Developing Institutional Capacity for Reproductive Health in Humanitarian Settings: A Descriptive Study.
BACKGROUND
Institutions play a central role in advancing the field of reproductive health in humanitarian settings (RHHS), yet little is known about organizational capacity to deliver RHHS and how this has developed over the past decade. This study aimed to document the current institutional experiences and capacities related to RHHS.


METHODS
Descriptive study using an online questionnaire tool.


RESULTS
Respondents represented 82 institutions from 48 countries, of which two-thirds originated from low-and middle-income countries. RHHS work was found not to be restricted to humanitarian agencies (25%), but was also embraced by development organizations (25%) and institutions with dual humanitarian and development mandates (50%). Agencies reported working with refugees (81%), internally-displaced (87%) and stateless persons (20%), in camp-based settings (78%), and in urban (83%) and rural settings (78%). Sixty-eight percent of represented institutions indicated having an RHHS-related policy, 79% an accountability mechanism including humanitarian work, and 90% formal partnerships with other institutions. Seventy-three percent reported routinely appointing RH focal points to ensure coordination of RHHS implementation. There was reported progress in RHHS-related disaster risk reduction (DRR), emergency management and coordination, delivery of the Minimum Initial Services Package (MISP) for RH, comprehensive RH services in post-crisis/recovery situations, gender mainstreaming, and community-based programming. Other reported institutional areas of work included capacity development, program delivery, advocacy/policy work, followed by research and donor activities. Except for abortion-related services, respondents cited improved efforts in advocacy, capacity development and technical support in their institutions for RHHS to address clinical services, including maternal and newborn health, sexual violence prevention and response, HIV prevention, management of sexually-transmitted infections, adolescent RH, and family planning. Approximately half of participants reported that their institutions had experienced an increase in dedicated budget and staff for RHHS, a fifth no change, and 1 in 10 a decrease. The Interagency RH Kits were reportedly the most commonly used supplies to support RHHS implementation.


CONCLUSIONS
The results suggest overall growth in institutional capacity in RHHS over the past decade, indicating that the field has matured and expanded from crisis response to include RHHS into DRR and other elements of the emergency management cycle. It is critical to consolidate the progress to date, address gaps, and sustain momentum.
School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia.
Nguyen-Toan
NT
Tran
WHO Collaborating Centre, Faculty of Health, University of Technology, Sydney, Australia.
Angela
A
Dawson
International Medical Corps, Washington, DC, United States of America.
Janet
J
Meyers
Women's Refugee Commission, New York, New York, United States of America.
Sandra
S
Krause
School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia.
Carina
C
Hickling
D000533:Altruism; D002662:Child Health Services / Q000458:organization & administration*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008427:Maternal Health Services / Q000458:organization & administration*; D011247:Pregnancy; D034121:Reproductive Health Services / Q000458:organization & administration*