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MOMENTUM Integrated Health Resilience (2021)
FAMILY PLANNING AND REPRODUCTIVE HEALTH IN FRAGILE SETTINGS
20 Essential Resources
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The Humanitarian-Development Nexus: Principles and Practice
Fragile settings are places affected by some combination of conflict, disasters, weak governance and institutions, population displacements, and other acute and chronic crises. In fragile settings, increased illness and death result from disruptions to basic health services and systems, including family planning and reproductive health care. Strengthening health resilience in fragile settings allows individuals and communities to better absorb, adapt, and transform in the face of recurrent shocks (or sudden events that impact vulnerability) and stresses (or long-term trends that impact vulnerability) and to build back better.
This collection will help individuals understand the complexities of fragile settings and opportunities for collaboration and coordination in fragile settings where both humanitarian and development assistance may be present. It offers practical tools for implementing partners and examples of effective programming relevant to family planning and reproductive health.
Publication
Webpage
Map
Data for Impact (2017)
Building Resilience in Health
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Health Cluster Guide: A Practical Handbook
World Health Organization (2020)
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The Humanitarian-Development Nexus: A Framework
MOMENTUM Integrated Health Resilience (2021)
Curated by
MOMENTUM Integrated Health Resilience & Knowledge SUCCESS
How to use this collection
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The Humanitarian-Development Nexus The State of FP/RH in Fragile Settings Tools for Planning and Implementation Training Materials Case Studies and Country Experiences
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The State of FP/RH in Fragile Settings
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Contributors
Design: Emily Haynes
Writers: Christopher Lindahl
Technical input and review: Alison Bodenheimer, Katie Morris, Gathari Ndirangu, Eric Ramirez-Ferrero
About Knowledge SUCCESS
Knowledge SUCCESS (Strengthening Use, Capacity, Collaboration, Exchange, Synthesis, and Sharing) is a five-year (2019-2024) global project led by a consortium of partners and funded by USAID’s Office of Population and Reproductive Health to support learning, and create opportunities for collaboration and knowledge exchange, within the family planning and reproductive health community. We use an intentional and systematic approach, called knowledge management, to help programs and organizations working in family planning and reproductive health collect knowledge and information, organize it, connect others to it, and make it easier for people to use.
About MOMENTUM Integrated Health Resilience
MOMENTUM Integrated Health Resilience works to improve access to and availability of high-quality, respectful, and person-centered MNCH/FP/RH care in fragile and conflict-affected settings. This project enhances coordination between development and humanitarian organizations and strengthens the resilience of individuals, families, and communities.
This collection was curated and published in November 2021. Resource links were active at the date of publication. Images courtesy of DFID Flickr, Images of Empowerment, USAID Flickr, and World Bank Photo Collection Flickr.
Acknowledgements
This collection is made possible is made possible by the support of the American People through the United States Agency for International Development (USAID) under the Knowledge SUCCESS (Strengthening Use, Capacity, Collaboration, Exchange, Synthesis, and Sharing) Project. Knowledge SUCCESS is supported by USAID’s Bureau for Global Health, Office of Population and Reproductive Health and led by the Johns Hopkins Center for Communication Programs (CCP) in partnership with Amref Health Africa, The Busara Center for Behavioral Economics (Busara), and FHI 360. The contents of this webpage are the sole responsibility of CCP. The information provided on this webpage does not necessarily reflect the views of USAID, the United States Government, or the Johns Hopkins University.
