CONCEPT NOTE

MISP Readiness Assessment workshop at Cox’s Bazar

Date: 12-13 March 2024, Venue: Hotel Seagull, Cox’s Bazar

The Minimum Initial Service Package (MISP) for Sexual and Reproductive Health (SRH) and Gender Based
Violence in Emergencies (GBViE) is a minimum standard at the onset of crises. SRH services, as well as
prevention and response to violence against women, are often not included in the country plans for
preparing for and responding to emergencies, or for adapting to and building resilience to climate change.
The gap in national plans combined with other factors such as cultural limitations, poverty, a lack of
education, social stigma and taboos, and so on, limits the country’s ability to ensure that life-saving
interventions for women and girls are available during emergencies, particularly for the most marginalized
and difficult to reach.

With under-resourced health systems and socio-cultural barriers, Bangladesh is not fully prepared to cope
with such shocks and struggled to keep a reasonable level of Sexual and Reproductive Health (SRH)
services. Furthermore, frequent natural disasters and lack of trained providers and supplies, impacting
access to SRH services and there is a need to improve access through the intersection of regular SRH
services and the application of the Minimum Initial Service Package (MISP).

The Ministry of Disaster Management and Relief, in the ‘Standing Orders on Disaster (SOD) 2019’, it is
mentioned that the Sexual and Reproductive Health (SRHE) sub-cluster will work under the Health Cluster
during the disaster/emergency period for implementing Minimum Initial Service Package (MISP) for SRH.
Other Government plans- ‘Bangladesh National Comprehensive Menstrual Regulation (MR) and Post-
Abortion Care (PAC) Services Guidelines’ and ‘National Plan of Action for adolescent Health Strategy 2017-
2030’ also mentioned about implementing MISP during emergencies. To support implementation of these
policy frameworks, UNFPA Bangladesh, with the support of APRO, has been working to strengthen local
health care providers' and first responders' capabilities through MISP training and other support to
enhance disaster preparedness. Moreover, during the COVID-19 crisis, UNFPA Bangladesh conducted its
first-ever virtual training on the MISP for health care professionals. However, despite these investments,
there are significant gaps in the implementation of these policies as well as the compliance to MISP
standards and requirements on the ground. To address this gaps UNFPA Bangladesh with the support
from Asia Pacific region, conducted MISP Readiness Assessment workshop during 07-09 November 2023
at Dhaka involving high level delegates from multiple ministries and concerned sectors including partners.
An action plan has been developed based on gap identification where it was found that Cox,s Bazar is the
unique district where doubling the humanitarian crises, hosting one of the largest refugee camps in the
world, housing Rohingya refugees who fled violence in Myanmar. Several climate change issues (e.g
cyclones, floods, and landslides etc.) pose additional challenges to daily living especially in the lives of
women and girls who are already disadvantaged, requiring the acceleration of adaptation efforts and
investment in disaster response preparedness, scaling up anticipatory action and support more systematic
resilience building of communities and institutions. Disaster response readiness for health in Cox's Bazar

Prepared by Mahfuza Mousumi, Programme Specialist, SRH, CXB

is crucial due to the vulnerability of the population, including both the local community and the refugee
population.

Latest Heath Sector Strategic Plan 2023-0224 for Cox’s Bazar also emphasis the importance of
multisectoral collaboration to ensure adequate capacity to anticipate, prepare for, respond to and reduce
the impact of imminent, or current hazards or conditions in the community. Under the guidance of the
Emergency Preparedness and Response (EPR) Technical Committee, the sector will ensure adequate
Emergency Preparedness capacity targeting natural disasters and artificial hazards in Cox’s Bazar (Fire,
Monsoon rain, Cyclone, Floods) and epidemic-prone Infectious/communicable disease (COVID-19,
Diphtheria, Measles, Varicella, AWD/Cholera). Across all planning scenarios, EPR has outlined key
activities for ensuring the continuity of access to lifesaving intervention and support local government
capacity building for humanitarian response and preparedness in the host community through enhancing
local community participation in EPR activities and promoting multi-sectoral integrated approaches to
address any humanitarian crises including recurrent surge/waves of COVID-19 infection in coming year.

