Primary health care and essential services

1Primary health care: organisation and Sphere benchmarks

Primary health care is the foundation of the response: curative consultations, integrated management of childhood illness (IMCI), antenatal and postnatal care, vaccination, nutritional screening, chronic diseases, referral to hospital. It relies on community health workers who detect cases, treat simple illnesses (malaria, diarrhoea, pneumonia) and monitor deaths.

Sphere planning benchmarks: about one primary health care facility per 10,000 people, one district hospital per 250,000 people, at least 22 skilled health workers (doctors, nurses, midwives) per 10,000 population, and a clinician who does not exceed 50 consultations per day. A utilisation rate of at least 1 new consultation per person per year indicates adequate access. Care is free at the point of service during the acute phase.

2The Minimum Initial Service Package for reproductive health (MISP)

The MISP defines the sexual and reproductive health services to be provided from the onset of a crisis, if possible within 48 hours. Its objectives according to the Inter-Agency Field Manual (IAWG, 2018):

• designate a lead organisation to coordinate reproductive health within the Health Cluster;
• prevent sexual violence and respond to survivors' needs: clinical management of rape, with HIV post-exposure prophylaxis within 72 hours and emergency contraception within 120 hours;
• prevent the transmission of HIV and other STIs (standard precautions, safe blood, condoms, continuity of antiretrovirals);
• prevent excess maternal and newborn morbidity and mortality: skilled birth attendance, basic (BEmONC) and comprehensive (CEmONC) emergency obstetric and newborn care, a 24/7 referral system, clean delivery kits for visibly pregnant women;
• prevent unintended pregnancies (contraception available);
• plan for comprehensive reproductive health services as soon as possible.

Safe abortion care, to the full extent of the law, is also among the priorities. The MISP is applied without waiting for a detailed assessment.

3Measles vaccination and routine immunisation

Measles kills on a massive scale in overcrowded camps, especially among malnourished children. The vaccination campaign is an absolute priority as soon as coverage is uncertain or below 90%:

• target: children aged 6 months to 15 years (at least 6 months to 5 years if resources are lacking), depending on the context and national policy;
• coverage target: 95%;
• vitamin A given at the same time to children aged 6 to 59 months;
• children vaccinated between 6 and 9 months receive a further dose at 9 months;
• monitored cold chain, injection safety, waste management.

Routine immunisation (Expanded Programme on Immunization) must resume as soon as possible: pentavalent, polio, pneumococcal, measles, etc. Coverage is checked through registers and surveys, not only through the number of doses administered.

4Mental health, psychosocial support and medicines

The IASC guidelines (2007) organise mental health and psychosocial support (MHPSS) into a four-layer pyramid: basic services and security delivered with dignity; community and family support; focused non-specialised support (psychological first aid, groups); specialised services. Mental disorders are common in conflict areas: WHO estimates that more than one person in five is affected. The mhGAP Humanitarian Intervention Guide enables non-specialist health workers to manage depression, psychosis, epilepsy or substance use, and psychological first aid can be taught to everyone.

For medicines, the Interagency Emergency Health Kit (IEHK 2017) makes it possible to start care without delay: the basic module (10 units) covers 1,000 people for 3 months for basic care, the supplementary module covers 10,000 people for 3 months at the level of qualified health workers, with separate modules (malaria, post-exposure prophylaxis). Kits are a start-up solution: you must quickly move on to consumption-based orders, with stock cards, inventories, the "first expired, first out" principle and alignment with the national essential medicines list.