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Tran et al. (2021)
Self-Care in Humanitarian and Fragile Settings
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Ready to Save Lives: Sexual and Reproductive Health Care in Emergencies
FP2030; IPPF; JSI; WRC; UNFPA; IAWG (2020)
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Strategic Guide to Family Planning in Humanitarian Settings
FP2020 (2020)
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Women's Refugee Commission (2021)
Contraceptive Services in Humanitarian Settings
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Disruptions and Adaptations: The Effects of COVID-19
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Snapshot of Contraceptive Services in Crisis-Affected Settings
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Ensuring Universal Access to Sexual and Reproductive Health Supplies
Reproductive Health Supplies Coalition, IAWG (2020)
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Casey et al. (2019)
Meeting the Demand of Women Affected by Ongoing Crisis in Eastern DRC
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Community-Based Counseling and Distribution of DMPA-SC in the DRC
Evidence to Action Project (2021)
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Social and Traditional Practices and Their Implications for Family Planning
Elmusharaf, Byrne and O’Donovan (2017)
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Save the Children (2020)
Reproductive Health in Emergencies Toolkit
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Providing Family Planning Services During Public Health Emergencies
WHO and USAID (2018)
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Minimum Initial Service Package Distance Learning Modules
Inter-Agency Working Group on Reproductive Health in Crises
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USAID defines health resilience as the “ability of people, households, communities, systems, and countries to mitigate, adapt to, and recover from shocks and stresses, in a manner that reduces acute and chronic vulnerabilities, and facilitates equitable health outcomes.” MOMENTUM Integrated Health Resilience helps to strengthen health resilience capacities at individual to national levels to prevent and mitigate vulnerability to shocks and stresses that can affect health and/or health systems, especially in fragile settings. This brief defines health resilience and health resilience capacities and explains how MOMENTUM helps to strengthen health resilience with examples from DRC, Mali, and South Sudan. Specific examples of interventions to strengthen absorptive, adaptive, and transformation capacities at individual, household, community, and systems levels are provided along with an overview of tools and approaches to measure health resilience.
About MOMENTUM Integrated Health Resilience
USAID’s MOMENTUM Integrated Health Resilience works to improve access to and availability of high-quality, respectful, and person-centered MNCH/FP/RH care in fragile and conflict-affected settings. This project enhances coordination between development and humanitarian organizations and strengthens the resilience of individuals, families, and communities.
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Resilience is a key concept for working in fragile settings. The examples in this resource show practitioners how health resilience can be integrated into programs. The measurement tools and approaches can be used and/or adapted to specific contexts.
MOMENTUM Integrated Health Resilience (2021)
Building Resilience in Health: The MOMENTUM Integrated Health Resilience Approach
Why is it essential?
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Why is it essential?
A basic understanding of the broader conversations around the humanitarian-development nexus is necessary to implement programs in fragile settings. This article unpacks how humanitarianism and development “often appear to be at odds with each other” because of the inability to reconcile key principles of humanitarianism with the longer-term, political, and rights-based approaches of development.
Many resources refer to “the humanitarian-development nexus”—but what is it? This article provides an explanation and historical background on the concept. The nexus refers to “the transition or overlap between the delivery of humanitarian assistance and the provision of long-term development assistance.” The humanitarian-development nexus is increasingly becoming the frame for viewing the intersection of humanitarian and development assistance, with the recognition that linear models or transitions from humanitarian to development assistance are obsolete. This article provides a broad overview of the concept and case studies where both humanitarian and development actors are operating.
About The Journal of International Humanitarian Action
The Journal of International Humanitarian Action is an open access peer-reviewed journal for researchers, policymakers, practitioners, and anyone moved to understand contemporary challenges, reflect critically on practices, and engage at humanitarian action’s leading edge.
Jon Harlad Sande Lie, published in The Journal of International Humanitarian Action (2017)
The Humanitarian-Development Nexus: Humanitarian Principles, Practice, and Pragmatics
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Why is it essential?
Development actors often pick up the work of humanitarian partners as health services and systems are restored after a crisis. This guide can help development actors understand how to effectively engage and collaborate with humanitarian partners.
This handbook provides a comprehensive overview of how partners coordinate through the health cluster system during a humanitarian crisis. It includes information about roles and responsibilities in the cluster; coordination skills; information management approaches; quality standards; effective advocacy; multi-sectoral responses; emergency preparedness; and assessments, planning, and monitoring. One specific chapter explores the humanitarian-development nexus (defined as the transition or overlap between the delivery of humanitarian assistance and the provision of long-term development assistance) including entry points, health system bottlenecks and approaches to strengthen resilience and longer-term recovery efforts. The guidance in this handbook applies in all types of crises, including slow onset crises and protracted emergencies. It will help familiarize development partners working in fragile settings with the existing humanitarian structures and approaches.