Following the National MRA workshop priorities, UNFPA Cox’s Bazar through the SRH working group
leadership plan to organize a workshop under the leadership of RRRC with involving multiple sectors and
district authorities to assess the readiness of MISP to come up with a pragmatic action plan based on
critical gaps and priorities for the Rohingya communities.

In collaboration with key stakeholders at Cox’s Bazar, UNFPA is committed to strengthen the MISP
readiness and capacity of the partners/stakeholders affected by natural disasters and climate change-

I. To implement the MISP for SRHiE and GBViE minimum standards at the onset of crises
II. To ensure that women, adolescents, youth, and persons with disabilities benefit from integrated.
SRH and gender-based violence related life-saving interventions; and.
III. To implement international standards and best practices in inter-agency coordination.
mechanisms at Cox’s Bazar that support those ‘left furthest behind’

2. The Minimum Initial Service Package

The MISP for SRH in crisis situations is a set of lifesaving priority interventions that respond to the SRH
needs of affected populations during an emergency crisis. These needs are often overlooked in the height
of emergency situations and may result in potentially life-threatening consequences. Providing lifesaving
SRH services prevents both morbidity and mortality related to SRH including maternal health care. The
timely provision of these services can avoid preventable deaths, illness and disability, much of which are
related to obstetric complications, sexual and gender-based violence, unintended pregnancy, STI/HIV and
other SRH-related conditions.

The MISP Framework is structured under six objectives (components) which outline the key action areas
to prevent illness and deaths during an emergency, the six objectives are:
1. Identify an organization to lead the implementation of the MISP
2. Prevent sexual violence and respond to the needs of the survivors
3. Prevent the transmission of and reduce morbidity and mortality due to HIV and other STIs
4. Prevent excess maternal and newborn morbidity and mortality
5. Prevent unintended pregnancies
6. Comprehensive SRH services, integrated into primary health care as soon as possible.

Prepared by Mahfuza Mousumi, Programme Specialist, SRH, CXB

The implementation of the MISP expands in all three phases of an emergency response: planning,
response and recovery. The recovery phase aims to integrate comprehensive SRH services at all levels of
the health service delivery.

UNFPA has conducted MISP Readiness Assessments (MRA) in different Asia and Pacific countries
including Bangladesh recently, the good practices will be reflected in this district level MRA workshop and
identify gaps and actions through contextualizing them with both refugee and host communities.
3. The MISP Readiness Assessment
The MISP Readiness Assessment (MRA) is a global standard to assess the readiness and the capacity of a
country to carry out the MISP interventions in the event of an emergency crisis. The MRA aims to provide
a snapshot of a country’s capacity to provide essential SRH services under the key components of the
MISP framework.
The assessment with the government’s leadership, helps to identify gaps in policy, resources and service
delivery, prioritize key areas for intervention, and on the basis of this develop a MISP action plan to
strengthen SRH services. The assessment takes the form of a workshop designed to engage a wide range
of stakeholders whose expertise and experiences help to respond to the MRA questions. The MRA
questionnaire is the main tool for executing the assessment. The questionnaire is structured to obtain
relevant information related to each MISP objective. This process collects rich information to help
describe the current SRH policy environment, coordination, resources and access to SRH and GBV services.
Additionally, it aids in defining and securing consensus on critical preparedness actions for effective
implementation. The process calls for a multi-stakeholder participation, with Directorate General of
Health Services (DGHS) taking ownership and playing a leading role in collaboration with UNFPA and other
key partners. MRA guidelines (guidelines link) developed by International Planned Parenthood Federation
(IPPF) in collaboration with UNFPA and IAWG will be considered for the MRA assessment.
Steps for conducting the MRA
There are six steps to the process of conducting the MRA:
Step 1: Identify the lead agency (UNFPA is the lead for SRHWG) and the key partners to be involved in the
assessment
Step 2: Prepare the supporting documents relevant to the MRA
Step 3: Complete the MRA Questionnaire
Step 4: Analyze MRA Questionnaire results and prioritize the gaps to address
Step 5: Develop the action plan
Step 6: Plan the follow-up

