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Taking Stock of Reproductive Health in Humanitarian Settings: 2012-2014 Inter-agency Working Group on Reproductive Health in Crises' Global Review
Chen Reis, Ruwan Ratnayake
(2015)
Conflict and Health, vol. 9 Supplment 1. Free download of all articles at: http://www.conflictandhealth.com/supplements/9/S1
The IAWG has undertaken an updated review to identify services, quanti
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fy progress, document gaps and determine future directions for programs, advocacy and funding priorities. The 2014 review clearly highlights that humanitarian and development actors must identify and develop effective strategies to meaningfully engage affected communities to icrease use of reproductive health services, meet their reproductive health needs, and augment participation in the programs that affect their lives
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The Federal Ministry of Health (FMOH) has been coordinating sector wide reforms that aim to improve equity and quality of maternal and child health
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services. As part of these efforts, the ministry is also exerting concerted efforts to improve availability and use of quality RMNCH pharmaceuticals. Management of RMNCH pharmaceuticals has had significant challenges such as poor availability of essential pharmaceuticals and wastages of valuable resources as pharmacy professionals were not demonstrating the required knowledge, skill and attitude towards availing the pharmaceuticals and ensuring their rational medicine use.
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In 2006, the Special Session of African Union Health Ministers adopted the Maputo Plan of Action for implementing the Continental Policy Framework on sexual and reproductive
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health and rights (SRHR), which expired at the end of 2015. The goal was for all stakeholders and partners to join forces and re-double efforts, so that together, the effective implementation of the Continental Policy framework including universal access to sexual and reproductive health by 2015 in all countries in Africa can be achieved. The Revised Maputo Plan of Action (MPoA) 2016 – 2030 was subsequently endorsed by the African Union Heads of State at the 27th AU Summit in July 2016 in Kigali, Rwanda. The plan reinforces the call for universal access to comprehensive sexual and reproductive health services in Africa and lays foundation to the Sustainable Development Goals, particularly Goal 3 and 5, as well as the African Union Agenda 2063.
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Modelling the health impacts of disruptions to essential health services during COVID-19 Module 1
Several epidemiological models have been created
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to assess the potential impact of disruptions to essential health services caused by COVID-19 on morbidity and mortality from conditions other than COVID-19 illness. This guide presents models that have been used to assess these indirect impacts. The effects have been studied in various settings, using a variety of models.
The guide is intended for people who need to understand what the models say, their construction and their underlying assumptions, or need to use models and their outcomes for planning and programme development and to support policy decisions for a country or region.
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The Policy Guidelines and Service Standards for National Sexual and Reproductive Health Programme document outlines the steps on how to offer and deliver
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services. Improving quality of care is critical to improving clients' health status as well as increasing access to, and utilization of Sexual and Reproductive Health services. Service Standards and Guidelines are intended to be used by programme managers, implementers, trainers, surpervisors, and service providers as a tool for delivering quality care measures.
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Global Sexual and Reproductive Health Service Package for Men and Adolescent Boys
IPPF, UNFPA
(2017)
The Global Sexual and Reproductive Health Service Package for Men and Adolescent Boys has been developed to support providers of sexual and reproductive
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health (SRH) services to increase the range and quality of services to meet the specific and diverse needs of men and adolescent boys. This package focuses specifically on the provision of such services integrated
within clinical and non-clinical contexts and follows a gender-transformative approach. It covers men and adolescent boys in all their diversity and takes a positive approach to SRH, seeing this not just as the absence of disease, but the positive expression of one’s gender, sex and sexuality. In doing so, this service package contributes to efforts to ensure universal access to sexual and reproductive health and rights (SRHR) as prioritized in the Sustainable Development Goals. This package is in no way intended to detract from the sexual and reproductive health and rights of women and adolescent girls, nor to divert resources, funding or attention from much-needed SRH services and programmes for women and adolescent girls.
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- Module 1: Understanding modelling approaches for sexual, reproductive, maternal, newborn, child and adolescent health, and nutrition
Coronavirus disease 2019 (COVID-19) has a wide range of docume
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nted effects. It directly causes death and disability for some people infected. However, disruption to essential health services, resources allocated to mitigation and therefore away from essential health service delivery, and the overall impact on the economy and society must also be considered within the response to COVID-19. Understanding the magnitude of all of these effects is an essential part of developing mitigation polices.
