Integration of MISP into the disaster risk reduction and preparedness action plans of provincial/district disaster management authorities

The International Planned Parenthood Federation / SPRINT project is advocacy for disaster risk reduction (DRR) and inclusion of Minimum Initial Service Package (MISP) and Sexual and Reproductive Health (SRH) into the national disaster risk reduction and management policies and programmes of government.

Case Study

Integration of [1] MISP into the disaster risk reduction and preparedness action plans of provincial/district disaster management authorities.

HFA Priority

Priority 1: Ensure that disaster risk reduction (DRR) is a national and a local priority with a strong institutional basis for implementation.

Priority 5: Strengthen disaster preparedness for effective response at all levels.

Abstract

The [2] IPPF [3] SPRINT project is advocacy for disaster risk reduction (DRR) and inclusion of Minimum Initial Service Package (MISP) and Sexual and Reproductive Health (SRH) into the national disaster risk reduction and management policies and programmes of government.

From 2013-2014, [4] Rahnuma Family Planning Association of Pakistan (FPAP) was successful in getting the provincial and district disaster management authorities of Gilgit Baltistan (GB), Punjab, Baluchistan, Sindh, FATA, Khyber Pakhtunkhwa (KPK) and Azad Jammu Kashmir (AJK) to include the MISP in their standard operating procedures (SOPs) and risk reduction action Plans.

Context

Pakistan is a particularly disaster-prone South Asian country due to the number of natural disasters that have killed, injured and affected millions in addition to inflicting huge economic costs. Pakistan itself has 28 million people affected by conflict and disasters.

In 2009 more than three million people in Pakistan were forced to flee their homes in the country’s northwestern areas as a result of political insecurity while forced displacement still exists in Khyber Pakhtunkhwa, Azad Jammu Kashmir and FATA.

Calamities such as floods particularly hit Punjab and Sindh while hill torrents affect the hilly areas of Khyber Pakhtunkhwa, Baluchistan and Gilgit Baltistan. In 2005, the Azad Jammu Kashmir (AJK) earthquake and the 2010 floods badly affected Punjab and Sindh, two of the agriculturally richest and most populated provinces. These two catastrophes illuminated how disasters exacerbated gender discrimination, gender-based violence (GBV) or sexual violence (SV), maternal and child mortality.

Location

Gilgit Baltistan (GB), Punjab, Baluchistan, Sindh, FATA, Khyber Pakhtunkhwa (KPK) and Azad Jammu Kashmir (AJK) – Pakistan.

How the problem was addressed?

The SPRINT Initiative in Pakistan, with support from its member associate Rahnuma- Family Planning Association of Pakistan, has been proactive since 2013 in advocating for SRH and MISP inclusion into the DRR and disaster risk management (DRM) plans at national and local levels.

The initiative is based on recognition of the vulnerabilities of women and young during emergencies, particularly in the remote parts of crisis affected Gilgit Baltistan, Punjab, Baluchistan, Sindh, FATA, Khyber Pakhtunkhwa and Azad Jammu Kashmir. These vulnerabilities include:

·       Inaccessibility;

·       Lack of SRH services for pregnant and lactating mother and adolescents;

·       Sexual and gender Based Violence;

·       Rapid HIV/ STI transmission,

Rahnuma FPAP through the SPRINT Initiative, successfully integrated MISP into the SOPs and DRR action plans of provincial and district disaster management authorities in these provinces.

Primarily the lead was taken by the International Planned Parenthood Federation (IPPF), through its member associate Rahnuma FPAP, which has been constantly liaising and advocating for MISP and inclusion of SRH components and service delivery into the SOPs and action plans. Initially, approaching the local, district and provincial governments and making them understand the relevance of MISP and SRH during crises was difficult.

SRH is the least prioritized issue during disasters and is often neglected. However with orientation on MISP through workshops and sensitization meetings that explained the importance of having a contingency plan and SOPs for responding to the SRH needs of vulnerable groups like pregnant and lactating women, young girls and adolescents, the process has led to a positive outcome.

