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capacity for obstetric fistula training, treatment and rehabilitation services at the country and regional levels. • The Campaign is committed to reinforcing south-south cooperation to promote the sharing of knowledge and skills, treatment and training, the development and implementation of national media and communication approaches, and the integration of best practices. Lessons Learned: • Fistula survivors are highly effective in raising awareness at all levels – testifying to the impact of treatment on maternal morbidity and the quality of women’s lives, and adding a new voice to maternal and reproductive health advocacy. The engagement of fistula survivors as advocates sheds light on the reality of this obstetric complication, contributing helpful information for more effective safe motherhood programming. Background Information: Obstetric fistula is a hole in the birth canal caused by prolonged, obstructed labour without prompt medical intervention; it is a tragic result of very low levels of access to and uptake of emergency obstetric care. A woman living with fistula is left with chronic incontinence and, in most cases, a stillborn baby. The smell of leaking urine or feces, or both, is constant and humiliating, often driving loved ones away. Left untreated, fistula can lead to chronic medical problems, including ulcerations, kidney disease, and nerve damage in the legs. Women with fistula can face economic, social and psychological damage. The courage women show in the face of such challenges is extraordinary. Surgical intervention can often treat the injury, with success rates as high as 90 percent when performed by experienced surgeons. The average cost of fistula treatment and post-operative care is approximately $300. Sadly, many women with the condition do not know that treatment is available or cannot afford it. Unfortunately, there are minimal data about, analyses of and comprehensive responses to this avoidable condition that brings suffering to so many women. While accurate prevalence data are scarce, it is estimated that at least 2 million women in Africa, Asia and the Arab regions are living with the condition, and some 50,000 to 100,000 new cases develop each year. The persistence of fistula is a signal that health systems are failing to meet the needs of women, especially the most marginalized – the young, poor, illiterate and rural. As a result, they have remained invisible and the issue largely neglected. Fortunately, the means to prevent and to treat fistula are well understood. Prevention – the ultimate goal – consists in universal access to high quality and accessible maternal health care services, including family planning, skilled birth attendance and emergency obstetric care. Reconstructive surgery can mend the injury and, with comprehensive care to address the social consequences, most women can resume full and productive lives. The overall goal of the Campaign to End Fistula is to make obstetric fistula as rare in the developing world as it is in the industrialized by 2015, in line with the MDG targets to improve maternal health. To date, 47 countries in Africa, Asia and the Arab States have joined the Campaign to End Fistula. The Campaign is working to build the evidence base and capacity for fistula-related interventions, to raise awareness, to facilitate international and regional partnerships, and to mobilize political and financial support. For the five-year period of the Campaign (2006 – 2011), the budget is US$78,133,000 for national, regional and global funding requirements. To date, more than $34 million has been mobilized toward the total budget. Implementation Partners: The primary implementing partners are Governments (Ministry of Health and other relevant ministries) with support from UNFPA in cooperation with other UN agencies, such as WHO, International NGOs, like EngenderHealth and others, regional and national NGOs and academic institutions. Contacts: Katherine Gifford UNFPA Tel: 1-212-297-5353 E-mail: gifford@unfpa.org 56 MDG Good Practices
MDG-5: Improve Maternal Health MDG target 5.A: Reduce by three quarters the maternal mortality ratio MDG target 5.B: Achieve, by 2015, universal access to reproductive health Constraint: Low Utilization of Reproductive Health Services by Remote Populations Poor quality of antenatal care along with shortfalls in procurement of equipment and commodities for reproductive health care Mongolia’s Support to the 3rd National Reproductive Health Programme 2007 – 2011 includes advocacy, technical and logistical support to formulate and implement a national strategy to improve reproductive health. This also includes financial support for capacity development and procurement of reproductive health commodities, including equipment and contraceptives. Components: • Improved quality of antenatal care (ANC) through the introduction of clinical pathways in antenatal care services; • Promotion of mobile reproductive health services and outreach activities to reach remote and vulnerable populations; • Increased syphilis testing through strengthening laboratories at the district level; • Skill-building of service providers to manage complications of pregnancy and childbirth, obstetric ultrasound, and cervical pathology; • Allocation of national funds for procurement of contraceptives in the government budget; • Construction of new building for maternity services in some provinces; • Upgraded medical equipment for maternal and newborn health; • Conducted National 2008 Reproductive Survey with wealth of data for programme monitoring and evaluation. Results: • The Maternal Mortality Rate (MMR) decreased from 69.7 per 100,000 live births in 2006 to 49 in 2008. • Increased first-trimester ANC coverage to 82 percent. • Increased syphilis testing of pregnant women. • Increased deliveries at facilities with comprehensive Emergency Obstetric Care services. • Increased capacity of service providers. • Increased government share in procurement of reproductive health commodities. Key Elements of Success: • Continued advocacy for reproductive health commodity security (RHCS) at all levels. • Strong coordination among WHO, UNFPA, ADB and GTZ to provide optimal support. • Persistent efforts to strengthen national capacity at all levels. • Favorable economic development until 2007 and the first half of 2008 before the financial crisis hit the country. Lessons Learned: • Introduction of special subsidies for poor pregnant women, such as vouchers, requires a high degree of inter-sectoral collaboration. • The telemedicine approach for maternal and newborn health shows great potential for success in countries like Mongolia that are challenged by vast distances and underdeveloped roads. Background Information: This programme is the Third National Reproductive Health Programme, which is synchronized with the UNFPA’s 4th Country Programme (2007 – 2011). Funding for the programme came mainly from the government. MDG Good Practices 57
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Foreword A decade has passed since
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