About the World Health Organization (WHO):
Dedicated to the well-being of all people and guided by science, the World Health Organization leads and champions global efforts to give everyone, everywhere an equal chance to live a healthy life.
World Health Organization (WHO) (2020)
Health Cluster Guide: A Practical Handbook
Why is it essential?
Though humanitarian and development actors often implement programs in overlapping geographies, collaboration between the two sectors is often lacking. Much of the thinking about the HDN has come from the humanitarian sector. This unique brief focuses on how to deliver health development assistance.
Numerous approaches have been developed to define the humanitarian-development nexus (HDN). It’s commonly defined as the transition or overlap between the delivery of humanitarian assistance and the provision of long-term development assistance. However, the effort to operationalize and document the humanitarian-development nexus remains elusive. The nexus marks a turning point in how we think about and understand humanitarian and development settings. We recognize that previous linear models are outdated—a region or country does not transition from humanitarian to development. This brief outlines a framework for the reproductive, maternal, newborn, child, and adolescent health in fragile settings. It covers core components such as leadership & governance, financing, and coordination. Expected publication in November 2021.
About MOMENTUM Integrated Health Resilience
USAID’s MOMENTUM Integrated Health Resilience works to improve access to and availability of high-quality, respectful, and person-centered MNCH/FP/RH care in fragile and conflict-affected settings. This project enhances coordination between development and humanitarian organizations and strengthens the resilience of individuals, families, and communities.
MOMENTUM Integrated Health Resilience (2021)
The Humanitarian-Development Nexus: A Framework for Reproductive, Maternal, Neonatal, Child, and Adolescent Health in Fragile Settings
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Why is it essential?
Quality reproductive health services have only recently been recognized as key lifesaving interventions. This report consolidates significant research and analysis organized around key, recognizable themes. The findings and recommendations can help program implementers prepare for and anticipate shocks and stresses that may impact continuity of sexual and reproductive health care.
While access to sexual and reproductive health care in humanitarian and fragile settings has improved in recent years, significant gaps remain to ensure women and girls can access the services they need. This landscape assessment explored and contributed to the evidence base on effective strategies for providing voluntary family planning services for women and girls in crisis settings. The report reviews existing literature and incorporates findings from a global survey; three case studies in Bangladesh, Nigeria, and Mozambique; and key informant interviews. It concludes with several recommendations for governments, donors, and implementing partners across the humanitarian-development nexus.
About the Women’s Refugee Commission (WRC):
WRC catalyzes transformative change to protect and empower women, children, and youth displaced by conflict and crisis.
About the Inter-Agency Working Group (IAWG) on Reproductive Health in Crises:
IAWG is an international coalition of organizations and individuals working collectively to advance sexual and reproductive health and rights in humanitarian settings.
About FP2030:
FP2030 works to ensure Voluntary modern contraceptive use by everyone who wants it, achieved through individuals’ informed choice and agency, responsive and sustainable systems providing a range of contraceptives, and a supportive policy environment.
Women's Refugee Commission, Inter-Agency Working Group on Reproductive Health in Crises, FP2030 (2021)
Contraceptive Services in Humanitarian Settings and in the Humanitarian-Development Nexus: Summary of Gaps and Recommendations from a State-of-the-Field Landscaping Assessment
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Why is it essential?
The findings and recommendations in this report can help program implementers prepare for and anticipate shocks and stresses that may impact continuity of sexual and reproductive health care.
The COVID-19 pandemic has disrupted health services across all contexts. Consequently, several experts note that sexual and reproductive health services were considered non-essential by many governments early in the crisis. This report is based on key informant interviews with representatives from UN agencies, ministries of health, and nongovernmental organizations. One part of a broader landscape assessment from the Women’s Refugee Commission, it describes the service disruptions that took place at the onset of the pandemic, adaptation to service-delivery models, and the factors affecting the availability (or unavailability) of services.
