515115 research-article2013
SJP0010.1177/1403494813515115K.O. SundnesIdentification of needs
Scandinavian Journal of Public Health, 2014; 42(Suppl 14): 102–105
CHAPTER 10
Identification of needs
Abstract Needs are not directly assessed, but rather, the identification of needs is the result of a complex process that requires integration and synthesis of many factors, including the results from numerous assessments. The assessments synthesised into needs include: (1) the pre-event levels of function; (2) the amount and types of damage sustained initially and existing at the current time; current (3) levels of function and the levels of function detected by the last assessment; (4) the presence of a surge; (5) the demands of the population affected; (6) the culture in which the event occurred; (7) the climate in the affected area; (8) the geography and access to the affected area; and (9) politics. The process consumes resources (costs). The transformation process (synthesis) of these many factors requires that those charged with synthesis have knowledge, field experience, insight, and experience using the process. Key Words: Assessments, basic societal functions (BSFs), climate, costs, culture, damage, expertise, factors, functions, geography, identification of needs, needs, pre-event, politics, process, requirements, surge, thresholds, transformation
Introduction The term “needs” has many different meanings. For the purpose of these Guidelines, as stated in the conceptual framework [1 pp33–101, 155], needs are defined as the differences between the required and available services and goods. Requirements are goods and services that must be available to the basic societal functions (BSFs) to be able to function at their functional threshold [1 pp74, 81, 90–2]. In order to define needs, the output of the assessments of the current state must be compared with what is required; the deficit constitutes the needs [1 pp59, 97, 114]. The needs do not include those goods required to meet the surplus (luxuries) that may have been present before the event (Figure 10.1) [1 pp74–5]. If the assessments of the levels of what is available indicate that the resources are below the critical threshold, then a critical need exists (i.e. the level of function at which the crude mortality rate increases) [1 pp75, 80]. When an assessment indicates that the levels of available supplies are below the functional threshold, a functional need exists [1 p97]. It should be clear that in order to identify the needs, the current assessments and the requirements must use identical indicators. Needs are expressed in terms of goods and/or services. A service is defined as the act of helping or doing work for another or for a community [2]. In this regard, goods and services are inputs to the transformation process that result in the function. To increase a level of function, therefore, requires either an increase in the amount of goods
and services or enhanced efficiency of the transformation process. This transformation from observed damage via assessed functional deficits to identification of goods and services needed requires many inputs (information derived from assessments) and expertise of the persons responsible for the synthesis. Identification of needs is a complex transformation process that requires integration and synthesis of information obtained from assessments by capable persons. When needs are identified, plans are developed in terms of the goods and services required to prevent further deterioration in the levels of functioning or to return the levels of functions to pre-event levels. The inputs used are diagrammed in Figure 10.2, and include information from assessment(s) of: (1) pre-event status including inventories; (2) damage; (3) levels of functions including the buffering capacity; (4) surges in the required levels of functions; (5) the demands of the affected population; and all information maintained in a static database includes: (a) culture; (b) climate; (c) geography; and (d) politics. Assessments Pre-event state The pre-event state for the BSF(s) being assessed is defined in terms of levels of function and in terms
© 2014 the Nordic Societies of Public Health DOI: 10.1177/1403494813515115
Downloaded from sjp.sagepub.com at SIMON FRASER LIBRARY on June 3, 2015
Identification of needs 103
Figure 10.1. Needs as defined by requirements and supplies.
