HEALTH RESERVE WORKFORCE AND EMERGENCY MEDICAL TEAMS (EMTs)
ATTACHMENT 23 Standard Operating Procedure for Physical and Mental Health Monitoring of
C. Medical (Emergency Box)
2. Flow of Receipt of Health Logistics Assistance
5.2 REPRODUCTIVE HEALTH SUB-CLUSTER
5.2.1 Assessment of Special Needs for Minimum Initial Service Packages (PPAM) Of Reproductive Health in a Health Crisis Emergency
A. Special Needs Assessment of Reproductive Health Services
A more in-depth and focused assessment of the implementation of PPAM Reproductive Health can be conducted a few days later by team consisting of members of the reproductive health sub-cluster or the person in charge of each component. The following are the steps in conducting a needs assessment for reproductive health services:
1. Collect secondary data / pre-crisis baseline data: target data, important indicators related to reproductive health such as crude birth rate, maternity by health workers, data on health service facilities188. This is done to get an overview of reproductive health conditions before the disaster occurred. This data can be taken from the RHA report conducted by the Health Crisis Center or the local Health Office.
2. Estimating the number of reproductive health targets for disaster response. The estimation was conducted using data on the number of IDPss obtained from the RHA team. Target estimation can also be done by using an application called
"PPAM calculator".
3. Assessing the condition of health care facilities, health workers and the availability of tools and drugs to provide reproductive health services.
a. Condition of health facilities, including the condition of health center (Puskesmas) PONED and PONEK hospitals: the condition of the building whether it can still be used or not; whether it is necessary to set up reproductive health service tents.
b. Condition of health workers: whether health workers are affected by disaster, physical and mental condition of health workers. Whether external assistance is needed or not (prioritize from neighboring districts/provinces that are ready to help), whether psychosocial support is needed or not for affected health workers.
c. Availability of tools, drugs and consumables for reproductive health services.
d. Referral system, especially for obstetric and neonatal emergencies: road conditions, availability of transportation, travel time to referral sites, safety factors, etc.
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4. If the disaster is large-scale, record institutions/organizations/Non- Governmental Organizations (NGOs) working in the reproductive health subcluster in the emergency response to the health crisis. This data can be obtained through coordination with the health sector. This is done to identify and divide the roles of organizations and institutions working in organizations and institutions that work in the field of reproductive health in areas affected by disaster, so that there is no overlap in providing assistance and services. The forms that must be completed in the assessment condition of health facilities as follows:
Table 5.1 Reproductive Health Care Facilities in Affected Areas Fasyankes
Name
Fasyankes Type
Government/
Private
PPAM Reproductive Health Service Type (Checked)
Description Normal
Childbirth
PONED PONEK CMR* KB IMS/
HIV
Description:
- Fasyankes : Health Care Facilities
- CMR : Clinical Management of Rape
Table 5.2 Health Service Provider Fasyankes
Name
Number of health service providers Description Dr SpOG Dr SpA General
Practitioner
Tocologist Nurse etc
Table 5.3 Availability of Blood Transfusion Facilities Types of Service Stocking
Place
The nearest health facility that provides
the service
Description
Yes No Fasyankes Name
Distance (KM) Normal childbirth
PONED
174 PONEK
Contraception/KB IMS/HIV
CMR
PPP Availability
5. Collecting data on the conditions of pregnant women and childbirth in IDPs camps by conducting interviews with 2-3 pregnant/birth mothers who were encountered in the IDPs camps. This data was collected to find out about the availability of services for pregnant women and postpartum women in IDPs camps. If possible, collect data on the condition of 190 conditions of other vulnerable groups such as toddlers, the elderly, people with disabilities in IDPs camps by conducting observations and interviews to identify their specific needs. The form that must be to be completed by data collection organizations engaged in reproductive health reproductive health during disasters as follows:
Table 5.4 Data collection of organizations engaged in reproductive health during disasters
Name of Organization
Program Working Area
Name and Contact Address
Description Name Email/Phone
Number
6. Conducting a risk assessment for Gender-Based Violence (GBV) in IDPs camps by conducting direct observations and interviews with IDPs camp managers and with IDPs representatives. The Risk assessment form of Gender-Based Violence (GBV) in IDPs camps can be seen above.
B. Parties Conducting Reproductive Health PPAM-Specific Assessments Subcluster will participate in the following needs assessments:
1. Rapid health assessment (RHA)
Representatives from reproductive health subcluster members will join the RHA team from the Ministry of Health Affairs/District Health Office. It is preferable to have a background of tocologist, doctor or specialist (Sp.OG) who has received PPAM training so that they can simultaneously at the same time provide delivery assistance that occurs during the assessment process.