Several epidemiological models have been created to assess the potential impact of disruptions to essential health services caused by COVID-19 on morbidity and mortality from conditions other than COVID-19 illness. This guide presents models that have been used to assess these indirect impacts. The effects have been studied in various settings, using a variety of models.
The guide is intended for people who need to understand what the models say, their construction and their underlying assumptions, or need to use models and their outcomes for planning and programme development and to support policy decisions for a country or region.
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This country snapshot provides an overview of national data relating to sexual and reproductive health and rights (SRHR) throughout the life course. Realization of SRHR requires provision of compreh
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ensive, people-centred services, that address the different elements of SRHR, and which are supported by an enabling environment, quality health systems, and meaningful community engagement. Multiple, synergistic cross-linkages exist within and between the different SRHR elements, leading to sequential outcome benefits throughout the life course.
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Reprod Health 19, 143 (2022). https://doi.org/10.1186/s12978-022-01452-4.
Delivery of quality reproductive health
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services has been documented to depend on the availability of healthcare workers who are adequately supported with appropriate training. However, unmet training needs among healthcare workers in reproductive, maternal, and newborn health (RMNH) in low-income countries remain disproportionately high. This study investigated the effectiveness of training with onsite clinical mentorship towards self-reported performance in RMNH among healthcare workers in Mwanza Region, Tanzania.
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According to the latest available data, over half of the world’s population lack access to essential health services, and health worker shortages
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are estimated to reach 10 million by 2030. These contextual factors point to an urgent need to explore innovative strategies – that go beyond a conventional health-sector response – for reaching people with the health services they need.
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Infectious disease epidemics pose a threat to reproductive, maternal, newborn and child health (RMNCH) both directly—by worsening women’s and children’s
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health outcomes—and indirectly—by reducing their access to services.1–4 Greater investment is therefore needed to mitigate the negative effects of COVID-19 and avoid a reversal of recent gains in RMNCH coverage and outcomes.1 However, COVID-19 has reduced household and government budgets,5 and there are concerns about the extent to which resources have been diverted away from RMNCH.
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The Government of Botswana’s SRH Policy Guidelines and Service Standards document provides the framework for developing a responsive strategy and an implementation plan for SRHR and HIV&AIDS Linkages and Integration. The global call on governments to demonstrate commitments to intensify linkages b
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etween sexual and reproductive health and HIV&AIDS at the policy and programme level is therefore an added opportunity for the government to review the current service provision model and optimize current resources to provide more integrated, comprehensive coordinated SRHR and HIV&AIDS services.
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The revision of the SRHR Policy is based on the results of the analysis of the implementation process of the past policy, which has provided evidence to
ensure that the revised policy is relevant and effective. The revision has also been done with the participation of all national stakeholders who
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have
also international experience on SRHR issues. The Ministry urges all public and private institutions to use this policy as a guide in the implementation of
SRHR services in the country.
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INTRODUCTION: The COVID-19 pandemic has disrupted health systems around the world. The objectives of this study are to estimate the overall effect of the pandemic on essential health service use and
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outcomes in Mexico, describe observed and predicted trends in services over 24 months, and to estimate the number of visits lost through December 2020.
METHODS: We used health information system data for January 2019 to December 2020 from the Mexican Institute of Social Security (IMSS), which provides health services for more than half of Mexico's population-65 million people. Our analysis includes nine indicators of service use and three outcome indicators for reproductive, maternal and child health and non-communicable disease services. We used an interrupted time series design and linear generalised estimating equation models to estimate the change in service use and outcomes from April to December 2020. Estimates were expressed using average marginal effects on the risk ratio scale.
RESULTS: The study found that across nine health services, an estimated 8.74 million patient visits were lost in Mexico. This included a decline of over two thirds for breast and cervical cancer screenings (79% and 68%, respectively), over half for sick child visits and female contraceptive services, approximately one-third for childhood vaccinations, diabetes, hypertension and antenatal care consultations, and a decline of 10% for deliveries performed at IMSS. In terms of patient outcomes, the proportion of patients with diabetes and hypertension with controlled conditions declined by 22% and 17%, respectively. Caesarean section rate did not change.
