Transcript Slide 1

Reproductive health humanitarian
response in Jordan : Achievements and
challenges
“Evaluation of the Implementation of MISP”
Dr Shible Sahbani
Dr Faeza Abu-Jalo
Maysa Al-Khateeb
Context
• 620,000 refugees registered
• 155,000 WRA
• 15,500 pregnant Women
• 85 %are in the communities
• 15 % are in the camps
(Za`atri, Azraq, KAP, CC, EJC)
Background during the evaluation
355,493 Syrian refugees in Jordan
164,365refugees in Zaatri Camp
133,660 refugees in urban areas
Humanitarian crisis ongoing
~1,500/day influx
RH indicators (Zaatri Camp)
14% of all births performed by caesarean
section
100% of births attended by skilled health
worker
The objectives of the evaluation
• Assess the extent to which MISP has been
implemented
• Identify the availability, accessibility and use of
RH services
• Describe the facilitating factors and barriers to
the implementation of MISP services
Coordination
Recommendation
Strengthen coordination in
urban settings
Mapping of Reproductive Health services
Update
•
Mapping of RH services in camps and urban
updated regularly, Reproductive health SWG
coordination and production of tools through
the SWG and uploading it on the interagency
portal.
•
UNFPA supported all health care providers
reproductive health kits and technical
support (e.g: assessments, capacity building)
also through coordination channeled
resources between partners
•
Mapping of Youth and GBV services in camps
and Urban,
•
Campaigns conducted inside and outside the
camps to increase access to the different
available services and increasing awareness,
linkages with other working groups
Coordination
Recommendation
Update
Involvement of key stakeholders such
as the MOH, WHO, local NGOs,
unfunded partners, and interagency protection and GBV
working groups
• RH SWG members almost
doubled.
• MoH participated actively
with capacity building for
RH partners providing
services to Syrian refugees
that included MoH , NGOs
and INGOs
UNFPA supported MoH to conduct MISP and RH
protocols training
Access
Recommendation
• Identify additional funding
for SRH and support
additional local NGOs that
are providing RH services for
Syrian refugees in urban
areas and the Jordan Valley.
• Locate SV services in safe
and private spaces.
• Discuss access to postabortion care in
coordination meetings.
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Update
UNFPA supported establishment of
static and mobile clinics in Jordan
valley
Establishment of more safe space in
camps and Urban
Development and training on SOPs
and referral pathways through
interagency approach
UNFPA piloted introduction of
miscarriage, post abortion care and
counselling data collection registry.
Access
Recommendation
• Establish Basic EmOC
services throughout
Zaatri
• Ensure timely,
accessible and
affordable transport
options
Update
• UNFPA/JHAS provide 24/7 basic EmOC in
Zatari camp, IFRC provide EmOC in
Azraq camp
• UNFPA supported EmOC training
conducted in Zatari ,training followed up
by development of certain monitoring
tool shared with stakeholders
• UNFPA through ECHO, BPRM and other
donors’ support expanded its delivery
site
• RH kits provided to partners for urgent
preparedness for EmOC, UNFPA and
UNHCR also developed clinical referral
guidelines
EmOC services
Reproductive Health protocols
Recommendation
•
Update
Review, establish and
• Development of reproductive
disseminate RH protocols on
health checklists, mapping of
care for survivors of SV and
services, development of action
management of STIs
plans
• Disseminate and discuss the
Inter-agency Field Manual
• IAFM shared with RH SWG, also
on Reproductive Health in
shared online training sources
Humanitarian Settings, 2010
“online MISP,CMR, preeclampsia
SGBV services
Recommendation
Update
• Provide care for survivors of
SV, particularly in urban
areas through collaboration
with MOH and relief
organizations.
• UNFPA through partnership
with MoH Conducted
training workshops for
Family Protection
Committees in MOH on
Violence against women
and violence against
children
Data utilization
Recommendation
• Improve data collection and use
of data for action
Revision of data collection tools with health care
providers
Today
• RH data collection tools has
been reviewed and updated
with partners.
• UNFPA updated the family
planning log book with RH
SWG.
• UNFPA and UNHCR share
data trends with partners to
guide interventions and
provide recommendations
Community participation
Recommendation
• Support information, education
and communication (IEC)
campaigns on the benefits to
seeking care and the availability,
location and hours of services
• Develop culturally appropriate
mechanisms for improving
knowledge about and attitudes
toward available clinical services
for survivors of violence
Update
• RH campaign organized a
where gynecologists and
midwives had a direct
interaction with refugees
• The IEC material was
developed in participatory
approach with the
community
Community participation
Recommendation
• Continue efforts to establish
community health post and
community outreach in
both Irbid and Za`tari camp
with a view to engaging the
community, including
adolescents and people
with disabilities, in the
delivery of services.
Update
• Agencies established a
network of CHW and
volunteers in Za`tari, Irbid,
Amman, Zarqa and other
areas ,through collaboration
with community task force,
RH SWG address
community outreach,
Community Awareness
Cultural and gender sensitivity
Recommendation
• Identify and support more
health care providers,
particularly female
providers
Update
• In all sites female midwives
are available
• Task shifting and part times
were advocated as possible
solutions
Transition
Recommendation
• Transition to comprehensive
RH services, including
improving the quality of
ANC according to national
protocols, such as the
detection and management
of anemia in pregnancy,
tetanus toxoid coverage,
syphilis and rubella
screening, and use of
standard documentation of
ANC visits.
Update
• TT vaccination and EPI services are
available in inside Za`tari and
additional two sites in Azraq camps ,
sites are working in collaboration
with MoH
• Anemia screening and treatment is
following RH protocols and further
recommended this through
nutrition intervention strategy and
Jordan nutrition fact sheet .
• UNFPA supported training for RH
providers on RH protocols which
include ANC and PNC protocol.
Challenges
The proportion of deliveries in girls under
the age of 18 was 11% in the first quarter of
2014 which represents a significant increase
compared to the average for 2013 of 5%.
Address youth SRH needs
Men and Youth involvement
Limited distribution of condoms
through community channels due to
cultural sensitivity
Challenges
In Za`trai UNFPA/JHAS remains the only provider
of normal delivery services with highly increasing
demands on the services ,
Changing governmental policies in regards to
refugees access to different services Public health
system is overstretched, it is increasingly
challenging to successfully refer patients from
clinics to MoH hospitals, this includes at times
issues around complicated deliveries
Increasing demands on higher quality of reproductive health
services inside and outside the camp with the capacity to
address more specialized services like Mammogram for
breast screening and pap smear .
Only provider of normal deliveries in
Za`trai camp
Deliveries conducted at UNFPA/JHAS
250
200
150
100
50
0
Delivery
Thank You!!!