of available goods and services. The pre-event state always serves as a point of reference and must be incorporated into the definition of needs. The preevent state includes available and accessible inventories. Damage As noted, damage relates to structure. One way to enhance the levels of function is to repair or replace damaged structure(s). Thus, the damage sustained must be integrated into the identification of needs. If victims are unable to receive needed health care due to damage to the health facilities, the facilities either must be repaired, alternate ones provided, or the patients may need to be transferred to facilities that can absorb a surge in patient loads. This may include providing temporary structures, such as field hospitals, in order to provide needed health care. Health personnel may have been killed or injured, may be unable to reach the medical facilities, or may be caring or searching for missing loved ones [3]. Thus, needs may be related to dealing with the damage (repair, reconstruction, replacement). Supplemental health personnel may have to be imported into the area. Included in the assessments of damage is whether the damage is ongoing or stopped, and whether repair and/or replacement is underway or completed. Levels of functions Generally, the most important factors to be considered in the identification of needs based on assessments are the changes that have occurred to the functional state of the BSFs being considered. The assessments of function define the levels of function at the time the assessment was conducted. The information derived from the most recent assessments not only must be compared with the levels of functions during the pre-event state, but also with the results of the previous assessments using the same indicators. Function differs from available supplies of goods and services.
The reverse also is true. The ultimate goal for the provision of goods and services is to prevent further deterioration of the levels of functioning (relief) and to return the levels of functions to their respective pre-event levels. Attaining the objectives of any intervention should contribute to achievement of the respective goals (recovery). Thus, the outcomes of an intervention relate back to the levels of functions. Available and accessible inventories must be subtracted from the overall requirements. The importance of available supplies has been discussed in detail elsewhere in this document. Assessments of functions include the goods and/or services that are contained in the buffering capacities and the response capacities required to cope with the expected surge of victims presenting to the medical facilities. Surge Assessments are useful in helping to detect sudden required increases in functions. Such sudden increases in requirements of functions have been called conditional/situational changes and must be met with the provision of goods and/or services to meet conditional needs [1 p115]. The surge capacity to absorb the increases in the volumes of patients presenting to medical facilities is such a case. Also, large bush and forest fires and search and rescue activities require temporary increases in functions due to extraordinary challenges. Situational requirements minus surge capacity represent conditional needs. Demands Demands are expressed by the stricken population as requirements. They contribute to the overall assessment of the situation and constitute important information. The affected population generally will have demands for assistance. However, care must be exercised not to take these demands at face value; demands often are not equivalent with requirements or needs [4]. Thus, demands of the population must be heeded, but before they are translated directly into needs, they must be verified (see conceptual framework [1 pp69–101]). The remaining factors denoted in italics within Figure 10.2 (culture, climate, geography, and culture) all bear on the definition of needs. Descriptions of these factors should be maintained in the static, pre-event database for the area impacted by the event. Each is factored into the definition of needs. Definitions of needs Culture Defined needs must be congruent with the culture of the affected society. What may seem to be a need
Downloaded from sjp.sagepub.com at SIMON FRASER LIBRARY on June 3, 2015
104 Chapter 10
ASSESSMENT PROCESS 1. Pre-event
including Inventories of Available Resources
2. Damage 3. Current Levels of Functions 4. Detection of
Surges
5. Demands
6. Culture 7. Climate
SYNTHESIS
Knowledge, Insight, and Experience
Resources (Costs)
8. Geography
9. Politics
NEEDS
Figure 10.2. Elements constituting the process for the identification of needs.
in one society may not be true in another. Thus, culture influences not only the needs of the society, but also may play a significant role in the assignment of priorities to meet the identified needs. The provision of health services disregarding the cultural specifics related to gender in the population may provoke serious problems in the affected community. The provision of beef products to a Hindu population or pork to Muslims would be inappropriate, despite the population’s determined need for protein. Another factor that is a key virtue for all responders and that may impact on the definition of needs is cultural sensitivity. However, occasionally, responders may harbour cultural biases that must be identified and managed.
Climate The implication of climate in the affected area should be obvious in the determination of needs. Should blankets or mosquito netting be provided? How much potable water must be provided? Needs in tropical and arctic regions are very different. Thus, climate must be considered in the determination of needs. Climate also shifts significantly during seasonal variations (e.g. in many places in Afghanistan, ambient temperatures range from a low of −20°C in winter to 45–50°C during the summer). Geography Similarly, the geography and access to the affected population may weigh heavily in the determination of
Downloaded from sjp.sagepub.com at SIMON FRASER LIBRARY on June 3, 2015
Identification of needs 105 needs. What will be the best methods for transporting the injured or for importing essential resources into the affected area? Would they vary if the affected area was desert or mountains?
synthesis. These factors are factored into the ultimate determination of needs.
