Inter-Agency Working Group (IAWG) on Reproductive Health in Crises

TERMS OF REFERENCE (ToR) Inter-agency Working Group (IAWG) on Reproductive Health in Crises 2016-2017

The IAWG Terms of Reference (TOR) is a tool for IAWG members to collectively identify annual progress, identify gaps and propose solutions to ensure women, men and young people in crisis situations have access to the MISP in the early days and weeks of new emergencies and comprehensive reproductive health services as the situation stabilizes. While the full membership of the IAWG itself is not tasked with undertaking specific activities to address the gaps, it is expected that IAWG member organizations, either individually or in partnership with others, will voluntarily commit to undertaking them. Thus, the TOR serves as a collective guiding post for its members to identify and prioritize gaps, progress and appropriate solutions.

I. Minimum Initial Service Package (MISP)

Proposed priorities for 2016-2017:  Advance discussion on programming around a smooth and effective transition from MISP to Comprehensive Reproductive Health (CRH) including a “Preparedness Lens.”

 Engage in global advocacy platforms.

 Contribute to the revision process of the Inter-Agency Field Manual (IAFM) on Reproductive Health (RH) in Humanitarian Settings.  Include and develop a donor base for mobilizing resources.

Advocacy:  Continue outreach to identify new members to engage with IAWG. o 2015 Status: With plans to identify new members from donors and stakeholders, including European donors, ICRC, IFRC, UN agencies, World Bank, medical societies, and governments, the IAWG secretariat has managed to re-engage existing members through its formalized structure. o 2016 Recommendations: Ongoing; IAWG members will continue recruiting new strategic members for advocacy, research, and service delivery. Development agencies can further be engaged through dialogue around the MISP and emergency and disaster risk management for health (EDRM-H).

Minimum Initial Service Package:  Improve the MISP response in real-time emergencies, with the IAWG Surge Capacity and United Nations (UN) agencies fielding RH coordinators, and the MISP sub-working group (SWG) holding teleconferences to share information, coordinate activities, and identify gaps. o Provide headquarters and regional IAWG groups with support for a MISP response in real-time emergencies. . 2015 Status: The IAWG regional SWGs are being reinvigorated, especially with efforts led by the Eastern Europe and Central Asia (EECA) region that has conducted emergency preparedness assessments for the MISP in 18 countries. . 2015 Status: The IAWG Steering Committee has released statements in select emergencies, including the Ebola response. . 2015 Status: UNFPA operates an IAWG sexual and reproductive health (SRH) surge capacity roster to deploy SRH coordinators in major crises. . 2016 Recommendation: MISP SWG members will take part in the IAFM revision process. o Facilitate MISP coordination at the field level. . 2015 Status: With updates to the IAWG website, a who is doing what where (WWW) mapping for SRH will include basic information, including: 1) if an SRH lead has been identified; 2) if a coordinating agency has been identified; 3) if a SRH working group (WG)has been activated; and 4) contact information. This activity continues to be tabled. . 2015 Status: SRH logistics and the supply chain (SRH Kits; transition to comprehensive SRH; and chronic supply shortages) have been identified as a critical gap. The IAWG has a logistics

