Increasing the Success Rate of Complex Fistula Repair

UNDP South-South|Galaxy Knowledge Hub

Increasing the Success Rate of Complex Fistula Repair

Experience exchange between health personnel from Côte d’Ivoire and Mali in dealing with complicated obstetric fistula cases

Challenges

While in developed countries obstetric fistula (OF) pathology has almost disappeared, in Côte d’Ivoire the prevalence was estimated at 2.6 per cent. The country had an extensive experience in OF management that started in the 1970s. However, the high turnover of trained surgeons had led to interruption of complex fistula repair procedures. Fortuitously, a complex OF management programme had been in existence and strengthened for 20 years in neighbouring Mali.

An obstetric fistula is an abnormal opening between the vagina and the bladder or rectum, typically caused by prolonged obstructed labour. It can lead to physical complications and poor psychosocial and economic outcomes and can either be simple or complex based on severity.

Toward a Solution

With support from UNFPA, Côte d’Ivoire and Mali cooperated in undertaking and increasing the success rate of complex OF repair. The partnership was ideal based on the similarity of cases, common language and ease of travel between the two countries.

With funding support from UNFPA and Korea International Cooperation Agency, a 10-day mission was launched in Côte d’Ivoire to treat patients with complex OF. This learning mission was supervised by experts and was intended to raise capacity of participating physicians. The diagnosis and medical intervention of the fistula were conducted by both Malian and Ivoirian medical teams.

Results

Twenty-six patients with complex OF were examined and repaired. In terms of success of a similar surgical repair procedure, the rate increased from 57 per cent in 2012 to 78 per cent in 2018.

The mission was an opportunity for health workers to increase knowledge and learn from each other. During the campaign, four professors of urology and gynaecology, two each from Mali and Côte d’Ivoire, supervised the training of less experienced medical doctors who operated on the patients. Five gynaecologists and four surgeons also benefited from the successful joint campaign. More importantly, this initiative proved that this capacity-development approach worked very well and could be made sustainable, thus would be benefitting more medical professionals and OF patients. In fact, the two countries agreed to continue working together. This South-South practice also showed great potentials for replication in other neighbouring Western African countries.

Lessons Learned

These are what made this initiative successful, potentially sustainable and even replicable to other countries:

Under this approach, many surgeons can be coached in such a short time;
Neighbouring countries share many values in common, which make their cooperation easier;
Standardization of definition and techniques will help to get result comparison between countries;
This is a strong possibility of joint proposals for resource mobilization.

Download PDF

CONTACT INFORMATION
Dr Bile Kouamé, National Obstetric Fistula Officer, United Nations Population Fund (UNFPA) Côte d’Ivoire | Argentina Matavel, Resident Representative, UNFPA Côte d’Ivoire

SDG
03 - Good Health and Well-being

SUPPORTED BY
United Nations Population Fund (UNFPA) Côte d’Ivoire; UNFPA Mali; Korea International Cooperation Agency

ABOUT

Disclosures

RESOURCES

Disclosures

ENGAGE

Disclosures

Alliance Application Form

Submit an Expression of Interest and/or Demand Signal. UNOSSC reviews submissions on a rolling basis.

1. Official name of organization / institution / government entity (exclusions to apply) *

2. Country *

3. Region *

4. SDG *

Secondary SDG *

5. Partner category *

6. Website *

7. Brief description of your institution (max. 150 words) *

Name for the Lead *

Title for the Lead *

Email address for the Lead *

Name for the co-lead

Title for the co-lead

Email address for the co-lead

Section 3. Expression of Interest in the Alliance *

Offer expertise, resources, partnership, or collaboration

Demand Signal (Request for cooperation, support, or partnership)

Both (Offering capabilities and expressing demand for collaboration)

Additional information on proposed areas of engagement may be requested through the platform following initial review by the Alliance Secretariat.

Section 4. Due Diligence and Integrity Declaration *

Our organization complies with United Nations values, principles, and ethical standards.

We are not subject to UN sanctions or listed on applicable UN exclusion or ineligibility lists.

We understand that participation in Alliance activities may be subject to due diligence conducted by the Alliance Secretariat, consistent with applicable UN policies.

We acknowledge that engagement under the Alliance does not imply formal membership.

Submission Note:

Submission of this Expression of Interest form does not automatically confer participation in the Alliance.

All submissions will be reviewed by the Alliance Secretariat, including basic eligibility screening and proportionate due diligence, as appropriate.

Participation in Alliance activities is determined based on relevance to articulated cooperation needs, alignment with Alliance principles, and integrity considerations.

Engagement under the Alliance is voluntary, non-binding, and facilitative in nature, and does not constitute funding approval, contractual commitment, or institutional membership.

The Alliance Secretariat may contact submitting entities for additional information or clarification during the review process.

Organization Registration

Authentication & Due Diligence This prototype simulates identity verification, due diligence confirmation, and an authentication step before submission. *

Due diligence declarationWe confirm compliance with UN values, ethical standards, and we are not subject to sanctions/exclusion lists.

First Name *

Last Name *

Email address *

Password *

Confirm Password *

Name of institution / organization *

Country / Region *

Organization Type *

Organization other *

Function / role *

Organization logo *

Maximum file size: 1 GB

I confirm this information is accurate and I agree to be contacted about network participation. *