IntraHealth will expand and augment its current fistula treatment program in Mali to address the comprehensive, holistic needs of women who have suffered from, or continue to suffer from, obstetric fistula, from treatment to reintegration. Through this commitment, IntraHealth and its partners will provide these resources to an estimated 800 women in up to seven regions of Mali (Kayes, Sikasso, Gao, Koulikoro, Bamako, Mopti, and S?gou). To achieve this goal, IntraHealth will work with partners in four key areas: the expansion of fistula treatment and care; improved data collection about the mental, psychosocial, and financial effects of fistula on women in Mali; development of a telephone support network and call-in center to enable pre- and post-repair peer support; and capacity-building of the health workforce to provide mental health and psychosocial assistance.
First, IntraHealth and its partners SamaHope and the Orange Mali Foundation will expand treatment and care for the significant backlog of fistula clients awaiting services by crowdfunding a fistula surgeon and creating a Welcome Center at Sikasso Regional Hospital. The Welcome Center will house the women and their caregivers over the 3-4 week period in which their surgeries and treatment at the hospital will occur. SamaHope anticipates funding at least 50 additional surgeries per year over the life of the commitment. Additional partners UNFPA/Mali, Direct Relief, and Inner Wheel Mali will provide fistula high-quality medicines and supplies to support 50 surgeries, to regional hospitals and Point G National Hospital which will augment the number and complexity of fistula cases they are able to treat. Second, IntraHealth will work with UNFPA/Mali to expand the collection and use of data about the mental, psychosocial, and financial effects of fistula on women in Mali to better understand how to meet their non-clinical needs pre- and post-surgery. Third, IntraHealth and the Orange Mali Foundation will develop a telephone support network and call-in center to enable pre- and post-repair support, addressing the social isolation that many fistula victims experience while providing them with current and accurate information on when and where they can seek specific services. Fourth, IntraHealth will work with the Orange Mali Foundation to expand the capacity of local NGOs to provide livelihood activities and financial inclusion support for women post-repair, enhancing their chances of successful reintegration in their communities. Finally, IntraHealth will work with the Peter C. Alderman Foundation across the continuum of care for women with fistula to build the capacity of health workers to provide mental health and psychosocial assistance to address the trauma that women and their families have experienced.
Within the first 100 days IntraHealth will launch its commitment to action through several critical activities that will set the stage for its success. IntraHealth will convene a stakeholder group of relevant government officials, training institutions and local representatives of the aforementioned partners in Mali. This group will create an MOU for the partnership and develop an action plan that articulates the role and deliverables for each partner; an M&E plan that includes expectations and norms for data collection, analysis and reporting; and a communication plan to ensure alignment across the partnership. The consortium of partners to the commitment will develop a communications and advocacy strategy that will specifically target national, regional and global audiences. This strategy will include a high level event in Mali co-created with the Government of Mali to raise visibility for fistula, a national fundraising telethon held by Inner Wheel Mali and the launch of the SamaHope crowdsourcing activity.
Throughout the first year, IntraHealth will train providers in fistula treatment and conduct fistula treatment campaigns, treating 350 women. Through its crowdsourcing activity, SamaHope will support 20 fistula repair surgeries in Sikasso. UNFPA/Mali, Inner Wheel Mali and Direct Relief will provide fistula repair and dignity kits/supplies. UNFPA and IntraHealth will collect and use data to create a GIS map for 2 regions that will be used to illustrate the reach and complexity of fistula. Orange Mali Foundation will finalize plans for the welcome center and contribute mobile phones to 350 women post-repair. IntraHealth and the Orange Mali Foundation will identify and support five local NGOs to provide livelihood training activities for women post-repair e.g., gardening and other IGAs. The Peter C. Alderman Foundation will work with IntraHealth to provide training for a cohort of 30 health workers in mental health and psychosocial assistance for fistula clients and their families. At the close of its first year, IntraHealth and its partners will conduct an assessment of the lessons and effectiveness of its efforts, making necessary adjustments to increase the impact of the partnership. Communications products will be prepared and distributed via social media and highlighted at a national event co-created with the Government of Mali.
The activities of the partnership will continue in Year 2 with accelerated success to the commitment targets and the Sikasso welcome center will be operational. An additional 400 women will receive fistula repair surgeries, holistic support services and mobile phones to access the support services. SamaHope will use the partnerships success to enhance its crowdsourcing information and expects an additional 30 surgeries to be supported. GIS mapping activities will be completed to include all regions of the commitment and sustainability plans for their upkeep will be created. Through the work with local NGOs, the commitment partners will document 2 stories of success and engage these organizations in the capacity building efforts for an additional five NGOs. At its end, two cohorts of health workers will have completed mental health and psychosocial support training and apprenticeship (60 health workers) and 50 women will have received training for livelihood activities.
Obstetric fistula is a preventable condition. It is the result of prolonged, obstructed labor, and delays in seeking care during pregnancy and childbirth. Most women who experience obstetric fistula live in poverty, often in remote, underserved areas with little or no access to health services, and little if any influence in decision-making about seeking care. Fistula can lead to incontinence, pain, and infections and is a highly stigmatized condition, leaving women and girls affected at high risk of social isolation with little means of psychosocial and financial support. An estimated two million women globally are living with fistula, and the WHO estimates that an additional 50,000-100,000 woman will develop fistula annually. Based on the incidence rates of 3-4 cases per 1,000 births, it is estimated that the number of new cases of fistula each year in Mali is between 1,804 and 2,405 (Ministry of Health, 2009).
Global and country-level advocacy has drawn attention to fistula as a preventable condition, but much work remains. Governments, multi-lateral agencies, NGOs, and philanthropists have focused investments on prevention and treatment, building the capacity of health systems to perform surgical repair of fistula, and supporting community efforts to reduce stigma and identify women needing repair. Globally, there has been a tangible gap in the attention and investments given to the health, psychological, social, financial, and reintegration needs of women who have undergone fistula repair, including women whose repair has been successful and those whose fistula is deemed irreparable. Fistula can be surgically repaired in approximately 90% of cases (EngenderHealth, 2014). Approximately 10% of cases will be deemed irreparable after several attempts at surgical repair. These women need a range of support services to stay healthy; restore, maintain and safeguard their dignity; and find other ways to improve their quality of life.
IntraHealth and its partners will advance the global community's understanding of the health, social, and financial services and other reintegration needs of women who have suffered, or continue to suffer, the scourge of fistula, and to augment the innovations and resources aimed at ending fistula and restoring women's dignity.
IntraHealth seeks partners who are committed to supporting women and girls affected by obstetric fistula, especially those operating in Mali, who can help build on the scope of the current commitment to include additional reintegration services essential for women's improved health, social, and economic livelihood. IntraHealth and its current partners are particularly interested in cultivating self-funded groups or individuals with skills and experience in building the capacity of physiotherapists and other health workers based in and around regional hospitals to provide post repair incontinence services as a key strategy for restoring women's social reintegration. IntraHealth is also seeking partners with expertise in women's economic empowerment to build local capacity in economic livelihood/small market enterprise activities that engage women with fistula, and partners with expertise as entrepreneurs for social good to explore the potential for establishing locally sustainable and affordable production of adult briefs for women with fistula.