Number of facilities with functioning obstetric fistula surgical treatment capacity
The total number of service delivery sites in a country where surgical repair for obstetric fistulas (OFs) are regularly provided.
To be included as a “functioning” OF treatment facility, the site must have:
- all essential equipment, medication and supplies in working order and located within the service delivery area or reasonably close by;
- management and administrative capacity to coordinate perisurgical care, surgeries and follow-up;
- at least one facility staff member trained to perform surgical repair of OF who offers this service on a routine basis*; and
- support staff with the necessary skills to provide ancillary services (i.e. dietary/kitchen, housekeeping, laboratory, anesthesia, nursing, surgical assistance) to make hospitalization and surgical fistula repair possible.
*For the purposes of a standard definition, performance of at least one surgery to repair OF(s) over a three month period will be considered “regular” provision. A notation may be made indicating periodic capacity for surgical OF repair services.
Service provision data from service delivery sites providing OF care in a country
Health information management systems; facility-based surveys; comprehensive emergency obstetric care needs assessments; service provision assessment (SPA) surveys
This indicator deals with access to services and the supply side of OF repair. It is used to assess whether adequate numbers of sites provide surgical repair services for genital fistulae resulting during childbirth or because of inflicted trauma. While no international standards exist regarding the acceptable number of facilities providing surgical fistula repair services, wherever OF is a prevalent issue, repair services should be available. Identifying geographic areas and thereby existing health facilities that should be offering OF repairs and assessing their capacity to provide these services forms the basis of the evaluation, development, or expansion of fistula programs.
Evaluating the regularity with which surgical repair services are provided may be difficult. Patterns and frequencies of fistula repairs may fluctuate based on changing service provision capacity – such as when specially trained surgeons visit the facility or when special medical teams bring with them necessary medications and supplies. Additionally, materials and supplies available at facilities may vary with supply cycles. For example, if facilities are stocked at the beginning of the fiscal year and surgeries exhaust supplies by mid-fiscal year, unless the facility is restocked, it cannot be counted among the facilities with functioning OF surgical treatment capacity for the entire year. Moreover, the measurement of OF surgical treatment capacity provides no information about the quality of the surgical repairs or what the facility’s success rate is.
access, obstetric fistula (OF), safe motherhood (SM)