1 SWG that conducted an online survey to identify gaps, as well as key informant interviews (KIIs). . 2016 Recommendations: The MISP SWG will continue to support headquarters (HQ) and field-level coordination.  Advocate for better cross-sectoral/cluster preparedness and response on the MISP/CRH. . 2015 Status: The International Strategy for Disaster Reduction (ISDR) SRH working group has developed a policy brief and national-level monitoring tool for field-testing. The EECA region has applied a detailed SRH preparedness tool to identify MISP needs, gaps and successes, and the Women’s Refugee Commission (WRC) will be releasing a good practice case study report on integrating SRH into EDRM-H at multiple levels. . 2016 Recommendation: Field-test national monitoring tool.  Continue development of tools in support of MISP implementation and monitoring efforts. o MISP Monitoring and Evaluation Tool . 2015 Status: CDC, Boston University, UNFPA, and WRC tested the MISP assessment tools in Nepal, and are finalizing the package that includes data collection and analysis tools for focus group discussions (FGDs), KIIs, literature reviews, and facility assessments. . 2015 Status: The IAWG Training Partnership has been re-established, focusing on the finalization and rollout of three clinical training modules on manual vacuum aspiration (MVA), vacuum extraction, and clinical management of rape survivors. . 2016 Recommendation: MISP SWG will liaise closely with the IAWG Training Partnership Initiative, safe abortion care (SAC) SWG, among other SWGs to address specific gaps. o User-friendly tools on the MISP, written with less jargon and for clinical professionals . 2015 Status: The WRC/Reproductive Health Response in Crises (RHRC)’s “universal” adaptable information, education, and communication (IEC) templates on specific objectives of the MISP, as well as PATH’s job aids on clinical management of rape survivors and other themes are available on the IAWG website. . 2016 Recommendation: Further disseminate existing tools on the IAWG website and through the listserv.  Build capacity of SRH coordinators and relevant actors to facilitate MISP implementation. o Develop a database on available SRH personnel to be deployed in emergencies by consolidating existing databases (Columbia University, Norwegian Refugee Council, Danish Refugee Council, and determining where the list will be housed. . 2015 Status: United Nations Population Fund (UNFPA), through IAWG, manages the SRH surge capacity initiative. IAWG has also re-established the Training Partnership Initiative. o Identify a core set of training materials to support clinical training of field-based SRH coordinators and clinicians, in addition to humanitarian coordinators. . 2015 Status: The IAWG Training Partnership Initiative has finalized clinical modules on MVA, vacuum extraction, and clinical management of rape survivors and is rolling out trainings in three training institutions in the global South. . 2016 Status: The IAWG Training Partnership Initiative to add a family planning module and finalize the modules on basic emergency obstetric care (EmOC) and signal functions. o Certify humanitarian actors, policy makers and donors in the MISP module. IAWG members are encouraged to incorporate the MISP module into their orientation package for all new health staff and to advocate internally for staff certification. . 2015 Status: The MISP module continues to be widely disseminated and incorporated into training curricula. Collectively, more than 5,600 people are currently certified in the original and revised modules. . 2016 Recommendation: Continue module dissemination; the IAWG to maintain a list of upcoming national, regional, and global trainings on the MISP.  Participate in IAWG opportunities to discuss uses for new and underutilized SRH technologies that facilitate effective MISP implementation. o Take part in the SRH Kit review processes as they occur to ensure new and underutilized SRH technologies are included in Inter-agency SRH Kits. . 2015 Status: See “Facilitate MISP coordination at the field level” on the work of the IAWG logistics SWG.  Include and develop donor base for mobilizing resources.

o A donor network/ profiling to be done for Humanitarian Emergencies.

. 2016 Status: The aim of this group would be: 2  How can it be ensured that SRH implementation in crises is better prioritized by donors, and therefore, better funded?

 How can it be ensured that donors are knowledgeable about the importance of rapid implementation of SRH services during an emergency response i.e. that SRH services are lifesaving services and not a luxury?

o The development banks such as World Bank and Asian Development Bank to be included since they have Climate Change portfolios, under which they fund various organizations.

. 2016 Recommendation: Develop a Donor Working Group under the IAWG. This will include the development of an IAWG donor strategy.

II. Adolescent Reproductive Health (ARH)

Priority objectives for 2016-2017:  Engage adolescents to build their capacity around how to develop and implement quality programs and work with working group members to enhance adolescent-inclusive collaboration and partnerships for advocacy, programming, M&E, and research.  Build adolescent sexual and reproductive health (ASRH) capacity through developing master trainers for ASRH, and sharing information on upcoming trainings, existing tools, and good practices.  Advocate and integrate ASRH into IAWG work, such as the IAFM revision; MISP, family planning, and safe- abortion care SWGs; across clusters/sectors; and discussions with development actors.