Adaptations identified by key informants include appropriate use of technology and telemedicine, provision of multiple months of short-acting contraceptives, and self-administration of DMPA-SC (with the DRC noted as a specific example).
About the Women's Refugee Commission (WRC)
WRC catalyzes transformative change to protect and empower women, children, and youth displaced by conflict and crisis.
Women's Refugee Commission (2020)
Disruptions and Adaptations: The Effects of COVID-19 on Contraceptive Services across the Humanitarian-Development Nexus
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Why is it essential?
Supplies are often unavailable in fragile settings. Without supplies, quality voluntary family planning and reproductive health services cannot be provided regardless of the setting.
This advocacy brief makes the case to governments, donors, development agencies, and humanitarian organizations to prioritize support for building supply chains that are resilient to the shocks and stresses routinely experienced in fragile settings.
About the Reproductive Health Supplies Coalition
The Reproductive Health Supplies Coalition is a global partnership of public, private, and non-governmental organizations dedicated to ensuring that all people in low- and middle-income countries can access and use affordable, high-quality supplies to ensure their better reproductive health.
About the Inter-Agency Working Group (IAWG) on Reproductive Health in Crises
IAWG is an international coalition of organizations and individuals working collectively to advance sexual and reproductive health and rights in humanitarian settings.
Ensuring Universal Access to Sexual and Reproductive Health Supplies
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Why is it essential?
This report pulls together data from literature reviews and technical consultations to tell a fuller story of family planning in places affected by crises. Program designers and Advocates can use its findings to better understand the need for greater investment in sexual and reproductive health in fragile settings.
This report provides an overview of availability and use of contraceptive services in humanitarian and fragile settings. Based on responses from 20 service delivery organizations across 42 countries and territories, the results include available contraceptive methods, rocurement methods, supply chain issues, and accessibility of services by specific populations.
About Women's Refugee Commission (WRC)
WRC catalyzes transformative change to protect and empower women, children, and youth displaced by conflict and crisis.
Women's Refugee Commission (2021)
Global Snapshot of Contraceptive Services across Crisis-Affected Settings: Landscaping Report
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Why is it essential?
This comprehensive first-of-its-kind toolkit for country-level decision-makers can ensure quality sexual and reproductive health services in fragile settings and during an emergency by focusing on preparedness before a crisis. Such preparedness activities should be incorporated into all work in fragile settings.
This comprehensive toolkit brings together knowledge and guidance in the relatively new, but growing, area of preparedness for sexual and reproductive health. The toolkit is aligned with key priorities, such as localization, participation of affected communities, and collaboration between humanitarian, development, and government actors.
It provides an overview of key concepts and frameworks, assessment tools, case studies, recommendations, and additional tools and guidance.
About FP2030
FP2030 works to ensure voluntary modern contraceptive use by everyone who wants it, achieved through individuals’ informed choice and agency, responsive and sustainable systems providing a range of contraceptives, and a supportive policy environment.
About the International Planned Parenthood Federation (IPPF)
IPPF leads a locally owned, globally connected civil society movement that provides and enables services and champions sexual and reproductive health and rights for all, especially the under-served.
About Jon Snow International (JSI)
JSI helps strengthen health systems and improve the ability of local providers and communities to deliver health services and create a healthy environment.
About the Women’s Refugee Commission (WRC)
WRC catalyzes transformative change to protect and empower women, children, and youth displaced by conflict and crisis.
About United Nations Population Fund (UNFPA)
UNFPA is the United Nations sexual and reproductive health agency with the mission to deliver a world where every pregnancy is wanted, every childbirth is safe and every young person's potential is fulfilled.
About the Inter-Agency Working Group (IAWG) on Reproductive Health in Crises
IAWG is an international coalition of organizations and individuals working collectively to advance sexual and reproductive health and rights in humanitarian settings.
FP2030; IPPF; JSI; WRC; UNFPA; IAWG (2020)
Ready to Save Lives: Sexual and Reproductive Health Care in Emergencies
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Why is it essential?
Self-care may be uniquely promising to complement provider-led, facility-based services in fragile settings where access to providers and facilities may be compromised.
