Reproductive Health in Disasters Project
By Prof Nibedita S. Ray-Bennett and Dr Te Klangboonkrong
The project entitled “Prototyping Reproductive Health (RH) Kits for Disasters and Crises” is a continuation of the International Planned Parenthood Federation (IPPF) funded evidence-based intervention project RHCC (Reproductive Health (RH) Kit 8 of UNFPA, Capacity building, Community awareness) (2015-2018). The RHCC was designed to improve the quality and availability of reproductive care during a major flood in Bangladesh. Following the intervention’s promising outcomes, Prof Nibedita Ray-Bennett and her collaborators developed an evidence-based protocol for two low-budget Kits named Facility and Mobile RH Kits localised for deployment in Bangladesh. These Kits consist of lifesaving medicines, equipment, and supplies, and can treat incomplete or missed abortions and post-abortion complications (PAC) during disasters and crises. The protocol phase was funded by the ESRC Impact Accelerator Account Large Rapid Response Scheme and IPPF’s Regional Fund (2019-2021).
Funded by ESRC Impact Acceleration Account (IAA) Partnership Builder Scheme and ESRC IAA Commercialisation Fund (2023-2025), Prof Nibedita Ray-Bennett and her collaborators prototyped Facility and Mobile RH Kits. The prototype phase for the Facility and Mobile Kits involved:
- Estimating the number of affected persons one Facility and Mobile Kit can serve based on vital statistics, surveys, interviews, and document review;
- Determining the cost of each Kit;
- Developing Instruction Guidelines for service providers to ensure quality of care;
- Developing Manuals containing detailed usage information and underpinning methodology for the benefit of users and customers;
- Packaging one medium-sized Facility Kit and one Mobile Kit for accreditation by the Government of Bangladesh’s National Technical Committee;
- Engaging with potential customers and users in Bangladesh and India.
Data collection commenced in Bangladesh after ethical approval in March 2024 from the University of Leicester’s School of Business Research Ethics Committee and the University of Dhaka’s Institute for Health Economics Institutional Review Board. Using multiple primary and secondary data sources, key assumptions underpinning the prototype design were made as follows:
- The assumption regarding the size of the affected population at risk of post-abortion complications was based on the review of demographic data, health trends, SDG targets, disaster profiles, and risks related to climate change.
- The volume of medicines and supplies was determined from a survey of 30 (out of 458) cyclone/flood shelters following the WHO’s cluster sampling design, five key informant interviews, and one focus group discussion with health personnel (consisting of 12 participants) conducted in the district of Cox’s Bazar from January to May 2024. The District of Cox’s Bazar was selected to ensure the site’s representativeness of Bangladesh’s topographical range (plains, coasts, and hill tracts) and exposure to different natural hazards.
- The estimated price range for the Kits was determined from two sources. One source was based on the retail market prices obtained by consultants from the University of Dhaka’s Institute for Health Economics, including any value-added taxes required for procurement under government or institutional frameworks. Another price source was RHSTEP (the manufacturer), which packaged one medium-sized Facility Kit and one Mobile Kit using their existing supplier’s cost in June 2024.
A Technical Advisory Group (TAG) was formed to seek advice on the prototype. This group comprised 15 high-level international and national experts representing nine institutions (e.g., Ipas, UNFPA, Directorate General of Family Planning (DGFP)). The project team met with the TAG four times over nine months. The project team also disseminated the project outputs on 19 November, 2024 in Dhaka with 17 key stakeholders: 11 from the Directorate General of Family Planning, and six TAG members. The project outputs included two manuals, a research brief, and one box each of the Facility, and Mobile demonstration Kits. We received invaluable feedback from the Stakeholders Dissemination Workshop, which will help us to prepare for the National Technical Committee’s accreditation in January 2025.