Fistula Can Be Fabulous
After being healed of obstetric fistula, women receive livelihood training to enable them to battle stigma and provide for their families.

What problem does your idea solve?
Obstetric fistula is a debilitating injury caused by obstructed labor, resulting in a hole (fistula) and persistent incontinence. Fistula can cause chronic infection and isolation from society. In Uganda, many efforts have been made in recent years to improve access and quality of treatment and facilities, and some focus on prevention education. The Ministry of Health encourages rehabilitation activities, but few efforts have been implemented, so establishing best practices is difficult.Explain your idea

Who benefits?


How is your idea unique?
Participants are typically sustenance farmers, making home life a difficult place to heal after surgery. As the only organization working to provide fistula treatment in southeastern Uganda, a catchment area of approximately 4,000 square mile, UVP would be closing the gap in services for fistula patients. Other organizations treating fistula in Uganda do not include a comprehensive reintegration program. The only other organization focused on reintegration at the same level of UVP implements a model that provides services on an outpatient basis, requiring women travel to a central location to partake in activities. Our approach alleviates many of the cost prohibitive activities associated with that model, such as travel. The Ministry of Health suggests reintegration activities happen in a patient’s home area. UVP’s approach can provide a case study on a different model to compare with current efforts, potentially leading to policy changes.Tell us more about you

What are some of your unanswered questions about the idea?
How can we turn the items made by the women during the program into a business to keep patients employed longer-term? If we establish a "business" side of the program, how can we work to ensure the activities are sustainable financially to avoid needing additional funding for the program and still allow for expansion? What type of outcomes of the program would we need to measure in order to prove this approach is more impactful or effective than other programs implemented?Where will your idea be implemented?
- Uganda
Experience in Implementation Country(ies)
- Yes, for more than one year.
Expertise in Sector
- I've worked in a sector related to my idea for more than a year.
Organizational Status
- We are a registered non-profit, charity, NGO, or community-based organization.
Idea Maturity
- Piloting: I have started to implement my solution as a whole with a first set of real users.
How has your idea changed based on feedback?
As a result of feedback from multiple stakeholders, we closely examined why we chose to host women away from their homes. From their answers, we can confidently move forward with our model, knowing it is serving our beneficiaries in the intended way. Based on discussions with former participants, patients, and staff, we added mechanisms for longer term support: programming that follows up with individual participants and ongoing education for participants to ensure continued learning. The process has also allowed us to dream a little bigger. With limited resources, we generally focus on our catchment area, but the human-centered design had us thinking about the larger opportunity to serve women across Uganda in coordination with other organizations, ideally in a standardized way.Who will implement this idea?
If we expand the program to accept more participants and partnered with other organizations to conduct multiple programs at one time, UVP would need two full-time people dedicated to coordinating up to 4 different sites across Uganda. The sites will be situated to be near common fistula camp locations in both eastern and western Uganda. The Managing Director will also be supporting this program part-time by providing financial oversight.Using a human-centered design approach, you may uncover insights that lead to small or foundational changes to your organization’s existing strategy or processes in order to unlock the potential of your idea. How would your organization go about making such changes?
Smaller programmatic changes can be implemented without prior notice to the Executive Board. These small decisions will be discussed with the Executive Director to ensure the shift does not breach the scope of the project or exceed financial resources. Larger foundational shifts will be presented and discussed in a monthly Board meeting and voted on by eligible members. In addition to continuing to utilize the human-centered design approach, we will create M&E logic framework in order to measure our impact and guide future programmatic shifts.What is it that most attracted you to Amplify instead of a more traditional funding model?
UVP measures the impact of our various programs utilizing both quantitative and qualitative M&E tools. The Amplify approach using human-centered design is the best way for us to expand our tools used to refine and create new iterations of programming. We respect and appreciate the insight that these exercises provide to ensure we are reaching our intended beneficiaries in a way that is most impactful.What challenges do your end-users face? (1) What is the biggest challenge that your end-users face on a day-to-day, individual level? (2) What is the biggest systems-level challenge that affects your end-users?
Our participants face great economic challenges upon returning home; inflation can increase food costs; as subsistence farmers, environmental issues like drought can cause food instability and shortage; women may return from surgery still incontinent, making it difficult to hold a consistent job, if she were to find one. Also, there are lingering effects from surgery that can require multiple visits to the health center in the 12–24 months after surgery that requires money for transport and medication. Additionally, if she runs her own business, it can be difficult for her to be there consistently if she is frequently visiting the health center, thus affecting her clientele. If her husband has abandoned her, she is then supporting children with minimal income.Tell us about your vision for this project: (1) share one sentence about the impact you would like to see from this project in five years and (2) what is the biggest question you need to answer to get there?
IMPACT: Establish reintegration programs associated with every fistula surgery camp at the 6 locations nationwide, being able to accept any willing woman to participate in the program, by 2023. QUESTION: How can we encourage autonomy of this program among multiple providers while ensuring consistent and sustainable program delivery and continuous program improvement, and provide the service to every willing woman treated for fistula in order to decrease the prevalence of fistula in Uganda?How long have you and your colleagues been working on this idea together?
- Between 6 months and 1 year
How many of your team’s paid, full-time staff are currently based in the location where the beneficiaries of your proposed idea live?
- Under 5 paid, full-time staff
Is your organization registered in the country you intend to implement your idea in?
- We are registered in all countries where we plan to implement.
My organization's operational budget for 2016 was:
- Between $100,000 and $500,000 USD
3 comments
Join the conversation:
CommentOpenIDEO