Lessons Learned from Reproductive Health Surveillance in Za atari Refugee Camp Jordan, 2013-2014 Michelle Dynes, EIS Officer/Epidemiologist, CDC Rachel Idowu, Medical Epidemiologist, CDC Ann Burton, Senior Public Health Officer, UNHCR Dina Jardaneh, Associate Public Health Officer, UNHCR Maysa Al-Khateeb, Emergency Reproductive Health Officer, UNFPA Shible Sahbani, Humanitarian Coordinator, UNFPA Sathyanarayanan Doraiswamy, Emergency RH Officer, UNHCR Basia Tomczyk, Health Scientist, CDC Center for Global Health Emergency Response and Recovery Branch
Za atari Refugee Camp Reproductive Health Surveillance BACKGROUND
Syrian Refugees Today http://data.unhcr.org/syrianrefugees/country.php?id=107 http://misp.lacrounfpa.org/unfpa/mispcalculator/advocacy/nje5mtywozqwozi0ozu7odu%3d
Syrian Refugees Today 155,647 http://data.unhcr.org/syrianrefugees/country.php?id=107 http://misp.lacrounfpa.org/unfpa/mispcalculator/advocacy/nje5mtywozqwozi0ozu7odu%3d
Syrian Refugees Today 155,647 18,678 http://data.unhcr.org/syrianrefugees/country.php?id=107 http://misp.lacrounfpa.org/unfpa/mispcalculator/advocacy/nje5mtywozqwozi0ozu7odu%3d
Jordan and Za atari Refugee Camp Aug 2013
Jordan and Za atari Refugee Camp Aug 2013 More than 520,000 refugees in Jordan Majority of refugees in urban settings
Jordan and Za atari Refugee Camp Aug 2013 More than 520,000 refugees in Jordan Majority of refugees in urban settings Over 120,000 Syrian refugees in Za atari camp 30,504 women aged 15-49 3,660 pregnant women
Photo 7/2013: http://www.mirror.co.uk/news/world-news/syriarefugee-camp-aerial-pictures-2067144
Za atari Refugee Camp Reproductive Health Surveillance HEALTH INFORMATION SYSTEM
UNHCR Health Information System (HIS)
UNHCR Health Information System (HIS) Standardized tool to design, monitor, and evaluate refugee public health HIS is implemented in over 18 countries Targets over 2.1 million refugees in camp and non-camp settings
UNHCR Health Information System (HIS) Standardized tool to design, monitor, and evaluate refugee public health HIS is implemented in over 18 countries Targets over 2.1 million refugees in camp and non-camp settings Up to 10 technical sections with three core pillars
UNHCR Health Information System (HIS) Standardized tool to design, monitor, and evaluate refugee public health HIS is implemented in over 18 countries Targets over 2.1 million refugees in camp and non-camp settings Up to 10 technical sections with three core pillars Standards and Indicators Tools and Guidelines Coordination and Support
UNHCR Health Information System (HIS) Standardized tool to design, monitor, and evaluate refugee public health HIS is implemented in over 18 countries Targets over 2.1 million refugees in camp and non-camp settings Up to 10 technical sections with three core pillars Standards and Indicators Tools and Guidelines Coordination and Support
UNHCR Health Information System (HIS) Standardized tool to design, monitor, and evaluate refugee public health HIS is implemented in over 18 countries Targets over 2.1 million refugees in camp and non-camp settings Up to 10 technical sections with three core pillars Standards and Indicators Tools and Guidelines Coordination and Support
Problem Statement RH component of the HIS in Za atari needed improvement Many contributing factors Transition & consolidation of comprehensive RH services highlighted need for quality RH data Delivery Room in Za atari Camp/UNFPA
Za atari Refugee Camp Reproductive Health Surveillance EVALUATION DESIGN
Evaluation Objectives
Evaluation Objectives Review the RH component of Za atari HIS Review national RH HIS and reporting templates to ensure proposed changes reflect national RH Implement a system for maternal and neonatal mortality audits in Za atari Provide technical support and facilitate implementation of RH component of HIS Develop an action plan to implement the proposed recommendations
Evaluation Objectives Review the RH component of Za atari HIS Review national RH HIS and reporting templates to ensure proposed changes reflect national RH Implement a system for maternal and neonatal mortality audits in Za atari Provide technical support and facilitate implementation of RH component of HIS Develop an action plan to implement the proposed recommendations
Evaluation Objectives Review the RH component of Za atari HIS Review national RH HIS and reporting templates to ensure proposed changes reflect national RH Implement a system for maternal and neonatal mortality audits in Za atari Provide technical support and facilitate implementation of RH component of HIS Develop an action plan to implement the proposed recommendations
Evaluation Objectives Review the RH component of Za atari HIS Review national RH HIS and reporting templates to ensure proposed changes reflect national RH Implement a system for maternal and neonatal mortality audits in Za atari Provide technical support and facilitate implementation of RH component of HIS Develop an action plan to implement the proposed recommendations
