1. 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

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

3. 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

4. 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

5. 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

6. 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

7. 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.

8. 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)

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

10. 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

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

12. 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

13. 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

14. 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

15. 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

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

17. For more information please contact Centers for Disease Control and Prevention 1600 Clifton Road NE, Atlanta, GA 30333 Telephone, 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348 E-mail: cdcinfo@cdc.gov Web: www.cdc.gov 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!