Reproductive Health Kits for Crisis

Situation
Minimal Initial Service Package
on Reproductive Health in
Emergency Situation
HEIZEL V. CREENCIA
MATERNAL HEALTH CLUSTER
 KEY TERMINOLOGIES
I. MISP – Minimum Initial Service Package
II. SRH – Sexual and Reproductive Health
III. UNFPA – United Nations Population Fund
IV. SPRINT – Sexual and Reproductive Health PRogramme
IN Crisis and PosT Crisis Situations in East Asia and the
Pacific.
V. IPPF – International Planned Parenthood Federation
 KEY TERMINOLOGIES
VI. SGBV – Sexual and Gender Based Violence
VII.VAWC – Violence against women and children
VII. MNH – Maternal and Newborn Health
VIII. HIV and STI’s – Human Immunodeficiency Virus and
Sexually Transmitted Infections
IX. WRA – Women of Reproductive Age
Women's group seeks help for pregnant
Marawi evacuees

The Center for Women’s

Resources says
pregnant women require
proper nutrition and pre-
natal check-ups which
are not readily available
in evacuation centers
 Progress in local reproductive health
legislation and guidelines
In the Philippines, the 2009 Magna
Carta of Women and the Responsible
Parenthood and Reproductive Health
Law of 2012 provide for the protection
of women and girls and ensures their
access to sexual and reproductive
health services during times of crises
through the implementation of the
Minimum Initial Service Package
for Sexual and Reproductive Health
in Emergencies (MISP for SRH).
In February 2016, the Philippine
Department of Health took the initiative
to launch a department-wide policy that
sets the guidelines for all stakeholders
in implementing the MISP for SRH,
which includes defining the core
package of services covered, as well as the implementing mechanism for rolling this
out on the ground and down to the communities.
 Target population of MISP
• Women
• Women of reproductive age (15 – 49 y/o)
• Male and Female children
Maslow’s Hierarchy of Needs
In depth view of Maslow’s Hierarchy of
Needs
 Reality during emergencies
• Deliveries
• Pregnant women
• Sexual activities
 What is MISP
• Minimum – Basic/ Limited to reproductive health/ will
address gender based violence
• Initial – For use in emergency with out site specific needs
assessment
• Service – Service to be delivered to affected population
• Package – Supplies and Reproductive Health Kits
• The Minimum Initial Service Package (MISP) for
Reproductive Health (RH) is a set of priority activities to
be implemented from the onset of a humanitarian crisis
(conflict or natural disaster),
• further scaled upand sustained to ensure equitable
coverage throughout protracted crisis and recovery while
planning is undertaken to implement comprehensive RH
as soon as possible.
• The priority RH services contained within the MISP are
essential services because all people, including people
affected by humanitarian emergencies, have a
fundamental human right to RH.
GOAL

The goal of the MISP is to reduce mortality, morbidity and

disability, particularly among women and girls in populations
affected by crises, including internally displaced persons
(IDPs), refugees and those affected but not displaced.
 OBJECTIVES AND ACTIVITIES
Ensure the health sector/cluster identifies an organization to
lead
• implementation of the MISP. The lead RH organization:
• Nominates an RH Officer to provide technical and operational support to all
• agencies providing health services;
• Hosts regular stakeholder meetings to facilitate implementation of the MISP;
• Reports back to the health sector/cluster meetings on any issues related to
• MISP implementation; and
• Shares information about the availability of RH resources and supplies.
Prevent and manage the consequences of
sexual violence by:
• Putting in place measures to protect affected populations,
particularly women and girls, from sexual violence;
• Making clinical care available for survivors of rape;
and
• Ensuring the community is aware of the available clinical
services.
 Reduce HIV transmission by:

• Ensuring safe blood transfusion practice;

