Maternal, newborn and child health in emergency settings
More than 500 women and girls die in emergency settings every day due to complications arising from pregnancy and childbirth (UNFPA, 2018, p. 3). In 2017, an estimated 535 million children (nearly one in four of the world’s children) lived in countries affected by emergencies (UNICEF, 2017). This report provides examples of organisations working in maternal, newborn and child health (MNCH) in emergency settings and some key technical resources.
Organisations working in maternal, newborn and child health (MNCH) in humanitarian emergencies largely implement the Minimum Initial Service Package (MISP) developed by the Inter-Agency Working Group on Reproductive Health in Crises (IAWG). Programmes focus on providing a range of basic health services at the onset of an emergency and then expand on these, adding more comprehensive services. Common tools and approaches in the onset phase include:
- Mobilising surge emergency healthcare staff to provide services;
- Establishing temporary health outposts close to crisis affected communities and designing referral systems for women and newborns in need of more comprehensive care;
- Providing mobile services;
- Ensuring health workers have the necessary supplies (equipment, drugs etc) by deploying emergency health care kits;
- Raising awareness amongst the affected population of how to access services.
Once humanitarian operations are up and running and/or a humanitarian emergency moves into the ongoing or protracted phase, common tools and approaches include rebuilding health facilities and systems, and training national and local health care workers (WHO, 2018, p. 17). Evidence of past training includes: training mobile health workers to provide elements of basic emergency obstetric care, blood transfusions and antenatal care in eastern Burma; and, training community health workers in Afghanistan to strengthen the link between the community and formal health services (Casey, 2015).
Organisations implementing MNCH programming largely focus on evidence-based interventions recommended by the World Health Organization (WHO). These include childhood immunisation, skilled birth attendants and emergency obstetric care. Proven interventions are scaled-up. For example mother and baby tents to support women to practice breastfeeding (Casey, 2015).
This review focuses on MNCH in emergency settings as defined in the following ways:
- Maternal: the health of women during pregnancy, childbirth and the postpartum period (Chi et al., 2015, p. 2);
- Newborn: the first 28 days after birth (UNICEF & Save the Children, 2018, p. 24);
- Child: up to 5 years of age as included in the World Health Organization’s continuum of care for maternal, newborn and child health (WHO, 2018, p. 10).
- Humanitarian emergencies: rapid, slow or onset situations caused by conflict, war, natural disasters or epidemic outbreaks (WHO, 2018, p. 17), resulting in a critical threat to the health, safety, security or well-being of a community or large number of people and requiring external assistance (IAWG, 2010).
- MNCH programming may involve working with refugees and internally displaced persons (IDPs) living in camps, settlements or urban areas and establishing primary health care posts, and/or working within existing damaged health systems or host country health systems.
This review identified a number of organisations with MNCH programming, including implementing, advisory and advocacy organisations. Evidence of MNCH programming in the onset and protracted phases of a humanitarian emergency is easily identifiable, including service provision and common implementation challenges. A number of organisations work with a standardised model of services including the three levels of the healthcare system (community, health centre and hospital) and the types of services that should be available at these levels.
Less easily identifiable were examples of programming for transitioning from the emergency to post-emergency phase and rebuilding health systems. A large number of the organisations reviewed for this report emphasised the importance of highly trained staff, particularly skilled birth attendants to improve maternal and newborn outcomes. However, only two organisations, Management Sciences for Health and International Medical Corps, had well-defined midwife training programmes.