Non-structural safety assessments: a case of 15 hospitals in Assam

Assessing Hospital Safety describes the audit which was conducted in fifteen government and private hospitals in the three districts of the Indian state of Assam. The audit focused on non- structural safety aspects in health facilities. The main findings were that all the aspects of non- structural hospital safety are given differential importance in the audited hospitals and health facilities in Assam. Aspects, which were researched, can be categorized in two types: general Safety aspects and disaster/ emergency preparedness aspects. Findings were shared with government and hospitals.

Read more Assam Case Study – Hospital Safety Audit

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.


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.


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.


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.


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: T: +91-11-2435 9221/2/3/4/5/6 (230) F: +91-11-2435 9220 W:

To view Photos of Sprint South Asia (Pakistan)

SPRINT Publication:



[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.

What we learned from Japan’s triple disaster: preparing for the unimaginable

What we learned from Japan’s triple disaster: preparing for the unimaginable
By Masahito Yamazawa

Saturday, 7 March 2015


We were not at all aware of the situation at the nuclear power plant; we were focused on starting treatment to the tsunami survivors. But soon after our arrival, we heard the news of the explosion. We had to pack up and change the location of our medical relief station. ‘You are going to leave us!’ said the survivors to us reproachfully. My heart was close to breaking with a mixture of guilt and fear, because I wanted to evacuate, be away from the danger of the radiation.

Ms. Ayumi Watanabe, a nurse from the Fukushima Red Cross hospital, faced this agonizing situation because at the time of the triple disaster – the Great East Japan earthquake, tsunami, and Fukushima Daiichi nuclear power plant accident – in March 2011, the Japanese Red Cross Society (JRCS) neither had the appropriate equipment nor clear guidelines on how our medical teams should operate amid the risk of radiation from a nuclear accident.

The Fukushima nuclear accident was a sharp wake-up call for us and since then, JRCS together with the International Federation of Red Cross and Red Crescent Societies (IFRC) have been active in reviewing our response operations to address such situations should it happen again.

JRCS established a nuclear disaster resource centre at our headquarters in October 2013 with the aim of collecting information and experiences in a digital archive ( and creating operational guidelines for domestic use so that JRCS medical teams are prepared and able to respond in the event of a nuclear disaster. The first draft of the guidelines was completed in 2014 and it will be finalized before by this April 2015. JRCS has started training 496 medical teams from all over Japan. Once they have completed their training, these medical teams could potentially be mobilized to provide assistance in various types of natural and technological disasters.

Globally, the International Red Cross and Red Crescent Movement has responded to the short and longer term consequences of the 1986 Chernobyl nuclear power plant accident. Over the course of 24 years, the Movement has embraced a range of activities within the affected countries of Belarus, Ukraine and Russia, such as providing relief assistance at the evacuation centres, radiation screening of people and food, health and psychosocial care, as well as in kind and financial assistance for the affected populations. The effects of this nuclear accident had an impact on a wide geographical area especially in Europe and thus, a number of National Red Cross Societies engaged in response and preparedness activities within their communities. In 2011, the IFRC and National Red Cross and Red Crescent Societies adopted a key resolution on preparedness to respond to the humanitarian consequences of nuclear emergencies at its General Assembly. The objective of the resolution is to develop and improve response plans, as well as to build up expertise and knowledge within the IFRC and to strengthen member National Societies’ capacity to assist affected populations during such an emergency.

Japan learned that we need to be prepared for the unimaginable, including technological hazards. We have embarked on this journey by taking the first step of protecting our staff and volunteers, so that they are able to support affected populations, because millions of our Red Cross and Red Crescent volunteers in 189 National Societies around the world are engaging daily on the front lines of emergencies.

Masahito Yamazawa, Director General of the Japanese Red Cross Nuclear Disaster Resource Centre, is leading the JRCS to be better prepared for nuclear and radiological emergencies. He graduated from the National Defence Academy. Before joining the JRCS, he was a Commandant at the Chemical School of the Japan Self Defence Force.