Gaborone, Botswana- Sexual and reproductive health needs do not pause nor stop for emergencies. Sexual activity and pregnancies do not stop for emergencies. Childbirth does not stop for emergencies. Menstruation does not stop for emergencies. These were phrases frequently used at the capacity building and advocacy workshops on the Minimum Initial Service Package (MISP) for Sexual and Reproductive Health (SRH) in emergencies, convened by the Ministry of Health and UNFPA.
The MISP for Sexual and Reproductive Health in Emergencies is a set of priority, life-saving actions required to respond to the sexual and reproductive health needs of affected populations at the onset of a crisis, and if these needs remain neglected, it could result in life-threatening consequences.
The series of workshops, supported with funding from UNFPA through the 2gether 4SRHR programme, is part of broader support to countries in the East and Southern Africa region to strengthen integration of MISP into regional and national disaster preparedness and response plans. Capacity building and advocacy for integration of MISP for SRH into national and district management plans is amongst the key priorities of the Botswana Action Plan that culminated from the 2022 MISP Readiness Assessment (MRA) supported by UNFPA and carried by broad stakeholder groups convened by the Ministry of Health. The aim of the MISP Readiness Assessment was to provide a snapshot of national and sub-national readiness and capacity to ensure access to essential SRH services during emergencies. Under the MRA thematic areas on coordination, the assessment stakeholders concluded that, whilst Botswana has a favorable legal and policy environment for disaster preparedness and response; and protection of SRHR, the national disaster and emergency preparedness plans do not specifically or adequately integrate SRH and/or the MISP.
The workshops, which were conducted across six prioritized districts of Hukuntsi, Okavango, Ngami, Letlhakeng, Tutume and Francistown brought together over 200 participants made up of district health management teams (DHMTs) including the DHMT Coordinators, Heads of Preventive Services, Medical Officers, Community Health Nurses, Nursing superintendents, nurses and midwives, heads of health facilities; and pharmacy, laboratory, health education and M&E officers among others. Other participants out of the health sector who from the first responders team included senior district level officials who are members of the District Disaster Management Committee (DDMC), District Multi-sectoral AIDS Committee (DMSAC) and Technical Advisory Committee (TAC).These district level structures are coordinated and chaired at the level of District Commissioner (DC) and District Council Secretary (CS), with membership spanning central and local government departments, government parastatals and agencies, and civil society organizations present in the district.
The specific objectives of these capacity building and advocacy workshops were to reflect on the current district disaster preparedness and response management, sensitize the district stakeholders on the importance of addressing SRH in emergencies, and advocate for the districts to commit to integration of the MISP for SRH into emergency/crisis preparedness and response plans. This integration will contribute to the reduction of preventable maternal and new-born mortality during and after crises, prevent and manage cases of sexual and gender-based violence, prevent and reduce morbidity and mortality due to HIV and other sexually transmitted infections (STIs), and prioritize access to contraceptives to reduce unintended pregnancies.
"Sexual and reproductive health services such as contraceptives, antenatal, childbirth and postnatal care, prevention of and treatment of HIV and other STIs, are part of essential health services that must continue without interruption in the event of any emergency or crisis situation, such as the recent COVID-19 outbreak or any disaster that the district or country may need to respond to. The health system must have the capacity to ensure that essential life-saving SRH services continue even amid emergencies," said Ms. Kesaobaka Dikgole, UNFPA’s SRH/HIV Linkages Coordinator.
She further underscored the importance of understanding and responding to the unique needs and vulnerabilities of different population groups such as women, girls, men, and boys, adolescents girls and you women, and marginalized populations such as people with disabilities, and people of diverse sexual orientation to ensure that no one is left behind during crisis preparedness and response. This is essential to ensuring the collective resilience of affected communities because these groups' needs, perspectives, and capacities are not only unique but also specific and in some cases with multiple intersecting vulnerabilities
Ms. Dikgole said it was crucial for the district disaster management committees to prioritize MISP for SRH during emergencies or disasters management. She also stressed the need to devote time and resources to preparedness and an effective response to disasters/emergencies and that the time to prepare is now.
She observed that globally and here in Botswana, it is evident that as health and other protective services are disrupted during emergencies or disasters, women and girls are at increased risks of unintended pregnancies, complications during pregnancy and childbirth, unsafe abortions, and all people are at heightened risks of sexual and gender based violence, STIs, and HIV acquisition, as well as harmful practices such as early, child, and forced marriages.
Participants reflected on their disaster management strategies and highlighted some of the challenges and opportunities as well as difficulties they face in discharging services. They further initiated the process of developing a district Action plan to integrate MISP into district disaster and emergency preparedness and response as a significant deliverable of the workshop.
Ms. Galaletsang Mudongo, SRH/HIV Integration Program Officer from the Ministry's SRH Division commended the participants for their insightful feedback and said that the workshop had increased the depth and quantity of their practical and applicable health knowledge, which can be useful while aiding the beneficiaries in the field.
“They now have new sets of abilities regarding how to take action to ensure the wellbeing of all beneficiaries thanks to their newly gained knowledge,” she said.
They now have new sets of abilities regarding how to take action to ensure the wellbeing of all beneficiaries thanks to their newly gained knowledge
The Inter-Agency Working Group on Reproductive Health in Crisis (IAWG) is responsible for developing the MISP. UNFPA, in partnership with stakeholders, supports the implementation of the MISP to ensure that all affected populations have access to lifesaving SRH services. The key goals of the implementation are to end unmet need for family planning, preventable maternal deaths, and gender-based violence (GBV) or harmful practices, even during humanitarian crises. UNFPA strives to ensure that MISP activities and additional SRH services are included in all phases of the humanitarian program cycle.
