Post on 24-Dec-2014
description
Procurement Issues and RHCS in Emergencies
Presented by the Humanitarian Response Unit’s
Dr. Henia Dakkak, Technical Specialist
Why RH services for populations in crisis?
Reproductive health is
• a human right
• a basic health need
• contributes to psychosocial well-being
RH needs continue … in fact, increase during crisis
• Risk of sexual violence may increase during social instability
• STI/HIV transmission can increase
• Lack of FP increases risks associated with unwanted pregnancy
RH needs continue … in fact, increase during crisis
• Malnutrition and epidemics increase risks of pregnancy complications
• Childbirth occurs on the wayside during population movements
• Lack of access to emergency obstetric care increases risk of maternal death
Heightened risk, greater need
• Women and children account for more than 75% of refugees and internally displaced
• 25% of this population at risk are women of reproductive age. 1 in 5 is likely to be pregnant
• More than 37 million people displaced by war
37 million people displaced worldwide
$1 million annual seed money for operations
Safe motherhood and family planning
Emergencies heighten already significant risks:
•Complications of pregnancy and childbirth leading cause of death for women under 50 in most developing countries
•Premature deliveries and miscarriages brought on by trauma
•Fewer than half of all deliveries in developing countries take place with a skilled birth attendant
Continuum of an emergency
Emergency Post-emergency
Exodus of the population
Loss of essential services
Restoration of essential services
Durable Solutions
Relative stability
Return to normality
MISP
Minimum Initial Service
Package
Provision of comprehensive RH services
Destabilizing event Durable solutions
When does UNFPA respond?
0. before emergencies strike1. in acute emergencies2. in refugee and IDP settings3. in post-conflict situations 4. in reconstruction and development
Kosovo pre-deployment of supplies
to Albania
Afghanistan contingency planning in
surrounding countries
Iraq comprehensive
preparedness plan for anticipated refugee movements and cross-border operations
Before emergency strikes
Before emergency strikes
Haiti
Contingency planning for large numbers of displaced
Bangladesh
Contingency planning for natural disaster response
Acute emergencies
Deployment of equipment, supplies and RH kits
Release of funds for local procurement
RH assessments and data collection and analysis for UN-wide targeting and response (CAP)
UNFPA ships pre-packaged supplies directly to field offices, Red Cross, Governments, local partners
Quick response saves lives
Acute crisis
Millions displacedHealth infrastructure
devastatedUNFPA has been
providing training, medicines and supplies through the Red Cross, UNHCR and other agencies, and basic HIV prevention for IDPs and Liberian refugees in four West African countries
UNFPA is the only provider of condoms in Liberia
Acute crisis
Liberia
Examples of UNFPA response in acute emergencies
Natural Disasters:
IndiaEl SalvadorDRC (Goma)KenyaMalawiMexicoIranMongoliaHaitiGrenada
Armed Conflict:
ColombiaSierra LeoneLiberiaIraqCongoIndonesia - MalukuPalestinian TerritoryIvory CoastAfghanistanSudan
For refugees and internally displaced persons, UNFPA:
Assesses RH and gender needs
Distributes RH supplies
Provides RH information
Trains NGO and local staff for delivery of services
Organizes HIV prevention initiatives
Helps to prevent gender Violence
Coordinate and collect data
Refugees and IDPs
Refugees:
Sierra Leone, Tanzania, Uganda, Sudan, Ethiopia, Kenya, Zambia, Guinea, Liberia, Pakistan, Iran, Yemen, Palestine
IDPs:
Eritrea, Liberia, Colombia, Afghanistan, Angola, DRC, ROC, Burundi, Somalia, Tajikistan, PNG, Sudan, CDI
Recent refugee and IDP programmes
Refugees and IDPs
Post-conflict recovery
• Renovation of health facilities
• Counseling
• Training
• Equipment and supplies
• Support to local NGOs
• Demographic data
Not enough beds, Bas Congo
Recovery Democratic Republic of Congo
ReconstructionRecovery
Rehabilitation of Hospital
Baby Ahmed!6.5 pounds
Mother in good shape2nd child, 6th pregnancy
Afghanistan
Angola
Establishment of maternal mortality programs
Rehabilitation of maternity centers
Provision of equipment, supplies
Retraining of health staff
Reestablishment of EmOC
HIV prevention
Safe blood supply
Strengthening of referral systems
Recovery
How does UNFPA respond?
1) Initial authorization up to $50,000-local procurement, transportation, consultants, etc.
2) Estimate the needs for RH kits
3) Emergency shipment of RH kits
3) Provision of technical assistance (advice and training)
4) Monitoring of RH service provision to affected population and kits distribution and data collection of RH indicators (access, coverage, availability of RH commodities and forecasting)
5) Advocacy for funding and inclusion of RH services and commodities within basic needs of affected populations in humanitarian response
What are the RH Kits?
• Pre-packaged sets of medicines, equipment and supplies designed to meet the most basic RH needs in crisis situations
• They are designed so that each kit can be used in contexts where there is little or no health infrastructure
RH kit for emergency situations Block 1
Primary health care/health centre level10,000 people for 3 months
Kit 0 1 2 3 4 5
•Training and administration •Condoms (male & female) •Clean delivery sets (individual)•Post-rape (EC and STI prevention, PEP)•Oral and injectable contraception•STI drugs
Post-Exposure Prophylaxis (PEP)
• Now a part of Kit #3 (“post-rape kit”)
• For accidental/possible exposure to HIV, including sexual violence
• Costs have come down dramatically – now much more affordable
RH kit for emergency situations Block 2
Kit 6 7 8 9 10
•Professional midwifery delivery kit
•IUD insertion
•Management of complications of abortion
•Suture of cervical and vaginal tears
•Vacuum extraction
Health centre level or referral level30 000 people for 3 months
Kit
11A
11B
12
RH kit for emergency situations Block 3
Referral level150 000 people for 3 months
•Surgical (reusable equipment) •Surgical (consumable items and drugs) •Blood transfusion (HIV testing)
Local Logistics Issues• Customs clearance• Observing the cold chain• Observing expiration dates • Transport and Distribution• Warehousing• Coordinating with local partners (MOH,
NGOs, other UN agencies)
Options to think about?
1) Pre-positioning in neighboring countries
2) Stockpiling in central warehouse or neighboring countries
3) Sending in supplies during crisis-airlifting, sea, road, train,etc
4) Air Dropping in areas that is inaccessible
5) Utilizing existing commercial networks for distribution
6) Role of the military/armed forces/peace keepers in regard to logistics and in demanding services and commodities
Challenges/Questions
1) Cost Effectiveness
2) Storage and distribution
3) Expiration dates and shelf time
4) Technical Support
5) Planning for long-term commodity security (once population stabilize)
6) Managing procurement and achieving commodity security in situation of high insecurities? (Iraq as an example)