It was felt that advocating and liaising with governments could take time and sometimes delay the desired outcome and policy changes due to firm administrative procedures. SPRINT therefore realized that it was extremely important to train and sensitize government officials on MISP and SRH during crises from the initial stage or inception of the project. Capacity building of local administrators and government officials on importance of MISP at disaster risk reduction and preparedness phase is something for which SPRINT now strongly advocates.

Results

Due to constant advocacy with national and local governments, integration of MISP and SRH into the action plans and SOPs of national Disaster management authorities (NDMA) and provincial disaster management authorities (PDMA) has become possible.

A 2014 situational assessment on SRH by SPRINT Pakistan rveled that the government awareness of SRH and the importance of MISP at the preparedness phase is extremely high, particularly in FATA and Punjab provinces. Constant advocacy in Pakistan has also led to the government institutions like the National Health Emergency Preparedness and Response Network (NHEPRN), the Health Service Academy (HSA), and the Pakistan Nursing Council taking an active role in the Reproductive Health Working Group managed by the United Nations Population Fund (UNFPA) and SPRINT Pakistan. There have been more than five MISP trainings in the country though the SPRINT project in 2014 which included various technical partners including government and other civil society organizations.  

Measuring success

SPRINT conducted a rapid assessment of SRH and MISP implementation in Pakistan, and it could be seen that the awareness among the district and local government especially in FATA and Punjab was very high with governments acknowledging the need for capacity building on MISP and RH components usage during emergencies.

SPRINT and UNFPA have also trained more than 20 government officials from NDMA, PDMA, NHEPRN etc., while more than 154 persons from international non-governmental organizations (INGOs) and Civil society organizations have now been trained on MISP and SRH during emergencies as a process of emergency preparedness and disaster risk reduction.

Relevance to HFA

DRR is a national and a local priority with a strong institutional basis for Implementation along with the building and strengthening of capacities on MISP. This ensures maximum collaboration between partners on emergency preparedness (HFA Priorities: 1 and 5)

The most common link between HFA or the Making Cities Resilient campaign and this SPRINT’s initiative is ensuring the participation of local and national governments along with various stakeholders in integrating SRH into DRR plans and policies. The training of various partners, especially national and local level government officials, to strengthen their understanding of MISP is core in terms of ensuring emergency preparedness.

Potential for replication

Advocacy for the inclusion of SRH and MISP during disasters into the already existing DRR Plans at national and district levels have now been replicated and in progress through the SPRINT initiative in Bangladesh as well.   The starting point is through integration of SRH and MISP into the curriculum of doctors and nurses in colleges and universities. The efforts aim to build capacities and orient future service providers on MISP implementation. The capacity building of government officials, local partners and front line service providers through MISP trainings has been core to SPRINT DRR and preparedness efforts.

Contribution by

Nimisha Goswami , South Asia Regional Manager, The SPRINT Initiative

(Sexual Reproductive Health Programme in Crisis and Post-Crisis Situations)

International Planned Parenthood Federation – South Asia Regional Office

IPPF House, C-139, Defence Colony New Delhi – 110024, India

e-M: ngoswami@ippfsar.org T: +91-11-2435 9221/2/3/4/5/6 (230) F: +91-11-2435 9220 W: www.ippfsar.org

To view Photos of Sprint South Asia (Pakistan)

https://www.dropbox.com/sh/je32gd8azp6zkic/AAD0E3z5e_b3BAAA7rZmcX_Fa?n=332396174#/

SPRINT Publication:

http://www.ippf.org/sites/default/files/sprinting_towards_change.pdf

 

Footnotes

[1] The Minimum Initial Service Package (MISP) for Reproductive Health is a priority set of life‐saving

activities to be implemented at the onset of every humanitarian crisis. The  MISP  is  an international standard as  outlined in the  Sphere Humanitarian Charter  and Minimum Standards in Disaster Response.