• Facilitating and enforcing respect for standard
precautions;
and
• Making free condoms available.
 Prevent excess maternal and newborn
morbidity and mortality by:
• Ensuring availability of emergency obstetric care (EmOC)
and newborn care services, including:
At health facilities: Ensure there are skilled birth
attendants and supplies for normal births and management
of obstetric and newborn complications;
At referral hospitals: Ensure there are skilled medical staff
and supplies for management of obstetric and newborn
emergencies;
• Establishing a referral system to facilitate transport and
communication from the community to the health center
and between health center and hospital;
and
• Providing clean delivery kits to visibly pregnant women
and birth attendants to promote clean home deliveries
when access to a health facility is not possible.
 Plan for comprehensive RH services,
integrated into primary health care (PHC)
as the situation permits. Support the health sector/cluster
partners to:
• Coordinate ordering RH equipment and supplies based
on estimated and observed consumption;
• Collect existing background data;
• Identify suitable sites for future service delivery of
comprehensive RH services; and
• Assess staff capacity to provide comprehensive RH
services and plan for training/retraining of staff.
 MISP and Comprehensive RH Services
RH Components Priority RH Services Comprehensive
(not in order of (MISP) RH Services
priority/importance)
FAMILY PLANNING None* Source and procure contraceptive
* Provide contraceptives such as supplies.
condoms, pills, injectables and Provide staff training.
IUDS to Establish comprehensive family
meet demand planning programming.
Provide community education.
GENDER-BASED Coordinate mechanisms to Expand medical, psychological,
VIOLENCE prevent sexual violence with social and legal care for survivors.
health, protection and other Prevent and address other forms
sectors/clusters. of GBV, including domestic
Provide clinical care for survivors violence, forced/early marriage
of rape. and female genital mutilation.
Provide community education.
Engage men and boys in GBV
programming.
RH Components Priority RH Services Comprehensive
(not in order of (MISP) RH Services
priority/importance)
M AT E R N A L A N D Ensure availability of emergency Provide antenatal care.
NEWBORN CARE obstetric and newborn care Provide postnatal care.
services. Train skilled attendants (midwives,
Establish a 24/7 referral system nurses, doctors) in performing
for obstetric emergencies. EmOC and newborn care.
Provide clean delivery packages Increase access to basic and
to visibly pregnant women and comprehensive EmOC and
birth attendants. newborn care.
STIS,INCLUDINGHIV Ensure safe blood transfusion Establish comprehensive STI
PREVENTIONAND practice. prevention and management
TREATMENT Facilitate and enforce respect for services, including partner tracing
standard precautions. and STI surveillance systems.
Make free condoms available. Collaborate in establishing
* Make syndromic treatment available as comprehensive HIV services as
part of routine clinical services for patients appropriate.
presenting for care.
* Make treatment available for patients
Provide care, support and
already taking ARVs, including for PMTCT, treatment for people living with
as soon as possible. HIV/AIDS.
Raise awareness of prevention,
care and treatment services for
Kit 0 Administration Kit 0
Kit 1 Condom Kit (Part A + B) 2
Kit 2 Clean Delivery Subkits (Individual) (Part A + B) 2
Kit 3 Rape Treatment Kit116 2
Kit 4 Oral and Injectable Contraception Kit 2
Kit 5 STI Kit 2
Kit 6 Clinical Delivery Assistance (Part A + B) Kit 1
Kit 7 IUD Kit 1
Kit 8 Management of Complications of Abortion Kit 1
Kit 9 Suture of Tears (cervical and vaginal) and Vaginal Examination Kit 1
Kit 10 Vacuum Extraction for Delivery (manual) Kit 1
To support the referral hospital
Kit 11 Referral level Kit for Reproductive Health (Part A + B) 1
Kit 12 Blood Transfusion Kit
 ADMINISTRATIVE ORDER 2016 - 0005
• SUBJECT: NATIONAL POLICY ON THE MINIMUM
INITIAL SERVICE PACKAGE (MISP) FOR SEXUAL AND
REPRODUCTIVE HEALTH (SRH) IN HEALTH
EMERGENCIES AND DISASTERS
HIGHLIGHTS OF ADMINISTRATIVE ORDER 2016 - 0005

• Page 1
- Philippines ranks 2nd to Vanuatu as the most disaster
prone country in the world.
- During crisis, reproductive health becomes more
significant because of new risks.
a. 15% of pregnancies may end up with complications
b. 5 – 15% will require C- section
c. Premature delivery is a possibility
HIGHLIGHTS OF ADMINISTRATIVE ORDER 2016 - 0005

