Rwanda is the most densely populated country in Africa. Over the last several years, the country has made significant strides in increasing access to family planning and decreasing maternal mortality by multiplying the number of hospitals and placing skilled health personnel in remote areas. Despite these advances in maternal and reproductive health, every year between 30,000 and 90,000 Rwandan women die or sustain injuries from a complication related to pregnancy or childbirth, including obstetric fistula.
Obstetric fistula results from prolonged or obstructed labor and often leads to incontinence, nerve damage, and severe social stigma. Since October 2006, EngenderHealth has collaborated with the Rwandan Ministry of Health (MOH) and key donors, including UNFPA and GTZ, to support treatment for Rwandan women living with fistula. EngenderHealth currently works with seven public hospitals:
- Ruhengeri Hospital
- Central University Teaching Hospital of Kigali (CHUK)
- Kanombe Military Hospital (KMH)
- Kibogora Hospital
- Kabgayi Hospital
- Nyamata Hospital
- Gahini Hospital
Through the USAID-supported Fistula Care project, EngenderHealth works with local and expatriate staff to train surgeons and nurses in fistula repair, provides equipment and supplies for fistula repair surgery, and collaborates with the MOH to ensure patient costs are covered. Recognizing that fistula is almost always preventable, EngenderHealth also works with health care staff to improve access to and quality of emergency obstetric care. At the national level, EngenderHealth works with the MOH to improve fistula prevention by integrating fistula messages with other maternal health and family planning services.
Fistula Care Rwanda also provides technical and logistical support to the National Safe Motherhood Technical Working Group and the fistula subcommittee, which provides a forum for groups working on fistula to coordinate their efforts; develop national norms, protocols, and tools for treatment and prevention; and help devise a national strategy to tackle the problem.
In 2010, the RESPOND Project provided guidance to the USAID mission in Kigali and the Rwandan Ministry of Health for the development of a national policy and strategy for family planning programs.