Unlike the indicator, “Met need for emergency obstetric care”, where UNICEF/WHO/UNFPA has set the minimum acceptable level of “met need” as 100 percent, no minimum acceptable level of “met need” has been established for OF surgical treatment, which is likely to be just under 100 percent. A small percentage of OF cases (particularly complex rectovaginal fistulas) are inoperable because of patient comorbidity or disease-related factors.  A small number of other OF cases do not require surgical treatment because they are simple, small, and the woman presents for care immediately after delivery (within a few hours or at most, days).  These situations make up the minority of OF cases diagnosed at facilities and generally do not have a significant impact on the actual percentage of “met need”.  However, among facilities with high case loads of OF repairs, evaluators may choose to exclude these cases from the denominator.

Analysis of this indicator over time can be used to assess significant changes in programs. Reductions in met need that were once high should prompt closer examination of changes in staff, treatment protocols, availability of essential medicines and supplies, etc. Comparison of the indicator across facilities may reflect facility-specific issues that require improvement.

Furthermore, meeting a women’s need for surgical repair of an OF is just one aspect of the treatment and healing process.  Because each OF patient has emotional, psychological, and economic needs, this indicator should be complemented with the indicator, “Percent of women who have been treated for obstetric fistula who receive reintegration services” to gauge the full range of care provided to women presenting with an OF.