Reproductive health subcluster representatives who are members of the RHA team will be equipped with minimum equipment to anticipate if there are pregnant women in IDPs camps who will give birth at any time during the
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assessment process. If the reproductive health subcluster has not been established in the region, the manager of the reproductive health/family health program at the Health Office will be a member of the RHA team.
2. Assessment of PPAM needs
If the reproductive health subcluster has been established, then the assessment is conducted by the reproductive health subcluster coordinator and the person in charge of each component. If the reproductive health subcluster has not been established, the program manager of reproductive health/family health at the health office who will conduct the assessment together with related cross- sectors such as IBI, BKKBN, the Office of Women's Empowerment and Child Protection (DP3A), and others.
C. Equipment to bring
Reproductive health subcluster representatives who are members of the RHA team will be equipped with the minimum equipment to anticipate if there are pregnant women in the in-IDPs camps who will give birth at any time in the middle of the assessment process. The minimum equipment that must be carried consists of:
1. Recommended individual equipment (survival kit) for team members as needed, such as:
a. Individual tents and tarpaulins for mats.
b. Sleeping bag.
c. First aid kit and personal medication (bring your own), chalk, ant/insect repellent (bring your own).
d. Personal protection medication: sunblock cream, mosquito repellent lotion (not provided).
e. Tableware: plate, spoon, fork, stainless steel knife, bottle/can opener.
f. 2 (two) pieces of multi-functional cloth.
g. Towels that can be dried immediately (microfiber).
h. Simple water filter equipment (either in the form of an aquatab/or water filter).
i. Water bottle and water bladder.
j. Flashlight.
k. Emergency/camping lamp.
l. Rechargeable battery.
m. Solar power pad, small and portable.
n. large backpack to store all equipment
2. Childbirth assistance tools can be in the form of midwife kits or partus sets that are equipped with medicines and consumables to help labor as needed.
3. Individual kits for postpartum mothers and newborns of at least 5 pieces each, or more if possible, to be carried on flights to the location of the disaster.
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D. How to Analyze, Use and Disseminate Assessment Results 1. Analyzing
After obtaining the scoring sheet, the coordinator or members of the reproductive health subcluster conducted an assessment by analyzing pre-crisis data and data obtained during emergency response such as:
a. Number of IDPss obtained from the RHA team, including data on adolescents, toddlers and elderly IDPss (if available).
b. assessment of the condition of health care facilities, health workers and the availability of tools and drugs to provide reproductive health services.
c. recording institutions/organizations/NGOs working in the field of reproductive health in health crisis emergency response.
d. data on the condition of pregnant women and childbirth in IDPs camps.
2. Factors that increase the risk of Gender-Based Violence (GBV) in coordination with the Prevention and Handling of Gender-Based Violence (PPKGB) and Women’s Empowerment subclusters use and disseminate the results of the assessment.
After analyzing the results, strategies and plans can be developed implementation of PPAM in crisis situations both in the form of PPAM implementation and logistical support according to the needs of IDPss in the area. The results of the analysis may include recommendations on how to ensure PPAM interventions are included in the report. Results recommendations are shared with all organizations involved in the disaster response, including the community through the existing health coordination and reporting systems in place during a disaster.
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Figure 5.2 Summary of the needs assessment
E. Calculation of Estimated Target Number and Health Logistics Needs Reproduction 1. Manual Statistical Estimation
The reproductive health subcluster coordinator should have secondary data obtained from the health cluster coordinator taken from the BPBD post in the disaster area, as for the data collected are as follows:
a. Baseline information (number of vulnerable groups)
Baseline information to be collected includes demographic and health data of affected vulnerable groups. If at the beginning of a health crisis emergency response, it is difficult to obtain data on reproductive health targets such as the number of women of reproductive age194 (WUS), pregnant women, sexually active men and so forth, then data can be estimated statistically from the number of IDPss. In the early phase of a disaster, data on particular populations (pregnant
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women, laboring women, women of reproductive age, etc.) can be statistically estimated by using the following estimation:
Table 5.5 Manual Statistical Estimation
No Variable Formula Example Notes
1 (Crude Birth Rate/
CBR)
Number of babies born per 1000 population in 1 year.
