Types of interventions

Examples of interventions

Mechanisms

1

Improve the demand for basic health services

Policies and activities aimed at stimulating the demand for basic health services

• Removal of user‐fees.

• Provision of specialised services (e.g. surgery, advanced family planning services etc.).

• Provision of birth notification documents to facilitate issuance of relevant ID document.

• Introduction of a voucher system.

• Subsidisation of health care provision.

• Provision of a 24‐hours health care service.

• Improved transportation (free ambulance service, other transport facilities especially at night).

• Infrastructural improvements (e.g. renovation of old infrastructure).

• Improvement of supplies of essential products at health facilities (blood for transfusion, clean delivery kits etc).

• Physical presence of health staff in the camps/ settlement areas.

• Introduction of a mobile clinic system.

Improving the demand for basic health services will improve the number of people visiting the health facility to seek care. For example in crisis settings.

• The physical presence of health personnel at health facilities will reassure potential clients of their physical safety and security while in the facility and hence encourage patients to seek services.

• The provision of health services through a mobile clinic system overcomes the security challenges that may exist for seeking health care at a fixed facility and therefore reach many vulnerable and critical patients who otherwise wouldn't be able to make it to the facility.

• The availability of a free or subsidised and secured transport system will encourage many patients to seek services which they would otherwise not do if security and availability were not guaranteed

2

Improve the supply of basic health services

Policies and activities aimed at increasing the supply and quality of health services

• Contracting with private providers to deliver a package of services.

• Linking payment of provider salaries and other incentives to specific performance targets.

• Task‐shifting.

• Involvement of lay or community health workers.

• Training/retraining of local health personnel, traditional birth attendants etc.

Supply‐side incentives will increase coverage and quality of health services provided. For example in a crisis setting, involving lay or community health workers and implementation of task‐shifting in health‐care delivery especially as the demand for health care may be exceptionally high, more clients/patients will be received in a shorter period of time, reducing the waiting time and possibly reducing the risk of complications due to delays in receiving care. Also, with more health care providers available and services quickly delivered, potential clients and patients will not have to travel to other places to seek care which might pose a security risk to the travellers etc.

3

Improve security for health personnel and infrastructure

Policies, actions and initiatives aimed at ensuring the safety of health and protection of health facilities

• Reducing the number of non‐essential staff at the facility during periods of insecurity.

• Transporting health personnel to and from the health facility in official institutional vehicles.

• Involving local communities in the construction, management and protection of health facilities.

• Policy of non‐acceptance of armed individuals into the health facility.

• Evacuation of foreign staff during times of high insecurity.

• Fencing the health facility.

• Adopting a non‐directive refugee policy.

With improved security for health personnel and infrastructure, personnel will be able to continue providing essential services and the population will be sure of receiving appropriate /competent care and treatment when they visit the health facility. Providing a safe means of transport for health personnel to and from health facilities, involving the community in the construction, management and protection of the facility, and providing a protective fence around the facility will enhance the morale and sense of security of health personnel, ensuring their availability and concentration to provide services.

4

Prevent sexual violence and provide appropriate assistance to survivors

Policies and activities aimed at preventing sexual violence and appropriate support for survivors

• Involvement and targeting of women in camp planning committees and for food distribution.

• Regular distribution of firewood to women.

• Provision of clinical and psychosocial care and legal support for survivors of rape.

• Improved lighting of settlement areas at night.

• Construction of separate, lockable latrines and shower facilities for males and females.

• Reduction of overcrowding.

• Non‐use of tents that unzip from the outside.

Risks for sexual violence will be reduced and survivors will be adequately supported. When these basic amenities are provided, and lighting is improved within the camps, women and girls will be less exposed to situations of increased risk of sexual violence. In crisis settings, many women and girls tend to be raped or sexually assaulted when they go to fetch firewood or water, away from the camp, or at night in camps with poor lighting systems. With the involvement of women in camp planning and food distribution, their inputs on aspects that expose them to sexual exploitation or abuse will be taken into consideration in the afore‐mentioned activities.

5

Reduce the transmission of HIV and other STIs

Policies and activities aimed at reducing the transmission of HIV and other STIs

• Promoting and ensuring safe blood transfusion practices.

• Facilitating and enforcing observation of standard precautions.

• Making condoms freely available.

With safe blood transfusion practices and observance of standard guidelines, the quality of blood used for transfusion will be improved as the screening process will be more efficient. As such, the risk of mothers and newborns being transfused with HIV and other STIs infected blood will be reduced.

When free condoms are available among crisis‐affected populations, coupled with appropriate health promotion messages, the demand and use will be enhanced, leading to improved safe sex practices and consequently reduced risk of transmission of HIV and other STIs.

6

Prevent excess maternal and newborn death and disability

Policies and activities aimed at reducing maternal and neonatal morbidity and mortality

• Ensuring availability of emergency obstetric care and newborn care (EmONC) services.

• Provision of clean delivery kits to all pregnant women and birth attendants.

• Provision of midwife delivery kits to facilitate safe deliveries in health facilities.

• Installing a referral system to manage obstetric emergencies.

• Undertaking regular maternal and newborn death audits.

• Recruiting more health personnel, especially midwives and doctors.

• Community sensitisation (pregnancy danger signs, facility‐based delivery, skilled birth attendance etc)

Mothers and newborns will readily get the care they need and cases of mortality and disability will be reduced. With most maternal and newborn deaths in crisis settings associated with the lack of or poor quality EmONC services, the availability of these services with the appropriate quality will reduce the risk of maternal and newborn deaths as the demand for these services tend to be higher in such settings.