Self-care is, according to WHO, "the ability of individuals, families, and communities to promote health, prevent disease, maintain health, and to cope with illness and disability with or without the support of a healthcare provider." In fragile settings, where health care providers may be difficult to reach, self-care interventions may show promise. This paper identifies opportunities for self-care in fragile settings. It calls for additional research on self-care and its applications in fragile and humanitarian settings. Existing evidence from more stable contexts, show that women can effectively self-administer DMPA-SC. Additionally, continuation rates are comparable to provider-administered care after one year. However, little evidence exists from fragile settings where self-care may be necessary because of strain on health care systems. The author concludes: “Ultimately, individuals living in humanitarian and fragile settings must be empowered to practice evidence-informed self-care. Enabling people to identify their own health needs and access appropriate information and interventions to prevent adverse health issues and manage their health conditions promotes self-reliance and autonomy.”
About Conflict and Health
Conflict and Health is a highly-accessed, open access journal documenting the public health impacts and responses related to armed conflict, humanitarian crises and forced migration.
Tran et al. (2021)
Sexual and Reproductive Health Self-Care in Humanitarian and Fragile Settings: Where Should We Start?
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Why is it essential?
The sections on preparedness and transition are particularly relevant for development actors working in crisis-prone settings. The planning guide helps identify actions in the humanitarian-development nexus that can ensure family planning and other health services are not disrupted or are restored as quickly as possible.
This planning guide, available in English, French, Spanish, and Portuguese, is for national and sub-national decision-makers. It leads them through a process for improving family planning in current or future fragile settings. The document focuses on preparedness, crisis actions, and ensuring a transition to routine family planning services. Users also have access to an orientation webinar introducing the guide.
About FP2030
FP2030 works to ensure Voluntary modern contraceptive use by everyone who wants it, achieved through individuals’ informed choice and agency, responsive and sustainable systems providing a range of contraceptives, and a supportive policy environment.
FP2020 (2020)
Family Planning in Humanitarian Settings: A Strategic Planning Guide
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Why is it essential?
The toolkit includes dozens of tools that organizations and governments implementing family planning and reproductive health programs can use and adapt. Since they have been used in humanitarian settings, they are, in many cases, leaner than many existing materials and are tailored to settings where travel may be limited.
This toolkit consolidates over a decade of Save the Children’s experience supporting and providing family planning and reproductive health services in humanitarian and fragile settings, such as Colombia, Bangladesh, Democratic Republic of Congo, Niger, Pakistan, Somalia, Syria, Uganda, and Yemen. Resources for NGOs and ministries of health are curated for clinical supervision and training; communications and fundraising; logistics and pharmacy; and monitoring and evaluation.
About Save the Children
Save the Children is a global leader in child health, education and protection, working in more than 100 countries.
Save the Children (2020)
Reproductive Health in Emergencies Toolkit
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Why is it essential?
The Collaboration Hub includes a wealth of information for implementing partners to learn about specific implementation experiences in the nexus. It also offers an opportunity for individuals and organizations to get involved and shape the ongoing global conversations about the humanitarian-development nexus and programming in fragile settings.
The CORE Group’s Humanitarian-Development Nexus Task Force brings together partners from the humanitarian and development sectors to improve interventions and strengthen collective efforts to achieve the Sustainable Development Goals. This Collaboration Hub includes resources developed by Task Force members (including tools, case studies, and briefs), upcoming events, and links to other groups working on issues related to the humanitarian-development nexus.
About CORE Group
CORE Group convenes global community health professionals to share knowledge, evidence, and best practices, and then translates these into the real world with a direct impact.
CORE Group
Humanitarian-Development Nexus Collaboration Hub
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Why is it essential?
This article provides program designers and implementers evidence for engaging the private sector in these fragile settings. The findings indicate that social franchising can be a successful strategy for increasing access to and use of family planning services even amid crises and settings with the potential for shocks and stresses.