• Disruption of vital access to RH care, information and

services will deprive pregnant and lactating women,
newborns, young people and men of essential health care
services or interventions such as pre natal, skilled birth
attendance, post partum care, newborn care, adolescent
sexual and reproductive health care, family planning, STI,
HIV and AIDS services.
• Because of the susceptibility of our country to disasters
RA 10121 was passed by the Philippine Congress to
strengthen PDRRM system.
 HIGHLIGHTS OF ADMINISTRATIVE
ORDER 2016 - 0005
• Page 2
• NDRRM framework envisions “ a country safer, adaptive
and disaster resilient Philippine Communities towards
sustainable development.
• NDRRM plan covers 4 thematic areas
a. Disaster prevention and mitigation
b. Disaster preparedness
c. Disaster response
d. Disaster rehabilitation and recovery
 HIGHLIGHTS OF ADMINISTRATIVE
ORDER 2016 - 0005
• National Disaster Response Plan (NDRP) has 11 clusters
• 1. Food and Non food items
• 2. Camp coordination and camp mgt.
• 3. Health
• 4. Education
• 5. Protection
• 6. Search, rescue and retrieval
• 7. Management of the dead and missing
 HIGHLIGHTS OF ADMINISTRATIVE
ORDER 2016 - 0005
• 8. Logistics
• 9. Emergency telecommunications
• 10. Law and Order
• 11. International Humanitarian Partner
DOH leads the Quad cluster
1. Health
2. Nutrition
3. Water, Sanitation and Hygiene (WASH)
4. Psychosocial services
 HIGHLIGHTS OF ADMINISTRATIVE ORDER
2016 - 0005
Declaration of policy
1. MISP for SRH is provided for in the Magna Carta for women
(RA 9710) in Aug 2009 and in the Responsible Parenthood
and Reproductive Health Law December 2012
2. IRR of Magna Carta for Women under Rule IV Rights and
empowerment, Section 13 provides that “there should be
timely, adequate and culturally appropriate provision of
comprehensive health services, including the implementation
of the MISP for SRH at the early age of crises”
 HIGHLIGHTS OF ADMINISTRATIVE
ORDER 2016 - 0005
• “ The LGU’s and the DOH shall ensure that a MISP for RH
including maternal and neonatal health kits as defined by the
DOH shall be given proper attention in crises situations as
disasters and humanitarian crisis.
• “The MISP package shall become part of the DOH response
to crisis and emergencies”
• Temporary facilities, EC’s and refugee camps shall address
the special needs of the ff situations: Normal and Complicated
deliveries, pregnancy complications, spread of HIV and STI’s
and GBV
 Objectives of MISP lifted in the AO
• 1. Provide guidelines to concerned agencies (DSWD, OCD
and DILG) and stakeholders.

• 2. To define core package that that will constitute MISP for

SRH to be integrated in the DOH essential service package for
emergencies

• 3. To create National Reproductive Health Coordinating Team

(RHCT) that will coordinate the implementation of the MISP for
SRH during emergencies.
 Scope and coverage
• 1. DOH Central and Regional offices
• 2. Attached agencies
• 3. Public and private health facilities
• 4. Civil society organizations
• 5. Private organizations
• 6. International and humanitarian partners
 General guidelines
• 1. MISP for SRH shall be implemented in all humanitarian
crises g, utilizing national guided by the principles of
humanity, neutrality and impartiality.
• 2. The MISP for SRH shall be implemented at the onset of an
emergency or disaster, without site specific needs
assessment, utilizing national estimates on population data
and health care, when available, and shall continue until
comprehensive RH services are in place.
• 3. All humanitarian partners providing SRH services during
emergencies and disasters shall comply with the MISP for
SRH as a SPHERE standard
 General guidelines
• 4. The DOH shall incorporate additional services to the
MISP for SRH to include Nutrition services for newborns ff
the IYCF – E and the Adolescent Sexual and
Reproductive Health
• 5. MISP shall be integrated in the following pillars of the
health system during emergencies and disasters.
 Specific Guidelines
1. Safe motherhood
2. Family planning
3. STI, HIV and AIDS
4. Gender Based Violence
 RHCT shall
• 1. Coordinate RH humanitarian response to address the
RH needs of internally displaced populations. ( pregnant
and lactating women, newborn, adolescents, PWD’s,
elderly and men.
• 2. Improve effectiveness, efficiency and speed of
response through linkages and coordination.
• 3. RHCT is responsible in all phases of emergencies
(please refer to page 8)
 Roles and responsibilities
• 1. Assist the LGU in the creation and activation of the
local RHCTs.
• 2. Designate Regional RH focal points to the local RHCT
who shall provide technical assistance to the affected
LGUs in the implementation of the MISP for SRH.
• 3. Advocate for the integration of the MISP for SRH in
local DRRM plans.
• 4. Monitor for SRH implementation of the LGUs and
provide feedback to National RHCT.