Sexual and Reproductive Health in Emergencies Global Learning Workshop

Transcription

1 Sexual and Reprductive Health in Emergencies Glbal Learning Wrkshp Atlanta, Gergia, USA Octber, 2014 Carlyn Baer 1

2 I. Backgrund In Octber, 2014, CARE USA s Sexual and Reprductive Health in Emergencies (SRH/E) team supprted by the Supprting Access t Family Planning and Pst-Abrtin Care in Emergencies (SAF-PAC) initiative hsted and facilitated a five-day wrkshp in Atlanta, Gergia, USA fcused n increasing participant s knwledge f Sexual, Reprductive, and Maternal Health (SRMH) needs during an emergency respnse as well as t prvide implementatin guidelines n key lifesaving SRHM interventins t crisis-affected ppulatins. The specific bjectives f the wrkshp were t: 1. Describe the imprtance and place f SRMH in emergency peratins 2. Identify and describe key cmpnents f a range f SRMH interventins that imprve r reduce the quality f SRMH prgram implementatin. 3. Identify management actins that supprt the implementatin f high-quality SRMH activities in crisis settings In determining the cmpsitin f the participants, we reached ut t Cuntry Directrs, Assistant Cuntry Directrs, Reginal Emergency Crdinatrs, and Reginal Directrs, t help identify apprpriate candidates frm CARE cuntry ffices that wuld be best suited t attend based n the fllwing criteria: 1. Hld a management/crdinatr psitin in health and/r emergency prgramming and wh wuld mst likely have a leading rle in supprting the CARE CO during an emergency respnse; 2. Wrk in a cuntry ffice that currently manages a SRMH prgram r included SRHM during an emergency respnse, and/r is listed as a high risk cuntry fr an emergency; Thrugh an applicatin prcess, participants were required t cmplete tw nline e-learning curses prir t the wrkshp that cvered cntent related t addressing gender-based vilence and the SRH minimum initial service package (the MISP). There were furteen participants frm a wide range f cuntries including Burundi, Demcratic Republic f the Cng (DRC), Ethipia, India, Indnesia, Myanmar, Nepal, Pakistan, Rwanda, Suth Sudan, Tanzania, and Turkey. The SAF-PAC initiative cvered accmmdatin and wrkshp csts with sme cuntries receiving supprt fr airfare determined n a case by case basis. Cuntry ffices cvered per diem, travel (when pssible), and visa csts. Wrkshp planning began in April, 2014 with the fllwing SRH/E members: Jesse Rattan (Prject Directr, SAFPAC), Dra Curry (Sr. Technical Advisr M&E), Kamlesh Giri (Sr. Technical Advisr, Clinical Training), Elizabeth Nznesky (Sr. Prgram Officer), Serena Huang (Prgram Officer), Jimmy Nzau (Sr. Reginal Advisr), and Carlyn Baer (Sr. Advisr fr SRH in Emergencies). II. SRH+ in Emergencies The need fr quality reprductive health services in lw resurce cuntries remains great. In times f natural and cnflict-related emergencies, hwever, unmet need fr family planning and ther SRH services intensifies as wmen and yung girls are subjected t increased risk f sexual vilence and explitatin, unwanted pregnancies due t lack f access t cntraceptives, and little t n access t maternal newbrn health care including emergency bstetric care services. Recmmended interventins (including family planning and pst-abrtin care) are ften unavailable in humanitarian settings. The lack f trained health care prviders, supervisin, and availability f cntraceptives and 2

3 supplies, alng with sci-cultural barriers, severely limit the quality f services even when they are available. Recgnizing that SRH services are a substantial part f the primary health care system and nt a standalne service that is prvided independently, we lked beynd the traditinal cmpnents f SRH/E interventins and tk a brader perspective n hw t address the health needs thrughut the wman s entire reprductive life time-line. With this visin, we expanded the cntent f the wrkshp t specify the supprt systems and prgram appraches needed t ensure the feasibility and viability f cmprehensive SRHM prgramming: 1) hw t prcure necessary SRH supplies and equipment; 2) identify the cadre f human resurces best suited t prvide SRH services; 3) understand the imprtance and use f mnitring and evaluatin systems, and indicatrs specific t SRMH that will allw prgrammers t ensure that SRH interventins were effective and reaching the ppulatins; 4) identified partnerships bth internal and external t CARE that SRH prgrammers culd wrk with t supprt and strengthen SRH respnses. Belw is the SRH + in Emergencies Prgramming Lgical Framewrk that depicts ur apprach fr the wrkshp: Using this framewrk, we, as facilitatrs, were able t develp cntent that will demnstrate hw the participants can achieve ur ultimate impact: Decrease mrtality and mrbidity amng wmen and girls in crisis-affected settings. 3

