Reproductive Health-related Resources to Implement
the Minimum Initial Service Package (MISP) at the Onset of an Emergency

Priority Reproductive Health Interventions: The Minimum Initial Service Package (MISP) for Reproductive Health

The Minimum Initial Service Package (MISP) for Reproductive Health is a priority set of life‐saving activities to be implemented at the onset of every humanitarian crisis. It forms the starting point for reproductive health programming and should be sustained and built upon with comprehensive reproductive health services throughout protracted crises and recovery.

Neglecting the MISP in humanitarian settings has serious consequences: preventable maternal and newborn deaths; sexual violence and subsequent trauma; sexually transmitted infections; unwanted pregnancies and unsafe abortions; and the possible spread of HIV.

Quick Resources on the MISP

Synopsis of the MISP
Source: IPPF/ Women’s Refugee Commission on behalf of IAWG on RH in Crises, December 2009

The 2009 revised synopsis summarizes the objectives and activities of the MISP as outlined in Reproductive Health in Humanitarian Settings: An Inter-agency Field Manual. The front page notes the objectives and the back page contains a matrix that maps minimum versus comprehensive reproductive health services, and an outline of the content of the IAWG Reproductive Health Kits. The synopsis is available in Bahasa Indonesian (UNFPA, April 2010, French (UNFPA, March 2010), English (Women’s Refugee Commission, January 2010) and Spanish (Columbia University, April 2010).

MISP advocacy sheet for policy makers
Source: IPPF/Women’s Refugee Commission on behalf of IAWG on RH in Crises, December 2009

This document summarizes the importance of implementing the MISP at the onset of every emergency for a policy audience. The advocacy sheet is also available in Thai here.

Inter-Agency Reproductive Health Kits for Crisis Situations (Fourth edition)
Source: Inter-Agency Working Group (IAWG) on Reproductive Health in Crises, January 2008

The essential drugs, equipment and supplies to implement the MISP have been assembled into a set of specially designed prepackaged kits – The Inter-Agency Reproductive Health Kits. The kits complement the objectives laid out in Reproductive Health in Humanitarian Settings: An Inter-agency Field Manual. The resource is also available in French and Spanish.

MISP and RH Kits Calculators

Spreadsheets to calculate the necessary statistics to implement the MISP, and the relevant quantities for ordering RH Kits.

Quick Resources to Monitor MISP Implementation

MISP checklist
Source: IAWG on RH in Crises, December 2009

The checklist can be used as a monitoring tool to ensure that all components of the MISP are implemented.

MISP Needs Assessment: Health Facility Questionnaire
Source: UNFPA, August 2011

This questionnaire is intended for use in the Horn of Africa but is applicable globally.

Health resources availability and mapping system (HeRAMS)
Source: IASC Global Health Cluster, August 2009

HeRAMS is a software-based information system developed by the Global Health Cluster to support the collection, collation and analysis of information on the availability of health resources in different areas and locations, and by type of point of delivery and level of care. Health resources include health facilities (infrastructure), personnel, and services provided, including those specific to the MISP. The matrix and checklist are accessible from the link. HeRAMS is also available in French.

Minimum Initial Service Package (MISP) roll out in EECA region
Source: UNFPA, EECA Team, 2011

A report on the first round of MISP roll out in 7 countries.

Summary report on first round in 2011

Guidelines and Tools for MISP Implementation

0. General/Overarching Topics

Adolescent Sexual and Reproductive Health Toolkit for Humanitarian Settings
Source: Save the Children/UNFPA, September 2009

The toolkit is a companion to Reproductive Health in Humanitarian Settings: An Inter-Agency Field Manual on and features an adolescent-inclusive version of the MISP. It includes user-friendly tools for assessing adolescent needs, fostering participation with communities and parents, and identifying reproductive health entry points in existing adolescent programs. It also contains tools for service providers to more effectively work with adolescents at the clinic and community level.

Inter-agency Field Manual on Reproductive Health in Humanitarian Settings: 2010 Revision for Field Review
Source: IAWG on RH in Crises, 2010

An update of the 1999 Reproductive Health in Refugee Situations: An Inter-agency Field Manual, this updated draft manual serves as a tool to facilitate decision-making in the planning, implementation, monitoring and evaluation of reproductive health interventions in refugee and refugee-like situations. The primary target audience for the Field Manual is field managers of health services. The steps to implement the MISP is explained in detail in Chapter 2. The Field Manual is also available in Arabic, French and Spanish. To order hard copies or participate in the field review process, please click here.

