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Table 1 Minimum Initial Service Package (MISP) Objectives and Activities

From: An overview of the sexual and reproductive health status and service delivery among Syrian refugees in Jordan, nine years since the crisis: a systematic literature review

1. Ensure the health sector/cluster identifies an organization to lead implementation of the MISP. The lead SRH organization:
• Nominates an SRH Coordinator to provide technical and operational support to all agencies providing health services
• Hosts regular meetings with all relevant stakeholders to facilitate coordinated action to ensure implementation of the MISP
• Reports back to the health cluster, GBV sub-cluster, and/or HIV national coordination meetings on any issues related to MISP implementation.
• In tandem with health/GBV/HIV coordination mechanisms ensures mapping and analysis of existing SRH services
• Shares information about the availability of SRH services and commodities
• Ensures the community is aware of the availability and location of reproductive health services
2. Prevent sexual violence and respond to the needs of survivors:
• Work with other clusters especially the protection or gender-based violence sub-cluster to put in place preventative measures at community, local, and district levels including health facilities to protect affected populations, particularly women and girls, from sexual violence
• Make clinical care and referral to other supportive services available for survivors of sexual violence
• Put in place confidential and safe spaces within the health facilities to receive and provide survivors of sexual violence with appropriate clinical care and referral
3. Prevent the transmission of and reduce morbidity and mortality due to HIV and other STIs:
• Establish safe and rational use of blood transfusion
• Ensure application of standard precautions
• Guarantee the availability of free lubricated male condoms and, where applicable (e.g., already used by the population), ensure provision of female condoms
• Support the provision of antiretrovirals (ARVs) to continue treatment for people who were enrolled in an anti-retroviral therapy (ART) program prior to the emergency, including women who were enrolled in PMTCT programs
• Provide PEP to survivors of sexual violence as appropriate and for occupational exposure
• Support the provision of co-trimoxazole prophylaxis for opportunistic infections for patients found to have HIV or already diagnosed with HIV
• Ensure the availability in health facilities of syndromic diagnosis and treatment of STIs
4. Prevent Excess maternal and newborn morbidity and mortality:
• Ensure availability and accessibility of clean and safe delivery, essential newborn care, and lifesaving emergency obstetric and newborn care (EmONC) services including:
  • At referral hospital level: Skilled medical staff and supplies for provision of comprehensive emergency obstetric and newborn care (CEmONC) to manage
  • At health facility level: Skilled birth attendants and supplies for uncomplicated vaginal births and provision of basic obstetric and newborn care (BEmONC)
  • At community level: Provision of information to the community about the availability of safe delivery and EmONC services and the importance of seeking care from health facilities. Clean delivery kits should be provided to visibly pregnant women and birth attendants to promote clean home deliveries when access to a health facility is not possible
• Establish a 24 h per day 7 days per week referral system to facilitate transport and communication from the community to the health center and hospital
• Ensure the availability of life saving post-abortion care in health centers and hospitals
• Ensure availability of supplies and commodities for clean delivery and immediate newborn care where access to a health facility is not possible or unreliable
5. Prevent unintended pregnancies:
• Ensure availability of a range of long-acting reversible and short-acting contraceptive methods (including male and female condoms and emergency contraception) at primary health care facilities to meet demand
• Provide information, including existing information, education, and communications (IEC) materials, and contraceptive counseling that emphasizes informed choice and consent, effectiveness, client privacy and confidentiality, equity, and non-discrimination
• Ensure the community is aware of the availability of contraceptives for women, adolescents, and men
Plan for comprehensive SRH services:
• Integrated into primary health care as soon as possible.
• Work with the health sector/cluster partners to address the six-health system building blocks: service delivery; health workforce; health information system; medical commodities; financing; and, governance and leadership.
  1. Note: It is also important to ensure that safe abortion care is available, to the full extent of the law, in health centers and hospital facilities