Decentralizing the management of obstetric fistula: the Kenyan experience

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• Decentralizing the management of obstetric
  fistula the Kenyan experience
• Presentation to the regional conference on
  fistula and maternal health Nouakchott
• December 10th to 13th 2007
• By
• Mwangangi, A.N.
• DRH (MOH-Kenya)

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(No Transcript)
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OF A LIFE SHATTERING BUT PREVENTABLE AND
TREATABLE PROBLEM
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Demographic data

• KDHS, 2003 estimates
• MMR 414 per 100,000 live births.
• IMR 77/1000
• CPR39
• TFR 4.9
• Un-met needs fo FP24
• Total population (projected) 35 million

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Obstetric Fistulae Magnitude

• The prevalence OF in Kenya is unknown but the
  incidence estimated at 3,000 annually (UNFPA/MOH
  2004 baseline survey)
• More pronounced particularly the pastoral regions
  of West Pokot, Garissa, Kitui, Machakos South
  Nyanza.

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OBSTETRIC FISTULAE MANAGEMENT

• In Kenya Crowned operation dry perineum

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WHY Decentralize Management of O.F.

• Initially Done in KNH (Referral Teaching
  Hospital, Nairobi) - far from where majority of
  patients were
• Few OBGYNs with expertise for OF surgery
• Patients treated not effectively rehabilitated
• Multidisciplinary approach for effective mnx of
  OF needed
• Hence with UNFPA Support Decentralization
  undertaken

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Interventions in place

• DRH with financial support from UNFPA has
• from 2005 to date initiated sustained a 3
• pronged approach to address this problem as
• follows
• Training core teams from 14 sites on management
  of OF patients (Doctor, Anesthetist,nurse,Social
  worker)
• Advocacy awareness creation campaigns for
  elimination culturally harmful practices to
  sensitize/mobilize communities to access OF/EOC
  services
• Integrating O.F. management into the on-going SM
  initiatives

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Achievements

• Three provincial one teaching hospitals already
  serving as training referral centers for the OF
  management for cases from surrounding districts
  established
• National Obstetric/F training Curriculum in place
• Trainings of core teams (doctors, nurses,
  counselors, physiotherapists anaesthetists) on
  OF management on-going
• Procurement of OF repair equipment and expendable
  supplies to the 4 training centres/hospitals done
• Minor renovations of operating rooms /
• theatres in the 4 training sites done

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Achievements 2

• To-date
• 73 Health Care service providers (30 doctors and
  43 other service providers) from 18 sites trained
  in OF management and repairs
• Trainees from the 10 sites have been provided
  with Obstetric (VVF) repair kits
• 200 women with obstetric fistula were repaired
  with a 90 success rate
• 30 patients with other urinary problems assisted.
  
• - Follow-up of some of the operated patients
• carried out

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Challenges

• The expensive nature of the OF management against
  scarce resources
• Successful mobilization campaigns through the
  traditional processes i.e. provincial
  administration and Chiefs barazas have lead to
  overwhelming response leading to too many
  patients seeking services.
• Inadequate follow-up of patients due to few
  overstretched health staff

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Next steps

• Continue supporting training/referral SITES and
  other facilities with skills to undertake
• Community mobilization campaigns
• to increase demand for access to Obstetric/F
  repair services, rehabilitation
• for BCC to increase ANC attendance deliveries
  with skilled attendants
• Discourage other harmful practices like FGM

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Next steps

• Strengthen
• Integration - long-term interventions into the
  SMI at all levels to prevent/reduce o/fistula
• Scale up Community midwifery initiative to extend
  skilled care attendance at community level
• Strengthen capacity for health facilities to
  offer BEOC/CEOC services
• Initiate selective renovations/refurbishment of
  operating rooms /theatres maternity waiting
  shelters nationally
• Advocacy- increase resources to strengthen OF
  services

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Next steps

• Strengthen S/supervision, M E
• Intensify sensitization of local Media on fistula
  related SM issues
• Capture prevalence in next KDHS/CENSUS 2008/2009
• Include OF in our roadmap
• Integration- OF into pre-service medical
  curriculi
• Strengthen Health systems /RH services in general
  (supplies, equipment, infrastructure, human
  resource)

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ASANTE SANA
END