Reproductive Health Assessment Toolkit for Conflict-Affected Women Welcome everyone. Introduce trainers. Have everyone go around and introduce themselves (name, what they do). CEI 2015.0 Implementing the Reproductive Health Assessment Toolkit for Conflict-Affected Women November 5, 2006

Objectives At end of the training, you will be able to: Plan for implementation Conduct a population-based survey Provide training to survey personnel Interpret Toolkit findings Present findings Access technical assistance from CDC

Training Agenda Questionnaire Sampling Training Analysis Planning process Programmatic responses Summary The agenda for today is as follows: Because the Toolkit walks you step-by-step of all the activities, we will only highlight aspects of the Toolkit that are important to implementation. We plan to use a range of didactic presentations, hands-on exercises, and small group work to achieve the goals of the training. We hope that you will be engaged and participate as much as possible. Also we designed the sessions of the training to build on one another, culminating to a small group exercise where you will get the opportunity to propose programmatic responses based on sample data from the Toolkit. We will have breaks throughout the day, and because of the opening ceremony for APHA, you will have a 2 hour lunch. However, it’s going to be a full day, and we do want to keep on schedule as much as we can. Please feel free to ask questions about the particular session; however if it is a question that may be better answered in latter session, we may put the question in a parking lot.

Reproductive Health for Refugees (RHR) Activity at CDC Before we talk about the Toolkit, I wanted to give a brief overview of our group at the Division of Reproductive Health at CDC and the history leading up the development of the Toolkit. DRH officially began a refugee reproductive health program in 1998 and has since broadened its targeted populations to refugees, internally displaced persons (IDPs), those who have returned to their countries of origin, and those who have integrated into the local host community. This broader definition allows public health officers to follow the full continuum of health from the emergency setting to that of viable communities.

DRH Refugee/IDP Activities This map give you a visual of the countries where we have worked as our activities have progressed. Since the early 1970s the Division of Reproductive Health at CDC has been carrying out national reproductive health surveys. However, little was known about reproductive health outcomes in conflict settings. The international community became more interested in the reproductive health of refugees and we began to receive multiple requests to conduct similar RH surveys, but on a smaller scale specific to conflict settings. We developed reproductive health surveys and gender based violence surveys for the conflict-affected populations. These surveys were conducted among diverse populations including Afghan refugees in Pakistan, Burmese refugees in Thailand, and returnees in East Timor and Kosovo. This was resource intensive with CDC scientists implementing and analyzing the surveys. And at the same time, demand for such surveys was growing. Afghanistan Colombia DRC East Timor Ethiopia Kosovo Nepal Pakistan Rwanda Tanzania Thailand

RHR Activity Goals Creation of tools Evaluation Promotion of data to action Strengthen capacity Translation and dissemination Within our RHR activity we create tools that can be utilized by field partners, such as the Toolkit. We design and conduct evaluations in order to learn from the field and develop best practices. We promote the use of data for programmatic change. All of our activities are designed to strengthen the capacity of field partners to collect and use data to improve their services. Finally we translate and communicate our findings and best practices to our partners through publications, workshops, conference presentations and trainings. www.cdc.gov/reproductivehealth/Refugee

Pilot Tests Ethiopia – March 2004 Sudanese refugees Eritrean refugees Democratic Republic of Congo (DRC) - March 2005 IDP camp 2 River populations Transient population Colombia – February 2006 Internally displaced In order to ensure that our Toolkit met our goals we conducted 3 pilot tests. Each pilot test informed the development of the Toolkit, specifically the development of the training manual, questionnaire, data entry program and data analysis. The pilot tests in Ethiopia and DRC were conducted with DRH staff present for the entire test. However, Colombia was a “true” test of the Toolkit. We worked with a local NGO that conducted the training, survey implementation, and data entry with limited assistance from DRH. We only observed the last day of training and the first day of data collection. In addition, Colombia provided a pilot test of cluster sampling. This pilot test demonstrated that the Toolkit is user friendly and can be used with remote TA from DRH.

Toolkit Purpose Provides tools to assess RH needs of conflict-affected women aged 15-49 Data to promote and enhance services to improve the reproductive health of women and their families Therefore, in an effort to meet the needs of the field and at the same time develop capacity in the humanitarian community to conduct quality reproductive health surveys, we decided to develop a toolkit. We used as our model, the Child Needs Assessment Toolkit developed by the Task Force for Child Survival and Development in Atlanta. The Toolkit was created with the financial assistance of USAID and the Andrew Mellon Foundation through the CDC Foundation. The purpose of the toolkit is to provide a set of tools to assess the reproductive health needs of conflict-affected women and encourage the use of the data to promote and enhance programs and services to improve the reproductive health of women and their families.

Toolkit Benefits Provides data for planning Achievable for staff with limited survey skills Tested methodology Pre-programmed data entry (CSPro) Preliminary results quickly available Reduced cost Builds capacity of staff Covers broad range of RH issues Comparable data As you can see here, there are several benefits to the Toolkit. The Toolkit emphasizes data to action by providing suggestions for data use. It also includes a pre-programmed, public domain data entry program. Users of the Toolkit can compare indicators to those from other surveys such as the demographic & health surveys (DHS). Remote technical assistance is also available from us at DRH via telephone, fax, and email.

Target Users Government Non-governmental organizations (NGOs) United Nations (UN) agencies Independent research consultants Others interested in providing RH services in conflict areas As we developed the Toolkit, we kept in mind who our target users would be. We designed this Toolkit for those with limited survey skills who provide or want to provide reproductive health services to conflict-affected populations. We often work closely with member organizations of the Reproductive Health Response in Conflict (RHRC) Consortium. They are examples of some of the organizations that provide health services to conflict-affected women and would be interested in using the Toolkit. However, we are also targeting government and UN agencies as well as independent research consultants as they are often hired by NGOs and UN agencies to conduct assessments.

Toolkit Components Planning checklist Sampling instructions Training manual Questionnaire Pre-programmed data entry Analysis guide Suggestions for data use The Toolkit is made up of several components, most of which are listed here. We will spend the rest of the morning going over these components in more detail which will prepare you for our afternoon activities of planning to use to the Toolkit and proposing programmatic or policy action as a result of some sample data.

Reproductive Health Assessment Toolkit for Conflict-Affected Women Any questions? www.cdc.gov/reproductivehealth/Refugee