1. Assessments for NCD health services in humanitarian settngs: what is
Assessments for NCD health services in humanitarian settings: what is needed?

Assessments for NCD health services
in humanitarian settngs: what is
needed?
David Beran MSc PhD
Division of Tropical and Humanitarian Medicine

2. Different target populations…
General Population
At risk, e.g. overweight, obese
At risk, high blood pressure
Undiagnosed NCD
Person with an NCD
NCD related complication
Death
Without NCD
With NCD
Palliative care

3. Different information needs

4. Data needs What is needed? Sources Background information
Preparedness
72 hours
1 week
1 month
Beyond 1 month
Phasing out
Data needs
What is needed?
Background information
Country, region, etc.
Disease specific data
Etc.
Sources
Secondary data
Global Reports
Local sources
Literature
Primary data
Quantitative
Qualitative
Objective information versus opinion
Use of observations

5. Data collection How? Who? Existing information Tools
Reviews
Tools
Adapted to each setting
Who?
Cultural issues
Language
Sensitive issues and situations
Types of questions
Issues
Quantitative versus Qualitative

6. Data analysis What data is collected and needed Timing
Preparedness
72 hours
1 week
1 month
Beyond 1 month
Phasing out
Data analysis
What data is collected and needed
Timing
Analysis has to be timely
Answers are needed quickly
For what purpose will data be used
Who will analyse
Detail needed
Reporting
Who?
How?
When?

7. Needs Assessments: what are we assessing?
Different levels of systems
Laws
Resources
Opportunities and constraints
Values and cultural factors
How these factors impact
System resources
Service providers
Service receivers
Those left out of the system
Disaggregation of these elements to gain better understanding of specific impact
Specialised diabetes services versus Primary Health Care
Services for children versus adults

8. An example of needs assessments: Rapid Assessment Protocols
RAPs have been used extensively to assess services for a variety of diseases, for the purpose of developing interventions*
Also used in humanitarian settings♯
WHO states that RAPs are an essential tool throughout the data collection process during humanitarian emergencies♭
Example: Multi-Cluster/Sector Initial Rapid Assessment (MIRA)
Main principles of RAPs that make them valuable in emergency settings are:
Speed
Use of multiple data sources
Pragmatism
Cost-effectiveness

9. An example of needs assessments: Rapid Assessment Protocols
Method for quickly developing a preliminary understanding of a situation where specific research techniques are chosen from a wide range of options
System perspective
Triangulation of data collection and data sources
Iterative data collection and analysis
Convergence of research and implementation

10. Example of the Rapid Assessment Protocol for Insulin Access (RAPIA)
Insulin and
medicines for
diabetes
Care
Other Problems
Ministry
of Health
Country
Person with diabetes

11. Laboratories (independent/private) Pharmacies (independent/private)
MACRO
Ministry of
Finance
Ministry of
Health
Ministry of
Trade
Central Medical Store
Private/Public
medicine importer
Diabetes Association
Educators
MESO
Regional Health
Authorities
Regional Central
Medical Store
Hospitals
Health
Centres
Laboratories (independent/private)
Pharmacies (independent/private)
MICRO
Pharmacy
Laboratory
People with diabetes
Healthcare
workers
Traditional
Healers

12. The RAPIA data collection
Information collected through
Interviews
Discussions
Observations
Document reviews
Statistics
Government reports
Etc.

13. Beran, D and Yudkin, JS. The Lancet, 2006
RAPIA results
Accessibility and
affordability of
Medicines
Positive policy
environment
Data collection
Community
involvement/
diabetes association
Prevention
measures
Patient education
and empowerment
Diagnostic tools
and
infrastructure
Healthcare
workers
Adherence issues
Organised centres
for care
Drug procurement
and supply
Beran, D and Yudkin, JS. The Lancet, 2006

14. RAPIA results - Mozambique 2003
Accessibility and
affordability of
Medicines
Data collection
Positive policy
environment
Community
diabetes
association
Prevention
measures
Strength
Patient education
and empowerment
Diagnostic tools
and
infrastructure
Needs
improvement
Create sustainable nation-wide access to affordable and reliable sources of insulin, in developing countries, through projects that improve distribution and the educated use of insulin by people with type 1 diabetes currently unable to obtain it.
Healthcare
workers
Adherence issues
Weakness
Organised centres
for care
Drug procurement
and supply

15. Concluding thoughts NCDs Humanitarian emergencies Needs assessments
Complex causes
Multiple actors in and outside health related actors
Multiple factors in and outside the delivery of healthcare
Wider needs not just NCDs
Humanitarian emergencies
Data needs and different stages
Dynamic situations
Needs assessments
Not another tool
Collect useful information
Easy data collection and analysis
Flexible – different setting and stages of emergency
Data for action

16. References used *
Scrimshaw NS, Gleason GR, editors. Rapid Assessment Procedures - Qualitative Methodologies for Planning and Evaluation of Health Related Programmes. Boston: International Nutrition Foundation for Developing Countries (INFDC); 1992.; Manderson L, Aaby, P. An epidemic in the field? Rapid assessment procedures and health research. Social Science and Medicine. 1992;35:
Ong B, Humphris G. Rapid Appraisal Methods in Health. In: Popay Jaw, G, editor. Researching the People's Health. London: Routledge; 1994.
Beebe J. Basic Concepts and Techniques of Rapid Appraisal. Human Organization. 1995;54(1):42-51.
Scrimshaw SCM, Hurtado, E. Rapid assessment procedures for nutrition and primary health care. Anthropological approaches to improving programme effectiveness. Tokyo: The United Nations University, 1997.
Rhodes T, Stimson, G.V., Fitch, C., Ball, A., Renton, A. Rapid assessment, injecting drug use, and public health. Lancet. 1999;354:65-8.
WHO. SEX-RAR guide : the rapid assessment and response guide on psychoactive substance use and sexual risk behaviour. Geneva, Switzerland: World Health Organization, 2002. ♯
Brennan RJ, Rimba K. Rapid health assessment in Aceh Jaya District, Indonesia, following the December 26 tsunami. Emergency medicine Australasia : EMA Aug;17(4):
Brown V, Guerin PJ, Legros D, Paquet C, Pecoul B, Moren A. Research in complex humanitarian emergencies: the Medecins Sans Frontieres/Epicentre experience. PLoS Med Apr 15;5(4):e89.
Silove D, Bryant R. Rapid assessments of mental health needs after disasters. JAMA Aug 2;296(5):576-8. ♭
WHO. A practical guide for country-level implementation of the Health Cluster. Geneva: World Health Organization, Inter-Agency Standing Committee, Global Health Cluster, 2009.