Minimum Initial Service Package Guides Crisis Care

The Inter-Agency Working Group designed the Minimum Initial Service Package (MISP) to guide quick response during the early, acute phase of a crisis. It lists a series of high-priority actions and the basic health care equipment, supplies, and materials needed. Reproductive health care providers can familiarize themselves with the MISP and integrate it into emergency preparedness training and response plans. (For further information on the MISP fact sheet and how to order its components, see Table 4)

The objectives of the MISP are to:

• Identify organizations and individuals to coordinate and implement the MISP (this organization or person is known as the reproductive health focal point);
• Reduce sexual violence and manage its consequences;
• Reduce HIV transmission by (1) enforcing adherence to the universal precautions for infection control and (2) guaranteeing the free availability of condoms;
• Reduce neonatal and maternal illnesses and deaths by (1) providing delivery kits for use by mothers and birth attendants, (2) providing delivery kits to midwives, and (3) initiating a referral system to manage obstetric emergencies;
• Plan for provision of complete reproductive health care, integrated into primary health care, as the situation permits (93, 117).

Emergency Kits Support MISP

Three principal kits support implementation of the MISP. They are (1) simple clean delivery kits for home use; (2) the New Emergency Health Kit-98, developed and revised by WHO; and (3) the UNFPA Reproductive Health Kit (see Table 4). These kits can be ordered at any time, without waiting for an emergency situation.

Women in South Darfur, Sudan, assemble safe delivery kits from locally obtained materials.The women are participating in a project of the American Refugee Committee and a local NGO, Ayya, to generate income for women in this strife-torn area. (Photo Credit: Sandra Krause,Women’s Commission for Refugee Women and Children)

Traditional birth attendants or pregnant women themselves can use the clean delivery kits. The kits can be made using simple, locally available supplies—a plastic sheet, two pieces of string to tie the umbilical cord in two places, a clean razor blade to cut the cord, and a bar of soap. These are the basic supplies needed to avoid umbilical cord infections in newborns and genital tract infections in mothers following the birth.

The New Emergency Health Kit-98 contains two different sets of drugs and medical supplies. One set is a basic unit and the other is supplementary. The basic unit should meet the needs of a population of 1,000 people for three months. The supplementary unit should cover a population of 10,000 people for three months.

The basic kit is meant for use by health care providers who may have had only limited training. It contains some medicines such as antimalarial drugs; renewable supplies such as gauze, gloves, and soap; equipment such as forceps, scissors, and syringes for surgical deliveries at health centers; supplies for some obstetric emergencies; and materials for post-rape care, including emergency contraception.

Only professional health workers should use the supplementary kit. It contains more drugs, renewable supplies, and equipment than the basic kit. (For details see http://www.who.int/hac/techguidance/ems/new_health_kit_content/en/)

The UNFPA Reproductive Health Kit, which is meant to be used only during the acute phase of an emergency, consists of 12 subkits that include condoms and other contraceptives, clean delivery kits for home births, post-rape supplies (emergency contraception), surgical delivery equipment, and blood transfusion supplies. Each subkit can be ordered separately (93).

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