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.

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 Hamlin Fistula Ethiopia to support activities at three regional Hamlin centers. Fistula Care partner IntraHealth International supports four pre-repair centers and conducts training and outreach to populations in the Amhara region covered by more than 540 health centers and health posts. 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)
Pre-repair units at district health centers located in Adet, Dangla, and Woreta
Pre-repair unit at Tefera Hailu Memorial Hospital in Sekota

Links

Resources for Fistula Services Developed in Ethiopia

Stories from the Field from Ethiopia

A New Pre-Repair Unit in Ethiopia

Program Results

As of December 2010:

A total of 2,346 fistula repair surgeries conducted at the Bahir Dar and Mekelle Hamlin centers. More than 650 women have arrived at the four pre-repair centers seeking care for obstetric complications, and 452 with obstetric fistula have been referred to Bahir Dar or Mekelle for repair.
Hamlin Fistula Ethiopia has trained more than 3,800 health workers in three regions in fistula prevention.
Fistula Care has trained more than 200 nurses and midwives and nearly 1,500 community health workers in the prevention, recognition and referral of obstetric fistula.
Fistula Care has equipped more than 2,000 community volunteers to provide information about fistula prevention and treatment in the communities around the four pre-repair centers managed by Fistula Care partner IntraHealth International.

Supported Sites

Three sites are supported through a bilateral agreement between USAID/Ethiopia and Hamlin Fistula Ethiopia:

Bahir Dar is located 340 kilometers northwest of Addis Ababa. Hamlin Fistula Ethiopia (formerly known as 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 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. In addition to Mekelle’s treatment services, community outreach activities raise awareness about fistula prevention. The pre-repair unit in the East Amharan town of Sekota refers fistula patients to Mekelle.

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.

Four pre-repair units are supported through Fistula Care:

Tefera Hailu Memorial Hospital in the town of Sekota, East Amhara opened a pre-repair unit in late November 2010 with support from Fistula Care partner IntraHealth International. The unit provides women with the first steps of fistula treatment. The unit has three rooms in which to accommodate patients and a staff mentor to address the physical, social and psychological impacts of fistula. When patients are healthy enough for surgery, they are referred and transported to the Hamlin Fistula Hospital in Mekelle, where they undergo fistula repair surgery.


	Pre-repair center


	Signpost welcomes clients

Fistula Care partner IntraHealth International is also 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.

Program Activities

Strengthening services

Fistula Care Ethiopia continues to train health workers to provide quality obstetric care to laboring women who face complications. Health worker training materials released in 2011 are available to Fistula Care partners.

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


	Awareness event participants

Fistula Care 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.