Reproductive health humanitarian response in Jordan : Achievements and challenges “Evaluation of the Implementation of MISP” Dr Shible Sahbani Dr Faeza Abu-Jalo Maysa Al-Khateeb

Context 620,000 refugees registered 155,000 WRA 15,500 pregnant Women 85 %are in the communities 15 % are in the camps (Za`atri, Azraq, KAP, CC, EJC)

Background during the evaluation RH indicators (Zaatri Camp) 14% of all births performed by caesarean section 100% of births attended by skilled health worker Humanitarian crisis ongoing ~1,500/day influx 355,493 Syrian refugees in Jordan 164,365refugees in Zaatri Camp133,660 refugees in urban areas

The objectives of the evaluation Assess the extent to which MISP has been implemented Identify the availability, accessibility and use of RH services Describe the facilitating factors and barriers to the implementation of MISP services

Coordination Recommendation Strengthen coordination in urban settings Update Mapping of RH services in camps and urban updated regularly, Reproductive health SWG coordination and production of tools through the SWG and uploading it on the interagency portal. UNFPA supported all health care providers reproductive health kits and technical support (e.g: assessments, capacity building) also through coordination channeled resources between partners Mapping of Youth and GBV services in camps and Urban, Campaigns conducted inside and outside the camps to increase access to the different available services and increasing awareness, linkages with other working groups Mapping of Reproductive Health services

Coordination Recommendation Involvement of key stakeholders such as the MOH, WHO, local NGOs, unfunded partners, and inter- agency protection and GBV working groups Update RH SWG members almost doubled. MoH participated actively with capacity building for RH partners providing services to Syrian refugees that included MoH, NGOs and INGOs UNFPA supported MoH to conduct MISP and RH protocols training

Access Recommendation Identify additional funding for SRH and support additional local NGOs that are providing RH services for Syrian refugees in urban areas and the Jordan Valley. Locate SV services in safe and private spaces. Discuss access to post- abortion care in coordination meetings. Update UNFPA supported establishment of static and mobile clinics in Jordan valley Establishment of more safe space in camps and Urban Development and training on SOPs and referral pathways through interagency approach UNFPA piloted introduction of miscarriage, post abortion care and counselling data collection registry.

Access Recommendation Establish Basic EmOC services throughout Zaatri Ensure timely, accessible and affordable transport options Update UNFPA/JHAS provide 24/7 basic EmOC in Zatari camp, IFRC provide EmOC in Azraq camp UNFPA supported EmOC training conducted in Zatari,training followed up by development of certain monitoring tool shared with stakeholders UNFPA through ECHO, BPRM and other donors’ support expanded its delivery site RH kits provided to partners for urgent preparedness for EmOC, UNFPA and UNHCR also developed clinical referral guidelines

EmOC services

Reproductive Health protocols Recommendation Review, establish and disseminate RH protocols on care for survivors of SV and management of STIs Disseminate and discuss the Inter-agency Field Manual on Reproductive Health in Humanitarian Settings, 2010 Update Development of reproductive health checklists, mapping of services, development of action plans IAFM shared with RH SWG, also shared online training sources “online MISP,CMR, preeclampsia

SGBV services Recommendation Provide care for survivors of SV, particularly in urban areas through collaboration with MOH and relief organizations. Update UNFPA through partnership with MoH Conducted training workshops for Family Protection Committees in MOH on Violence against women and violence against children

Data utilization Recommendation Improve data collection and use of data for action Today RH data collection tools has been reviewed and updated with partners. UNFPA updated the family planning log book with RH SWG. UNFPA and UNHCR share data trends with partners to guide interventions and provide recommendations Revision of data collection tools with health care providers

Community participation Recommendation Support information, education and communication (IEC) campaigns on the benefits to seeking care and the availability, location and hours of services Develop culturally appropriate mechanisms for improving knowledge about and attitudes toward available clinical services for survivors of violence Update RH campaign organized a where gynecologists and midwives had a direct interaction with refugees The IEC material was developed in participatory approach with the community

Community participation Recommendation Continue efforts to establish community health post and community outreach in both Irbid and Za`tari camp with a view to engaging the community, including adolescents and people with disabilities, in the delivery of services. Update Agencies established a network of CHW and volunteers in Za`tari, Irbid, Amman, Zarqa and other areas,through collaboration with community task force, RH SWG address community outreach,

Community Awareness

Cultural and gender sensitivity Recommendation Identify and support more health care providers, particularly female providers Update In all sites female midwives are available Task shifting and part times were advocated as possible solutions

Transition Recommendation Transition to comprehensive RH services, including improving the quality of ANC according to national protocols, such as the detection and management of anemia in pregnancy, tetanus toxoid coverage, syphilis and rubella screening, and use of standard documentation of ANC visits. Update TT vaccination and EPI services are available in inside Za`tari and additional two sites in Azraq camps, sites are working in collaboration with MoH Anemia screening and treatment is following RH protocols and further recommended this through nutrition intervention strategy and Jordan nutrition fact sheet. UNFPA supported training for RH providers on RH protocols which include ANC and PNC protocol.

Challenges The proportion of deliveries in girls under the age of 18 was 11% in the first quarter of 2014 which represents a significant increase compared to the average for 2013 of 5%. Address youth SRH needs Men and Youth involvement Limited distribution of condoms through community channels due to cultural sensitivity

In Za`trai UNFPA/JHAS remains the only provider of normal delivery services with highly increasing demands on the services, Changing governmental policies in regards to refugees access to different services Public health system is overstretched, it is increasingly challenging to successfully refer patients from clinics to MoH hospitals, this includes at times issues around complicated deliveries Increasing demands on higher quality of reproductive health services inside and outside the camp with the capacity to address more specialized services like Mammogram for breast screening and pap smear. Challenges

Only provider of normal deliveries in Za`trai camp Deliveries conducted at UNFPA/JHAS

Thank You!!!