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Manjate NJ, Martins JD, Amado R, Nhanombe A, Canana N, Cumbi L, Pires G, Muamine E, Cambe MI, Domingos A, Chicumbe S. Estimating the cost for obstetric fistula repair in hospitals of Mozambique: a low-income country. HEALTH ECONOMICS REVIEW 2024; 14:65. [PMID: 39186146 PMCID: PMC11346298 DOI: 10.1186/s13561-024-00542-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 07/24/2024] [Indexed: 08/27/2024]
Abstract
BACKGROUND Obstetric fistula is incident and prevalent in low-income countries. Globally, about 100,000 women develop fistula annually. In Mozambique, more than 2,000 fistulas are reported annually. A national strategy to combat obstetric fistula has been implemented in Mozambique from 2012-2020. This strategy is under review, making it opportune to generate evidence that reflects the course of the strategy implemented to subsidize/optimize the definition of priorities of the new strategy to achieve universal health coverage. In Mozambique, information on the costs incurred to treat fistula is scarce. This study aims to estimate the mean unit cost of repair/treatment of simple and complex obstetric fistula in Mozambique. METHODS We carried out a retrospective evaluation, from the provider's perspective, using the Ingredient and Stepdown approaches. The mean unit cost was obtained by the sum of individual and shared ingredients to treat fistula. Cost dimensions included Direct Medical Costs (personnel, drugs, and supplies), Overhead and Capital Costs (administration and capital assets' costs, respectively). The average exchange rate was USD 1 = MZN 61.47. Data were collected in secondary, tertiary, and quaternary hospitals of Zambézia and Nampula provinces in 2021. Costs borne by patients and their families and loss of productivity were not included. RESULTS The mean cost for Simple Obstetric Fistula repair was MZN 14,937.21 (USD 243) and Complex Obstetric Fistula was MZN 21,145.68 (USD 344) per person operated. Regardless of the type of fistula, the repair cost was MZN 18,072.18 (USD 294). CONCLUSION Without neglecting that prevention is better than plasty, the results show feasible levels of fistula repair costs for mobilization of funds. For the estimated 2,000 fistulas reported annually, the government needs an average MZN 36,144,360 (USD 588,000).
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Affiliation(s)
- Nelmo Jordão Manjate
- Programa de Sistemas de Saúde, Distrito de Marracuene, Instituto Nacional de Saúde de Moçambique, Estrada Nacional nº 1, Bairro da Vila - Parcela 3934, Província de Maputo, Moçambique.
| | - Janet Dulá Martins
- Programa de Sistemas de Saúde, Distrito de Marracuene, Instituto Nacional de Saúde de Moçambique, Estrada Nacional nº 1, Bairro da Vila - Parcela 3934, Província de Maputo, Moçambique
- Instituto de Higiene e Medicina Tropical da Universidade Nova de Lisboa, Lisboa, Portugal
| | - Regina Amado
- Instituto de Higiene e Medicina Tropical da Universidade Nova de Lisboa, Lisboa, Portugal
| | - Armindo Nhanombe
- Programa de Sistemas de Saúde, Distrito de Marracuene, Instituto Nacional de Saúde de Moçambique, Estrada Nacional nº 1, Bairro da Vila - Parcela 3934, Província de Maputo, Moçambique
| | - Neide Canana
- Malaria Consortium, Cidade de Maputo, Moçambique
| | - Laurentino Cumbi
- Programa de Sistemas de Saúde, Distrito de Marracuene, Instituto Nacional de Saúde de Moçambique, Estrada Nacional nº 1, Bairro da Vila - Parcela 3934, Província de Maputo, Moçambique
| | - Germano Pires
- Programa de Sistemas de Saúde, Distrito de Marracuene, Instituto Nacional de Saúde de Moçambique, Estrada Nacional nº 1, Bairro da Vila - Parcela 3934, Província de Maputo, Moçambique
| | - Elídio Muamine
- Programa de Sistemas de Saúde, Distrito de Marracuene, Instituto Nacional de Saúde de Moçambique, Estrada Nacional nº 1, Bairro da Vila - Parcela 3934, Província de Maputo, Moçambique
| | - Maria Isabel Cambe
- Programa de Sistemas de Saúde, Distrito de Marracuene, Instituto Nacional de Saúde de Moçambique, Estrada Nacional nº 1, Bairro da Vila - Parcela 3934, Província de Maputo, Moçambique
| | - Ausenda Domingos
- Fundo das Nações Unidas para População (UNFPA), Cidade de Maputo, Moçambique
| | - Sérgio Chicumbe
- Programa de Sistemas de Saúde, Distrito de Marracuene, Instituto Nacional de Saúde de Moçambique, Estrada Nacional nº 1, Bairro da Vila - Parcela 3934, Província de Maputo, Moçambique
