Consultation on Reproductive HealthTechnologies for Crisis SettingsConsultation on Reproductive HealthTechnologies for Crisis Settings13-14 May 2008Seattle, Washington
Sandra Krause, Director
Reproductive Health Program
Women’s Commission for Refugee Women and Children
Who are Populations in Crisis?Who are Populations in Crisis?
lThirty-five million people live in the worldas refugees and internally displacedpersons, uprooted from their homes byarmed conflict, persecution and naturaldisasters.
lA refugee has crossed an internationalborder; an internally displaced person hasfled her home but is still in her owncountry.
Origin of Major Refugee and DisplacedPopulationsOrigin of Major Refugee and DisplacedPopulations
1. Sudan (including Darfur)....................6 million
2. Iraq...............................................3.8million
3. Colombia ................................3.2 million
4. Former Palestine....................3 million
5. Afghanistan......................2.3 million
6. Democratic Republic of Congo.......2.1 million
7. Uganda........................1.7 million
Rwanda Genocide 1994Rwanda Genocide 1994
Rwanda Genocide
Early Days of Crisis SituationsEarly Days of Crisis Situations
Emergency/CrisisEmergency/Crisis
lUNHCR: “Any situation in which the life orwell-being of refugees will be threatenedunless immediate and appropriate action istaken and which demands andextraordinary response and exceptionalmeasures”
lWHO and Centers for Disease Control:“Crude mortality is > 1 death per 10,000people per day.”
RHRInter-agencyField ManualRHRInter-agencyField Manual
Four technical areas of RH:Four technical areas of RH:
lSafe Motherhood includingemergency obstetric care
lFamily Planning
lSTIs/HIV/AIDS
lGender-based violence
Minimum Initial Service Package (MISP)Minimum Initial Service Package (MISP)
lMinimum
lInitial
lService
lPackage
lBasic, limited RH
lfor use in emergencies, withoutsite-specific needs assessment
lservices to be delivered to thepopulation
lsupplies and activities,coordination and planning
Objectives of the MISPObjectives of the MISP
lIdentify an organization or individual to facilitatethe coordination and implementation
lPrevent and manage the consequences of
sexual violence
lReduce HIV transmission
lPrevent excess neonatal and maternalmorbidity and mortality
lPlan for comprehensive RH services
Reproductive Health KitsReproductive Health Kits
1). Interagency Reproductive Health Kits
lProvides the material resources to implement theMISP
lDesigned for three months
lComprises 12 kits
lCan be ordered from UNFPA
2). Interagency Emergency Health Kit
lFormerly the New Emergency Health Kit (NEHK)
lDesigned by WHO, UNHCR, UNICEF, UNFPA, MSFICRC/IFRC
lIncludes: EC, PEP, materials for universalprecautions, midwifery kit
RH kits deliveredto the field
Clean delivery kitcontents
Brief History and Evolution of RH in CrisisBrief History and Evolution of RH in Crisis
lWomen’s Commission, Refugee Women andReproductive Health Care: ReassessingPriorities (1994)
lSexual violence associated with genocide inRwanda and Bosnia Hercegovina
lInternational Conference on Population andDevelopment (1994)
lReproductive Health for Refugees Consortium(1995)
lInter-Agency Working Group on ReproductiveHealth in Refugee Situations (1995)
Overall Goal of MISPOverall Goal of MISP
To reduce mortality andmorbidity, particularly amongwomen and girls in the initialphase of an emergency.
Terms of Reference forRH Coordinator / Focal Point (1)Terms of Reference forRH Coordinator / Focal Point (1)
lBe focal point for RH services and providetechnical assistance to refugees and agencies
lLiaise with national and regional authorities
lLiaise with other sectors to ensure a multi-sectoral approach to RH issues
lCreate/adapt and introduce standardizedstrategies for RH – integrated with PHC
Terms of Reference forRH Coordinator / Focal Point (2)Terms of Reference forRH Coordinator / Focal Point (2)
lInitiate and coordinate information sharingsessions
lIntroduce standardized protocols
lDevelop or adapt and introduce RHmonitoring forms
lReport regularly to health coordinationteam
Prevent and manage sexual violencePrevent and manage sexual violence
lSystems to prevent violence are in place
nWomen have their own registration cards
nSafe access to food (distributed to women),fuel (firewood), water and latrines
nWomen participate in the decisions that affectthem
nCode of Conduct against sexual abuse andexploitation in place with reportingmechanisms (protection officer)
lHealth services able to manage womensurviving sexual violence
The MISP only includessexual violence – not all forms ofgender-based violenceThe MISP only includessexual violence – not all forms ofgender-based violence
Reduce maternal and neonatalmorbidity and mortalityReduce maternal and neonatalmorbidity and mortality
lReferral system to manage obstetricemergencies *follow up to ensure referralfacility is prepared for emergencies
lMidwife delivery kits available for clean andsafe deliveries at the health facility
lClean delivery kits for mothers or birthattendants for clean home deliveries
Planning for comprehensive RHservicesPlanning for comprehensive RHservices
lData collection, including maternal, infant andchild mortality
lIdentification of sites for future RH servicedelivery
lAssessment of staff capacity and orderingsupplies
What the MISP is NOTWhat the MISP is NOT
lReproductive health assessment
lAnte and post-natal care
lFamily planning
lComprehensive RH services
lAll forms of gender-based violence
lTraining of staff (TBAs, CHWs, midwives)
lSensitization campaign for condomdistribution
The Emergency ResponseThe Emergency Response
lComprehensive RH diverts attention frompriority RH and other priority needs in anemergency
SPHERE GuidelinesSPHERE Guidelines
Integrated into 2000 version
Standard in 2004
MISP AssessmentsMISP Assessments
Pakistan, 2003Pakistan, 2003
Chad, 2004Chad, 2004
Indonesia (tsunami) 2005Indonesia (tsunami) 2005
Uganda 2006Uganda 2006
Jordan 2007Jordan 2007
FindingsFindings
Research showshumanitarian actors aregenerally not familiar withthe MISP and it is not beingimplemented at the onsetof an emergency.Research showshumanitarian actors aregenerally not familiar withthe MISP and it is not beingimplemented at the onsetof an emergency.
Global ResponseGlobal Response
lIAWG MISP Working Group
nMISP Coordinator Job Description
nSample proposal
nIntegrate the MISP in complex emergency courses
Global ResponseGlobal Response
lMISP DistanceLearning Module
nPublished in September2006
nAvailable in multiplelanguages
nCertificate of completion– pass online post-test
nVerifies 3.5 continuingeducation credits for USnurses
MISP PartnershipTraining
ConclusionConclusion
The MISP is a coordinated set of priorityactivities for implementation in the early daysand weeks of a crisis.
The MISP reduces morbidity, mortality anddisability particularly among women andnewborns. It also sets the stage fromestablishing more comprehensive RHservices as the situation stabilizes.
Although the MISP is a well establishedstandard of care it is not systematicallyimplemented in crisis situations.
What can you do to improve RH inCrisis?What can you do to improve RH inCrisis?
•Humanitarian actors, donors, policy makersand others could:
get certified in the distance learningmodule today
submit and review proposals and budgetsto ensure the MISP is included in all healthsector proposals
Fund the MISP
Ensure there is a overall RH coordinator inall new emergencies and an RH focal pointin every agency working in the healthsector
