Integration Workshop on Minimum Initial Service Package () for Sexual and Reproductive Health in Disters- Dates: 23rd Nov 2015 Venue: LA Carte, Gangtok,
disters (Gangtok & Namchi). Background: Two Regional Trainings have been carried out a pilot initiative covering all 4 districts of in collaboration with the State Dister Management Authority. Efforts and initiatives will be taken by UNFPA nad Sphere India to provide technical support for integrating in Dister Management Plan of health department, State dister management plan, health department PIP (program implementation plan) and integrating in health and dister management plans of 4 targeted districts. Activities to be included in the State Health PIP for 2016: Efforts will be taken to allocate funds by the NRHM for capacity building, compiling and pre positioning Safe Delivery kits, Dignity kits/rh Kits and other activities specific to post disters and for technical review and monitoring of the project. Objectives of the Integration workshop: To develop capacity of resource in developing the district dister management plans and health microplan. To develop a roadmap for the initial planning of the integration of in district microplans in. To identify and activate the district teams who will take the integration forward in the 4 districts of. To prepare a logistic plan for procurement of Kits at the district level. To integrate in district dister management micro-plans, health plans and district dister management plans in 4 districts of. Outcome: Enhanced capacity of 48 Resource s from 4 districts in developing health and dister microplans. Preparation of 4 district dister management plans and health microplans. Annual Action Plan included in the 4 district microplans. integrated in district dister management and health plans of 4 districts. Enhanced capacities for implementation of in targeted 4 districts of Introduction and Opening: Prabhakar Rai, SSDMA in his inaugural speech expressed his heartfelt gratitude to Sphere India and UNFPA for extended all their support to the initiative in Odisha. Dr. Henna Hejazi in her introduction thanked the leadership of the SSDMA and said that the Health Department h to become the Lead Agency in taking the initiative forward in the state. She expressed the need for advocacy, capacity building and pre positioning of RH kits at the district level. She shared her vision of a multi sectoral team at the district level and to further roll out in block levels. She shared ide of how best we can integrate in the district plans. Dr. Khirod Kumar Rout expressed his vision of having a common perspective and plan. He discussed the methodology and processes which would be adopted to develop the district microplans. Page 2 of 13
disters (Gangtok & Namchi). The aim of the workshop he emphized is to prepare a holistic plan integrating all components of including GBV in the district Health Plans. He emphized on the special care which is required post disters to address reproductive health and prevent sexual violence. He pointed out that at the end of the workshop we should be able to activate and allot responsibilities to each district team, develop a logistic plan, map vulnerable are and come out with a roadmap to provide maternal newborn support, psychosocial support to rape victims and address issues related to adolescent health and gender bed violence. West Contingency Plan: DDMA (District Dister Management Authority), S/W 1. District Collector, S/W - Chairman 2. Zilla Adakshya- Co-Chairman 3. Addl. District Collector (Adm.) - Member Secretary 4. Chief Medical Officer - Member 5. Joint Director, HRDD Member 6. Addl. District Collector (Dev.) Member 7. District Project Officer Convenor BDMA (Block Dister Management Authority/Committee) formed for inclusion of in DM activities 1. SDM Chairman 2. BDO Co-Chairman 3. MO Member Secretary 4. Zilla Panchayat member Convenor 5. Registered NGOs Member 6. Police Member 7. Dy. Secretary - Member Objectives of the Plan 1. Implementation of for SRH in times of dister. 2. Prevention and management of sexual violence in disters. 3. Quick response in a co-ordinated manner to avoid duplicacy of services 4. Reducing maternal and new born mortality and morbidity 5. Reducing transmission of HIV and other STI services during Dister Road map Targeted Area Maternal and neonatal health Data collection & analysis SGBV Stakeholders 1. Health Deptt., 2. NGOs/Panchayats 1. Health Deptt. 2. NGOs/Panchayats 1. NGOs/Panchayats 2. Police 3. Health Activities 1.Providing clean delivery kits to pregnant women 2.Emergency obstetric and newborn care and 24/7 referral services 3.Identification of vulnerable group 3. Asha/AWW- under the guidance of MO, survey, selection of risk group. 4. Helps in data collection 6. Referral mechanism for rape surivivors. 7. Ensuring their physical safety. 8. A complete medical examination and Page 3 of 13