Politics
Importantly, there are costs associated with the transformation of information into needs. Transformation processes require resources, consume human time, have opportunity costs, and use supplies and equipment, physical space, and organisational costs. Consumption of available resources by the process may have substantial opportunity costs that may prevent the provision of other processes required in the provision of interventions.
Politics should have no role in the determination of needs. However, this rarely is the case, and the sociopolitical setting may play heavily into the determination of needs. Such attempts always must be annotated. However, politics often play significantly into plans and their implementation. Synthesis process Each of the above factors must be integrated into the identification of needs. Unlike the concepts generally held, the assessments that help to identify needs are not straightforward. Identification of needs involves the synthesis of many factors. Often, integration of some of these factors seems intuitive, but their integration must occur at a conscious level. Severe errors have occurred when it is assumed that needs can be readily assessed. The conversion of the information obtained from assessments (monitoring) into needs constitutes a transformation/production process. The synthesis is conducted for specific BSFs as well as for the overall picture. The identification of overall needs requires knowledge of the interrelationships between the BSFs. The process requires expertise, which is a learned ability/skill. It requires knowledge of the BSFs and their interdependencies. Such expertise must be obtained through education and experience using the synthesis process during actual disasters or obtained during drills and exercises that are critiqued. The process, which is a part of overall disaster management, yields outputs that are the needs. An important part of preparedness is the identification of expected/anticipated requirements given the hazards to which a given society is at risk. Knowledge of the history of previous events and the prevailing science associated with the responses to the losses of functions that occurred during such events, facilitates anticipation of the requirements that will occur with similar types of events. Thus, inclusion of the anticipated requirements enhance disaster response plans and colour the identification of potential needs. Identification of anticipated needs requires information from the management of previous disasters/crises. Preparedness is based on history and available resources. Lastly, the synthesis requires the knowledge, insight, and experience of persons providing the
Costs
Priorities The assignment of priorities has been detailed elsewhere and is discussed in further detail in the next chapter on strategic planning. Suffice it to say here that all needs must be prioritised by their order of importance. Critical needs must have the highest priority. Furthermore, during times of severely limited available resources, higher priorities may be assigned to the needs in some BSFs, while sacrificing others. All needs are not equal. Summary Identification of needs is a complex process and requires special expertise and experience. The process is an exercise in integration of many factors, each of which has different weights. Thus, it is not possible to directly assess needs, and it is important to understand the processes that play into the determination of actual needs. Based on the identified needs, strategic plans are developed to meet the current and future needs. The interventions selected require prioritisation by experts. References [1] Task Force on Quality Control of Disaster Management, World Association for Disaster and Emergency Medicine and Nordic Society for Disaster Medicine. Health disaster management: guidelines for evaluation and research in the Utstein style. Sundnes KO and Birnbaum ML (eds). Prehosp Disaster Med 2003;17(Suppl 3). [2] Thompson D (ed). The concise Oxford dictionary of current English, 9th ed, Clarendon Press: Oxford. 1995. [3] Emergency and Humanitarian Action, World Health Organization and Regional Office for South East Asia. Tsunami 2004: a comprehensive analysis, NLM classification number HC79. D45. India: SEARO, 2013. [4] Rubin M, Heuvelmans JH, Tomic-Cica A, et al. Healthrelated relief in the former Yugoslavia: needs, demands, and supplies. Prehosp Disaster Med 2000;15:1–11.
