Improving maternal health by reducing obstetric fistula through provider capacity building and a community outreach campaign in Rwanda

Obstetric fistula is a childbearing injury that has been relatively neglected, despite its devastating impact. A leading cause of fistula in Rwanda are untrained general practitioners performing emergency C-sections in local hospitals. Approximately 183 new cases occurred in 2014 (Rwanda Health Management Information System). To combat this issue, the Rwanda Family Health Project (RFHP) partnered with the Ministry of Health to provide clinical mentoring for healthcare providers from 10 district hospitals in C-section procedures. The project also trained doctors at a central district hospital and followed that by organizing treatment sessions in April 2014 to surgically treat fistula for residents nationwide.

 To increase public awareness, RFHP and the ministry implemented a six-month Obstetric Fistula Prevention and Repair Awareness Campaign (OFPRAC) in four districts, with a focus on encouraging mothers to deliver in health facilities and attend four antenatal care (ANC) visits during their pregnancy. The campaign is estimated to have reached more than 35,530 people via theater plays (18,800 attendees), weekly radio programs (8,120,000 estimated listeners), door-to-door outreach (13,375 households reached), and community meetings hosted by 536 trained community health workers. It was found that half of the women who arrived for treatment nationwide were from the four districts targeted by RFHP. Additionally, the information hotline received 150 to 200 calls related to fistula during the campaign, suggesting that the campaign helped to increase care-seeking and treatment. Based on these positive results, the ministry plans to scale up the program to two additional districts this year and is supporting the effort across the country.