Antiretroviral therapy for refugees and internally displaced persons: a call for equity.

Available evidence suggests that refugees and internally displaced persons (IDPs) in stable settings can sustain high levels of adherence and viral suppression. Moral, legal, and public health principles and recent evidence strongly suggest that refugees and IDPs should have equitable access to HIV treatment and support. Exclusion of refugees and IDPs from HIV National Strategic Plans suggests that they may not be included in future national funding proposals to major donors. Levels of viral suppression among refugees and nationals documented in a stable refugee camp suggest that some settings require more intensive support for all population groups. Detailed recommendations are provided for refugees and IDPs accessing antiretroviral therapy in stable settings

Progress and gaps in reproductive health services in three humanitarian settings: mixed-methods case studies

Background Reproductive health (RH) care is an essential component of humanitarian response. Women and girls living in humanitarian settings often face high maternal mortality and are vulnerable to unwanted pregnancy, unsafe abortion, and sexual violence. This study explored the availability and quality of, and access barriers to RH services in three humanitarian settings in Burkina Faso, Democratic Republic of the Congo (DRC), and South Sudan. Methods Data collection was conducted between July and October 2013. In total, 63 purposively selected health facilities were assessed: 28 in Burkina Faso, 25 in DRC, and nine in South Sudan, and 42 providers completed a questionnaire to assess RH knowledge and attitudes. Thirty-four focus group discussions were conducted with 29 members of the host communities and 273 displaced married and unmarried women and men to understand access barriers. Results All facilities reported providing some RH services in the prior three months. Five health facilities in Burkina Faso, six in DRC, and none in South Sudan met the criteria as a family planning service delivery point. Two health facilities in Burkina Faso, one in DRC, and two in South Sudan met the criteria as an emergency obstetric and newborn care service delivery point. Across settings, three facilities in DRC adequately provided selected elements of clinical management of rape. Safe abortion was unavailable. Many providers lacked essential knowledge and skills. Focus groups revealed limited knowledge of available RH services and socio-cultural barriers to accessing them, although participants reported a remarkable increase in use of facility-based delivery services. Conclusion Although RH services are being provided, the availability of good quality RH services was inconsistent across settings. Commodity management and security must be prioritized to ensure consistent availability of essential supplies. It is critical to improve the attitudes, managerial and technical capacity of providers to ensure that RH services are delivered respectfully and efficiently. In addition to ensuring systematic implementation of good quality RH services, humanitarian health actors should meaningfully engage crisis-affected communities in RH programming to increase understanding and use of this life-saving care

The forgotten population? A call to invest in adolescent well-being in humanitarian and fragile settings

Adolescents are disproportionately affected in humanitarian and fragile settings, where they will often find themselves in high-risk situations and may be forced to take on adult roles within their families and communities. They are also more likely to have poor well-being outcomes related to disrupted or no access to optimum nutrition, health services and protection, as well as opportunities for education, training, and employment. Our paper aims to provide an overview of current interventions focusing on adolescent well-being and to provide a set of policy and programmatic recommendations to prevent long-term consequences of crisis and conflict on adolescents’ lives. According to the UN H6+ Technical Working Group on Adolescent Health and Well-beings’ framework for adolescent well-being, this article analyses adolescents’ backgrounds and interventions oriented to them within humanitarian and fragile settings. In this sense, we refer to five domains that include: good health and optimum nutrition; connectedness, positive values and contribution to society; safety and a supportive environment; learning, competence, education, skills and employability; and agency and resilience

Funding for reproductive health in conflict and post-conflict countries: a familiar story of inequity and insufficient data.

Paul Spiegel and colleagues discuss a new study that examines funding for sexual and reproductive health programs in conflict-affected low-income countries

Family planning in refugee settings: findings and actions from a multi-country study

Abstract Background To address family planning for crisis-affected communities, in 2011 and 2012, the United Nations High Commissioner for Refugees and the Women’s Refugee Commission undertook a multi-country assessment to document knowledge of family planning, beliefs and practices of refugees, and the state of service provision in the select refugee settings of Cox’s Bazar, Bangladesh; Ali Addeh, Djibouti; Amman, Jordan; Eastleigh, Kenya; Kuala Lumpur, Malaysia; and Nakivale, Uganda. Methods The studies employed mixed methods: a household survey, facility assessments, in-depth interviews, and focus group discussions. Results Findings on awareness and demand for family planning, availability, accessibility, and quality of services showed that adult women aged 20–29 years were significantly more likely to be aware, to have ever used, or are currently using a modern method as compared to adolescent girls aged 15–19 years. Facility assessments showed limited availability of certain methods, especially long-acting and permanent methods. Despite availability, in all sites, focus group discussion participants—especially adolescents—reported many accessibility-related barriers to using existing services, including distant service delivery points, cost of transport, lack of knowledge about different types of methods, misinformation and misconceptions, religious opposition, cultural factors, language barriers with providers, and provider biases. Conclusion Based on gaps, partners to the study developed short and long-term recommendations around improving service availability, accessibility, and quality. There remains a need to scale up support for refugees, particularly around adolescent access to family planning services.https://deepblue.lib.umich.edu/bitstream/2027.42/136880/1/13031_2017_Article_112.pd

Neonatal survival interventions in humanitarian emergencies: a survey of current practices and programs.

BACKGROUND: Neonatal deaths account for over 40% of all deaths in children younger than five years of age and neonatal mortality rates are highest in areas affected by humanitarian emergencies. Of the ten countries with the highest neonatal mortality rates globally, six are currently or recently affected by a humanitarian emergency. Yet, little is known about newborn care in crisis settings. Understanding current policies and practices for the care of newborns used by humanitarian aid organizations will inform efforts to improve care in these challenging settings. METHODS: Between August 18 and September 25, 2009, 56 respondents that work in humanitarian emergencies completed a web-based survey either in English or French. A snow ball sampling technique was used to identify organizations that provide health services during humanitarian emergencies to gather information on current practices for maternal and newborn care in these settings. Information was collected about continuum-of-care services for maternal, newborn and child health, referral services, training and capacity development, health information systems, policies and guidelines, and organizational priorities. Data were entered into MS Excel and frequencies and percentages were calculated. RESULTS: The majority of responding organizations reported implementing components of neonatal and maternal health interventions. However, multiple barriers exist in providing comprehensive care, including: funding shortages (63.3%), gaps in training (51.0%) and staff shortages and turnover (44.9%). CONCLUSIONS: Neonatal care is provided by most of the responding humanitarian organizations; however, the quality, breadth and consistency of this care are limited

Recommendations for provision of antiretroviral therapy to refugees and IDPs in stable settings.

<p>ART, antiretroviral therapy; MOH, Ministry of Health; NSP, National Strategic Plan; PEPFAR.</p

Results of UNHCR-sponsored evaluations conducted in Malaysia and Kenya.

a<p>≥25 weeks on treatment; cut-offs: Malaysia, 40 copies/ml and Kenya, 5,000 copies/ml. The difference in cut-offs was due to collection method: blood plasma was collected using routine phlebotomy services in Malaysia and whole blood was collected as dried blood spots in Kenya. Note that the 5000 copies/ml cut-off used here differs from the 1000 copies/ml reported previously <a href="http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.1001643#pmed.1001643-Mendelsohn3" target="_blank">[29]</a>. A higher cut-off has been used to conform to current guidelines <a href="http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.1001643#pmed.1001643-World2" target="_blank">[36]</a>.</p>b<p>≥30 days on treatment.</p