The World Health Organization (WHO) estimates that every year, Kenya records 3,000 new cases of obstetric fistula—a chronic disability that has severe physical, psychological, social and economic consequences on women.
Despite it being preventable and treatable, only 1,000 fistula surgeries (less than half of the cases) are done in Kenya yearly. Due to the increased cost of living, only 7.5 per cent of the girls and women can access fistula-related medical care, including surgery, at around $60 (Sh7,000). Furthermore, less than 10 per cent of health facilities in the country can offer basic emergency obstetric care and only six per cent comprehensive emergency obstetric care.
The ‘Fistula Belt’ is, therefore, synonymous with counties with high levels of poverty, insufficient infrastructure, lack of specialised workforce, poor referral networks and over-reliance on donor support. Women and girls hence live with the debilitating experiences of constant leaking of urine and/or faeces and the indignity of severe stigma and isolation.
Fistula, an injury caused by long, painful obstructed labour and the leading cause of disability during childbirth, calls for a multi-pronged approach. That entails strengthening primary health care, expansion of fistula treatment networks and post-repair support through multi-sectoral partnership, political goodwill and action for the patients.
To address maternal mortality and morbidity, the government has in place strategies, policies and guidelines aimed at ending fistula by 2030. With the devolution of health functions, therefore, the implementation of these policies lies squarely on the shoulders of the county leadership.
Studies show regional fistula treatment networks are effective in increasing awareness and access to fistula care services, reducing stigma and enhancing post-operative follow-up and reintegration support. But such networks only thrive in the backdrop of solid implementation frameworks that strengthen a people-centred approach to healthcare.
This year’s World Fistula Day theme, “End fistula now: Invest in quality healthcare, empower communities!”, is a real call to action—even as the newly elected governors settle down to implement the policy frameworks in the most affected counties.
It’s a call to change of focus to ‘the triangle that moves mountains in healthcare’: Political goodwill for county and supra county-level policy, legislative and resource mobilisation frameworks; quality healthcare by appointing knowledgeable and experienced technocrats to the health management teams; and empowerment of communities through public participation and support from civil societies.
Such sustainable commitments through partnerships, increased funding and provision of an enabling framework not only increase social participation but also enhance self-care and self-reliance yonder the five-year tenure.
Hopefully, such actions will leave a long-lasting mark on these women by rebuilding their dignity and reintegration into society, robust mental well-being and a more meaningful engagement for economic sustainability.
Dr Wekesa, an obstetrician, gynaecologist and health systems strengthening expert, is the chief of party, USAid Imarisha Project, at Amref Health Africa in Kenya. Dr Ndirangu is the country director, Amref Health Africa in Kenya.