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  • Objetive y Origens of the RH Kits The RH kits for emergency situations was created to aid victims of armed conflicts and natural disasters, refugees, internally displaced, or any population in a situation of crisis. The kits are specifically designed to respond to needs in the initial phases of an crisis . UNFPA is the UN agency charged with overseeing the composition and distribution of the kits, he composition and distribution of La composicion y distribucion de este kit es obra del UNFPA, a instancias del “Simposio Inter-Agencial sobre la Salud Reproductiva de Refugiados” (Junio 1995).
  • Risks of HIV transmission during disasters, emergencies, wars and n post war situation may be very high. Each context has its own risks and possibilities for prevention interventions. Prevention programming must take the local HIV context into account.
  • We should be looking after all RH in emergencies and in humanitarian context – but HIV prevention is especially important.
  • Comprende 12 subkits repartidos en 3 bloques (Cada uno para un nivel diferente de servicios y para un numero distinto de personas para los primeros 3 meses) . Hay u n subkit especifico para la administracion y la formacion del personal. Despues de este periodo inicial de 3 meses, las necesidades deben calcularse a base del consumo mensual. Suministros adicionales se pueden pedir por canales normales del ministerio de salud u organizacion que este proporcionando los servicios. Los kits estan disenados para dar servicios donde no los hay. Subkit 4: anticonceptivos hormonales Subkit 5: Diagnostico y tratamiento de las Enfermedades de Transmision Sexual (ETS). Composicion del Kit – Bloque 1. Bloque 1 es para 10,000 personas durante un periodo de 3 meses.
  • Bloque 2 – kits que dan cobertura al nivel de centros de salud para 30,000 personas durante un periodo de 3 meses. Contiene 5 sub-kits. Subkit 8: Complicaciones de los abortos naturales (miscarriage), y abortos de riesgo (unsafe). Subkit 9: Sutura de desgarros del perineo durante el parto y examenes vaginales.
  • 3 subkits, for referral level, each with enough supplies for 150 000 people for 3 months These kits have supplies for the referral level to manage obstetric emergencies, such as performing CS and laparotomies It can be used to strengthen the emergency hospital in the camp as well as the local distric hospital. (The RH kit is complementary to the WHO new emergency health kit.) Demonstration of CD ROM...
  • General presentation

    1. 1. UNFPA in Emergencies Presented by the Humanitarian Response Unit’s Dr. Henia Dakkak, Technical Specialist
    2. 2. Why RH services for populations in crisis? <ul><li>Reproductive health is </li></ul><ul><li>a human right </li></ul><ul><li>a basic health need </li></ul><ul><li>contributes to psychosocial well-being </li></ul>
    3. 3. RH needs continue … in fact, increase during crisis <ul><li>Risk of sexual violence may increase during social instability </li></ul><ul><li>STI/HIV transmission can increase </li></ul><ul><li>Lack of FP increases risks associated with unwanted pregnancy </li></ul>
    4. 4. RH needs continue … in fact, increase during crisis <ul><li>Malnutrition and epidemics increase risks of pregnancy complications </li></ul><ul><li>Childbirth occurs on the wayside during population movements </li></ul><ul><li>Lack of access to emergency obstetric care increases risk of maternal death </li></ul>
    5. 5. Heightened risk, greater need <ul><li>Women and children account for more than 75% of refugees and internally displaced </li></ul><ul><li>25% of this population at risk are women of reproductive age. 1 in 5 is likely to be pregnant </li></ul><ul><li>More than 37 million people displaced by war </li></ul>
    6. 6. 37 million people displaced worldwide $1 million annual seed money for operations
