Photo Credit: Alexandre Bonneau-Afroto/ALIMA
Expanding High-quality Fistula Surgery Access Throughout Tanzania
Country: Tanzania
Amount: $1,501,188
Duration: 2 years
Problem
An estimated one million women in low-income countries suffer from obstetric fistula. Obstetric fistula is a devastating childbirth injury, usually caused by prolonged, obstructed labor without adequate medical help. It leaves women incontinent (unable to control urine or feces) and often socially ostracized. In Tanzania, as in many parts of Africa, hundreds of new fistula cases occur each year, yet most of these women cannot access the surgery that would cure them. Fistula not only causes chronic medical issues like infections and skin ulcers, but also immense psychological trauma—women are frequently shunned due to odor and inability to bear more children.
The tragedy is that fistula is treatable: a surgical repair, costing a few hundred dollars, can often completely restore continence and health. However, barriers abound: there is a shortage of trained fistula surgeons, many women in remote areas never find out that help is available, and even if they do, traveling to a hospital is expensive and difficult. Hospitals themselves may not prioritize fistula repairs because they are focused on emergency cases or more routine services. As a result, thousands of Tanzanian women remain untreated, suffering needlessly for years or decades.
Approach
Fistula Treatment Network Expansion: Our grant supports the Fistula Foundation to scale up its innovative Treatment Network Model in Tanzania. Instead of one-off surgeries, this model creates a coordinated countrywide network of hospitals, surgeons, and community outreach to find and treat women with fistula systematically. Over the next two years, the expansion project will:
Provide over 3,000 fistula repair surgeries to women who need them. These surgeries will be performed at multiple hospitals across Tanzania that are part of the network. The grant covers costs like surgical supplies, hospital fees, and patient transportation, ensuring the surgeries are free for the women.
Train and mentor 16 additional fistula surgeons. By increasing the number of skilled local surgeons, the model builds long-term capacity. Trainees include existing Tanzanian doctors (often younger obstetricians or surgeons) who will learn fistula repair techniques through supervised surgeries. This grows the pool of experts who can continue serving women beyond the project period.
Expand the network of partner hospitals by 50%. This means recruiting more hospitals into the program, especially in underserved regions. Each network hospital agrees to dedicate time and space for fistula camps or regular fistula surgery lists. They also commit to follow best practices (like having a ward for recovery and proper postoperative care). The network model coordinates these facilities so that if one region has a waitlist, patients can be referred to another where capacity is available.
Enhance patient outreach: The project also bolsters efforts to identify and refer women with fistula. This includes community education through local radio, women’s groups, and health workers so that women know treatment exists. Patient transportation and accommodation are arranged to eliminate cost barriers. In essence, the network “finds” the patients and supports them through the whole journey to being healed.
Path to Scale
The model is designed for scalability by establishing a countrywide network of fistula care, increasing surgeon capacity, and developing repeatable referral pathways that streamline access to treatment.
By strategically identifying underserved regions, training local surgeons, and strengthening hospital partnerships, there is long-term sustainability beyond donor funding.
Why we think the grant is cost-effective
Fistula surgery is one of the most cost-effective health interventions, costing $786 on average, and the cost per DALY averted is $73. The project will avert 32,992 DALYs.
Because fistula typically affects women who are in their twenties, a successful surgery will provide a woman with 40+ years of healthy life.