disters (Gangtok & Namchi). 4. SDM 5. RMDD/PHED psychosocial support. 9. Supervision of ce. 10. Arrangement of separate water & sanitation supplies in relief camp to prevent SGBV. HIV/STI All stakeholders 1. Syndromic approach, condom promotion,safe BT, universal precaution, inter-sectoral coordination. Activities on in PRE, During Post Dister. PRE-Dister (Awareness, IECs, training of staffs, mock exercises in dealing with ms cualty, identification of risk groups, identification of safe shelter/location) During (immediate response in co-ordinated manner) Post Dister (Recovery & rehabilitation, data collection and analysis, continuation of predister activities related to ). Et/North Contingency Plan: Examples of steps Activities required for Focal Key actors Challenges Resources Timeframe 1.Coordination: Coordinate and implement /SRH in disters and establish teams to support the Coordinator 1.Ensure that Coordinator is in place and functioning within the health coordination structure 1. Raise awareness of policymakers and programme managers on importance of SRH in emergencies. 2. Identify an appropriate Coordinator. 3. Establish dedicated teams at the state and the district level. Identified coordinator s and teams GMC, Health, Social Welfare, Civil Defence, 1.SRH/Gender needs not seen priority 2. Lack of capacity to plan and implement. 3. Lack of knowledge among service providers. 4. Lack of integration of SRH in policies and programmes 5. Complicated process. 6. Large number of actors working in disters 2.Ensure that SRH focal points are available in the field/on site or have access to affected 1. Preparation of databe of the. Population GMC, Health, Social Welfare, Civil Defence, 1.Lack of data on SRH 3.Make available material for implementing 1. Identification of organisation. 2. Finalize the materials according to need bis Identified organization s. GMC, Health, Social Welfare, Civil Defence, 1.Lack of capacity to plan and implement Page 4 of 13
disters (Gangtok & Namchi). Examples of steps Activities required for Focal Key actors Challenges Resources Timeframe 2.Integrate SRH into existing dister management plans and health plans: Build capacity to implement the for SRH in disters 1.Identify existing management plans 1. Prepare the dister management plans/health plans. 2. Carry out workshops for implementation of the plans. 3. Carry out mock drills to check the functionality of the plans. SDMA, DDMA and health officials GMC, Health 1. Lack of knowledge in preparation of plans. 2. Difficulty in implementatio n of plans. manpower 2. Conduct trainings 1. Conduct trainings and integrate the components of in the plans. 2. Create data bank of trainers/trainings. SDMA, DDMA, GMC, Health, Social Welfare, Civil Defence, SDMA 1.Lack of capacity to plan and implement 2. Strengthening coordination of SRH stakeholders and activities. manpower Examples of steps Activities required for Focal Key actors Challenges Resource s Timefra me 3. Sexual Violence: Prevent sexual violence and provide sistance to survivors 1.Ensure that prevention and response mechanism are in place to protect affected s from sexual violence 1. Understand the consequences of sexual violence. 2. Address the consequences of sexual violence like health, psycho-social, safety/security, legal/justice SDMA, DDMA, GMC, Health, Police, Social Welfare, Civil Defence, 1. Large number of actors working. 2.Cordinatio n problem 3.Absence of one stop focal point Manpow er 1.Ensure that medical services, including psychosocial support, are available for survivors 1. Capacity Building and training of stakeholders 2. Establishment of coordinating mechanism for appropriate psychosocial support SDMA, DDMA, GMC, Health, Police, Social Welfare, Civil Defence, 1. Large number of actors working. 2.Cordinatio n problem 3.Absence of one stop focal point Manpow er Page 5 of 13
