Resilient Sexual & Reproductive Health Facilities
In 2019, International Planned Parenthood Federation/Western Hemisphere Region (IPPF) and Engineers Without Borders USA (EWB), with the support of the Clara Lionel Foundation, committed to strengthen the emergency preparedness and response capacity of local Sexual and Reproductive Health (SRH) providers in the Caribbean. Disaster preparedness and response must consider SRH needs and the disproportionate threats of violence and reproductive health complications faced by women and girls. Integrating SRH has been proven to reduce morbidity and mortality related to HIV, unplanned pregnancy and pregnancy complications, psychosocial challenges, and gender-based violence, all of which increase in the aftermath of disasters. Through this commitment, partners will assess health facilities and work with local engineers to implement clinic retrofits, as well as engage the community, particularly women and girls, to incorporate SRH into disaster preparedness The results of this project will be shared across IPPF offices to support member associations seeking to improve their humanitarian impact.
International Planned Parenthood Federation/Western Hemisphere Region (IPPF/WHR), Engineers Without Borders USA (EWB-USA) and the Clara Lionel Foundation commit to pilot a strategy to support the resilience of sexual and reproductive health (SRH) providers in the Caribbean, developing a systematic model for disaster risk reduction among Caribbean civil society organizations serving vulnerable communities.
This commitment will involve IPPF/WHR member associations in up to four countries: Antigua, Barbados, the Dominican Republic, and Trinidad & Tobago. In each country, member associations will select one clinic for the pilot project. Project activities will strengthen the preparedness of these clinics to provide SRH care in disaster contexts, particularly life-saving services such as access to condoms and other contraceptives, medical attention and counseling for victims of sexual violence, and safe abortion wherever allowed by law. Furthermore, these clinics will be positioned to serve as disaster hubs – places where community members can gather to receive information, support and safety, and which emergency medical teams can use as a logistical base.
In Phase One, EWB-USA will conduct vulnerability assessments at each clinic, evaluating both structural and non-structural components. EWB-USA will also research local supply chains for materials and labor. In parallel, IPPF/WHR’s humanitarian officer will work with member associations to identify operational and capacity-building needs, including developing or revising emergency response plans.
In Phase Two, EWB-USA will work with local engineers to execute the recommended clinic retrofits. EWB-USA will provide project management, capacity building around systems use and maintenance, and conduct a final evaluation. Simultaneously, IPPF/WHR will support member associations in addressing the operational needs identified in Phase One. Member associations will also engage their community, particularly women and girls, to incorporate SRH into disaster preparedness.
In Phase Three, partners will document and share results across the global IPPF network and disaster risk reduction and humanitarian actors in the region, such as the Caribbean Disaster Emergency Management Agency with the goal of potentially scaling the project across the Caribbean.
Phase One: Planning and Initial Assessment: June-August 2019
Conduct initial health facility assessment (EWB)
Prepare trip reports and recommend member associations to participate in Phase II (EWB)
Phase Two: Project Implementation:
Develop recommendations for each Member Associations (EWB)
Adjust WHO health facility assessment to local context (IPPF and EWB)
Develop IPPF Humanitarian Preparedness and Response Capacity Assessment (IPPF)
Conduct assessment to identify capacity building needs at each MA (IPPF)
January – June 2020
Conduct WHO health facility assessment (EWB and IPPF)
Contract local partners (EWB)
Oversee structural retrofitting and other needs (EWB)
Develop and test emergency preparedness and response plan at each MA (IPPF)
Conduct capacity building sessions for member association volunteers & youth members (IPPF)
July – December 2020
Capacity building about system use and maintenance (EWB)
Assess quality of project (EWB)
Support member association DRR and humanitarian partnership building (IPPF)
Phase Three: Documentation and Dissemination: January – June 2021
Bring member associations together to share experiences and build a network of Caribbean SRH organizations that support each other in crisis (IPPF)
Conduct final evaluation of project including re-application of WHO Safe Health Facilities Tool (IPPF)
Document and share project results with key actors, e.g. CEDEMA, other IPPF global regions (IPPF)
Follow-up visit to check clinic infrastructure & disaster readiness (EWB)
Assess value of expanding project model to other countries in or beyond the Caribbean (CLF)
The Caribbean region is uniquely vulnerable to the threats of climate change, including increasingly frequent and severe hurricanes. The risk of climatic events is compounded by poverty and inequitable access to healthcare, education, and political power, particularly for women and girls.
Following the devastating 2017 hurricane season, Member Associations of the International Planned Parenthood Federation/Western Hemisphere Region (IPPF/WHR) joined national response efforts across the region. The Caribbean Family Planning Affiliation provided sexual and reproductive health (SRH) and primary care to Barbudan evacuees in Antigua and Anguilla. In Puerto Rico, Profamilias deployed mobile units and community health educators to provide counseling and contraceptives and support general aid distribution; however, its two main clinics were shuttered for over three months due to lack of power and running water.
