Building national resilience for sexual and reproductive health: learning from current experiences.

In disasters women face increased health and protection risks resulting in the critical need for sexual and reproductive health (SRH) services. Since 1997 the Minimum Initial Service Package (MISP) has been the standard of care for SRH in humanitarian settings. Recent disasters have shed many lessons around humanitarian response including the promise that preparedness efforts can have for a timely and adequate SRH response during crises. A multisectoral and multidisciplinary health emergency and disaster risk management system further protects public health and reduces morbidity mortality and disability associated with emergencies. This has been recognized in recent global frameworks and commitments including the Sendai Framework for Disaster Risk Reduction 2015-2030; the Global Strategy for Women’s Children’s and Adolescent Health; and the Sustainable Development Goals. All of these frameworks provide a facilitative environment for integrating SRH into the United Nations International Strategy for Disaster Reduction’s Thematic Platform for Emergency and Disaster Risk Management for Health. In 2015 the Women’s Refugee Commission (WRC) collected examples of efforts to integrate SRH within emergency and disaster risk management for health (EDRMH) exploring achievements challenges and reflections in the Eastern Europe and Central Asia (EECA) region Macedonia and Pakistan. Main conclusions included: The process of assessing MISP readiness in the EECA region facilitated coordination among diverse stakeholders and identified gaps and recommendations for collective action with built-in accountability and experience-sharing opportunities across countries in the region; Persistent advocacy and a multisectoral approach in Macedonia led to policy setting at the national level and forging of partnerships to prepare for a more coordinated MISP response; Reflections from recent emergency responses within a pre-existing RH working group in Pakistan allowed for national- and provincial-level preparedness planning as well as a district-level pilot to develop and implement SRH preparedness plans with community involvement. Common challenges across case studies included: Lack of awareness presence of culturally grounded assumptions or sensitivities and lack of standard operating procedures (SOPs) at the policy level around SRH needs and priorities in emergencies; Lack of coordination among relevant departments and organizations prior to coming together on a common agenda to address SRH as part of EDRM-H; Weaknesses of existing primary health care systems—especially for sexual violence prevention and response—led to limitations in existing health preparedness and response plans; Limited engagement of community members particularly at-risk groups; Limited financing for SRH preparedness especially for actual implementation of action plans. Learning regarding SRH inclusion within disaster risk management systems remains nascent. However these case studies offer early learning that can inform work on this topic moving forward. Most importantly efforts to integrate SRH into EDRM-H appear to take a non-linear path based on opportunities honest reflection and iterative processes. Further where response capacity is overwhelmed in spite of preparedness efforts adaptability and flexibility become important ingredients for continuous improvement. Based on learning advocacy coordination and partnerships capacity-building leadership ownership inclusion of community and at-risk groups resilient primary health care systems and financing appear to be critical for countries to successfully integrate SRH into EDRM-H at all levels. More initiatives that strengthen community capacity are needed as well as evidence and tools to support this focus. A strong evidence-base of best-practices can prevent SRH from being sidelined from preparedness and empowerment activities at the community level laying the groundwork for optimal response when crises occur.