disters (Gangtok & Namchi). Examples of steps Activities required for 4.Maternal and newborn mortality and morbidity: Prevent excess death and illness among mothers and newborns 1.Provide clean delivery kits to visibly pregnant women and birth attendants 2.Provide midwifery kits to health facilities 3.Establish a functioning 24/7 obstetric emergency referral system 4.Provide for safe abortion care facilities 5.Include the needs of adolescent 1. Preparation of clean delivery kits. 2. Sufficient procurement of clean delivery kits. 3. Identification of storage facilities. 4. Plan the distribution of delivery kits. 1. Make sure that midwifery kits are available at the health centres. 1. Planning and establishment of functioning obstetric emergency referral system 1. Essential Counselling services. 2. Establishment of referral and transportation for safe abortion services and management of complications. 1. Ensure that the pregnant adolescent are aware of the risk of pregnancy and know where to access MNH services. 2. Ensure FP access for adolescent and young people Focal Key actors Challenges Resources Pregnant women and their families. Women of the affected Women and their partners who are pregnant Adolescent GMC, Health, Social Welfare, Civil Defence, GMC, Health, Social Welfare, Civil Defence, GMC, Health, Social Welfare, Civil Defence, GMC, Health, Social Welfare, Civil Defence, GMC, Health, Social Welfare, Civil Defence, 1. Large number of actors. 2.Issues of accountability 1. Large number of actors. 2.Issues of accountability 1. Shortage of trained staffs. 2. Establishment of communication system to communicate with more qualified nel for medical guidance and support. 1. Face problem in counselling. 1.Engagement of traditional birth attendants or community health workers in identification and referral of pregnant adolescent 3.Perpared Kits 3.Perpared Kits 3.Equipment s 3.Equipment s 1.Facilities for MNH services 2. Training Timeframe Minimum 12 Minimum 12 Minimum 24 Minimum 24 Minimum 12 (Contd) Examples of steps Activities required for Focal Key actors Challenges Resourc es Timefra me 4.Maternal and newborn mortality and morbidity: Prevent excess death and illness among mothers and newborns 6. Make provision for family planning (FP) services. 7.RH Kits/Dignity Kit 1. Provide information-iec. 2. Ensure sufficient supplies of contraceptives according to the needs of the society. 1. List the items to be included in the kits. 2. Ensure sufficient supplies Women of the affected SDMA, DDMA, GMC, Health, Social Welfare, Civil Defence, SDMA, DDMA, GMC, Health, Social Welfare, Civil Defence, 1.Refusal of the society to FP services 1. Large number of actors. 2.Issues of accountabil ity 2. Trained Manpo wer. 3.Perpa red Kits 2. Trained Manpo wer. 3.Perpa red Kits Minimu m 12 Minimu m 12 Page 6 of 13
disters (Gangtok & Namchi). Examples of steps Activities required for Focal Key actors Challenges Resources Timefra me 5. HIV and other STIs: Reduce the transmission of HIV/STIs 1. Ensure that standard precautions are in place 1. Advocacy about standard precautions. 2.Preparation of Standard precaution kit Health nel SDMA,DDMA, GMC, Health, Civil Defence and NGOs 1. Refusal to practice standard precautions.. 2.Standard precaution kit Minimu m 12 2. Ensure availability of condoms 1.Impart knowledge on use of condoms 2. Ensure availability of free condom and accessibility. SDMA,DDMA, GMC, Health, Civil Defence and NGOs 1.Refusal to use condoms. 2.Storage place Minimu m 12 3.Ensure safe 1. Organise voluntary blood transfusion blood donation camps. 2. Screening of the collected blood. SDMA,DDMA, GMC, Health, Civil Defence and NGOs 1. Timely availability of blood. 1.Blood banks Minimu m 12 Examples of steps Activities required for Focal Key actors Challenges Resources Timefra me 6. Plan for 1.Collect comprehensive background SRH services information Integrate comprehensive SRH care into primary health care services 2. Assess staff and identify training needs 1. Divide responsibility. 2. Collect background information from district, health department etc 1. Prepare module per the local needs. 2. Assign responsibility after training SSDMA SSDMA SDMA,DDM A, Health SDMA,DDM A, Health 1.Carry out surveys per need 1. Identification of to be trained. manpower manpower 3.Identify procurement channels and sess monthly drug supplies. 1. Assign responsibility. 2. Fix dates for sessment of monthly supplies on monthly bis. 3. Identify procurement channels SSDMA SDMA,DDM A, Health 1. Favouritism in choosing the suppliers for procurement. 2.Manpowe r Page 7 of 13