Downloaded from sjp.sagepub.com at SIMON FRASER LIBRARY on June 3, 2015
SJP0010.1177/1403494813515115K.O. SundnesIdentification of needs
Scandinavian Journal of Public Health, 2014; 42(Suppl 14): 102–105
CHAPTER 10
Identification of needs
Abstract Needs are not directly assessed, but rather, the identification of needs is the result of a complex process that requires integration and synthesis of many factors, including the results from numerous assessments. The assessments synthesised into needs include: (1) the pre-event levels of function; (2) the amount and types of damage sustained initially and existing at the current time; current (3) levels of function and the levels of function detected by the last assessment; (4) the presence of a surge; (5) the demands of the population affected; (6) the culture in which the event occurred; (7) the climate in the affected area; (8) the geography and access to the affected area; and (9) politics. The process consumes resources (costs). The transformation process (synthesis) of these many factors requires that those charged with synthesis have knowledge, field experience, insight, and experience using the process. Key Words: Assessments, basic societal functions (BSFs), climate, costs, culture, damage, expertise, factors, functions, geography, identification of needs, needs, pre-event, politics, process, requirements, surge, thresholds, transformation
Introduction The term “needs” has many different meanings. For the purpose of these Guidelines, as stated in the conceptual framework [1 pp33–101, 155], needs are defined as the differences between the required and available services and goods. Requirements are goods and services that must be available to the basic societal functions (BSFs) to be able to function at their functional threshold [1 pp74, 81, 90–2]. In order to define needs, the output of the assessments of the current state must be compared with what is required; the deficit constitutes the needs [1 pp59, 97, 114]. The needs do not include those goods required to meet the surplus (luxuries) that may have been present before the event (Figure 10.1) [1 pp74–5]. If the assessments of the levels of what is available indicate that the resources are below the critical threshold, then a critical need exists (i.e. the level of function at which the crude mortality rate increases) [1 pp75, 80]. When an assessment indicates that the levels of available supplies are below the functional threshold, a functional need exists [1 p97]. It should be clear that in order to identify the needs, the current assessments and the requirements must use identical indicators. Needs are expressed in terms of goods and/or services. A service is defined as the act of helping or doing work for another or for a community [2]. In this regard, goods and services are inputs to the transformation process that result in the function. To increase a level of function, therefore, requires either an increase in the amount of goods
and services or enhanced efficiency of the transformation process. This transformation from observed damage via assessed functional deficits to identification of goods and services needed requires many inputs (information derived from assessments) and expertise of the persons responsible for the synthesis. Identification of needs is a complex transformation process that requires integration and synthesis of information obtained from assessments by capable persons. When needs are identified, plans are developed in terms of the goods and services required to prevent further deterioration in the levels of functioning or to return the levels of functions to pre-event levels. The inputs used are diagrammed in Figure 10.2, and include information from assessment(s) of: (1) pre-event status including inventories; (2) damage; (3) levels of functions including the buffering capacity; (4) surges in the required levels of functions; (5) the demands of the affected population; and all information maintained in a static database includes: (a) culture; (b) climate; (c) geography; and (d) politics. Assessments Pre-event state The pre-event state for the BSF(s) being assessed is defined in terms of levels of function and in terms
© 2014 the Nordic Societies of Public Health DOI: 10.1177/1403494813515115
Downloaded from sjp.sagepub.com at SIMON FRASER LIBRARY on June 3, 2015
Identification of needs 103
Figure 10.1. Needs as defined by requirements and supplies.
