Reproductive health services for Syrian refugees in Zaatri Camp and Irbid City, Hashemite Kingdom of Jordan: an evaluation of the Minimum Initial Services Package

Abstract

BackgroundThe Minimum Initial Services Package (MISP) for reproductive health, a standard of care in humanitarian emergencies, is a coordinated set of priority activities developed to prevent excess morbidity and mortality, particularly among women and girls, which should be implemented at the onset of an emergency. The purpose of the evaluation was to determine the status of MISP implementation for Syrian refugees in Jordan as part of a global evaluation of reproductive health in crises.MethodsIn March 2013, applying a formative evaluation approach 11 key informant interviews, 13 health facility assessments, and focus group discussions (14 groups; 159 participants) were conducted in two Syrian refugee sites in Jordan, Zaatri Camp, and Irbid City, respectively. Information was coded, themes were identified, and relationships between data explored.ResultsLead health agencies addressed the MISP by securing funding and supplies and establishing reproductive health focal points, services and coordination mechanisms. However, Irbid City was less likely to be included in coordination activities and health facilities reported challenges in human resource capacity. Access to clinical management of rape survivors was limited, and both women and service provider’s knowledge about availability of these services was low. Activities to reduce the transmission of HIV and to prevent excess maternal and newborn morbidity and mortality were available, although some interventions needed strengthening. Some planning for comprehensive reproductive health services, including health indicator collection, was delayed. Contraceptives were available to meet demand. Syndromic treatment of sexually transmitted infections and antiretrovirals for continuing users were not available. In general refugee women and adolescent girls perceived clinical services negatively and complained about the lack of basic necessities.ConclusionsMISP services and key elements to support implementation were largely in place. Pre-existing Jordanian health infrastructure, prior MISP trainings, dedicated leadership and available funding and supplies facilitated MISP implementation. The lack of a national protocol on clinical management of rape survivors hindered provision of these services, while communities’ lack of information about the health benefits of the services as well as perceived cultural repercussions likely contributed to no recent service uptake from survivors. This information can inform MISP programming in this setting.

Perspectives of displaced Syrian women and service providers on fertility behaviour and available services in West Bekaa, Lebanon

“…A similar situation has been reported in an evaluation of RH services offered to Syrian refugees in Jordan. 34 In addition to showing that the Lebanese health system is non-responsive to the RH needs of refugee women, our findings point to the misfit of emergency health care provision programmes, such as the MISP, in addressing these needs. This confirms the necessity of planning and providing family planning services through considerations given to contextual factors and cultural norms of the refugee population.…”

Health needs and priorities of Syrian refugees in camps and urban settings in Jordan: perspectives of refugees and health care providers

“…Participants also identified the high smoking prevalence among Syrian refugees as a major contributor to the increase in chronic conditions. These findings suggest relief efforts should increase emphasis on the prevention and management of chronic diseases in order to tailor the response to the burden of disease in this population (21,22). Many of the Syrian refugee participants expressed that the lack of transportation was an issue when trying to access care, especially for after-hour emergencies.…”

Family planning in refugee settings: findings and actions from a multi-country study

“…Other studies have similarly documented challenges in supply chain management and provider biases that limit access to and uptake of family planning services in humanitarian settings [1,[4][5][6]. Studies examining the sexual and reproductive health (SRH) outcomes of refugees and internally displaced persons within camp settings compared to the host community present varying results, with both superior and inferior health outcomes between the two populations [7][8][9][10].…”