disters (Gangtok & Namchi). Examples of steps Activities required for Focal Key actors Challenges Resources Timefra me 7. Plan for data in dister 1.Collect bic data required during different phes of disters 1. Identification of different sources of data. 2. Validation of data/ Quality of data. Population SSDMA, DDMA 1. Validation of data. manpower 2. Establish indicators for monitoring of 1. Prepare checklist to monitor the data. SSDMA SSDMA, DDMA 1. Accountabilit y through monitoring and evaluation manpower Session 2: Roll out and Integration in Odisha: Dr. Khirod Kumar Rout Activities undertaken in Odisha: STATE LEVEL: State Sensitization meeting 02 State TOT s State Planning Meeting 12 District Training budget provision made in NHM PIP Integration SRH Plan in State Dister Plan DISTRICT LEVEL: Calculation of logistics for in the State action plan for 12 districts Kitting planning for the state Micro plan for 12 disticts Pool of Resource s -National Trainers -State Trainers -District Trainers Data on rapid analysis for in dister Participated in National Dister day. The following details were discussed during the session Data on Rapid Analysis for in Disters. Calculation of Logistics for in Disters YeaRLY Activity Plan Action Planning for integrating diff. components of into Dister Preparedness and Contingency Plan of State/District Page 8 of 13
disters (Gangtok & Namchi). Budget allocations for Trainings on at District Level. RH Kit budget estimations Break up of NHM Funds for 2015-16 Kit Planning Plan Ahead for Integration. Reproductive health kits for dister affected situations: Dr. Henna Hejazi Reproductive health kits are standardized, pre-packed kits, intended for use during natural or humanitarian crises. A range of 18 different kits catering to varying needs are kept in stock, ready for immediate dispatch in urgent or emergency situations. The 18 different kits are divided into three categories. All are designed to respond to three months' need. Block 1: 8 kits for a of 10,000 people The items in these kits are intended for use by service providers delivering reproductive health care at community and primary health care level. Kit 0 Administration/training supplies Kit 1A Male condoms Kit 1B Female condoms Kit 2A Clean delivery, individual Kit 2B Clean delivery, birth attendants Kit 3 Post rape treatment Kit 4 Oral and injectable contraception Kit 5 Treatment of STIs Block 2: 7 kits for a of 30,000 people The kits contain both disposable and reusable material, and are intended for use by trained healthcare providers with additional midwifery and selected obstetric and neonatal skills at the health centre or hospital level. Kit 6A and 6B are used together, but can be ordered separately. Kit 6A Clinical delivery sistance,reusable equipment Kit 6B Clinical delivery sistance,drugs and disposable equipment Kit 7 Intrauterine devices (IUDs) Kit 8 Management of miscarriageand complications of abortion Kit 9 Suture of tears (cervical and vaginal)and vaginal examination Kit 10A Vacuum extraction delivery kit Kit 10B Vacuum extraction delivery kit Block 3: 3 kits for use at referral or surgical obstetric level For a of 1,50,000 people. Kits 11A and 11B are usually used together, but can be ordered separately. Kit 11A Referral level, reusable equipment Kit 11B Referral level, disposable equipment Kit 12 Blood transfusion kit intervention that need to be done S. No. Response period 1 Pre Dister Period Page 9 of 13
disters (Gangtok & Namchi). 2 During Dister 3 Post Dister Period 1.PRE DISASTER PERIOD: Preparation Objective Action Training sessions in Sensitisation of the government and the NGO workers to the concept of Conduct of regular training courses for the target workers. Creating of modules Preparation of the RH health Kits Identification of Potential coordinators 2.During Dister To keep ready the kits in warehouses which will reduce the delivery time to the dister affected individuals To reduce the time to get in qualified people sensitized and trained in various pects of delivery Preparation Objective Action Designating Coordinators for Distribution of the RH health Kits Monitoring To streamline the activity of. Its also does delivery of the necessary aid at the earliest To deliver