Adolescent reproductive health:  Advocate for quality adolescent SRH programming in humanitarian settings. o February 2016 Status: . Child Fund has actively reached out to its senior management team and emergencies unit to integrate SRH as a core component within protection. . ARH SWG is developing a fact sheet on ASRH programming in humanitarian settings. . International Planned Parenthood Federation – Sexual and Reproductive Health Program in Crisis and Post-Crisis Settings (IPPF-SPRINT) recognizes the importance of adolescent and youth trainings in emergencies. Hence, in post-Earthquake Nepal, IPPF-SPRINT included several youth volunteers during MISP trainings to build their capacity for MISP delivery and SRH programming. o 2016 Recommendations: . SWG facilitators to expand membership by focusing on adolescent participation. . SWG facilitators to work more closely with the IAWG SWGs (such as the MISP and Voluntary Contraception (VP)) via global evaluation advocacy. . SWG to finalize fact sheet and provide ASRH-related facts/statistics for the IAWG website. . An inter-agency youth development SWG is co-chaired by the World Health Organization (WHO) and UNFPA. The IAWG ARH SWG can reach out for messaging around humanitarian settings. . Advocate for ASRH to be part of SRH in developing protocols for emergency preparedness. . Work on a bottom-up approach to advocacy to spark adolescents to initiate campaigns around ASRH and ensure sustainable advocacy at the national level.  Build manager, provider, community leader, and others’ capacity to facilitate their recognition of and champion for ASRH within their areas of work. o February 2016 Status: . In collaboration with the VC SWG, the ARH SWG trained youth at the International Conference on Family Planning (ICFP) to enact scenarios around barriers to accessing family planning in crisis-settings. . ARH SWG is developing a ToR for a roving ASRH trainer to institutionalize ASRH capacity. . CARE has actively reached out to senior leadership and received commitment to integrate adolescent and youth work within the agency. . WHO is drafting pre-service training guidelines on working with young clients.