1. Coordination

Health Cluster Guide: A Practical Guide for Country-Level Implementation of the Health Cluster
Source: IASC Global Health Cluster, WHO, 2009

This Guide suggests how the Health Cluster lead agency, coordinator, and partners can work together during a humanitarian crisis to achieve the aims of reducing avoidable mortality, morbidity and disability, and restoring the delivery of and equitable access to preventive and curative health care as quickly as possible. It highlights key principles of humanitarian health action and how coordination and joint efforts among health sector actors working in partnership can increase the effectiveness and efficiency of health interventions. It draws on IASC and other documents but also includes lessons from field experience.  Guidance on reproductive health coordination is explained on pages 48-49 in the chapter on “Assuring Effective Coordination”.

2. Preventing and Responding to Sexual Violence

IASC Guidelines for GBV interventions in humanitarian emergencies
Source: Inter-Agency Standing Committee, September 2005

The purpose of these guidelines is to enable communities, governments and humanitarian organizations, to establish and coordinate a set of minimum multi-sectoral interventions to prevent and respond to sexual violence during the early phase of an emergency. The Guidelines specifically details minimum interventions for prevention and response to sexual violence to be undertaken in the early stages of an emergency. Twenty-five action sheets have been developed in ten functional/sectoral areas. The guidelines are available in Arabic, Bahasa Indonesian, French, and Spanish and the Matrix in Arabic, English, French, Spanish.

Clinical Management of Rape Survivors: Developing Protocols for use with Refugees and Internally Displaced Persons
Source: WHO/UNHCR, 2004

The guide is designed for health care providers in the medical management of rape survivors, including women, men and children. It aims to assist qualified health care providers (medical coordinators, medical doctors, clinical officers, midwives, and nurses) to develop protocols for the management of rape survivors, based on available resources, materials, drugs, and national policies and procedures. Managers and trainers of health care services can also use the guide to plan for survivor care and train health care providers accordingly. The guide is also available in French and Arabic.

Job Aids for Health Care Providers in Humanitarian Settings
Source: PATH/UNFPA, 2010.

The job aids aim to provide clear and simple guidance on how to correctly perform vacuum extractions, sterilize equipment, and provide post-rape care for adults and children. To access the job aids, please click here.

3. Preventing the Transmission of HIV

IASC Guidelines for Addressing HIV in Humanitarian Settings
Source: Inter-Agency Standing Committee, updated December 2009

This revised version of the 2004 guidelines are aimed to help those involved in emergency response, and those responding to the epidemic, to plan the delivery of a minimum set of HIV prevention, care and support interventions to people affected by humanitarian crises. The guidelines take into account improvements in humanitarian coordination; the growing understanding that antiretroviral therapy can be provided in low-resource settings, including in conflict zones; how quality HIV programming can be achieved when resources and personnel are pooled; and a shared concern that an understanding of all the facets of HIV prevention, treatment, care and support, and of the relevant human rights considerations, is an essential part of preparedness for humanitarian crises.

Job Aids for Health Care Providers in Humanitarian Settings
Source: PATH/UNFPA, 2010.

The job aids aim to provide clear and simple guidance on how to correctly perform vacuum extractions, sterilize equipment, and provide post-rape care for adults and children. To access the job aids, please click here.

4. Preventing Excess Maternal and Newborn Morbidity and Mortality

Field-friendly Guide to Integrate Emergency Obstetric Care in Humanitarian Programs
Source: Women’s Refugee Commission on behalf of the RHRC Consortium, July 2005

This field-friendly guide focuses on the practical aspects essential for successfully implementing emergency obstetric care in the field, including the UN process indicators for monitoring and evaluation of services. It is designed for organizations, program managers and field staff that provide reproductive health care in humanitarian crises. A list of key resources is included in each of the steps. The guidelines can be accessed in Arabic, French and Spanish.

Inter-agency Field Manual on Reproductive Health in Humanitarian Settings
Source: IAWG on RH in Crises, 2010

An update of the 1999 Reproductive Health in Refugee Situations: An Inter-agency Field Manual, this updated draft manual serves as a tool to facilitate decision-making in the planning, implementation, monitoring and evaluation of reproductive health interventions in refugee and refugee-like situations. The primary target audience for the Field Manual is field managers of health services. Maternal newborn health programming is explained in detail in Chapter 6. The Field Manual is also available in Arabic, French and Spanish. To order hardcopies or participate in the field review process, please click here.