    7. 7. Safe motherhood and family planning <ul><li>Emergencies heighten already significant risks: </li></ul><ul><ul><li>Complications of pregnancy and childbirth leading cause of death for women under 50 in most developing countries </li></ul></ul><ul><ul><li>Premature deliveries and miscarriages brought on by trauma </li></ul></ul><ul><ul><li>Fewer than half of all deliveries in developing countries take place with a skilled birth attendant </li></ul></ul>
    8. 8. Continu um of an emergenc y Emergenc y Pos t - emergency E xod us of the population Loss of e s sen t ial services Restora t ion of essential servic e s Durable Solu t io ns Relative stability Re turn to normality M ISP Minimum Initial Service Package Provisi o n of comprehensive RH servic e s Destabilizing event Durable s olu t io ns
    9. 9. When does UNFPA respond? <ul><li>0. before emergencies strike </li></ul><ul><li>in acute emergencies </li></ul><ul><li>in refugee and IDP settings </li></ul><ul><li>in post-conflict situations </li></ul><ul><li>in reconstruction and development </li></ul>
    10. 10. <ul><li>Kosovo </li></ul><ul><li>pre-deployment of supplies to Albania </li></ul><ul><li>Afghanistan </li></ul><ul><li>contingency planning in surrounding countries </li></ul><ul><li>Iraq </li></ul><ul><li>comprehensive preparedness plan for anticipated refugee movements and cross-border operations </li></ul>Before emergency strikes
    11. 11. Before emergency strikes Haiti Contingency planning for large numbers of displaced Bangladesh Contingency planning for natural disaster response
    12. 12. Acute emergencies Deployment of equipment, supplies and RH kits Release of funds for local procurement RH assessments and data collection and analysis for UN-wide targeting and response (CAP)
    13. 13. UNFPA ships pre-packaged supplies directly to field offices, Red Cross, Governments, local partners Quick response saves lives Acute crisis
    14. 14. <ul><li>Millions displaced </li></ul><ul><li>Health infrastructure devastated </li></ul><ul><li>UNFPA has been providing training, medicines and supplies through the Red Cross, UNHCR and other agencies, and basic HIV prevention for IDPs and Liberian refugees in four West African countries </li></ul><ul><li>UNFPA is the only provider of condoms in Liberia </li></ul>Acute crisis Liberia
    15. 15. Examples of UNFPA response in acute emergencies <ul><li>Natural Disasters : </li></ul><ul><li>India </li></ul><ul><li>El Salvador </li></ul><ul><li>DRC (Goma) </li></ul><ul><li>Kenya </li></ul><ul><li>Malawi </li></ul><ul><li>Mexico </li></ul><ul><li>Iran </li></ul><ul><li>Mongolia </li></ul><ul><li>Haiti </li></ul><ul><li>Grenada </li></ul><ul><li>Armed Conflict : </li></ul><ul><li>Colombia </li></ul><ul><li>Sierra Leone </li></ul><ul><li>Liberia </li></ul><ul><li>Iraq </li></ul><ul><li>Congo </li></ul><ul><li>Indonesia - Maluku </li></ul><ul><li>Palestinian Territory </li></ul><ul><li>Ivory Coast </li></ul><ul><li>Afghanistan </li></ul><ul><li>Sudan </li></ul>
    16. 16. For refugees and internally displaced persons, UNFPA: <ul><li>Assesses RH and gender needs </li></ul><ul><li>Distributes RH supplies </li></ul><ul><li>Provides RH information </li></ul><ul><li>Trains NGO and local staff for delivery of services </li></ul><ul><li>Organizes HIV prevention initiatives </li></ul><ul><li>Helps to prevent gender </li></ul><ul><li>Violence </li></ul><ul><li>Coordinate and collect data </li></ul>Refugees and IDPs
    17. 17. Refugees: Sierra Leone, Tanzania, Uganda, Sudan, Ethiopia, Kenya, Zambia, Guinea, Liberia, Pakistan, Iran, Yemen, Palestine IDPs: Eritrea, Liberia, Colombia, Afghanistan, Angola, DRC, ROC, Burundi, Somalia, Tajikistan, PNG, Sudan, CDI Recent refugee and IDP programmes Refugees and IDPs
    18. 18. Post-conflict recovery <ul><li>Renovation of health facilities </li></ul><ul><li>Counseling </li></ul><ul><li>Training </li></ul><ul><li>Equipment and supplies </li></ul><ul><li>Support to local NGOs </li></ul><ul><li>Demographic data </li></ul>Not enough beds, Bas Congo Recovery Democratic Republic of Congo
    19. 19. Reconstruction Recovery Rehabilitation of Hospital Baby Ahmed! 6.5 pounds Mother in good shape 2 nd child, 6 th pregnancy Afghanistan