3 . UNFPA Indonesia translated ASRH toolkit into Bahasa Indonesia. UNFPA has translated the ASRH Toolkit in Arabic that is currently only available in soft copy. . Save the Children conducted an ASRH Toolkit training in the Philippines, Kenya, Somalia, Lebanon, and DRC. . International medical Corps (IMC) has formed an internal adolescent health taskforce and developed a multi-sectoral ToR to support integrated adolescent-friendly programming and utilize gender-based violence (GBV), Mental Health and Psychosocial Support in Humanitarian Emergencies (MHPSS), and water and sanitation for health (WASH) sectors as entry-points for ASRH interventions. . IMC in collaboration with UNFPA has conducted a Training of Trainers on ASRH in emergencies for humanitarian actors from several states in South Sudan. . Child Fund has developed a Community of Practice, in which program directors and youth specialists in Asia receive support on ASRH integration and commit ASRH line items within their annual operating plans and budgets. Training will be held in spring 2015. . IPPF, through the SPRINT Initiative has been able to engage and reach out to young volunteers through various emergency responses globally. o 2016 Recommendations: . Fundraise for ARH SWG’s roving trainer position for a master trainer for ASRH. . ARH SWG members to initiate annual monitoring of adolescent-friendliness in their SRH programs, to monitor change and gather information for advocacy and fundraising. . UNFPA/Save the Children to continue disseminating and translating the ASRH Toolkit. . Hold regional trainings for development agencies/practitioners. . Foster mentorship, on-the-job trainings, or field exchanges for junior ASRH staff. . Compile Global Young ASRH Trainers/Youth leaders for technical assistance. . Share details of events on ASRH across the globe.  Increase programs that address ASRH in humanitarian settings. o February 2016 Status: . Youth programming in the Syrian crisis by Save the Children, IMC, and others. . Child Fund supports the ASRH program in response to Typhoon Haiyan in the Philippines, as well as child protection integration, which integrates ASRH in the Ebola response for Liberia. . WRC, Johns Hopkins University, Save the Children, IMC, International Rescue Committee (IRC), and Kachin Development Group (KDG) are piloting projects to prevent and respond to early marriage in Burma, Ethiopia, and Lebanon. . IMC is implementing a comprehensive ASRH program to improve access to and utilization of SRH information and services in Nepal. IMC is also piloting the recently developed national curriculum on Menstrual Hygiene Management in schools in the same district. o 2016 Recommendations: . Advocate with IAWG SWGs and cluster/sectors per the first objective: “Advocate for quality adolescent SRH programming in humanitarian settings.” . Service delivery agencies to continue to increase adolescent-friendly SRH programs. . Develop set of core competencies for ASRH practitioners. . Develop ASRH integration priorities, inclusive of engagement with other sectors.  Document and share best practices and lessons learned in addressing adolescents in humanitarian settings. Post documents and lessons learned on ARH SWG list at IAWG. o February 2016 Status: . UNFPA is undertaking a review of its country programs for good practices around safe spaces, mobile clinics, and peer education. It is developing a guidance note from findings. . With Center for Disease Control and Prevention (CDC) funding, the WRC, Johns Hopkins University (JHU), IMC, Save the Children, and KDG are documenting learning based on secondary analysis from action-oriented research on needs of very young adolescents in Ethiopia, Lebanon, and Thailand. . ARH SWG is conducting a systematic literature review of good practices in ARH programming to directly inform the revision process of the ARH chapter of the IAFM. . As part of the Typhoon Yolanda Response, IMC implemented a Safe Motherhood Program for girls under 19 years and will be documenting best practices for ensuring adolescent- friendly services, as well as improving outcomes for high risk teenage pregnancies. . IMC has evaluated an ASRH project in Gondar, Ethiopia that supports a long-dormant youth center through health education, life skills enhancement, alternative basic education, recreational activities, promotion of mental health and psychosocial well-being, peer counseling, and referral to IMC strengthened adolescent-friendly SRH services. 4 . During IPPF-SPRINT’s Nepal earthquake and flood response in Bangladesh, youth served as tremendous resources when engaged through distribution of SRH kits. o 2016 Recommendations: . Update ARH chapter and ensure integration of ASRH issues in other IAFM chapters. . SWG facilitators to allocate a time during calls for members to share best practices and challenges for adaptations to working papers, proposals, advocacy, etc. . Continue to review relevant humanitarian appeals to assess inclusion of adolescents, estimate budget requirements and mobilize funding on adolescent issues.  Support research studies on adolescent SRH. o February 2016 Status: . The WRC, JHU, IMC, IRC, and KDG are piloting prevention and response strategies to early marriage in Ethiopia, Lebanon, and Thailand. . JHU, Save the Children, and UNHCR are examining measurement for unaccompanied children. . Child Fund is examining lesbian, gay, bisexual, transgender, queer or questioning, and intersex (LGBTQI)’s GBV experiences in the Philippines; youth-led research. o 2016 Recommendations: Conduct practical operations research to show the effectiveness of specific strategies and process evaluations to document ASRH good practices in crisis settings. . Ongoing list of research ideas:  Examination of unique SRH needs and outreach strategies for at-risk sub-groups, including married adolescents, very young adolescents, girl mothers, adolescent heads of households, male adolescents, LGBTI adolescents, and adolescents with disabilities. How to make peer education programs effective in humanitarian settings.  Compile and evaluate fundraising strategies used across the globe by youth led organizations and capacity building efforts for resource mobilization.  Asses the global scenario on ARH funding, particularly in emergency-settings.  How to advocate and provide long-term family planning methods to adolescents.  Holistic, multi-sectoral models for health, protection, education, water and sanitation, and livelihoods that impact ASRH outcomes at the population level.  ASRH program models across relief through development, including preparedness.

III. Voluntary Contraception (VC)

Priorities:  Feed into IAFM manual revision, update technical pieces (this may include more comprehensive family planning (FP) approaches (integration of FP with other SRH elements: GBV referrals, safe abortion counseling, adolescent health, inclusion of fertility treatments).  Documentation of learning to date on FP: Need to show what is feasible in which settings, otherwise ground may be lost. This will be referenced in the IAFM revisions.  Raise the profile of crisis populations in the development community.  Foster broad SWG participation.

