1. UNHCR Health Information System Retrospective analysis of Reproductive health indicators in post- emergency refugee camps Sathya Doraiswamy, UNHCR

2. Background 2014: Global Evaluation of RH in Crises 2006: UNHCR Health Information System (HIS)

3. http://twine.unhcr.org/app/

4. Objectives Analyze trends in RH indicators Benchmark RH indicators against existing minimum standards Provide examples of good practice and gaps in RH service delivery, using HIS to explain differences

5. Methods Monthly camp data 2007-2013 from Twine database 10 countries / 56 camps 7 RH indicators

6. Methods (cont’d) Country and camp inclusion: - Completeness – 90% of its monthly reports - Total reporting months – At least 6 months RH indicator inclusion: -MISP objectives -Plausibility

7. Methods (cont’d) IndicatorFormula Maternal mortality rateNumber of pregnancy-related deaths / Total number of live births x 100000 Neonatal mortality rateNumber of deaths for newborns < 28 days of life / Total number of live births x 1000 Proportion of births attended by skilled health worker Number of deliveries attended by trained health workers / Number of deliveries x 100 Proportion of live births performed by caesarian section Number of live births performed by caesarian section / Number of live births x 100 Proportion of ANC mothers who were screened for syphilis during pregnancy Number of pregnant women who had been screened for syphilis during the antenatal period at the time of delivery / Total number of live births x 100 Rate of condom distribution among the population Number of condoms distributed per month (male and female) / Total population Proportion of rape survivors who receive post-exposure prophylaxis (PEP) within 72 hours of an incident occurring Number of rape survivors who receive PEP within 72 hours of an incident / Total number of rape cases reported x100

8. Results CountryNo. of cam ps No. of mont hs of data HIS imp. yr Monthly Camp PopulationMonthly Camp Live Births MeanStd Dev Media n IQRMeanStd Dev Media n IQR Banglad esh 21542007 14,52 9 3,037 14,51 0 6,01843.112.84321 Chad169942007 17,95 3 7,960 17,36 2 9,50557.147.653.549 Djibouti1712008 13,56 5 4,031 13,13 3 8,24023.17.32210 Kenya54122007 81,72 3 33,47 0 48,52 9 185.983.9186.5113 Nepal21052007 19,29 1 8,961 18,23 6 14,85 4 29.817.32619 Tanzania1962007 57,85 0 8,262 60,59 1 12,32 0 177.835.6174.545 Thailand96482008 15,90 7 11,47 4 15,82 5 10,27 4 36.427.73326 Uganda137402007 15,33 3 16,88 4 8,302 16,38 0 39.251.81551.5 Yemen31972008 20,31 4 7,307 21,77 0 7,96540.317.83917 Zambia41492008 11,86 4 4,245 10,68 7 5,33549.2109.231

9. Results: MMR

10. Results: NMR

11. Results: SBA at delivery

12. Results: C-section rates

13. Results: Syphilis screening

14. Results: Condom distribution

15. Results: Access to PEP

16. Limitations Not representative of all refugee camps Same country – changing contexts Under-reporting of mortality Lack of decentralized data at sub-national levels for host Data quality Work in progress

17. Conclusions Improvements in key RH indicators seen over years Achievements in some indicators better than the others More needs to be done to reach set targets Data quality needs to be assured Mortality reporting needs review

18. Acknowledgements United Nations High Commissioner for Refugees –Ms. Cornier –Ms. Schilperoord –Dr. Spiegel –Dr. Haskew –Mr. Pike US Centers for Disease Control and Prevention –Ms. Whitmill –Mr. Blanton –Dr. Tomczyk UNHCR country HIS programs