Wishful thinking versus operational commitment: is the international guidance on priority sexual and reproductive health interventions in humanitarian settings becoming unrealistic?

Abstract

Twenty-one years ago, a global consortium of like-minded institutions designed the landmark Minimum Initial Service Package (MISP) for sexual and reproductive health (SRH) to guide national and international humanitarian first responders in preventing morbidity and mortality at the onset of chaos, destruction, and high insecurity caused by disasters or conflicts. Since then, the MISP has undergone limited change and has become an international reference in humanitarian response. This article discusses our perspectives regarding the 2018 changes to the MISP that have created division among humanitarian field practitioners, academics, advocates, and development agencies. With more than 50 pages, the new MISP chapter dilutes key guidance and messages on the most life-saving activities, leaving actors with excessive room for interpretation as to which priority activities need to be first implemented. Consequently, non-life-saving interventions may take precedence over essential ones. Insecurity, scarce human and financial resources, logistics constrains, and other limitations imposed by field reality at the onset of a crisis must be considered. We strongly recommend that an institution with the mandate, legitimacy, and technical expertise in the review of guidelines reexamines the 2018 edition of the MISP. We urge experienced first-line responders, national actors, and relevant agencies to join efforts to ensure that the MISP remains focused on a very limited set of essential activities and supplies that are pragmatic, field-oriented, and, most importantly, immediately life-saving for people in need.

A forgotten group during humanitarian crises: a systematic review of sexual and reproductive health interventions for young people including adolescents in humanitarian settings

“…These findings show that the limited spectrum of SRH services delivered in humanitarian settings has not changed since previous evaluations [16, 17]. Even though the MISP has been criticised by some actors as being too comprehensive to deliver at the start of a crisis [44], we would argue that the interventions described in this package should at the very least be provided to populations including young people in stabilised post-conflict settings.…”

Integrating sexual and reproductive health into health system strengthening in humanitarian settings: a planning workshop toolkit to transition from minimum to comprehensive services in the Democratic Republic of Congo, Bangladesh, and Yemen

“…This was confirmed in January 2017 when we reviewed the literature on Google Scholar and Google Search using word strings or equivalents combining reproductive health , MISP, humanitarian, transition, and comprehensive services. We proceeded with the design process, which first engaged members of the IAWG who had extensive operational experience, including in facilitating the SRH response coordination as well as recovery planning in complex emergencies, and who struggled over the years with conveying what is lifesaving and comprehensive SRH [ 17 ]. Drawing from their MISP implementation practice and capacity development experience related to the coordination of the MISP and MISP-related clinical services, authors outlined the contents of the toolkit before extending successive drafts to other IAWG members [ 18 ].…”

Navigating the crisis landscape: engaging the ministry of health and United Nations agencies to make abortion care available to Rohingya refugees

“…However, not all in the humanitarian community agreed. In their 2018 article on the 2018 IAFM revision [21], the authors describe feeling that the process of including safe abortion care in the MISP had gone too far. In an argument that echoes, "abortion is too complicated" in the early days of an emergency, Tran and Schulte-Hillen contend that during acute emergencies, the technical capacity and leadership on SRH is too limited to attempt to develop and implement abortion services.…”