Collaboration and Coordination to End Fistula

The latest IJGO supplement asks for honest answers to a complex question: just how far have we come in the prevention and treatment of obstetric fistula?

FIGO's Gillian Slinger addresses challenges to ending fistula

Now Obstetric Fistula: Where We Currently Stand, jointly written by FIGO’s Fistula Surgery Training Initiative and the International Society of Fistula Surgeons (ISOFS), draws on decades of clinical and programmatic expertise to put these milestones in context.

As part of our expert series, FIGO spoke to Gillian Slinger, Senior Project Manager, about the progress FIGO’s Fistula Surgery Training Initiative has made in addressing the global treatment gap.

“Since the last supplement in 2007, efforts have been made to bring obstetric fistula to the world’s attention and to help more affected women, including a UN-approved International Day to End Obstetric Fistula, launched in 2013, which FIGO actively participates in.

Progress is undeniably being made on prevention and treatment but it is all too slow; the global community is lagging woefully behind reducing maternal mortality and morbidity, especially in countries where health indicators are the most alarming and the furthest behind targets for the 2030 Agenda for Sustainable Development.

Due to a severe shortage of competent fistula surgeons, it is estimated that only one in 50 women with a fistula can access life-changing surgery to recover from this most de-humanising condition, which tragically affects up to two million women in 60 countries. Up to 100,000 new cases develop every year.

Our paper Obstetric Fistula: Where We Currently Stand calls to action governments and partners alike, to take decisive steps to move nearer the ambitious target to end fistula by 2030.

We highlight the impact of our FIGO Fistula Surgery Training Initiative, a state-of-the-art global programme based on the world’s first standardised curriculum for fistula surgeons. With a wealth of experience, and working with the world’s leading fistula surgeons and a vast network of collaborating partners, we are building treatment capacity in affected countries by training many more fistula surgeons and holistic care teams to address the global treatment gap.

With our 62 trainee fistula surgeons – FIGO Fellows – presently involved from 22 countries, the programme is making a significant contribution to bridging the fistula treatment gap. I am thrilled that they have collectively reached the landmark number of 10,000 fistula repairs. This is a tremendous achievement and I have no doubts whatsoever that the programme will play a major role in ending obstetric fistula in the future.

However we worry that the current global economic climate and re-directing of precious funds into other health issues has slowed support for women with obstetric fistula. Present resources - both financial and human - are insufficient.

To prevent a serious U-turn in progress and to close the fistula treatment gap, an urgent re-doubling of efforts across the maternal health and fistula treatment sector is required. We need substantially more emphasis on what I call the ‘3 Cs’ and the ‘3 Ps’: Communication, Collaboration and Coordination, and Partners, Partners, Partners.

My hope for 2030 is that with continued work on improvement of maternal and newborn health, increased funding will be available for the fistula treatment community - including for our own programme.

Women with obstetric fistula are the living proof of high maternal mortality and a stark indicator of system-wide failures throughout the life course for women and girls. We desperately need many more trained, competent fistula surgeons and care teams in high-need countries to accelerate efforts in closing the fistula treatment gap, and to move the global community nearer ending obstetric fistula in all countries.

I believe it is vitally important to give an up-date account of the great progress we are making. With our article in the IJGO supplement, we hope to show both how the programme works to close the treatment gap, and also how much is left to do to reach affected women in all settings.”

To read Addressing the fistula treatment gap and rising to the 2030 challenge and the full supplement, click here.