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...
Procurement Issues and RHCS in EmergenciesPresented by the Humanitarian Response Unit’s Dr. Henia Dakkak, Technical Specialist
Why RH services for populations in crisis?Reproductive health is• a human right• a basic health need• contributes to psychosocial well-being
RH needs continue … in fact, increase during crisis• Risk of sexual violence may increase during social instability• STI/HIV transmission can increase• Lack of FP increases risks associated with unwanted pregnancy
RH needs continue … in fact, increase during crisis• Malnutrition and epidemics increase risks of pregnancy complications• Childbirth occurs on the wayside during population movements• Lack of access to emergency obstetric care increases risk of maternal death
Heightened risk, greater need• Women and childrenaccount for more than75% of refugees andinternally displaced• 25% of this populationat risk are women ofreproductive age. 1 in 5is likely to be pregnant• More than 37 millionpeople displaced bywar
37 million people displaced worldwide$1 million annual seed money for operations
Safe motherhood and family planningEmergencies heighten already significant risks: •Complications of pregnancy and childbirth leading cause of death for women under 50 in most developing countries •Premature deliveries and miscarriages brought on by trauma •Fewer than half of all deliveries in developing countries take place with a skilled birth attendant
Continuum of an emergency Emergency Post-emergencyDestabilizing event Durable Durable solutions Solutions MISP Provision of comprehensive RH Minimum Initial Service Package services Exodus of Loss of Restoration Relative Return to the essential of essential stability normality population services services
When does UNFPA respond?0. before emergencies strike1. in acute emergencies2. in refugee and IDP settings3. in post-conflict situations4. in reconstruction and development
Before emergency strikes Kosovo pre-deployment of supplies to Albania Afghanistan contingency planning in surrounding countries Iraq comprehensive preparedness plan for anticipated refugee movements and cross- border operations
Before emergency strikesHaitiContingency planning forlarge numbers of displacedBangladeshContingency planning fornatural disaster response
Acute emergenciesDeployment of equipment, supplies and RH kitsRelease of funds for local procurementRH assessments and data collection and analysis for UN-widetargeting and response (CAP)
Acute crisis Quick response saves lives UNFPA ships pre-packaged supplies directly to field offices, Red Cross, Governments, local partners
Acute crisis Millions displaced Health infrastructure Liberia devastated 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 UNFPA is the only provider of condoms in Liberia
Examples of UNFPA response in acute emergenciesNatural Disasters: Armed Conflict: ColombiaIndia Sierra LeoneEl Salvador LiberiaDRC (Goma) IraqKenya CongoMalawi Indonesia - MalukuMexico Palestinian TerritoryIran Ivory CoastMongolia AfghanistanHaiti SudanGrenada
Refugees and IDPs For refugees and internally displaced persons, UNFPA: Assesses RH and gender needs Distributes RH supplies Provides RH information Trains NGO and local staff for delivery of services Organizes HIV prevention initiatives Helps to prevent gender Violence Coordinate and collect data
Recovery Democratic Republic of Congo Post-conflict recovery • Renovation of health facilities • Counseling • Training • Equipment and supplies • Support to local NGOs • Demographic data Not enough beds, Bas Congo
Recovery Afghanistan Reconstruction Rehabilitation of Hospital Baby Ahmed! 6.5 pounds Mother in good shape 2nd child, 6th pregnancy
Recovery 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
How does UNFPA respond?1) Initial authorization up to $50,000-local procurement, transportation, consultants, etc.2) Estimate the needs for RH kits3) Emergency shipment of RH kits3) Provision of technical assistance (advice and training)4) 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)5) Advocacy for funding and inclusion of RH services and commodities within basic needs of affected populations in humanitarian response
What are the RH Kits?• Pre-packaged sets of medicines, equipment and supplies designed to meet the most basic RH needs in crisis situations• They are designed so that each kit can be used in contexts where there is little or no health infrastructure
RH kit for emergency situations Block 1Primary health care/health centre level 10,000 people for 3 monthsKit0 •Training and administration1 •Condoms (male & female)2 •Clean delivery sets (individual)3 •Post-rape (EC and STI prevention, PEP)4 •Oral and injectable contraception5 •STI drugs
Post-Exposure Prophylaxis (PEP)• Now a part of Kit #3 (“post-rape kit”)• For accidental/possible exposure to HIV, including sexual violence• Costs have come down dramatically – now much more affordable
RH kit for emergency situations Block 2Health centre level or referral level 30 000 people for 3 monthsKit6 •Professional midwifery delivery kit7 •IUD insertion8 •Management of complications of abortion9 •Suture of cervical and vaginal tears10 •Vacuum extraction
RH kit for emergency situations Block 3 Referral level 150 000 people for 3 months Kit11A •Surgical (reusable equipment)11B •Surgical (consumable items and drugs)12 •Blood transfusion (HIV testing)
Local Logistics Issues• Customs clearance• Observing the cold chain• Observing expiration dates• Transport and Distribution• Warehousing• Coordinating with local partners (MOH, NGOs, other UN agencies)
Options to think about?1) Pre-positioning in neighboring countries2) Stockpiling in central warehouse or neighboring countries3) Sending in supplies during crisis-airlifting, sea, road, train,etc4) Air Dropping in areas that is inaccessible5) Utilizing existing commercial networks for distribution6) Role of the military/armed forces/peace keepers in regard to logistics and in demanding services and commodities
Challenges/Questions1) Cost Effectiveness2) Storage and distribution3) Expiration dates and shelf time4) Technical Support5) Planning for long-term commodity security (once population stabilize)6) Managing procurement and achieving commodity security in situation of high insecurities? (Iraq as an example)