Michelle Dynes, EIS Officer/Epidemiologist, CDCRachel Idowu, Medical Epidemiologist, CDC

Ann Burton, Senior Public Health Officer, UNHCRDina Jardaneh, Associate Public Health Officer, UNHCR

Maysa Al-Khateeb, Emergency Reproductive Health Officer, UNFPAShible Sahbani, Humanitarian Coordinator, UNFPA

Sathyanarayanan Doraiswamy, Emergency RH Officer, UNHCRBasia Tomczyk, Health Scientist, CDC

Lessons Learned from Reproductive Health Surveillance in Za’atari Refugee Camp —

Jordan, 2013-2014

Center for Global Health

Emergency Response and Recovery Branch

BACKGROUND

Za’atari Refugee Camp Reproductive Health Surveillance

Syrian Refugees Today

http://data.unhcr.org/syrianrefugees/country.php?id=107http://misp.lacrounfpa.org/unfpa/mispcalculator/advocacy/NjE5MTYwOzQwOzI0OzU7ODU%3D

Syrian Refugees Today

http://data.unhcr.org/syrianrefugees/country.php?id=107http://misp.lacrounfpa.org/unfpa/mispcalculator/advocacy/NjE5MTYwOzQwOzI0OzU7ODU%3D

155,647

Syrian Refugees Today

http://data.unhcr.org/syrianrefugees/country.php?id=107http://misp.lacrounfpa.org/unfpa/mispcalculator/advocacy/NjE5MTYwOzQwOzI0OzU7ODU%3D

18,678

155,647

Jordan and Za’atari Refugee Camp – Aug 2013

Jordan and Za’atari Refugee Camp – Aug 2013

More than 520,000 refugees in Jordan Majority of refugees in

urban settings

Jordan and Za’atari Refugee Camp – Aug 2013

More than 520,000 refugees in Jordan Majority of refugees in

urban settings

Over 120,000 Syrian refugees in Za’atari camp 30,504 women aged

15-49 3,660 pregnant women

Photo 7/2013: http://www.mirror.co.uk/news/world-news/syria-refugee-

camp-aerial-pictures-2067144

HEALTH INFORMATION SYSTEM

Za’atari Refugee Camp Reproductive Health Surveillance

UNHCR Health Information System (HIS)

UNHCR Health Information System (HIS)

Standardized tool to design, monitor, and evaluate refugee public health HIS is implemented in over 18 countries Targets over 2.1 million refugees in camp and non-camp

settings

UNHCR Health Information System (HIS)

Standardized tool to design, monitor, and evaluate refugee public health HIS is implemented in over 18 countries Targets over 2.1 million refugees in camp and non-camp

settings Up to 10 technical sections with three core

pillars

UNHCR Health Information System (HIS)

Standards and

Indicators

Tools and Guidelines

Coordination and

Support

Standardized tool to design, monitor, and evaluate refugee public health HIS is implemented in over 18 countries Targets over 2.1 million refugees in camp and non-camp

settings Up to 10 technical sections with three core

pillars

UNHCR Health Information System (HIS)

Standards and

Indicators

Tools and Guidelines

Coordination and

Support

Standardized tool to design, monitor, and evaluate refugee public health HIS is implemented in over 18 countries Targets over 2.1 million refugees in camp and non-camp

settings Up to 10 technical sections with three core

pillars

UNHCR Health Information System (HIS)

Standards and

Indicators

Tools and Guidelines

Coordination and

Support

Standardized tool to design, monitor, and evaluate refugee public health HIS is implemented in over 18 countries Targets over 2.1 million refugees in camp and non-camp

settings Up to 10 technical sections with three core

pillars

Problem Statement

RH component of the HIS in Za’atari needed improvement

Many contributing factors

Transition & consolidation of comprehensive RH services highlighted need for quality RH data

Delivery Room in Za’atari Camp/UNFPA

EVALUATION DESIGN

Za’atari Refugee Camp Reproductive Health Surveillance

Evaluation Objectives

Evaluation Objectives

Review the RH component of Za’atari HIS

Review national RH HIS and reporting templates to ensure proposed changes reflect national RH

Implement a system for maternal and neonatal mortality audits in Za’atari

Provide technical support and facilitate implementation of RH component of HIS

Develop an action plan to implement the proposed recommendations

Evaluation Objectives

Review the RH component of Za’atari HIS

Review national RH HIS and reporting templates to ensure proposed changes reflect national RH

Implement a system for maternal and neonatal mortality audits in Za’atari

Provide technical support and facilitate implementation of RH component of HIS

Develop an action plan to implement the proposed recommendations

Evaluation Objectives

Review the RH component of Za’atari HIS

Review national RH HIS and reporting templates to ensure proposed changes reflect national RH

Implement a system for maternal and neonatal mortality audits in Za’atari

Provide technical support and facilitate implementation of RH component of HIS

Develop an action plan to implement the proposed recommendations

Evaluation Objectives

Review the RH component of Za’atari HIS

Review national RH HIS and reporting templates to ensure proposed changes reflect national RH

