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1. OECD
2. Publications
3. Eradicating obstetric fistula in Sierra Leone: Iceland’s transformative
partnership with UNFPA
ERADICATING OBSTETRIC FISTULA IN SIERRA LEONE: ICELAND’S TRANSFORMATIVE
PARTNERSHIP WITH UNFPA
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* Iceland
* Development co-operation in practice
* Development Co-operation Directorate
* Case study
13 March 2023
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ABSTRACT
Obstetric fistula, a neglected health condition, is heavily affecting women’s
and girls’ health, rights and empowerment in Sierra Leone. Iceland’s support to
a transformative intervention by the UNFPA and the Ministry of Health and
Sanitation aims to eradicate fistula by 2030. The comprehensive approach covers
prevention and surgical treatment, whilst promoting social reintegration and
addressing gender and social norms.
CHALLENGE
Sierra Leone has one of the highest lifetime risks of pregnancy-related
mortality and morbidity, including obstetric fistula. Affecting the most
vulnerable women and girls, the condition leaves them incontinent, often leading
to chronic medical problems, depression, social isolation and poverty. As
fistula is almost entirely preventable, eradicating it in Sierra Leone requires
a comprehensive and transformative approach that addresses and eliminates its
root causes. As a small donor, Iceland was seeking ways to strengthen its impact
on gender equality and women’s empowerment and to target some structural causes
of gender inequality in Sierra Leone.
APPROACH
Iceland has been a long-standing supporter of both the Government of Sierra
Leone and the United Nations Population Fund’s (UNFPA) Global Campaign to End
Fistula, which aims to improve access to quality maternal health services to
prevent and manage obstetric fistula. Building on its successful co-operation
with the UNFPA, and recommendation from a 2021 evaluation to strengthen
cross-sectoral linkages across education, health, and gender at the country
level, Iceland signed a five-year, USD 7 million project agreement in 2022 to
scale up its support for the elimination of fistula in Sierra Leone – a country
where Iceland is expanding its bilateral co-operation. The integrated fistula
elimination project, in partnership with UNFPA and the Ministry of Health and
Sanitation, was officially launched in May 2022. The six pillars of the project
are:
1. Informing adolescent girls and women, and key community actors, on sexual and
reproductive health and rights (SRHR) for preventing obstetric fistula.
2. Identifying obstetric fistula survivors and linking them to care.
3. Providing rehabilitation and social reintegration services to survivors
before and after surgery.
4. Strengthening the capacity of targeted referral hospitals to provide fistula
and other gynecological surgeries as part of their routine reproductive,
maternal, newborn, child and adolescent health (RMNCAH) services package.
5. Strengthening targeted health facilities to provide quality preventative
RMNCAH services.
6. Setting up a knowledge management system to bolster the obstetric fistula
programme in the country.
The project involves:
* A national taskforce to provide leadership, technical guidance, and programme
co-ordination.
* Reliance on multiple partners, both within the government and civil society
organisations (CSOs), such as the Haikal Foundation and Aberdeen Women’s
Centre, which support the project by conducting community mobilisation and
providing medical care.
* A results-based approach to use evidence from the programme to inform the
modelling and development of tools with the aim to maximise efficiency.
RESULTS
During the first year of the project, an initial resource mapping identified
support-structures within communities. Outreach efforts involve a variety of
approaches, including radio jingles in local languages, radio discussion
sessions and public events.
Initial results in 2022 include:
* Policy engagement. A National Fistula Strategy is being drafted. Strategic
activities have been integrated into the work plans of key ministries and
CSOs, and obstetric fistula is now a key focus area in the revised National
Reproductive, Maternal, New-born, Child, and Adolescent Health and Nutrition
strategy. A multi-stakeholder Fistula Taskforce was established to oversee
the national fistula programme, consisting of the Ministry of Health and
Sanitation and other key line ministries, CSOs, academia, and professional
associations.
* Prevention. Awareness information has reached 360 women and girls, and 120
fistula ambassadors and champions from all 16 districts have been trained in
prevention, identifying fistula and referring those affected for care.
* Medical care and social reintegration. 104 women and girls have been screened
for obstetric fistula, 42 women living with obstetric fistula have undergone
fistula repair surgery with a 100% success rate, and 54 obstetric fistula
survivors have undergone rehabilitation and social reintegration.
* Capacity building. Training efforts reached 78 health care providers and 38
providers of emergency obstetrics and new-born care.
LESSONS LEARNT
* Starting with a small grant in 2020 gave Iceland the confidence to
substantially scale-up support to end fistula. Iceland was already working in
Sierra Leone and looking to establish bilateral co-operation in
district-level fishing communities. Investing in a national programme through
a multilateral partner was a logical step for a small bilateral donor like
Iceland.
* Tackling some structural causes of gender inequality through a transformative
approach can achieve systematic and long-lasting impact on the status of
gender equality.
* Comprehensively addressing health system challenges while promoting social
reintegration and economic empowerment of women and girls through training
can remove social and cultural barriers to gender equality and help to change
power relations and economic, gender and other social norms.
* Prevention and increasing access to treatment are important for tackling
obstetric fistula. As part of its prevention measures the project focuses
strongly on addressing gaps in knowledge among adolescent girls, women and
men on the causes and consequences of obstetric fistula. It also seeks to
improve patient identification and referral mechanisms to enable more women
and girls to access quality fistula management services, including by
identifying support structures within communities.
* Government leadership and multi-stakeholder collaboration are key to the
success of the programme. Collaborating with government officials across
ministries and at the district level, as well as with healthcare providers,
district officials and multilateral partners, strengthens the programme’s
capacity to reach different communities, and to integrate measures to
eradicate fistula into national strategies and plans.
FURTHER INFORMATION
UNFPA (2023), Obstetric Fistula in Sierra Leone,
https://sierraleone.unfpa.org/en/topics/obstetric-fistula-4.
UNFPA (2022), UNFPA News, “Fistula survivors recognized in a ceremony to
celebrate their reintegration into communities”, 9 December 2022,
https://sierraleone.unfpa.org/en/news/fistula-survivors-recognized-ceremony-celebrate-their-reintegration-communities.
UNFPA (2021), Annual Report 2021 – Delivering on the transformative agenda,
https://sierraleone.unfpa.org/sites/default/files/pub-pdf/annual_report_2021-_unfpa_sierra_leone.pdf.
UNFPA Sierra Leone (2020), “Addressing obstetric fistula in Sierra Leone”
(video),
https://www.youtube.com/watch?v=9q0otZT8Jv0&t=1s&ab_channel=UNFPASierraLeone.
OECD RESOURCES
OECD (2023), OECD Development Co-operation Peer Reviews: Iceland 2023, OECD
Development Co-operation Peer Reviews, OECD Publishing, Paris,
https://doi.org/10.1787/a1552817-en.
OECD, “Guidance on gender equality and the empowerment of women and
girls”, Development Co-operation
Fundamentals, https://read.oecd-ilibrary.org/view/?ref=1143_1143052-b7ff8og4ir&title=Guidance-on-Gender-Equality-and-the-empowerment-of-women-and-girls.
To learn more about Iceland’s development co-operation see:
OECD, "Iceland", in Development Co-operation Profiles,
https://doi.org/10.1787/fd3d1d29-en.
See more In Practice examples from Iceland here:
https://www.oecd.org/development-cooperation-learning?tag-key+partner=iceland#search.
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