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Bari K, Oliver VL, Abbas S, Marthias T, Kane S. The economic consequences of obstetric fistula: A systematic search and narrative review. Int J Gynaecol Obstet 2024; 166:238-249. [PMID: 38243609 DOI: 10.1002/ijgo.15370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Revised: 12/18/2023] [Accepted: 01/02/2024] [Indexed: 01/21/2024]
Abstract
BACKGROUND Obstetric fistula develops from obstructed labor and is a devastating condition with significant consequences across several domains of a woman's life. This study presents a narrative review of the evidence on the economic consequences of obstetric fistula. METHODS Three databases were searched, and search results were limited to English language papers published after 2003. Search results were reviewed for relevance based on title and abstract followed by full text review using specific inclusion and exclusion criteria. Bibliographies of papers were also scanned to identify relevant papers for inclusion. Data were extracted under three categories (defined a priori): the economic consequences of having the condition, the economic consequences of seeking care, and the macroeconomic impacts. RESULTS The search returned 517 unique papers, 49 of which were included after screening. Main findings identified from the studies include women losing their jobs, becoming dependent on others, and losing financial support when relationships are lost. Seeking care was economically costly for families or unaffordable entirely. There were no studies describing the impact of fistula on national economies. CONCLUSION Economic consequences of obstetric fistula are multifaceted, pervasive, and are intertwined with the physical and psychosocial consequences of the condition. Understanding these consequences can help tailor existing fistula programs to better address the impacts of the condition. Further research to address the dearth of literature describing the macroeconomic impact of obstetric fistula will be critical to enhance the visibility of this condition on the health agendas of countries.
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Affiliation(s)
- Kimiya Bari
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Victoria L Oliver
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Shazra Abbas
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Tiara Marthias
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Sumit Kane
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
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Rajagopal K, Pollaczek L, Chu J, Mann H. Measuring the cost-effectiveness of treating rectovaginal and vesicovaginal fistulas: A multicenter global study by the Fistula Foundation. Int J Gynaecol Obstet 2024; 165:480-486. [PMID: 38563795 DOI: 10.1002/ijgo.15502] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 02/22/2024] [Accepted: 03/10/2024] [Indexed: 04/04/2024]
Abstract
OBJECTIVE Surgery for obstetric fistula is a highly effective treatment to restore continence and improve quality of life. However, a lack of data on the cost-effectiveness of this procedure limits prioritization of this essential treatment. This study measures the effectiveness of fistula surgeries using disability-adjusted life years (DALYs) averted. METHODS In 2021 and 2022, the Fistula Foundation funded 20 179 fistula surgeries and related procedures at 143 hospitals among 27 countries. We calculated DALYs averted specifically for vesicovaginal fistula and rectovaginal fistula procedure types (n = 13 235 surgeries) by using disability weights from the 2019 Global Burden of Disease study. We based cost calculations on direct treatment expenses, including medical supplies, health provider fees, and preoperative and postoperative care. We measured effectiveness using data on the risk of permanent disability, country-specific average life spans, and treatment outcomes. RESULTS The total treatment cost was $7.6 million, and a total of 131 433 DALYs were averted. Thus, the cost per DALY averted-the cost to restore 1 year of healthy life-was $58. For this analysis, we took a cautious approach and weighted only surgeries that resulted in a closed fistula with restored continence. We calculated DALYs averted by country. Limitations of the study include data entry errors inherent in patient logs and lack of long-term outcomes. CONCLUSION The current study demonstrates that obstetric fistula surgery, along with having a significant positive impact on maternal health outcomes, is highly cost-effective in comparison with other interventions. The study therefore highlights the benefits of prioritizing fistula treatment as part of the global agenda for maternal health care.