Activities related to these priorities:  Can be discussed further on calls: How to move the industry in these directions?  Share learning on adaptation of existing tools and where to make them available: either vetting process to choose or focus on adaptation. Develop a series of recommendation for adaptation.  Address provider attitudes and bias.

What might we need to move forward with these priorities?  SWG participation: Have more free call-in lines, to prevent cost from being an obstacle, with possible alternate calls in Asia/U.S. time.  Help with documentation needs: Have a consultant do key informant interviews with all participants to find out what they do in FP and what documentation exists. The consultant will allow this to occur quickly so the information compiled may be used in the IAFM revision. Translations, e.g., English – French, should be considered. Information can also be pulled from regional working groups.  Facilitate South-to-South interaction: Give resources to participants to develop recommendations and guidance. This can be further facilitated through interaction of regional IAWG.

5  Request co-leadership for SWG for Francophone Africa and Asia regions.  Event tomorrow: Share learning on FP in emergencies and successes in commodities and supply chain. People will rotate around tables and talk for about 20 minutes per table.

Voluntary Contraception:  Reposition VC within the MISP. o Develop and advocate suggested revisions to the IAFM MISP chapter (building off the IAWG position paper for the repositioning of FP within the MISP that clearly outlines the justification and recommendations). . Status: Ongoing . Point of contact (POC): Ashley Wolfington/Jennifer Schlecht o Mobilize members of this SWG to review and revise the IAFM chapter on VC. . Status: New . POC: Ashley Wolfington/Jennifer Schlecht o Document learning from contraception program implementation, to date. This activity may include assisting organizations to document their case studies/learning, hiring a consultant to cull learning through interviews, or implementing an IAWG survey via survey monkey. . Status: New . POC: TBD  Raise visibility of VC for crisis affected populations within global communications. o Position VC for populations affected by crisis (messaging and needs) within high level dialogues (Every Woman Every Child (EWEC) and Family Planning 2020 (FP2020), among others). . Status: Ongoing . POC: Ai Doody (liaise with advocacy and accountability WG)  Diversify involvement in the WG (NEW). o Develop strategy for liaising with regional IAWGs for input to global processes. . Status: New . POC: Melissa Garcia

IV. Gender-Based Violence (GBV):

Overall goal:  The IAWG GBV SWG aims to improve quality, access, and availability of priority minimum and comprehensive GBV services in humanitarian settings through improved cross sector collaboration, engaging in the establishment of technical standards and advocacy for GBV related aspects of SRH and rights.

Gender-based violence:  Serve as a discussion platform/network/think tank for GBV programming and new innovative approaches. o Activities: . Monthly SWG meetings with agendas and minutes. . Presentations from external/internal members on relevant topics. . Monthly updates from sub-sub-working groups. o Group members: . All IAWG SWG members  Review current status advocate for GBV protocols to be developed in countries with existing humanitarian emergencies or who are at risk because protocols do not exist. o Activities: . Map out lack of national GBV protocols in countries with existing humanitarian emergencies or who are at risk. . Representatives from UNFPA and WHO to be engaged. . Existence and quality o Group members: . Sandra Krause, Janet Meyers, Henia Dakkak, Chen Reis, Holly Williams  Support efforts to integrate clinical management of rape (CMR)/clinical care for sexual assault survivors (CCSAS) trainings into curricula of national training institutions (nurses, midwives, medical doctors (MDs)). o Activities: 6 . Advocacy . Technical support . Liaise with WHO as they develop the CMR training o Group members: . Henia Dakkak, Sanni Bundgaard, Janet Meyers, Nadine Cornier  Provide technical support to operational research or intervention implementation, clinical care quality, protocol changes, etc. o Activities: . Community based care for GBV survivors (WRC). . Active identification of GBV survivors in health facilities (IRC). o Group members: . Sandra Krause/Mihoko Tanabe, Sanni Bundgaard, Nadine Cornier  Support efforts around community engagement and local partner engagement during humanitarian emergencies. o Activities: . Identify eligible partners in countries with/at risk of humanitarian emergencies. . Capacity building/assist/support local partners identified. . Share contacts of local partners with the wider SRH community. o Group members: . Henia Dakkak, Sophia Wanjiku  Ensure health sector engagement and ownership over aspects of GBV (beyond sexual violence (SV)) that are related to health service provision. Make sure that the health sector lives up to its responsibilities and encourages participation in discussions around future roles. Influence and participate in global/regional/national decisions or resource development (protocols/guidelines) around GBV and SRH. o Activities: . WHO GBV guidelines for review . MISP revised module . Health cluster guide . IAFM o Group members: . Sanni Bundgaard, Henia Dakkak, Sandra Krause, Janet Meyers, Maysa Al-Khateeb  Strengthen health sector GBV data collection/M&E and evaluate standard indicators, data-bases used, etc. o Activities: . Learn more about the status of GBV information management systems (IMS). . Find ways to share/use data that has been collected. o Group members: . Sanni Bundgaard, Nadine Cornier, Sandra Krause, Maysa Al-Khateeb  Actively address gaps in current GBV programming (comprehensive abortion care, emergency contraception, quality service provision). Ensure that the next IAWG global evaluation will show increased availability of quality services for GBV survivors in humanitarian crises. o Activities: . Link with the SAC SWG to better understand how the two SWGs overlap and can collaborate. o Group members: . Janet Meyers, Nadine Cornier, Aurelie Leroyer, Sarah Neusy

