2. Assessment checklist
In the initial crisis situation, there are a few key reproductive health (RH) interventions that programmes should ensure are available, and these do not require an assessment. The Minimum initial service package (MISP) for reproductive health (RH) in crisis situations outlines the initial response necessary and includes the minimum activities for HIV/STI (sexually transmitted infection) prevention and treatment, and is a standard included in the 2004 revision of the Sphere handbook, Humanitarian charter and minimum standards in disaster response for humanitarian assistance providers. The Sphere Manual, Interagency Field Manual (IAFM) for RH in Emergencies and the 2005 Interagency Standing Committee (IASC) Guidelines for HIV in Emergencies are all under revision; however, they will most likely contain most of the following interventions for the initial emergency response to HIV:
- Prevention of HIV transmission in health care settings by ensuring universal precautions are adhered to
- Ensuring access to condoms;
- Providing PEP for treatment of rape survivors, and for other non-occupational and occupational exposure to HIV;
- Management of sexually-transmitted infections;
- Management of opportunistic infections and interventions to prevent illness;
- Continuing anti-retroviral treatment (ART) for those under treatment as quickly as possible
- Obtain the most recent seroprevalence rates of HIV in displaced populations and surrounding communities.
- Obtain the prevalence and types of STIs.
- Assess the level and quality of available health services for testing and treatment of HIV, and for providing blood transfusions.
- Assess if the affected populations already had access to anti-retroviral treatment (ART)s and prevention of mother to child transmission (PMTCT).
- Identify those on ART.
- Assess the level of existing risks and factors that make the risk groups more vulnerable to HIV infection (risk groups usually include women, children and adolescents, single-headed households, certain ethnic and religious groups, minorities, people with disabilities, and drug addicts).
Security and access
- Determine the existence of ongoing natural or human-generated hazards.
- Determine the overall security situation, including the presence of armed forces or militias.
- Determine the access that humanitarian agencies have to the affected population.
Establish HIV/AIDS surveillance
Existing baseline data may include:
- Voluntary blood donor testing
- STI incidence and trends
- Sentinel surveillance of pregnant women
- Voluntary counselling and testing (VCT) for HIV
- Prevention of maternal to child transmission (PMTCT) including counselling and testing of pregnant/delivering women of unknown status
- Trends in condom usage
- Incidence and trends of gender-based violence (GBV)
- Number of clients receiving ARTs
- Number of family planning clients
- Number of women receiving drugs for PMTCT
- Number of newborns receiving PMTCT prophylaxis.
- Determine the capacity of and the response by the ministry of health of the country or countries affected by the disaster.
- Coordinate with international experts such as UNAIDS.
- Determine the status of national health facilities and their capacity to provide HIV counselling and testing, treatment and PMTCT services.
- Determine the availability of standardised protocols, ART and PMTCT drugs, supplies, and equipment for all HIV services listed above.
- Review existing referral systems.
- Determine the status of the existing health information system (HIS).
- Determine the capacity of existing logistics systems to procure, distribute and store HIV related drugs, testing kits and other supplies.
Refer to Chapter 8.5 Health, for details relating to health system capacity.
Consider data from other relevant sectors
- Nutritional status
- Environmental conditions
- Food and food security.
Source: Adapted from IASC 2004. Guidelines for HIV/AIDS interventions in emergency settings-currently under revision (2008); RHRC. Minimum initial service package (MISP) for reproductive health (RH) in crisis situations.