Availability and accessibility of minimum initial service package for reproductive health in Bidibidi refugee settlement, Yumbe district, Uganda

Abstract

Background: The Minimum Initial Services Package (MISP) for reproductive health is a standard of care in humanitarian emergencies. The study investigated the availability and accessibility of MISP for reproductive health services as well as challenges faced by health services providers in implementing the MISP in Bidibidi refugee settlement. Methods: A cross-sectional study using both quantitative and qualitative techniques of data collection was conducted. A census of 19 health facilities was done including (3 Health Centre (HC) II, 15 HCIIIs and 1HCIV). A total of six focus group discussions (FGDs) and five key informants interviews (KIIs) were held. Data were collected using Health Facility Assessment (HFA) standard checklist, FGD and KII guides. Quantitative data were analysed using Excel spreadsheet while qualitative data was analysed using thematic content analysis technique. Results: The study found that coordination of MISP was being implemented, reproductive health focal point persons were appointed in most health facilities (3/3HCII; 10/15 HCIII and 1/1 HCIV) and regular coordination meetings were held in (2/3 HCII, 10/15 HCIII and 1/1 HCIV). Basic Emergency Obstetric and Newborn Care (BEmONC) services were provided in all 19/19 facilities and Comprehensive Emergency Obstetric and Newborn Care (CEmONC) in the HCIV. Misoprostol drugs were available in all (3/3 HCIIs and 1/1 HCIV) but only in (3/15 HCIII). Majority of HCs provided clinical care for rape survivors (2/3HCII, 15/15 HCIII and 1/1 HCIV) including Post- Exposure Prophylaxis (PEP) in all (15/15 HCIII and 1/1 HCIV). Emergency contraceptive pills (ECPs) were totally not available in (HCII 0/3 and HCIV 0/1) level but in a few HCIII (5/15) respectively. Anti-Retroviral drugs were available in most HCIII (13/15) and in HCIV (1/1). Family planning services and Syndromic treatment of STIs were offered in almost all health facilities (2/3 HCII, 15/15 HCIII and 1/1 HCIV). Most HCs lacked menstrual hygiene supplies (0/3 HCII, 1/15 HCIII and 0/1 HCIV). Main barriers to MISP accessibility included: distance to the health facility, costs of getting services, language barrier and male partner involvement as well as attitude of service providers. Challenges of MISP implementation included; inadequate medicines and supplies, workload, transport, communication and stigma. Conclusion: Despite the availability of MISP services in Bidibidi refugee settlement, several factors constrain accessibility including distance, costs, attitude of service providers, inadequate supplies and communication challenges.