the RH Kits to the community at the earliest so the mortality and morbidity can be minimized. To make use of the resources in the best way and to minimize the wtage. To do need bed distribution of the RH kits To improve the efficiency of the distribution mechanism. for training. Committee to study the local content of the Kits and to procure the same locally. The need of identification of the warehousing and logistical partners The selection of potential coordinators form the senisitised individual picked up during the training program Appointment of the government and/or the NGO workers coordinators for Use of the appropriate resources available in the dister zone to deliver the kits to the affected. To make use of logistics available from all sectors to get the resources to the affected. Role of the coordinator to get the warehousing stock monitoring and to prevent the stock out of the Kits. To sure the quality of care guidelines are adhered to. 3.Post Dister Preparation Objective Action Integration of the activities during the dister in to Comprehensive Health care To streamline the activity of and to decree the component of the Health care. The coordinator is the who is responsible to blend the dister work with Page 10 of 13
disters (Gangtok & Namchi). Restoration of the of the RH Kits Monitoring To ensure that the pre dister set up of health care is rebuilt and the is slowly withdrawn the health care is developed. The goal is to use the framework to build the health care facilities. RH Kits have to be replenished during the post dister phe there may be requirement of the same in the dister area or in any new dister that may follow. To analyse the success of the delivery and to scrutinize that the standards of the quality of care were adhered to. the comprehensive health care. The committee designated for of RH Kits should perform the duty. Committee formed of members of various Government and NGOs to study the delivery model of and to derive learning from the same. Page 11 of 13
disters (Gangtok & Namchi). Annexures Annex A:Agenda Time Session Details Resource Person 10:00 10:15 AM Registration 10:15 10:30 AM Brief Introduction to Advocacy Film 10:30 11:30 AM Need to integrate part of State Dister Plan Annex B: INDEX Dr. Henna Hejazi, Programme Manager, Sphere India Dr. Henna Hejazi, Programme Manager, Sphere India 11:30 12:00 PM Roll out in India Dr. Henna Hejazi Programme Manager, Sphere India 12:00 01:00 PM Integration of in State dister plan of Orissa Dr. Khirod Kumar Rout Nodal Officer, Odisha 01:00 01:30 noon Lunch 01:30 02:00 PM Roadmap to effective implementation in Dr. Henna Hejazi Programme Manager, Sphere India 02:00 02:30 PM Contingency Plan West and South Dr. Sil, District Health Officer, Namchi 02:30 03:00 PM Contingency Plan Et Mter Trainer 03:00 03:30 PM Contingency Plan North Mter Trainer 03:30 04:00 PM 04:00 04:30 PM Health Microplans Dr. Khirod Kumar Rout Nodal Officer, Odisha COVER PAGE SHOWING MONOGRAMS OF GoO & NHM,DISTRICT MAP WITH LEGENDS ONE MAP SHOWING HEALTH INSTITUTION, DELIVERY POINTS & NGO LOCATION AND ANOTHER REGARDING MRCs, SHELTER HOMES IN VULNERABLE AREAS LIST OF HEALTH INSTITUION, NGO INSTITUTION (PPP MODE). LIST OF MRCs & SHELTER HOMES. LIST OF HR INCLUDING NHM STAFF & NON HEALTH SECTOR GOVT INSTITUTION WITH THEIR CONTACT DETAILS LIST OF NODAL PERSONS AT DISICTRICT, CHC, PHC & OTHER SITES WITH CONTACT NOs LIST OF LEADING NGOs NODAL PERSONS & THEIR CONTACT DETAILS LIST OF VULNERABLE VILLAGES & NAC AREAS WITH POPULATION LIST OF SCHOOLS IN VULENERBLE AREAS MEMBERS OF DISTRICT TASK FORCE MEMBERS OF BLOCK TASK FORCE MEMBERS OF DISTRICT GBV COMMITTEE MEMBER OF DISTRICT RAPID ESPONSEE TEAM MEMBERS OF BLOCK RAPID RESPONSE TEAM MEMBERS OF DISTRICT CONTROL ROOM WITH CONTROL ROOM CONTACT NOs Page 12 of 13
disters (Gangtok & Namchi). MEMBERS OF BLOCK CONTROL ROOM WITH CONTROL ROOM CONTACT NOs DISTRICT & BLOCK MONITORING & SUPERVISION TEAM LIST OF NIRBHAYA & SRADHA CLINICS DISTRICT AND BLOCK REPORTING FORMATS GO I & GoO GUIDE LINES & STATE DIRECTIVE LETTERS DOCUMENTS RELATED TO PREPARTORY ACTIVITIES DETAILMENT OF TRANSPORT FACILLITIES STOCK POSITIOON OF ESSENTIAL DRUGS & DISTRIBUTION PLAN ALTERNATE POWER BACKUP SYSTEM INEGRATED PLANNING OF NDRAF,ODRAF,FIRE SERVICE & FOREST PERSONNEL IEC COMMUNICATION & PLANNING LIST OF ICE LINED REFRIGERATOR POINTS AT CUT OFF AREAS DISTRICT HEALTH CONTNIGENCY PLAN Page 13 of 13