Although fragile settings may lack strong private health services, the private sector, public-private partnerships, and private sector models should not be dismissed. The specific context of a given fragile setting should inform engagement with the private sector. In Mali, for example, Marie Stopes International (MSI) applied a social franchising model, originally developed for the private sector, to public-sector facilities in Mali. MSI is one of the largest non-governmental providers of family planning services in Mali and operates in an additional 36 countries. MSI supported public-sector community health centers, known as CSCOMs in Mali, through training, supervision, supplying commodities, and demand creation. The three regions where the model was implemented saw increases in access, choice, and use of family planning.
About Global Health: Science and Practice
GHSP is a no-fee, open access, peer-reviewed online journal intended to be a resource for public health professionals who design, implement, manage, evaluate, and otherwise support health programs in low- and middle-income countries.
Gold et al. (2017)
Increasing Access to Family Planning Choices Through Public-Sector Social Franchising: The Experience of Marie Stopes International in Mali
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Why is it essential?
Family Planning: A Global Handbook for Providers is the global standard for family planning service provision. Chapter 27 notes that family planning is “lifesaving, essential service, and should be maintained throughout an epidemic.” It helps family planning service providers adapt during an epidemic to ensure the continuity of essential family planning services.
Family Planning: A Global Handbook for Providers offers family planning services providers clear, evidence-based and current information to support them in providing high-quality family planning. It provides information on a wide range of contraceptive methods and explores additional family planning service delivery topics such as maternal and newborn health, sexually-transmitted infections and serving diverse groups of clients.
Chapter 27 provides information for family planning providers on balancing the demands resulting from an outbreak with the maintenance of family planning services.
The chapter notes that medical eligibility criteria does not change during an epidemic; many effective methods can be self-initiated and/or used without ongoing provider support. Service provision approaches may need to be adapted through digital health or other approaches.
About World Health Organization (WHO)
Dedicated to the well-being of all people and guided by science, the World Health Organization leads and champions global efforts to give everyone, everywhere an equal chance to live a healthy life.
About the United States Agency for International Development (USAID)
USAID leads international development and humanitarian efforts to save lives, reduce poverty, strengthen democratic governance and help people progress beyond assistance.
World Health Organization (WHO) and United States Agency for International Development (USAID) (2018)
Providing Family Planning Services During Public Health Emergencies—Chapter 27 of Family Planning: A Global Handbook for Providers
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Why is it essential?
The evidence summary and policy brief recommend actions needed to minimize service disruptions that are applicable beyond the COVID-19 pandemic.
The MISP (Minimum Initial Service Package for Sexual and Reproductive Health) is an internationally recognized “coordinated set of lifesaving priority SRH activities and services to be implemented at the onset (within 48 hours whenever possible) of every humanitarian emergency.” The MISP was developed by the Inter-Agency Working Group for Reproductive Health in Crises that brings together humanitarian and development organizations. The objectives of the MISP are to:
1. Ensure identification of an organization to lead the implementation of the MISP for SRH.
2. Prevent sexual violence and respond to the needs of 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. Plan for comprehensive SRH integrated into primary health care as soon as possible.
The activities contained in the MISP are generally carried out by the health cluster and a variety of partners on the ground, including UN agencies, government ministries, and local and international NGOs.
Updated distance learning modules (available in Arabic, English, French, and Portuguese) provide a foundation for sexual and reproductive health components of a humanitarian response.
About Inter-Agency Working Group (IAWG) on Reproductive Health in Crises
IAWG is an international coalition of organizations and individuals working collectively to advance sexual and reproductive health and rights in humanitarian settings.
Inter-Agency Working Group on Reproductive Health in Crises
Minimum Initial Service Package Distance Learning Modules
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Why is it essential?
This study provides additional evidence of the strong demand for voluntary family planning in fragile and conflict-affected settings. It also details the feasibility of increasing modern contraceptive use and broadening method mix. These findings can be used to advocate for the inclusion and prioritization of FP/RH services in fragile contexts.
