A monitoring and evaluation team from the School of Public Health and Community Medicine, UNSW Associate Professor Anna Whelan and future PhD candidates) were involved in a week of training of trainers on sexual and reproductive health in crisis in Kuala Lumpur at the end of April. The PhD candidates will be following up on several aspects of this AusAID funded initiative, exploring the broad question of aid effectiveness and whether training “works”. One student will be examining the curriculum and training; the other will be following a cohort of participants to analyse their impact on their organisations and whether changes resulted; the third will be examining participants’ roles during a crisis. Little did the team expect that this would happen so soon!

At the training, over 40 participants mainly from the East and Southeast Asia region were grouped into twelve country teams. Each of the country teams came up with an action plan to integrate sexual and reproductive health (SRH) into their country’s emergency preparedness plans. Sessions included hands-on logistics and coordination exercises and each individual was asked to take on personal responsibility for ensuring implementation so that the needs of women and children in crisis and disasters were better met. The Myanmar country team was represented by two national officers of UNHCR and UNFPA. Another of the participants was from the regional UN Office for the Coordination of Humanitarian Affairs.

As soon as the training of trainers ended, cyclone Nargis hit Myanmar on 2 and 3 May 2008 affecting millions of persons. The two participants arrived home in Myanmar on the 5th and were instructed to assist in the emergency coordination efforts. Once communications were restored, they were in contact with each other, the SPRINT Secretariat in IPPF Regional Office in Kuala Lumpur and UNSW and have kept all updated of the situation - that is not being reported in much of the media. They were also in contact with the Regional Office Asia-Pacific of UNOCHA and the Thailand country team that was composed of national staff from UNFPA and the Thai Red Cross who were also active in the emergency relief efforts from their end.

What is most heartening is that the participants began using the information and methods gained from the training: they attended the coordination meetings (Health Cluster) and were advocating for what they had learned in the training; they decided that they needed to form a SRH sub-cluster; they requested materials from the training that would assist them to advocate for ordering the correct supplies/kits and appropriate coordination mechanisms; they worked with the local and international non-government organisations that were very active and they were able to get out into the delta area to educate and advocate for women and children.

Evidence from their communication and efforts on the ground will form part of the report from UNSW monitoring team to AusAID and IPPF, showing that research can provide timely and valuable information. However longer term, lessons learned will be drawn to assist Australia’s response to providing aid effectively. The next training of trainers of the Minimum Initial Service Package for SRH in Crises will be held in Sydney June 30th-July 4th and Fiji July 7-11th.

Updates from participants:

• By the 9th of May, we received this response from our colleague indicating supplies were arriving and being distributed locally:
• “Thanks a lot for all the contacts and efforts for Myanmar. UNFPA sent RH kits about 10 kits each of block A & B, and 1 set of Kit 11A&B which are arriving tomorrow. The MOH camp is now in Yangon General Hospital and I met with them, explained about the kits for distribution plan. We also received $30,000 and are preparing 5,000 dignity kits initially.
• I will attend the cluster meeting for protection at 5pm this evening. Ms. PTT, Assistant Rep and Dr. NW, NPO will be in Health cluster, but we will work together. I am copying MISP CDs to distribute to relief agencies.
• I am translating MISP awareness and guideline for field level staff, and almost finish now. We all are very sad because of the news from the field. Best regards,”
• On the 13th of May the Situation Report from UNOCHA included information that SRH supplies had been received and were being distributed by a number of non-government organisations in Yangon and the delta areas. The participants went out to the delta areas and were planning to advocate for the needs of women and children and were going to conduct their own assessment of the situation in the field.

The update on the 14th of May was hopeful:

“Please be informed that UNHCR provided clean delivery kits to Health Implementing Partners, AMI,`MSF-AZG and Malteser to provide the pregnant women at their camp-based medical team and at their mobile medical teams in Nargis affected areas in Yangon and Ayeyarwady Divisions. During the meetings with health IPs, I explained MISP Chart to respective health coordinators and medical officers and requested them to emphasize on Maternal and child care in the camps and in affected community, to make sure availability of condoms (UNHCR provided male and female condoms to IPs and PSI also provided their General Practitioners at affected areas) and also availability of required treatment for HIV and STI including ART. It was reported by AZG that there is an increased demand of condoms and contraceptives at their existing clinics, camp-based clinics and mobile clinics in affected areas. During my monitoring trip to Ayeyarwady Division (Planned to go tomorrow), I have planned to make advocacy to Township Medical Officers on MISP if I get a chance as UNHCR is mainly focusing on shelter, logistics and protection. In addition, I'll check the situation of the hospitals whether they can utilize RH kits which will be provided by UNFPA or not, so that UNFPA can decide which hospital need to provide RH kits.”