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Affiliation(s)
| | | | - Jesse Chu
- Fistula Foundation, San Jose, California, USA
| | - Hannah Mann
- Fistula Foundation, San Jose, California, USA
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Manjate NJ, Sitoe N, Sambo J, Guimarães E, Canana N, Chilaúle J, Viegas S, Nguenha N, Jani I, Russo G. Testing for SARS-CoV-2 in resource-limited settings: A cost analysis study of diagnostic tests using different Ag-RDTs and RT-PCR technologies in Mozambique. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001999. [PMID: 37310935 DOI: 10.1371/journal.pgph.0001999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 05/09/2023] [Indexed: 06/15/2023]
Abstract
Early diagnosis of SARS-CoV-2 is fundamental to reduce the risk of community transmission and mortality, as well as public sector expenditures. Three years after the onset of the SARS-CoV-2 pandemic, there are still gaps on what is known regarding costs and cost drivers for the major diagnostic testing strategies in low- middle-income countries (LMICs). This study aimed to estimate the cost of SARS-CoV-2 diagnosis of symptomatic suspected patients by reverse transcription polymerase chain reaction (RT-PCR) and antigen rapid diagnostic tests (Ag-RDT) in Mozambique. We conducted a retrospective cost analysis from the provider's perspective using a bottom-up, micro-costing approach, and compared the direct costs of two nasopharyngeal Ag-RDTs (Panbio and Standard Q) against the costs of three nasal Ag-RDTs (Panbio, COVIOS and LumiraDx), and RT-PCR. The study was undertaken from November 2020 to December 2021 in the country's capital city Maputo, in four healthcare facilities at primary, secondary and tertiary levels of care, and at one reference laboratory. All the resources necessary for RT-PCR and Ag-RDT tests were identified, quantified, valued, and the unit costs per test and per facility were estimated. Our findings show that the mean unit cost of SARS-CoV-2 diagnosis by nasopharyngeal Ag-RDTs was MZN 728.00 (USD 11.90, at 2020 exchange rates) for Panbio and MZN 728.00 (USD 11.90) for Standard Q. For diagnosis by nasal Ag-RDTs, Panbio was MZN 547.00 (USD 8.90), COVIOS was MZN 768.00 (USD 12.50), and LumiraDx was MZN 798.00 (USD 13.00). Medical supplies expenditures represented the main driver of the final cost (>50%), followed by personnel and overhead costs (mean 15% for each). The mean unit cost regardless of the type of Ag-RDT was MZN 714.00 (USD 11.60). Diagnosis by RT-PCR cost MZN 2,414 (USD 39.00) per test. Our sensitivity analysis suggests that focussing on reducing medical supplies costs would be the most cost-saving strategy for governments in LMICs, particularly as international prices decrease. The cost of SARS-CoV-2 diagnosis using Ag-RDTs was three times lower than RT-PCR testing. Governments in LMICs can include cost-efficient Ag-RDTs in their screening strategies, or RT-PCR if international costs of such supplies decrease further in the future. Additional analyses are recommended as the costs of testing can be influenced by the sample referral system.
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Affiliation(s)
| | - Nádia Sitoe
- Instituto Nacional de Saúde, Marracuene, Mozambique
| | - Júlia Sambo
- Instituto Nacional de Saúde, Marracuene, Mozambique
| | | | | | | | - Sofia Viegas
- Instituto Nacional de Saúde, Marracuene, Mozambique
| | | | - Ilesh Jani
- Instituto Nacional de Saúde, Marracuene, Mozambique
| | - Giuliano Russo
- The Wolfson Institute for Population Health, Queen Mary University of London, London, The United Kingdom
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Katabogama JB, Mpirimbanyi C, Cyuzuzo T, Muvunyi V, Urimubabo C, Rickard J. Costs Associated With Surgical Infections at a Tertiary Referral Hospital in Rwanda. J Surg Res 2022; 280:94-102. [PMID: 35964487 DOI: 10.1016/j.jss.2022.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 06/04/2022] [Accepted: 07/08/2022] [Indexed: 11/30/2022]
Abstract
INTRODUCTION In low-income and middle-income countries, there is a high demand for surgical care, although many individuals lack access due to its affordability, availability, and accessibility. Costs are an important metric in healthcare and can influence healthcare access and outcomes. The aim of this study was to determine the financial impact of infections in acute care surgery patients and factors associated with inability to pay the hospital bill at a Rwandan referral hospital. MATERIALS AND METHODS This was a prospective observational study of acute care surgery patients at a tertiary referral hospital in Rwanda with infections. Data were collected on demographics, clinical features, hospital charges, and expenses. Factors associated with inability to pay the hospital bill were analyzed using Chi-squared and Wilcoxon rank sum tests. RESULTS Over 14 mo, 191 acute care surgery patients with infections were enrolled. Most (n = 174, 91%) patients had health insurance. Median total hospital charges were 414.24 United States Dollars (interquartile range [IQR]: 268.20, 797.48) and median patient charges were 41.53 USD (IQR: 17.15, 103.09). At discharge, 53 (28%) patients were unable to pay their hospital bill. On a univariate analysis actors associated with inability to pay the bill included transportation via ambulance, occupation as a farmer, diagnosis, complications, surgical site infection, and length of hospital stay. On a multivariable analysis, intestinal obstruction (adjusted odds ratio 4.56, 95% confidence interval 1.16, 17.95, P value 0.030) and length of hospital stay more than 7 d (adjusted odds ratio 2.95, 95% confidence interval 1.04, 8.34, P value 0.042) were associated with inability to pay the final hospital bill. CONCLUSIONS Although there is broad availability of health insurance in Rwanda, hospital charges and other expenses remain a financial burden for many patients seeking surgical care. Further innovative efforts are needed to mitigate expenses and minimize financial risk.
