Health Needs Assessment in Emergencies

1. Health Needs Assessment in Emergencies Sandro Colombo, November 2002

2. Routine and non-routine information systems • Routine: • Surveillance Systems • Health (Unit-managed) Information Systems • Civil registration (vital statistics) • Non-routine • Rapid Health Assessments • Surveys

3. 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

4. Alert Decision 1 Preparation RHA Decision 2 Analysis Emergency Action Decision 3 Sitrep • Who does • what? • When? • How? • With whom? • Emergency? • Y/N • What needs? • What • constraints? • What local • resources? • Response? • Which one • (which • resources)? • What • evolution? • Action? • If yes, • which one, • which • resources • required? • Presents • main • findings • Gives • recommen- • dations: • What to do? • Why? • By whom? • To do what? • (ToRs) • Which team? • Where? • How? • ( methods) • How? • (logistics) • What • happened? • Where? • RHA? • When? Political/financial considerations Pre- assessment sitrep Reference values ?? 1 day possibly during RHA 1-4 days 0 few hours/ days ?? Hypothetical Timeframe

5. 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?

6. 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?

7. 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)

8. 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

9. 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?

10. What is available in the EHA webpage? • Short introduction with objectives • SitrepTemplate • Instructions • Reference Values

13. Objectives of the template • selecting what information to collect in the initial RHA, and • summarising this information in a simple and standard reporting format

14. 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

15. EHA first sitrep http://www.who.int/disasters/sitrep.cfm

16. Reference Values

17. 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 localknowledge • 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

18. 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

19. 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)

20. 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)

21. 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 thelayout 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

22. Non-routine data collection methods

23. 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