Abstract
BackgroundFollowing the Nepal earthquake in April 2015, UNFPA estimated that 1.4 million women of reproductive age were affected, with approximately 93,000 pregnant and 28,000 at risk of sexual violence. A set of priority reproductive health (RH) actions, the Minimum Initial Services Package (MISP), was initiated by government, international and local actors. The purpose of this study was to identify the facilitators and barriers affecting the implementation of priority RH services in two districts.MethodsIn September 2015, a mixed methods study design was used in Kathmandu and Sindhupalchowk districts to assess the implementation of the priority RH services five months post-earthquake. Data collection activities included 32 focus group discussions with male and female participants aged 18–49; 26 key informant interviews with RH, gender-based violence (GBV), and human immunodeficiency virus (HIV) experts; and 17 health facility assessments.ResultsThe implementation of priority RH services was achieved in both districts. In Kathmandu implementation of emergency RH services started within days of the earthquake. Facilitating factors for successful implementation included disaster preparedness; leadership and commitment among national, international, and district level actors; resource mobilization; strong national level coordination; existing reproductive and child health services and community outreach programs; and supply chain management. Barriers included inadequate MISP training for RH coordinators and managers; weak communication between national and district level stakeholders; inadequate staffing; under-resourced and fewer facilities in rural areas; limited attention given to local GBV and HIV organizations; low availability of clinical management of rape services; and low awareness of GBV services and benefits of timely care.ConclusionEnsuring RH is included in emergency preparedness and immediate response efforts and is continued through the transition to comprehensive care is critical for national governments and humanitarian response agencies. The MISP for RH remains a critical component of response efforts, and the humanitarian community should consider these learnings in future emergency response.
Highlights
Following the Nepal earthquake in April 2015, United Nations Population Fund (UNFPA) estimated that 1.4 million women of reproductive age were affected, with approximately 93,000 pregnant and 28,000 at risk of sexual violence
key informant interviews (KII) A total of twenty-four KIIs were conducted in Kathmandu and Sindhupalchowk with informants representing the Department of Health Services (DoHS), UN agencies and, international and national organizations
Thirteen KIIs were conducted in Kathmandu including seven interviewees working on reproductive health (RH), five interviewees working on gender-based violence (GBV), and one interviewee working on human immunodeficiency virus (HIV)
Summary
Following the Nepal earthquake in April 2015, UNFPA estimated that 1.4 million women of reproductive age were affected, with approximately 93,000 pregnant and 28,000 at risk of sexual violence. A set of priority reproductive health (RH) actions, the Minimum Initial Services Package (MISP), was initiated by government, international and local actors. As greater numbers of people become displaced and the contexts of their displacement becomes more diverse, ensuring access to the standard of care of priority RH services must be included in all types of emergency response efforts. The priority RH services, known as Minimum Initial Services Package (MISP) for RH, were identified in 1996 and included in the Reproductive Health in Refugee Situations: An Inter-agency Field Manual (IAFM) in 1999 [1]. The MISP is a coordinated set of activities designed to prevent and manage the consequences of sexual violence, reduce transmission of human immunodeficiency virus (HIV), prevent excess newborn and maternal morbidity and mortality, and to plan for comprehensive RH services. Additional priority activities include: access to contraception for existing users; syndromic management of sexually transmitted infections (STIs); continued access to antiretroviral (ARV) drugs for those in need, as well as prevention of mother-to-child transmission (PMTCT) of HIV; and access to menstrual hygiene supplies [3]
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