IAWG GESC February 12, 2014 NYC, NY Retrospective Analysis of Reproductive Health and HIV/AIDS Indicators in United Nations High Commissioner for Refugees Post-emergency Camps Center for Global Health International Emergency and Refugee Health Branch Dr. Basia Tomczyk

Outline  Background  Objectives  Methods  Next Steps  Advocacy

HIS Overview The HIS was developed in 2006 to systematically track health outcomes in refugee settings HIS is a user-friendly, web-accessible database of pre- tabulated health indicators (n=110) At the start of 2010, HIS was operational in : – 21 countries – 85 refugee camps – 24 different partners – 1.5 million camp-based refugees

Global Evaluation of RH in Crises  Unique opportunity to assess reproductive health care at the facility level  Access to surveillance data improves understanding of a WRA health status

Global Evaluation of RH in Crises  The purpose of this study is to conduct a retrospective review of RH indicators, assess MDG-based RH and HIV/AIDS benchmarks and propose additional and/or substitute indicators using the UNHCR HIS database and indicators

Objectives – Analyze trends in antenatal care, delivery, postnatal care, family planning, SGBV and HIV/AIDS indicators – Benchmark RH indicators against existing minimum standards in comprehensive reproductive health – Provide examples of good practice and gaps in RH service delivery, using HIS to explain differences – Make recommendations for advocacy, program management and resource allocation

Methods Design – Retrospective analysis of trends of RH indicators Study Population – Bangladesh, Burundi, Cameroon, Central African Republic, Chad, Congo (DR), Congo (Rep), Djibouti, Ethiopia, Ghana, Guinea, Kenya, Liberia, Namibia, Nepal, Rwanda, South Sudan, Sudan, Tanzania, Thailand, Uganda, Yemen and Zambia.

Methods Inclusion criteria – Countries with all camp HIS data that have records that are plausible. (For example, no indicators are more than 100%) – All camps within the country must have had at least one HIS evaluation – Countries with camps that have at least 6 months of data (Doocy et al. used 6 months)

Methods Inclusion criteria – Countries with camps that have no more than one month of missing data – Data from 2007 to obtain sufficient trends

Methods Data analysis – RH indicators will include all components of ANC, delivery, PNC and SGBV and HIV/AIDS care – Primarily descriptive data analysis – Data will be analyzed using SAS version 9.3

Ethical Issues  Submitted to CDC for project determination and was determined not to be human subjects research  No personal or facility identifying information

Limitations  The quality and completeness of data is known to be somewhat variable during the first months of using the system  Sensitive subjects, such as SGBV and post abortion care, may not be reported accurately  The UNHCR HIS is limited to camp settings  HIS data is predominantly collected in health facilities

Next Steps  Review updated data and spreadsheets via Twine  Data cleaning, triaging indicators (cannot be more than 100%)  Populate table shells, rates, etc  Write peer review publication  Submit to clearance

Key Advocacy Messages  A retrospective analysis of trends in RH gathered from facilities and aggregated on a country level provide valuable information not previously analyzed  Identifying longer-term trends in RH issues among refugees will provide information on a country and global level

Key Advocacy Messages  Compare the indicators to the Millennium Development Goals and refugee health standards helps to acknowledge RH in crises  Provide data for public health action, interventions, policies, and further research

Project Partners  Co-PIs  Ms. Nadine Cornier  Dr. Christopher Haskew  Mr. Curtis Blanton  Student Intern  Jennifer Whitehall

For more information please contact Centers for Disease Control and Prevention 1600 Clifton Road NE, Atlanta, GA Telephone, CDC-INFO ( )/TTY: Web: The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. Thank you!