International Obstetric Fistula Working Group
Training for Fistula Treatment Workshop
Niamey, Niger - 19-20 April 2005
RECOMMENDATIONS
Global Workshop Recommendation: Improve the health system capacity in the management of
pregnancy and delivery in order to ensure the effective prevention of obstetric fistula
Training Standards and Technical Guidelines
1 – Based on the experiences of treatment and training of providers which were presented
(Nigeria, Niger, Mali, Kenya and Tanzania) consensus was reached regarding the following
issues:
- The minimum qualifications needed to manage simple obstetric fistula cases
- The minimum duration of training for the treatment of simple cases of obstetric fistula
- The minimum number of successfully treated cases needed during training to acquire
competence in treatment of simple fistula cases
- The content of the training
- The supervision of trained providers
- The requirements for a fistula treatment training centre
Further recommendations were made to:
2- Emphasize the importance of developing a national strategy adapted to local needs in
every country and to advocate for the Ministry of Health to take responsibility, in
estimating the needs of the health system, the number of patients that require fistula
surgery, train the doctors and provide the necessary support. While needs will vary per
country, it was recommended that every country should have at least one national
reference centre capable of handling both simple and complex fistula cases. Depending
on the prevalence, each region should have at least one fistula repair unit capable of
repairing simple cases of fistula.
3- Train multidisciplinary teams (urologists, gynaecologists, general surgeons, theatre and
post-operative nurses, anaesthetists) for the elimination of obstetric fistulas. Health
professionals should be selected based on their ability to immediately apply their skills
upon return to their posts.
4- Avoid a backlog of simple fistula cases through regular management by trained doctors
at regional hospitals while referring all complicated cases to the specialists at the
national reference centre.
5- Ensure that the trained personnel will have the right conditions (equipped, functional
health centres and incentives) to work on their return to the health facilities
6- Develop basic guidelines for training in fistula treatment: Organisations such as
UNFPA, WHO, the International Federation of Urologists and EngenderHealth should
join FIGO to make available, as soon as possible, a guide on the basic principles of
training for health providers in fistula treatment. The guide should include clinical
modules with a standardised classification of types of cases, algorithmes de prise en
charges, different operation techniques, and framework for evaluation of skills as well as
modules on counselling. It would also be useful to have visual training materials
available, including videos, photos and slides. It is first necessary to analyse pre-existing
documents, curricula and tools.
7- Improve data collection: Establish a regional (global?) database to collect data on fistula
treatment that can be used by the different centres to improve monitoring and evaluation
and make data available for research. At national level, ensure systematic data collection
to improve the services for fistula clients and evaluate the quality of obstetric care
Fistula Counselling Guidelines
Based on the results of a number of country experiences and current experiences in this area, it
was recommended to consider the following:
10 Conduct community-level research to evaluate the need for information among
patients, health providers and the community
11 Develop a comprehensive and integrated communication plan including all of the
different aspects (counselling, mass communication, etc.) and which takes into
consideration the socio-cultural and religious context
12 Ensure counselling is approached in a cross-cutting and integrated manner (ANC,
time of diagnosis, pre and post-operative) and involves service providers, social workers,
support groups and community health workers
13 Counselling should be provided for the patients, their spouses, their family and
community members, each of which would receive targeted messages.
Mapping Training Needs and Capacities
Based on the data from the 14 completed questionnaires and the information from needs
assessments, the following recommendations were developed:
14 Develop a working group to refine the questionnaire and determine universal
definitions for the terms used. Revised questionnaire should be sent to each Campaign
country to be completed.
15 Work to improve fistula data collection at the national level, taking into account
reoccurring cases, and arrive at consensus on the type of information to be collected.
16 Advocate the training of motivated providers, not limiting them to various
specializations, and ensure adequate follow-up support.
17 Proceed with the evaluation of potential regional training centres for the training of
trainers. (i.e. Tanguieta, Bugando, Point G…) in order to set up regional fistula training
centres connected with the various national training and/or repair centres (regional
fistula network)
18 Each country should develop a national fistula strategy that defines their needs in terms
of training, treatment, referral centres, and ensures adequate support, incentives and an
enabling environment for providers to continue providing care after training.
19 Each country should work to ensure a minimum of two national trainers per country.
20 Pre-service curricula for doctors and midwives should include proper management of
labour, post-partum care, early recognition, referral and post-fistula treatment care.
Training Models
Based on the experiences of different types of training used in Kenya, Uganda, Tanzania and
Nigeria, the following recommendations were agreed:
21 The most recommended model is training at specially designated centres for training
according to the criteria mentioned, and directed at providers possessing the minimum
qualifications
22 In the framework of training and the continuous evaluation of trainee’s performance,
a supervision strategy should be developed (suggested model: permanent and dynamic
partnership between the trainer and the trained providers and regular collection of data
and feed-back)
23 The training should reach diploma level at universities to better motivate providers, but
which requires structuring and standardisation of training. A working group should be
put in place to reflect on the methods needed to realise this.
24 Establish a network of surgeons and programme managers involved in the fistula
campaign to organise a meeting between the African experts currently involved in fistula
elimination in order to improve South-South cooperation