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Comparing Three Models of Fistula Care Among Five Facilities in Nigeria and Uganda

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A Multidisciplinary Approach to Obstetric Fistula in Africa

Part of the book series: Global Maternal and Child Health ((GMCH))

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Abstract

Little evidence exists regarding the lived experiences of those accessing, utilizing, and providing quality fistula repair care in low- and middle-income countries with varied health structures, policies, and human resource capacities. This chapter explores three models of care (basic routine, pooled/camp-based, and holistic-routine) across select sub-Saharan African program settings. We applied a qualitative approach in five hospitals in Nigeria and Uganda to assess experiences with provision and receipt of fistula repair. In-depth interviews were conducted with women affected by fistula (n = 82), accompanying family members (n = 17) and health service providers of fistula repair and counseling and policy-level actors (n = 40). Focus group discussions were conducted with male and female community stakeholders and post-repair clients (n = 18). The models face varying levels of shared and unique features of “structure and process” and “awareness and access” barriers and enablers to experiencing quality fistula care. Intermittent and insufficient funding, constrained referral systems, and inadequate human resource capacity influence care provision led to patients experiencing long wait times and or limited post-operative counseling and reintegration services. Model effectiveness was influenced by clients and community awareness, socio-cultural norms and other contextual factors. The three models elucidate prevailing barriers and enablers to effective and quality repair and post-operative care. The multi-layered needs of complex and stigmatizing conditions like fistula and health systems bottlenecks are paramount; lived experiences of women, communities, and practitioners offer insight into how features of the models can be improved, integrated with routine systems, and leveraged to better address women’s needs in fistula prevention, treatment, and rehabilitation.

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Acknowledgements

We would like to acknowledge Charity Ndwiga (Population Council-Kenya, Emmanuel Nwala (Population Council-Nigeria), and Hassan Kanakulya (EngenderHealth-Uganda) for their provision of contextual insights and thank Erin Mielke and Mary Ellen Stanton of the U.S. Agency for International Development for their review of this chapter.

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Correspondence to Pooja Sripad .

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Sripad, P., Johnson, C., Tripathi, V., Warren, C.E. (2022). Comparing Three Models of Fistula Care Among Five Facilities in Nigeria and Uganda. In: Drew, L.B., Ruder, B., Schwartz, D.A. (eds) A Multidisciplinary Approach to Obstetric Fistula in Africa. Global Maternal and Child Health. Springer, Cham. https://doi.org/10.1007/978-3-031-06314-5_20

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  • DOI: https://doi.org/10.1007/978-3-031-06314-5_20

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-031-06313-8

  • Online ISBN: 978-3-031-06314-5

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