Humanitarian response to reproductive and sexual health needs in a disaster: the Nepal Earthquake 2015 case study

Figures & data

Figure 1. Map of Nepal, Nepal Earthquake 2015 epicentres

Figure 2. MISP for RH. Source: UNFPA fact-sheet¹⁷

Table 1. Response interventions implemented during the immediate response phase, after Nepal Earthquake 2015

Distribution of individual clean delivery kits
Description	Clean delivery kits including chlorhexidine for prevention of umbilical cord infection among newborns
Beneficiaries	1100 visibly pregnant women in all 31 earthquake-affected districts, except in Kathmandu Valley
Setting up of WHO Medical Camp Kits (MCKs) and medical tents
Description	40 MCKs provided by WHO with all necessary equipment for establishing a birthing centre and a functional outpatient department More than 350 medical tents provided by UNFPA, UNICEF and German Development Cooperation MCKs were installed in damaged hospitals, primary health centres and health posts to serve as emergency shelters for the provision of health services Other medical tents served as shelters for RH services
Outcomes	More than 100 birthing centres resumed their services under these tents
Deployment of nursing and medical teams with skilled birth attendance competencies
Description	25 nurses qualified as skilled birth attendants (in 24 birthing centres) were deployed as well as 8 senior nurses (to cover 40 birthing centres) This programme was supported by UNICEF and implemented through the MIDSON The nurses volunteered from Government hospitals and nursing colleges They provided extra support and onsite coaching to the regular maternity staff, helped staff cope with the surge of activities, and facilitated institutional deliveries and timely management of complicated pregnancies/deliveries. Some nurses also volunteered to join NGOs' emergency programmes One roving obstetrician was deployed to the affected hospitals to initiate/continue c-sections and other medical reproductive health procedures
Outcomes	By June 2015: antenatal care was re-established in all services sites; majority of birthing centres were able to provide delivery services and c-section services were available in 13/14 district hospitals
Organisation of outreach reproductive health camps
Description	The RH camps were mobile in nature, remaining in one site for about 2–4 days before moving to the next community. The number of mobile camps ranged from 8–14 per district considering its population coverage and needs. It also included on-site local capacity-building, enabling referrals to health facilities and a mobile unit for awareness raising sessions. It was implemented together with District Public Health Offices (DPHOs). Information on the scheduled dates for mobile RH camps was disseminated through Female Community Health Volunteers (FCHVs) youth groups prior to the camps 132 RH camps were conducted in 128 villages, with support from UNFPA RH camps were carried out by national health professionals Provided SRH services free of charge for earthquake-affected people in remote communities in all 14 affected districts^Citation7 Provided life-saving healthcare support to women and their families, ranging from antenatal and postnatal check-ups, safe delivery, family planning, lab testing facilities (including for HIV), management of sexually transmitted infections (STI), psychosocial support, health response to gender-based violence and referrals. Key health messages and information were delivered to women and girls Free of charge transportation of severe cases identified through the camp ensured
Beneficiaries	104,740 women and adolescent girls reached. UNFPA has estimated that the needs of 1.4 million affected people were covered
Distribution of emergency reproductive health (ERH) kits
Description	1331 ERH kits provided to tertiary level hospitals, district hospitals and smaller health facilities in all the 14 most affected districts, through a total of 37 partners. The kits were also used in the outreach RH camps and in the WHO Medical Camp Kits. The additional kits were supplied/replenished depending on the request from MoH, DPHOs and /or implementing partners Provided at community, primary health care and referral hospital levels, ranging from one to up to 35 boxes of equipment Kits included contraceptives, drugs and supplies for STI treatment and clinical delivery assistance, instruments, equipment and supplies for the management of obstetric complications, including assisted deliveries and c-sections, medical abortion and post-rape treatment kits Misoprostol was added to the kits where a programme aiming to prevent post-partum haemorrhage during home deliveries was already ongoing
Outcomes	213 health facilities benefited from the ERH kits UNFPA has calculated that the needs of an estimated 1.4 million affected population were covered
Provision of psychosocial counselling
Description	Provision to maternity hospital health workers who needed support, on voluntary basis, for six weeks after the disaster to help them cope with the stress induced by the earthquake and repeated aftershocks and the unprecedented surge in caseload they were handling Social mobilisers and health services providers trained on psychosocial counselling were identified and hired in close collaboration with DPHO and DWO
Beneficiaries	About one quarter of the 400 staff of the central referral maternity hospital, in Kathmandu

Figure 3. Coordination of SRH sector interventions, Nepal earthquake 2017

Table 2. Response interventions implemented during the intermediate response phase, after Nepal Earthquake 2015

