Evaluation of the Implementation of the Minimum Initial Service Package (MISP) for Reproductive Health among Syrian Refugees in Irbid City and Zaatri Camp, Jordan

Conducted by the Inter-agency Working Group on RH in Crises

Sandra Krause/Women’s Refugee CommissionHolly Williams/CDCSamira Sami/CDCMonica Onyango/Boston UniversityWilma Doedens/UNFPA

Outline Introduction Objectives Methods Context Preliminary Findings Recommendations Next Steps

IntroductionGlobal Evaluation Literature review MISP assessment (Jordan) In-depth assessment Coverage study in the in-depth assessment

sites Agency commitment study Health information system Funding analysis

MISP Evaluation: Objectives Assess the extent to which MISP has been

implemented in Irbid City and Zaatri Camp. Identify the availability, accessibility, and use

of MISP services. Describe facilitating factors and barriers to

the implementation of MISP services.

MISP Objectives1. Ensure the health sector/cluster identifies

an organization to lead implementation of the MISP.

2. Prevent and manage the consequences of sexual violence.

3. Reduce HIV transmission.4. Prevent excess maternal and newborn

morbidity and mortality.5. Plan for comprehensive RH services as the

situation permits.

Additional priorities of the MISP Ensure contraceptives are available to meet

the demand. Ensure treatment of sexually transmitted

infections (STIs) is available. Ensure antiretrovirals (ARVs) are available to

continue treatment for people already on ARVs including for prevention of mother to child transmission.

Distribute culturally relevant menstrual protection materials to women and girls.

MISP Evaluation: Methods Inter-agency preparatory work Field work: 17 – 21 March 2013 Institutional Review Board (Human Subjects

Protection) approval by CDC Mixed methods

Key stakeholder interviews and meetings Health facility assessments Focus group discussions (FGDs)

Context

366,212 Syrian refugees in Jordan (425,771 and 65,040 unregistered)o 168,468 refugees in Zaatri Camp (192,193)o 133,660 refugees in urban areas (169,538)

Ongoing humanitarian crisiso ~1,500/day influx

Credit: Jeff J Mitchell/Getty Images, The Guardian

Credit: Sandra Krause/WRC

Priority Concerns of Refugee Women and Girls in Zaatri Camp• Desire to be treated with dignity and respect.• Hygiene

o Toilets: maintenance, not sex-specific.o Lack of clean water.o Major desire for hygiene and cleaning products.

• Inequitable distributions.• Lack of supervision of community/street

leaders.• Strong perception of no outreach from

agencies.• Inability to work or volunteer.• Reported increase in domestic violence.

Context Specific to Zaatri Camp

• High level of medical care.• Low level of community engagement and

primary health care.

Credit: UNFPA

Credit: UNFPA

Priority Concerns of Refugee Women and Girls in Irbid City

• High rent and utility costs.• Inability to work.• Inequitable distribution and need for UN

supervision.• Strong need for UN card to improve quality of

life.• More flexibility related to purchases with

vouchers.• Strong tensions with host community.

Context Specific to Irbid City

• Ministry of Health• Non-governmental organizations

Credit: UNFPACredit: Sandra Krause/WRC

Credit: Sandra Krause

Preliminary findings related to the MISP1) Coordination of the MISP

• Positive impressions. • Need for further focus on urban areas.

2) Prevent and manage sexual violence• Camp: inadequate lighting in camps and

distance to services.• Urban: distance to schools.• Limited availability and knowledge of clinical

services.

Preliminary findings related to the MISP (cont)3) Reduce HIV Transmission

• Safe blood transfusion.• Standard precautions are generally in place.• Condoms available but access is restricted.

4) Prevent maternal and newborn morbidity/mortality• Skilled birth attendants are available.• Basic/Comprehensive emergency obstetric and

newborn care available.• 24/7 referral services established but limited.• Negative perceptions by community of health

services.• Distribution of clean delivery kits not

implemented.

Preliminary findings related to the MISP (cont)5) Planning for Comprehensive RH Services

• Gap in background data for RH.• Sites for future RH services are in process.

6 ) Additional Priorities• Strong desire for family planning: generally

available (except some methods) for married couples.

• Lack of protocols for STI care.• ARVs very limited.• Gap in menstrual hygiene supplies.

Limitations Time and security Minimal field time Very preliminary analysis FGD participants found it difficult to focus on

RH questions

Recommendations Scale up efforts to ensure basic needs for

reproductive health are being met through the provision of hygiene products.

Implement safety measures to protect women and children from violence, such as safe transport to schools in Irbid City and adequate lighting and sex-specific latrines in Zaatri Camp.

Scale up the availability of care for survivors, particularly in urban areas and that all health care providers and protection staff are informed about the availability and location of care for survivors.

Recommendations (cont) Develop culturally appropriate mechanisms for

improving knowledge about the benefits of seeking care and available clinical services for survivors of sexual violence.

Undertake culturally appropriate methods to inform the community of where to access free condoms and other forms of family planning.

Ensure the availability of and access to emergency obstetric and newborn care 24 hours a day, seven days a week.

Next Steps

Global evaluation: advocate findings in advance of:o International Conference on Population and

Development (ICPD) + 20o Post-Millennium Development Goals (MDGs)

Develop beneficiary and field partner reports.

Acknowledgements Jordanian Ministry of Health UNHCR UNFPA IRC Jordanian Women’s Union Gynecologue Sans Frontieres

(GSF) Royal Medical Services (RMS) Jordan Health Aid Society

(JHAS)–Women’s Clinic Physicians Across Continents

(PAC) Moroccan Field Hospital (MFH) Marfraq Hospital

IFH Noor Al Hussein Foundation Amman Jordan Association IMC MDM Medair UNAIDS International Relief &

Development WHO Save the Children MISP Evaluation Translators

Thank You!