1. Procurement Issues and RHCS in
Emergencies
Presented by the Humanitarian Response
Unit’s
Dr. Henia Dakkak, Technical Specialist

2. Why RH services for populations in
crisis?
Reproductive health is
• a human right
• a basic health need
• contributes to psychosocial well-being

3. RH needs continue …
in fact, increase during crisis
• Risk of sexual violence may increase
during social instability
• STI/HIV transmission can increase
• Lack of FP increases risks associated
with unwanted pregnancy

4. RH needs continue …
in fact, increase during crisis
• Malnutrition and epidemics increase
risks of pregnancy complications
• Childbirth occurs on the wayside
during population movements
• Lack of access to emergency obstetric
care increases risk of maternal death

5. Heightened risk, greater need
• Women and children
account for more than
75% of refugees and
internally displaced
• 25% of this population
at risk are women of
reproductive age. 1 in 5
is likely to be pregnant
• More than 37 million
people displaced by
war

6. 37 million people displaced
worldwide
$1 million annual seed money for operations

7. Safe motherhood and family planning
Emergencies heighten already significant risks:
•Complications of pregnancy and childbirth leading cause of death
for women under 50 in most developing countries
•Premature deliveries and miscarriages brought on by trauma
•Fewer than half of all deliveries in developing countries take place
with a skilled birth attendant

8. Continuum of an emergency
Emergency Post-emergency
Destabilizing event Durable
Durable solutions
Solutions
MISP Provision of
comprehensive RH
Minimum Initial Service Package services
Exodus of Loss of Restoration
Relative Return to
the essential of essential
stability normality
population services services

9. When does UNFPA respond?
0. before emergencies strike
1. in acute emergencies
2. in refugee and IDP settings
3. in post-conflict situations
4. in reconstruction and development

10. Before emergency strikes
Kosovo
pre-deployment of
supplies to Albania
Afghanistan
contingency planning
in surrounding
countries
Iraq
comprehensive
preparedness plan for
anticipated refugee
movements and cross-
border operations

11. Before emergency strikes
Haiti
Contingency planning for
large numbers of displaced
Bangladesh
Contingency planning for
natural disaster response

12. Acute emergencies
Deployment of equipment, supplies and RH kits
Release of funds for local procurement
RH assessments and data collection and analysis for UN-wide
targeting and response (CAP)

13. Acute crisis
Quick response saves lives
UNFPA ships pre-packaged supplies directly to field
offices, Red Cross, Governments, local partners

14. Acute crisis
Millions displaced
Health infrastructure Liberia
devastated
UNFPA has been
providing training,
medicines and supplies
through the Red Cross,
UNHCR and other
agencies, and basic
HIV prevention for
IDPs and Liberian
refugees in four West
African countries
UNFPA is the only
provider of condoms
in Liberia

15. Examples of UNFPA response
in acute emergencies
Natural Disasters: Armed Conflict:
Colombia
India Sierra Leone
El Salvador Liberia
DRC (Goma) Iraq
Kenya Congo
Malawi Indonesia - Maluku
Mexico Palestinian Territory
Iran Ivory Coast
Mongolia Afghanistan
Haiti Sudan
Grenada

16. Refugees and IDPs
For refugees and internally
displaced persons, UNFPA:
Assesses RH and gender needs
Distributes RH supplies
Provides RH information
Trains NGO and local staff for
delivery of services
Organizes HIV prevention
initiatives
Helps to prevent gender
Violence
Coordinate and collect data

17. Refugees and IDPs
Recent refugee and IDP programmes
Refugees:
Sierra Leone, Tanzania,
Uganda, Sudan,
Ethiopia, Kenya,
Zambia, Guinea, Liberia,
Pakistan, Iran, Yemen,
Palestine
IDPs:
Eritrea, Liberia,
Colombia, Afghanistan,
Angola, DRC, ROC,
Burundi, Somalia,
Tajikistan, PNG, Sudan,
CDI

18. Recovery Democratic Republic of Congo
Post-conflict recovery
• Renovation of health facilities
• Counseling
• Training
• Equipment and supplies
• Support to local NGOs
• Demographic data
Not enough beds, Bas Congo

19. Recovery Afghanistan
Reconstruction
Rehabilitation of Hospital
Baby Ahmed!
6.5 pounds
Mother in good shape
2nd child, 6th pregnancy

21. Recovery Angola
Establishment of maternal mortality programs
Rehabilitation of
maternity centers
Provision of
equipment, supplies
Retraining of health
staff
Reestablishment of
EmOC
HIV prevention
Safe blood supply
Strengthening of
referral systems

22. How does UNFPA respond?
1) Initial authorization up to $50,000-local procurement,
transportation, consultants, etc.
2) Estimate the needs for RH kits
3) Emergency shipment of RH kits
3) Provision of technical assistance (advice and training)
4) Monitoring of RH service provision to affected
population and kits distribution and data collection of
RH indicators (access, coverage, availability of RH
commodities and forecasting)
5) Advocacy for funding and inclusion of RH services
and commodities within basic needs of affected
populations in humanitarian response

23. What are the RH Kits?
• Pre-packaged sets of medicines, equipment
and supplies designed to meet the most
basic RH needs in crisis situations
• They are designed so that each kit can be
used in contexts where there is little or no
health infrastructure

24. RH kit for emergency situations
Block 1
Primary health care/health centre level
10,000 people for 3 months
Kit
0 •Training and administration
1 •Condoms (male & female)
2 •Clean delivery sets (individual)
3 •Post-rape (EC and STI prevention, PEP)
4 •Oral and injectable contraception
5 •STI drugs

25. Post-Exposure Prophylaxis (PEP)
• Now a part of Kit #3 (“post-rape kit”)
• For accidental/possible exposure to HIV,
including sexual violence
• Costs have come down dramatically – now
much more affordable

26. RH kit for emergency situations
Block 2
Health centre level or referral level
30 000 people for 3 months
Kit
6 •Professional midwifery delivery kit
7 •IUD insertion
8 •Management of complications of abortion
9 •Suture of cervical and vaginal tears
10 •Vacuum extraction

27. RH kit for emergency situations
Block 3
Referral level
150 000 people for 3 months
Kit
11A •Surgical (reusable equipment)
11B •Surgical (consumable items and drugs)
12 •Blood transfusion (HIV testing)

28. Local Logistics Issues
• Customs clearance
• Observing the cold chain
• Observing expiration dates
• Transport and Distribution
• Warehousing
• Coordinating with local partners (MOH,
NGOs, other UN agencies)

29. Options to think about?
1) Pre-positioning in neighboring countries
2) Stockpiling in central warehouse or neighboring countries
3) Sending in supplies during crisis-airlifting, sea, road, train,etc
4) Air Dropping in areas that is inaccessible
5) Utilizing existing commercial networks for distribution
6) Role of the military/armed forces/peace keepers in regard to
logistics and in demanding services and commodities

30. Challenges/Questions
1) Cost Effectiveness
2) Storage and distribution
3) Expiration dates and shelf time
4) Technical Support
5) Planning for long-term commodity security (once
population stabilize)
6) Managing procurement and achieving commodity
security in situation of high insecurities? (Iraq as an
example)