Prevention and treatment strategies and interventions.

 RECOMMENDATIONS

  •  Ensure investments to enhance fundamental obstetric services; strengthen reproductive and maternal and newborn health-care systems with adequate well-trained, skilled medical personnel (i.e. midwives, doctors, surgeons, nurses and anaesthetists), infrastructure and supplies; ensure functioning quality assurance and monitoring mechanisms; and implement strategies to ensure timely access to safe and high-quality surgical repair, including during public health emergencies; 
  •  Implement and monitor human rights-based, gender-sensitive and multisectoral national strategies, policies, action plans and budgets to eliminate obstetric fistula by 2030. Plans and budgets must incorporate the prevention and treatment of fistula and the socioeconomic reintegration and follow-up of fistula patients into programming and budget for achieving the Sustainable Development Goals (including preventing child marriage and adolescent pregnancy and ending gender-based violence and gender inequality); 
  • Strengthen government-led national task forces for tackling fistula, to enhance national coordination and improve partner collaboration, including partnering with in-country efforts to increase high-quality surgical capacity and promote universal access to essential and life-saving surgery accompanied by quality assurance mechanisms to address the significant backlog of women and girls awaiting care, with the involvement of key ministries (e.g. for gender issues, social protection, finance and education); 
  • Ensure equitable access and coverage, by means of national plans, policies and programmes, to provide high-quality maternal and newborn health services, in particular emergency obstetric and newborn care, skilled birth attendance, timely and safe surgery, where needed, fistula treatment and family planning services that are financially, geographically and culturally accessible;
  •  Improve the quality of surgical training and obstetric health care in countries to prevent all types of fistulas; (f) Improve referral pathways, increase accessibility to fistula services, including through the provision, in strategically selected hospitals, of continuously available fistula services, and provide the full continuum of holistic care and followup of fistula survivors; 
  • Focus on universal health coverage to ensure universal access to the full continuum of care, including mental health care, in particular in rural and remote areas, through the equitable distribution of health-care facilities and trained medical personnel, collaboration with the transport sector to provide affordable transport, and the promotion of and support for community-based solutions; 
  • (h) Address the underlying determinants of health, such as gender discrimination and socioeconomic factors, that render women and girls more vulnerable to maternal morbidities;

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