Decades of conflict in eastern DRC has resulted in cycles of stability and conflict. Despite this fragility, the provision of high-quality family planning services is possible—there is evidence that women living in such settings want contraception. In six rural health zones supported by a consortium of partners (Columbia University’s RAISE Initiative, Save the Children, IRC, and CARE) modern contraceptive use among married women ranged from 8.4% to 26.7% compared to 7.5% for the country as a whole in 2017.
About PLOS One
PLOS ONE is an inclusive journal community working together to advance science for the benefit of society, now and in the future. Founded with the aim of accelerating the pace of scientific advancement and demonstrating its value, we believe all rigorous science needs to be published and discoverable, widely disseminated and freely accessible to all.
Casey et al. (2019)
Meeting the Demand of Women Affected by Ongoing Crisis: Increasing Contraceptive Prevalence in North and South Kivu, Democratic Republic of the Congo
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Why is it essential?
Self-care, including self-injection of DMPA-SC, can be an effective approach in fragile settings where access to trained providers may be limited. This brief describes a process of scale-up that was intentional and applicable in additional settings. It’s lessons are invaluable for those focused on community health and policy advocacy.
Community-based distribution of contraceptives, particularly DMPA-SC, can overcome barriers to the use of family planning by reducing the cost of seeking care and increasing the method mix available. This brief describes E2A’s approach to increasing availability of DMPA-SC in the Kasai Central, Kasai Oriental, Lomami, and Lualaba provinces of the Democratic Republic of the Congo. It outlines the road ahead for strengthening the links between community-based distribution and self-care. Over the course of three years, E2A conducted pilot testing, initial expansion, institutionalization, and expansion. It was then able to offer a wider mix of contraceptives to women and girls in rural DRC through provision of DMPA-SC and other methods through non-clinical community-based distribution.
About Evidence to Action Project
The Evidence to Action (E2A) Project was, from 2011–2021, USAID’s global flagship for strengthening family planning and reproductive health service delivery. E2A partnered with governments, local NGOs, and communities to increase support, build evidence, and facilitate the scale-up of what works for expanding access to quality health services that can transform families, communities, and nations.
Evidence to Action Project (2021)
Scaling Up Community-Based Counseling and Distribution of DMPA-SC in the DRC
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Why is it essential?
The toolkit provides a general overview of how the humanitarian sector approaches adolescent sexual and reproductive health and rights. In fragile settings, this can help ensure development assistance organizations know what humanitarian organizations will prioritize and identify areas for collaboration and coordination.
This toolkit helps organizations "prioritize and implement effective programs to address and fulfill adolescents' sexual and reproductive health and rights." The Inter-Agency Working Group on Reproductive Health in Crises consulted with more than 130 people from 75 organizations, including youth. Streamlined activities and strategies ensure adolescents and youth have access to quality sexual and reproductive health care during humanitarian crises. The toolkit addresses how to ensure meaningful participation of youth; priority ASRH services, activities, and interventions; assessments and data use; and effective ASRH program management.
About Inter-Agency Working Group (IAWG) on Reproductive Health in Crises
IAWG is an international coalition of organizations and individuals working collectively to advance sexual and reproductive health and rights in humanitarian settings.
Inter-Agency Working Group on Reproductive Health in Crises (2020)
Adolescent Sexual and Reproductive Health Toolkit for Humanitarian Settings: A Companion to the Inter-Agency Field Manual on Reproductive Health in Humanitarian Settings
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Why is it essential?
The methods used in this study can be replicated by other researchers with an interest in social and traditional norms in these settings. For those designing and implementing programs, the findings contextualize the realities and perceptions of the people experiencing crises, which should always be taken into account.
Due to ongoing conflict, poor health outcomes (including high child mortality), and other drivers of fragility, the social norms in fragile settings may differ from those in traditional development settings. Uptake of family planning and utilization of services are driven, in part, by those social norms. The authors used participatory ethnographic evaluation and research (PEER) to understand determinants of family size and understand social and traditional practices in post-conflict South Sudan. It finds that people have large families due to social pressure, to compensate for men lost due to conflict, and high child mortality. ”In order to generate demand for family planning in South Sudan, priority should be given first to improve infant and child health,” it concludes.
