Taking stock of reproductive health inhumanitarian settings: Preliminaryfindings from the 2012-2014 globalevaluation
Sandra Krause
Women’s Refugee Commission
On behalf of the
Inter-agency Working Group on ReproductiveHealth in Crises
Inter-agency Working Group (IAWG)on Reproductive Health in Crises
1994: Refugee Women and Reproductive HealthCare: Reassessing Priorities.
1994: International Conference on Populationand Development Programme of Action
1995: Formation of the IAWG on ReproductiveHealth (RH) in Crises
Inter-agency Working Group (IAWG)on Reproductive Health in Crises
2002-2004: First IAWG global evaluation of RHin humanitarian settings
RH services were generally well established andconsistent with pre-existing standards in stablerefugee settings.
Gender-based violence and HIV/AIDS serviceswere comparatively weak.
Services for internally displaced persons wereseverely lacking.
Little information regarding the RH ofpopulations in acute emergencies.
2012-2014 Global evaluation
Literature review
Institutional capacity assessment
MISP assessment
Jordan
In-depth and service availability
South Sudan, DRC, Burkina Faso
SRH funding trends
Health Information System (HIS) reviewand analysis
Preliminary findings: Progress
Increased institutional capacity towards RH inhumanitarian settings
Improved policies.
Increased dedicated guidelines and resources.
Improved accountability to stakeholders.
Increased investments in dedicated humanand financial resources.
Enhanced integration of disaster risk reductionin emergency management cycle.
Preliminary findings: Progresscont’d
Increased RH programming in humanitariansettings
Improved MISP response andcomprehensiveness of clinical services.
Expanded array of program delivery strategies.
Increased number of emergency health andprotection programs noting RH inhumanitarian appeals.
Preliminary findings: Progresscont’d
Increased funding for RH to conflict-affectedsettings overall
Analysis of official development assistance(ODA) to 18 conflict-affected countries showedan increase of 298% in overall ODA for RH from2002-2011. This reflects a broader increases inoverall ODA.
Preliminary findings: Gaps
Reproductive health components
Comprehensive abortion care
Emergency obstetric care, including post-abortion care
Long-term and permanent methods ofcontraception; emergency contraception
Prevention of mother-to-child transmission ofHIV
Clinical care for survivors of sexual violence
Cervical cancer screening and treatment
Preliminary findings: Gaps cont’d
Quality of care
Community perceptions of poor servicequality.
Lack of information about the benefits andavailability of services.
Challenges and delays to implementingcomprehensive RH services.
Discrepancies between NGO-supported andnon-supported health facilities.
Logistics and supply chain gaps.
Preliminary findings: Gaps cont’d
Funding
Over half (56.3%) of the 298% increase in totalRH ODA disbursements was due to asubstantial increase in HIV/AIDS funding.
Average annual per capita ODA for RHactivities to non-conflict-affected countrieswas 57% higher than to conflict-affectedcountries.
Recommendations
Training and capacity development
Improve capacity of Ministries of Health andNGOs.
Strengthen engagement and collaboration ofRH actors through the disaster planning andresponse cycle.
Advance “task-sharing” to address humanresource shortages.
Recommendations cont’d
Implementation
Improve information, education andcommunication among communities.
Strengthen quality transition from MISP tocomprehensive RH services.
Strengthen RH supply chain management andresupply.
Strengthen attention to RH in urban areas.
Research agenda
Dedicated and predictable funding for theIAWG on RH in Crises
Next steps
Publish a series of articles in Conflict andHealth (September 2014).
Implement advocacy and communicationscampaign to disseminate findings andrecommendations.
Acknowledgements
IAWG Global Evaluation SteeringCommittee Agencies:
Centers for Disease Control and Prevention
Columbia University
International Medical Corps
Kings College London
Marie Stopes International
Medecins Sans Frontieres
United Nations High Commissioner for Refugees
United Nations Population Fund
University of New South Wales
Women’s Refugee Commission
