©2012 international medical corps janet meyers capacity assessment of humanitarian organizations to...
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©2012 International Medical Corps
Janet Meyers
Capacity assessment of humanitarian organizations to
implement the MISP and comprehensive reproductive
health: Global review
©2012 International Medical Corps
Global Review Objectives• To review the commitment to, scope, coverage,
quality and use of RH service by populations affected by humanitarian crisis;
• To identify and document progress made since the last IAWG global evaluation in 2004;
• To identify gaps and areas for improvement; and• To provide guidance for implementation,
management, funding and future research areas.
©2012 International Medical Corps
Components of 2013 Global Review
– Literature review – Assessment of agency commitment and capacity– In-depth assessment of RH service availability and
quality – Assessment of RH service availability and use– MISP assessment– Funding trends for RH in crises– Review of UNHCR Health Information System (HIS)
RH data
©2012 International Medical Corps
Capacity Assessment Team• Nguyen-Toan Tran, MD, MSc, DrMed, University of New South
Wales • Carina Hickling, MPH, PhD Student • Sandra Krause, RN, MPH , Reproductive Health Program, Women's
Refugee Commission, NY, NY • Janet Meyers, RN, MPH, International Medical Corps• Angela Dawson, PhD, University of Technology Sydney• Louise Lee-Jones, MSc, BA• Valerie Wisard• Rainer Tan, MD Candidate, University of Lausanne• Seher Shafiq, Master of Global Affairs Candidate, Munk School of
Global Affairs
©2012 International Medical Corps
Objectives of Capacity Assessment Study
• Evaluate the overall state of Reproductive Health in Humanitarian Settings (RHHS) since 2004
• Assess the capacity of institutions – institutional policy – accountability mechanisms – program delivery strategy – financial resources – human resources– technical guidance – procurement of supplies related to RHHS
©2012 International Medical Corps
Methodology
• Elements of Capacity: Structured Theoretical Framework – based upon Allan Kaplan’s capacity building model
• Ethical approval from the Faculty of Health of the University of Technology Sydney
• Cross-sectional online survey from April to August 2013
• Purposive sampling – IAWG, GHC and CORE Group listservs
©2012 International Medical Corps
Characteristics of Institutional Respondents
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Institutional Policy
Missing
Don't know
No
Yes
2%
6%
23%
68%
Has an RHHS-related institutional policy or policy-like document
©2012 International Medical Corps
Accountability Mechanisms
IASC Matrix on Agency Roles and Responsibilities for Ensuring a Coordinated, Multisectoral Fuel Strategy in Humanitarian Settings
Code of Conduct for the International Red Cross & Red Crescent Movement and NGOs in Disaster Relief
IASC Guidelines on Mental Health and Psychosocial Support in Emergency Settings
UN Secretary General’s Bulletin “Special measure for protection from sexual exploitation and sexual abuse”
Humanitarian Accountability Principles
Inter-Agency Standing Committee (IASC) Gender Handbook in Humanitarian Action
IASC Guidelines for HIV/AIDS Interventions in Emergency Settings
The Sphere Project. Humanitarian Charter and Minimum Standards in Disaster Response Interventions in Humanitarian Assistance
IASC Guidelines for Gender-based Violence Interventions in Humanitarian Assistance
24%
56%
62%
65%
71%
78%
78%
84%
92%
Proportion of institutions with policies and systems in place to abide by these international standards
©2012 International Medical Corps
Accountability Mechanisms
Arrange mechanisms for beneficiaries to contact organizational representatives, lodge complaints and seek redress
Establish ongoing communication with affected populations about the institution and its project plans and work
Enforce systems within the organization to respond to improper conduct by staff
Engage beneficiary participation in all programming steps -- assessing, planning, implementing and monitoring the project
RH indicators collected as part of the institutional health information system and/or monitoring and evaluation system
49%
69%
69%
70%
86%
Proportion of institutions with mechanisms in place to follow major principles of accountability
©2012 International Medical Corps
Program Delivery Strategy
Private sector
NGO
Government institution / relevant ministry
UN agency
5%
58%
62%
85%
Institutions leading or co-leading coordination
©2012 International Medical CorpsPresentation Title
Gender mainstreaming, equality programming, male involvement
Community-based programming: e.g mobilization, engagement, outreach, etc.
