Preparing for and responding to sexual and reproductive health in disaster settings: evidence from Fiji and Tonga

Abstract

Pacific Island countries are vulnerable to disasters, including cyclones and earthquakes. Disaster preparedness is key to a well-coordinated response to preventing sexual violence and assisting survivors, reducing the transmission of HIV and other STIs, and preventing excess maternal and neonatal mortality and morbidity. This study aimed to identify the capacity development activities undertaken as part of the SPRINT program in Fiji and Tonga and how these enabled the sexual and reproductive health (SRH) response to Tropical Cyclones Winston and Gita. This descriptive qualitative study was informed by a framework designed to assess public health emergency response capacity across various levels (systems, organisational, and individual) and two phases of the disaster management cycle (preparedness and response). Eight key informants were recruited purposively to include diverse individuals from relevant organisations and interviewed by telephone, Zoom, Skype and email. Template analysis was used to examine the data. Differences in the country contexts were highlighted. The existing program of training in Tonga, investment from the International Planned Parenthood Federation (IPPF) Humanitarian Hub, the status of the Tonga Family Health Association as the key player in the delivery of SRH, together with its long experience of delivering contract work in short time-frames and strong relationship with the Ministry of Health (MoH) facilitated a relatively smooth and rapid response. In contrast, there had been limited capacity development work in Fiji prior to Winston, requiring training to be rapidly delivered during the immediate response to the cyclone with the support of surge staff from IPPF. In Fiji, the response was initially hampered by a lack of clarity concerning stakeholder roles and coordination, but linkages were quickly built to enable a response. Participants highlighted the importance of personal relationships, individuals’ and organisations motivation to respond, and strong rapport with the community to deliver SRH. This study highlights the need for comprehensive activities at multiple levels within a country and across the Pacific region to build capacity for a SRH response. While the SPRINT initiative has been implemented across several regions to improve organisational and national capacity preparedness, training for communities can be strengthened. This research outlines the importance of formalising partnerships and regular meetings and training to ensure the currency of coordination efforts in readiness for activation. However, work is needed to further institutionalise SRH in emergencies in national policy and accountability mechanisms. Pacific Island countries experience many disasters, including cyclones and earthquakes. The International Planned Parenthood Federation (IPPF) has been working in the Pacific to help build skills to improve the response to sexual and reproductive health (SRH) and rights during disasters. This paper describes research to identify capacity building activities that helped prepare organisations in Fiji and Tonga and how this affected the delivery of SRH during Tropical Cyclone Winston in 2016, and Tropical Cyclone Gita in 2018. Key informants in senior positions from relevant organisations were recruited and interviewed by telephone, Zoom, Skype and email. We used a framework that described different levels of capacity across phases of the disaster management cycle to analyse the data. Eight key informants described differences in Fiji and Tonga’s preparedness activities before Tropical Cyclones Winston and Gita that affected the way in which services were delivered. The Tonga Family Health Association was well established as a key player in SRH service delivery before Gita and had built relationships and delivered training for disaster response to staff across a number of organisations including the Ministry of Health (MoH). These preparedness efforts facilitated a smooth and rapid response. In Fiji, the response was initially affected by a lack of training, role clarity and coordination, but linkages were quickly built to deliver care and services. Participants highlighted the importance of personal relationships, individuals’ and organisations’ motivation to respond, and strong links with the community to deliver SRH care. This study highlights the need for inclusive activities at individual, organisational and national levels within countries and across the Pacific region to build capacity for a SRH response.