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Evaluation of the MISP for Reproductive Health Services in Post-earthquake Nepal

In April and May 2015, two devastating earthquakes hit central Nepal. More than 5 million people were affected, of whom 1.4 million were estimated to be women of reproductive age. More than 90,000 women were estimated to be pregnant, and 10,300 were expected to give birth over one month. Approximately 4,500 women were predicted to suffer complications from pregnancy and childbirth, and an estimated 28,000 women were presumed to experience sexual violence.
The Minimum Initial Service Package (MISP) is a coordinated set of priority activities designed to prevent and manage the consequences of sexual violence; reduce HIV transmission; prevent excess newborn and maternal morbidity and mortality; and, plan for comprehensive reproductive health services. Additional priority activities include:
ensure contraceptives are available to meet demand; ensure people presenting with symptoms of sexually transmitted infections (STIs) receive treatment; ensure people on antiretrovirals (ARVs), including for prevention of mother-to-child treatment, continue treatment; and address menstrual hygiene.
In September 2015, the Women’s Refugee Commission led a mission to Nepal to evaluate the implementation of the MISP in the six months following the earthquake in the capital, Kathmandu, and in Sindhupalchowk, a rural district. The evaluation explored awareness of the MISP; implementation of the standard; and factors that influenced implementation.
The evaluation found that all MISP services and priority activities were largely available in both Kathmandu and Sindhupalchowk. Some services were only partially available based on the availability at a limited number of facilities in the district. Some services, where they were available, were of questionable comprehensiveness/quality. There was a major gap in community knowledge about culturally sensitive
reproductive health issues, the benefits of seeking care, and the location of services for sexual violence, STIs, and HIV. Many key informants were not aware of what services were available at each health facility for the comprehensive management of rape (CRM), specifically the use of emergency contraceptives (EC) and post-exposure prophylactics (PEP).

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