©2012 International Medical Corps Janet Meyers Capacity assessment of humanitarian organizations to implement the MISP and comprehensive reproductive health:

©2012 International Medical Corps

Janet Meyers

Capacity assessment of humanitarian organizations to

implement the MISP and comprehensive reproductive

health: Global review


Global Review Objectives• To review the commitment to, scope, coverage,

quality and use of RH service by populations affected by humanitarian crisis;

• To identify and document progress made since the last IAWG global evaluation in 2004;

• To identify gaps and areas for improvement; and• To provide guidance for implementation,

management, funding and future research areas.


Components of 2013 Global Review

– Literature review – Assessment of agency commitment and capacity– In-depth assessment of RH service availability and

quality – Assessment of RH service availability and use– MISP assessment– Funding trends for RH in crises– Review of UNHCR Health Information System (HIS)

RH data


Capacity Assessment Team• Nguyen-Toan Tran, MD, MSc, DrMed, University of New South

Wales • Carina Hickling, MPH, PhD Student • Sandra Krause, RN, MPH , Reproductive Health Program, Women's

Refugee Commission, NY, NY • Janet Meyers, RN, MPH, International Medical Corps• Angela Dawson, PhD, University of Technology Sydney• Louise Lee-Jones, MSc, BA• Valerie Wisard• Rainer Tan, MD Candidate, University of Lausanne• Seher Shafiq, Master of Global Affairs Candidate, Munk School of

Global Affairs


Objectives of Capacity Assessment Study

• Evaluate the overall state of Reproductive Health in Humanitarian Settings (RHHS) since 2004

• Assess the capacity of institutions – institutional policy – accountability mechanisms – program delivery strategy – financial resources – human resources– technical guidance – procurement of supplies related to RHHS


Methodology

• Elements of Capacity: Structured Theoretical Framework – based upon Allan Kaplan’s capacity building model

• Ethical approval from the Faculty of Health of the University of Technology Sydney

• Cross-sectional online survey from April to August 2013

• Purposive sampling – IAWG, GHC and CORE Group listservs


Characteristics of Institutional Respondents


Institutional Policy

Missing

Don't know

No

Yes

2%

6%

23%

68%

Has an RHHS-related institutional policy or policy-like document


Accountability Mechanisms

IASC Matrix on Agency Roles and Responsibilities for Ensuring a Coordinated, Multisectoral Fuel Strategy in Humanitarian Settings

Code of Conduct for the International Red Cross & Red Crescent Movement and NGOs in Disaster Relief

IASC Guidelines on Mental Health and Psychosocial Support in Emergency Settings

UN Secretary General’s Bulletin “Special measure for protection from sexual exploitation and sexual abuse”

Humanitarian Accountability Principles

Inter-Agency Standing Committee (IASC) Gender Handbook in Humanitarian Action

IASC Guidelines for HIV/AIDS Interventions in Emergency Settings

The Sphere Project. Humanitarian Charter and Minimum Standards in Disaster Response Interventions in Humanitarian Assistance

IASC Guidelines for Gender-based Violence Interventions in Humanitarian Assistance

24%

56%

62%

65%

71%

78%

78%

84%

92%

Proportion of institutions with policies and systems in place to abide by these international standards


Accountability Mechanisms

Arrange mechanisms for beneficiaries to contact organizational representatives, lodge complaints and seek redress

Establish ongoing communication with affected populations about the institution and its project plans and work

Enforce systems within the organization to respond to improper conduct by staff

Engage beneficiary participation in all programming steps -- assessing, planning, implementing and monitoring the project

RH indicators collected as part of the institutional health information system and/or monitoring and evaluation system

49%

69%

69%

70%

86%

Proportion of institutions with mechanisms in place to follow major principles of accountability


Program Delivery Strategy

Private sector

NGO

Government institution / relevant ministry

UN agency

5%

58%

62%

85%

Institutions leading or co-leading coordination

©2012 International Medical CorpsPresentation Title

Gender mainstreaming, equality programming, male involvement

Community-based programming: e.g mobilization, engagement, outreach, etc.

Technical assistance to partners or other institutions on RHHS

Grant allocation to international institutions for RHHS activities

Grant allocation to local institutions for RHHS activities

Capacity building, training or refreshers on RHHS

Research, documentation and dissemination

Service delivery of components of comprehensive RH in post-conflict/recovery situations

Recovery (including transition to comprehensive RH services)

MISP service delivery in emergency

Emergency management and coordination of RHHS

DRR/Other components & RHHS

DRR/Emergency preparedness & RHHS

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

21%

24%

18%

17%

15%

20%

17%

17%

17%

17%

15%

7%

12%

40%

33%

46%

15%

24%

46%

30%

40%

40%

49%

44%

40%

44%

15%

16%

18%

11%

12%

16%

15%

18%

16%

18%

16%

16%

18%

15%

17%

9%

37%

29%

12%

28%

16%

20%

11%

17%

21%

16%

Started before 2004 Started in 2004 or after Don’t know when No


Family planning

Newborn health

Maternal health

HIV awareness, prevention, treatment and care

Management of sexually transmitted infections

Care for survivors of sexual violence

Prevention of gender-based violence

Adolescent RH

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

26%

26%

31%

22%

25%

22%

22%

18%

42%

35%

38%

37%

31%

33%

40%

37%

17%

16%

17%

20%

20%

22%

20%

17%

10%

16%

9%

13%

17%

17%

12%

20%


Community-based Interventions


Advocacy and Policy Work

Portfolio of donor agencies, relevant ministries with decision power on budget alloca-tion or other funding mechanisms

