Minimum initial service package (MISP) for sexual and reproductive health in disasters

Abstract Background The Syrian refugee crisis has led to massive displacement into neighboring countries including Jordan. This crisis has caused a significant strain on the sexual and reproductive health (SRH) services to the host communities and Syrian refugees. The Minimum Initial Service Package (MISP) is a standard package of services that should be implemented at the onset of an emergency. Due to their importance in protracted humanitarian crisis, this systematic review aimed to assess the utilization of SRH and MISP after 9 years of the crisis. Methods We searched PubMed, Medline/Ovid and Scopus for both quantitative and qualitative studies from 1 January 2011 to 30 November 2019. Our search included both free text key words and Medical Subject Headings (MeSH) for various forms and acronmym of the following terms: (Sexual and) Reproductive Health, Sexual/Gender-based/Family/Intimate partner violence, Minimum Initial Service Package, MISP, Women, Girls, Adolescents, Syrian, Refugee, Jordan, Humanitarian crisis, War, (armed) conflict, and Disaster. Boolean operators and star truncation (*) were used as needed. We further conducted an in-depth review of the available grey literature published during the same timeframe. Using a narrative synthesis approach, two authors independently extracted and analyzed data from published papers. After removal of duplicates, screening, and assessing for eligibility of 161 initially identified citations, 19 papers were selected for review. Results Findings from this review indicated a number of barriers to access, utilization, and implementation of SRH services, including lack of reliable information on sexual and gender-based violence (SGBV), aggravation of early marriages by crisis setting, gaps in the knowledge and use of family planning services, inadequate STIs and HIV coverage, and some issues around the provision of maternal health services. Conclusion The findings from this review are suggestive of a number of barriers pertaining to access, utilization, and implementation of SRH services. This is especially true for transitioning from MISP to comprehensive SRH services, and particularly for refugees outside camps. Following are needed to address identified barriers: improved inter-agency coordination, better inclusion/engagement of local initiatives and civil societies in SRH services delivery, improved quality of SRH services, adequate and regular training of healthcare providers, and increased awareness of Syrian women and adolescent girls. Also, more implementing research is required to identify ways to transition SRH provision from the MISP to comprehensive care for the Syrian refugee population in Jordan.

Download Full-text

Factors affecting the implementation of the Minimum Initial Service Package (MISP) for reproductive health during crisis: the case of Eritrean refugees in northern Ethiopia

10.21203/rs.3.rs-16079/v1 ◽

2020 ◽

Author(s):

Alemayehu Bayray Kahsay ◽

Alemshet Teshale Haftu ◽

Afewerki Tesfahunegn Nigusse

Keyword(s):

Reproductive Health ◽

Sexual Violence ◽

Sexual And Reproductive Health ◽

Home Country ◽

Refugee Camp ◽

Health Needs ◽

Reproductive Age ◽

Factors Associated ◽

Service Package ◽

Women And Girls

Abstract Background: The Minimum Initial Service Package (MISP) is a series of crucial actions required to respond to reproductive health needs at the onset of every humanitarian crisis. Moreover, MISP is a coordinated priority activity to prevent and manage the consequences of sexual violence; prevent excess maternal and newborn morbidity and mortality; reduce HIV transmission; and plan for comprehensive RH services beginning in the early days and weeks of an emergency. During conflicts, natural disasters and public health emergencies, sexual and reproductive health needs are often overlooked. Women and girls may lose access to family planning services, exposing them to unintended pregnancy in dangerous conditions. Women and girls also become more vulnerable to sexual violence, exploitation and HIV infection. In this article we document the practices and factors associated with availability and implementation of services as measured by the MISP for reproductive health in the Eritrean refugee camp, Northwestern zone of Tigray, Ethiopia. Methods: we conducted an institution based cross sectional study from October 07- 30, 2019 among female reproductive age groups (15-49yrs) who arrived and lived in the refugee camp from June 01 to October 07, 2019. A systematic random sampling method was applied to recruit 422 participants. We collected the data through face-to-face interview using a structured questionnaire. Binary Logistic regression was applied to assess factors associated with MISP implementation. Results: About 38% of the refugees utilized Minimum Initial Service Package of reproductive health during their stay in the camp. Factors like age of 15–24 years [AOR = 0.38(95% CI,0.20-0.73)], being rural residents in home country [AOR =0 .53(95% CI,0.34-0.83], short time length of stay in the refugee camp [AOR = 0 .56(95% CI,0.33-0.95)] were negative predictors, while previous exposure to health information[ AOR = 2.24(95% CI1.44-3.48)] was a positive predictor of MISP services utilization among the refugees in the reproductive age. Conclusion: The MISP of reproductive health utilization in the refugee camp is relatively high . Previous information on reproductive health helped the refugees in utilizing the service, while a short stay in the refugee camp, being rural residents in their home country and being young age were barriers to utilization of MISP of RH. Strengthening and introducing sexual and reproductive health services for the youth during early crisis would prevent morbidity in refugees. Key words: MISP, RH, Eritrean Refugee camp, Ethiopia

Download Full-text

Sexual and reproductive health self-care in humanitarian and fragile settings: where should we start?

