Strengthening Primary Health Care to end Obstetric Fistula in Ghana

Primary Health Care (PHC) is an essential, practical, scientifically, and socially acceptable means of health care that can ensure quality, accessible and affordable health for all. By signing on to the Sustainable Development Goals (SDGs), Ghana pledged to make a determined effort to ensure that all Ghanaians have access to appropriate, high-quality, affordable, timely, conveniently located, and socially acceptable health care.

Yet, Ghana’s PHC system has not reached its full potential as globally expected, notably in terms of women’s access to sexual and reproductive health (SRH) services. The present government listed the country’s weakened PHC system as one of its national priorities in its 2016 political party manifesto; proposing to solve it by increasing PHC in terms of access, quality, and availability of skilled professionals. Gaps in facilities providing health care services in Ghana include the lack of requisite human resource, essential equipment, drugs, and other logistics to effectively deliver quality healthcare. These gaps have been found as contributing causes to maternal and newborn mortality and morbidity as well as additional childbirth issues such as obstructive labour which is a leading cause of obstetric fistula.

Obstetric Fistula 

Obstetric fistula is directly linked to one of the leading causes of maternal mortality: difficult labor during delivery or a lack of sufficient obstetric care, according to the World Health Organization. Obstetric fistula is a painful consequence of protracted, obstructed labor that causes urine, faeces, or both to flow from the vaginal opening. The persistent and embarrassing odor of leaked urine, faeces, or both causes health and psychological problems, as well as social isolation. This can lead to financial difficulty, community stigmatization, and a lower overall quality of life.

Women who suffer from obstetric fistula experience constant embarrassment, and social discrimination. In the long term, if left untreated, this avoidable illness can lead to chronic medical conditions like skin infections, kidney problems, and even death. According to the United Nations Population Fund (UNFPA), 500,000 women and girls worldwide suffer from fistula, with obstructed labor accounting for around 8% of maternal deaths. According to statistics, 90% of pregnancies in which the mother gets a fistula end in stillbirth.

Not only is the condition treatable, but it is also be preventable. According to WHO, surgical repair of an obstetric fistula has a 90% success rate in simple cases and a 60% success rate in complex situations. Sexual and reproductive health care, access to contraception, access to skilled birth attendants, and high-quality emergency obstetric care can all help to prevent this injury and can be treated with reconstructive surgery.

The Situation in Ghana

In Ghana, this condition mostly affects the most marginalized citizens, mainly young, impoverished, and uneducated women in rural regions. Many of them do not seek treatment, either because they are unaware that their fistula may be repaired or because they cannot afford the procedure. The UNFPA estimates that the typical cost of fistula treatment, including surgery and post-operative care, is over $700, which is out of reach for most poor women. According to a 2015 Ghana Health Service/UNFPA report, an estimated 1,300 new cases of obstetric fistula are recorded annually with 1.6-1.8 cases occurring per 1000 birth.

Way Forward

As we mark this year’s International Day to End Obstetric Fistula under the theme “End Fistula Now: Invest in Quality Healthcare, Empower Communities!” ARHR calls on government to scale up its efforts to end obstetric fistula and all other maternal complications through a strengthened PHC system.

A central element to achieving this would be strengthened CHPS compounds; which is one element that Ghana is using to ensure PHC. A strengthened CHPS compound will improve the geographical and social access of women and underserved communities to basic health needs, investing in and improving the quality of maternal health care, as well as empowering women, adolescent girls and communities to gain an understanding of the condition and the role each has to play in addressing it. While staffing CHPS compounds with skilled personnel and resources to ensure quality health service delivery, especially sexual and reproductive health, government also needs to restructure Ghana’s PHC system to focus more on SRH health promotion and prevention rather than the curative component. This can be achieved largely through improving women and adolescent girls’ access to SRH information and services, such as contraception and access to skilled birth attendants (midwives) and high-quality emergency obstetric care.

While providing financial avenues for women and girls who cannot afford to undergo fistula repair surgery, there is also a need for the government, family, and communities to build social support structures to help them heal emotionally and reintegrate them into society before and after fistula repair surgery.

Attaining zero fistula conditions in Ghana is possible with the right resources and strengthened health systems for prevention and treatment. Providing periodic trainings for midwives and other nurses and improving SRH services will have far reaching implications for achieving this aim and Ghana’s ambition of attaining universal health coverage (UHC) by 2030.


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