Strengthening obstetric fistula care: an environmental scan of a comprehensive treatment program in Malawi

Obstetric fistula (OF) is a preventable childbirth injury caused by prolonged obstructed labor and is prevalent in sub-Saharan Africa. Women with OF often experience stigma, isolation, and economic challenges. Although global initiatives aim to eliminate OF, descriptive evidence on models of program delivery and strategies for community reintegration following OF repair remains limited. This study used Harris and Brooker’s six-step environmental scan framework to explore experiential knowledge related to an OF repair program in Malawi. Data included internal documents and key informant interviews with program staff. An inductive approach guided analysis, with recurring themes identified through collaborative review. The scan focused on outreach, program delivery, and reintegration components to inform future program development. The analysis of 24 documents and seven key informant interviews resulted in the identification of five themes: (1) awareness and education; (2) medical treatment and surgical repair; (3) comprehensive education and psychosocial support; (4) supporting reintegration; and (5) challenges in care delivery. The findings highlight a holistic and community-engaged model of care that extends beyond surgical repair to include education, psychosocial support, and reintegration strategies. Outreach efforts are central to increasing access and reducing stigma. Post-operative care must emphasize not only physical healing but also personal empowerment through literacy, vocational training, and counseling. Community reintegration initiatives support long-term independence. Despite successes, challenges such as funding instability, staffing shortages, and difficulties reaching rural and remote populations persist, limiting the scalability and sustainability of the program’s impact. This study highlights the importance of integrated, community-informed approaches to OF care. Findings emphasize the need for expanded awareness, mobile outreach, comprehensive reintegration services, and sustained investment in training and infrastructure. Embedding OF care within national health systems, rather than relying solely on external funding, is essential for long-term sustainability. The Malawi program offers a promising model that can inform future initiatives aimed at strengthening OF services across sub-Saharan Africa and similar global contexts.