National health strategy

Recovery policies and plans

Emergency response policies and plans

DRR/other components

DRR/emergency preparedness policies and plans

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

15%

23%

11%

13%

9%

10%

18%

27%

31%

40%

26%

40%

12%

15%

13%

20%

16%

19%

33%

27%

31%

18%

28%

16%



Clinical RHHS

Cervical cancer treatment

Cervical cancer screening

STIs/RTIs

Adolescent SRH

MISP

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

2%

2%

27%

20%

13%

16%

21%

40%

37%

51%

7%

12%

21%

21%

20%

52%

46%

7%

16%

10%

Started before 2004 Started in 2004 or after Don't know when No


Maternal Newborn Health

Prevention of maternal-to-child transmission of HIV

Postnatal maternal and newborn care

Emergency obstetric care

Care during delivery

Antenatal care

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

17%

23%

22%

27%

29%

31%

42%

39%

37%

40%

21%

18%

21%

17%

17%

22%

11%

15%

15%

9%



Family Planning

Postpartum family planning

Emergency contraception

Permanent methods (surgical sterilization)

Long-acting methods (e.g. IUD, Implants)

Short-acting methods (e.g. pills, condom, injectables)

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

18%

22%

16%

26%

34%

37%

35%

17%

33%

34%

15%

20%

20%

20%

20%

18%

15%

38%

16%

9%



GBV

Prevention of forced early marriage

Prevention of female genital mutilation/cutting

Domestic violence or intimate partner violence

Sexual violence prevention and response (rape, sexual abuse, sexual exploitation)

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

15%

20%

18%

22%

26%

16%

34%

43%

12%

15%

21%

20%

29%

39%

17%

10%



HIV

Care and support

ARV and ART interventions

Voluntary counseling and testing

Prevention

0% 20% 40% 60% 80% 100%

12%

11%

18%

27%

17%

17%

34%

37%

18%

17%

20%

21%

33%

38%

18%

9%



Financial Resources

Missing

Don't know

No substantial change in funding for RHHS

A decrease in funding for RHHS

An increase in funding for RHHS

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

2%

16%

20%

13%

49%

Institutional change in RHHS funding from 2004 to 2012


Human Resources: Proportion of Dedicated Staff for RHHS

Before 2004 2004-2006 2007-2009 2010-20120%

20%

40%

60%

80%

100%

Proportion of institutions with dedicated RHHS staff

©2012 International Medical CorpsPresentation Title

Missing

Don't know

No

Yes

0% 20% 40% 60% 80% 100%

10%

4%

13%

73%

Proportion of institutions routinely identifying an RH Focal Point


Proportion of Institutions Reporting High Level Workforce Competencies

Before 2004 2004-06 2007-09 2010-120%

10%

20%

30%

40%

DRR/ emergency reparednessDRR/other componentsMISP coordination and managementMISP service deliveryMISP community outreachGender mainstreaming/equalityRecovery, including comprehensive RHResearchPolicy/advocacy


Top Resource Materials since 2004


IAWG Clinical Guidance Needs

Cervical Cancer

Comprehensive abortion care

STI

Maternal health

Newborn health

MISP service delivery

HIV

Adolescent

GBV

Family planning

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

34%

37%

40%

43%

45%

48%

48%

49%

51%

52%

Proportion of institutions requiring clinical guidance to be developed by IAWG to support their institution's work on RHHS


Preferred Training Methods

Webinars

Mobile technologies

Face-to-face, country level

Face-to-face, regional level

Face-to-face, field level

E-learning modules

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

32%

32%

50%

51%

59%

63%

Preferred training methods


RH Procurement Issues

Stock out of any RH supplies

Delay in identifying sources for RH supplies

Difficulty in sourcing quality RH supplies

Delay in obtaining or distribution of Interagency RH Kits

21%

49%

56%

81%

RH procurement issues in previous 5 years


Recommendations• Formalize the Inter-agency Working Group (IAWG)

structure• Continue annual work meetings and support to

regional working groups on RHHS• Systematically identify a lead agency to lead RH

coordination in all emergencies• Develop or adapt practical guidance for emerging

topics• Strengthen RH supply chain management and re-

supply


Recommendations• Implement established mechanisms of accountability• Advocate for engagement of development and

humanitarian sections• Strengthen formal partnerships and build resilience

of crisis affected communities• Ensure well-funded dissemination strategy for

guidance resources• Continuously improve quality and access to address

gaps in service delivery

Documents

©2012 International Medical Corps Janet Meyers Capacity assessment of humanitarian organizations to implement the MISP and comprehensive reproductive health: