Chapter 6
Planning for Comprehensive RH Services

OBJECTIVE PLAN FOR THE PROVISION OF COMPREHENSIVE RH SERVICES, INTEGRATED INTO PRIMARY HEALTH CARE, AS THE SITUATION PERMITS.   This includes: collecting existing background data on maternal and neonatal mortality, STI and HIV prevalence, contraceptive prevalence and preferred methods, and RH knowledge, attitudes and behavior of the affected population, if available; identifying suitable sites for future service delivery of comprehensive RH services; assessing staff capacity to provide comprehensive RH services and a plan for training/retraining staff; ordering equipment and supplies through routine supply lines, based on estimated and observed consumption.

Why is planning for comprehensive RH a priority?

It is essential to plan for the integration of RH activities into primary health care during the initial phase. If not, the provision of these services may be delayed unnecessarily which may increase the risk of unwanted pregnancies, complications of pregnancy and delivery and sexually transmitted infections, including HIV. By having data collected, an appropriate service site selected, staff prepared and supplies ordered, comprehensive RH services will be up and running quickly when the stable phase of the emergency has been reached.

When should planning for comprehensive RH services take place?

It is essential to plan, in collaboration with displaced women, youth and men, for the integration of comprehensive, good quality RH activities into PHC as soon as possible during the initial phase. If not, the provision of these services may be delayed unnecessarily.

What is the difference between minimum (MISP) and comprehensive RH services?

This chart below shows which RH technical activities are part of the MISP and which are elements of expanded RH services.

Experience has shown that, in addition to providing the MISP, it is also important to respond to the displaced population's needs by initiating complementary RH services, if possible, including: antibiotics to treat people with symptoms of STIs (STI Treatment RH Kit 5); basic hygiene materials ordered locally and provided to all women and girls, including a 3-month supply of sanitary materials, underwear, soap and towels; the availability of basic contraceptives in order to respond to the demand of women with prior experience with contraceptives, who can no longer access their chosen method (Oral and Injectable Contraception, Interagency RH Kit 4 and IUD Kit 7).

Where can reliable data on the displaced population be found?

Part of planning for comprehensive RH services includes the collection of background information on maternal, infant and child mortality, HIV/STI prevalence and contraceptive prevalence data. This information can be obtained from such sources as WHO,[71] UNFPA,[72] the World Bank [73] and the Demographic and Health Survey [74] (DHS). It may be easier for staff at headquarters of implementing agencies to gather this information. For internally displaced people, the MOH may also have health statistics available. Useful tools for gathering data include the RHRC Consortium's Refugee Reproductive Health Needs Assessment Field Tools [75] and the RHRC Monitoring and Evaluation Toolkit.[76]

Good practices in planning for comprehensive RH services observed in Darfur [77] UNFPA maintains a comprehensive health information system in South Darfur. The MISP Coordinator in North Darfur developed statistical data collection forms for the safe motherhood unit and translated them into Arabic.

What are the characteristics of a suitable site for delivering comprehensive RH services?

It is important to address the following factors when selecting suitable sites:

	security both at the point of use and while moving between home and the service delivery point
	accessibility to all potential users
	privacy and confidentiality during consultations
	easy access to water and sanitation facilities
	appropriate space
	possibilities to maintain aseptic conditions [78]
	communications and transport for referrals
	tools for compiling and analyzing data
	locked storage facilities for supplies and files

What about staff and supplies?

An assessment of the capacity of staff to undertake comprehensive RH services should be made and plans put in place to train/retrain staff. Protocols and job aids should be provided to support quality service delivery according to evidence-based best practices.

Equipment and supplies for comprehensive RH services should be ordered through routine supply lines, based on estimated and observed consumption. Taking these actions will allow comprehensive services to begin as soon as the situation stabilizes and all the components of the MISP are in place.

MISP Comprehensive RH Monitoring

Planning for the provision of comprehensive RH services initiated Indicators to monitor planning for comprehensive RH coordination: Basic background information collected (see Appendix A on monitoring and evaluation) Sites identified for future delivery of comprehensive RH services Staff assessed, training protocols identified Procurement channels identified and monthly drug consumption assessed Which supplies are needed or which Interagency RH Kit(s) could be ordered to address this issue? [79] Number Name Color Kit 4: Oral and injectable contraception sub-kit White Kit 5: STI sub-kit Turquoise Kit 7: IUD sub-kit Black

Challenges and Solutions

1) What if there appears to be a lack of female health workers?   Efforts should be made to identify and engage female health workers, particularly in contexts where religious or cultural norms bar male health workers from examining female patients. Another option is to ensure a female attendant or friend accompanies the woman seeking medical care. 2) Finding background information on maternal, infant and child mortality, HIV/STI prevalence and contraceptive prevalence of the displaced population can be challenging to access, especially for an NGO trying to find this information without the assistance of WHO and UNFPA. What can an agency do to obtain reliable data on the displaced population?   This information may be available from the MOH. In addition, the agencies that attend the RH coordination meeting may be able to collectively obtain reliable data online from Web sites such as UNFPA,[80] WHO [81] and USAID.[82] If possible, try to collect data from the Internet before traveling or requesting headquarters to assist.

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NOTES

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