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|INDICATOR 4h. # and % of disaster/crisis-affected people supported through/by CARE who accessed at least one SRH service \\ (Focus on women of and adolescent girls of reproductive age and access to SBA, contraception, GBV management)||
|**Why this indicator? What will it measure and provide information for? ** \\ This indicator relates to **one of CARE’s four core sectors for humanitarian response: Shelter, FNS, SRH, WASH.** **It aims to gather disaggregated data on number of crisis / disaster affected households supported by CARE and/or its partners with SRH assistance and its grounding in relevant sector standards.** \\  **Access to healthcare is a critical determinant for survival in the initial stages of disaster. Disasters almost always have significant impacts on the public health and well-being of affected populations.** All individuals, including those living in disaster-affected areas, have the right to reproductive health (RH). To exercise this right, affected populations must have access to comprehensive RH information and services to make free and informed choices. Quality RH services must be based on the needs of the affected population. They must respect the religious beliefs, ethical values and cultural backgrounds of the community, while conforming to international human rights standards. Women and girls are especially vulnerable during emergencies if their reproductive health needs are not met as it exposes them to elevated risk of maternal mortality including risks of unintended pregnancies and negative consequences of unsafe abortion in resource constrained settings.||
|**Target (CARE Humanitarian & Emergency Strategy 2013-2020) :** \\  **Humanitarian assistance provided by/through CARE (partners) reaches at least 5-15% (depending on emergency type) of all households affected by a particular disaster / crisis ** (OR if appropriate and more precise: of all disaster / crisis affected households of a specific geographic area in need of particular technical assistance)||
|**What Humanitarian Standards and Humanitarian Indicators is this indicator connected to? ** \\  **This indicator refers to the ** [[https://handbook.spherestandards.org/|SPHERE minimum SRH standards for essential health services]] which focus on priority reproductive health services of the Minimum Initial Service Package (MISP) at the onset of an emergency and comprehensive RH as the situation stabilizes. \\  The[[https://www.humanitarianresponse.info/en/applications/ir|**Humanitarian Response Indicators Registry**]]** includes SRH outcome indicators** also focus on \\ * Basic and Comprehensive Emergency Obstetric Care (B/CEmOC) services \\ * Clinical management of sexual violence \\ * Birth assistance by skilled attendants \\ [[http://www.oecd.org/derec/adb/tool-kit-gender-equality-results-indicators.pdf|**AusAid/OECD Gender Equality Toolkit**]]specifically requires the monitoring of the number of pregnancy and hygiene packs delivered to women and girls (compared with the proportion of affected females) and of the percentage of women and girls with access to contraceptive services.||
|**Definitions and key terms** \\  **Sphere standards defines the main objective of SRH programs** as the availability of adequate SRH capacities and their coordination for ensuring that especially women and girls of reproductive age have access to: \\ * Emergency obstetric and newborn care services (and skills) \\ * MISP related supplies and common contraceptive methods \\ * Services for the prevention and treatment of STDs and tuberculosis \\ * Clinical management of sexual violence (including psycho-social support \\ **Emergency obstetric and newborn care: **In order to prevent maternal and newborn mortality and morbidity resulting from complications (approx. 15% of pregnancies), skilled birth attendance at all births, Basic EmOC capacities and neonatal resuscitation should be available at all primary healthcare facilities with a referral system to and from a primary healthcare facility with BEmOC and newborn care, and to a hospital with newborn care services. \\ **Minimum Initial Service** **Package:** The MISP defines those services that are most important for preventing RH-related morbidity and mortality among women, men and adolescents in disaster settings. It comprises a coordinated set of priority RH services that must be implemented simultaneously to prevent and manage the consequences of sexual violence, reduce the transmission of HIV, prevent excess maternal and newborn morbidity and mortality. \\ **RH supplies:** Supplies for the MISP must be ordered, distributed and stored to avoid delay in getting these essential products to the population. Standard kits such as the Interagency Emergency Health Kit or the Interagency Reproductive Health Kits, facilitate the preparedness for the delivery of MISP. \\ **Sexual violence:** All actors in disaster response must be aware of the risk of sexual violence including sexual exploitation and abuse by humanitarians, and must work to prevent and respond to it. Incidence of sexual violence should be monitored and aggregate information safely and ethically compiled and shared to inform prevention and response efforts. Measures for assisting survivors must be in place in all primary-level health facilities and include skilled staff to provide clinical management Survivors of sexual violence should be supported to seek and be referred for clinical care and have access to mental health and psychosocial support, protection and legal support.  ||
