Provision of sexual and reproductive health services to internally displaced women and refugees in Africa: a systematic review.
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AIM: The objective of this review is to identify the types of sexual and reproductive health (SRH) services that had been provided to internally displaced persons (IDP) and refugees in Africa, the key stakeholders and partners who provide these services, and the modes of service delivery. METHOD: A systematic review was done using published quantitative and qualitative study designs, and grey literature, the provision and delivery of SRH services for displaced persons was reviewed. Studies included met at least two criteria. Only studies carried out from 2010 till date were included. Data of interest were extracted and the mixed-methods appraisal tool (MMAT) was used to evaluate the quality of each study. Primary outcomes included SRH services delivery, including family planning services; sexually transmitted infections (STI); reproductive cancer prevention, diagnosis, care and treatment; and response to sexual gender-based violence (SGBV). RESULTS: Twenty-one publications met the criteria for the review. While some SRH services are available for women in IDP and refugee camps, adolescent SRH services, preventive care for gynaecological cancers and voluntary abortion care were generally not available. Service delivery was faced with some limitations, including lack of funds, authorization and policy issues, training gaps and lack of supplies. Nurses, midwives, community health workers (CHWs) and lay refugees were the key personnel providing services. They were overworked in most places. Services were primarily funded by the United Nations (UN) and non-governmental organizations (NGOs), but governments, private enterprises and community-based organizations (CBO) worked together to provide care. CONCLUSION: There is a need to expand service delivery for women IDPs and refugees in Africa to include comprehensive SRH care. Deploying more qualified/trained personnel can improve the effectiveness and reliability of the care provided. Better funding for SRH care can help to improve service delivery and the incorporation of other aspects of SRH into care provision.