Technical assistance to partners or other institutions on RHHS
Grant allocation to international institutions for RHHS activities
Grant allocation to local institutions for RHHS activities
Capacity building, training or refreshers on RHHS
Research, documentation and dissemination
Service delivery of components of comprehensive RH in post-conflict/recovery situations
Recovery (including transition to comprehensive RH services)
MISP service delivery in emergency
Emergency management and coordination of RHHS
DRR/Other components & RHHS
DRR/Emergency preparedness & RHHS
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
21%
24%
18%
17%
15%
20%
17%
17%
17%
17%
15%
7%
12%
40%
33%
46%
15%
24%
46%
30%
40%
40%
49%
44%
40%
44%
15%
16%
18%
11%
12%
16%
15%
18%
16%
18%
16%
16%
18%
15%
17%
9%
37%
29%
12%
28%
16%
20%
11%
17%
21%
16%
Started before 2004 Started in 2004 or after Don’t know when No
©2012 International Medical Corps
Family planning
Newborn health
Maternal health
HIV awareness, prevention, treatment and care
Management of sexually transmitted infections
Care for survivors of sexual violence
Prevention of gender-based violence
Adolescent RH
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
26%
26%
31%
22%
25%
22%
22%
18%
42%
35%
38%
37%
31%
33%
40%
37%
17%
16%
17%
20%
20%
22%
20%
17%
10%
16%
9%
13%
17%
17%
12%
20%
Started before 2004 Started in 2004 or after Don’t know when No
Community-based Interventions
©2012 International Medical Corps
Advocacy and Policy Work
Portfolio of donor agencies, relevant ministries with decision power on budget alloca-tion or other funding mechanisms
National health strategy
Recovery policies and plans
Emergency response policies and plans
DRR/other components
DRR/emergency preparedness policies and plans
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
15%
23%
11%
13%
9%
10%
18%
27%
31%
40%
26%
40%
12%
15%
13%
20%
16%
19%
33%
27%
31%
18%
28%
16%
Started before 2004 Started in 2004 or after Don’t know when No
©2012 International Medical Corps
Clinical RHHS
Cervical cancer treatment
Cervical cancer screening
STIs/RTIs
Adolescent SRH
MISP
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
2%
2%
27%
20%
13%
16%
21%
40%
37%
51%
7%
12%
21%
21%
20%
52%
46%
7%
16%
10%
Started before 2004 Started in 2004 or after Don't know when No
©2012 International Medical Corps
Maternal Newborn Health
Prevention of maternal-to-child transmission of HIV
Postnatal maternal and newborn care
Emergency obstetric care
Care during delivery
Antenatal care
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
17%
23%
22%
27%
29%
31%
42%
39%
37%
40%
21%
18%
21%
17%
17%
22%
11%
15%
15%
9%
Started before 2004 Started in 2004 or after Don't know when No
©2012 International Medical Corps
Family Planning
Postpartum family planning
Emergency contraception
Permanent methods (surgical sterilization)
Long-acting methods (e.g. IUD, Implants)
Short-acting methods (e.g. pills, condom, injectables)
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
18%
22%
16%
26%
34%
37%
35%
17%
33%
34%
15%
20%
20%
20%
20%
18%
15%
38%
16%
9%
Started before 2004 Started in 2004 or after Don't know when No
©2012 International Medical Corps
GBV
Prevention of forced early marriage
Prevention of female genital mutilation/cutting
Domestic violence or intimate partner violence
Sexual violence prevention and response (rape, sexual abuse, sexual exploitation)
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
15%
20%
18%
22%
26%
16%
34%
43%
12%
15%
21%
20%
29%
39%
17%
10%
Started before 2004 Started in 2004 or after Don't know when No
©2012 International Medical Corps
HIV
Care and support
ARV and ART interventions
Voluntary counseling and testing
Prevention
0% 20% 40% 60% 80% 100%
12%
11%
18%
27%
17%
17%
34%
37%
18%
17%
20%
21%
33%
38%
18%
9%
Started before 2004 Started in 2004 or after Don't know when No
©2012 International Medical Corps
Financial Resources
Missing
Don't know
No substantial change in funding for RHHS
A decrease in funding for RHHS
An increase in funding for RHHS
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
2%
16%
20%
13%
49%
Institutional change in RHHS funding from 2004 to 2012
©2012 International Medical Corps
Human Resources: Proportion of Dedicated Staff for RHHS
Before 2004 2004-2006 2007-2009 2010-20120%
20%
40%
60%
80%
100%
Proportion of institutions with dedicated RHHS staff
©2012 International Medical CorpsPresentation Title
Missing
Don't know
No
Yes
0% 20% 40% 60% 80% 100%
10%
4%
13%
73%
Proportion of institutions routinely identifying an RH Focal Point
©2012 International Medical Corps
Proportion of Institutions Reporting High Level Workforce Competencies
Before 2004 2004-06 2007-09 2010-120%
10%
20%
30%
40%
DRR/ emergency reparednessDRR/other componentsMISP coordination and managementMISP service deliveryMISP community outreachGender mainstreaming/equalityRecovery, including comprehensive RHResearchPolicy/advocacy
©2012 International Medical Corps
Top Resource Materials since 2004
©2012 International Medical Corps
IAWG Clinical Guidance Needs
Cervical Cancer
Comprehensive abortion care
STI
Maternal health
Newborn health
MISP service delivery
HIV
Adolescent
GBV
Family planning
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
34%
37%
40%
43%
45%
48%
48%
49%
51%
52%
Proportion of institutions requiring clinical guidance to be developed by IAWG to support their institution's work on RHHS
©2012 International Medical Corps
Preferred Training Methods
Webinars
Mobile technologies
Face-to-face, country level
Face-to-face, regional level
Face-to-face, field level
E-learning modules
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
32%
32%
50%
51%
59%
63%
Preferred training methods
©2012 International Medical Corps
RH Procurement Issues
Stock out of any RH supplies
Delay in identifying sources for RH supplies
Difficulty in sourcing quality RH supplies
Delay in obtaining or distribution of Interagency RH Kits
21%
49%
56%
81%
RH procurement issues in previous 5 years
©2012 International Medical Corps
Recommendations• Formalize the Inter-agency Working Group (IAWG)
structure• Continue annual work meetings and support to
regional working groups on RHHS• Systematically identify a lead agency to lead RH
coordination in all emergencies• Develop or adapt practical guidance for emerging
topics• Strengthen RH supply chain management and re-
supply
©2012 International Medical Corps
Recommendations• Implement established mechanisms of accountability• Advocate for engagement of development and
humanitarian sections• Strengthen formal partnerships and build resilience
of crisis affected communities• Ensure well-funded dissemination strategy for
guidance resources• Continuously improve quality and access to address
gaps in service delivery