Percent of obstetric fistula treatment facilities that provide social reintegration services
The percent of obstetric fistula (OF) treatment facilities that provide onsite social reintegration services or provide referrals for these services, by type of services provided and spatial distribution of facilities. Treatment of OF can either be through catheter management or surgical intervention.
The minimum reintegration service package, as defined by WHO’s guiding principles, should include counseling on what fistula is, how the injury was sustained, future risk factors and how to prevent fistula from occurring again, including the use of family planning and good obstetric care (2006). However, the essential components of reintegration services have not been universally agreed upon due to insufficient evaluation of existing services as well as scarce data on the factors associated with successful reintegration. Therefore, users of this indicator will need to define what reintegration services to include in the national/program context. The following are examples of other reintegration services that are currently being provided or have been recommended:
- other psychosocial support services (e.g. peer groups, peer counseling)
- literacy training
- income generation activities (e.g. micro-credit, vocational training, small business promotion)
- provision of new clothes
- funds for transport home
- accompanied return to community/family
Availability of the service requires several factors to be present. The facilities that offer reintegration services should have:
- provided the service within the last three months
- essential supplies, materials or equipment for reintegration services (e.g. contraceptives, literacy tools, etc.)
- staff qualified to provide the service; and/or
- clear protocols and documentation for referrals.
Where possible geographic mapping of sites is helpful to determine coverage. In this case, geographic distribution may focus more on the referral site locations (e.g. non-governmental organizations or other existing programs) rather than the location of treatment sites.
This indicator is calculated as:
(Number of sites providing defined social reintegration services onsite or through referral / Total number of sites providing fistula treatment services) x 100
Number of sites country-wide providing OF treatment; number of treatment sites providing or referring for reintegration services; types of reintegration services provided either directly or through referral; geographic location of the sites including organizations engaged in referrals.
The number of sites assessed will likely be too small for useful disaggregation, but in some contexts it may be interesting to compare private vs. public facilities.
Facility-based survey; program reports; national geographic mapping of health facilities
Treating OF requires a holistic approach which requires more than surgical and medical care.
Women with this condition have been traumatized and require services to address their emotional, psychological, and economic needs. Unfortunately, there are few experiences in specific reintegration programs upon which to draw, given the limited resources allocated to fistula care and the scarcity of people working on the long-term needs of these girls and women (WHO, 2006). Nonetheless, there is a common understanding of the importance of this support and including a core reintegration indicator in OF programs may help initiate national dialogue to define and include reintegration services.
This process indicator can assist with understanding the availability and coverage of reintegration services. It provides information on what percent of sites are providing the requisite nationally recommended services. The information collected to calculate the indicator can also assist with program planning and may show where additional interventions are needed.
Geographic mapping will allow understanding of where there are coverage
gaps for certain populations. It may also be useful to compare findings with the indicator, “Percent of women who have been treated for obstetric fistula who receive family planning or birth spacing counseling”, to more fully understand whether services are actually available and offered to women after treatment.
Over time once services are established it can be used to monitor whether the services are maintained. However, trend analysis of the indicator may be difficult as reintegration is an emerging area and the types of services offered will likely change based on new evidence.
The evidence-base on the essential interventions and modes of service delivery for reintegration is weak. Comparison within and between countries may be difficult due to wide variations in the types of services offered. Also, quality of reintegration services cannot be determined by this indicator.
access, obstetric fistula (OF), family planning, community, 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