 

[2] The International Planned Parenthood Federation (IPPF) is a global service provider and a leading advocate of sexual and reproductive health and rights for all. It is a worldwide movement of national organizations working with and for communities and individuals.

 

[3] The SPRINT Initiative is a Sexual and Reproductive Health (SRH) Programme in Crisis and Post-Crisis Situations. It is an Australian Government funded initiative, managed by the International Planned Parenthood Federation.

 

[4]Since 1953, the Family Planning Association of Pakistan (FPAP) (member association of IPPF) has helped women, men and young people access critical sexual and reproductive healthcare (SRH) services, including family planning. They were instrumental in establishing a separate Ministry of Population Welfare, as well as for introducing the first ever policy on population control in South Asia. FPAP is now known as Rahnuma (one who shows the path and provides direction) to reflect its holistic approach towards development in Pakistan.

Implementing the Minimum Initial Service Package for Reproductive Health in the Aftermath of the Zamboanga City Crisis

The SPRINT Initiative provided an emergency response grant of 50,000 USD to the Family Planning Organization of the Philippines (FPOP) to implement the Minimum Initial Service Package (MISP) among the communities in Zamboanga City displaced by short-term armed conflict in 2013. 

Case Study

Implementing the Minimum Initial Service Package (MISP) for Reproductive Health in the Aftermath of the Zamboanga City Crisis

HFA Priority

HFA Priority 1: Ensure that disaster risk reduction is a national and a local priority with a strong institutional basis for implementation.

HFA Priority 5: Strengthen disaster preparedness for effective response at all levels.

Abstract

The SPRINT Initiative provided an emergency response grant of 50,000 USD to the Family Planning Organization of the Philippines (FPOP) to implement the MISP among the communities in Zamboanga City displaced by short-term armed conflict in 2013.

As a local organization delivering sexual reproductive health (SRH) services, FPOP had added value as they have an extensive network and are able to assess and respond rapidly.   Young people can be engaged in SRH service provision and form a strategic part of capacity building and implementation.

Continuous Support from SPRINT in MISP training pre-disaster and involvement in multiple SRH humanitarian responses has contributed to significant growth of FPOP’s Humanitarian Programme.

Context

On 9 September 2013, fighting broke out in coastal villages of Zamboanga city between a faction of the Moro National Liberation Front and the Armed Forces of the Philippines, which spread to the nearby island province of Basilan.

·       SRH needs continue and increase during crises.

·       The risk of sexual violence may increase during social instability.

·       STI/HIV transmission may increase in areas of high population density.

·       The lack of family planning services increases risks associated with unwanted pregnancies.

·       Childbirths also incur higher risks in conflict crises.

·       Lack of access to emergency obstetric care increases the risk of maternal deaths.

·       Additionally, adolescent SRH needs are of particular concern in crises.

Location

Zamboanga City, Philippines

How the problem was addressed?

The SPRINT Initiative provided an emergency response grant in the amount of $50,000 USD to FPOP to implement the MISP for Reproductive Health among the displaced population in Zamboanga City for a duration of three months – October to December 2013.

Following an on-the-ground assessment by FPOP in the weeks following the outbreak of violence, FPOP submitted their proposal to provide potentially lifesaving SRH information and services to people sheltering in the “Grandstand” (Joaquin F. Enriquez, Jr. Sports Complex), the largest evacuation centre (EC), on Cawa-Cawa Boulevard, and other designated centres. The populations of Grandstand, Cawa-Cawa, and some of the other ECs are predominately Muslim, with many from the Badjao and Tausug tribes.

Project activities consisted of reproductive health medical missions (RHMMs) for SRH service provision, distribution missions (DMs) for provision of RH Kits (clean delivery kits, dignity kits, hygiene kits), and health information sessions (HIS) for information and sensitization on a range of SRH topics and services.

