Eradicating obstetric fistula in Sierra Leone: Iceland’s transformative partnership with UNFPA

Challenge

Sierra Leone has one of the highest lifetime risks of pregnancy-related mortality and morbidity, including obstetric fistula. Affecting the most vulnerable women and girls, the condition leaves them incontinent, often leading to chronic medical problems, depression, social isolation and poverty. As fistula is almost entirely preventable, eradicating it in Sierra Leone requires a comprehensive and transformative approach that addresses and eliminates its root causes. As a small donor, Iceland was seeking ways to strengthen its impact on gender equality and women’s empowerment and to target some structural causes of gender inequality in Sierra Leone.

Approach

Iceland has been a long-standing supporter of both the Government of Sierra Leone and the United Nations Population Fund’s (UNFPA) Global Campaign to End Fistula, which aims to improve access to quality maternal health services to prevent and manage obstetric fistula. Building on its successful co-operation with the UNFPA, and recommendation from a 2021 evaluation to strengthen cross-sectoral linkages across education, health, and gender at the country level, Iceland signed a five-year, USD 7 million project agreement in 2022 to scale up its support for the elimination of fistula in Sierra Leone – a country where Iceland is expanding its bilateral co-operation. The integrated fistula elimination project, in partnership with UNFPA and the Ministry of Health and Sanitation, was officially launched in May 2022. The six pillars of the project are:

1. 1.

   Informing adolescent girls and women, and key community actors, on sexual and reproductive health and rights (SRHR) for preventing obstetric fistula.

2. 2.

   Identifying obstetric fistula survivors and linking them to care.

3. 3.

   Providing rehabilitation and social reintegration services to survivors before and after surgery.

4. 4.

   Strengthening the capacity of targeted referral hospitals to provide fistula and other gynecological surgeries as part of their routine reproductive, maternal, newborn, child and adolescent health (RMNCAH) services package.

5. 5.

   Strengthening targeted health facilities to provide quality preventative RMNCAH services.

6. 6.

   Setting up a knowledge management system to bolster the obstetric fistula programme in the country.

The project involves:

• A national taskforce to provide leadership, technical guidance, and programme co-ordination.

• Reliance on multiple partners, both within the government and civil society organisations (CSOs), such as the Haikal Foundation and Aberdeen Women’s Centre, which support the project by conducting community mobilisation and providing medical care.

• A results-based approach to use evidence from the programme to inform the modelling and development of tools with the aim to maximise efficiency.

Results

During the first year of the project, an initial resource mapping identified support-structures within communities. Outreach efforts involve a variety of approaches, including radio jingles in local languages, radio discussion sessions and public events.

Initial results in 2022 include:

• Policy engagement. A National Fistula Strategy is being drafted. Strategic activities have been integrated into the work plans of key ministries and CSOs, and obstetric fistula is now a key focus area in the revised National Reproductive, Maternal, New-born, Child, and Adolescent Health and Nutrition strategy. A multi-stakeholder Fistula Taskforce was established to oversee the national fistula programme, consisting of the Ministry of Health and Sanitation and other key line ministries, CSOs, academia, and professional associations.

• Prevention. Awareness information has reached 360 women and girls, and 120 fistula ambassadors and champions from all 16 districts have been trained in prevention, identifying fistula and referring those affected for care.

• Medical care and social reintegration. 104 women and girls have been screened for obstetric fistula, 42 women living with obstetric fistula have undergone fistula repair surgery with a 100% success rate, and 54 obstetric fistula survivors have undergone rehabilitation and social reintegration.

• Capacity building. Training efforts reached 78 health care providers and 38 providers of emergency obstetrics and new-born care.