    20. 21. Angola Establishment of maternal mortality programs Rehabilitation of maternity centers Provision of equipment, supplies Retraining of health staff Reestablishment of EmOC HIV prevention Safe blood supply Strengthening of referral systems Recovery
    21. 22. How does UNFPA respond? <ul><li>Initial authorization up to $50,000-local procurement, transportation, consultants, etc . </li></ul><ul><li>Estimate the needs for RH kits </li></ul><ul><li>Emergency shipment of RH kits </li></ul><ul><li>Provision of technical assistance (advice and training) </li></ul><ul><li>Monitoring of RH service provision to affected population and kits distribution and data collection of RH indicators (access, coverage, availability of RH commodities and forecasting) </li></ul><ul><li>Advocacy for funding and inclusion of RH services and commodities within basic needs of affected populations in humanitarian response </li></ul>
    22. 23. What are the RH Kits? <ul><li>Pre-packaged sets of medicines, equipment and supplies designed to meet the most basic RH needs in crisis situations </li></ul><ul><li>They are designed so that each kit can be used in contexts where there is little or no health infrastructure </li></ul>
    23. 24. RH kit for emergency situations Bloc k 1 Primary health care/health centre level 10,000 people for 3 months <ul><li>Kit </li></ul><ul><li>0 </li></ul><ul><li>1 </li></ul><ul><li>2 </li></ul><ul><li>3 </li></ul><ul><li>4 </li></ul><ul><li>5 </li></ul><ul><li>Training and administration </li></ul><ul><li>Condoms (male & female) </li></ul><ul><li>Clean delivery sets (individual) </li></ul><ul><li>P ost-rape (EC and STI prevention, PEP) </li></ul><ul><li>Oral and injectable contraception </li></ul><ul><li>STI drugs </li></ul>
    24. 25. Post-Exposure Prophylaxis (PEP) <ul><li>Now a part of Kit #3 (“post-rape kit”) </li></ul><ul><li>For accidental/possible exposure to HIV, including sexual violence </li></ul><ul><li>Costs have come down dramatically – now much more affordable </li></ul>
    25. 26. RH kit for emergency situations Bloc k 2 <ul><li>Kit </li></ul><ul><li>6 </li></ul><ul><li>7 </li></ul><ul><li>8 </li></ul><ul><li>9 </li></ul><ul><li>10 </li></ul><ul><li>Professional midwifery delivery kit </li></ul><ul><li>IUD insertion </li></ul><ul><li>Management of complications of abortion </li></ul><ul><li>Suture of cervical and vaginal tears </li></ul><ul><li>Vacuum extraction </li></ul>Health centre level or referral level 30 000 people for 3 months
    26. 27. <ul><li>Kit </li></ul><ul><li>11A </li></ul><ul><li>11B </li></ul><ul><li>12 </li></ul>RH kit for emergency situations Bloc k 3 Referral level 150 000 people for 3 months <ul><li>Surgical (reusable equipment) </li></ul><ul><li>Surgical (consumable items and drugs) </li></ul><ul><li>Blood transfusion (HIV testing) </li></ul>
    27. 28. Local Logistics Issues <ul><li>Customs clearance </li></ul><ul><li>Observing the cold chain </li></ul><ul><li>Observing expiration dates </li></ul><ul><li>Transport and Distribution </li></ul><ul><li>Warehousing </li></ul><ul><li>Coordinating with local partners (MOH, NGOs, other UN agencies) </li></ul>
    28. 29. Options to think about? <ul><li>Pre-positioning in neighboring countries </li></ul><ul><li>Stockpiling in central warehouse or neighboring countries </li></ul><ul><li>Sending in supplies during crisis-airlifting, sea, road, train,etc </li></ul><ul><li>Air Dropping in areas that is inaccessible </li></ul><ul><li>Utilizing existing commercial networks for distribution </li></ul><ul><li>Role of the military/armed forces/peace keepers in regard to logistics and in demanding services and commodities </li></ul>
    29. 30. Challenges/Questions <ul><li>Cost Effectiveness </li></ul><ul><li>Storage and distribution </li></ul><ul><li>Expiration dates and shelf time </li></ul><ul><li>Technical Support </li></ul><ul><li>Planning for long-term commodity security (once population stabilize) </li></ul><ul><li>Managing procurement and achieving commodity security in situation of high insecurities? (Iraq as an example) </li></ul>