Inter-agency Global Evaluation of RH Services for Refugees and IDPs

Inter-agency Global Evaluationof RH Services for Refugeesand IDPsInter-agency Global Evaluationof RH Services for Refugeesand IDPs

Component 4 Part B: Assessment ofthe Minimum Initial Service Package(MISP) of Reproductive Health forSudanese Refugees in Chad

UNFPA

Women’s Commission for RefugeeWomen and Children

PurposePurpose

The purpose of this assessment was todetermine the availability and quality ofemergency response to thereproductive health needs of refugees

MethodologyMethodology

Refugee crisis in Eastern Chad chosen basedon the following criteria:

–Recent acute emergency involving refugees withan affected minimum population of 20,000

–Involvement of non-functioning infrastructures

–Presence of (UN) coordinated humanitarianresponse activities

–presence of IAWG agency field staff willing tofacilitate travel

–Visa and security clearance easily obtainable

Assessment conducted in April 2004

4 camps and 4 IDP setting visited

Evaluation ToolsEvaluation Tools

Tools developed by study team, based onInter-agency Field Manual and RHRCConsortium’s Needs Assessments FieldTools:

–Semi-structured field staff interview questionnaire

–Focus group discussion guide for refugeecommunity interviews

–Observational resource and services checklist

–Assessment site basic information form

FindingsFindings

Most humanitarian actors in Chad unfamiliarwith MISP

Did not know the MISP’s overall goal, keyobjectives and priority activities

No overall RH coordinator

Only one agency had an identified RH focalpoint

Limited overall coordination of humanitariansituation

No routine coordination of health or RHactivities

Prevent and ManageSexual ViolencePrevent and ManageSexual Violence

Some activities in some camps for theprevention of sexual violence

Protection needs of majority of refugees wereunmet

No UN protection officers, focal points orreporting mechanisms

INGOs had codes of conduct but local NGOsdid not

Clinical protocols said to be followed but wererarely available

Lack of systematic interventions to addressneeds of vulnerable groups

Reduce Transmission of HIVReduce Transmission of HIV

Priority activities to prevent transmission ofHIV/AIDS nonexistent or limited

Grossly inadequate supplies for universalprecautions in national health structures

INGOs adequately supplied for universalprecautions and to provide teaching to localstaff but no written protocols in place

Free condoms not visible or available

Reduce Neonatal and MaternalMorbidity and MortalityReduce Neonatal and MaternalMorbidity and Mortality

Priority interventions were not in place

Pregnant women were not provided cleandelivery kits

INGOs said to provide TBAs and midwiveswith clean delivery kits but lack of suppliesreported

Lack of equipment, supplies, skills to providebasic EmOC:

–Basic EmOC provided by only one NGO

–Poor referral system and limited emergencytransport

Planning for ComprehensiveRH ServicesPlanning for ComprehensiveRH Services

No evidence of specific planning forcomprehensive RH services

Bypassing MISP interventions (e.g. EmOC) toestablish services such as ANC

Planning HIV/AIDS awareness campaignsbefore ensuring condom availability

Training TBAs and midwives before informingcommunity about urgent referrals

Giving little attention to family planning, STImanagement, and youth

LimitationsLimitations

Geographically wide scattering ofrefugee population and camps

Unfavourable road conditions andrestricted travel times

Limited time with field staff

Translation/interpreters not ideal

Limited time to pretest evaluation tools

Recommendations(Applicable to Any Emergency)Recommendations(Applicable to Any Emergency)

All IAWG members should increaseawareness and understanding of theMISP among humanitarian actors:

–Develop user-friendly learning materials

–Conduct trainings

–Ensure MISP standards reflected in grantproposals aimed at responding toemergencies

Recommendations (cont’d)Recommendations (cont’d)

Assure that health coordination is in placeand appoint RH focal point early inemergency

Identify an RH focal point in each site forcoordination of MISP

Allocate funds to support MISP activities in allsettings and ensure coordination with nationalgovernments

Maintain a network of experienced RHcoordinators

Facilitate ordering and distribution of RH Kits