MNH Sub-Working Group

Purpose:

  • The purpose of the MNH SWG discussion was to discuss priority actions for the SWG over the upcoming year and how to measure the impact of the MNH SWG work at field level. Since 2013, the SWG has not met formally to move the work of the IAWG forward and members have been working at the agency-level on specific initiatives such as training courses and guidelines.

Top three priorities discussed include:

  • Re-establishing the MNH SWG with a core group of active members to advance IAWG initiatives.
  • Stock-taking of MNH technical guidelines and training materials used in field programming, and opportunities to strengthen coordination and harmonize messaging with other technical SWGs (e.g. VC, SAC, HIV/STIs, and GBV).
  • Lead the review and revision of MNH content in the IAFM and MISP.

It is important as a SWG to define the lens that we use to narrow our scope of work.  The IAWG consists of a variety of local service provision, humanitarian, development, community and government actors with a mandate to focus on reproductive health in emergencies. The definition of emergency is increasingly dynamic and a factor to discuss when establishing MNH priorities.

Successful MNH service delivery in any setting is dependent on the strength of overall health system in which the services are being delivered.  Notes from the SWG conversation are framed below through the lens of WHO’s Health System Building Blocks (leadership/governance, health care financing, health workforce, medical products and technologies, information sharing and service delivery) and the MISP.

 Notes from the SWG conversation:

  • Leadership and governance
    • Are there strategic frameworks in place with oversight, regulations, and accountability at the local and national levels for MNH?
    • The MISP emphasizes:
      • RH Officer in place.
      • Meetings to discuss SRH implementation held.
      • SRH officer who reports back to health cluster/sector.
      • Protection system in place for women and girls.
    • Challenges:
      • The lack of a functioning government in emergency contexts and/or the lack of government/community involvement from the beginning of an intervention, which affects sustainability of any intervention.
      • Lack of national endorsement of adoption of curricula for MNH training or incorporation of MNH into disaster risk reduction and preparedness planning.
    • Opportunities:
      • MNH programs can leverage IAWG actors at the local, national, regional, and international levels that have access to different resources (i.e. political, funding, contextual knowledge) by working together to address roadblocks for adequate MNH coverage in emergencies.
      • Advocacy for human resources in key environments as part of disaster risk reduction (DRR) (prevention, mitigation, and preparedness).
      • Foster connections between development actors and national associations of midwifery and obstetrics and the International Confederation of Midwives.
  • Health care financing
    • Are there adequate funds for sustaining MNH interventions during and after the acute phase of an emergency in ways that people can use and afford the services?
    • Challenges:
      • Funding for the acute phase of an emergency is by definition a non-sustainable financing stream.
      • How to include core MNH activities in acute phase funding appeals that can form a foundation to subsequently conduct capacity development/redevelopment as the acute phase transitions into a recovery or protracted phase of an emergency?
    • Opportunities:
      • How to get MNH/SRH funded in the first 72 hours?
  • Health workforce
    • What are IAWG members doing to ensure there are sufficient numbers and mix of staff, fairly distributed; and that they are competent, responsive, and productive?
    • The MISP emphasizes staff capacity is assessed and trainings are planned during the planning for comprehensive SRH services.
    • Challenges:
      • Is the baseline assumption of MNH skills accurate? For example, how to deliver basic emergency obstetric and newborn care (BEmONC) services to a community during an emergency if (1) the capacities for providing those services are not already available in terms of acceptance of procedures and skills and (2) training is not a priority.
      • How to follow up with health-care providers for training quality and ongoing support?
      • The lack of collaboration and communication between IAWG members who are addressing training of health care providers at field level and may not be sharing or utilizing available resources.
      • Guidelines and a vertical approach to training may not be a practical solution for health care workers functioning in an emergency.
      • In an emergency, the usual health care providers are likely not present. Other health care providers are often adapting to a new environment. Delivering BEmONC and comprehensive emergency obstetric and newborn care (CEmONC) services in this context is difficult.
    • Opportunities:
      • Leverage the revitalization of the Training Partnership initiative for information sharing.
      • Reach out to regional IAWGs for compiling contextual resources and sharing the information in a central location.
      • Develop practical resources for health care providers working in emergencies.
  • Medical products and technologies
    • Is there equitable access to SRH supplies (medical products, vaccine, and technology)?
    • The MISP emphasizes: SRH Kits and supplies available and used, standard precautions practiced, free condoms available, clean delivery kits provided to birth attendants and visibly pregnant women, SRH equipment and supplies ordered for comprehensive services.
    • Challenges
      • Items in the inter-agency SRH Kits do not provide provisions for active management of the third stage of labor (AMTSL) or population FP needs (i.e. implants).
    • Opportunities
      • The inter-agency SRH Kits will be revised in conjunction with the IAFM and MISP.
      • Review the contents of the kits and make suggestions in terms of updating the available supplies in emergencies to provide evidence-based services.
  • Information and research
    • Challenges:
      • Information on current MNH service capacity and practices may not be available before or during an emergency.
    • Opportunities:
      • What are the resources within the IAWG for collecting information on MNH outcomes when planning for comprehensive RH services?
  • Service delivery
    • How to deliver effective, safe, quality MNH care to those who need them, when and where needed, with minimal waste of resources?
    • The MISP emphasizes: medical services and psychosocial support available for survivors, community awareness of services; safe and rational blood transfusion in place; EmOC care services available; 24/7 referral system established; sites identified for future delivery of comprehensive SRH services.
    • Challenges
      • MNH interventions are often defined as maternal or newborn. The mother and the newborn are a unit. The role of the father within the unit should also be addressed. The idea that maternal emphasis is still key in addressing interventions for the dyad because the newborn is dependent on the mother for survival.
      • There is a need to address an entry strategy into a crisis, in addition to an exit strategy, to foster relationships and programs that will be sustainable to handover to local actors at the conclusion of an acute response.
      • There are many births that happen in refugee camp settings when other services and resources are theoretically available. The shifting landscape of refugees to increasingly urban contexts adds a new layer of complexity to service provision. The needs for mapping resources change from a camp environment because there is a self-contained cadre of services available in an urban environment and there are many private and public sector actors and community service organizations that may be resources for the affected population.
    • Opportunities
      • Reframing the mother/newborn into a dyad or as part of a larger family unit in the IAFM and MISP revisions.