Factors that impact the timely treatment of obstetric fistulas in Malawi: The perspective of health care providers

Background: In sub-Saharan African countries, women face a high risk of obstetric fistulas. In Malawi, the prevalence rate is 1 per 1000 women. Studies suggest that several obstacles exist that prevent obstetric fistula patients from getting timely treatment for their condition. Aim: The aim of this article was to find out the factors that delay the timely treatment of obstetric fistula patients at Malawian hospitals. Setting: The study was conducted at the Queen Elizabeth Central Hospital, a referral hospital, situated in Blantyre, Malawi, and the findings have been generalised to all the hospitals in Malawi. Methods: An exploratory case study, employing key interview questions, was used to provide insights into why there are delays in providing treatment and care for fistula patients. Purposive sampling technique was used to identify study respondents. Key informant interviews were conducted with 16 health care personnel at a hospital in Malawi. Results: The presence of numerous cases of complicated obstetric fistula cases overwhelms the health care system in Malawi. In addition, the severe shortage of staff, lack of obstetric fistula surgery training, low staff morale, inadequate infrastructure or equipment and water scarcity in the city of Blantyre contribute towards delayed treatment of fistulas at the hospitals. Conclusion: The presence of numerous cases of obstetric fistulas is overwhelming health services, and hence there is a need for devising and implementing health policies that will motivate Malawian health personnel to undertake obstetric fistula surgery and care

Promoting and prioritising reproductive health commodities: understanding the emergency contraception value chain in South Africa

Use of emergency contraception is low in South Africa despite high rates of unplanned and unwanted pregnancies. Existing studies have demonstrated that women access emergency contraception from commercial pharmacies rather than from public health facilities at no charge. Research has also demonstrated that awareness of emergency contraception is a key barrier to improving uptake, especially in the public health sector. This study investigates the low use of emergency contraception in South Africa and employs a qualitative value chain analysis to explore the role of market and regulatory structures in creating an enabling environment for the supply and promotion of emergency contraception. The results suggest that there are several 'market imperfections' and information barriers impacting on the effective supply of emergency contraception to women who are dependent on the public health sector for their health care. Balancing commercial interests with reproductive health needs, it is argued, may form a crucial part of the solution to the low uptake of emergency contraception in South Africa (Afr J Reprod Health 2010; 14[1]:9-20)