CBR 23/1000 Number of IDPss 10,000
If there is no CBR data, can use an estimate of 4%
(usually too large for Indonesia) CBR 23/1000 (SDKI, 2012)
2 women of child- bearing age
27% of the total population/
IDPss
27% x 10,000
= 2,700
Estimates of WUS based on population projections Indonesia in 2010-2035 is 26.8%
3 Estimated number of pregnant women A Estimated number
of live births in 1 year
CBR x Number of IDPss = (a)
23/1000 x 10,000 = 230
4/100 x 10,000 = 400 (if no CBR data available)
B Estimated number of births per month
(a): 12 230 : 12 = 19 400 : 12 = 33 (if no CBR data available)
C Estimated number of pregnancies that resulting in stillbirth or miscarriage (Estimated 20% of pregnancies or 25% of live births)
(a)x 0.25 230 x 0,25
=58
400x 0.25 = 100 (if no CBR data available)
D Estimated number of pregnancies in 1 year
(a) + (c) = (d) 230 + 58 = 288
400 + 100 = 500 (if no CBR data available)
E Estimated number of pregnant women in a given month (70% of d)
70% x (d) 70% x 288 = 202
70% x 500 = 350 (if no CBR data available)
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In addition to the above targets, if possible, collect data on vulnerable groups:
1) Persons with disabilities.
2) Children who are alone/separated from their families.
3) Women as the head of the family.
4) Moderately and severely dependent elderly without family or separated from their family.
This vulnerable group should be placed in a tent located close to the reproductive health tent so that they are protected, easy to access services and can be monitored regularly.
b. The results of the initial needs assessment are used to:
1) Assess the condition of health care facilities (function and eligibility) including for maternal neonatal emergency services.
2) Assess the condition of health workers in the affected area (number, condition, and type of health workers available).
3) Assess the availability of medical devices, medicines and consumables to support reproductive health services.
c. Development and implementation of intervention plans after data collection on reproductive health targets and initial needs assessment, a PPAM response plan is developed in a health crisis situation. Implementation of the intervention plan is carried out in accordance with data and assessment results as well as conditions in the field. Monitoring the implementation of each intervention the person in charge of the PPAM component conveys the activities that have been carried out such as activities in the maternal neonatal component: mobile clinic services, antenatal services and distribution of individual kits for pregnant women (pregnant women's kits) with postpartum (postpartum women's kits) by using the postpartum mothers) using the agreed form (see attachment).
2. PPAM Calculator for Reproductive Health
The estimation was conducted using data on the number of IDPss obtained from the RHA team. Target estimation can also be done by using an application called the
"PPAM calculator". The PPAM calculator was developed at the global level to facilitate obtain some target population estimation data by196 using data on the number of IDPss and using presentation statistics of the number of specific groups obtained from census data, population and health surveys and other sources. The data available in the PPAM calculator are at the national level, and can be used at lower levels if data are available. The PPAM calculator is a tool that can help program coordinators and program managers to determine the demographics of the affected population. The objectives/benefits of PPAM Reproductive Health are as follows:
a. This estimate can be used for fundraising and prioritizing programs in a health crisis.
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b. Facilitate program managers in developing strategies and work programs during disaster emergency response to match the number of targets.
Figure 5.3 PPAM Calculator App
The MISP calculator can be accessed at the following link: http://31.220.6.96:8080/ or accessible via QR Code. Data is presented in the form of graphs and tables. The PPAM calculator only requires the number of affected populations. The calculator will work automatically and simply provide the data to the user. The calculation results can be downloaded and will generate an excel format that can be used for program development. If the program manager already has specific data, then the program manager can enter the specific data directly so that the calculation results will automatically change by adjusting the changes from the specific data that has been updated. The way to use the PPAM Calculator is as follows:
a. Select the desired province, district and sub-district.
b. Click on the input of the number of affected people.
c. Click calculate and it will automatically calculate detailed data related to reproductive health PPAM program needs.
d. If the number of exposed populations will change then calculation or recalculation is done.
The data generated refers to the demographic profile of the affected population will appear, which is sourced from 1) SIAK, DUKCAPIL 2021; 2) Population Census, BPS 2020. The PPAM calculator can present several forms such as graphs, tabular, and maps. The data presented on the graph consists of:
a. Women of child-bearing age.
b. Details of adolescents aged 10 - 19 years.
c. Number of live births.
d. Next month's maternal and newborn health needs.
e. Estimation of WUS using modern contraceptives.
181 f. Estimation of people living with HIV
Other basic statistics, maternal and newborn health data, and access to reproductive health services in each region can be seen in more detail in the tabular analysis results.