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Affiliation(s)
| | | | - Thierry Cyuzuzo
- University of Rwanda, College of Medicine and Health Sciences, Kigali, Rwanda
| | - Vital Muvunyi
- University of Rwanda, College of Medicine and Health Sciences, Kigali, Rwanda
| | - Christian Urimubabo
- University of Rwanda, College of Medicine and Health Sciences, Kigali, Rwanda; Department of Surgery, University Teaching Hospital of Kigali, Kigali, Rwanda
| | - Jennifer Rickard
- University of Rwanda, College of Medicine and Health Sciences, Kigali, Rwanda; Department of Surgery, University Teaching Hospital of Kigali, Kigali, Rwanda; Department of Surgery, University of Minnesota, Minneapolis, Minnesota.
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6
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Werner K, Lin TK, Risko N, Osiro M, Kalanzi J, Wallis L. The costs of delivering emergency care at regional referral hospitals in Uganda: a micro-costing study. BMC Health Serv Res 2021; 21:232. [PMID: 33726738 PMCID: PMC7961167 DOI: 10.1186/s12913-021-06197-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 02/19/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Uganda experiences a high morbidity and mortality burden due to conditions amenable to emergency care, yet few public hospitals have dedicated emergency units. As a result, little is known about the costs and effects of delivering lifesaving emergency care, hindering health systems planning, budgeting and prioritization exercises. To determine healthcare costs of emergency care services at public facilities in Uganda, we estimate the median cost of care for five sentinel conditions and 13 interventions. METHODS A direct, activity-based costing was carried out at five regional referral hospitals over a four-week period from September to October 2019. Hospital costs were determined using bottom-up micro-costing methodology from a provider perspective. Resource use was enumerated via observation and unit costs were derived from National Medical Stores lists. Cost per condition per patient and measures of central tendency for conditions and interventions were calculated. Kruskal-Wallis H-tests and Nemyeni post-hoc tests were conducted to determine significant differences between costs of the conditions. RESULTS Eight hundred seventy-two patient cases were captured with an overall median cost of care of $15.53 USD ($14.44 to $19.22). The median cost per condition was highest for post-partum haemorrhage at $17.25 ($15.02 to $21.36), followed by road traffic injuries at $15.96 ($14.51 to $20.30), asthma at $15.90 ($14.76 to $19.30), pneumonia at $15.55 ($14.65 to $20.12), and paediatric diarrhoea at $14.61 ($13.74 to $15.57). The median cost per intervention was highest for fracture reduction and splinting at $27.77 ($22.00 to $31.50). Cost values differ between sentinel conditions (p < 0.05) with treatments for paediatric diarrhoea having the lowest median cost of all conditions (p < 0.05). CONCLUSION This study is the first to describe the direct costs of emergency care in hospitals in Uganda by observing the delivery of clinical services, using robust activity-based costing and time motion methodology. We find that emergency care interventions for key drivers of morbidity and mortality can be delivered at considerably lower costs than many priority health interventions. Further research assessing acute care delivery would be useful in planning wider health care delivery systems development.
