Poor funding, scant attention escalate Nigeria’s obstetric fistula burden
• Country Bears 40 Per Cent of World’s Burden
• 90% Of Cases Are Untreated
• Only Three Of 12 Fistula Centres Receive Govt Funding
• States Have No Budget For Ailment
• Dearth Of Trained Surgeons Persists
With only three out of 12 fistula centres receiving funding from the Federal Government, and little or no repair works carried out on them yearly, the country’s plan to eliminate obstetric fistula, in line with the Sustainable Development Goal Three (SDG 3), which seeks healthy living for all, would be very difficult to attain.
The condition- an abnormal opening in the birth canal, resulting in uncontrolled leakage of urine or feces- is an indication of poor access to quality maternal healthcare, according to the United Nations declaration.
While developed countries like the United States, have managed to eliminate obstetric fistula, achieving same in the country may remain an uphill task, as access to skilled healthcare professionals and services, as well as, other limitations, continue to hamper progress earlier made.
Up-to-date data from the Federal Ministry of Health indicate that the country bears 40 per cent of the world’s fistula burden, yet 90 per cent of these cases go untreated.
Each year in the country, only about 5, 000 out of the about 200, 000 women living with the condition benefit from free surgery, through support from foreign partners at the 12 dedicated fistula centres nationwide. The remaining 195,000 added to new cases that spring up annually (about 12, 000), all remain untreated, ultimately ostracised by their loved ones and suffering in silence.
This data excludes the large scale unreported births happening outside health facilities, which if included, would likely increase the number of new cases to about 20, 000 yearly, according to the National Strategic Framework and Plan for VVF Eradication by the Federal Ministry of Health (FMOH).
At this rate, experts say it would take a long time for the country to finally eliminate the ailment, except government takes drastic step to address the situation.
Some of the 12 dedicated fistula centres in the country are National Obstetric Fistula Centre Abakaliki, Ebonyi State; National Obstetric Fistula Centre, Katsina State; National Obstetric Fistula Centre Ningi, Bauchi State; Maryam Abacha Women and Children’s Hospital Sokoto; Ogoja General hospital Cross River State; University College Hospital Ibadan, Oyo State; Hajia Gambo Sawaba General Hospital and VVF Center, Zaria, Kaduna State. They all offer free fistula services with support from foreign partners.
But despite their availability, investigation by The Guardian reveals that many sufferers are still unaware of their existence, and as such pay huge cost at private and government hospitals for treatment.
A visit to a private, state and federal government hospitals in Lagos State by The Guardian, revealed the huge amount fistula patients are asked to cough out for medical attention.
At Hovas Place Hospital, a private medical facility situated at 5th Avenue, Festac Town, the sum of N700, 000 was demanded for a repair. According to the gynaecologist on duty, Dr. Uche, the charge ranges from N500, 000 to N700, 000 depending on the severity of the condition. “It is not a routine surgery, we may have to bring in an expert depending on the severity,” he said.
At the Lagos State University Teaching Hospital (LASUTH), N135, 000 was demanded for the cost of surgery, aside additional charges for admission, laboratory tests, blood purchase among others. There was not much difference from what obtains at the Lagos University Teaching Hospital (LUTH), a federal tertiary facility.
A doctor at LUTH who preferred anonymity said the entire cost may climb up to N250, 000. “After getting the money, the patient will have to bear in mind that the surgery wont be immediate, as she would be on the queue for as long as three months before it gets to her turn,” the doctor informed.
Despite being aware of designated fistula centres across the country, doctors, mostly refer their clients to these paid facilities. Mrs. Saidat Moroof, who has now been cured of the ailment, told The Guardian that she waited for five years before she could save money for a surgery at LASUTH.
“I was affected by the condition in 2011, after giving birth to my baby at a traditional birth attendant facility. After that, I went to the General Hospital Ikorodu, where I was referred to LASUTH. There I was told to bring N200, 000 for the surgery. Since I was born, I have never seen that kind of money. It took me five years to save the money, as I had to borrow from friends, and my husband had to sell his plot of land, before we could raise the money,” she recalled.
Moroof, who claimed ignorance of the centres offering free fistula repairs said: “If I had known, I could have gone there since. Imagine all the money we ended up spending. Even up till now, we are still repaying the loan we obtained.”
According to experts, many of these women die with this pathetic condition, which would have been easily treated if they had adequate awareness, since most of them are from poor backgrounds and cannot afford the cost of surgery.
Director Vesicovaginal Fistula (VVF) Centre in Kebbi, Dr. Abubakar Dakingari, confirmed this in an interview with newsmen saying, “85 per cent of patients in our centre are rural dwellers, who are poor and lack access to healthcare facilities.”
Many of these women are located in rural areas far from the free fistula centres, and some completely unaware of the centres, submitted Dr. Suleiman Zakariya, a clinical associate at Fistula Care Plus added.
