Met need for surgical treatment among women diagnosed with obstetric fistula seeking surgical repair services
The percent of all women seeking surgical repair services for and diagnosed with obstetric fistula (OF) who receive surgical treatment for the condition, within a given timeframe (generally annually) and by facility.
This indicator is calculated as:
(Number of women surgically treated for OF / Total number of women diagnosed with OF in the same time period) x 100
Although successful first attempts at fistula closure should be around 85%, of which 90% should be without incontinence (WHO, 2006), repeat surgeries are sometimes needed for complex cases. Regardless of whether a woman has had one or multiple surgical repairs, and regardless of the outcome of the surgery, she should be counted once in the numerator.
Total number of OF diagnoses in a given time period; total number of women treated for OF within same timeframe. Data should be stratified by health facility and possibly type of facility (e.g. public, private, non-governmental, community-based), but could be aggregated to obtain a regional or national percentage.
Unlike the indicator, “Met need for emergency obstetric care”, where UNICEF/WHO/UNFPA has set the minimum acceptable level of “met need” as 100 percent, no minimum acceptable level of “met need” has been established for OF surgical treatment, which is likely to be just under 100 percent. A small percentage of OF cases (particularly complex rectovaginal fistulas) are inoperable because of patient comorbidity or disease-related factors. A small number of other OF cases do not require surgical treatment because they are simple, small, and the woman presents for care immediately after delivery (within a few hours or at most, days). These situations make up the minority of OF cases diagnosed at facilities and generally do not have a significant impact on the actual percentage of “met need”. However, among facilities with high case loads of OF repairs, evaluators may choose to exclude these cases from the denominator.
It has been estimated that more than 2 million women are living with OF, although it is impossible to determine the true extent of this problem (WHO, 2006). The girls and women who suffer from OF usually live in abject poverty and in remote villages, shunned or blamed by society and unable to seek appropriate medical care. Thus, it is extremely difficult to accurately measure the prevalence or incidence of OF when so few have access to health care. By capturing the met need for OF treatment among the women who reach a health facility, this outcome indicator provides a measure of the capacity of health facilities to meet the needs of women who require surgical treatment for OF.
Analysis of this indicator over time can be used to assess significant changes in programs. Reductions in met need that were once high should prompt closer examination of changes in staff, treatment protocols, availability of essential medicines and supplies, etc. Comparison of the indicator across facilities may reflect facility-specific issues that require improvement.
Although this is a measure of access to care among health facility clients seeking OF surgery, the indicator does not address quality of services.
Furthermore, meeting a women’s need for surgical repair of an OF is just one aspect of the treatment and healing process. Because each OF patient has emotional, psychological, and economic needs, this indicator should be complemented with the indicator, “Percent of women who have been treated for obstetric fistula who receive reintegration services” to gauge the full range of care provided to women presenting with an OF.
access, obstetric fistula (OF), safe motherhood (SM)
WHO: Department of Making Pregnancy Safer. 2006. Obstetric Fistula: Guiding principles for clinical management and programme development. http://whqlibdoc.who.int/publications/2006/9241593679_eng.pdf