Niger: Forging Partnerships to Improve Emergency Obstetric Care Services and Prevent Fistula
“Every maternal death is an event we can avoid and one that we should never allow to happen. Women who die under our care are faces that stay in our memories and haunt our dreams. These are women in the prime of their lives..."
—Fatima Bakire, MD, Dosso Regional Hospital
In the West African country of Niger, safe motherhood is out of reach for a majority of women. Many factors contribute to this unfortunate reality: Niger has one of the highest fertility rates in the world (roughly eight births per woman), and an accelerating rate of maternal mortality (an increase from 920 deaths per 100,000 live births in 1995 to 1,600 in 2000). Most (85%) of the country's women deliver babies without skilled medical care, a reality which can have dire consequences for women's health, including obstetric fistula.
The exact number of women living with fistula in Niger is unknown. As a result of the stigma associated with this condition, and with most of the population (85%) living in rural areas, fistula statistics are not readily available. It is believed, however, that obstetric fistula is relatively common, with countless women currently suffering from this condition, because most women lack access to emergency obstetric care. Additional risk factors contributing to fistula are poverty, early marriage, and pregnancy at a young age. In certain regions of the country, girls are married as early as 9 years old, and 36% of girls age 15-19 have either been pregnant or already have at least one child. One of the key ways to prevent obstetric fistula is to ensure that women have access to quality emergency obstetric care services.
 |
Training participants work together on a group exercise focusing on the acts critical to saving a woman’s life during an obstetric complication. |
In response to these challenges, EngenderHealth is spearheading a national project to support the “Réseau pour l'Eradication des Fistules,” or Network to Eradicate Fistula, an association of more than 40 nongovernmental organizations and government agencies partnering to prevent and treat obstetric fistula in three main regions of Niger.
As part of the project, EngenderHealth led the first of three trainings throughout Niger to improve health care providers' skills in preventing obstetric fistula and maternal death. The training took place from April 24 to 28, 2006, in the region of Dosso (one of eight regions in Niger).
Nearly 30 nurses and midwives from the Dosso Regional Hospital and three peripheral health centers participated in a quality improvement workshop. The goal of the training was to help providers identify the issues in and challenges to providing essential life-saving care for women experiencing obstetric complications, as well as how to implement a process of improving the quality of services in their own facilities.
Through a series of presentations, group exercises, and role plays, health providers discussed the concept of emergency obstetric care, the critical measures needed to save a woman's life, and the seemingly small mistakes that can jeopardize a woman's life during an obstetric emergency. Participants also learned about the quality improvement approach, clients' and providers' rights, leadership and communications skills, and facilitative supervision. Towards the end of the training, providers from each health facility discussed practical, low-cost solutions to some of the problems they face in providing emergency obstetric care and developed detailed workplans for implementing positive changes.
| “This training is extremely useful,”said Yacouba Djidata, midwife at the Maternity in Lacouroussou. “We do this work everyday, and now we're realizing what we've been doing wrong and how to change things.” |
The training materials used were the Quality Improvement for Emergency Obstetric Care Leadership Manual and Toolbook, adapted from EngenderHealth's COPE® (client-oriented, provider-efficient services) quality improvement methodology by EngenderHealth and the Averting Maternal Death and Disability Program (AMDD) at Columbia University. COPE is a process for improving quality in health services by encouraging and enabling service providers and other staff at a facility to assess the services they provide jointly with their supervisors. Using various tools, they identify problems, find the root causes, and develop effective solutions.
 |
Training facilitator Dr. Fatima Bakire leads participants in a discussion to identify facility staff roles and responsibilities. |
The training in Dosso is the first step toward taking a broader quality improvement approach to improving emergency obstetric care and preventing fistula in the region. The training will be followed by frequent on-site supervision by both EngenderHealth and district supervisors and by discussion to ensure progress and identify issues and solutions so that obstetric emergencies are dealt with in a timely and efficient manner.
Read these resources to learn more about EngenderHealth's global response to fistula:
Fistula and ACQUIRE: Read about EngenderHealth's managing role in the ACQUIRE Project and its efforts to prevent and treat fistula and provide reintegration services to clients in Bangladesh, Democratic Republic of Congo, Ethiopia, Guinea, Rwanda and Uganda, along with regional efforts in East and West Africa.
Campaign to End Fistula: Obstetric Fistula Needs Assessment Report: Findings from Nine African Countries: Results from a groundbreaking needs assessment conducted by EngenderHealth and the United Nations Population Fund (UNFPA) in nine African countries.
Fistula Fact Sheet
Coming Home Again : Hope for Ugandan Girls and Women with Obstetric Fistula
For more information, see EngenderHealth's Niger country profile.