A ‘Community Engagement’ Approach to Treating Fistula in Guinea


This article is part of a series by RH Reality Check with contributions from  EngenderHealth, Guttmacher Institute, the International Women’s Health Coalition, the Fistula Foundation, the United Nations Population Fund (UNFPA), and the Campaign to End Fistula.  All articles in this series represent the views of individual authors and their organizations and can be found at this link.

In the city of Kissidougou, Guinea, 127 citizens volunteer their time and energy alerting families in their communities about steps they can take to support the health of pregnant women. These citizens—both men and women—visit family compounds, identify pregnant women, and refer them to facilities where they can get the care they need. They deliver health talks and pass out information at community events like weddings and baptisms to encourage pregnant women to seek care and to deliver their babies at health facilities. They also inspire men to help their wives and sisters get the care they need while pregnant or in labor.

These are the front lines of the “Comités Villageois de Protection de la Mère et de l’Enfant” (Village Safe Motherhood Committees), a community-driven initiative for saving lives and preserving health for women in Kissidougou. As in many poor countries, 60 percent of pregnant women in Guinea deliver at home without a skilled attendant. As a result, Guinea’s maternal death rate is among the highest in the world: 980 per 100,000 live births. Another consequence of limited maternal care is obstetric fistula, a debilitating injury caused by prolonged or obstructed labor that often results in the stigmatization and social isolation of women living with it.

But timely, skilled care can prevent both maternal deaths and injuries. While much work is ongoing to improve the quality of care at health facilities, these investments only go so far if the communities they serve don’t seek help there or understand the value of doing so. Changing attitudes and practices related to childbirth requires complementary strategies to educate families to recognize risks and danger signs during pregnancy and to engage communities more broadly to address the social, cultural, and logistical barriers that can limit women’s access to timely medical care.

Success in “community engagement” is precisely what has set the city of Kissidougou apart in its efforts to address fistula care over the last three years. In partnership with EngenderHealth, the Kissidougou mayor and city council sought to engage the population by spearheading several innovative community-driven initiatives, including the Village Safe Motherhood Committees. Since the initiative was launched in May 2009, 20 Village Safe Motherhood Committees have formed in 12 districts across the city, involving 64 women and 63 men. In addition to promoting healthy practices during pregnancy and childbirth, committee volunteers also identify women living with fistula and refer them to sites where they can receive services.

Another community-driven initiative that evolved in Kissidougou is a dedicated effort to provide social support to fistula clients following surgery through the use of “Waiting Homes.” Waiting Homes are spaces within host family compounds for women who are recuperating from fistula surgery, especially those who have experienced deep emotional distress due to the profound social isolation wrought by living with the condition for years. Here, for two to three weeks, families provide a caring environment in which women receive extensive counseling and psychosocial support that helps facilitate a smooth reintegration to community life. During this period of social reimmersion, fistula clients also receive training in public speaking and interpersonal communication to empower them to play a role in raising awareness about fistula and maternal health risks as they reintegrate into their communities.

To sustain the work being done for fistula, city leaders also crafted a strategy to improve the management and revenue-generating capacity of the central market in Kissidougou. As a result, the district’s revenue has increased more than 400 percent; a portion of the revenue is allocated toward public services, including 5 percent for fistula prevention, treatment, and reintegration.

Because of these efforts, hundreds of women in Guinea have had a second chance at life. Since 2005 when the Kissidougou District Hospital first began regularly treating fistula patients, more than 600 women have walked out of these doors with renewed dignity, hope, and wholeness. The community engagement solutions here have since become a model for others. They have been so effective at helping Kissidougou women recover from fistula, both physically and emotionally, that they have been replicated in Guinea’s Labé region.

Engaging communities in improving maternal health and survival takes time, and the success of such efforts depends on the commitment of multiple stakeholders, from hospital staff to the population to local leaders, whose political will and vision in this case were instrumental for success. The experience in Kissidougou is proof that investments like these can yield important long-term benefits for the health needs of entire communities.

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