CONNECTING fistula patients to life changing free treatment through mobile money has been a fundamental initiative implemented by Vodacom Foundation aimed at empowering women and alleviating poverty in the society.
Fistula inhibits women’s ability to work and to interact within communities, driving them deeper into poverty and further undermining their economic and social positions.
In most cases, fistula can be treated with surgery but many women in Tanzania cannot afford the cost of accessing medical help. Corporations around the world have joined the fight against obstetric fistula in response to international pleas on combating the condition.
This has resulted in significant contributions made towards treatment and its eradication by a number of organisations. The Vodacom Foundation is supporting the government efforts to improve access to health services in the country, and curb related maternal deaths.
The Vodacom Foundation is the corporate social investment arm of Vodacom Tanzania. As part of its policy to tackle maternal health challenges in the country, in 2012 Vodacom Tanzania Foundation joined forces with Comprehensive Community Based Rehabilitation in Tanzania (CCBRT) to provide obstetric fistula treatment.
CCBRT’s programme also empowers former patients of obstetric fistula through entrepreneurship training programmes at its Mabinti Centre. One of the beneficiaries of the project is Prisca, a 36 years old woman living in Kasulu District, Kigoma Region, far north-west of Tanzania.
She is the mother of six children and lives with her husband, a smallscale farmer. One day, her husband came home to find her in severe labour pains of her sixth pregnancy. He quickly rushed her to the nearest health centre and after a twelve hour struggle, she gave birth to a healthy baby boy.
However, a week after giving birth, her joy was cut short when she started experiencing something strange: she could not control her bowels. Disheartened by her condition, Prisca began to isolate herself. Her husband noticed that she had become more withdrawn and confronted her.
After disclosing her condition, her husband was shocked, thinking that perhaps she was not cleaning herself properly. He then began to see that it was a major problem. Having no knowledge about her condition, Prisca completely stopped interacting with her friends and relatives and though she received help from village elders, the condition prolonged.
Three years after, her neighbour told her that Kabanga Mission Hospital in the nearby town of Kasulu could assist women with problems like hers. This information prompted Prisca and her husband to seek help from a nearby health centre, which ultimately referred her to Kabanga Hospital, a CCBRT partner site in Kasulu, for fistula surgery.
Since her successful treatment, Prisca has re-integrated with her family and community. However, not every woman is as fortunate as her. CCBRT is a health care organisation that works to prevent disability, provide affordable medical and rehabilitative services, and aid the empowerment of people with disabilities and their families in Tanzania.
It also seeks to prevent disability through early identification by strengthening the maternal and newborn health system throughout Dar es Salaam.
CCBRT’s fistula programme uses an innovative technology platform, M-PESA - Vodacom’s mobile financial solution to arrange payments for transportation of patients from across the country, including rural areas where affected women usually reside, for treatment at CCBRT hospital, or a partner facility across the country.
CCBRT can transfer funds via mobile phones to a network of ambassadors in communities who identify women with fistula and provide the woman’s bus fare to travel to Dar es Salaam or a CCBRT satellite hospital for treatment.
A large number of former patients who have recovered from fistula become ambassadors of the programme. According to the Director of Vodacom Tanzania Foundation, Rosalynn Mworia, since 2012, Vodacom provided a toll-free number 0800 752 227 for use by patients and referrals for fistula treatment.
“For over 19 years, ambassadors of the fistula treatment initiative identify women with obstetric fistula in their communities and refer them for treatment at CCBRT hospital. This is done free of charge by using a Vodacom’s toll- free number. When the patient arrives at the hospital, the ambassador receives a small incentive, again via M-PESA,” she says.
So far, the Vodacom Foundation has paid for over 3,000 women to receive obstetric fistula treatment at CCBRT. This system has been very successful in reaching patients in peripheral areas who would otherwise have lacked a chance to receive treatment and enrich their lives.
Elaborating on the power of using digital communication on Vodacom’s Supa-network, Mworia says, “Across Africa, cell phones are rapidly pushing the boundaries of what’s possible. From an isolated rural village, an expectant mother can learn about antenatal care.
A business owner can make a bank deposit through her phone. A farmer can access current crop prices. The potential is endless.” Now, in Tanzania, cell phones offer a chance of treatment to women living with obstetric fistula – a painful and often ostracizing condition that follows prolonged and obstructed childbirths, causing chronic incontinence and even paralysis.
