May 2008

IAWGReproductive Health Kits

Components of the MISP

• Identify a coordinator

• Prevent and manage the consequences of sexual violence

• Reduce HIV transmission

• Prevent excess neonatal and maternal morbidity and mortality

• Plan for comprehensive RH services, integrated into PHC, as soon as possible

Continuum of an emergency

Emergency

Post-emergency

Exodus of the population

Loss of essential services

Restoration of essential services

Relative stability

Return to normality

Destabilizing event Durable solutions

MISP &RH Kits

Comprehensive RH servicesMedical supply chain

RH kits for emergency situations

• Block 1 (kit 0 to 5)Primary health care/health centre level10 000 people for 3 months

• Block 2 (Kit 6 to 10) Health centre level or referral level30 000 people for 3 months

• Block 3 (kit 11 and 12) Referral level150 000 people for 3 months

“Standard“ population

Adult males 20% Women of reproductive age (WRA) 25% Crude birth rate 4%

Number of pregnant womenNumber of deliveries

Complicated abortions/pregnancy 20% Vaginal tears/delivery 15% Caesarean sections/delivery 5% WRA who are raped 2% WRA using contraception 15%

Oral contraception 30%Injectables 65%IUD 5%

Important suppliesin kits but not in MISP

• Meet pre-existing family planning needs

Basic FP methods to meet spontaneous demand

• Ensure syndromic treatment for STIs

Antibiotics to treat people presenting with an STI symptom

Updating RH Kits

Aim to review bi-annually

1. Survey (English and French)- Covering kit use over previous 2 years

- targets consignees from Procurement records and other implementing partners (identified by consignees)

- Part I: Implementation of MISP, logistics, guidelines/IEC materials, training

- Part II: Technical feedback on kit contents

2. Background paper(s) on new technologies - Already successfully piloted by partner(s)

- WHO supported (guidelines and/or EDL)

Updating RH Kits

• RH Kit review meeting 1999, 2003, 2005, 20081. IAWG technical focal points:

review survey results and background paper(s) make recommendations input from UNFPA procurement

2. RH kit booklet edited and translated3. Procurement takes action4. Updated kits available (1 year…)

• Since 2005: Consistency with IAEHK update process

Challenges

• Medicines “slow” to make it on the EML (PEP)

• No formal “Essential RH Devices” list

• Sole manufacturers, patents

• Regulatory (quality, specifications)

• Where to stop!?- Kits need a lot of logistic planning and action

- Reordering kits is not cost-effective

- Timely, sensible, sustainable “post-kit” supply mechanisms

Thank you

Group work15 min discussion, 15 min

feedback

• Look at the technologies on the wall- Which should be included in the RH kits

- Which others should be put forward for inclusion on the Essential Medicines or Essential Devices List?

• How can this group contribute to early inclusion of new technologies in WHO guidance