This is the abstract presentation of Manju Karmacharya, which was presented as part of the 9th session of #APCRSHR10 Virtual, on the theme of "Humanitarian response and sexual and reproductive health and rights (SRHR) in Asia and the Pacific". C H A I R Chonghee Hwang Senior Manager, Family Planning 2020 (FP2020) P L E N A R Y S P E A K E R Tomoko Kurokawa Humanitarian Advisor, UNFPA Asia Pacific "Building Resilience across the Humanitarian Development Peacebuilding Nexus" A B S T R A C T P R E S E N T E R S * Sahlil Ahmed | Challenges Health Workers Face While Providing Sexual and Reproductive Health Services to Rohingya Refugees in Refugee Camps in Cox’s Bazar, Bangladesh: A Qualitative Study * Sayantan Chowdhury | Genesis of maternal mortality surveillance and response in the Rohingya refugee crisis * Sigma Ainul | Contraceptive non-use among the Rohingya and changing dynamics in post-displacement to Bangladesh * Manju Karmacharya | Transitioning from Minimum Initial Service Package to Comprehensive SRHR services responding Rohingya crisis in protracted Emergency in Cox’s Bazar, Bangladesh For more information on this session go to www.bit.ly/apcrshr10virtual9 #SRHR #sexualhealth #reproductiverights #familyplanning #womenshealth #genderequality #SDGs #BodilyAutonomy #humanitariancrisis #humanitariandisaster #pandemic

1. Transitioning from Minimum Initial Service Package
to Comprehensive SRHR Services
Responding to the Rohingya Crisis
in Cox’s Bazar, Bangladesh
MANJU KARMACHARYA
12 OCT 2020

3. Outlines
Background
Humanitarian Coordination: SRH Working Group
Coordination
MISP and Comprehensive SRHR services
Major Interventions and progress (2018-2019)
Challenges
Way Forward

4. Background
The Cox’s Bazar Rohingya camp is the largest refugee camp in the
World after the influx started on 25 Aug 2017
Total 1.2 million population (854,704 Rohingya and 440,000 host)
52% women; highly vulnerable of risk of Gender-Based Violence
304,388 women of reproductive age: need of life-saving SRH services
Complex emergencies; Cyclones, COVID 19 pandemic; crucial to
address their immediate SRHR needs.
Thus, UNFPA, in coordination with the MoH, RRRC and other relevant
SRHR stakeholders, implemented:
 MISP immediately after the onset of the crisis
 Comprehensive SRHR services in protracted emergency

5. Humanitarian Coordination in Cox’S Bazar, Bangladesh
Inter Sector Coordination
Group (ISCG) COORDINATION
SHELTER
/NFI
NUTRITION HEALTH PROTECTION LOGISTICS
MHPS
S
GBV CPSS
FOOD
SECURIT
Y
SRH
WASH
SITE
MGMT
EDUCA
TION
CHW
WG

6. SRH Working Group Coordination
Meeting lead by UNFPA

7. SRH Working Group: Objectives
Ensure SRHR issues of the target population are addressed as a priority
Facilitate the implementation of MISP , transitioning to comprehensive SRHR services
Promote the application of appropriate international / national standards
Mapping of SRHR services & promote implementation
Provide guidance for new service points/ study/research.
Coordinate with other MOH and partners/Sectors
Strengthen a coordinated referral system
Information management support
Advocacy with policy and decision makers and donors for resource mobilization

8. Rohingya refugee crisis is estimated to affect 1.2 million in Cox’s Bazar
including 304,388 women of reproductive age
(UNFPA estimates from the icddr,b study)
UNFPA’s response in Cox’s Bazar:
UNFPA has provided: Minimum Initial Service Package (MISP) for SRH services responding to the crisis
304,388 women of
reproductive age
28,800 currently
pregnant women
Approximately 1100 likely
to experience obstetric
complications during
delivery in the next 3
months
All women and girls,
including adolescent
girls at risk of GBV
1.2 million people
affected
Dignity Kits Women Friendly
Spaces
Mobile
Reproductive
Health Camps
Reproductive
Health Kits
Psychosocial
Support
Clinical
Management
of Rape
Protection &
Awareness
Messaging
Deployment
of Midwives

9.  22 Health
Facilities
 19 Women
Friendly
Space

10. Transition: MISP to Comprehensive SRHR services
After influx stabilization, the service transitioned from MISP to comprehensive SRHR including
SRH morbidity such as Obstetric Fistula and Cervical Cancer Screening

11. Provision of Comprehensive SRHR services
Strengthening health facilities with 24/7 Basic/ Comprehensive Emergency Obstetric & New-born Care services
 ANC, PNC, Institutional Delivery and New born Care
 Family Planning services
 Menstrual Regulations (MR); Post Abortion Care (PAC)
 Clinical Management of Rape (CMR)
 STI Identification and syndromic management
 HIV Prevention and management
 Adolescent Sexual and Reproductive Health and Rights
 Obstetric Fistula screening and surgical treatment
 Cervical cancer screening, colposcopy and cold coagulotherapy
 Referral services: Community to health facilities and referral sites
 Regular RH kits, supplies of Essential medicines, supplies and equipment
 Community based SRHR services and referral through Community Health Workers

