The Training Partnership of the Inter-Agency Working Group (IAWG) on Reproductive Health in Crisis Situations

1 Strategy Paper for Donor Agencies The Training Partnership of the Inter-Agency Working Group (IAWG) on Reproductive Health in Crisis Situations At a glance: Why Reproductive Health matters in crisis situations? 1. Reproductive Health problems are the leading cause of women s ill health and death worldwide. 1 2. Approximately 75 to 80 percent of all crisis-affected populations are women and children. 3. Reproductive Health services are essential to save lives and prevent illness, trauma and disability. 4. Services need to be implemented at the onset of every emergency. 5. International law supports the rapid and unobstructed implementation of Reproductive Health by humanitarian actors. 2 6. Reproductive Health services are part of international standards as outlined in the Sphere Humanitarian Charter and Minimum Standards in Disaster Response. 3 7. Neglecting Reproductive Health in humanitarian settings has serious consequences: preventable maternal and newborn deaths; sexual violence and subsequent trauma, sexually transmitted infections, unwanted pregnancies and unsafe abortions; and the possible spread of HIV. 8. The Global Health Cluster endorses Reproductive Health as a standard in health service provision in emergencies as outlined in the Health Resources Availability Mapping System (HeRAMS). 4 1 UNFPA. State of the World Population 2005. 2 Geneva Convention (IV) Relative to the Protection of Civilian Persons in Time of War (1948); Geneva Conventions, common art. 3; International Covenant on Civil and Political Rights, art. 6; Geneva Convention (IV) Relative to the Protection of Civilian Persons in Time of War, arts. 23, 55, 59, 60 (1948); Protocol Additional to the Geneva Conventions of 12 August 1949, and relating to the Protection of Victims of International Armed Conflicts (Protocol 1), art. 70; Protocol Additional to the Geneva Conventions of 12 August 1949, and relating to the Protection of Victims of Non-International Armed Conflicts (Protocol II), arts. 9-11; Convention on the Elimination of All Forms of Discrimination Against Women (CEDAW); the International Covenant on Economic, Social and Cultural Rights (ICESCR). 3 Sphere Project. 2004 (revised). http://www.sphereproject.org/content/view/27/84/lang,english/ 4 IASC Global Health Cluster. January 2009. http://mcram.org/background%20documents/herams_jan09.pdf

2 A. INTRODUCTION Neglecting Reproductive Health in crisis, protracted and chronically underfunded situations has potentially serious consequences. It is essential for the survival and well-being of the populations surviving crises and living in protracted situations, that emergency and recovery responses also implement life-saving Reproductive Health services and integrate them into primary health care services. Addressing Reproductive Health in crisis situations is essential for the achievement of the Millennium Development Goals, in particular MDG 5 (improving maternal health) and its target on universal access to Reproductive Health, and for the realization of the Programme of Action of the International Conference on Population and Development (ICPD Cairo, 1994), where the needs of populations surviving crises were stated: All migrants, refugees, asylum seekers and displaced persons should receive basic education and health services. The Inter-Agency Working Group on Reproductive Health in Crises (IAWG) regroups the leading experts in the field of Reproductive Health in crisis situations, and gives emphasis on inter-agency networking and collaboration. The IAWG Training Partnership further stresses a non-vertical approach and South- South partnership and cooperation, thus ensuring effectiveness and sustainability of the overall capacity building efforts. Our implementation strategy emphasizes: a. Regional and national ownership, which is in line with the principles of the Paris Declaration on aid effectiveness. States and local stakeholders will be enabled to exercise leadership over their development strategies and coordinate actions to mainstream Reproductive Health into their emergency preparedness plans and responses. b. The involvement of beneficiaries in humanitarian response and the strengthening of country capacities to prepare for, mitigate and respond to humanitarian crises, as put forward by the Good Humanitarian Donorship Initiative. B. BACKGROUND I. The Inter-Agency Working Group on Reproductive Health in Crisis Situation (IAWG) In 1995, to respond to the gaps in life-saving Reproductive Health services in humanitarian situations and to follow the agenda set out by the International Conference on Population and Development held in Cairo 5, the Inter-Agency Working Group on Reproductive Health in Crisis Situations (IAWG) was formed. A group of more than 30 UN agencies, NGOs, academic and donor institutions form the core of the IAWG. Its task is to facilitate access to Reproductive Health for refugees, internally displaced populations and other populations affected by crisis situations. The IAWG holds annual meetings and IAWG sub-groups address specific technical or advocacy issues. II. Implementing existing standards Over the years, the IAWG has developed many tools, including in 1999 a field reference called Reproductive Health in Refugee Situations - an Inter-Agency Field Manual. 6 This field manual addresses Safe Motherhood, Sexual Violence, Sexually Transmitted Infections and HIV, Family Planning, Reproductive Health for Young People, and other Reproductive Health related issues. 5 Programme of Action. Cairo: International Conference of Population and Development; 1994 6 Reproductive Health in Refugee Situations - an Inter-Agency Field Manual. Geneva: UNHCR; 1999