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Affiliation(s)
- Kalin Werner
- Division of Emergency Medicine, University of Cape, Cape Town, South Africa.
| | - Tracy Kuo Lin
- Department of Social and Behavioral Sciences, Institute for Health & Aging, University of California, San Francisco, San Francisco, CA, USA
| | - Nicholas Risko
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Martha Osiro
- Division of Emergency Medicine, University of Cape, Cape Town, South Africa
| | | | - Lee Wallis
- Division of Emergency Medicine, University of Cape, Cape Town, South Africa
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Navarro SM, Sibiya A, Nourian MM, Stewart KA, Ottesen TD, Price RR. Addressing Supply Chain Management Issues in Cost-effective Maternal and Pediatric Global Surgery: A Call to Action. Int J MCH AIDS 2020; 9:77-80. [PMID: 32123631 PMCID: PMC7031878 DOI: 10.21106/ijma.295] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Persistent global disparities in maternal and neonatal outcomes exist, in part, due to a lack of access to safe surgery. This commentary examines the relative need for increased focus on access to safe maternal and pediatric surgery globally, starting with a focus on cost-effective surgeries. There is a need to understand context-specific surgeries for regions, including understanding regional versus tertiary development. Most important is a need to understand the crucial role of supply chain management (SCM) in developing better access to maternal and pediatric surgery in limited resource settings. We evaluate the role of SCM in global surgery and global health, and the current landscape of inefficiency. We outline specific findings and takeaways from recent solutions developed in pediatric and maternal surgery to address SCM inefficiencies. We then examine the applicability to other settings and look at the future. Our goal is to summarize the challenges that exist today in a global setting to provide better access to maternal and pediatric surgery and outline solutions relying on structural, SCM-related framework.
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Affiliation(s)
- Sergio M Navarro
- Department of Surgery, Baylor College of Medicine, Houston, TX, USA.,Said Business School, University of Oxford, Oxford, UK.,Global Surgery Student Alliance (GSSA), Boston, MA, USA
| | - Andile Sibiya
- Said Business School, University of Oxford, Oxford, UK
| | - Maziar M Nourian
- Global Surgery Student Alliance (GSSA), Boston, MA, USA.,Department of Anesthesia, Vanderbilt School of Medicine, Nashville, TN, USA
| | - Kelsey A Stewart
- Department of Obstetrics and Gynecology, University of Minnesota, Minneapolis, MN, USA
| | - Taylor D Ottesen
- Global Surgery Student Alliance (GSSA), Boston, MA, USA.,Department of Orthopedics and Rehabilitation, Yale University School of Medicine, New Haven, CT, USA
| | - Raymond R Price
- Center for Global Surgery, University of Utah, Salt Lake City, UT, USA
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Mantey R, Kotoh AM, Barry M, Redington W. Womens' experiences of living with obstetric fistula in Ghana-time for the establishment of a fistula centre of excellence. Midwifery 2019; 82:102594. [PMID: 31874317 DOI: 10.1016/j.midw.2019.102594] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 11/06/2019] [Accepted: 12/01/2019] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To explore the experiences of women living with Obstetric Fistula in Ghana. DESIGN A descriptive qualitative design involving face-to-face semi-structured interviews following institutional ethical approval. SETTING Urban and rural setting in the Mfantseman Municipal Area (MMA) in the Central Region (CR) of Ghana PARTICIPANTS: A purposive sample of thirty- two women who had experienced obstetric fistula (OBF) FINDINGS: Three core themes emerged and these were i) Women's perceptions of OBF, ii) Experiences of women living with OBF iii) Coping strategies of women living with OBF CONCLUSION AND IMPLICATIONS FOR PRACTICE: There is a need for a multi-agency coordinated approach to the treatment and management of OBF in Ghana. The findings support the need for a dedicated specialist fistula centre to treat women and to meet the educational needs of health care professionals with strategies to prevent as well as support women with OBF. The hub and spoke organisation design for health care systems has proved beneficial in other health settings providing a level of quality that would not be possible otherwise. It is time to end the suffering of women living with obstetric fistula.
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Affiliation(s)
- Rose Mantey
- Mercy Women's Catholic Hospital and Obstetric Fistula Centre Mankessim, Ghana.
| | - Agnes M Kotoh
- Department of Population, Family and Reproductive Health, University of Ghana School of Public Health, P. O. Box LG 13 Legon. Ghana.
| | - Maebh Barry
- Department of Nursing & Midwifery, University of Limerick, Ireland.
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