On the 20th of May we received information about their activities during the week and they provided information about what was lacking in the standard kits that had been sent:

“Please be informed that UNFPA organised an orientation session on MISP of SRH in Crisis situation to the medical doctors who are volunteering in the medical mobile teams in Nargis affected areas on 17 May 2008. Overall goal, objectives and activities were briefed by me and Thwe explained them in detail. We mainly focused on Maternal and Neonatal Health, HIV/STI and finally followed by SGBV to avoid sensitivity. The session was followed by discussion and availability of technical and material support mainly by UNFPA. We will conduct some more sessions in the next week.

During my field trips to the affected Townships on 17 May and 19 May, I explained about MISP to the medical officers including specialists and military doctors of mobile teams. I got the opportunity to discuss with camp in charge for the preventive measures of SGBV in & around the camps, discussed with medical teams for the continuous availability of CDK, regular AN care with TT for pregnant women, Contraceptives, condoms, HIV/ HBS/STI test kits, STI drugs, ART. Although Contraceptives, ART, STI treatment are not included in MISP, these are also important for the people in the crisis situation [note from the SPRINT Secretariat: STI treatment and family planning are part of comprehensive SRH, which is a key objective of the MISP]. Since Indian, China and Laos medical teams are providing medical treatment, they agreed to support for MISP as much as they can.

However, I didn't get the chance to meet with Government Health authorities during my trips.”

On the 26th of May we received information that the meetings and trainings for government health practitioners went underway and that more sessions will be held for volunteer doctors:

“Please find this wk's update sent by Dr. Paul Spiegel, Chief, Public Health and HIV Section, DOS, UNHCR FYI. In addition, I got the opportunity to share the same information during the meeting with State Health Director, Mon State Health department on 22 May 2008 during our meeting and he promised to share MISP-SRH information with all agencies in Mon State and the health officials at their coordination meeting which will be held on 27 May 2008. The State Health Director will also discuss with agencies on the availability of necessary supplies for prevention and manangement of maternal & neonatal health, HIV/STI and SGBV. We will conduct the next session on 27 May 2008 for Myanmar volunteer doctors at Myanmar Medical Association.”

UNHCR Weekly Public Health and HIV update of 15-21 May 2007 wrote:

“Myanmar: HCR Health Coordinator and UNFPA staff gave orientation on Min’m Initial Service Package for Repro Health in Crisis situation to the newly arrived Indian, Chinese and Laos medical doctors volunteering to provide assistance to the victims of the cyclone. Main focus was on Maternal and Neonatal Health, HIV/STI and SGBV. This message was repeated on several occasions during 2 day trips by Health Coordinator to Nargis affected Townships; in particular, medical officers including military doctors participating in mobile teams were oriented on MISP; Camp in charge officers were sensitized about the preventive measures of SGBV in & around the camps.”

On 30th of May 2008, Myanmar country team again provided updates:

“Requested and organized by Burnet Institute, UNFPA and UNHCR conducted an orientation session on "Women protection and MISP of SRH in Crisis situation" to the medical doctors, coordinators, field workers and volunteers from 16 agencies who are involving in Nargis emergency response on 29 May 2008 and over 40 participants attended. In addition to the information on MISP, we emphasized the key advocacy messages on women protection. During the general discussion, UNFPA announced that “Clean Delivery Kits’, contraceptives & condoms and “Dignity Kits” for women and girls are available for all agencies who are implementing emergency response. UNHCR is responsible to provide shelter material and tool, non-food items like kitchen sets, blankets, soap, ITN and etc; UNHCR is also distributing CDK, contraceptives and condoms in some affected areas through implementing partners.

I planned to conduct a session for UNHCR staff on 04 June 2008.”

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SPRINT Secretariat

26 June 2008