These experiences confirmed the critical role of local health facilities and healthcare workers in emergency response. At the same time, they highlighted the need for more intensive disaster preparation through healthcare infrastructure hardening, creation and testing of emergency response plans, capacity building of health workforce, and coordinating with local organizations and governments to promote inclusion of SRH in disaster preparedness.
Across the region, health facilities are a key component of national and local initiatives to reduce the risks associated with natural hazards. Local health facilities can serve as response hubs immediately after a disaster and community cornerstones during long-term recovery, providing a localized response that is rapid, cost effective, and locally acceptable. However, to play this crucial role, health facilities must have resilient infrastructure, evidence-based emergency response plans, and trained and committed staff.
Furthermore, disaster preparedness and response must consider sexual and reproductive health (SRH) needs and the disproportionate threats of violence and reproductive health complications faced by women and girls in humanitarian settings. Integrating SRH in emergency response reduces morbidity and mortality related to HIV, unplanned pregnancy and pregnancy complications, psychosocial challenges, and gender-based violence, all of which increase in the aftermath of disasters. Most importantly, SRH care is a fundamental right of all people, including those living in emergencies.
The Caribbean Resilience project focuses on disaster preparedness for clinics that provide sexual and reproductive health care, which is a lifesaving but often forgotten need in the aftermath of disasters. With the generous support of the Clara Lionel Foundation, International Planned Parenthood Federation Western Hemisphere Region (IPPFWHR) is partnering with Engineers Without Borders USA (EWB-USA) to strengthen emergency preparedness and response capacity of two partners: the Belize Family Life Association (BFLA) and the Dominican Republic Family Wellness Association (PROFAMILIA). This has been a rich learning period for all partners, providing insights into milestones and ways of working that can be applied to future resilience investments. Over the past year, the partners invested considerable time and effort on clarifying design scope and resilience requirements ahead of the construction phase. In the Dominican Republic, improvements to the urban “Sabana Perdida” clinic will include:
Conversion of dilapidated and dangerous metal parking structure into a flexible outdoor community space; Roof weatherization, including a protocol for consistent maintenance to reduce the risk of water damage after major storms; Solar panel installation and maintenance training, which will reduce the clinic’s carbon footprint and ensure a reliable backup energy source in case of power grid failure; Accessibility improvements, including installation of a wheelchair ramp and widening of interior waiting area and hallways.
With technical assistance from EWB-USA and IPPFWHR, Profamilia’s team solicited and rigorously evaluated proposals from local contractors and solar system vendors. This process included the adaptation of the Rocky Mountain Institute’s field-level checklist for solar quality assurance. Building on this experience, the organization’s executive leadership and board of directors have set a goal to solarize the rest of their national clinic network. In Belize, improvements to the rural community clinic in Dangriga Creek include:
Foundation and ground regrading; Installation of a perimeter fence to improve drainage and reduce erosion; Roof reinforcements.
In addition to physical upgrades, both partners have strengthened their operational preparedness for climate hazards. In 2020 EWB-USA staff and volunteer engineers drafted Disaster Preparedness Checklists, building on tools previously developed by the World Health Organization and with extensive input from IPPFWHR and local partners. The checklists support health facility managers and technicians to ensure clinic staff maximize preparation for an imminent natural disaster, and are equipped with the knowledge they need to safely enter and operate the clinic after a disaster. Profamilia and BFLA staff have participated in trainings on the Checklists and are incorporating them into their existing disaster management plans. EWB-USA and IPPFWHR also developed an Infrastructure Resilience Guide to help clinic leaders identify vulnerabilities and prioritize resilience upgrades. The Guide was developed during this project specifically to address the needs of small community clinics and will be a key tool for designing and evaluating future resilience initiatives.
The partners are seeking $700,000 of funding to build on the generous initial investment from the Clara Lionel Foundation and scale the project to other Caribbean countries or other regions. Partners are also seeking in-kind support—including for travel, lodgings, solar and building equipment—from organizations and people interested in supporting disaster preparedness, women’s rights, and sexual and reproductive healthcare in the Caribbean. They welcome ideas on strategic partnerships in the health sector and in disaster risk reduction the Caribbean and the target countries of Antigua, Barbados, Dominican Republic, and Trinidad and Tobago. This includes insights on strengthening security of cloud-based electronic health records and continuity of internet and communications access during and after natural disasters.
Through this partnership IPPF/WHR, EWB-USA and Clara Lionel Foundation will create a replicable model, with best practices and lessons learned of integrating SRH into emergency response that can be shared with other organizations interested in improving their humanitarian impact. For the infrastructure improvements, EWB-USA will develop an open-sourced manual that includes the approach methodology, design standards and final implementation of the engineering recommendations.