The manuals and the protocol are the first national training packages and guideline respectively for healthcare providers on management of obstetric fistula, pelvic organ prolapse and gender-based violence.
The Government of Nepal has unveiled its first ever competency-based training manuals on pelvic organ prolapse(POP) and obstetric fistula as well as a clinical protocol on gender-based violence (GBV).
POP (also called uterine prolapse or fallen womb) is a bodily condition in which pelvic muscles can no longer adequately support organs in the pelvic area and is a significant reproductive morbidity in Nepal. Obstetric fistula - one of the most serious injuries of childbearing - is a hole in the birth canal, caused by prolonged and obstructed labor due to lack of timely and adequate medical care, early or closely spaced pregnancies.
The manuals and the protocol are the first national training packages and guideline respectively for healthcare providers on management of POP, obstetric fistula and GBV. They were developed by the Ministry of Health and Population (MoHP) with technical and financial assistance fromUNFPA, the United Nations Population Fund, and also with Jhpiego's technical support.
In the absence of a competency-based training package on POP, health service providers previously did not have standards for performing surgeries and were relying on anecdotal reports, compromising on the quality of care. With the training package, service providers are now expected to have comprehensive knowledge about this condition that affects many adult women today on how to provide quality care. The Nepal Demographic Health Survey (NDHS 2011) showed 6 percent women of reproductive age group (15-49 years) suffer from POP.
Similarly, the country was in great need of a competency-based training package on obstetric fistula. Due to lack of such training manual, it was challenging to ensure the availability of competent service providers who could manage this condition and provide proper surgical, medical and psychological care to the women living with fistula developed during childbirth or due to other causes.
Many fistula cases remain hidden in Nepal due to lack of knowledge about its treatment and shame associated, arriving at accurate prevalence datacontinues to be a challenge.
Likewise, as health care providers are often the first professional contact for GBV survivors, it is important that they have the required competencies to deal with them in a health setting. The NDHS 2011 showed that among women (15-49 years), 22 percent experience physical violence and 12 percent sexual violence at least once.
However, health service providers had not been equipped to provide the best possible care to GBV survivors. The clinical protocol aims at empowering health care providers to identify GBV survivors, manage cases and make appropriate referrals. The protocol will also help conduct a clinical assessment of GBV survivors, provide appropriate treatment, preserve medico-legal evidences and report the findings to an appropriate level.
The training packages and the protocol were unveiled on November 6 amid an event attended by MoHP Secretary Shanta Bahadur Shrestha, senior officials from the ministry, UNFPA Deputy Representative Kristine Blokhus and officials from several government agencies, hospitals, academia, development partners and Jhpiego.
Video: Obstetric Fistula in Nepal