Establishment of shelter and transition homes
Description	14 shelters (UNFPA) and 36 transition homes (UNICEF) established adjacent to district hospitals and health facilities in all affected districts except Kathmandu To temporarily house mothers, newborns and injured children under 5 years, to secure their access to health services, food, water and sanitation before they could safely return to their communities Winterised to offer a safe haven during winter
Beneficiaries	15,031 pregnant or post-partum women, >5000 newborns in 13 districts; unknown number of injured children under 5 years of age Nearly one out of six of these women belonged to traditionally marginalised Dalit communities
Establishment of female friendly spaces
Description	97 Female-friendly spaces (FFS) established in the 14 districts, including 14 supported by UNFPA and German Development Cooperation Consisted of large tents staffed with care-takers and counsellors, established near health facilities to offer a multisectoral response to gender-based violence
Beneficiaries	147,337 women and adolescent reached Over 15,000 adolescent girls and women survivors of GBV reached with psycho-social counselling services 2799 cases of GBV recorded by UNFPA (pooled with cases recorded through outreach RH camps)
Establishment of adolescent-friendly services corners
Description	Adolescent-friendly service corners set-up in all 132 outreach RH camps, with linkages with adolescent-friendly information corners in schools and adolescent-friendly service centres in health facilities Run by trained adolescent facilitators Awareness-raising activities conducted to promote the use of SRH services. Topics covered: consequences of teenage/adolescent pregnancy, childbirth, danger signs during pregnancy, contraceptives, issues relating to menstrual health and hygiene, consequences of unsafe abortion, gender-based violence and risk of STIs, HIV
Beneficiaries	4231 young people reached (of which 71% females) by awareness programmes 14,666 adolescents received adolescent sexual and RH services
Implementation of a menstrual health and hygiene management (MHM) programme
Description	Sanitary pads were distributed for free through MoH and Ministry of Education to secondary schools in all 14 most-affected districts. The sanitary pads were donations from India and China School teachers and health workers trained on menstrual health management information and education and on how to make re-usable sanitary pads.
Beneficiaries	4148 adolescent girls in Dhading district only. The total number of beneficiaries in other districts is unknown.
Distribution of midwifery kits
Description	1080 Midwifery kits provided by UNICEF, to maternity units and birthing centres of 14 districts Midwifery kits included equipment, renewable and drugs. Delivered to birthing centres across the 14 most affected districts
Beneficiaries	Approximately 50,000 pairs of mothers and babies
Distribution of newborn suits
Description	53,000 newborn suits provided by UNICEF, for the prevention of hypothermia Delivered to birthing centres across the 14 most affected districts
Beneficiaries	53,000 newborns
Distribution of dignity kits
Description	Distribution of 56,000 kits directed by the UNFPA team or its partner agencies. Kits contained items to maintain personal hygiene and safety such as clothes, reusable sanitary pads, underwear, towel, soap, toothbrush and toothpaste, nail clippers and flashlight
Beneficiaries	56,000 women and girls
Distribution of motivational kits
Description	10,327 kits distributed by the RH sub-cluster partners Kits contained dignity kit items complemented with supplies, job aids and basic medicines to help female community health volunteers (FCHVs) continue service provision to their communities.
Beneficiaries	10,327 FCHVs

Table 3. Training, guidelines and tools developed during the recovery phase

Type	Description
Training on the IAWG Inter-agency Field Manual on Reproductive Health in Humanitarian Settings MISP guidelines^Citation8	25 public health staff trained, who later trained 100 of their colleagues in four earthquake-affected districts
Development and dissemination of a reproductive health training manual and supplementary material	Including an onsite coaching manual, plus information about outreach RH camp preparedness and a trauma-healing package
Development and implementation of a safe birth checklist	Using existing global guidelines, after training by the Nepal Health Sector Support Program (NHSSP)/DFID, to improve the quality and safety of birthing services in birthing centres and maternity units
Trainings and awareness sessions on GBV prevention and care in humanitarian settings	Provided to more than 400 protection cluster members, FCHVs , Nepal Scout members and stakeholders.^Citation19 GBV prevention messages were disseminated through local FM radios
Training on clinical management of rape	Provided to over 300 health workers in all district hospitals and other health facilities in the 14 most affected districts in collaboration with several NGOs and the main maternity hospital of Kathmandu
Training on the use of the global adolescent sexual and reproductive health toolkit in humanitarian settings^Citation20	74 health workers were trained, using a guideline adapted from global guidance, by the Family Health Division of MoH in 2014
Training on immediate trauma and mass casualty management	Provided to 56 health workers, including psycho-social first-aid, preventing post-traumatic syndrome disorder and how to find cases and refer them to relevant health facilities

Transporting medical supplies following the 2015 earthquake in Nepal

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