CONCLUSION: Significant disruptions in health services show that the pandemic has strained the resilience of the Mexican health system and calls for urgent efforts to resume essential services and plan for catching up on missed preventive care even as the COVID-19 crisis continues in Mexico.
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Women, girls and marginalized groups who are largely dependent on natural resources for livelihoods are among the hardest hit by extreme weather patterns. These weather patterns limit their access to food, water, shelter, education and access to essential
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health services, including those that address sexual and reproductive health and rights (SRHR), gender-based violence (GBV) and preventing harmful practices such as child marriage and female genital mutilation.
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Evidence- and rights-based national policies, guidelines and legislation play a key role in improving sexual, reproductive, maternal, newborn, child and adolescent health (SRMNCAH), framing the enab
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ling environment for equitable provision and accessibility of quality services. The SRMNCAH policy survey monitors the existence of national SRMNCAH laws, policies, strategies and guidelines and the extent to which they are aligned with WHO recommendations on SRMNCAH. This publication reports on the findings from the 2023 WHO SRMNCAH policy survey.
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he UNFPA “Programmatic guidelines: Cash and Voucher Assistance in Sexual and Reproductive Health programming in Emergencies” explains how CVA can be effectively integrated into humanitarian resp
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onses to help women, girls, and other vulnerable groups access lifesaving and comprehensive SRH services. Rooted in UNFPA’s mandate, this document provides practical direction for designing, implementing, and monitoring CVA within SRH programming.
The guidance highlights the barriers that hinder access to SRH care, such as affordability, availability, acceptability, and appropriateness, and illustrates how CVA can address financial obstacles by covering transport, user fees, or other indirect costs, while reinforcing health system strengthening efforts. CVA is presented as a complementary tool that supports both emergency and long-term SRH goals. Within humanitarian emergencies, it can contribute directly to achieving MISP objectives, including:
Enabling survivors of sexual violence to access clinical and psychosocial care;
Supporting the continuation of HIV and STI treatment, including coverage of transport;
Facilitating safe deliveries and emergency obstetric and newborn care; and
Removing financial barriers to voluntary family planning and contraceptive access, while ensuring informed choice and avoiding coercion.
Beyond the MISP, CVA also supports the transition to comprehensive SRH services in protracted emergencies and recovery phases. Examples include using cash or vouchers to encourage antenatal and postnatal care, ensure menstrual hygiene, sustain cancer prevention and treatment, fund obstetric fistula repair, and promote SRH education among adolescents.
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This summary highlights the experiences, results and actions from the implementation of the Rapid Assessment Tool for Sexual and Reproductive Health and HIV Linkages in Botswana. The tool – develo
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ped by IPPF, UNFPA, WHO, UNAIDS, GNP+, ICW and Young Positives in 2009 – supports national assessments of the bi-directional linkages between sexual and reproductive health (SRH) and HIV at the policy, systems and services levels. Each country that has rolled out the tool has gathered and generated information that will help to determine priorities and shape national plans and frameworks for scaling up and intensifying linkages. Country experiences and best practices will also inform regional and global agendas.
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What recommendations did the assessment produce?
• Developing guidelines and plans to further the process of SRH and Hiv integration.
• Training stakeholders at different levels of the health system on how to integrate activities.
• E
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stablishing mechanisms for collaboration/coordination on SRH and Hiv at different levels.
• Developing plans for SRH and Hiv integration that include: situation analysis; feasibility studies; assessment of needs for reorganizing and reorienting services towards better integration; necessary tools (e.g. job descriptions, work plans); and tools to evaluate service quality and user satisfaction in relation to integration.
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The WHO document "Integrating the prevention and control of noncommunicable diseases in HIV/AIDS, tuberculosis, and sexual and reproductive health programmes: implementation guidance" provides a fra
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mework for integrating noncommunicable diseases (NCDs) into existing health programs for HIV/AIDS, tuberculosis (TB), and sexual and reproductive health (SRH). It emphasizes the importance of a people-centered approach to enhance healthcare accessibility and efficiency, especially in low-resource settings. The document outlines strategies for strengthening policy, financing, capacity building, and health system infrastructure. It offers actionable steps, tools, and case studies to support countries in reducing the burden of NCDs through integrated, holistic care within primary health services.
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