Freeing Women from Trauma and Stigma of Fistula

By Debola F Ogunbiyi

A project that is as humanitarian as it is urgent was recently flagged off in the Conference Room of the Federal Ministry of Health and Social Welfare in Abuja by the Coordinating Minister for Health, Professor Muhammad Ali Pate. The Fistula-Free Programme (FFP) is a timely initiative aimed at bringing sustainable succor to hundreds of thousands of Nigerian women and girls who are victims of a serious yet preventable ailment that devastates lives nationwide. This condition, obstetric fistula, involves an abnormal opening between a woman’s genital tract and her urinary tract or rectum, often caused by obstructed labor, a leading cause of maternal mortality.

The United Nations Population Fund (UNFPA) describes obstetric fistula as the most severe pregnancy-related disability, leading to nerve damage, which causes significant pain and difficulty in walking. Victims often face rejection from their husbands, ostracization from their communities, and a life of shame and isolation. If left untreated, the condition can result in premature death due to infection or kidney failure. While obstetric fistula is treatable, the cost of medical intervention remains prohibitive for many affected women.

According to a 2023 World Health Organization report, Nigeria ranks second only to India in maternal, stillbirth, and neonatal deaths globally. It is estimated that over 1,000 women die per 100,000 live births in Nigeria. These statistics underscore the critical importance of the programme.

As stated by Pate, the primary goal of the Fistula-Free programme, similar to other initiatives prioritized by the ministry and based on its strategic sector roadmap, is to establish “a health system that leaves no one behind and saves lives.” To ensure the success of FFP, it has been integrated into the health insurance scheme under the National Health Insurance Authority (NHIA), so that beneficiaries will continue to have financial access to care and receive ongoing medical attention to minimize the risk of recurrence.

In his detailed presentation at the event, DG, NHIA, Dr. Kelechi Ohiri providd further context describing obstetric fistula as a chronic condition that lies at the intersection of poverty and vulnerability, with the majority of its victims being young, poor, and ostracized.

The Fistula-Free Programme is integral to the federal government’s intensified focus on supporting disadvantaged individuals within its health plan through a dedicated Vulnerable Fund. The targets include indigent disabled persons and women going through childbirth complications. Commenting on this, Dr. Kelechi Ohiri, Director-General of the National Health Insurance Authority (NHIA), emphasized that “it is about building the platform for health insurance to cover the poor.” The FFP is therefore a beacon of hope for the 12,000 Nigerian women who develop obstetric fistula each year and those who have endured the condition for years.

Consider Amina, a young woman married off at 15 who gave birth at 17. After a challenging labor, she welcomed her son into the world, but her body was severely traumatized. For one or more of many reasons that cause obstetric fistula – either that her pelvis was too small, the baby’s head too big, or the baby badly positioned – Amina’s labor had been long and difficult, and there was no money for a Caesarean section. Amina’s childbirth resulted in an abnormal opening between her vagina and bladder, causing uncontrollable urine leakage.

Amina found no relief after childbirth. Isolated, shunned, and ostracized by family and community members, her life seemed over with nowhere to turn. Thanks to the FFP, fictional yet representative characters like Amina now have hope for an end to the pain and other devastating consequences of obstetric fistula.

The Vulnerable Group Fund (VGF), a special fund established by the federal government to help disadvantaged Nigerians access affordable healthcare, will provide the resources to make this miracle a reality. The Fund aims to reduce delays in obtaining life-saving interventions and provide financial access to health services. The VGF will cover treatment (surgery), transportation to specialized centers, and counseling for affected individuals.

Beyond obstetric fistula, the VGF will support groups facing various health challenges, including children under five, pregnant women, the elderly, the physically and mentally challenged, and others who are too frail or too poor to help themselves. The fund will ensure these groups are enrolled into the health insurance system, enabling them access life-saving interventions and financial support, significantly reducing mortality and morbidity rates among them.

To ensure the success of VGF-funded initiatives like FFP, funding comes from multiple sources: The Basic Health Care Provision Fund (BHCPF), health insurance levy, telecommunications tax, government allocations, returns from investments made by the Governing Council, and grants, donations, gifts, and other voluntary contributions. This diverse funding stream underscores the federal government’s commitment to improving healthcare for underprivileged Nigerians.

The extensive collaboration among stakeholders in the FFP is another significant strength. While the NHIA’s Governing Council will manage the VGF, the success of the initiative requires many contributors. It is therefore commendable that a Steering Committee has been established to drive the Fistula Free Programme, which will be implemented by the NHIA using the VGF. Chaired by Dr. Kelechi Ohiri, DG/CEO, NHIA, the committee includes a strong representation of health experts and managers from the public and private sectors: Dr. Halima Mukkadas, MD, National Obstetric Fistula Centers (NOFICs); Dr. Kolawole Owoka, CEO of United Healthcare, Representative of Third-Party Administrators; Prof. Okechukwu Ikpeze, President of the Society of Obstetricians and Gynecologists of Nigeria (SOGON); Dr. Simeon Onyemaechi, Chair of the Forum of Executive Secretaries, State Social Health Insurance Agencies (SSHIA); Mr. Kabiru Attah, CEO of EngenderHealth, and representative of CSOs; TBC, Representative of Development Partners; Dr. Binyerem Ukaire, Head of Family Health, Federal Ministry of Health; Dr. Anuma N.O., Head of Hospital Services, Federal Ministry of Health; and Dr. Sikiru Salawudeen, Director of the Informal Sector, NHIA.

This committee brings together diverse expertise to ensure the effective implementation and oversight of the initiative. Its responsibilities include providing strategic guidance and direction for the intervention, reviewing intervention progress and making recommendations for improvement, ensuring adherence to programme goals, objectives, and desired outcomes, advocating for the prevention of fistula and care for those affected, overseeing the monitoring and evaluation of the intervention’s impact, and addressing any challenges and risks that may arise during implementation. Additionally, the NHIA will be responsible for establishing guidelines for service delivery and payments within the Fund, assessing and accrediting Third-Party Administrators (TPAs) for claims processing, overseeing data collection and programme evaluation, and facilitating collaboration between stakeholders in the health sector.

All the foregoing portends hope for Nigerians. It is heartening to imagine Amina’s life a few years from now. Thanks to the healthcare blueprint, she is healthy, empowered, and integrated into her community. The pain and isolation she once endured are distant memories, replaced by the joy of motherhood and a vibrant community life. That is definitely a future to look forward to.

*Ogunbiyi is a public affairs analyst