Implemeting the Syndromic Approach in a Humanitarian Context

Location:

Introduction:

Ongoing conflict in Yemen has resulted in one of the world’s largest humanitarian crises, with more than 20 million people in need of assistance and less than half the country’s health facilities functioning.

Project Description:

In 2010, Save the Children launched a program in Amran governorate in western central Yemen to address the sexual and reproductive health needs of displaced women and girls. Save the Children, in collaboration with the Ministry of Health, trained mobile health teams of doctors, midwives, and nurses to deliver a range of services including contraception, antenatal care, and postnatal care. The program later expanded to other governorates and districts. As of 2017, Save the Children in Yemen’s health program is functional in 8 governorates supporting almost 75 fixed health facilities and mobile teams serving 110 sites.

Results:

Soon after mobile health teams were deployed, health providers began to report a large number of clients in need of STISexually transmitted infection case management and it became critical to address this service gap. In order to do so, Save the Children staff first reviewed Yemen’s national guidelines on the syndromic management of STISexually transmitted infections to ensure they were up to date and there were no major discrepancies with WHOWorld Health Organization guidelines. Then, Save the Children partnered with the WHOWorld Health Organization, the Ministry of Health, and governorate officials to conduct a training on syndromic management of STISexually transmitted infections for 25 midwives.

At static health facilities, the team printed and displayed STISexually transmitted infection syndrome management flow charts to aid health providers in case management. Mobile health teams used smaller flip charts during their outreach activities. The health team also worked closely with community volunteers and trained them to share messages on STISexually transmitted infection signs and symptoms and encourage women to come to the facility or mobile clinic for care. STISexually transmitted infection services were integrated into the full package of SRHSexual and reproductive health services provided in the program and were delivered in a confidential space, which helped to reduce stigma. In addition, rapid syphilis tests were integrated into routine antenatal care that was provided by mobile health teams. From January to December 2017, more than 6,000 women and men received treatment for an STISexually transmitted infection in Save the Children supported facilities in Yemen.

Lessons Learned:

Securing support and buy-in from the Ministry of Health and governorate officials to implement the syndromic approach was important to the success of the program. In order to do so, it was important to position STISexually transmitted infection services as an integral component of a comprehensive package of SRHSexual and reproductive health services. Partner notification and treatment remains challenging due to the polygamous context, although it is encouraged during counseling. The program also works hard to ensure a steady supply of STISexually transmitted infection commodities and drugs but this is often affected by the procurement delays and barriers resulting from ongoing insecurity. Despite these challenges, the program has successfully been able to improve provider competency on syndromic management of STISexually transmitted infections and expand women’s access to these important services.