Most importantly, the field manual includes the Minimum Initial Service Package for Reproductive Health in Crisis Situations (MISP). This has become an internationally accepted standard and is included in the Sphere Guidelines 7. The IAWG also designed Inter-Agency Reproductive Health Kits containing essential medical supplies and drugs for the implementation of the MISP. Capacity building is also crucial to IAWG. We have prepared humanitarian workers to better coordinate and implement Reproductive Health services as part of relief efforts. Quality training not only raises awareness of Reproductive Health in crisis situations, but also improves emergency preparedness and responses, and contributes to the number of skilled health workers and educators. 3 III. Training Partnership As the frequency and intensity of emergencies and their related Reproductive Health needs continue to rise, demand for training has also increased. One of the IAWG s main challenges is to address this demand and to conduct quality Reproductive Health training for humanitarian staff on a regular basis. The IAWG has established a sub-working group called the IAWG Training Partnership for Reproductive Health in emergencies, which brings together training and public health institutions from around the world, as well as UN agencies and NGOs to deliver Reproductive Health trainings in the most effective and sustainable manner. There are still challenges ahead of the IAWG Training Partnership, particularly in relation to the systematic implementation of the Reproductive Health standards in emergencies. These challenges include: 1. The scarcity of trainers and field workers skilled in the delivery of Reproductive Health services. Emergency preparedness in Reproductive Health requires the establishment of a regional and national network of trained and qualified field workers ready to be deployed; 2. The difficulty of keeping track of former trainees and tapping into their skills when the needs arise at the onset of a crisis situation at the national or regional level; 3. Lack of financial resources to support training institutions and participants to run/attend training courses; 4. Need for updating, disseminating and promoting training materials. C. IAWG TRAINING PARTNERSHIP STRATEGY 2010 2014 I. Objectives The IAWG Training Partnership Strategy for the period 2010 to 2014 has three objectives: 1. Capacity building of strategic partners 2. Piloting new training modules 3. Improving quality of training 7 Humanitarian Charter and Minimum Standards in Disaster response, The Sphere Project, 2004 Edition, p 289. The Sphere project is a programme of the NGO consortia, launched in 1997 to develop a set of universal minimum standards in core areas of humanitarian assistance. The aim of the project is to improve the quality of assistance provided to people affected by disasters and to enhance the accountability of the humanitarian system in disaster response.

