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Campaign to End Fistula - UNFPA




September 7, 2011 - In Tanzania, maternal health care is free of charge but many women, particularly in rural areas, can’t even afford transportation to a hospital. Mobile phones are offering a solution. The United Nations Population Fund, UNFPA, supports a project that facilitates access to fistula treatment by transferring money through SMS to cover travel expenses to a clinic. This is one of a number of UNFPA projects that use communication technology to improve maternal health care in developing countries.

In unexpected ways, mobile phones have become efficient tools in development aid. In poor and remote areas, where communication and infrastructure are usually limited, mobile phones are more often available—and networks more reliable— than, for instance, computers or the Internet.

UNFPA, an international development agency that promotes reproductive health and rights, supports several projects that use mobile phone technology to improve maternal health care—m-health.

In Tanzania, women who live with obstetric fistula, a severe childbirth injury caused by prolonged obstructed labour, can pay for their travel to a clinic through SMS money transfers. In Rwanda, mobile phones are used by health workers to alert in case of a maternal health emergency. In Mali, m-health will be used as a monitoring tool to feed information from the field into national data bases.

Text messaging to travel in Tanzania

In developed countries, obstetric fistula is essentially unheard of, but in Tanzania, where about half of all deliveries take place at home, often without any help from skilled birth attendants and far from health facilities, the problem is widespread. Nearly 4,000 new cases of fistula occur every year throughout the country; about 2 million women are estimated to live with the condition in the world.

Fistula can, in most cases, be repaired with surgery. But for women who don’t receive treatment, the condition leads to chronic incontinence, a constant leaking of urine and/or feces. Apart from the physical damage, fistula creates a considerable social and psychological burden. Fistula makes it almost impossible to work: because of the odor, survivors are often abandoned by their families and communities.

A clinic in the capital Dar es Salaam provides fistula treatment for free, but many women can’t afford to travel there from the remote areas where obstetric care is harder to come by and injuries of childbirth more common. The mobile phone initiative provides a longed-for solution. The number of patients who have received fistula treatment has more than doubled at the Comprehensive Community Based Rehabilitation in Tanzania (CCBRT), with UNFPA support.

“I had gone to various hospitals to ask about treatment, but they all told me they couldn’t do it,” said a 31-year-old woman who arrived at the clinic in Dar es Salaam. “An ambassador in my village explained that the hospital in Dar es Salaam could send money [for transport] through the phone and then I could come for treatment.”

The system is fairly simple. The amounts required to cover travel expenses are sent through SMS to mobile phones that have been previously distributed to ‘fistula ambassadors’—often health workers or former patients—in different parts of the country. The ambassadors retrieve the money at the local mobile phone agency and pay for the patient’s trip. When the patient reaches the hospital, the ambassador receives a small incentive via the same system.


In Rwanda, another project involving mobile phones has been very successful. As an alert tool, the phones are used to send SMS text messages requesting emergency assistance. Between March and May 2010, about 500 community health workers in a country-side pilot district received mobile phones and accessed training through the Rapid-SMS project, supported by UNFPA, UNICEF and the World Health Organization.

Thanks to the project, women in remote areas were able to receive emergency care much faster, and the number of ante-natal care attendances and deliveries at the facility increased.

“I sent a text and after that they gave me feedback; in 15 minutes the ambulance came,” said a community health worker in Musanze, Northern Rwanda. It saved the life of a woman and her newborn son. She needed emergency obstetric care at the time of delivery; if it had not been for the availability of the mobile phone system, she would have had to be carried to the nearest health facility, a journey that could take more than one hour in the most precarious conditions.

As in many developing countries, maternal health care is often deficient, and pregnancy and childbirth can mean major risks for women’s health and lives. Every year approximately 1,000 women die from pregnancy-related causes. About 80 per cent could have been saved if they had received adequate health care, according to UNFPA.

The international community has agreed on a development goal—MDG 5—to reduce maternal deaths by three quarters between 2000 and 2015. However, among eight other goals, this is the farthest from being achieved.

Mobile phones to collect data

It is important to get an overview of the problem to be able to adequately plan interventions. Maternal health-related data is essential, and mobile phones have proven to be very useful when it comes to its collection.

This is the focus of the Rapid-SMS project in Rwanda. About 75 per cent of all pregnancies in a pilot district were registered through SMS and relevant information related to the number of successful deliveries, complications during pregnancy and maternal and neonatal deaths were reported from remote areas through mobile technology.

A similar project will take place in Mali, a country where maternal and child death rates are very high. Apart from feeding important data into national data bases, mobile phones will be used to monitor contraceptive stock-outs and availability of life-saving drugs, keeping stocks updated.