Evaluation of the Implementation of the
Minimum Initial Service Package (MISP) for
Reproductive Health among Syrian Refugees
in Irbid City and Zaatri Camp, Jordan
Conducted by the Inter-agency Working Group on RH
in Crises
Sandra Krause/Women’s Refugee Commission
Holly Williams/CDC
Samira Sami/CDC
Monica Onyango/Boston University
Wilma Doedens/UNFPA
Outline
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Introduction
Objectives
Methods
Context
Preliminary Findings
Recommendations
Next Steps
Introduction
Global Evaluation
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Literature review
MISP assessment (Jordan)
In-depth assessment
Coverage study in the in-depth assessment
sites
Agency commitment study
Health information system
Funding analysis
MISP Evaluation: Objectives
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Assess the extent to which MISP has been
implemented in Irbid City and Zaatri Camp.
Identify the availability, accessibility, and use
of MISP services.
Describe facilitating factors and barriers to
the implementation of MISP services.
MISP Objectives
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Ensure the health sector/cluster identifies
an organization to lead implementation of
the MISP.
Prevent and manage the consequences of
sexual violence.
Reduce HIV transmission.
Prevent excess maternal and newborn
morbidity and mortality.
Plan for comprehensive RH services as the
situation permits.
Additional priorities of the MISP
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Ensure contraceptives are available to meet
the demand.
Ensure treatment of sexually transmitted
infections (STIs) is available.
Ensure antiretrovirals (ARVs) are available to
continue treatment for people already on
ARVs including for prevention of mother to
child transmission.
Distribute culturally relevant menstrual
protection materials to women and girls.
MISP Evaluation: Methods
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Inter-agency preparatory work
Field work: 17 – 21 March 2013
Institutional Review Board (Human Subjects
Protection) approval by CDC
Mixed methods
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Key stakeholder interviews and meetings
Health facility assessments
Focus group discussions (FGDs)
Context
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366,212 Syrian refugees in Jordan
(425,771 and 65,040 unregistered)
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168,468 refugees in Zaatri Camp (192,193)
133,660 refugees in urban areas (169,538)
Ongoing humanitarian crisis
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~1,500/day influx
Credit: Jeff J Mitchell/Getty Images, The Guardian
Credit: Sandra Krause/WRC
Priority Concerns of Refugee Women
and Girls in Zaatri Camp
• Desire to be treated with dignity and respect.
• Hygiene
o Toilets: maintenance, not sex-specific.
o Lack of clean water.
o Major desire for hygiene and cleaning products.
• Inequitable distributions.
• Lack of supervision of community/street
leaders.
• Strong perception of no outreach from
agencies.
• Inability to work or volunteer.
• Reported increase in domestic violence.
Context Specific to Zaatri Camp
• High level of medical care.
• Low level of community engagement and
primary health care.
Credit: UNFPA
Credit: UNFPA
Priority Concerns of Refugee Women
and Girls in Irbid City
• High rent and utility costs.
• Inability to work.
• Inequitable distribution and need for UN
supervision.
• Strong need for UN card to improve quality of
life.
• More flexibility related to purchases with
vouchers.
• Strong tensions with host community.
Context Specific to Irbid City
• Ministry of Health
• Non-governmental organizations
Credit: UNFPA
Credit: Sandra Krause/WRC
Credit: Sandra Krause
Preliminary findings related to
the MISP
1) Coordination of the MISP
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Positive impressions.
Need for further focus on urban areas.
2) Prevent and manage sexual violence
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Camp: inadequate lighting in camps and
distance to services.
Urban: distance to schools.
Limited availability and knowledge of clinical
services.
Preliminary findings related to the
MISP (cont)
3) Reduce HIV Transmission
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Safe blood transfusion.
Standard precautions are generally in place.
Condoms available but access is restricted.
4) Prevent maternal and newborn morbidity/mortality
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Skilled birth attendants are available.
Basic/Comprehensive emergency obstetric and
newborn care available.
24/7 referral services established but limited.
Negative perceptions by community of health
services.
Distribution of clean delivery kits not
implemented.
Preliminary findings related to the
MISP (cont)
5) Planning for Comprehensive RH Services
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Gap in background data for RH.
Sites for future RH services are in process.
6 ) Additional Priorities
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Strong desire for family planning: generally
available (except some methods) for married
couples.
Lack of protocols for STI care.
ARVs very limited.
Gap in menstrual hygiene supplies.
Limitations
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Time and security
Minimal field time
Very preliminary analysis
FGD participants found it difficult to focus on
RH questions
Recommendations
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Scale up efforts to ensure basic needs for
reproductive health are being met through the
provision of hygiene products.
Implement safety measures to protect women
and children from violence, such as safe transport
to schools in Irbid City and adequate lighting and
sex-specific latrines in Zaatri Camp.
Scale up the availability of care for survivors,
particularly in urban areas and that all health care
providers and protection staff are informed about
the availability and location of care for survivors.
Recommendations (cont)
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Develop culturally appropriate mechanisms for
improving knowledge about the benefits of
seeking care and available clinical services for
survivors of sexual violence.
Undertake culturally appropriate methods to
inform the community of where to access free
condoms and other forms of family planning.
Ensure the availability of and access to
emergency obstetric and newborn care 24 hours
a day, seven days a week.
Next Steps
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Global evaluation: advocate findings in
advance of:
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International Conference on Population and
Development (ICPD) + 20
Post-Millennium Development Goals (MDGs)
Develop beneficiary and field partner reports.
Acknowledgements
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Jordanian Ministry of Health
UNHCR
UNFPA
IRC
Jordanian Women’s Union
Gynecologue Sans Frontieres
(GSF)
Royal Medical Services (RMS)
Jordan Health Aid Society
(JHAS)–Women’s Clinic
Physicians Across Continents
(PAC)
Moroccan Field Hospital (MFH)
Marfraq Hospital
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IFH Noor Al Hussein Foundation
Amman Jordan Association
IMC
MDM
Medair
UNAIDS
International Relief &
Development
WHO
Save the Children
MISP Evaluation Translators
Thank You!