Cargando…

Facilitators and barriers in implementing the Minimum Initial Services Package (MISP) for reproductive health in Nepal post-earthquake

BACKGROUND: Following the Nepal earthquake in April 2015, UNFPA estimated that 1.4 million women of reproductive age were affected, with approximately 93,000 pregnant and 28,000 at risk of sexual violence. A set of priority reproductive health (RH) actions, the Minimum Initial Services Package (MISP...

Descripción completa

Detalles Bibliográficos
Autores principales: Myers, Anna, Sami, Samira, Onyango, Monica Adhiambo, Karki, Hari, Anggraini, Rosilawati, Krause, Sandra
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6092803/
https://www.ncbi.nlm.nih.gov/pubmed/30127844
http://dx.doi.org/10.1186/s13031-018-0170-0
_version_ 1783347594016063488
author Myers, Anna
Sami, Samira
Onyango, Monica Adhiambo
Karki, Hari
Anggraini, Rosilawati
Krause, Sandra
author_facet Myers, Anna
Sami, Samira
Onyango, Monica Adhiambo
Karki, Hari
Anggraini, Rosilawati
Krause, Sandra
author_sort Myers, Anna
collection PubMed
description BACKGROUND: Following the Nepal earthquake in April 2015, UNFPA estimated that 1.4 million women of reproductive age were affected, with approximately 93,000 pregnant and 28,000 at risk of sexual violence. A set of priority reproductive health (RH) actions, the Minimum Initial Services Package (MISP), was initiated by government, international and local actors. The purpose of this study was to identify the facilitators and barriers affecting the implementation of priority RH services in two districts. METHODS: In September 2015, a mixed methods study design was used in Kathmandu and Sindhupalchowk districts to assess the implementation of the priority RH services five months post-earthquake. Data collection activities included 32 focus group discussions with male and female participants aged 18–49; 26 key informant interviews with RH, gender-based violence (GBV), and human immunodeficiency virus (HIV) experts; and 17 health facility assessments. RESULTS: The implementation of priority RH services was achieved in both districts. In Kathmandu implementation of emergency RH services started within days of the earthquake. Facilitating factors for successful implementation included disaster preparedness; leadership and commitment among national, international, and district level actors; resource mobilization; strong national level coordination; existing reproductive and child health services and community outreach programs; and supply chain management. Barriers included inadequate MISP training for RH coordinators and managers; weak communication between national and district level stakeholders; inadequate staffing; under-resourced and fewer facilities in rural areas; limited attention given to local GBV and HIV organizations; low availability of clinical management of rape services; and low awareness of GBV services and benefits of timely care. CONCLUSION: Ensuring RH is included in emergency preparedness and immediate response efforts and is continued through the transition to comprehensive care is critical for national governments and humanitarian response agencies. The MISP for RH remains a critical component of response efforts, and the humanitarian community should consider these learnings in future emergency response.
format Online
Article
Text
id pubmed-6092803
institution National Center for Biotechnology Information
language English
publishDate 2018
publisher BioMed Central
record_format MEDLINE/PubMed
spelling pubmed-60928032018-08-20 Facilitators and barriers in implementing the Minimum Initial Services Package (MISP) for reproductive health in Nepal post-earthquake Myers, Anna Sami, Samira Onyango, Monica Adhiambo Karki, Hari Anggraini, Rosilawati Krause, Sandra Confl Health Research BACKGROUND: Following the Nepal earthquake in April 2015, UNFPA estimated that 1.4 million women of reproductive age were affected, with approximately 93,000 pregnant and 28,000 at risk of sexual violence. A set of priority reproductive health (RH) actions, the Minimum Initial Services Package (MISP), was initiated by government, international and local actors. The purpose of this study was to identify the facilitators and barriers affecting the implementation of priority RH services in two districts. METHODS: In September 2015, a mixed methods study design was used in Kathmandu and Sindhupalchowk districts to assess the implementation of the priority RH services five months post-earthquake. Data collection activities included 32 focus group discussions with male and female participants aged 18–49; 26 key informant interviews with RH, gender-based violence (GBV), and human immunodeficiency virus (HIV) experts; and 17 health facility assessments. RESULTS: The implementation of priority RH services was achieved in both districts. In Kathmandu implementation of emergency RH services started within days of the earthquake. Facilitating factors for successful implementation included disaster preparedness; leadership and commitment among national, international, and district level actors; resource mobilization; strong national level coordination; existing reproductive and child health services and community outreach programs; and supply chain management. Barriers included inadequate MISP training for RH coordinators and managers; weak communication between national and district level stakeholders; inadequate staffing; under-resourced and fewer facilities in rural areas; limited attention given to local GBV and HIV organizations; low availability of clinical management of rape services; and low awareness of GBV services and benefits of timely care. CONCLUSION: Ensuring RH is included in emergency preparedness and immediate response efforts and is continued through the transition to comprehensive care is critical for national governments and humanitarian response agencies. The MISP for RH remains a critical component of response efforts, and the humanitarian community should consider these learnings in future emergency response. BioMed Central 2018-08-15 /pmc/articles/PMC6092803/ /pubmed/30127844 http://dx.doi.org/10.1186/s13031-018-0170-0 Text en © The Author(s). 2018 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research
Myers, Anna
Sami, Samira
Onyango, Monica Adhiambo
Karki, Hari
Anggraini, Rosilawati
Krause, Sandra
Facilitators and barriers in implementing the Minimum Initial Services Package (MISP) for reproductive health in Nepal post-earthquake
title Facilitators and barriers in implementing the Minimum Initial Services Package (MISP) for reproductive health in Nepal post-earthquake
title_full Facilitators and barriers in implementing the Minimum Initial Services Package (MISP) for reproductive health in Nepal post-earthquake
title_fullStr Facilitators and barriers in implementing the Minimum Initial Services Package (MISP) for reproductive health in Nepal post-earthquake
title_full_unstemmed Facilitators and barriers in implementing the Minimum Initial Services Package (MISP) for reproductive health in Nepal post-earthquake
title_short Facilitators and barriers in implementing the Minimum Initial Services Package (MISP) for reproductive health in Nepal post-earthquake
title_sort facilitators and barriers in implementing the minimum initial services package (misp) for reproductive health in nepal post-earthquake
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6092803/
https://www.ncbi.nlm.nih.gov/pubmed/30127844
http://dx.doi.org/10.1186/s13031-018-0170-0
work_keys_str_mv AT myersanna facilitatorsandbarriersinimplementingtheminimuminitialservicespackagemispforreproductivehealthinnepalpostearthquake
AT samisamira facilitatorsandbarriersinimplementingtheminimuminitialservicespackagemispforreproductivehealthinnepalpostearthquake
AT onyangomonicaadhiambo facilitatorsandbarriersinimplementingtheminimuminitialservicespackagemispforreproductivehealthinnepalpostearthquake
AT karkihari facilitatorsandbarriersinimplementingtheminimuminitialservicespackagemispforreproductivehealthinnepalpostearthquake
AT anggrainirosilawati facilitatorsandbarriersinimplementingtheminimuminitialservicespackagemispforreproductivehealthinnepalpostearthquake
AT krausesandra facilitatorsandbarriersinimplementingtheminimuminitialservicespackagemispforreproductivehealthinnepalpostearthquake