Fistula surgeon training initiative focuses on enabling surgeons to manage obstetric fistula, involving a multi-year effort to train surgeons through training programs at accredited fistula center “Koohi Goth Fistula Hospital Karachi”. The initiative offers training through competency-based skill development. Training is structured into three levels of competence, starting with simple cases and advancing to high-complexity repairs, focuses on a competency-based, hands-on approach to managing, preventing, and repairing genital fistulae, with the passage of times the candidate reaches to grant certification who can independently repair fistula. The training based on the standardized manuals, mentorship, and logbooks to ensure proficiency in vaginal repairs, with a focus on high-quality care, team-based holistic support, and proper post-operative assessment.