Capacity building of strategic partners emphasizes the importance of inter-agency and interinstitutional networking and collaboration, including South-South partnerships, in order to facilitate the sharing of materials and best practices among training partners. Specifically, we will share existing training materials with partners from the South to enable them to build their in-country capacity. We will focus on building the capacity of multi-agency country teams, starting with selected crisis-prone countries and regions, including Sub-Saharan Africa, the Middle East and the Asia Pacific. The recipients of the training materials will be ministries of health and education, national and regional training institutions (such as medical universities, nursing, midwifery and public health schools, and key NGOs) who will adapt them according to the local context. Emphasis will be given to the integration of Reproductive Health into national emergency preparedness plans and to the institutionalization of Reproductive Health in crises into pre- and in-service training curricula for nurses, midwives, doctors, public health specialists and humanitarian actors. Such institutionalization will help bridge the gap between preparedness, immediate relief, recovery and development. Piloting new training modules: The identification of gaps in training will help set priorities for capacity building activities. Based on this analysis, we will develop and field test key modules on Reproductive Health in crises as well as on new Reproductive Health technologies for low-resource settings. We will also pilot innovative training methods when appropriate, such as e-learning and mobile phone learning, and will collaborate closely with training champions such as the UN Institute for Training and Research (UNITAR). Improving quality of training: Quality control is a key objective in all our deliverables, including high standard of trainers and quality standard of training materials that need to be informed by evidence, reproduced by other trainers, accessible to adult learners, translated and adapted. Training will also lead to the proper certification of trainees, a process to be linked with country and internationally agreed standards. Monitoring and evaluation will be key to quality control and will take place at different levels to ensure that trainers and training courses are effective, that trainees are competent in their skills, and that overall programming adhere to sound and effective management standards. Supervisory and support systems will be put in place to help improve in-country standards of implementation. 4 II. Proposed Activities 2010-2014 The key activities proposed for the period 2010-2014 include: A. Training courses 1. Advocacy package: country actors have expressed the need for an advocacy package to help them brief Government, academic, UN and NGO decision makers on the importance of mainstreaming Reproductive Health in crises into national policy, training curricula and national development agenda. > Key outcomes: national decision-makers have an increased awareness of the importance of Reproductive Health in crises and are supportive of related national policy changes. 2. Minimum Initial Service Package (MISP) for Reproductive Health in Crisis Situations, a Distance Learning Module: the 2006 edition has been instrumental in enhancing the awareness of the international community on the issue. The tool is now in need for technical update, improved design to suit adult e-learning and re-publication. > Key outcome: humanitarian actors have easy access to and an increased knowledge of quality and updated Reproductive Health standards in emergency. 3. Coordinator s training of trainers and in-country rollout: successfully piloted in Asia Pacific in 2008 and 2009, this training targeting coordinators and managers working in Reproductive Health and/or in the humanitarian field will be rolled out to other regions, including Africa, Middle East and Latin America. Inter-agency approach, national ownership and accountability, and focus on emergency preparedness planning form the core principles of this training package.

5 > Key outcome: national inter-agency country teams are enabled to move forward the mainstreaming of Reproductive Health in crises into their national emergency preparedness plan, training curricula and emergency and recovery responses. 4. Clinical Outreach Trainings on essential Reproductive Health procedures: to support the delivery of quality life-saving Reproductive Health services by providers working in a humanitarian setting at the field level and who are often too busy to leave their duty station to attend training, national training institutions will directly reach out directly to them and provide refresher trainings and technical support. > Key outcome: beneficiaries receive essential quality Reproductive Health services delivered by skilled service providers. 5. New Reproductive Health technologies for Reproductive Health in crises: low-resource settings where there is a scarcity of electricity, water, and human resources require suitable and creative Reproductive Health technologies. Selected technologies, such as screening and diagnostic tests, treatment options and systems of telemedicine for health, will be piloted and studied. > Key outcome: sustainable and quality Reproductive Health services are available for the community. B. Management 1. Project management office of the IAWG Training Partnership: the Training Partnership requires a project management office to coordinate, manage, provide technical support and monitor all project activities. The project management office is located in Geneva and will be led by an inter-agency team. 2. Regional management hubs: besides a central project management office in Geneva, regional secretariats will be set up in the Africa, Latin America, Middle East and Asia Pacific region. Regional program coordinators from the different hubs will work closely with the regional UNFPA Humanitarian Coordinators and other regional UN and NGO actors to give technical and managerial support to incountry capacity building partners. The regionalization of the management network is crucial for a cost-effective and contextualized technical assistance and cooperation. > Key outcome (1&2): the activities of the IAWG Training Partnership are effectively managed, coordinated among partners, monitored and evaluated at the global and regional levels. 3. Action research hubs: besides regular monitoring and evaluation of the project, action research will be conducted by selected regional and national research institutions from the South that are closely linked with the training institutions. This global action research network will greatly contribute to enhancing the much needed body of evidence on capacity building for Reproductive Health in crises. > Key outcome: results of action research inform policy change and improve programming of Reproductive Health in crises. 4. Annual review meetings and final dissemination conference: these meetings will bring implementing partners from across the regions together on an annual basis to share best practices and lessons learnt. A final conference will allow wider dissemination of the findings and best practices cumulated during the project period. > Key outcome: best practices are widely disseminated and delivery of Reproductive Health services in crises and recovery is improved. Note: if you are interested in a full proposal based on this strategy paper, kindly write to doedens@unpfa.org or lbaker@unfpa.org