Home to more than 11 million people, Rwanda is the most densely populated country in Africa. Over the last several years, Rwanda made significant strides to increase family planning access and decrease maternal mortality, including building more hospitals and placing more skilled health personnel in remote areas. Despite these advances, fertility rates remain high and maternal mortality and morbidity such as obstetric fistula means risk for many women.
Obstetric fistula results from prolonged or obstructed labor and often leads to incontinence, nerve damage, and severe social stigma. Beginning in October 2006, in partnership with the Rwandan Ministry of Health (MOH) and key donors, including United Nations Population Fund and the German Society for Technical Cooperation (GTZ), EngenderHealth worked to support treatment for Rwandan women living with fistula. EngenderHealth’s work included support in 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 U.S. Agency for International Development (USAID)–supported Fistula Care project, EngenderHealth worked with local and expatriate staff to train surgeons and nurses in fistula repair, provided equipment and supplies for fistula repair surgery, and collaborated with the MOH to ensure that patient costs are covered. Recognizing that fistula is almost always preventable, EngenderHealth also worked with health care staff to improve access to and the quality of emergency obstetric care. At the national level, EngenderHealth worked with the MOH to improve fistula prevention by integrating fistula-related messages with other maternal health and family planning services.
Fistula Care Rwanda also provided technical and logistical support to the National Safe Motherhood Technical Working Group and the fistula subcommittee, which provided a forum for groups working on fistula to coordinate their efforts; developed national norms, protocols, and tools for treatment and prevention; and helped devise a national strategy to tackle the problem. In 2010, the RESPOND Project provided guidance to the USAID mission in Kigali and the Rwandan MOH for the development of a national policy and strategy for family planning programs.