Uganda

	Hospital staff rounds

Uganda is a landlocked country in East Africa. In recent years, Uganda has been recognized for mounting the most effective national response to the AIDS epidemic. Other public challenges await similar successes. The combination of a high fertility rate and low access to quality maternal care continues to put Ugandan women at risk of pregnancy-related death and disability. Large numbers of fistula cases in need of surgery have been documented in hospital records, and there are surely still more women with fistula who are not yet aware that fistula can be repaired.

USAID-supported fistula services in Uganda began in October 2004.  Fistula Care Uganda has been working with two private, faith-based hospitals to prevent and repair fistula:

• Kitovu Mission Hospital, Masaka District
• Kagando Mission Hospital, Kasese District

Program Results

As of June 2010 (since July 2005):

• A total of 1,716 fistula repair surgeries supported.
• 34 doctors and 78 nurses have been trained in fistula repair surgery and management.
• Over 150 health care providers have received training on fistula and family planning counseling.

For Communications Materials developed in Uganda, please click here.

Supported Sites

Kitovu Mission Hospital is located 120 km southwest of Kampala in Masaka District, on the shores of Lake Victoria. The 200-bed hospital has a special fistula repair clinic, which serves as a referral site for complex fistula repairs. Visiting master surgeons regularly hold camps at Kitovu Hospital at which many women with fistula can be repaired at once. This provides an important opportunity to train both new and existing fistula surgeons, along with surgical teams. Fistula Care is helping Masaka District Hospital, a 240-bed public hospital nearby, to refer patients with fistula to Kitovu Hospital and to strengthen its emergency obstetric care to prevent new fistulas from occurring.  

Kagando Mission Hospital is located in Kasese District in southwestern Uganda, along the Congolese border. It opened in 1965 as a hospital primarily for lepers operated by the Africa Inland Mission. Over time, the Kagando Hospital diversified greatly, and today it offers 200 beds and services ranging from maternity to surgery to health education. The hospital is part of a rural development initiative that focuses on prevention, invites voluntary service, and encourages the community to be part of the decision-making process. Fistula Care is working with Bwera District Hospital, a public hospital with 120 beds, to refer fistula patients to Kagando Hospital and to improve its emergency obstetric services.   

Program Activities

Strengthening services

Fistula Care Uganda supports hospitals in public-private partnerships to provide fistula repair surgery. It is working with the Ministry of Health to identify and train surgical teams, as well as following up to ensure that doctors can continue to refresh and use their surgical skills. Outreach camps to other parts of the country are planned.

Improving fistula prevention

Fistula Care is working to improve the quality of obstetric care for Ugandan women in several ways. Midwives and medical officers are being trained on labor monitoring. Men are encouraged to get involved in family planning promotion and fistula prevention efforts. Radio broadcasts, posters, and video spots are being shared across the country.

Analyzing and reporting data

Fistula Care supports the fistula technical working group to monitor fistula at the national level. Site staff compile data quarterly, using the data to improve the quality of services. Both Kitovu and Kagando hospitals are participating in the global prospective study on the determinants of  postoperative outcomes of fistula repair.

Encouraging a supportive policy environment

Fistula Care supports and participates in a national fistula working group, which collaborates with the Ministry of Health to bring together everyone working on fistula each year. Fistula Care Uganda helped to create “Learn From My Story,” a DVD of women with fistula sharing their stories. This collection is used in a variety of ways to raise awareness about the problem of fistula, both locally and worldwide.