Job Aids for Health Care Providers in Humanitarian Settings
Source: PATH/UNFPA, 2010.

The job aids aim to provide clear and simple guidance on how to correctly perform vacuum extractions, sterilize equipment, and provide post-rape care for adults and children. To access the job aids, please click here.

5. Planning for Comprehensive Reproductive Health

Guidelines for the Care of Sexually Transmitted Infections in Conflict-affected Settings
Source: Women’s Refugee Commission on behalf of the RHRC Consortium, December 2004

The guidelines aim to raise awareness of the complexities of sexually transmitted infection (STI) care and to highlight the areas where improvements may be possible. They are designed for health coordinators, program managers and technical advisors, and were developed to show that effective STI care requires investment in technical capacity to design and implement appropriate, technically sound programs. The guidelines can be accessed in Arabic, French,and Spanish.

Inter-agency Field Manual on Reproductive Health in Humanitarian Settings
Source: IAWG on RH in Crises, 2010

An update of the 1999 Reproductive Health in Refugee Situations: An Inter-agency Field Manual, this draft manual serves as a tool to facilitate decision-making in the planning, implementation, monitoring and evaluation of reproductive health interventions in refugee and refugee-like situations. The primary target audience for the Field Manual is field managers of health services.The Field Manual is also available in Arabic, French and Spanish. To order hardcopies or participate in the field review process, please click here.

Training Tools on the MISP

Minimum Initial Services Package (MISP) for Reproductive Health in Crisis Situations: A Distance Learning Module
Source: Women's Refugee Commission, July 2011

The MISP module is a self-instructional learning tools that helps to increase knowledge of priority reproductive health services to initiate at the onset of a crisis. The MISP incorporates a multi-sectoral set of activities to be implemented by humanitarian workers operating in health, camp design and management, community services, protection and other sectors. The MISP module is particularly useful for members of emergency response teams, and other first humanitarian responders in crisis situations. It includes chapter quizzes and an online interactive post-test. A passing score on the post-test will result in certification in the MISP module.

The 2006 version of the module is available in Arabic, Bahasa Indonesian, French, Russian and Spanish pending the translation of the new version.

Emergency Contraception for Conflict Affected Settings: A Reproductive Health Response in Conflict Consortium Distance Learning Module
Source: Women's Refugee Commission on behalf of the RHRC Consortium, updated 2008

The distance learning module has been developed to meet the need for increased awareness and knowledge about emergency contraception (EC) among health service providers working with refugee and IDPs. The module is ideal for providers working in crisis-affected situations who wish to learn about EC, need to refresh their current level of knowledge and/or would like to incorporate EC services into their reproductive health programs. Appropriate users of this module include family planning staff, community health workers, health educators, counselors, trainers, program managers, nurses, doctors, midwives and other health care personnel working in crisis settings. The module is further available in French and Spanish.

HIV/AIDS Prevention and Control: A short course for humanitarian workers. Facilitator's Manual
Source: Women's Refugee Commission on behalf of the Reproductive Health Response in Conflict Consortium, November 2004

This five-day course on HIV/AIDS prevention and control aims to assist humanitarian workers deepen their individual understanding of the complexities of HIV/AIDS and to equip participants with the knowledge and skills needed to improve HIV/AIDS program design and implementation in their communities. Two CD-Roms accompany the facilitator’s manual, containing presentations, posters, handouts and additional resources for use both during the course and for supplemental research. This manual is also available in Arabic, French, Spanish and Swahili.

Clinical Care for Sexual Assault Survivors: A Multi-Media Training Tool.
Source: The International Rescue Committee, 2008

The goal of this tool is to improve the clinical care of sexual assault survivors in low resource settings by demonstrating compassionate, competent, and confidential care in keeping with international standards. It is intended for use in the training of all staff in health clinics (clinicians and non-clinicians) who interact with sexual assault survivors. The tool is available in both English and French.

Clinical Management of Rape e-learning Programme
Source: UNHCR/UNFPA/WHO, 2010

This e-learning programme aims to give health-care providers an opportunity to learn how to provide an appropriate and integrated package of care to survivors of sexual violence in humanitarian settings. The content is based on the 2004 Clinical Management of Rape Survivors: Developing Protocols for use with Refugees and Internally Displaced Persons. The tool is available in both English and French as downloadable and online versions.

For more information on reproductive health in humanitarian settings, please see:
Inter-agency Working Group on Reproductive Health in Crises Resource Page
Reproductive Health Response in Crises (RHRC) Consortium