UNFPA urges Nigeria to declare state of emergency on VVF

According to estimates, Nigeria currently has over 800,000 Vesico Vaginal Fistula (VVF) patients and 20,000 are estimated to be added to this number every year.
However, the United Nations Population Fund (UNFPA), an agency that supports Nigeria in the fight against the disease condition, repairs only about 100,000 patients annually.

Due to this, the UNFPA has said that Nigeria needs to declare a state of emergency  on the disease.

The issues confronting the Nigerian health sector are huge, ranging from massive cor­ruption and lackadaisical at­titude of the governments at all levels to hostile health professionals.

VVF is one of the the troubling issues.

VVF, according to experts, is a hole(s) resulting from the breakdown in the tissue be­tween the vaginal wall and the bladder or rectum caused by unrelieved obstructed la­bour, that is, a labour that last­ed more than 24 hours.

The consequences of such damage are urinary or faecal incontinence and related con­ditions. In extreme cases the urethra, bladder and vaginal wall can be completely eroded.

The presence of VVF in any country, experts say, is a clear indication that the country’s health systems is not working. By implication, it therefore means that with the increasing cases of VVF, Nigeria’s health system is weak.

Speaking with journalists last week, the United Nations Population Fund (UNFPA) Representative in Nigeria, Ra­tidzai Ndhlovu, regretted that the rising cases of VVF is an embarrassment to the gov­ernment and people of Nige­ria. She therefore called for the declaration of a state of emer­gency to tackle the situation.


There is an increase in women with Fistu­la in the north eastern states, especially in Internally Dis­placed Persons (IDPs) in Bor­no .

“VVF is an embarrassing situation for Nigeria. This is because Fistula is as a result of health systems that are not working very well. You don’t have the human resource, par­ticularly the midwives who provide skilled care during pregnancy, delivery and after delivery. If we have enough midwives stationed in all our primary health care centres with the things that are need­ed in the hospital and women go to deliver there, we will not have fistula.

“If people exercise good habits of bearing children, spacing children, not getting pregnant at tender age, if all that is done, it is possible to eradicate fistula.

“For me, Nigeria should be an example of countries that will eradicate fistula in Africa because it has the capacity to do that,” she said.


“Yes it is possible to erad­icate VVF. It is possible but the question is, are we ready to make it possible? We know what needs to done.

“For example, the Feder­al Ministry of Health has in­troduced the one function­al PHC in every ward, where each of these PHCs will have four midwives and the head of the PHC will be a midwife. That is excellent programme. If we make it work and we re­ally have one functional PHC in every ward in this country with all those midwives func­tioning and working and also helping the community to come get services from these PHCs, definitely, we will erad­icate these problem.

“If we also help the com­munities to understand that the use of family and contra­ceptives is just about quali­ty of life, getting a family that is happy including good food, good education up to the lev­els that your children can go, it will go a long way. Nigeria is blessed with intelligent peo­ple, all of them, but we lose all those intelligent young girls by the way side. We never support them to go to school.

“But we also need to address that beside the midwives, the health facilities and the is­sue of changing of what fami­ly planning is all about so that people can accept it with no fear. Family planning is just more than contraceptives.

“For me, it is possible to have zero case of Fistula in the country but people need to change their perception of planning their life which is family planning.”

On what the UNFPA is doing to assist the government of Ni­geria tackle the situation, she said: “We provide a lot of training, building the capacity of our doctors, we have trained over 90 doctors to be able to do fis­tula surgeries, we also trained nurses to be able to provide post operative attention or care to the women who have gone through the surgery.

“We provided capacity building of the health facilities themselves by providing them with the surgical kits for fistu­la just to make sure that they have all that is needed for fis­tula surgeries to take place.

“We do what is possible within the available resourc­es, but when you look at the needs and what we are doing, it seems so small even though we are doing so much.

“But why is it like that? We do so much in UNFPA but the needs continue to grow above what we can do. This is because we are not preventing more cases coming in. Our ef­fort is like pouring water into a bucket without a base.

“For me, we really need to see that the governments take it upon themselves to ensure that midwives who have been trained are not left to languish at home with no jobs. They are trained but they don’t get employed and at the end they leave the country or they just do other things apart from midwifery.”

Also speaking on the state of VVF in the country, the National Fistula Analysts of the UNFPA, Dr. Musa Elisha, advocated for the declaration of the state of emergency in the fight against VVF in the country.

“We need to declare a state of emergency in the entire Ni­geria, not just Borno State.

“In Nigeria, every day we have 55 new Fistula cases. We need to declare the state of emergency in the entire coun­try. Don’t forget that Fistula is a sign that the health system in the country is not working.

“Again, there are sociocul­tural issues that presuppose VVF including lack of ed­ucation for girls, early mar­riage and child birth and oth­er issues of harmful traditional practices in our communities. Until we tackle these practic­es all over Nigeria, Fistula will continue to remain an issue for us,” he noted.

He continued, “With the improvement in the secu­rity situation in Borno State, areas that were previously cut off are becoming more acces­sible and women are now able to come out from their commu­nities. Women who have fistula in the communities and people are not aware are now coming out which shows that there is an increase in women with Fistula in Borno State."

He disclosed that UNFPA has agreed to support the VVF centre in Borno state with equipment because the cen­tre have been abandoned since the insurgency started many few years ago.


"We are also collaborating with the Borno State branch of the Society of Obstetric and Gyneacologists of Nige­ria (SOGON) so that the cost of these repairs will be less for UNFPA."

“When we went there, we were able to count physically on the ground 25 women, but by the time we spent two days there, we already had 50 wom­en. It is obvious that the two doctors we have on ground are not able to contain with the in­creasing cases of women who are coming up with the con­dition. Again, we have plans on ground to support the state with expert surgeons who will now go and take care of the dif­ficult cases.

“For the long term plans we have for the state, we want to build the capacity of the resi­dent doctors in the state so that they will be able to manage those complex cases in which for now, they rely on UNFPA to handle.”

While reiterating that VVF has become a national chal­lenge in Nigeria, he lamented that: “We have fistula because even though we have the need­ed information on what causes Fistula, but we lack the politi­cal will to take action.”

Preventing Fistula, Elisha said, is the same thing as pre­venting maternal deaths be­cause they are related. “In Ni­geria, every day women die as a result of the pregnancy relat­ed complications; it is the so-called lucky ones that end up with Fistula. When the Fistu­la victim end up with leaking urine, smelling and suffer­ing from stigma, is she real­ly lucky?”