RH Services in
Emergency Situation
Objectives of this session
• To define the RH services in emergencies
• To identify types of RH services needed in
emergency situations
• To know the contents of MISP
• To agree on who to implement MISP
Reproductive Health
• Is a state of complete physical, mental and
social well being and not merely the absence of
disease and infirmity, in all matters relating to
the reproductive system and to its functions and
processes
RH Components
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Safe motherhood- Making pregnancy safer
Family planning
RTIs/STIs and HIV/AIDS
Adolescent Health
Harmful Traditional Practice (FGM)
Safe Abortion
Infertility
Menopause
Reproductive cancers (cervical and breast)
Male involvement
Counseling in RH
Women empowerment
RH priorities in Sudan
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Safe motherhood- Making pregnancy safer
Family planning
RTIs / STIs and HIV/AIDS
Adolescent Health
Harmful Traditional Practice (FGM)
Safe Abortion
Maternal Mortality
• MM is a Leading cause of healthy life lost
among women 15-45
• 585,000 women die each year = One every
minute
• 99% in the developing countries (Sudan??)
• Compared to women in their twenties, less than 20 girls
has double chance to die from childbirth, 5 time chance
if less than 15
Healthy life lost from selected causes in adults 15-44 years
in the developing world, 1990
Percentage of all causes
Maternity-related causes
18%
6.6%
HIV
36%
STD's
9.3%
Reproductive health problems
Reproductive health problems
8.4%
7%
Tuberculosis
2.5%
Respiratory infections
2.4%
2.5%
Anemia
1.5%
5.8%
Depressive disorders
2.9%
1%
Homicides and violence
6.1%
2.1%
Motor vehicle injuries
8.2%
3.2%
Self-inflicted injuries
4%
2.7%
0.4%
Alcohol dependence
1.8%
War
20%
12%
1.5%
8.9%
15%
10%
Women
5%
4.2%
0%
5%
10%
Men
Source: World Bank. World Development Report 1993, Investing in Health
15%
20%
Elderly
CYCLE OF REPRODUCTIVE ILL-HEALTH
Osteoporosis/
prolapse
Reproductive
tract cancers
Maternal &
neonatal
LBW
malnutrition/
Unwanted
morbidity &
gender
pregnancy
mortality
violence
anemia
Unsafe
Unregulated
sexual
fertility
practice
FGM
Harmful
traditional
practices
Birth
Sexual
STI/HIV
Infertility
So RH is a Major Concern
What shall we do during
emergencies?
Guiding principles for
intervention
• Community participation
• Quality of care
• Integration of services
• Inclusion of IEC activities
• Coordination among partners
Community participation
• To ensure acceptability, appropriateness &
sustainability
• To account for cultural, economic & religious
background
• Can give information's for planning: providers need for
training, selection of care delivery sites, gender of
providers needed, birthing preferences
• Should include both men & women
Quality of care
• Use of appropriate technology & skills
• Providing adequate information's & counseling
• Ensure accessibility
• Ensure privacy & confidentiality
• Continuity of care
Integration of services
• Either at facility or provider levels
• Depends on skills & resources available
• Good communication/coordination at all levels
Inclusion of IEC activities
• Awareness raising among all groups (men, women,
adolescent..)
• Essential for informed choice of services
• Essential to combat HTPs
• Step in Behavior Change
Coordination among partners
Among
• Sectors (health, education, ….)
• Agencies (Gov, UN agencies, NGOs, CBOs,...)
• Levels of service provision (primary, secondary & tertiary)
Depends on whom will coordinate
(Knowledge, skills & commitment)
Key RH Resource
Reproductive Health in Refugee situations:
An Inter-agency Field Manual
Available electronically in
English online at:
www.rhrc.org
What’s the MISP?
• Minimum: Basic, limited RH
• Initial: For use in emergency, without site-specific needs
assessment
• Service: Services to be delivered to the population
• Package: Supplies and activities, coordination and
planning
RH Components of MISP
Safe Motherhood
Family Planning
Gender-based Violence
STI/HIV/AIDS
Safe Motherhood
• To promotes healthy mothers and healthy babies throughout
pregnancy, at the time of delivery including emergency obstetric care
& after delivery
• Through:
 Promote clean home deliveries: clean delivery kits (trained VMW for 1,000)
 Facilitate safe facility deliveries: facilities equipping (equipped facility B-EmOC for
30,000 )
 Establish referral system: to manage obstetric complications (15% of pregnancies)
(C-EmOC for 150,000)
• Monitor service provision
• Organize for comprehensive RH services as soon as situation stable
Family Planning
For mother
• Averting unwanted pregnancies would prevent at least 1 in 4 maternal deaths
For children
• Adequate spacing (>2 yrs) can prevent 1 in 4 infant deaths
For the family
• Planning births permits controlled use of household resources
FP services in Emergencies
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High – quality services: drug, counseling, follow – up
Availability of services
IEC
Training of providers
Sexual & Gender-Based
Violence
Mortality: Murder, Suicide
Physical morbidity: Trauma, STIs / HIV, Unwanted pregnancy/Birth,
unsafe abortion
Psychosocial: Trauma, Anxiety, Depression, Post-traumatic Stress
Disorder (PTSD), Sexual dysfunction, Inability to function in daily life,
Compromised respect, social position
Reference
•Only 5-8% of adult sexual assault reported
to authorities
So ...