|**Data and information required to calculate the indicator** \\  **Unit Description: **Number and percentage \\ **Numerator:** Number of households / people having received sector specific assistance by/through CARE (partners) **caseload reached (**reference: guidance note for participant reporting, PIIRS project categories). \\ **Denominator:** Total number of disaster/crisis affected households / people** overall caseload ** (specify if possible: HH / people in need of specific assistance **specific caseload**) \\ **Disaggregation:** \\ **Mandatory:** Sex, age and disability/special needs (specify Head of Household); \\ **Sector specific:** SRH health status; Type of SRH assistance received; Proximity to SRH service facilities \\ **Context specific:** legal status (host, IDP, refugee, registered / not registered); Household tenure situation (owner / owner-occupier; renter; squatter; no tenure); Type of settlement (urban / rural; formal / informal) or displacement site/situation (self-settled / planned camp; collective center; host family);||
|**Suggested method for data collection** & **Possible data sources** \\ Monitoring this indicator will rely on a combination of primary and secondary/tertiary data sources with more or less comparable methodologies of data collection. Triangulation might be needed in order to consolidate confidence levels of data used. CARE should adopt data collection methodology for nominator to ensure alignment with most reliable sources for denominator data. \\  **Nominator: **assistance monitoringconducted by CARE directly, through partners or remotely (third party); data collected through activity reports, observation at location, end user surveys etc. \\ **Denominator:** mainly from secondary sources such Government/UN sanctioned general assessments (including MIRA or other multi-sectoral / interagency assessments); data can be further refined (e.g. with regards to disaggregation) / validated through more in depth assessments conducted by CARE including geo-data (coordinates)||
|**Level of effort needed for data collection and reporting: ****MEDIUM HIGH** \\ Household specific monitoring for nominator and denominator data requires **high level of effort** including detailed surveying of households, geo-data, establishment of databases etc. LoE can be reduced by limiting detailed surveying to robust samples with potential for longitudinal surveying of sentinel households / sites. \\  **Frequency of reporting** should be aligned with availability of secondary data for caseload (denominator) as well as with frequency of interventions by CARE and/or partners (e.g. post distribution monitoring, seasonal surveys, gender specific surveys). \\ **Minimum requirement:** \\ * Current status reported through **sitreps (frequency varies)**; \\ * consolidated data reported **annually through PIIRS** ||
|**Data analysis and interpretation of results for this indicator: explaining trends (e.g. caseload needs, actors providing assistance) during reporting time, how and why the outcome was reached, and how CARE contributed to the outcome** \\ This indicator requires constant adjustment of data with the documentation of trends on \\ * caseload (overall, sector specific, reached by CARE) and disaggregation (see above) \\ * assistance provided by CARE and others \\ * alignment of assistance with minimum standards (SPHERE) and/or multi-agency agreed standards \\ * recovery of housing by affected population \\ To assess **adequacy and gender sensitivity** of assistance provided (by CARE and others) more analysis is required with regards to: \\ * Extent to which assistance provided by CARE and/or others is aligned with minimum SRH standards \\ * Extent to which CARE interventions reach the most vulnerable groups (women & girls in particular) as identified through relevant assessments \\ * Extent to which assistance provided supports BEmOC services and MISP \\ * Extent to which BEmOC services recover without external assistance  ||
|**Other considerations** \\ Data related to the technical adequacy of assistance provided should always be analyzed while taking into account the feedback received from the affected population itself. Their perceptions are captured through data and information collected under the **Global indicator related to the satisfaction of crisis/disaster affected people with the relevance, timeliness and accountability of humanitarian interventions in areas of CARE’s response.** ||

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