Programmes

This project is being implemented  by Amref Health Africa in Uganda with funding from an anonymous Donor and Amref UK.  The project is being implemented in the districts of Arua, Nebbi, Zombo, Koboko, Yumbe and Moyo districts,  in the West Nile Region, Uganda. The project duration is 36 months (November 2022 to October 2025). The main project aim is To improve the health and socio-economic status of women who have suffered from obstetric fistula and other obstetric conditions.

• Target Population; Women with obstetric fistula – 504 women who are suffering from obstetric fistula in the West Nile region of Uganda, who are often poor, socially isolated and cannot afford or access corrective surgery.
• Women with other obstetric conditions – 576 women with non-fistula conditions will be treated through surgery and provided with ongoing support, which will reduce the future numbers of women suffering from fistula.
• Health workers, including Village Health Teams – 180 health workers will be trained on identifying, supporting and referring clients for treatment, providing treatment to women with fistula, and how they can play a role in the prevention of fistula in their communities.
• Community members – Community members will be engaged to support the re-integration of fistula survivors back into their communities and can play an active role in the prevention of fistula among women in their communities and removing the stigma-surrounding fistula.
• Family members and communities of women with obstetric fistula (indirect beneficiaries) – Wider families and communities will benefit as the women will be able to actively participate in all areas of family life and will be able to contribute towards household income through 404 women joining the women’s groups and accessing of seed funding.

The specific objectives of the project are to:

1. Increase community awareness on RMNCAH services including family planning, antenatal care (ANC), postnatal care (PNC), fistula, teenage pregnancies and gender based violence.
2. Improve the capacity of health workers in fistula repair and management in order to expand fistula repair centers and take services nearer to the population.
3. Treat 504 women with obstetric fistula and 576 with other birth defects through provision of quality fistula treatment services.
4. Improve social economic status of 504 women treated for obstetric fistula through reintegration into the communities, life skilling and seed funding.

Project strategies for successful implementation

1. PREVENTION

• Community sensitization through VHTs, Health Workers, Mass media, Dialogue meetings and Fistula champions
• Capacity building for health workers on Basic Emergency Obstetric Care
• Health promotion by VHTs – Family planning, ANC attendance, Facility based deliveries and prevention of GBV in the community

2. TREATMENT AND CARE

• Support free surgical treatment to clients
• Building capacity of health workers on obstetric fistula care through on-the-job training during medical camps
• Building capacity of treatment hospitals to provide quality obstetric fistula care through provision of medical equipment and supplementary medicines.

3. REINTEGRATION

• Post-operative follow-up and psychosocial support to clients and family members
• Linkage to Village Saving and Loan Association Groups (VSLA) and other government poverty eradication programme

Business skills development and start-up capital for teenage clients.

Project interventions/Activities

1. Objective 1: Increase community awareness on RMNCAH services including family planning, antenatal care (ANC), postnatal care (PNC), fistula, teenage pregnancies and gender based violence.

• Train new (VHTs) to identify and refer women with fistula signs and symptoms to the health facilities.
• Provide monthly transport facilitation for Village Health Team to identify and refer women with fistula signs and symptoms to the health facilities.
• Identify and train fistula champions.
• Provide monthly facilitation for Fistula Champions to conduct social mobilization, advocacy and referral of fistula clients in the community.
• Print job aids on obstetric fistula signs and symptoms for use by the VHTs and Fistula champions during community mobilization activities.
• Facilitate radio announcements per year to mobilize communities for medical camps.

1. Objective 2: Improve the capacity of health workers in fistula repair and management in order to expand fistula repair centers and take services nearer to the population.

• Conduct training of health workers. on Basic Emergency Obstetric Care and the identification and referral of women with fistula symptoms.
• Print OF health facility screening algorithm and distribute to health facilities within the project districts.
• Conduct quarterly supervision and mentorship sessions for health workers.

1. Objective 3: Treat women with fistula and other birth defects through provision of quality fistula treatment services

• Procure medicines, sundries PPEs and essential theatre instruments to support management of clients during medical camps.
• Facilitate health workers per quarter to conduct screening of women with fistula symptoms prior to the medical camps.
• Provide transport fares for fistula clients and patient caretakers
• Conduct 32 medical camps per year (one camp per district per quarter)
• Facilitate hospital stay for women who have undergone OF operation and their caretakers for a period of two weeks
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1. Objective 4: Improve social economic status of 504 women treated for obstetric fistula through reintegration into the communities, life skilling and seed funding.

• Link and provide seed funds to 192 fistula clients to join Village Savings and Loan Groups Per Year
• Facilitate life skills training for teenagers and young women) in catering, tailoring, hairdressing and liquid soap making.
• Facilitate district and sub-county community development officers to conduct quarterly follow up of the women groups and skilled clients to monitor progress in savings and business development.

1. Objective 5: Monitoring and Evaluation

• Conduct situational assessment to establish and document accurate fistula situation in West Nile region.
• Conduct Participatory reflection, reviews and learning sessions aimed at reviewing progress, generating learnings and evidence for improved programing.
• Conduct quarterly data quality assessments at health facilities and implement quality improvement projects within the partner health facilities.
• Participate in annual national fistula commemoration in year 1 of the project.
• Conduct Baseline and End line evaluation.

Our main partners in project implementation are; Main partners directly involved during implementation

• The Ministry of Health will provide strategic and operational guidance in alignment with the national fistula management strategy.
• Arua and Nebbi district governments will provide leadership, facilities, technical supervision, staff time and information systems to support the project.
• Local women’s groups with experience in conducting activities such as offering loans and savings schemes to members will be identified based on location to facilitate the social re-integration of treated women and provide them with economic opportunities.
• Village Health Team (also referred to as Community Health Workers in other contexts) will take the lead on community-level mobilization, case identification and linkage to care.
• Community leaders will be involved and will support community mobilization and male involvement activities, such as the inter-generational dialogues.
• Regional (Arua) and District (Nebbi) Referral hospitals will provide primary – tertiary treatment for fistula cases depending on location and need.