joint-aus-us-gov-review-hamlin-fistula-ethiopia-final-report.doc

Physical rehabilitation of ailments caused by fistula

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Physical rehabilitation of ailments caused by fistula is provided in all the fistula centres. The social reintegration of patients who had simple forms of fistula is showing encouraging results with successful pregnancies following the cure. However, the demand for social reintegration of fistula patients who had complex forms of fistula, requiring daily medical care for the rest of their lives, exceeds the available capacity. Prevention, as usual, is the best approach. Because most MNCH services are delivered through the public health system in Ethiopia, the opportunities and challenges of prevention lie largely with government policies and programs, significantly assisted by international agencies and civil society. Primary prevention is mostly about implementing the Family Code limiting the age at marriage to 18 years (not yet universally applied), improving education and nutrition of the girl child, delaying first pregnancy when the mother is immature (not yet accepted everywhere), and preventing high parity through family planning (long-acting methods). Secondary prevention, i.e. ensuring all pregnancies are safely delivered, is progressing (albeit relatively slowly) due to the placement of midwives and surgically skilled health officers in upgraded health centres. However, the coverage of births attended by skilled attendants was still less than 5% in rural areas in 2011 according to the EDHS, and the Caesarean section rate not higher than 1%. Tertiary prevention through the use of bladder catheterization after prolonged labour is still far from being generalized. Projections for the short (2015) and longer (2020) terms have been the subject of complex computations, taking into account the demographic growth, the past and current rates, and the progress of health services and human resources for health since 2005. In the best possible case scenario, assuming that all HSDP-IV and Road Map targets are reached, there should remain only 22,400 untreated fistula cases in the country in 2015 and 3,000 in 2020, with a projected elimination in 2021. In the worst case scenario, assuming no progress in the performance of the health services, there will remain 25,800 untreated fistula cases in 2015 and 13,800 in 2025, with no set date for elimination. It is likely that the true situation will fall between these extremes, with a remaining number of untreated fistula cases of 24,000 in 2015 and 8,400 in 2020. In this case, the elimination is envisaged in 2025. CONCLUSIONS AND RECOMMENDATIONS Thirty recommendations are presented in eight sections in the table below: AusAID Health Resource Facility 47 Managed by HLSP in association with IDSS
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AID and USAID Review of Support to Hamlin Fistula Ethiopia (Ethiopia) 31/05/2018 Services Order 230 Draft report Conclusions Recommendations 1. Fistula will continue in Ethiopia for at least another 10 years in the best case and 15 years in the most likely case (see scenarios).
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