Niger

Niger is a landlocked nation in West Africa where access to health centers and hospitals is often difficult, especially for the 85% of the population that lives in rural areas. Only one-third of all births are assisted by a trained health professional. Many women are quite young when they marry and begin to bear children. More than two-thirds of women between 15 and 19 years of age are pregnant or are already mothers of at least one child.

EngenderHealth began its support for fistula services in Niger in 2005 through a grant from the Bill & Melinda Gates Foundation. USAID support began in 2007 via the AWARE-Reproductive Health project. Fistula Care is working with four public hospitals to prevent and/or repair obstetric fistula:

Lamordé National Hospital, Niamey
La Maternité Issaka Gazoby, Niamey
Maradi Regional Hospital, Maradi
Dosso Regional Hospital, Dosso

The Niger Fistula Care program is being implemented by the Fistula Eradication Network (REF), a coordinating body made up of women’s groups, civil society associations, public hospitals, development partners, the Ministry of Health, and the Ministry of Women’s Promotion. The REF structure ensures government buy-in and support of all fistula activities in the country.

Program Results

As of June 2010 (since the start of USAID support):

A total of 566 fistula repair surgeries supported.
Sixteen doctors and 152 nurses were trained in fistula repair surgery.
Twenty community volunteers have been trained to conduct outreach within their communities on early marriage, gender-based violence, and danger signs during pregnancy and childbirth.

For Communications Materials developed in Niger, click here.

Supported Sites


	Lamorde National Hospital

Lamordé National Hospital is affiliated with the Université Abdou Moumouni de Niamey. As a large teaching hospital in Niger’s capital, Lamordé is home to many health care professionals in training, as well as to surgeons who hold faculty positions. Fistula repair is a part of the curriculum for urology students, and surgical interns from the university have the opportunity to learn alongside fistula surgeons doing repairs. Lamordé was the first public hospital in Niger to provide fistula repair services.

La Maternité Issaka Gazoby is the national referral maternity hospital in Niger. The maternity carries out more than 7,000 deliveries each year. Women with obstructed labor are referred to Issaka Gazoby, so the hospital carries out many cesarean sections and sometimes diagnoses new cases of obstetric fistula. The hospital provides family planning methods and counseling, along with specialized antenatal care for at-risk mothers. Its work helps to prevent fistula from occurring. While Issaka Gazoby is not currently carrying out fistula repairs, Fistula Care and trained surgeons from Lamordé will assist the surgical teams from Issaka Gazoby to establish fistula repair


	Issaka Gazoby Hospital

services at the maternity hospital by 2009.

Maradi Regional Hospital is located at least a day’s journey from Niamey, directly north of Kano, Nigeria. In spite of ongoing staffing and space constraints, Maradi Regional Hospital provides emergency obstetric care and family planning services alongside its diverse, routine inpatient and outpatient services. Site staff have been trained on quality service delivery and infection prevention as well as fistula case management.

Dosso Regional Hospital is located southeast of Niamey, at the intersection of the road to Benin and the highway that connects to the east of the country. Like Maradi, Dosso is the administrative center for its region. The Dosso Regional Hospital provides emergency obstetric care and family planning services, along with routine inpatient and outpatient services.

Program Activities

Strengthening services

REF is working to strengthen routine services at the three existing fistula repair sites. Trained fistula surgeons will continue to obtain new skills for performing more complex surgeries through ongoing training and supervision. Many challenges remain to ensure that those who have been trained to repair obstetric fistula are fully able to apply their skills. Even when trained surgeons are available and motivated at supported sites, the overall hospital workload is at times overwhelming, and surgery for fistula patients is often postponed. REF is advocating for fistula surgeries to be routinely scheduled, and it is collaborating with hospital administrators to strategize ways to address the current backlog of fistula patients.

Improving fistula prevention

Fistula Care supports social mobilization work to encourage communities to create solutions for the maternal health challenges that they face, while improving community-health facility relations. The social mobilization program reached out to more than 6,000 community members in just six months, working with communities to collect data on current practices related to maternal and neonatal health, and then to help stakeholders and opinion leaders to encourage community members to embrace change that will result in improved health outcomes. Social mobilization has also been effective in publicizing the causes of fistula and the availability of services.

Analyzing and reporting data

Hospital staff monitor the outcomes of fistula surgeries and report on their progress quarterly. Staff are working to use data to improve the services they provide. Lamordé and Maradi hospitals are participating in the global prospective study on the determinants of postoperative outcomes of fistula repair.