DEADLINE: 11TH JANUARY, 2023
SUSTAINABLE FAMILY HEALTHCARE FOUNDATION (SFHF)
REQUEST FOR PROPOSAL FOR BASELINE/NEEDS ASSESSMENT, RESOURCE MAPPING AND CONTEXT ANALYSIS OF OBSTETRIC FISTULA (IDENTIFICATION OF FISTULA & PERSONS WITH DISABILITIES (ADULT & CHILDREN)/VSLA) IN FCT WITH DESK REVIEW OF CONTEXT IN OTHER TARGET STATES (KATSINA, KEBBI, ZAMFARA AND SOKOTO)
BACKGROUND INFORMATION
Obstetric fistula is a complication that arises from obstructed or prolonged labor, which creates a hole or opening in the birth canal. Prolonged obstructed labor that does not receive prompt medical care stops the blood supply to the tissues of the vagina, bladder, and/or rectum. Unrelieved obstructed labor can compress a woman’s bladder, urethra, rectum, and vaginal wall between the foetal head and maternal pubis leading to necrosis of the compressed tissues. Necrosis then causes uncontrolled leakage of urine from the bladder through the vagina (vesico-vaginal fistula) and leakage of stool from the rectum (NDHS 2018). Studies have shown that most fistula occur in countries in sub-Saharan Africa or South Asia with poorly resourced health systems.
The World Health Organization (WHO) estimates that between 50, 000 to 100, 000 women worldwide develop obstetric fistula each year. In the “National strategic framework for the elimination of obstetric fistula in Nigeria (2019-2023)”, the Federal Ministry of Health stated that Nigeria accounts for 40% of the worldwide
fistula prevalence with approximately 150,000 to 200,000 cases and 12,000 new cases yearly in Nigeria, which makes a disproportionate 7.5% of this global burden. According to the 2008 Nigeria Demographic and Health Survey (NDHS), the prevalence history of leaking urine among women aged 15-49 years, which was approximated to represent the prevalence of fistula, is 0.4%. Although, the majority of Obstetric Fistula can be surgically closed, and continence regained, about 10% of Vesico-Vaginal Fistula (VVF) remain incontinent in spite of the closure of the fistula because of involvement of the urinary sphincter (Ozge Tuncalp et al; 2014).
The causes of obstetric fistula are not far-fetched, ranging from poverty, early child marriage, inadequate infrastructure at government owned and mission facilities, low literacy levels, socio-cultural and religious sentiments, and low political will to drive the health agenda across states in Nigeria. Moreover, survivors of fistula have limited access to economic empowerment opportunities, they are poor and are more susceptible to abuse, harassment and discrimination due to reliance majorly on their spouses, family and or care givers
for support. More so, they have limited access to quality and affordable health care services, as there is inadequate equipment, unskilled and or inadequate health care workers to improve health outcomes of those affected by fistula. In some communities, women and girls with fistula cases are ostracized and kept at the mercy of others due to socio-cultural undertones associated with the scourge of fistula.
Worst hit by the incidence of fistula are the clusters of women and girls with disabilities who have poorer health outcomes due to stigmatization, discrimination, inaccessible and non-inclusive health facilities that promote their sexual and reproductive health rights. The WHO estimates that persons with disabilities are three times more likely to be denied health care. Thus, the urgency for funding and intersectoral collaboration to bridge the gaps. Moreover, considering that the country still grapples with the effect of the COVID-19
pandemic on healthcare delivery, which has seen a 10% decline in sexual and reproductive health (SRH) services; it is more important than ever to ensure that persons with disabilities are included and integrated into the Sexual Reproductive Health (SRH) service delivery in Nigeria.
Project Description
The first phase of the Comprehensive and Inclusive Women’s Health Project in Nigeria (CIWHIN) was implemented for 3 years (January 2020-December 2022) in Nigeria with funding from Australian Government’s Department of Foreign Affairs and Trade, CBM Australia, CBM New Zealand and CBM UK, and
implemented by the Sustainable Family Healthcare foundation (SFHF). The project focused on promoting rights and access to Sexual and Reproductive Health services for Women and Girls including Persons with Disabilities in Nigeria, through community sensitization, demand creation and health system strengthening for Maternal and Newborn Health and Fistula care.
The evaluation report of the first phase of the project gave rise to the need to scale up the project to sustain the gains achieved and to engender ownership and sustainability, hence, the CIWHIN + project. The new phase has a project period of four years and commenced in April 2023.
SCOPE OF WORK
The focus, scope and depth of the study should be in line with the project’s outline and should recognize the political, economic, and cultural context of the target area councils in FCT to be covered by the project. The study will assess the level of readiness of the health systems and community-based structures in the project intervention wards in FCT and other target states to deliver and support quality obstetric fistula services, including behavioral patterns that influence access to existing prevention, treatment and rehabilitation services that are inclusive for women and girls with obstetric fistula. The scope of work will also target men, women, girls and boys including men, women, girls and boys with disabilities and also provide an analysis of the situation in terms of access to quality health services (maternal and child health, sexual and reproductive
health, fistula, and mental health) economic empowerment and livelihood through Village Savings and Loan Associations (VSLA) within the area councils in focus. This will entail service availability and accessibility mapping in the project locations.