Conflict and Health ◽

10.1186/s13031-021-00358-5 ◽

2021 ◽

Vol 15 (1) ◽

Author(s):

Nguyen Toan Tran ◽

Hannah Tappis ◽

Pierre Moon ◽

Megan Christofield ◽

Angela Dawson

Keyword(s):

Reproductive Health ◽

System Approach ◽

Sexual And Reproductive Health ◽

Digital Health ◽

Self Care ◽

Global Community ◽

Care Continuum ◽

Service Package ◽

Health Support ◽

Context Specific

AbstractRecent crises have accelerated global interest in self-care interventions. This debate paper aims to raise the issue of sexual and reproductive health (SRH) self-care and invites members of the global community operating in crisis-affected settings to look at potential avenues in mainstreaming SRH self-care interventions. We start by exploring self-care interventions that could align with well-established humanitarian standards, such as the Minimum Initial Service Package (MISP) for Sexual and Reproductive Health in Crises, point to the potential of digital health support for SRH self-care in crisis-affected settings, and discuss related policy, programmatic, and research considerations. These considerations underscore the importance of self-care as part of the care continuum and within a whole-system approach. Equally critical is the need for self-care in crisis-affected settings to complement other live-saving SRH interventions—it does not eliminate the need for provider-led services in health facilities. Further research on SRH self-care interventions focusing distinctively on humanitarian and fragile settings is needed to inform context-specific policies and practice guidance.

Download Full-text

Minimum initial service package (MISP) for sexual and reproductive health for women in a displacement setting: a narrative review on the Syrian refugee crisis in Lebanon

Reproductive Health ◽

10.1186/s12978-021-01108-9 ◽

2021 ◽

Vol 18 (1) ◽

Author(s):

Dana Nabulsi ◽

Maya Abou Saad ◽

Hussein Ismail ◽

Myrna A. A. Doumit ◽

Fatima El-Jamil ◽

...

Keyword(s):

Reproductive Health ◽

Sexual And Reproductive Health ◽

Narrative Review ◽

System Level ◽

Refugee Women ◽

Service Package ◽

Syrian Refugee ◽

Wide Range ◽

Women And Girls ◽

Comprehensive Services

Abstract Background Women and girls are disproportionately affected in times of conflict and forced displacement, with disturbance in access to healthcare services leading to poor sexual and reproductive health outcomes. The minimal initial service package (MISP) was created to mitigate the consequences of conflict and prevent poor sexual and reproductive health (SRH) outcomes, especially among women and girls. The aim of this narrative review was to explore the SRH response for Syrian refugee women and girls in Lebanon, with a focus on MISP implementation. Methodology A comprehensive literature search was conducted for peer-reviewed articles in 8 electronic databases and multiple grey literature sites for articles published from March 2011 to May 2019. The target population was Syrian refugee women in Lebanon displaced from Syria as a result of the conflict that erupted in March 2011. The selected articles addressed MISP, SRH needs and services, and barriers to service access. A narrative synthesis was conducted, guided by the six main objectives of the MISP. Results A total of 254 documents were retrieved, from which 12 peer-reviewed articles and 12 reports were included in the review. All identified articles were descriptive in nature and no studies evaluating MISP or other interventions or programs were found. The articles described the wide range of SRH services delivered in Lebanon to Syrian refugee women. However, access to and quality of these services remain a challenge. Multiple sources reported a lack of coordination, leading to fragmented service provision and duplication of effort. Studies reported a high level of sexual and gender-based violence, pregnancy complications and poor antenatal care compliance, and limited use of contraceptive methods. Very few studies reported on the prevalence of HIV and other STIs, reporting low levels of infection. Multiple barriers to healthcare access were identified, which included system-level, financial, informational and cultural factors, healthcare workers. Conclusion This study highlights the main SRH services provided, their use and access by Syrian refugee women in Lebanon. Despite the multitude of services provided, the humanitarian response remains decentralized with limited coordination and multiple barriers that limit the utilization of these services. A clear gap remains, with limited evaluation of SRH services that are pertinent to achieve the MISP objectives and the ability to transition into comprehensive services. Improving the coordination of services through a lead agency can address many of the identified barriers and allow the transition into comprehensive services.

Download Full-text