According to Mworia, Vodacom Tanzania Foundation also has supported CCBRT’s entrepreneurship programme for recovered fistula patients. The Mabinti Centre is an entrepreneurial centre that trains former fistula patients in handcrafts such as sewing and screen-printing.
This initiative has enabled former patients to return home both cured and with a skill set, that enables them to engage in incomegenerating activities.
“Once the women start their businesses, follow-up support in the form of home visits and coaching sessions is provided by Mabinti Centre staff for one year after graduation. The purpose of this initiative is to cure the patient and have a lasting impact on recovered patients and their communities,” Mworia says.
Since 2007, the Mabinti Centre has trained over 100 women - many of whom still work at the centre, further honing their skills and receiving a sustainable income on the production line. She also mentioned that apart from CCBRT, the Foundation has also partnered with other hospitals to tackle broader underlying contextual factors that translate into poor maternal and child health outcomes in the country.
The partnership has provided financial assistance to Obstetric Fistula patients to CCBRT satellite hospitals, such as Kilimanjaro Christian Medical Centre (KCMC), Selian Lutheran Hospital, Songea Regional Hospital, to name a few.
Utilizing Vodacom Tanzania MPESA mobile money system, CCBRT can transfer funds via mobile phones to a network of communities’ advocates who identify women with Obstetric Fistula and cover the woman’s transportation costs to the hospital.
The Foundation, in collaboration with CCBRT, has also trained traditional birth attendants in preventative aspects of maternal health. As a result, lives are being saved. In 2007, CCBRT and the Government of Tanzania formed a Public-Private Partnership to facilitate construction and operation of a new maternity and newborn hospital with CCBRT as the champion for the project.
The objective is to treat-high risks pregnancies and provide comprehensive emergency obstetric care in order to reduce disability incidents related to maternal health and prevent newborn deaths.
Vodacom Tanzania Foundation through its mother company Vodafone Foundation UK contributed 8bn/-for the construction, equipping and preparation of the maternity and newborn hospital- at CCBRT in its mobilizing maternal health phase two focused on the prevention of maternal deaths in the country.
The newly constructed hospital will have the capacity to perform 12, 000 deliveries per year. Such service will be integrated into the regional healthcare system as a referral hospital facility. Brenda Msangi is the Chief Executive of CCBRT.
She acknowledges that CCBRT’s partnership with the Vodacom Foundation has provided needed support for women suffering from fistula.
“Since the start of the project, the number of patients referred for treatment has increased rapidly. In the first year that M-PESA was introduced into our referral system, we saw a 65 per cent increase in the number of women treated for obstetric fistula. The network of fistula ambassadors has also expanded to all regions of the country. In 2016, about 87 per cent of obstetric fistula patients were referred via M-PESA. This means that ambassadors played their roles to their best level,” Msangi commented.
Many women in Tanzania lose their lives on the often long and arduous journey to a health facility, or may find themselves in a facility that is understaffed and ill-equipped to respond appropriately to preserve their lives. Although considerable progress has been made to ensure that women survive childbirth, basic maternal healthcare remains a significant challenge.
Furthermore, there is a dire need for knowledge of cautionary symptoms that prompt women to seek timely healthcare. Women play a fundamental role in human progress and have a significant place in society. As mothers their position is unique because they bear and bring up children with extreme care.
Indeed, a child’s first school is his/her mother’s lap. However, a number of factors can hinder a woman’s development by inhibiting her full potential and interrupting her daily functions. Fistula is one of the most debilitating conditions that affects thousands of women in Tanzania.
It is a serious health problem prevalent in low income countries where many women give birth without sufficient medical assistance, or do not reach a hospital in time. The World Health Organisation (WHO) estimates that two million girls and women live with fistula worldwide.
Additionally, 50,000 - 100,000 new cases occur each year. In Tanzania alone it is estimated that approximately 3,000 new cases of obstetric fistula occur each year however, only a third (about 1,000) get treated. Moreover, awareness of obstetric fistula is still low in developing countries.
Currently, the Vodacom Tanzania Foundation has supported over 120 projects in the country, investing over 14bn/-in the process. Other big projects include building 34 classrooms equipped with 1,035 desks, providing and connecting over 300 computers in secondary schools across the country and helping 7,931 women with zero-interest loans to support their enterprise projects.
It is time for the World to heed the call made by United Nations Member States in the 2018 United Nations Resolution on ending fistula - in which they committed to eradicate the distressing condition within a decade. Achieving this goal requires increased investment, innovation and partnerships - and the Vodacom Foundation is leading the way in this.