The Minimum Initial Service Package (MISP) for Sexual and Reproductive Health (SRH) is a priority set of life-saving interventions to be implemented at the onset of every humanitarian crisis . The first objective of this international standard in humanitarian response is to ensure that the health sector or cluster identifies an organization to lead the implementation of the MISP . The second objective is to prevent sexual violence and respond to the needs of survivors. The third objective is to prevent the transmission of and reduce morbidity and mortality due to HIV and other sexually-transmitted infections. The fourth objective is to prevent excess maternal and newborn morbidity and mortality. The fifth objective is to prevent unintended pregnancies, and the last and sixth objective is to plan for comprehensive SRH services that are integrated into primary healthcare. The MISP also notes the importance of ensuring that safe abortion care is available to the full extent of the law, as another priority. Planning for comprehensive SRH should occur as soon as possible and in close coordination with the health sector or cluster partners to strengthen the six health system building blocks as defined by the World Health Organization . These blocks encompass service delivery, the health workforce, health information system, medical commodities, financing, and governance and leadership.
Since the conception of the MISP in the mid-1990s, there has been progress in scaling up SRH services in crises-affected settings . For example, the global awareness of the MISP increased, and implementing MISP-related clinical services made headway, such as HIV prevention and gender-based violence prevention and care for survivors . However, there are still critical gaps, including the challenge in implementing the MISP fully and systematically, the limited transition from the MISP to comprehensive SRH services and service integration into primary healthcare as the situation stabilizes, and insufficient attention to adolescent SRH needs .
Field experience has shown that Objective 6 of the MISP remains challenging to implement . It requires vision, leadership, effective coordination skills, and a sound understanding of the local situation and opportunities related to health system recovery. As highlighted in Objective 6, the clinical services of the MISP should be sustained, improved in quality, and expanded upon with other comprehensive SRH services and programming throughout protracted crises and the recovery and reconstruction phases . Comprehensive SRH builds upon the MISP as described in Fig. 1, and its planning and implementation must occur as soon as possible.
Priorities for achieving comprehensive SRH include improving the quality and coverage of MISP services as well as including SRH services that fall outside of the MISP. According to the 2018 Guttmacher-Lancet Commission, comprehensive SRH services are essential sexual and reproductive health services that must meet public health and human rights standards, including the ‘Availability, Accessibility, Acceptability, and Quality’ framework of the right to health . Examples of such services encompass, among others, accurate information and counseling on sexual and reproductive health, including evidence-based, comprehensive sexuality education; prevention, detection, and treatment of reproductive cancers; and information, counseling, and care related to sexual function and satisfaction.
To fully achieve Objective 6 of the MISP and support local and international stakeholders in planning for the delivery of comprehensive SRH services, there must be consideration of several critical aspects. Such aspects include communication among decision-makers (including national governments) and implementing partners, adequate financing, effective coordination, supply chain management, human resources management, monitoring and evaluation, and a system of information sharing, feedback, and meaningful participation of and accountability to the affected community. As with the MISP, comprehensive SRH services must be of good quality and accessible for all crisis-affected populations, including adolescents, unmarried as well as married women and men, persons living with disabilities, and lesbian, gay, bisexual, queer, questioning, intersex, and asexual people [10, 11].
To support the planning process and bridge the nexus between the acute humanitarian response and post-acute development phase, the Training Partnership Initiative of the Inter-Agency Working Group on SRH in Crises (IAWG), with the WHO Global Health Cluster, started designing in 2017 a workshop toolkit. The toolkit objective was to support SRH coordinators and stakeholders in their efforts to plan for comprehensive SRH, with the understanding that Objective 6 of the MISP is not about the implementation of comprehensive SRH services but its programmatic planning. This article aims to describe the toolkit design, the piloting, and the final product.