4 III. Summary f Wrkshp Sessins Belw is a summary f what was cnducted during the curse f the wrkshp. The SAF PAC team plus ther CARE USA staff cntributed t the success f the learning event. 1. SRH in Emergencies and Glbal CARE: Jesse Rattan pened the wrkshp with a presentatin abut why SRH is imprtant t CARE as an rganizatin and hw it fits int CARE s glbal prgram strategy. She als prvided cncrete and illustrative examples f recent emergencies where SRH was a key interventin in respnding t the needs f crisis-affected ppulatins. 2. SRH activities and the Humanitarian Prgram Cycle: Carlyn Baer described the imprtance f incrprating SRH activities int all phases f the humanitarian prgram cycle t ensure that SRH needs are met and vulnerable ppulatins are being reached. The SRH interventins identified per each phase are as fllws: a) Preventin: inclusin f SRH activities in disaster risk reductin practices and management b) Preparatin: Include SRH analysis and activities in cuntry ffice Emergency Preparedness Plans. c) Respnse: Implementatin f the Minimum Initial Services Package (MISP) fr Reprductive Health d) Recvery: Prvide expanded and cmprehensive SRH services fr the cmmunity. 3. Maternal and Newbrn Health: Kamlesh Giri gave a presentatin describing the maternal and nenatal health situatin in humanitarian settings with a fcus n integrating emergency bstetric care in crisis settings since it is knwn that 15% f all deliveries face ptentially life threatening cmplicatins. He als explained the cncepts and skills assciated with EmOC and newbrn care, and defined the signal (essential) functins assciated with EmOC and newbrn care services. 4. Family Planning, Sexually Transmitted Infectins, and HIV : Jimmy Nzau presented n the imprtance f including family planning interventins during and emergency and described the key actins necessary t establish family planning services in crisis settings. Even thugh family planning is nt an bjective f the MISP, we feel that it is an imprtant interventin that needs t be included during the SRH emergency implementatin phase and CARE SRH/E team is wrking with glbal leaders via IAWG t include family planning in the next MISP revisin. Jimmy als talked abut hw HIV and STIs are public health prblems and can be exacerbated during emergencies due t sexual vilence r explitatin and prvided basic interventins t be taken t prevent transmissin f HIV and treatments fr STIs. 5. Child Health: As part f the SRMH plus apprach fr this wrkshp, Jesse Rattan included a presentatin abut the need t include child health interventins int the SRMH + package. Presentatin pints included key prgram appraches t address the implementatin f child health services and defining basic indicatrs fr child health fr prgram design and mnitring. 6. Cmmunicable diseases: Dra Curry gave a presentatin abut why cmmunicable diseases are an imprtant element f SRHM plus as they can cause harm t pregnant wmen and newbrns. In her presentatin, she explained the terms cmmunicable disease, vaccine preventable disease, and epidemic prne disease. She als listed key health indicatrs t be used t design and mnitr cmmunicable disease activities in emergencies and described pssible cmmunicable disease interventins t be used in emergencies. 4

5 7. Rle f Surveillance Systems in Emergencies: Dra Curry s presenting talked abut the purpse f surveillance and the reasns fr a special surveillance system in emergencies with a fcus n the UN Early Warning and Actin Respnse System (EWARS) and assciated respnsibilities. 8. Intrductin f the Minimum Initial Services Package fr Reprductive Health in Crisis Situatins: This presentatin, given by Carlyn Baer, utlined the gal (T reduce mrbidity and mrtality amng wmen and girls in crisis-affected ppulatins) and the bjectives f the MISP. The presentatin als described what life-saving SRH interventins shuld be implemented and prvides guidance n hw t implement them. 9. Gender-based Vilence in Emergencies (GBV): Theresa Hwang and Leigh Stefanik (Gender and Empwerment Team) gave a sessin n addressing abut gender and GBV in emergency health respnses and described the GBV aspects within the MISP such as preventin f sexual vilence, prvisin f clinical care fr survivrs f rape and making these services available. : putting int place measures t prtect affected ppulatins frm sexual vilence. 10. Prcurement f SRH supplies: Liz Nznesky gave a sessin titled Getting the Gds: prviding a practical intrductin t the prcurement f essential supplies fr delivering pririty SRH services in emergencies. It fcused n: 1) hw t rder Reprductive Health kits, clean delivery kits and hygiene kits frm UNFPA Cuntry Offices and the UNFPA Prcurement Services Branch in Denmark; 2) hw t reduce prcurement lead time by pre-psitining kits and putting in place pre-supply agreements, and 3) what resurces are readily available t CARE prgram staff t help them get the rights gds t the right place in a timely manner as cst-effectively as pssible. 11. Identifying CARE partners that supprt SRH activities and prgrams: Carlyn Baer identified cre partnerships bth internal (CARE Emergency Grup, CARE USA SRMH team) and external (IAWG, WHO Glbal Health Cluster, UNFPA) that the SRH/E team wrks clsely with n a regular basis. 12. Mnitring and Evaluating SRH Indicatrs in crisis settings: During this presentatin, Dra Curry identified apprpriate data surces fr prgram design and nging mnitring f health situatin in emergency settings. She als prvided a list f key SRMH indicatrs t use in these settings and hw t calculate and analyze each ne. 13. CARE s psitin n access t safe abrtin: Christina Wegs, Senir Advisr fr Glbal Plicy and Advcacy gave a presentatin n CARE s psitin n access t safe abrtin which was adpted by the CI Executive Cmmittee in January, CARE s psitin states that CI supprts vluntary, nn-discriminatry access t safe abrtin, as this stance is aligned with CARE s cre values, missin, and identity: keeping wmen and girls at the center f ur wrk and as an rganizatin cmmitted t scial justice and human rights. 5

