Joint monitoring to improve SRH service quality in Rohingya refugee camps, Bangladesh

Background

Ensuring consistent quality of sexual and reproductive health (SRH) services in large humanitarian responses is challenging due to multiple implementing partners, varying clinical capacity and limited system-wide accountability mechanisms. The Rohingya refugee response in Cox’s Bazar, Bangladesh—serving nearly one million displaced people—involves more than 50 organisations delivering SRH services. To strengthen service quality and coordination, the SRH Working Group established a joint monitoring mechanism to assess facility readiness and identify system-wide gaps.

Methods

A structured monitoring framework was implemented across 107 health facilities providing SRH services in the refugee camps. Multidisciplinary teams conducted supportive supervision visits using standardised assessment tools covering service availability, workforce capacity, infection prevention and control practices, respectful maternity care, clinical protocol adherence and commodity availability. Data were collected through facility observations, document reviews and staff interviews. Findings were analysed to identify priority gaps and inform coordinated quality improvement actions.

Results

The initiative generated the first inter-agency overview of SRH service readiness across the humanitarian health system. Monitoring findings identified variations in service quality between facilities, including gaps in workforce competencies, infection prevention practices and supply chain reliability. Results informed targeted corrective actions and supported coordinated follow-up through the SRH Quality Improvement Technical Team.

Conclusions

Inter-agency monitoring mechanisms can strengthen accountability and improve service quality in complex humanitarian health systems. The Cox’s Bazar experience demonstrates how coordinated monitoring across multiple partners can generate actionable evidence to guide system-wide quality improvement in refugee health services.

Key messages

• Inter-agency joint monitoring strengthens accountability and improves the quality of sexual and reproductive health services in large humanitarian health systems.

• Structured monitoring across humanitarian partners generates evidence to guide system-wide quality improvement in refugee health services.