12. Capacity
Building
Quality Service: Inter-
agency MonitoringEvidenced based
interventions driven by
Quality Data
Management
Coordination,
Collaboration and
Partnerships
Advocacy and
Resource Mobilization
Knowledge Management:
Guidelines, Tools; Kobo
SRH Working
Group: Major
Interventions and
Progresses

13. Source: Delivering-Supplies-in-Crisis-Rohingya-Situation-Report.pdf https://www.friendsofunfpa.org/wp-content/uploads/2019/04/Delivering-Supplies-in-Crisis-
Rohingya-Situation-Report.pdf UNFPA Bangladesh Humanitarian Response Facts activities and impact from Annual Report Jan to Dec 2019
0
50
100
150
200
250
300
Kit 1
A
Kit 2
A
Kit 2
B
Kit 3 Kit 4 Kit 5 Kit 6
A
Kit 6
B
Kit 7 Kit 8 Kit 9 Kit 10 Kit 11
A
11B Kit 12
Utilization of RH kits, commodities,
supplies in 2018 and 2019 by SRHR
Partners
Total -2018 Total -2019
Total RH kits used 403 (2018) & 703 (2019)
Total benefitted 76,955 (2018) & 145,160 (2019)
Total 13,721 Clean delivery kits distributed in 2017/18

14. Major Achievements
Services 2018 2019
Facility Based Delivery (FBD) 21.5% (icddr,b 2018) 47% (Annual JRP 2019)
Contraceptive Prevalence Rate (CPR) 33.7% (icddr,b 2018) Trend (icddr,b 2019)
Comprehensive Emergency Obstetric and
New-born Care (CEmONC) site at camp
2 4
Adolescent Friendly Service (YMSG) 2 (Oct 2018) 5
Referral hub at community (ambulance) No Yes
Obstetric Fistula Screening Out reach Camp ORC, HFs, CHWs
Cervical Cancer screening No Yes
Comprehensive SRHR training package -CHWs/Vs No Yes
Comprehensive SRHR Training to CHWs/Vs No 1000 out of 1600
Source:https://www.researchgate.net/publication/328228423_Report_on_Demographic_profiling_and_needs_assessment_of_maternal_and_child_health_MCH_care_for_the_Rohingya_refu
gee_population_in_Cox's_Bazar_Bangladesh and Annual Report JRP 2019)

15. Family Planning Services in 2018 and 2019
Pills
47%
Condom
10%
Injectables
41%
IUD
1%
Implant
1%
Percentage of People received Family
Planning Services by Method in 2018
Condom
8%
Pill
55%
DEPO IM
26%
DMPA SC
8%
IUD
1%
Implant
2%
Percentage of People received Family
Planning Services by Method in 2019

16. Community Health Workers /Volunteers (Total 1600)

17. PICTORIAL FLIP CHART EDUCATIONAL
MATERIAL ON COMPREHENSIVE SRHR
TOT: FACILITATOR GUIDE AND
REFERENCE MATERIAL FOR CHWS
SUPERVISOR/MANAGERS

18. REFERRAL HUB AT
COMMUNITY
AMBULANCE AT HEALTH
FACILITY

19. Capacity
Building

20. Joint Monitoring:
Cervical Cancer Screening

21. Inter-Agency Monitoring: RRRC, UNFPA, UNHCR and NGOs

22. No one left
behind: SRHR
Services for
Marginalized
Special Group

23. COVID19 Pandemic Response:

24. Distribution of
Dignity Kits

25. CHALLENGES
Mentorship for midwives
Turnover of skilled Healthcare Providers
 Limited referral hub at community
Availability of Blood donors for CEmONC
services at the camp level
Low utilization of essential SRHR
services due to COVID19 pandemic
Inter-agency monitoring
Implanon services only by Doctors
Funding
WAY FORWARD
Distance mentorship for midwives
Additional Healthcare Providers and capacity building
Expansion of referral hubs at community
Coordination with CHW- Working Group/Sectors for
mobilization of CHWs for listing of Blood donors group
Mobilization of CHWs/Vs to increase the utilization of
the SRHR services
Encouragement for volunteer interagency monitoring
following 9 rules of humanitarian aid workers
Advocacy on Implanon service by Midwives/
paramedics for increasing access to LARC
Resource Mobilization

26. Conclusion
Acute Setting: MISP
Coordination saves lives- during acute and protracted settings
Protracted Setting:
Provision of comprehensive life saving SRHR including MNH services with
enabling environment by skilled human recourses for averting maternal and
newborn mortality and morbidities

27. Thank You Very Much