RAPID HEALTH ASSESSMENT PROTOCOLS FOR EMERGENCIES
( By WHO - OMS, 1999 )

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1 - Conducting the assessment

The steps for carrying out the assessment are: collecting data, analysing them, presenting results and conclusions, and monitoring.

Always take into consideration the following questions:


· How feasible is it to collect this information, given available personnel and resources?

· Is it worth the cost?

· How reliably do the data reflect the situation of the entire population affected by the emergency, i.e. how representative are they?


Collecting the data

Emergencies are often chaotic, and data collection during a rapid health assessment may not proceed in a step-by-step, logical fashion. Yet the plan for data collection and analysis must be systematic. In addition, the limitations of the various sources of information must be borne in mind during data collection and analysis. There are four main methods of collecting data:


- review of existing information;
- visual inspection of the affected area;
- interviews with key informants; and
- rapid surveys.

Review of existing information

Review baseline health and other information at national and regional levels from government, international, bilateral, and NGO sources about the following:


- the geographical and environmental characteristics of the affected area;

- administrative and political divisions of the affected area;

- the size, composition, and prior health and nutritional condition of the population affected by the emergency;

- health services and programmes functioning before the emergency; and

- resources already allocated, procured or requested for the emergency response operation.


Even official data sources are subject to limitations. For example, census data may underestimate certain subgroups or the population as a whole. In addition, morbidity surveillance data may represent an incomplete picture because diseases are routinely under-reported and the extent of under-reporting often varies.

Visual inspection of the affected area

When travel is undertaken by air, useful preliminary observations of the affected area can be made before landing. These may include a gross estimate of the extent of the disaster-affected area (e.g. the extent of flooding or of storm damage), mass population movements, condition of infrastructure (e.g. roads and railways), and of the environment.

A walk through the emergency-affected area may give you a general idea of the adequacy of shelter, food availability, environmental factors (such as drainage and vector breeding), other potential hazards, and the status of the population. The age and sex distribution and size of the population should be estimated.

During the observation, the affected area should be roughly mapped. Such maps should indicate the extent of the area affected, the distribution of the population, and the location of resources, including medical facilities, water sources, food distribution points, and temporary shelters.

Even careful observation may result in a biased impression. If the area visited is more or less severely hit than the rest, the observer may think the overall condition of the entire affected area is better or worse than it is. In addition, the most severely affected persons are often the least visible; injured or sick persons are more likely to be inside shelters and less accessible to visitors.

Interviewing key informants

Conduct interviews with key personnel in the area and with persons from every sector of the affected population:


- clan, village, and community leaders;

- area administrators or other government officials, teachers;

- health workers (including traditional birth attendants and healers);

- personnel from local and international emergency response organizations, including United Nations bodies working in the area; and

- individuals in the affected population.


The information collected from these interviews should include:


- the interviewees’ perception of the event (cause and dynamics);
- pre-emergency conditions in the affected area;
- geographical distribution and size of the affected population;
- age and sex distribution of the population and average household size;
- adequacy of security and prevalence of violence;
- current morbidity and death rates and causes;
- current food supplies, recent food distribution, and future food needs;
- current supply and quality of water;
- current adequacy of sanitation;
- other priority needs of the affected population, such as shelter and clothing;
- current status of transport, fuel, communication, and other logistic necessities; and
- current resources available in the affected community, including medical equipment, drugs, and personnel.

Concerns expressed by the people interviewed can be further investigated during the rapid health assessment. For example, if health workers report an outbreak of cholera in the emergency-affected area, this should be confirmed or refuted immediately by the assessment team.

The interview with key personnel should be used for planning the establishment of a surveillance system monitoring morbidity, mortality, and nutritional status.

Assessment personnel should always keep in mind that information derived from interviews is coloured by the interviewees’ perceptions. These perceptions are subject to the same biases mentioned above regarding visits to the affected area. Moreover, informants may intentionally exaggerate the extent of damage, injury or illness to solicit emergency assistance for the population they represent.

Rapid surveys

Because surveys take more time and resources, they should be reserved for data which are essential but may not be available from other sources. Such data could include:


- sex and age distribution of the affected population;

- average family size;

- number of persons in vulnerable groups, such as unaccompanied children, single women, households headed by women, and destitute elders;

- recent death rates;

- recent rates of health conditions that are specific to the type of emergency, such as diarrhoea, traumatic injuries, burns, and respiratory distress;

- nutritional status;

- vaccination coverage among children;



- state of housing; and

- access to health care, food, water, and shelter.


For a more complete description of survey techniques for rapid health assessment, see Annex 1.

Analysing the data

The data collected during the rapid assessment must be analysed quickly and thoroughly, and the results made available to decision-makers as soon as possible to derive the greatest benefit from the information.

The analysis should use standard techniques to ensure its comparability to assessments conducted in other situations, and to subsequent assessments that will be carried out during the current emergency. For example, standard case definitions for diseases should be used.

The analysis should be as specific as possible to ensure the best targeting for interventions. Data should be disaggregated and treated separately, according to administrative area, period, and type of population, to get specific estimates. The sources of data should always be specified, and an attempt made to assess their reliability.

Presenting results and conclusions

The presentation of the results and conclusions of the rapid assessment should have the following characteristics.


· It should be clear. Decision-makers or staff of local, national, and international organizations whose action depends on the results of the rapid assessment may have little training in interpreting health and epidemiological data. User-friendly language should be used; graphs can help make complex data and trends more easily understood.

· It should be standardized. The results should be presented in widely recognized formats so that they can be compared with other assessments. For example, the prevalence of moderate and severe malnutrition should be expressed as a percentage of the target population. In an emergency due to sudden population displacement, mortality should be calculated as the number of deaths per 10000 people per day.

· It should give clear indication of the highest priority needs and how to address them. Chronic or pre-existing conditions and needs should be distinguished from the new ones related to the emergency. The members of the rapid assessment team should arrive at clear recommendations for implementing organizations. For a suggested standard report format, see page 85.

· It should be widely distributed. Copies of the report should be distributed to all organizations involved in the emergency response operations.


Monitoring

The rapid health assessment should be only the first step in collecting data. Ongoing data collection is necessary to evaluate the effect of health programmes implemented before or as a result of the rapid assessment. For example, after recent death or morbidity rates are calculated from data derived from a survey conducted during the rapid assessment, a surveillance system should be established, or reestablished, to monitor future trends.

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