DAR ES SALAAM, Tanzania — Across Africa, cell phones are rapidly pushing the boundaries of what’s possible. From an isolated rural village, a business owner can make a bank deposit through her phone; a farmer can access current crop prices; and an expectant mother can learn about antenatal care. And now, in Tanzania, cell phones offer a chance of treatment for women living with obstetric fistula – a painful and often ostracizing condition that follows prolonged and obstructed childbirths and causes chronic incontinence and even paralysis.
In most cases, fistula can be treated with surgery, but many women in Tanzania cannot afford the cost of accessing medical help. Using cell phones, Tanzania’s largest provider of fistula surgery – Comprehensive Community Based Rehabilitation in Tanzania (CCBRT) – is breaking down this barrier.
Six women from Mbeya, including this 20-year-old, received treatment through CCBRT. Photo: Lisa Russell
An estimated 3,700 new cases of obstetric fistula occur in Tanzania every year, but only about 1,000 get treated. “Sadly, most women living with the condition do not know that treatment is available, or they just can’t afford it,” explains CCBRT’s Chief Executive Officer, Erwin Telemans, who is also responsible for the mobile phone initiative.
Fistula surgery is free, but other costs present a barrier
At their hospital in Dar es Salaam, CCBRT provides fistula surgery free of charge, but the high cost of transportation and accommodation still prevented fistula survivors in remote villages from seeking treatment. So CCBRT came up with a solution. Using Vodafone’s mobile banking system M-PESA (M for “mobile” and PESA for “money” in Swahili), the institution sends money to fistula survivors to cover travel costs to the hospital in Dar es Salaam for their repair surgery.
The money is sent via SMS to fistula volunteer ambassadors, who may be former patients, health workers, or staff of nongovernmental organizations, to identify and refer women suffering from fistula for treatment. The ambassadors retrieve the money at the local Vodafone M-PESA agent and buy bus tickets for the patients. When the patient arrives at the hospital, the ambassador receives a small incentive, again via M-PESA.
A network of assistance
“The ambassador called the CCBRT hospital, received the money for the tickets, and then he got us the bus tickets,” says a 20-year-old fistula patient in Mbeya. “There were six of us, so we took a bus from Mbeya to Mbongo, where there was a CCBRT driver waiting to pick us up.”
Since the start of the project, the fistula ambassadors’ network has expanded to all regions of the country, and the number of women who have been able to access fistula surgery has increased by 65 per cent. Between January and December 2010, 54 ambassadors referred 129 women for fistula repair via M-PESA, with almost half of the cases treated at CCBRT.
“I had gone to various hospitals to ask about treatment, but they all told me they couldn’t do it,” says a 31-year-old fistula patient in Mbeya. “An ambassador explained that the CCBRT hospital could send money through the phone and then I could come for treatment.”
This 31-year-old woman from Mbeya tried to get treatment at several hospitals before she found out about the CCBRT programme. Photo: Lisa Russell
Accommodating women before and after surgery
In order to overcome lodging costs, which is the second biggest barrier to accessing fistula treatment, UNFPA is supporting the renovation and equipping of a building near the hospital to accommodate women who are waiting for or recovering from surgery.
“Many women travel long distances to get treated. Having the capacity to offer special accommodation to women with fistula enables us to treat many more patients. It also helps encourage those who don’t have the resources or are too embarrassed to lodge elsewhere to seek treatment,” says Mr. Telemans.
An agreement recently signed between CCBRT and the Kabanga Hospital will allow the establishment of a fistula centre in the Kigoma Region, 1,000 kilometres from the capital. The new centre will help reduce travel to quality treatment facilities and will address the high prevalence of fistula in the region. The centre will start operations in June 2011.
Pregnant teens face higher risks
According to the latest United Nations statistics, Tanzania is one of 11 countries that together account for 65 per cent of all maternal deaths worldwide. Every fourth woman who dies during pregnancy in Tanzania is a teenager—more than half the girls in the country get pregnant before they turn 19.
Birthing decisions are often made by the husband or mother-in-law, who may favour traditional practices. “A quarter of Tanzanian women would use family planning if they had access to it and had the support of their husbands and communities. This would be one step toward healthier and less risky pregnancies and labour, helping reduce vulnerabilities associated with maternal deaths and disabilities like fistula,” says UNFPA Representative, Ms. Julitta Onabanjo.
Only half of births take place in health facilities
Adding to this stark reality, nearly half of all births in Tanzania currently take place outside a health facility. “Women might have to travel for many hours—even days—by bus, donkey cart or on foot to reach a hospital or medical centre. It is often too late for a safe delivery by the time they get there,” Ms. Onabanjo adds.
Even when the woman reaches a hospital in time, the facilities are often ill-equipped or under-staffed and cannot provide the care they need, particularly if there are complications. Basic emergency obstetric and neonatal care is only available in about 5 per cent of Tanzania’s health centres.
Although health services for pregnant women are free, there are other indirect costs and charges that they need to meet. With 34 per cent of Tanzanians falling below the poverty line, these costs are often too high. “That’s where M-PESA is making a difference,” says Ms. Onabanjo.