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Taking stock of reproductive health in humanitarian settings: Preliminary findings from the 2012-2014 global evaluation. Sandra Krause Women’s Refugee Commission On behalf of the Inter-agency Working Group on Reproductive Health in Crises.
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Taking stock of reproductive health in humanitarian settings: Preliminary findings from the 2012-2014 global evaluation Sandra Krause Women’s Refugee Commission On behalf of the Inter-agency Working Group on Reproductive Health in Crises
Inter-agency Working Group (IAWG) on Reproductive Health in Crises • 1994: Refugee Women and Reproductive Health Care: Reassessing Priorities. • 1994: International Conference on Population and Development Programme of Action • 1995: Formation of the IAWG on Reproductive Health (RH) in Crises
Inter-agency Working Group (IAWG) on Reproductive Health in Crises • 2002-2004: First IAWG global evaluation of RH in humanitarian settings • RH services were generally well established and consistent with pre-existing standards in stable refugee settings. • Gender-based violence and HIV/AIDS services were comparatively weak. • Services for internally displaced persons were severely lacking. • Little information regarding the RH of populations 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) review and analysis
Preliminary findings: Progress • Increased institutional capacity towards RH in humanitarian settings • Improved policies. • Increased dedicated guidelines and resources. • Improved accountability to stakeholders. • Increased investments in dedicated human and financial resources. • Enhanced integration of disaster risk reduction in emergency management cycle.
Preliminary findings: Progress cont’d • Increased RH programming in humanitarian settings • Improved MISP response and comprehensiveness of clinical services. • Expanded array of program delivery strategies. • Increased number of emergency health and protection programs noting RH in humanitarian appeals.
Preliminary findings: Progress cont’d • Increased funding for RH to conflict-affected settings overall • Analysis of official development assistance (ODA) to 18 conflict-affected countries showed an increase of 298% in overall ODA for RH from 2002-2011. This reflects a broader increases in overall ODA.
Preliminary findings: Gaps • Reproductive health components • Comprehensive abortion care • Emergency obstetric care, including post-abortion care • Long-term and permanent methods of contraception; emergency contraception • Prevention of mother-to-child transmission of HIV • Clinical care for survivors of sexual violence • Cervical cancer screening and treatment
Preliminary findings: Gaps cont’d • Quality of care • Community perceptions of poor service quality. • Lack of information about the benefits and availability of services. • Challenges and delays to implementing comprehensive RH services. • Discrepancies between NGO-supported and non-supported health facilities. • Logistics and supply chain gaps.
Preliminary findings: Gaps cont’d • Funding • Over half (56.3%) of the 298% increase in total RH ODA disbursements was due to a substantial increase in HIV/AIDS funding. • Average annual per capita ODA for RH activities to non-conflict-affected countries was 57% higher than to conflict-affected countries.
Recommendations • Training and capacity development • Improve capacity of Ministries of Health and NGOs. • Strengthen engagement and collaboration of RH actors through the disaster planning and response cycle. • Advance “task-sharing” to address human resource shortages.
Recommendations cont’d • Implementation • Improve information, education and communication among communities. • Strengthen quality transition from MISP to comprehensive RH services. • Strengthen RH supply chain management and resupply. • Strengthen attention to RH in urban areas. • Research agenda • Dedicated and predictable funding for the IAWG on RH in Crises
Next steps • Publish a series of articles in Conflict and Health (September 2014). • Implement advocacy and communications campaign to disseminate findings and recommendations.
Acknowledgements • IAWG Global Evaluation Steering Committee 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