#1UNITED STATES USAID AGENCY USAID INTERNATIONAL DEVELOPMEN FROM THE AMERICAN PEOPLE ACQUIRE project STRENTHENING FISTULA SERVICES AT KEBBI VVF CENTER: THE JOURNEY SO FAR a presentation by Dr. Hassan L Wara Fistula surgeon, Birnin Kebbi VVF Center, Kebbi State, Nigeria. April 14th, 2008#2UNITED STATES AGENCY USAID RNATIONAL DEVELOPME FROM THE AMERICAN PEOPLE BRIEF HISTORY ACQUIRE project ■ Started as a unit of Obgyn Department of the state Specialist Hospital, in 1991 ■Fistula Center initiated by 1st lady of the state in 1992 and commissioned as full pledged center in 1995. ■ NCWS and GHON sponsored training of a fistula surgeon and 4 trained nurses in fistula management at the initial stage.#3UNITED STATES USAID TERNATIONAL AGENCY OPMENT DEVELOPM USAID FROM THE AMERICAN PEOPLE Early Challenges ■ Huge backlog of VVF clients ACQUIRE project Lacked sustainability: due to frequent change in Government and policies ■ Poor motivation leading to non commitment ■ Inadequate manpower ■ Poor funding mechanism ■ Poor data management#4UNITED ERNATION STATES USAID AGENCY EVELOPMENT USAID FROM THE AMERICAN PEOPLE Early interventions ACQUIRE project ■■ In 1992, the 1st lady of the state took special interest in fistula, enhanced better management and improved funding. ■ Tulsi Chanrai Foundation supported with equipments, consumables and improved nutrition ■ UNFPA trained a doctor and nurses and supplied some equipments during the fortnight campaign. ■ Dr. Kees has been visiting the Center to provide expertise and reduce backlog#5NONG UNITED ST USAID DEVELOPMENT AGENCY USAID FROM THE AMERICAN PEOPLE ACQUIRE projec ACQUIRE INTERVENTION ■ Holistic approach covering fistula prevention, repair and rehabilitation with social reintegration of clients. ■ Cross cutting issues such as advocacy, capacity building, family planning and research. ■ Community involvement to ensure sustainability. ■ Data management training.#6STATES USAID INTERNATIONAL AGENCY PMENT DEVELOPME USAID FROM THE AMERICAN PEOPLE Fistula repairs ■ Regular repairs ₤ACQUIRE project ■ Pooled effort fistula repairs (done twice) ■ Standardized pre and post operative management ■ Effective follow up schedules#7UNITEDS STATES USAID TERNATIONAL SAGENCY DEVELOPMENT USAID FROM THE AMERICAN PEOPLE ACQUIRE project Capacity Building ■ ACQUIRE sponsored my training as trainer in fistula surgery with Dr. Kees Waaldjik ■ Subsequently, 4 doctors and 2 nurses have undergone initial training in fistula surgery and management ■ Kebbi VVF Hospital to be developed as a training site in VVF surgery.#8UNITED S INTERNATION STATES USAID GENCY DEVELOP OPMENT ELOPMEN USAID FROM THE AMERICAN PEOPLE Infection Prevention ACQUIRE project Purpose: Decrease hospital infection to barest minimum and improve quality of repairs. ACQUIRE trained 2 trainers in infection prevention and additional 3 in general IP Step down training done locally with support from hospital management.#9UNITED USAID ERNATIONAL AGENCY ELOPMENT USAID FROM THE AMERICAN PEOPLE ACQUIRE project Fistula & Family Planning Counseling Training Purpose: To help the client to make an informed decision and improve quality of service ACQUIRE trained 4 trainers in fistula counseling and many others on family planning counseling. Step down training on Fistula counseling is planned.#10UNITED STATES USAID TERNATIONAL AGENCY EVELOPMENT USAID FROM THE AMERICAN PEOPLE ACQUIRE project Gaps/Challenges Rehabilitation and skill acquisition facilities ■ Substandard laboratory ■ Inadequate and improper mixing of nursing staff ■ Sustained supply of consumables ■ Record keeping#11UNITED STATES AGENCY INTERNAT ERNATIONAL USAID DEVELOPMEN USAID FROM THE AMERICAN PEOPLE Other challenges ACQUIRE project ■ Measures to prevent fistula still ineffective ■ Community awareness needs improvement as FGM practices like Gishiri/Gurya cut are still happening. ■ Manpower inadequate at the grassroots level ■ Most State Governments still do not provide free maternal services. ■ Poverty.