Step 1: Identify the lead agency(-ies) and the key partners to be involved (Completed)
The Civil Surgeon of Cox’s Bazar district will play the leading role for the actual assessment while UNFPA
CXB office will provide technical and administrative support. Subject to discussion with Civil Surgeon and
Health Sector Coordination Group, key partners and stakeholders will be identified but potential partners
will be as follows:

Key government ministries and agencies – engaging local representatives from multiple sectors
● District and divisional representation from DGHS, DGFP, DGNM
● Representatives from Department of Disaster Management (DDM), Ministry of Disaster
Management and Relief (MoDMR), Coxs Bazar
● Representative from Ministry of Women and Children Affairs (MOWCA), Coxs Bazar
● Representative from Department of Youth Development (DYD), Coxs Bazar
● Representative from Department of Social Services (DSS), Coxs Bazar

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 ● Representative from Ministry of Local Government and Rural Development (MoLGRD), Coxs Bazar

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 ● Other Entities
SRH WG partners, UN Agencies, NGOs, FBOs, community-based organizations representing youth leaders,
women, people with disabilities, people with diverse SOGIESC, religious leaders, people living with HIV
etc.

Selected participants should represent a diverse mix, encompassing policy experts,

administrative/management professionals, public health specialists, and field staff associated with the
various components of the MISP. The MRA process is also the opportunity to bring together humanitarian
and development actors to ensure comprehensive disaster response preparedness and resilience
building. It fosters collaboration across diverse thematic areas relevant to MISP, including health, social
welfare, disaster management, and community engagement. This contributes to a well-rounded
understanding of the local situation and helps leverage each other’s knowledge and resources effectively.
Bridging humanitarian and development actors also aligns with the humanitarian-peace-development
nexus approach as well as promoting climate change adaptation challenges. Participants should be alerted
at least three weeks ahead to ensure they are briefed and receive the required documents in a timely
manner.
Step 2: Prepare the supporting documents relevant to the MRA
UNFPA will facilitate collecting the relevant national and Rohingya Response/Health Sector approved
documents in advance.

Step 3: Complete the MRA Questionnaire

The MRA Questionnaire is composed of a set of 58 questions that will help look at the following elements:
1. The enabling policy environment that supports SRH services during emergencies
2. SRH coordination mechanisms during preparedness
3. SRH data collection at different levels
4. Resources for MISP preparedness and implementation
5. Health service readiness for MISP implementation

The questionnaire will be translated for participants who need language assistance, and a digital tool will
be used for data entry. The questionnaire comprises Sections 0, 1 and 2. The structure of the questionnaire
are as follows:

