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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 now supports fistula treatment and prevention at four public hospitals. Fistula Care works with two additional hospitals exclusively to strengthen fistula prevention and enhance referrals:
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 fistula activities in the country.
As of September 2013 (since the start of USAID support):
Presentation about the Fistula Eradication Network
Program Update: First Lady of the Republic of Niger Visits EngenderHealth
Stories from the Field from Niger
|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.
Maradi Regional Hospital is located roughly 400 miles east of 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.
Tahoua Regional Hospital is located in the administrative capital of the Tahoua region, which stretches from the Mali border down to the Nigerian border. Unlike many other regions, Tahoua does not have sub-regional maternity hospitals, which means that the Maternité Tassigui of Tahoua Regional Hospital delivers more than 4,000 babies each year. Fistula Care support to Tahoua began in 2010.
La Maternité Issaka Gazoby is the national referral maternity hospital in Niger. Women with obstructed labor are referred to Issaka Gazoby so the hospital carries out many cesarean sections and 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.
|Issaka Gazoby Hospital|
Téra District Hospital is in Téra, a town in the Niger’s western Tillabéri region. Although not many fistula clients present to Téra District Hospital, its staff is keen to screen and refer incontinent patients. In addition to its provision of emergency obstetric services and family planning counseling and methods, the hospital will also work to institutionalize the correct use of the partograph and immediate catheterization for women who have experienced prolonged labor. Fistula Care support to Téra District Hospital began in 2010.
REF is working to strengthen routine fistula services at four 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 backlog of fistula patients.
Fistula Care has supported 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. Fistula Care also supports hospital staff to develop action plans that will improve the quality of the maternity services they deliver. Fistula Care stresses the importance of the partograph, immediate catheterization, family planning, and infection prevention, providing training for health workers.
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, and Maradi, Dosso, and Tahoua Regional Hospitals are participating in Fistula Care’s retrospective review of cesarean section records.