Upon SPRINT’s funding of the response, FPOP assembled a team of staff in Zamboanga City. Additional important objectives were coordination of reproductive health in the project area and planning for comprehensive reproductive health services through baseline data gathering and documentation of services provided.

In addition to staff, at least 30 youth volunteers were recruited and trained to assist with project activities. These youths were oriented on the MISP and project implementation and formed a strategic part of capacity and implementation.

Completing the list of internally displaced persons (IDPs) was difficult in the early stage of the project. Partial lists by local authorities proved to be inaccurate. Shipping of supplies for the medical missions was sometimes delayed by typhoons. In cases when help from armed forces was required for shipment, more priority was given to arms and ammunition causing delays. Among the challenges was the threat to the security of the team in the conflict area. This led to a refocusing certain evacuation centres and sometimes, medical teams were kept indoors due to shootings.

The cooperation of local organizations and officials plus the aid of external groups and government agencies facilitated implementation of the project. There was sufficient support in terms of provision of information, data and resources. The team saw that the project could have benefitted from tighter coordination between and among the agencies involved.

Results

At the close of the project, a total of 3,159 people had been provided with SRH assistance, including 638 pregnant women, 520 lactating women, and 2,001 women of reproductive age served through 10 reproductive Health Medical Missions across 13 evacuation centres.

During these missions, 539 family planning services and 1,846 maternal and neonatal health services were provided. A total of 9,657 male condoms were distributed in 12 distribution missions covering 10 evacuation centres. 2,606 blue kits were given to women of reproductive age, 518 black kits to pregnant women, and 266 orange kits to lactating women. The overall impact on the community was the increased timely access to life saving SRH services.

Measuring success

SPRINT developed a standardized Post-Emergency Review Protocol and Tool that was adapted for use in evaluating FPOP’s Zamboanga City emergency response project in December 2013. Data collection methods included documentation of quantitative performance indicators (including service statistics) based on the project proposal, semi-structured interviews with FPOP staff, and focus groups with coordination partners, SPRINT staff members, and project beneficiaries.

Key recommendations post review included:

-        Extend the reach of MISP training for response staff within partner agencies;

-        SPRINT resource mobilization for medical equipment for FPOP medical missions;

-        Preposition clean delivery kits (Kit 2A) at the FPOP national office.

Relevance to HFA

HFA Priorities 1 and 5

SPRINT works to build an enabling environment so that policy and funding is increasingly supporting in SRH in crises and strengthens county coordination teams (e.g. the Philippines Reproductive Health Working Group) to respond effectively during a crisis.

Capacity building with training on the MISP and reproductive Health (RH) commodities incorporates risk reduction into emergency preparedness. The results have institutionalized HFA principles into SRH programming in the six priority countries of SPRINT, including the Philippines.

Potential for replication

This practice was replicated during the emergency response in Implementing the MISP in the Wake of TS Haiyan. The experience and lessons learned from the Zamboanga experience greatly assisted in the planning, coordination and implementation of the MISP. Additionally, the trained youth volunteers that were involved in previous responses were able to take on increasingly important roles as needed in the TS Haiyan response.

Recommendations for replication:

·       Delivering SRH Services as a Local Organization Has Added Value;

·       Young People can be Engaged in SRH Service Provision;

·       Continuous Support from SPRINT and Involvement in Multiple SRH Humanitarian Responses Has Contributed to Significant Growth of FPOP’s Humanitarian Programme.

Contribution by

Dr. Subatra Jayaraj, SPRINT ESEAOR Regional Manager

The SPRINT Initiative, International Planned Parenthood Federation East & South East Asia and Oceania Region

Contact: subatra@ippfeseaor.org,

T:+60342566122, F:+60342566386

Documentation to share

Photos, Video and Post Emergency Review on Zamboanga available at the link below:

Click here to view SPRINT for Good Practice Showcase at AMCDRR, Bangkok