Prepared by Mahfuza Mousumi, Programme Specialist, SRH, CXB

Section 0 General Information—This section provides information on who completed the questionnaire,
the partners involved and the specific geographical area (national or sub-national) the answers of the
questionnaire related to.
Section 1 Sub-national level overall readiness: policies, coordination, and resources—A set of questions
focusing on the policy environment, coordination mechanisms at Coxs Bazar district, local SRH data and
financial resources. It includes four sub-sections:
1. National and Sub-national disaster management policies and plans
2. Coordination mechanisms for SRH disaster management
3. SRH data at national and sub-national level
4. Resources for MISP implementation
Section 2 Readiness to provide services as outlined in the MISP—A set of questions focusing on the
readiness to provide the MISP-related services. Most questions look at existing SRH services (during
stable times) to understand how these can be leveraged. It includes six sub-sections:
1. MISP Services—General
2. MISP Objective 2—Prevent sexual violence and respond to the needs of survivors
3. MISP Objective 3—Prevent the transmission of and reduce morbidity and mortality due to HIV
and other STIs
4. MISP Objective 4—Prevent excess maternal and newborn morbidity and mortality
5. MISP Objective 5—Prevent unintended pregnancies
6. Other priority activity: Safe abortion care to the full extent of the law
Step 4: Analyze MRA Questionnaire results and prioritize the gaps to address
A muti-stakeholder workshop will be held in 12-13 March, 2024 at Cox’s Bazar. Once the MRA
Questionnaire is completed, the responses will be analyzed collectively and eventually translated into a
national MISP action plan and more specific preparedness activities. The workshop participants will
identify existing capacities and assets, identify and prioritize the needs and gaps, and identify which areas
need resources for stronger emergency responses.
Participants will undertake a process to:
• Analyze and reflect on the responses provided in each section of the MRA Questionnaire
• Identify existing capacities and assets; as well as the needs and gaps
• Identify which areas need resources and preparedness
The success of the prioritization step calls for structured and well-facilitated discussions. The role of the
facilitators is essential as well as the knowledge on the local context among stakeholders involved.
Step 5: Action Plan
Developing a MISP action plan is one of the essential components of the MRA. The action plan should be
developed with the team that completed the MRA Questionnaire. Based on the priority gaps identified in
Step 4, the group identifies interventions for each action, defines the resources required and the
timeliness of implementation. If additional resources need to be mobilized, this should be clearly marked
in the Action Plans. How action plan will be developed is mentioned in the MRA guideline (page 34)
Once the action plan is finalized, UNFPA and the district SRHWG team should ensure that participants
agree on:
• who will monitor the action plan’s implementation
• at what frequency

Prepared by Mahfuza Mousumi, Programme Specialist, SRH, CXB

• when the group will reconvene to collectively look at the progress made.
The action plan will be shared with the District Authority/Civil Surgeon for implementation.
Step 6: Plan the follow-up
To ensure the action plan is implemented and progressing, the RRRC, with support from UNFPA, should
put in place a clear process for supportive monitoring and resource mobilization strategies. To ensure the
action plan is implemented and progress is made as expected, the SRHWG team, with support from
UNFPA, will develop a monitoring framework and resource mobilization plan. The MISP action plan will
be shared with concern stakeholders including District Commissioner and Civil Surgeon for next steps.
UNFPA will do continuous coordination and support RRRC and district authorities for implementation of
the action plan.

4. Monitoring & Evaluation

The MISP action plan will be the starting point for MISP implementation at Rohingya Camps. UNFPA will
coordinate with RRRC and Health Sector for MISP roll out.
5. Expected Output
A comprehensive report and action plan will be developed which outlines Rohingya response of Cox’s
Bazar’s readiness to implement the MISP framework during emergencies and priority areas that need to
be strengthened, agreed upon by all stakeholders. Through the MRA process, all relevant stakeholders
come together under enhanced RRRC/government leadership to collaboratively implement MISP in crisis
situations, guaranteeing both effective and efficient responses.

6. Workshop Schedule and Agenda

The workshop will be conducted in person, leading by SRH unit at UNFPA Coxs Bazar, local facilitators and
with technical support from UNFPA Dhaka.
Proposed dates for MRA Workshop (Two Days)

Proposed Date of workshop: 12-13 March 2024

Tentative Program
Day-1 Day-2 Remarks

Official Opening
Session 1 Session5
-MISP Refresher -Development of MRA Action
- Situation overview on Rohingya response, CXB Plans- and MRA
- Policy and guideline applicable for CXB Indicators
-Orientation of MRA Digital tool
Session 2
-Complete Responses to question on MRA tool Session6
Session 3 -Development of the
-validation of responses by all participants monitoring tool
-and implementation of
Action Plans

Session 4 Session 7
-Validation, analysis, prioritization -Finalizing draft priorities and
and key sharing
-Closing remark

Prepared by Mahfuza Mousumi, Programme Specialist, SRH, CXB

interventions for SRH during emergencies

Prepared by Mahfuza Mousumi, Programme Specialist, SRH, CXB