NEW YORK, United States – Mama Hadija, now in her 60s, had grown accustomed to living in shame. Over 25 years ago, in the rural town of Morogoro, Tanzania, Ms. Hadija experienced a prolonged, obstructed labour. The ordeal caused her to develop an obstetric fistula, a form of internal damage that results in incontinence, stigma and isolation.
The continued occurrence of obstetric fistula is a global health tragedy. The injury is preventable with the help of a skilled attendant during delivery, such as a doctor, nurse or midwife who can recognize complications and provide, or seek, emergency care.
It is also often treatable, but because it affects women lacking access to basic health care, those who experience this condition are often burdened by it for years – or, like Ms. Hadija, decades.
Women with fistula are often shunned by their communities. For a long time, Ms. Hadija lived apart from her family, in a small hut, alone.
A life-changing innovation
Only 49 per cent of women in Tanzania give birth with the assistance of a skilled attendant, according to the most recent State of the World Population report. The country sees over 3,000 new fistula cases annually, and it is widely estimated that there have been 24,000 to 30,000 fistula cases in the last 10 years.
In the coastal city of Dar es Salaam, the Comprehensive Community-Based Rehabilitation Hospital in Tanzania (CCBRT) provides free fistula repair surgeries. Yet transportation costs are an enormous barrier to care for women in rural areas.
Ms. Hadija’s family had heard about the programme, but the cost of transport from Morogoro was simply unaffordable.
UNFPA and the CCBRT Hospital launched an innovative initiative in 2009 to reach rural women like Ms. Hadija. This programme uses the M-Pesa mobile banking system – a service offered by the telecommunications company Vodafphone – to send transport fare to patients via mobile phones.
Ambassadors for health
To identify and assist these women, the CCBRT Hospital has community ‘ambassadors’ who find and reach out to women living with fistula. In Morogoro, a community ambassador named B'hango Lyangwa identified Ms. Hadija in February 2010.
Using his mobile phone, provided by CCBRT, Mr. Lyangwa called the hospital to explain the situation. When it was determined that Ms. Hadija would be a candidate for the fistula repair programme, the hospital sent transport funds to the ambassador via the M-Pesa mobile banking system.
With Ms. Hadija, Mr. Lyangwa visited an M-Pesa location, where the funds were dispersed. He then escorted Ms. Hadija to the bus depot, ensured she got on the bus, and made sure the driver understood where she was going and whom she would meet.
Community ambassadors receive a small incentive payment for their services.
Mobile phones a critical tool
A few weeks later, Ms. Hadija had received a successful surgery and was recovering at the CCBRT Hospital’s fistula ward.
The programme helped increase by 65 per cent the number of women able to access fistula surgery in 2010, according to CCBRT. And the numbers kept climbing, from 268 in 2010 to 500 in 2012.
The M-Pesa referral programme is now funded by Vodafone, and UNFPA continues to work with CCBRT to support services for fistula survivors. For example, a hostel, refurbished with assistance from UNFPA, provides free meals and accommodation to patients awaiting surgery.
And the CCBRT Hospital is not alone in its efforts to serve fistula survivors using mobile phones. The Freedom from Fistula Foundation in Kenya is using mobile funds and community education to provide free fistula repair surgeries. And the Aberdeen Women's Centre in Sierra Leone has launched a toll-free hotline to provide information and care options to women living with fistula.
The popularity of mobile phones – expected to reach a 1 billion subscribers by 2015 – is proving to be a critical resource in the effort to end fistula and give women like Ms. Hadija a new chance at life.
– Lisa Russell