V. Safe Abortion Care (SAC)

SAC SWG Objectives (based on activities discussed in small groups):  By May 31, 2016, the SAC sub-working group will: o Create a position statement on SAC in humanitarian settings endorsed by the SWG. o Participate in the integration of SAC throughout the revised IAFM and update comprehensive abortion care (CAC) technical chapter. o Develop and publish online resource hub for SAC in humanitarian settings. o Prepare and present at least four webinars on SAC issues of interest to IAWG members. o Conduct formative analysis of institutional change strategies (to inform eventual development of an institutional change toolkit).

7 o Support original research projects on SAC among IAWG agencies. o Conduct annual assessment of IAWG agencies’ SAC programming. o Explore process for and define the contents of a SAC Kit for humanitarian settings.

o Facilitate at least three opportunities for IAWG agencies to share experiences cultivating internal support for SAC programming (“It’s just lunch”). o Secure diversified funding for IAWG secretariat and related activities to ensure full integration of SAC.  By May 31, 2018, the SAC sub-working group will: o Lead the development and adoption of an IAWG position statement on SAC in humanitarian settings.

o Develop a toolkit to help internal champions catalyze institutional change on SAC within their agency. o Ensure that a SAC Kit for humanitarian settings is available for agencies responding to crises.

o Develop and disseminate a package of best-practice monitoring tools for SAC in humanitarian settings. o Generate and disseminate a list of standardized post abortion care (PAC)/SAC indicators.

Year one work plan:  Create a safe abortion position statement – In progress o Responsible: Erin Wheeler o Small group: Angel Foster, Monica Onyango, Sabine Baunach, Rebecca Brown (?), Christina Wegs, Anna Kim  Prepare for the integration of SAC in IAFM o Tasks . Identify and interview CAC chapter users. – To be completed  Responsible: Angel Foster . Develop suggestions on how to position SAC in each chapter. – In progress . Distribute statements into one document and share with SWG for comments. – To be completed  Responsible: Erin Wheeler and Sara Casey . In small group, discuss how to integrate into MISP if MISP 1) stays a minimum and 2) expands beyond minimum. – To be completed  Responsible: Mihoko Tanabe . Ensure one SAC SWG member is on review committee for each chapter. – To be completed  Responsible: Erin Wheeler o Responsible: Erin Wheeler and Sara Casey o Small group: Angel Foster, Bill Powell, Mihoko Tanabe, Rebecca Brown, Nathaly Spilotros, Bierne Roose-Snyder, Bergen Cooper, Monica Onyango  Develop and publish online SAC resource hub. – To be completed o Responsible: Sarah Knaster o Small group: Kelsea DeCosta, Bill Powell, Monica Onyango  Prepare and present SAC webinars. – To be completed o Four webinars o Responsible: Bergen Cooper o Small group: Bill Powell, Rebecca Brown (?)  Conduct formative analysis of institutional change strategies. – In progress o Responsible: Christine Wegs and Erin Wheeler o Small group: N/A  Support original research among IAWG agencies. – To be completed o Responsible: Bill Powell and Angel Foster o Small group: Monica Onyango, Erin Wheeler  Conduct annual assessment of IAWG agencies’ SAC programming. – To be completed o Responsible: Nathaly Spilotros o Small group: Erin Wheeler, Mihoko Tanabe, Sabine Baunach  Define the contents of a SAC Kit for humanitarian settings. – To be completed o Responsible: Angel Foster o Small group: Bill Powell, Monica Onyango  Facilitate SAC experience sharing opportunities between agencies (“it’s just lunch”). – In progress