He continued: “This is the reason why there is need to create more awareness about these centres and about the prevention of obstetric fistula,” he added. Zakariya stressed the need to prevent obstetric fistula disease through the prevention of prolonged obstructed labour.
While admitting that many new cases are left untreated as a result of shortage of qualified surgeons, he said the nation has very few specialists in the area, with only about 10 capable of manage complex cases.
Presently, the Federal Government only makes budgetary provision for the three federal fistula centres in Ebonyi, Kastina and Bauchi states. The rest are managed by state governments without specific allocations for obstetric fistula.
The FMOH budget for the three federal centres in 2016 were; N580, 745, 316 for Abakiliki; N626, 607, 620 for Bauchi and 704,378,898 for Kastina. In the 2017 budget N504, 843, 474 is budgeted for Abakiliki; N655,055,665 for Bauchi and N753, 569, 538 for the Kastina facility.
While the allocation in itself is commendable, medical directors of the affected centres say releasing the funds to them is a different kettle of fish altogether, according to reports, even though experts are of the opinion that timely release of this funds is great importance.
Their frustration is shared by the National Programme Officer, Reproductive Health/Obstetric Fistula, UNFPA Nigeria, Dr. Musa Elisha, who in a chat with The Guardian, lamented the scenario.
According to him, the country has created a budget line for obstetric fistula, but minimal resources are allocated. The plan for six national fistula centres in each zone, by the Goodluck Jonathan’s administration has not been realised up till now.
The Growing Girls and Women in Nigeria (GWIN) programme of the Jonathan administration offered free fistula repair to women and girls in the three states of Bauchi, Katsina and Ebonyi, but now this is no longer running. Presently, there is no state-specific data on obstetric fistula, he said.
Also, the Country Programme Manager, USAID Fistula Care Project Nigeria, Iyeme Efem, commends the Federal Government for setting up a Fistula Desk to coordinate fistula activities nationally.
He, however, bemoaned the fact that the desk has not been well funded since inception. According to him, “Without such funding, the government will be paying lip service to fistula intervention at coordinating level. The Federal Government has also done well by setting up national centres at the different geo-political zones. Each of those centres has budgetary allocation, but as usual, the budgeted funds are not released. So, we end up with facilities that have no consumables to conduct repairs, who end up depending on USAID to fund consumables for their repairs.
“This is not fair to the women and the facility staff, who really want to work but lack the funds to do so. If you look at their budget on the website, you will see that they are well funded, but releasing the funds for the activities is a major challenge. I would, therefore, appeal to the Federal Government to do its best to release funds, so these facilities can cater for women with fistula. At this rate, depending on USAID alone will not clear the backlog of 200, 000 women living with the ailment in the country, and the 12, 000 new cases occurring annually,” he said.
On how state-owned centres source for funds, Efem said: “States do not have separate budget for fistula. If we want to coordinate surgery at the state level, we have to bring funding for that, except for staff and the facility, every other thing is provided by us.
“State governments should support USAID, because most repair of women with fistula happen at state levels. Several state governments have made it a point of duty to support the repairs in their states. But many more states have not seen this as an issue even though none of them is free from it,” he said.
In line with the theme for this year, which is hope, healing, and dignity for all, Efem said the USAID Fistula Care Plus Project seeks to offer fistula clients hope for their condition. People need to know that obstetric fistula can be repaired. Once repaired, the patient can get back her life and dignity. The repairs are free, thanks to the Support of USAID Nigeria. Women with this condition should just go to any fistula centre in the country or call the number- 0813-986-1008 and the patient will receive help.
He called for the inclusion of fistula in the upcoming National Demographic Health Survey (NDHS 2018). Lead person at a fistula centre in Ibadan, Oyo State, , Prof. Oladosu Ojengbede, told The Guardian that there is always difficulty raising money for consumables for the centre, adding that many times, patients have to buy consumables while the surgeons supplement or support. “Sometimes the Federal Ministry of Health supplies especially during special programmes such as the Rapid Results Initiative. Ongoing treatments are supported by Engender Health FC+.
Although there is no designated budget for fistula at the state level, he said the state government offers supportive care for patients, pointing out that about 50 patients were admitted at the centre last week.
In Lagos State, The Guardian also confirmed that there is no specially designated budget for fistula. The Family Planning Manager, Lagos Ministry of Health, Dr. Atobutele Olayinka, said this is because there are few cases in Lagos.
“We don’t find many cases in Lagos State, but there are still few cases, which are handled at the state teaching hospital. There is no specially designated fund coming from the Federal Government for fistula. Although the patients pay for the cost of surgery, consultation is always free. We also have lots of non-governmental organisations that offer free surgeries although these NGOs are mostly not in Lagos so there are always problems referring indigent patients to them,” she said.
According to her: The state is doing a lot in terms of prevention of fistula. ‘Part of the message we send out to people is to avoid early marriages, because early marriage can lead to obstruction of labour due to undeveloped pelvic. We also create a lot of awareness on the need to practise family planning,” she said.