1. May 2008 IAWG Reproductive Health Kits

2. Components of the MISP Identify a coordinator Prevent and manage the consequences of sexual violence Reduce HIV transmission Prevent excess neonatal and maternal morbidity and mortality Plan for comprehensive RH services, integrated into PHC, as soon as possible

3. Continuum of an emergency Emergency Post-emergency Exodus of the population Loss of essential services Restoration of essential services Relative stability Return to normality Destabilizing event Durable solutions MISP & RH Kits Comprehensive RH services Medical supply chain

4. RH kits for emergency situations Block 1 (kit 0 to 5) Primary health care/health centre level 10 000 people for 3 months Block 2 (Kit 6 to 10) Health centre level or referral level 30 000 people for 3 months Block 3 (kit 11 and 12) Referral level 150 000 people for 3 months

5. “Standard“ population  Adult males 20%  Women of reproductive age (WRA)25%  Crude birth rate 4%  Number of pregnant women  Number of deliveries  Complicated abortions/pregnancy20%  Vaginal tears/delivery15%  Caesarean sections/delivery 5%  WRA who are raped 2%  WRA using contraception15%  Oral contraception30%  Injectables65%  IUD 5%

6. Important supplies in kits but not in MISP Meet pre-existing family planning needs Basic FP methods to meet spontaneous demand Ensure syndromic treatment for STIs Antibiotics to treat people presenting with an STI symptom

7. Updating RH Kits Aim to review bi-annually 1.Survey (English and French) - Covering kit use over previous 2 years - targets consignees from Procurement records and other implementing partners (identified by consignees) - Part I: Implementation of MISP, logistics, guidelines/IEC materials, training - Part II: Technical feedback on kit contents 2.Background paper(s) on new technologies - Already successfully piloted by partner(s) - WHO supported (guidelines and/or EDL)

8. Updating RH Kits RH Kit review meeting 1999, 2003, 2005, 2008 1.IAWG technical focal points:  review survey results and background paper(s)  make recommendations  input from UNFPA procurement 2.RH kit booklet edited and translated 3.Procurement takes action 4.Updated kits available (1 year…) Since 2005: Consistency with IAEHK update process

9. Challenges Medicines “slow” to make it on the EML (PEP) No formal “Essential RH Devices” list Sole manufacturers, patents Regulatory (quality, specifications) Where to stop!? - Kits need a lot of logistic planning and action - Reordering kits is not cost-effective - Timely, sensible, sustainable “post-kit” supply mechanisms

10. Thank you

11. Group work 15 min discussion, 15 min feedback Look at the technologies on the wall - Which should be included in the RH kits - Which others should be put forward for inclusion on the Essential Medicines or Essential Devices List? How can this group contribute to early inclusion of new technologies in WHO guidance