In addition, the PPAM Calculator can also present a map of the distribution of reproductive health needs.
The PPAM Calculator can also enter/change the location-specific data if the required variables are available, so that the needs and the results of data analysis presented by the PPAM calculator can be more specific and detailed in accordance with the actual conditions.
F. Global and National Reproductive Health PPAM Logistics and Other Supporting Tools.
1. Tools, Drugs and Consumables for Reproductive Health Services to Provide Reproductive Health Services at Health Facilities:
a. Tools
1) Midwife/Tocologist Kit
This is a package of tools, medicines and consumables for childbirth assistance. It is necessary to ensure that the tools and medicines are complete and check the expiration date of the medicines. Kit distributed to midwives who are on duty in affected areas/in IDPs camps. Ensure transportation and access are available to affected locations. Kits are provided if no labor aid equipment/midwifery tools are available damaged or lost during a disaster.
2) Reproductive Health Kit
A reproductive health kit is a set of tools, drugs and essential consumables that are designed to provide priority reproductive health services for people affected by crisis/disaster in locations in which there are no health facilities or the health facilities are damaged and not functioning.
a) Reproductive health kits are developed for a population of a certain number to be used over a three-month period. Reproductive health contents are medical devices, drugs and consumables used in health centers and hospitals, but packaged specifically according to the hospitals, only that they are packaged specifically according to the action / type of service so that it is very easy when used in the emergency response stage of the health crisis.
b) Currently, reproductive health kits are not available in Indonesia and must be imported from Copenhagen, Denmark. However, it can be delivered in a short period of time (within 1-2 weeks) after ordering if sent by airplane.
c) The reproductive health kit is adapted from international standards that are adapted to the policies and reproductive health service standards in Indonesia. List of equipment and medicines in the reproductive health kit that has been adapted is contained in the Guidebook Logistic Support for Reproductive Health PPAM in Crisis Health.
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d) Reproductive health kits are only used in major disasters where a lot of health infrastructure is damaged, not functioning and unable to provide health services as usual. The need for kits depends on the number of evacuees, the type of services to be provided and the estimated length of time displaced.
Reproductive health subcluster coordinator and person in charge of logistics component organize the supply and distribution of reproductive health kits by:
a) Coordinating to record health service facilities that are damaged and unable to provide health services.
b) Proposing the need for reproductive health kits through the provincial/municipal health office.
Provincial/district/municipal health offices may procure their own reproductive health kit needs by referring to the guidelines for Logistic Support for PPAM Implementation.
a) The local health office may submit a request for the supply of reproductive health kits through a letter to Ministry of Health Affairs c.q. Director of Nutrition-Mother Child Health (MCH). The Ministry of Health Affairs will forward the request to UNFPA Indonesia to support supplies of reproductive health kits from the international warehouse in Copenhagen - Denmark.
b) The provincial or district/city health office may coordinate with other organizations/institutions/parties that are engaged in the humanitarian field for the procurement of reproductive health kits.
● Ensure transportation and access to the location for kit distribution.
● Prepare an adequate place/location/warehouse for temporary storage of reproductive health kits before distribution.
● Checking the completeness of tools and drugs as well as the expiry date of the attachments available outside the reproductive health kit before distribution.
● Distribute reproductive health kits in accordance with criteria of health facilities (first-level health facilities, advanced referral health facilities, etc).
● Provide explanation and understanding on how to use of the reproductive health kit.
● Handing over the kit to the person in charge of the activity/head of the health center and/or hospital by signing minutes of goods handover.
Table 5.6 Comparison of Global and Adapted Reproductive Health Kits in Indonesia
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Notes: The color code in the table above is in accordance with the color code on the reproductive health kit packaging
In 2019, there was a revision of the reproductive health kit at the international level with several changes.
a) Reproductive health kits are no longer divided by block but rather by health facility level, namely:
● Community level.
● Primary health facilities (PONED Healt Center).
● Referral health facilities (PONEK hospitals).
b) Changes to contraceptive kits:
● Kit 1 consisting of Kit 1A which is the male condom
● Kit 7 consisting of Kit 7A, the IUD kit, and Kit 7B, the implant kit, both of which are part of the complementary commodities.
c) Supplementary Commodities
Additional complementary commodities are a set of tools, consumables and drugs that can be ordered under certain conditions to complement an existing kit:
● Where the service provider has been trained to use the specialized supplies.
● Where the commodity type was already in use before the crisis.