Implementation of the health strategy continues in the RVs whereby UNHCR would achieve responsible disengagement by end of 2018. Health strategy outlines UNHCR operation progressively change from a resource intense parallel health care system to community based health care sustainable model in which community based health workers provide critical services to refugee communities and earn their livelihood. In the long run, UNHCR assistance would be to engage networks of self-help groups to identify individuals, families or groups through community based protection.
Transition of health operation to community based health care, conversion of basic health units (BHUs) into maternal child health (MCH) centres and associated staff reductions remain challenging. Lady health visitors (LHVs) or community midwives (CMW) and medical technicians (MTs) or multipurpose primary health care workers trained in Integrated Management of Maternal, Neonatal and Childhood Illnesses (IMNCI) protocols provide consultations to people seeking health care mostly for seasonal and common diseases. LHVs/CMWs provide RH, antenatal, perinatal and postnatal care, while medical technicians or multipurpose primary health care workers do routine vaccination of children, carryout investigations through rapid diagnostic test kits and dispense medicines; supported by a network of volunteer community health workers. Non communicable diseases and complicated cases with danger signs are referred to appropriate health care facilities and pre-referral care is provided in accordance with the IMNCI Protocols and guidelines. Progressive downscaling is closely managed and monitored by partners and timely support is provided whenever needed to avert outbreaks or rise in morbidity and mortality.
The office is working in close collaboration with UNICEF, WHO and of department of health to include refugee children living in RVs in district routine immunization plans, polio eradication campaigns, and improving vaccinators network; with WHO on prevention and treatment of leishmaniosis and with UNFPA on family planning and institutional delivery promotion.
In comprehensive response, these LHVs, CMWs, paramedics and community health workers would receive IMNCI and refresher trainings, skill enhancement opportunities, instruments and equipment including CHW kits needed to function more effectively. However, more challenging is to institutionalize work of LHVs and paramedics to run MCH centres in terms of workload management, data collection and financial viability as self-reliant health facility would require capacity building of staff. In some refugee villages, because of unique circumstances, with no nearby health facilities, not enough deliveries or LHV, CMWs not willing to relocate for security reasons special incentives would need to be offered to embed staff in these refugee villages.
In prioritise response, MCH model would continue to be rolled out, managed by trained paramedical staff with periodic training of health staff and community health workers.