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Health Needs Assessment in Emergencies

Sandro Colombo, November 2002

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Routine and non-routine information systems

• Routine:– Surveillance Systems– Health (Unit-managed) Information Systems– Civil registration (vital statistics)

• Non-routine– Rapid Health Assessments– Surveys

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What a RHA is and for what is used?

“collection of subjective and objective

information in order to measure damage and

identify those basic needs of the affected

population that require immediate response”

From: RHA protocols for emergencies, WHO, 1999

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HypotheticalTimeframe

Alert Decision 1

• What happened?• Where?• RHA?• When?

Pre-assessmentsitrep

??

Preparation

• To do what? (ToRs)• Which team?• Where?• How? ( methods)• How? (logistics)

few hours/days

RHADecision 2

• Emergency? Y/N• What needs?• What constraints?• What local resources?• Response?• Which one (which resources)?• What evolution?

1-4 days

Emergency

0

Analysis

• Action?• If yes, which one, which resources required?

possiblyduring RHA

Referencevalues

Sitrep

• Presents main findings• Gives recommen- dations:• What to do?• Why?• By whom?

1 day

ActionDecision 3

• Who does what?• When?• How?• With whom?

??

Political/financialconsiderations

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Which are the key questions in a RHA?

• Is there an emergency or not?

• What is the main health problem?

• What is the existing response capacity?

• What decisions need to be made?

• What information is needed to make these decisions?

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Which information to collect?

• Why ask this question?

• Is the question clear?

• Where to find the information?

• What to do with the answers, once we

have them?

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Needs or capacity assessment?

• Both:

– needs can have increased (augmented

hazards to health, e.g. epidemic) or

– capacity too meet “normal” or increased

needs can have diminished (h.infrastructure

destroyed, but health hazards not augmented)

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Main steps of a RHA

• Set the assessment priorities

• Collect the data:

– reviewing existing information

– inspecting the affected area

– interviewing key people

– carrying out a rapid survey

• Analyse and interpret the findings

• Present results and conclusions

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Preparing for a NA

• What should I know before going to the field?

• What methods are appropriate, considering:

– the given emergency context, and

– the security, time, logistic, technical constraints?

• What composition of the NA team?

• Which logistics, communication & transport?

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What is available in the EHA webpage?

• Short introduction with objectives• SitrepTemplate• Instructions• Reference Values

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Objectives of the template

• selecting what information to collect in the initial RHA, and

• summarising this information in a simple and standard reporting format

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Advantages of using a standard template

• Quicker and comparable analysis

• Ensures all important items of information are included

• Consolidates information from different sources into a single document

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http://www.who.int/disasters/sitrep.cfm

EHA first sitrep

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Reference Values

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RHA: a few tips (1)

• Concentrate on your sector, but don’t lose sight of the context

• Concentrate on the NOW, but look at the past (WHY?) and think of the future (...WHAT IF...?)

• use local knowledge

• Don’t create expectations! A NA, as a rule, should be followed by response

• Share with your team, report to your HQ, but leave something for who remains in the field

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RHA: a few tips (2)

• Don’t be too ambitious: time is short

• Being roughly right is generally better than

being precisely wrong

• Biased conclusions from the RHA can do

more harm than not taking any action

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What is needed for a RHA?• Clear lines of authority and reporting• Partnerships• Division of responsibilities and agreed procedures• Maps• Transport• Radio or mobile/sat phones• Tent, food?• Security clearance• Qualified personnel• Interpreters (if no local assessors are part of the team)• Data collection forms, containers for specimen, other

equipment• Guarantee of follow-up (response, other assessments)

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Defining needs

• Need for a desiderable end state (e.g. health)• Need for a health care intervention, an intermediate

state (a product of derived demand in economics)• Normative need: I.e. defined by professionals (an

example of a socially constructed need)• Need as the capacity to benefit from health care

(economist’s view concerned about the change in state)

• Felt need/wants: individually experienced• Demand: expressed need• Comparative need: against a reference group• Need as a deficit: the difference between a norm -

2,100 Kcl- and the reality (the actual intake of calories)

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Looking for the perfect Rapid Needs Assessment Protocol

Attributes of an ideal protocol format:

• disaster specificity/robustness: is it for any type of disasters?

• comprehensive scope: is it for sites, systems and areas, for all?

• metadata available: who says this? Can I contact him/her again?

• information priorities: are priority items covered?

• performance indicators: are they SMART?

• benchmarks: present?

• data structure: is the layout user friendly?

• portability: does it fit in your pocket?

• time target: can it be filled quickly?

• usability: does it allow for immediate data entry?

Adapted from D.Bradt, 2001

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Non-routine data collection methods

Type When What How

Rapidreconnaissa-nce

Immediately after adisaster

A quick, preliminaryinspection of the disasterarea

Satellite imagery Overflights Mapping Drive/walk through

RHA As soon as it ispossible to go to thearea

A quick collection ofinformation to confirm theemergency, measure theimpact, identify healthneeds and guideresponse

Visual inspection Analysis of records Interview of keyinformants Rapid surveys(MUAC, etc)

Surveys When the situationstabilises andresponse has beenactivated

A detailed study in whichinformation is systemati-cally collected in a sampleof population (morbidity,mortality, nutrition, KAP)

Probability sampling Non-probability s.

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Which information?• The population:

– numbers, characteristics, & trends– morbidity and mortality

• The vital needs:– security– food– water– shelter & sanitation– clothes and blankets– domestic utensils and fuel– health care

• The support systems:– information– logistics– coordination– resource flow