Health workers face challenges to provide SRH services to Rohingyas

The Bangladesh government has ensured sexual and reproductive health (SRH) services to Rohingya refugees in Cox’s Bazar camps, but the health workers are facing challenges to do the job.

The challenges reported by most of the health workers were healthcare seeking behaviours of refugees, lack of technical and counselling skills for providing SRH services, lack of contextual orientation, language barrier, and feeling of insecurity in the camps, according to a study presented at an international conference.

Sahlil Ahmed, a doctor who works with the Rohingya refugees, conducted the qualitative study and presented at the 10th Asia Pacific Conference on Reproductive and Sexual Health and Rights (APCRSHR10) held virtually.

The 9th session of APCRSHR10 titled ‘Humanitarian Response and Sexual and Reproductive Health and Rights in Asia Pacific’ was co-hosted by the APCRSHR10, and Reproductive Health Association of Cambodia (RHAC) and CNS 

Sahlil said providing SRH services in emergency situations is challenging to health workers as the estimated burden is high.

This qualitative study aimed to explore the challenges that health workers face while providing SRH services to Rohingya refugees in refugee camps, which will help the service providers and policy makers to develop and implement necessary training and support, she said.

She conducted the study in 10 primary healthcare centres and five fixed health posts, one secondary hospital in Ukhiya Health Complex in five refugee camps in Cox’s Bazar.

Unspecified job description and inadequate knowledge and skills for providing SRH services were the major challenges reported by the community health workers (CHWs), she said.

Doctors and midwives mentioned challenges in diagnosing diseases due to scanty spaces for physical examination and lack of lab support.

Inadequate supply of drugs and lack of appropriate higher facilities for referral was also mentioned.

Staff turnover and maintenance of privacy in health facilities were the key challenges indicated during implementing services delivery strategies.

Location of facilities and road conditions were perceived as security concerns and challenges for female health workers whereas acceptance by the community people was much more challenging for male health workers.

“As a doctor you might feel that medicine is not necessary, but for a patient that is very important. So it’s tough to meet their expectations,” said a clinical supervisor in the in-depth interview.

“To do proper counselling is tough as we get around 150 patients per day. If we try to give them proper counselling it will be impossible for us,” said another doctor.

Beginning in August 2017, over 800,000 Rohingya refugees fled into Bangladesh to escape genocide in their home nation of Myanmar.

This massive influx of people, a large proportion who were women and children, led to a complex humanitarian emergency requiring large scale international support.

Sayantan Chowdhury, Programme Analyst, Maternal Health at Cox's Bazar, UNFPA Bangladesh conducted a study to know the development and establishment of the maternal and perinatal mortality surveillance and response system in the camps.

“The lessons learned during the study helped to establish key components for a robust surveillance system and helped to further shape the community health worker mortality reporting,” Sayantan said at the conference.

“At present all the camps are having a functional community based maternal mortality surveillance system.”

Sigma Ainul, Program Manager & Senior Program Officer at Population Council Bangladesh, said “religious opposition to contraceptives is grounded in ethnic self-preservation, but strongly supported by systematically spreading misconceptions regarding health risks, and stigmatising users as promiscuous.”

“There is a preference for large families as a result of dominant religious belief such as huzurs muslim religious leaders tell them not to use a contraceptive method,” she said.

Manju Karmacharya, Sexual and Reproductive Health and Rights in Emergencies Programme Specialist at UNFPA Bangladesh, however, said the utilization of the SRH services has increased significantly with their programmes inside the camp.

“Institutional delivery increased from 21.5% in 2018 to 47% in 2019; contraceptive prevalence rate (CPR) increased to 35% in 2019 from 32.7% in 2018; adolescent friendly service centres increased from 2 in 2018 to 5 in 2019,” she said while giving examples.

Chonghee Hwang, Senior Manager with Family Planning 2020 (FP2020 Secretariat), while chairing the session said emergencies are hard on everyone but the toll is especially heavy on the poorest and the marginalised and underserved members of the community.

“Women, girls and other marginalised groups face increased risk of unintended pregnancies, maternal mortality and disability, sexual and gender based violence, unsafe abortions and sexually transmitted infections including HIV.

“In particular Asia Pacific region has been facing various humanitarian emergency situations, due to internal conflicts, natural disasters and now the pandemic. With increasing risk of climate change and global health crises displacement will continue and possibly increase more.

“So now it is really a time that we need to accelerate our efforts for advancing family planning and reproductive health preparedness work, to meet global crises of increasing humanitarian emergencies with evermore people living as refugees and internally displaced,” Chonghee Hwang said.