Provisional funding estimate · Model v0.1
Relieving suffering through fistula repair
A repair operation can relieve the physical discomfort and emotional distress associated with a fistula, an injury that can cause persistent incontinence. We estimate what support for Fistula Foundation could achieve.
Accepting donations; remaining funding gap unverified.
Checked 12 October 2026. This is a program-level scenario, without a confirmed next project or allocation.
USU relieved within the first year
≈7per $100 donated · Central scenario
days of substantial relief, summed across modeled patients
additional treatment courses with lasting relief
Gross later relief, counting postoperative days 91–365. The central calculation is 7.3 USU. Deaths prevented and surgical harms are unestimated. Fractional outcomes are expected averages, not a promise to fund part of a particular person’s care.
Our three scenarios give about 1.4, 7.3 and 26.8 USU per $100. These are WSI assumptions, not measured donation returns or statistical bounds. Actual additional benefit could be zero.
Why this opportunity
Relief matters even when lives saved are not counted
Some interventions prevent short, severe illnesses. Others relieve distress that persists day after day. Fistula repair makes this second kind of benefit visible: a modest average reduction in suffering can accumulate into a substantial benefit over time.
This is an early test of the same intensity × duration approach used throughout WSI. We count a change in suffering, rather than assigning a value to the diagnosis or assuming surgery removes every difficulty in a person’s life.
One USU is a stipulated six-hour kidney-stone pain reference of 47.25 intensity-hours. The reference is a convention, not an empirically established equivalence across conditions. How the unit works
Explore the estimate
What could your support help relieve?
Modeled benefit for $100
7.3USU relieved
7.2days of substantial relief
0.026courses with lasting relief
Central: $1,500 per procedure; 75% additional courses; 65% lasting relief; 2-point average intensity reduction. All scenarios credit 80% fistula care and 275 days of relief per relieved course.
Benefits scale linearly for illustration. A donation is not tied to an identified patient. We have not verified how much further funding can be used at this rate.
| Scenario | Cost / procedure | Additional courses | Lasting relief | Intensity reduction | USU relieved |
|---|---|---|---|---|---|
| Lower | $2,000 | 50% | 50% | 1 | 1.4 |
| Central | $1,500 | 75% | 65% | 2 | 7.3 |
| Higher | $1,000 | 100% | 80% | 3 | 26.8 |
“Additional courses” allows for treatment that would happen anyway, repeat procedures and allocation delays. “Lasting relief” is a provisional outcome fraction. The scenarios change several assumptions together; none is a confidence limit.
Follow the calculation
A few inputs, one visible calculation
Convert support into treatment
Use a broad $1,500 allowance per procedure. Count 80% as fistula care, then assume 75% becomes distinct additional treatment courses that otherwise would not happen within the credited year.
$100 ÷ $1,500 × 80% × 75%
= 0.040 additional treatment coursesAllow for incomplete relief
Assume 65% of those courses provide substantial relief throughout our credited window. We do not assign the full benefit to every operation.
0.040 × 65% = 0.026 courses with lasting relief
0.026 × 275 days = 7.15 relief daysEstimate the reduction in suffering
Assign a 2-point average reduction on the 0–10 intensity scale. This is one combined physical and emotional change, averaged across all hours, including sleep. We do not add separate scores for incontinence, pain and distress.
7.15 days × 24 hours × 2 intensity points ÷ 47.25
= 7.3 USU relieved per $100
The mathematical rule is unchanged: people × hours × change in average intensity ÷ 47.25, with linear weighting, p = 1. An avoided illness uses its full included course; relief uses the difference between the assumed untreated and treated experience.
The evidence and our choices
What supports these assumptions?
Cost: allow for more than the operation
Fistula Foundation reports $624 per patient for surgery, postoperative care and physical rehabilitation. That figure does not represent every organizational cost. [F1] Its 2025 audit records $24,023,353 in total expenses; it reports 19,577 surgeries that year, including related childbirth injuries. [F2] [F3]
Dividing those figures gives about $1,227 per reported procedure. This is an accounting comparison, not a measured cost of one more repair: grants, capacity-building and operations may fall in different periods, and partners can supply other resources. We round the central allowance upward to $1,500 and test $2,000 and $1,000. We do not add the $624 again.