Implement a system for maternal and neonatal mortality audits in Za’atari

Provide technical support and facilitate implementation of RH component of HIS

Develop an action plan to implement the proposed recommendations

Evaluation Objectives

Review the RH component of Za’atari HIS

Review national RH HIS and reporting templates to ensure proposed changes reflect national RH

Implement a system for maternal and neonatal mortality audits in Za’atari

Provide technical support and facilitate implementation of RH component of HIS

Develop an action plan to implement the proposed recommendations

Evaluation Methods

Evaluation Methods

August 18 to September 14, 2013

Qualitative Key informant interviews Facility site visits Review of RH documents, tools, and indicators Stakeholder meetings

Quantitative HIS reproductive health data

Evaluation Methods

August 18 to September 14, 2013

Qualitative Key informant interviews Facility site visits Review of RH documents, tools, and indicators Stakeholder meetings

Quantitative HIS reproductive health data

Evaluation Methods

August 18 to September 14, 2013

Qualitative Key informant interviews Facility site visits Review of RH documents, tools, and indicators Stakeholder meetings

Quantitative HIS reproductive health data

THE FINDINGS

Za’atari Refugee Camp Reproductive Health Surveillance

Multiple Non-traditional Health Actors

Multiple Non-Traditional Health Actors

Varied data

collection methods

High staff turnover

Lack of information sharing

Varied data

collection methods

High staff turnover

Lack of information sharing

Multiple Non-Traditional Health Actors

Varied data

collection methods

High staff turnover

Lack of information sharing

Multiple Non-Traditional Health Actors

Contributed to incomplete & inconsistent

reporting

Varied data

collection methods

High staff turnover

Lack of information sharing

Multiple Non-Traditional Health Actors

Contributed to incomplete & inconsistent

reporting

Reduced data quality

Varied data

collection methods

High staff turnover

Lack of information sharing

Multiple Non-Traditional Health Actors

Data Quality – Weekly HIS Profile Reports

Data Quality:

Data Quality – Weekly HIS Profile Reports

Few health actors reported family planning

(FP) data

Data Quality: Weekly HIS Detailed Reports

Data Quality: Weekly HIS Detailed Reports

No mechanism to monitor

complete postnatal care

(PNC)

Data Quality: Weekly HIS Detailed Reports

No SGBV cases reported

No mechanism to monitor

complete postnatal care

(PNC)

ACTION PLAN

Za’atari Refugee Camp Reproductive Health Surveillance

Health Information System Action Plan

Standardize RH Data

Collection

Improve information Sharing

Encourage timely

submission

Train on registers and user guides

Develop FP register

Development of a RH Tally Sheet

Health Information System Action Plan

Standardize RH Data

Collection

Improve information Sharing

Encourage timely

submission

Train on registers and user guides

Develop FP register

Development of a RH Tally Sheet

Pregnancy Card implementation

Involve CHWs

Health Information System Action Plan

Standardize RH Data

Collection

Improve information Sharing

Encourage timely

submission

Train on registers and user guides

Develop FP register

Development of a RH Tally Sheet

Pregnancy Card implementation

Involve CHWs

Identify a RH Focal Point within each partner

Implement a Mortality Event Review & Response protocol

LESSONS LEARNED

Za’atari Refugee Camp Reproductive Health Surveillance

Lessons Learned

A flexible, systematic approach

to data collection and reporting is

needed

Lessons Learned

Engagement with and training of

health actors on key RH data to be

collected at different phases

A flexible, systematic approach

to data collection and reporting is

needed

Lessons Learned

A flexible, systematic approach

to data collection and reporting is

needed

Agreement on and development of a

standardized approach to RH data collection at global

level

Engagement with and training of

health actors on key RH data to be

collected at different phases

Lessons Learned

A flexible, systematic approach

to data collection and reporting is

needed

Agreement on and development of a

standardized approach to RH data collection at global

level

Using RH registers early in a crisis highlight key

women’s health outcomes and guide

interventions

Engagement with and training of

health actors on key RH data to be

collected at different phases

Lessons Learned

Provider involvement in

development and adoption of tools

enhances commitment and

collaboration

Lessons Learned

Data sharing between services

provided inside and outside the camps

Provider involvement in

development and adoption of tools

enhances commitment and

collaboration

Lessons Learned

Evaluate quality of HIS data early &

work with partners to develop and

implement an action plan

Data sharing between services

provided inside and outside the camps

Provider involvement in

development and adoption of tools

enhances commitment and

collaboration

For more information please contact Centers for Disease Control and Prevention1600 Clifton Road NE, Atlanta, GA 30333Telephone, 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348E-mail: cdcinfo@cdc.gov Web: www.cdc.gov

The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

AcknowledgementsUNHCRUNFPAMinistry of Health, Jordan Za’atari Health Actors - GSF, IMS, IRD, JHAS, MDM, MFH, MSF, RMS, Saudi ClinicCDC Syrian refugee population

Center for Global Health

Emergency Response and Recovery Branch