Providing the Minimum Initial Service Package for RH for Communities with High Food Insecurity Levels in Yemen (IPC 4 and above) - parameter 1 of the 1st SA The project aims to fill key gaps in access to lifesaving reproductive health services for most vulnerable communities affected by food insecurity in Yemen, by providing support to existing health facilities and avoiding their discontinuation of reproductive health services. Access to maternal and newborn health services has been grossly undermined by the prolonged crisis. and coupled with the increasing food insecurity and looming famine, has led to greatly increased vulnerabilities of women of reproductive age particularly pregnant women. According to HeRAMS conducted in 2018, only 20 percent of health facilities in Yemen provided maternal and newborn health services, a decrease from 37 percent reported in 2016. Recent UNFPA field assessments have confirmed gaps in RH services that require urgent interventions such as staffing, equipment, and medicine needed for providing life-saving Emergency Obstetric Care (EmONC) services. Malnutrition among pregnant women predispose to increased cases of fetal growth retardation, low birth weight, and increased risk of fetal and newborn deaths as well as maternal complications.
 
This project will support scale-up of provision of the Minimum Initial Service Package (MISP) for Reproductive Health in alignment with the Minimum Service Package of Yemen in 45 districts categorized as IPC4 and above that have been jointly prioritized by the Health, WASH, Nutrition, FSAC, and Education Clusters as the most in need and most at risk of increasing mortality and morbidity. Emergency Reproductive Health kits will be procured and distributed to all facilities within the 45 priority districts to enable provision of reproductive health services. Direct support to service delivery will also be provided for selected health facilities to fill gaps and ensure that the full range of Emergency Obstetric and Newborn Care signal functions are performed in full. The health facilities will link to existing programs for community based reproductive health services provided by community midwives working in underserved that UNFPA is already supporting. This will strengthen linkage between the communities and the health facilities to ensure continuum of care for safe pregnancy and childbirth care and reproductive health in general.

More specifically, the project will directly support the provision of RH services in facilities lying in 15 IPC 4 or above districts, through the payment of incentives to providers, supporting operational costs, monitoring, supervision and technical support to the providers. The facilities in the 15 districts are already providing EmONC services with UNFPA's support, and this project will allow them to continue RH service provision. For the other 30 IPC 4 or above districts, the project will provide existing health actors with RH kits and essential medicines to provide RH services within the scope of the MISP for RH. The list of districts indicating the type of support is present in the annex.

To respond to the famine, a full scale up of services is required, including reproductive health services. Literature illustrates the impact of famine on the pregnancy outcome, including that of newborns (Impact of famine during pregnancy and infancy on health in adulthood, Yang Z et. al, 2008). While efforts are being scaled up by FSAC actors, efforts to respond to the malnourished pregnant women and their newborns are required to save their lives. Famine is also associated with the increased prevalence of obstructed labor (The New “Obstetrical Dilemma”: Stunting, Obesity and the Risk of Obstructed Labour, C.K. Wells, 2017). This indicates the need to provide and strengthen emergency obstetric and neonatal care (both basic and comprehensive), in areas with IPC 4 and above.
 
The MISP for reproductive health is a proven high impact intervention recommended as a humanitarian standard that must be made available at a minimum to all populations affected by humanitarian crisis to