About Reproductive Health
Reproductive Health focuses on all aspects of human reproduction. The journal includes sections dedicated to adolescent health, female fertility, and midwifery, and all content is open access.
Elmusharaf, Byrne and O’Donovan (2017)
Social and Traditional Practices and Their Implications for Family Planning: A Participatory Ethnographic Study in Renk, South Sudan
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Why is it essential?
Resources are grouped into five categories:
The Humanitarian- Development Nexus
Women's Refugee Commission (2020)
Women's Refugee Commission (2021)
Reproductive Health Supplies Coalition, Inter-Agency Working Group on Reproductive Health in Crises (2020)
The State of FP/RH in Fragile Settings
Tools for Planning and Implementation
Tools for Planning and Implementation
Training Materials
Case Studies and Country Experiences
The Humanitarian-Development Nexus
The State of FP/RH in Fragile Settings
Planning and Implementation Tools
Training Materials
Case Studies and Country Experiences
Reproductive Health Supplies Coalition, IAWG (2020)
Increasing Access to FP Through Public-Sector Social Franchising
Gold et al. (2017)
Humanitarian-Development Nexus Collaboration Hub
CORE Group
Inter-Agency Working Group on Reproductive Health in Crises (2020)
Adolescent SRH Toolkit for Humanitarian Settings
Lie (2020)
The Humanitarian- Development Nexus
The Humanitarian- Development Nexus
The Humanitarian- Development Nexus
The State of FP/RH in Fragile Settings
The State of FP/RH in Fragile Settings
The State of FP/RH in Fragile Settings
The State of FP/RH in Fragile Settings
The State of FP/RH in Fragile Settings
Tools for Planning and Implementation
Tools for Planning and Implementation
Tools for Planning and Implementation
Tools for Planning and Implementation
Training Materials
Minimum Initial Service Package Distance Learning Modules
Inter-Agency Working Group on Reproductive Health in Crises
Minimum Initial Service Package Distance Learning Modules
Inter-Agency Working Group on Reproductive Health in Crises
The MISP (Minimum Initial Service Package for Sexual and Reproductive Health) is an internationally recognized “coordinated set of lifesaving priority SRH activities and services to be implemented at the onset (within 48 hours whenever possible) of every humanitarian emergency.” The MISP was developed by the Inter-Agency Working Group for Reproductive Health in Crises that brings together humanitarian and development organizations. The objectives of the MISP are to:
Ensure identification of an organization to lead the implementation of the MISP for SRH.
Prevent sexual violence and respond to the needs of survivors.
Prevent the transmission of and reduce morbidity and mortality due to HIV and other STIs.
Prevent excess maternal and newborn morbidity and mortality.
Prevent unintended pregnancies.
Plan for comprehensive SRH integrated into primary health care as soon as possible.
The activities contained in the MISP are generally carried out by the health cluster and a variety of partners on the ground, including UN agencies, government ministries, and local and international NGOs.
Updated distance learning modules (available in Arabic, English, French, and Portuguese) provide a foundation for sexual and reproductive health components of a humanitarian response.
About the Inter-Agency Working Group (IAWG) on Reproductive Health in Crises
IAWG is an international coalition of organizations and individuals working collectively to advance sexual and reproductive health and rights in humanitarian settings.
The MISP is recognized within the humanitarian community as the standard for implementing sexual and reproductive health programs in humanitarian settings. Familiarity with it is necessary to effectively carry out programs in fragile settings and protracted crises where development actors are working.
Tools for Planning and Implementation
Case Studies and Country Experiences
Case Studies and Country Experiences
Case Studies and Country Experiences
Tools for Planning and Implementation
Tools for Planning and Implementation
The Humanitarian- Development Nexus
The Humanitarian- Development Nexus
The Humanitarian- Development Nexus
The State of FP/RH in Fragile Settings
The State of FP/RH in Fragile Settings
The State of FP/RH in Fragile Settings
Tools for Planning and Implementation
Tools for Planning and Implementation
Case Studies and Country Experiences
Case Studies and Country Experiences
Case Studies and Country Experiences
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Get The Resource
Get The Resource