•Assume high starting point
•Expect underreporting
Sexual & Gender-Based
Violence
• Prevention
 Community involvement: situation of facilities, timing of service
provision
 IEC
 Food & shelter assistance
 Protection
• Care
 Medical care: including emergency contraception
 Psychological care
 Follow-up
STIs/HIV
• Increased risk because
• Commercial sex work
• Sexual violence
• Psychological trauma
• Disruption of preventive and curative services
• Unsafe transfusion practice
• Increase intravenous and other drug use
• High prevalence of STIs
STIs/HIV
• Universal precaution in the health setting:
 Hand washing, gloves, protective clothing, safe handling of sharp objects, disposal
of waste materials, equipments processing & treating injuries at work
• Access to condom
 Good quality, free, proper promotion & training on use
• Safe blood transfusion
 Previously tested
• Access to STI care
 Effective case management, IEC
• Comprehensive care for people with HIV/AIDS
 Clinical management, supportive care, education, counseling, social & home based
care
RH Kits
What are the RH Kits?
• Sets of medicines, equipment and
supplies designed to meet the most basic
RH needs in crisis situations
• They are designed so that each kit can be
used in contexts where there is little or no
health infrastructure
Block 1
Community and Primary health care
Kit 1: Part B (Female Condoms)
Kit 2: Clean Delivery Kit
Sub kit 2: Clean Delivery Kit
Kit 3: Rape Treatment Kit
Kit 4: Oral and Injectable
Contraception
Kit 5: Treatment of STIs
Block 2
Community, Health Center or Referral Level
Kit 6: Clinical Delivery Assistance
(Health Facility)
Kit 7: Intra-Uterine Device
Kit 8: Management of Miscarriage and
Complications of Abortion
Kit 9: Suture of Tears
Kit 10: Vacuum Extraction for Delivery
(Manual) Kit
Block 3
Referral Level
Kit 11A: Referral Level Kit
Kit 11B: Drugs and Disposable
Equipment
Kit 12: Blood Transfusion Kit
Subject
area
Family
planning
MISP
Comprehensive
services
Make contraceptives •Source and procure
available for any
contraceptive supplies
demand, if possible •Offer sustainable
access to a range of
contraceptive methods
•Provide staff training
•Provide community
IEC
Subject
area
Gender
Based
Violence
MISP
Comprehensive
services
•Coordinate systems
to prevent sexual
violence
•Ensure health
services available to
survivors of sexual
violence
•Assure staff trained
(retrained) in sexual
violence prevention
and response
systems
•Expand medical and
psychological and
legal care for survivors
•Prevent and address
other forms of GBV,
including domestic
violence, forced/early
marriage, female
genital cutting,
trafficking, etc.
•Provide community
IEC
Subject
area
MISP
Safe
•Establish referral
Motherhood system for obstetric
emergencies 24/7
•Provide clean
delivery kits
•Provide midwife
delivery kits
Comprehensive
services
•Provide antenatal
care
•Provide postnatal
care
•Train midwife
Subject
area
STIs (including
HIV)
prevention and
treatment
MISP
•Provide access to free
condoms
•Ensure adherence to
universal precautions
•Assure safe blood
transfusions
Although STI
programming is not part
of the MISP, it is
important to make
treatment available for
patients presenting for
care as part of routine
clinical services
Comprehensive
services
•Identify and manage STIs
•Raise awareness of
prevention and treatment
services for STIs/HIV
•Source and procure
antibiotics and other
relevant drugs as
appropriate
•Provide care, support and
treatment for people living
with HIV
•Collaborate in setting up
comprehensive HIV and
AIDS services as
appropriate
•Provide community IEC
GUIDELINES FOR ASSIGNMENT
Title: Situation analysis: status and needs
Identify the variation in the status and needs of women 4
and men according to the state of the conflict in each
region:
Darfur –
Kassala –
Nouba Mountain –
Blue Nile –
The report submission will be next week. 4
Thanks