8 o Responsible: Bierne Roose-Snyder o Small group: Christina Wegs, Erin Wheeler, Nathaly Spilotros  Secure diversified funding for IAWG. - Complete o Responsible: Sarah Knaster o Small group: N/A

VI. Logistics

Major Objective:  To improve the global coordination of the IAWG member agencies for the availability of SRH commodities and supplies in crisis-affected settings.

Specific Objectives:  To gather more information about SRH commodity supply chain gaps and solutions from IAWG member agencies.

Activities: o Conduct literature review (completed). o Develop Logistics Questionnaire (Survey Monkey) and share draft with relevant personnel at John Snow, Inc. (JSI), UNFPA, and other relevant IAWG members. o Finalize Logistics Questionnaire and implement among IAWG agencies. o Analyze survey results and document findings. o Use results to finalize in-depth qualitative interview tool. o Conduct, analyze, and document findings from qualitative key informant interviews. o Finalize quantitative and qualitative results in a report. o Disseminate results. o Develop and implement logistics SWG advocacy strategy to address the findings. . Utilize findings from quantitative and qualitative logistics research to determine most effective, efficient and feasible strategies for this working group to address some of the logistics barriers. . Consider the development of specific guidance tools based on the gaps and some identified solutions learned.

VII. Maternal and Newborn Health (MNH)

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

9 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 o Are there strategic frameworks in place with oversight, regulations, and accountability at the local and national levels for MNH? o 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. o 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. o 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 o 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? o 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? o Opportunities: . How to get MNH/SRH funded in the first 72 hours?  Health workforce o 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? o The MISP emphasizes staff capacity is assessed and trainings are planned during the planning for comprehensive SRH services. o 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. o 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. 10 . Develop practical resources for health care providers working in emergencies.  Medical products and technologies o Is there equitable access to SRH supplies (medical products, vaccine, and technology)? o 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. o 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). o 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 o Challenges: . Information on current MNH service capacity and practices may not be available before or during an emergency. o Opportunities: . What are the resources within the IAWG for collecting information on MNH outcomes when planning for comprehensive RH services?  Service delivery o How to deliver effective, safe, quality MNH care to those who need them, when and where needed, with minimal waste of resources? o 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. o 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. o Opportunities . Reframing the mother/newborn into a dyad or as part of a larger family unit in the IAFM and MISP revisions.

VIII. Research and Data

Priority for 2016-2017  Revision of Data, Monitoring and Evaluation Chapter of IAFM.

Process for IAFM Revision  Other SWG approaches for IAFM revisions. o Safe Abortion Care SWG will talk about broader changes that should be made as a group and then individuals will offer to draft sections. Drafts will be shared with larger SWG for edits before pulling them all together to submit to IAWG. o Contraception SWG will take a different approach: as a group they will discuss edits that should be made to the chapter and then one member will volunteer to incorporate edits into a draft for IAWG  The SWG will form a task group (survey will be sent out for volunteers) who will decide what the best process is moving forward but will involve leading revisions and sharing with the broader group. 11 12