6 IV. Learning and Sharing During the preparatin and implementatin f this wrk shp, there were several infrmative mments and lessns learned alng the way n hw t imprve the effectiveness and impact f the wrk shp. There were als several activities/actins that we undertk prir t the actual week f the wrkshp that lent its success. Lessns learned during the curse f the wrkshp: Allw mre time fr crss-sharing cuntry experiences: The participants were kenn t share SRH related activities frm their cuntries and t discuss in-depth as a grup abut the wrk that they were invlved in. This encuraged participants t critically think thrugh their SRH engagement at the cuntry level as well as identify entry pints fr SRH integratin within existing cuntry ffice activities. This activity was ften cited as ne f the mre imprtant and infrmative aspects f the wrkshp. Prvide didactic infrmatin in advance: While we tried t strike a balance between presentatins, grup wrk, and discussins, the mtivated participants suggested that sme f the presentatins and cntent culd be prvided prir t the wrkshp in the frms f n-line curses, assigned reading, and webinars. This will then reduce the amunt f time allcated fr didactic presentatins given during the wrkshp and pen up mre time fr grup discussins and sharing experiences related t SRH/E activities. Increase the amunt f grup wrk and activities in the wrkshp: Similar t the first pint, participants requested fr mre grup wrk and activities in rder t hne their understanding f SRH in Emergencies and t practice n and apply sme f the skills learned in the wrkshp (e.g. RH kit calculatin, cuntry wrk plans and bjectives). As facilitatrs, we need t prvide mre structure and be mre creative abut develping activities that will increase the impact f what they are learning. Wrkshp prcess highlights Flexibility/Adaptability: Being agile and flexible during the curse f the wrkshp t address the interests and needs f the grup. Via ur Eyes/Ears activity, we were able t be respnsive t the daily feedback frm the participants and then recalibrate ur presentatins/activities/appraches t meet these requests and suggestins. Scial utings: Organizing scial gatherings utside f wrkshp hurs prvided additinal pprtunities fr the participants t cme tgether in a casual setting and talk abut the wrk that they are ding and t share experiences. One participant cmmented that this was really valuable since it made them like a part f the SRH/E team and mre hmely. It als allwed fr CARE USA staff t meet and greet the participants and learn abut the vast and varied wrk that is being dne in the SRH sectr thrughut the rganizatin. Preparatin and rganizatin: Key that the team started t plan fr the wrkshp well in advance. This included: identifying the participants and cnfirming their attendance, bking the venue fr the wrkshp and accmmdatin, rganizing the cntent and activities fr the wrkshp; and als dedicating time t meet tgether as a grup t review and revise cntent prir t the wrkshp t ensure that all f the necessary subject matter was cvered. Strng and apprpriate cntent: Participants appreciated the cntent that was presented t them and felt that the infrmatin was valuable and relevant t the wrk that they were ding in their individual cuntries. 6

7 V. Feedback frm the participants At the end f the wrkshp, the participants cmpleted an evaluatin f the verall wrkshp and gave it an average f 4.5 with 5.0 being the highest scre and classified as excellent. The highest marks (4.8 and 4.7 respectively) were given t the statements: The training met my expectatins, and I wuld recmmend the curse t clleagues with similar respnsibilities. The lwest mark (3.8) was given when asked if there was adequate time fr discussin. The participants rated the usefulness f the training with an average scre f 8.5 ut f With these high marks, the SRH/E facilitatrs and participants were pleased with the utcme and cnsider this wrkshp an verall success. The facilitatrs will make the necessary adjustments based n the cmments and feedback frm the participants, fr the next glbal learning wrkshp. VI. Next steps: Review cuntry wrk plans and supprt SRH activities Referring t the phases f humanitarian prgram cycle (preventin, preparatin, respnse, and recver) alng with the suggested SRH interventins fr each phase, participants develped individual cuntry wrk plans t identify: 1) what they are currently ding in their cuntry in terms f including SRH interventins during that phase; and 2) what they are nt ding but wuld like t d t ensure SRH activities are included and addressed. Based n this activity, the SRH/E team will review these wrk plans alng with the participants and determine specific actins t be taken as a team t assist the cuntry ffices in reaching their bjectives. VII. Attachments List f participants Agenda Fr mre infrmatin abut the wrkshp, please visit: Fr mre infrmatin abut CARE s wrk in SRH in Emergencies, please visit ur Reprductive Health in Crisis Settings Knwledge Center! 7