Case mix: keep the first model focused
The charity says severe perineal tears account for about 20% of its surgical cases. [F1] We use the remaining 80% as an approximate fistula share, an assumption about future allocation. Benefits from tear repair remain outside this calculation. Changes in case mix would change the estimate.
Outcomes: relief can persist, but recovery is incomplete
A Ugandan study followed 60 women after fistula repair, with 58 assessed at one year. Roughly 61% reported no urinary incontinence at three months and 67% at one year. Physical symptoms and psychosocial measures generally improved, although some problems persisted. [F4]
We use 65% as a provisional fraction with substantial lasting relief. The study was small, had no untreated comparison group and was not a representative sample of today’s Fistula Foundation programs. Being continent also does not mean all suffering has ended. This supports an exploratory scenario, not a precise success rate for new donations.
Duration and intensity: deliberately simple judgments
We credit only days 91–365 after surgery, a 275-day window. That avoids projecting lifetime benefits from one-year follow-up. It does not establish that relief is constant, and it gives no credit for earlier improvement.
The central 2-point intensity reduction is our judgment, not a clinical finding. It represents a moderate average improvement while allowing residual symptoms and periods with little or no conscious distress. Lower and higher scenarios use 1 and 3 points. We do not convert a disability weight, depression score or quality-of-life scale into USU.
The 75% additional-course factor is also a judgment. Public evidence does not tell us how many distinct treatment courses the next donation would bring forward beyond other funding, repeat operations or care that would happen anyway. We test 50% and 100%; actual additional delivery may be lower, including zero.
What remains outside the number
Included
One combined physical and emotional reduction associated with fistula relief, in women receiving additional treatment through future programs. Only the selected postoperative window enters the estimate.
Unestimated
Surgical pain, complications and other adverse effects; relief in the first 90 days or after year one; partial improvement outside the credited group; tear repair; family, income and mortality effects.
This is gross later relief. Omitting surgical recovery from the credited period does not subtract its suffering. The result is not a complete net benefit or a guaranteed lower bound. Deaths prevented are unestimated, not zero.
The AMF analysis uses a different cost model and counts young-child malaria benefits from three years of net protection. This report counts selected relief in the first postoperative year. Their headlines alone cannot establish which use of money is better.
Funding snapshot · 12 October 2026
An active program, with funding need still to verify
Fistula Foundation is accepting general donations. Its September 2026 announcement of a new Uganda treatment network provides recent evidence of expansion. [F5] Neither establishes the remaining unfunded amount, the next marginal project or when a new donation would reach patients.
Support fistula treatment
The general donation link goes to Fistula Foundation. The charity determines allocation. Our model does not reserve a surgery, earmark support for Uganda or promise a particular result.
Donation options at Fistula Foundation →
Check the charity’s current plans before using this estimate for a large funding decision. The status here is a dated snapshot.
Inspect and improve
Sources and reproducible inputs
- Fistula Foundation: FAQsReported direct cost and approximate case mix. How much does it cost to treat obstetric fistula?; Can perineal tears be treated?
- Fistula Foundation: 2025 audited financial statementsOrganization-wide expense context; not a marginal-cost estimate. Statements of Activities, printed page 3 (PDF page 6), 2025 total expenses
- Fistula Foundation: 2025 resultsReported annual surgical volume, including related childbirth injuries.
- El Ayadi et al. (2019): Trajectories of physical and psychosocial health after fistula repairOne-year outcome context, not a controlled donation-impact study or a current portfolio average. Table 2 and discussion; 60-woman Ugandan longitudinal cohort
- Fistula Foundation: Uganda treatment network launchCurrent program activity; not proof of a remaining funding gap.
The most useful refinements would be a current unfunded delivery budget, cost per completed treatment course, one-year patient outcomes across partners, and a direct estimate of the change in experienced suffering. The source file keeps published facts separate from our choices.