Evaluation Objectives Review the RH component of Za atari HIS Review national RH HIS and reporting templates to ensure proposed changes reflect national RH Implement a system for maternal and neonatal mortality audits in Za atari Provide technical support and facilitate implementation of RH component of HIS Develop an action plan to implement the proposed recommendations
Evaluation Methods
Evaluation Methods August 18 to September 14, 2013 Qualitative Key informant interviews Facility site visits Review of RH documents, tools, and indicators Stakeholder meetings Quantitative HIS reproductive health data
Evaluation Methods August 18 to September 14, 2013 Qualitative Key informant interviews Facility site visits Review of RH documents, tools, and indicators Stakeholder meetings Quantitative HIS reproductive health data
Evaluation Methods August 18 to September 14, 2013 Qualitative Key informant interviews Facility site visits Review of RH documents, tools, and indicators Stakeholder meetings Quantitative HIS reproductive health data
Za atari Refugee Camp Reproductive Health Surveillance THE FINDINGS
Multiple Non-traditional Health Actors
Multiple Non-Traditional Health Actors Varied data collection methods High staff turnover Lack of information sharing
Multiple Non-Traditional Health Actors Varied data collection methods High staff turnover Lack of information sharing
Multiple Non-Traditional Health Actors Varied data collection methods High staff turnover Lack of information sharing
Multiple Non-Traditional Health Actors Varied data collection methods High staff turnover Lack of information sharing Contributed to incomplete & inconsistent reporting
Multiple Non-Traditional Health Actors Varied data collection methods High staff turnover Lack of information sharing Contributed to incomplete & inconsistent reporting Reduced data quality
Data Quality Weekly HIS Profile Reports
Data Quality Weekly HIS Profile Reports Few health actors reported family planning (FP) data
Data Quality: Weekly HIS Detailed Reports
Data Quality: Weekly HIS Detailed Reports No mechanism to monitor complete postnatal care (PNC)
Data Quality: Weekly HIS Detailed Reports No mechanism to monitor complete postnatal care (PNC) No SGBV cases reported
Za atari Refugee Camp Reproductive Health Surveillance ACTION PLAN
Health Information System Action Plan Standardize RH Data Collection Improve information Sharing Encourage timely submission Train on registers and user guides Develop FP register Development of a RH Tally Sheet
Health Information System Action Plan Standardize RH Data Collection Improve information Sharing Encourage timely submission Train on registers and user guides Develop FP register Development of a RH Tally Sheet Pregnancy Card implementation Involve CHWs
Health Information System Action Plan Standardize RH Data Collection Improve information Sharing Encourage timely submission Train on registers and user guides Develop FP register Development of a RH Tally Sheet Pregnancy Card implementation Involve CHWs Identify a RH Focal Point within each partner Implement a Mortality Event Review & Response protocol
Za atari Refugee Camp Reproductive Health Surveillance LESSONS LEARNED
A flexible, systematic approach to data collection and reporting is needed Lessons Learned
Lessons Learned A flexible, systematic approach to data collection and reporting is needed Engagement with and training of health actors on key RH data to be collected at different phases
Lessons Learned A flexible, systematic approach to data collection and reporting is needed Engagement with and training of health actors on key RH data to be collected at different phases Agreement on and development of a standardized approach to RH data collection at global level
Lessons Learned A flexible, systematic approach to data collection and reporting is needed Engagement with and training of health actors on key RH data to be collected at different phases Agreement on and development of a standardized approach to RH data collection at global level Using RH registers early in a crisis highlight key women s health outcomes and guide interventions
Provider involvement in development and adoption of tools enhances commitment and collaboration Lessons Learned
Lessons Learned Provider involvement in development and adoption of tools enhances commitment and collaboration Data sharing between services provided inside and outside the camps
Lessons Learned Provider involvement in development and adoption of tools enhances commitment and collaboration Data sharing between services provided inside and outside the camps Evaluate quality of HIS data early & work with partners to develop and implement an action plan
Acknowledgements UNHCR UNFPA Ministry of Health, Jordan Za atari Health Actors - GSF, IMS, IRD, JHAS, MDM, MFH, MSF, RMS, Saudi Clinic CDC Syrian refugee population For more information please contact Centers for Disease Control and Prevention 1600 Clifton Road NE, Atlanta, GA 30333 Telephone, 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348 E-mail: cdcinfo@cdc.gov Web: www.cdc.gov The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. Center for Global Health Emergency Response and Recovery Branch