Number of doctors trained in obstetric fistula repairs
The number of doctors who have been trained in conservative and surgical management of fistulas, incurred during childbirth or because of inflicted trauma, within a given timeframe (generally the last calendar year).
Training records. Data can be disaggregated by sex, type of specialty (e.g. general surgeon, obstetrician/gynecologists, urologist), type of facility (e.g. public, private, non-governmental, community-based), and by district and urban rural location. If a refresher training is being conducted, the corresponding indicator should be “Number of doctors receiving a refresher training in obstetric fistula repairs”.
If targeting and/or linking to inequity, classify trainees by areas served (poor/not poor) and disaggregate by area served.
Successful treatment for women suffering from obstetric fistula (OF) includes the surgical repair of fistulas from trained providers. This process indicator is a proxy for the readiness of doctors to treat obstetric fistula. Based on the Fistula Care project’s Fistula Treatment Training Strategy (EngenderHealth, 2008), the training program should include elements of medicine and surgery as well as the service delivery system. Specific components of a training program might include:
- Techniques for simple surgical fistula repair
- Management of possible side effects and complications from surgery and medications
- Knowledge of accepted standard regimens for analgesia and anesthesia
- Knowledge of relevant infection prevention practices
- Knowledge of counseling, informed choice and client –provider interaction
- Medical screening and pre-operative assessment
- Post-operative care and follow- up of clients
- Establishment, management and supervision of logistics, service delivery and surgical theater
- Client record keeping system
- Referral system
The duration of training in simple repair surgery varies with the doctor’s initial surgical skills and professional background. For specialists (surgeons, obstetrician/gynecologists, urologists), initial trainings generally last 2–12 weeks. For general practitioners with a minimum of three years of surgical experience, the training is 4-12 weeks. Because fistulas vary greatly in complexity and difficulty of repair, a gradual increase beyond 12 weeks is envisaged for skill and surgical efficiency, starting with simple cases and then progressing to moderate then high complexity cases.
Effective follow-up is crucial and integral to training. Typically, trainees need two or more follow-up trainings before they become fully confident in their surgical skills at a particular competence level, even for simple fistula surgery. The Fistula Care project has developed a Fistula Services Facilitative Supervision and Medical Monitoring form for training follow-up (EngenderHealth, 2008).
The International Federation of Gynecologists and Obstetricians (FIGO) coordinated the production of a training manual, the Global Competency-Based Fistula Surgery Training Manual, aimed at healthcare providers from low- and middle-income countries involved in the prevention and management of OF (FIGO, UNFPA, 2011). The training curriculum articulates what fistula surgical training should be, which allows both trainer and trainee performance to be objectively evaluated and appropriate follow-up conducted of the surgeons who have been trained. Standardization also allows more doctors to be trained while identifying what fistula surgeons can safely undertake at a given level of skill or experience (Rushwan and Ruminjo, 2011). The manual was pilot tested in several centers in 2011 and is currently being rolled out.
The indicator does not provide information about the quality of the training or the quality of services provided by the trained doctors. To assess mastery of knowledge and skills, evaluators should also collect data for the indicator, “Surgical competency upon completion of OF training”.
This indicator captures only number of doctors trained, however, training reports should record the other cadres of individuals trained in fistula including nurses, non-nurse counselors, anesthetists, physiotherapists, facility management/administration, support staff, and community liaisons (including NGOs and community-based organizations).
access, training, safe motherhood (SM), obstetric fistula (OF)
EngenderHealth, 2008, Fistula Care Training Strategy. http://www.fistulacare.org/pages/pdf/Training/FistulaTrainingStrategyEngenderHealthFistulaCare070708formatted.pdf
EngenderHealth, 2008, Fistula Services Facilitative Supervision and Medical Monitoring for Training Sites and Training Follow-up. http://www.fistulacare.org/pages/pdf/Training/FistulaSupervisionandMonitoringforTrainingsiteandtrainingfollowupApril08formatted.pdf
FIGO, UNFPA, 2011. Global Competency-Based Fistula Surgery Training Manual. http://www.figo.org/sites/default/files/uploads/wg-publications/fistula/FIGO_Global_Competency-Based_Fistula_Surgery_Training_Manual_0.pdf
Rushwan H. and Ruminjo J., 2011. “Pursuing a Standard of Care for Training New Fistula Surgeons”. RH Reality Check. http://www.rhrealitycheck.org/blog/2011/03/04/pursuingstandard-care-training-fistula-surgeons