access to medical care is particularly difficult for women in rural areas, resulting in high maternal mortality and disability. Although fistula repair surgery has been available in Ethiopia for nearly 50 years, it is estimated that there are still 100,000 women with the condition in rural areas across the country.

USAID-supported fistula services in Ethiopia began in 2006 in Amhara, the region with the highest prevalence of obstetric fistula, and expanded to Tigray and the Southern Nations, Nationalities, and People's Region (SNNPR) in 2007.

The USAID/Ethiopia Mission has an agreement with the Addis Ababa Fistula Hospital to support activities at three regional Hamlin centers. Fistula Care partner, IntraHealth International, supports three pre-repair centers and 15 health posts in the Amhara region . The two programs coordinate their activities in the Amhara region.

• The Bahir Dar Hamlin Fistula Center in the Amhara Region
• The Mekelle Hamlin Fistula Center in the Tigray Region
• The Yirga Alem Hamlin Fistula Center in the Southern Nations and Nationalities Peoples Region (SNNPR)
• District health centers located in Adet, Dangila, and Woreta, and fifteen associated health posts in the Amhara Region

Program Results

 As of June 2010:

• A total of 2,103 fistula repair surgeries conducted at the Bahir Dar and Mekelle centers. More than 580 women have arrived at the three pre-repair centers seeking care for obstetric complications, and 408 with obstetric fistula were referred to the Bahir Dar hospital for repair.
• IntraHealth International has trained more than 200 nurses and midwives and nearly 1,000 community health workers.
• The Addis Ababa Fistula Hospital has trained more than 3,000 health workers in three regions in fistula prevention.
• More than 1,200 community volunteers have been trained to provide information about fistula prevention and treatment in the communities around the three pre-repair centers.

Supported Sites

Bahir Dar is located 340 kilometers northwest of Addis Ababa. The Addis Ababa Fistula Hospital opened a branch obstetric fistula repair center in Bahir Dar to increase access to fistula repair services for women living in rural areas. USAID supports the Bahir Dar Hamlin Fistula Hospital, a 44-bed facility, to provide quality fistula surgery. The Bahir Dar Fistula Center works closely with the Felege Hiwot Regional Hospital in Bahir Dar (a large public hospital serving the Amhara Region) to facilitate women's access to cesarean section services. The fistula center supports a community outreach component to raise awareness about fistula prevention. The hospital refers complicated fistula cases to the Addis Ababa Fistula Hospital.

The Mekelle Hamlin Fistula Center is located 466 miles north of Addis Ababa, in the Tigray Region. The Mekelle Hamlin Fistula Center has 28 beds for fistula patients. Support to this center began in 2007. Community outreach activities are supported to raise awareness about fistula prevention. Complicated cases are referred to Addis Ababa.

The Yirga Alem Hamlin Center in the Southern Nations, Nationalities, and People's Region (SNNPR) receives support to create awareness and education about fistula prevention and treatment.

Fistula Care's partner, IntraHealth International, is working with health centers located in Adet, Dangla, and Woreta to identify and screen women with fistula and provide referrals for repair. To decongest the Bahir Dar fistula center, these health centers provide nutritional support, treatment of infections and infestations, and counseling, so that women with fistula are ready to be repaired at the time that they are referred. With funding from USAID, an emergency obstetric unit has been renovated and providers trained at the Dangla Health Center to provide cesarean section services. This center will become operational in early 2009.

Fistula Care, through IntraHealth International, has worked with 15 health posts in the Amhara Region to strengthen connections between the community level and urban areas. Community health workers work with mentors from health facilities to identify and follow up with women with fistula.

Watch the stories of Tihun, Yeserash, and Abebu — three young women from Ethiopia who have survived obstetric fistula. The women and their family members give insight into the difficulties of life with fistula, the joys of being repaired, and the lessons learned from their experiences.

Program Activities

Strengthening services

Fistula Care Ethiopia continues to train health workers to provide quality obstetric care to laboring women who face complications. It is looking forward to expanding the program to additional government-run health facilities.

Improving fistula prevention

Fistula Care raises community awareness of fistula causes and prevention by using health extension workers and fistula mentors to share messages through drama, posters, and other media. Fistula Care stresses the importance of communication between health posts, centers, and hospitals. Health extension workers and traditional birth attendants are recognizing danger signs and referring obstetric emergencies so that women receive care before a fistula can develop.

Encouraging a supportive policy environment

Fistula Care collaborates with Women's Campaign International to raise awareness about fistula among Amhara parliamentarians. It participates in National Fistula Week at both the state and the federal levels. It holds awareness events with diverse audiences to ensure that the problem of obstetric fistula in Ethiopia is prioritized and addressed.