Case study: Action on Fistula

Challenge

Astellas wanted to identify how best to create a corporate giving initiative which would leverage its expertise in urology and commitment to building access to medicines. Working with Forster Communications it ran a strategic review and identified obstetric fistula, a condition caused by prolonged obstructed labour, leading to faecal or urinary incontinence or both.

While virtually eradicated in developed countries, there are an estimated two million untreated cases of obstetric fistula globally (WHO). Alongside physical suffering, women with fistula are often stigmatised because of constant and humiliating odour which in many cases drives their family, friends and neighbours away.

The condition provided a clear opportunity for action, being an area of unmet need where few companies were involved and where Astellas could make a significant impact.

It then located a geographical area to focus its efforts. Kenya was selected as fistula was a significant issue there, particularly in rural communities: the United Nations Population Fund (UNFPA) estimates 3,000 new cases of fistula occur annually. But, it also had sufficient infrastructure to run a programme; analysis identified that Kenya had existing hospitals with spare beds but a need for more trained fistula surgeons.

Results

Action on Fistula has transformed the landscape for fistula treatment in Kenya in enduring ways.

It has given 2,363 women with obstetric fistula life-changing reconstructive surgery, surpassing the three -year target by an impressive 97%. One woman treated had waited a staggering 51 years for surgery.

The programme has created a long-lasting legacy in the treatment of patients with obstetric fistula far beyond its three-year duration. It significantly increased surgical capacity in Kenya to treat the condition, by training six fistula surgeons to global competency standards set by the International Federation of Gynecology and Obstetrics.

It also set up a Fistula Treatment Network to extend access to services, with seven treatment centres across Kenya providing fistula surgeries on a routine basis. With greater access to treatment, closer to where they live, women are no longer placed on waiting lists to receive surgery, nor are they forced to travel vast distances for treatment. The network of sites and surgeons work closely together, sharing information and resources, and creating a strong community of practice that will be sustained far beyond the duration of the Action on Fistula initiative.

To ensure women living with fistula in rural communities can be identified and helped, Action on Fistula is running a major outreach programme, and training community workers to identify and encourage patients to access treatment. Through the programme, five local organisations have trained 222 community health workers, conducted 6,545 outreach activities and reached 412,000 community members in 43 of Kenya’s 47 counties.

As part of its innovative outreach approach the campaign has:

• Established a national fistula hotline where an operator screens potential fistula patients and, if they meet the threshold, refers the clients to the nearest treatment centre. It has received 839 calls from 33 Kenyan counties, resulting in the successful referral of 88 patients
• Educated 1,600 healthcare providers on fistula signs and symptoms and referral methods, enhancing awareness at health centres close to where women live. The programme revealed awareness of fistula is very low, even within the healthcare system. After education, 20% of hotline callers were referred through the health facilities
• Distributed over 20,000 calendars and posters in English and Swahili to healthcare facilities, community centres, government offices and public places, showing the signs and symptoms of fistula, and indicating facilities where women in need of treatment should be referred. In addition, T-shirts, key chains, notepads and bracelets with the campaign logo and telephone hotline have been distributed throughout target areas, to raise awareness of fistula and the programme
• Formed partnerships with 15 media houses in Kenya that broadcast fistula messages on the radio, reaching across the country. The radio spots have included prerecorded public service announcements, as well as live talk shows where listeners can call in to get more information.

A rolling internal and external communications campaign has resulted in 80 pieces of media coverage with a circulation of 95.1 million, and employees fundraising €23,187 across 12 countries to provide vital treatment and care for additional women with fistula.

Client verdict

“Astellas’ investment in Fistula Foundation has done something truly transformational, not just for Kenya but for the field of fistula treatment. More facilities in Kenya now provide routine fistula treatment, more surgeons are delivering this care, and more communities know that this devastating injury exists, and that it can be treated for free,”

Kate Grant, CEO, Fistula Foundation