of available goods and services. The pre-event state always serves as a point of reference and must be incorporated into the definition of needs. The preevent state includes available and accessible inventories. Damage As noted, damage relates to structure. One way to enhance the levels of function is to repair or replace damaged structure(s). Thus, the damage sustained must be integrated into the identification of needs. If victims are unable to receive needed health care due to damage to the health facilities, the facilities either must be repaired, alternate ones provided, or the patients may need to be transferred to facilities that can absorb a surge in patient loads. This may include providing temporary structures, such as field hospitals, in order to provide needed health care. Health personnel may have been killed or injured, may be unable to reach the medical facilities, or may be caring or searching for missing loved ones [3]. Thus, needs may be related to dealing with the damage (repair, reconstruction, replacement). Supplemental health personnel may have to be imported into the area. Included in the assessments of damage is whether the damage is ongoing or stopped, and whether repair and/or replacement is underway or completed. Levels of functions Generally, the most important factors to be considered in the identification of needs based on assessments are the changes that have occurred to the functional state of the BSFs being considered. The assessments of function define the levels of function at the time the assessment was conducted. The information derived from the most recent assessments not only must be compared with the levels of functions during the pre-event state, but also with the results of the previous assessments using the same indicators. Function differs from available supplies of goods and services.
The reverse also is true. The ultimate goal for the provision of goods and services is to prevent further deterioration of the levels of functioning (relief) and to return the levels of functions to their respective pre-event levels. Attaining the objectives of any intervention should contribute to achievement of the respective goals (recovery). Thus, the outcomes of an intervention relate back to the levels of functions. Available and accessible inventories must be subtracted from the overall requirements. The importance of available supplies has been discussed in detail elsewhere in this document. Assessments of functions include the goods and/or services that are contained in the buffering capacities and the response capacities required to cope with the expected surge of victims presenting to the medical facilities. Surge Assessments are useful in helping to detect sudden required increases in functions. Such sudden increases in requirements of functions have been called conditional/situational changes and must be met with the provision of goods and/or services to meet conditional needs [1 p115]. The surge capacity to absorb the increases in the volumes of patients presenting to medical facilities is such a case. Also, large bush and forest fires and search and rescue activities require temporary increases in functions due to extraordinary challenges. Situational requirements minus surge capacity represent conditional needs. Demands Demands are expressed by the stricken population as requirements. They contribute to the overall assessment of the situation and constitute important information. The affected population generally will have demands for assistance. However, care must be exercised not to take these demands at face value; demands often are not equivalent with requirements or needs [4]. Thus, demands of the population must be heeded, but before they are translated directly into needs, they must be verified (see conceptual framework [1 pp69–101]). The remaining factors denoted in italics within Figure 10.2 (culture, climate, geography, and culture) all bear on the definition of needs. Descriptions of these factors should be maintained in the static, pre-event database for the area impacted by the event. Each is factored into the definition of needs. Definitions of needs Culture Defined needs must be congruent with the culture of the affected society. What may seem to be a need
Downloaded from sjp.sagepub.com at SIMON FRASER LIBRARY on June 3, 2015
104 Chapter 10
ASSESSMENT PROCESS 1. Pre-event
including Inventories of Available Resources
2. Damage 3. Current Levels of Functions 4. Detection of
Surges
5. Demands
6. Culture 7. Climate
SYNTHESIS
Knowledge, Insight, and Experience
Resources (Costs)
8. Geography
9. Politics
NEEDS
Figure 10.2. Elements constituting the process for the identification of needs.
in one society may not be true in another. Thus, culture influences not only the needs of the society, but also may play a significant role in the assignment of priorities to meet the identified needs. The provision of health services disregarding the cultural specifics related to gender in the population may provoke serious problems in the affected community. The provision of beef products to a Hindu population or pork to Muslims would be inappropriate, despite the population’s determined need for protein. Another factor that is a key virtue for all responders and that may impact on the definition of needs is cultural sensitivity. However, occasionally, responders may harbour cultural biases that must be identified and managed.
Climate The implication of climate in the affected area should be obvious in the determination of needs. Should blankets or mosquito netting be provided? How much potable water must be provided? Needs in tropical and arctic regions are very different. Thus, climate must be considered in the determination of needs. Climate also shifts significantly during seasonal variations (e.g. in many places in Afghanistan, ambient temperatures range from a low of −20°C in winter to 45–50°C during the summer). Geography Similarly, the geography and access to the affected population may weigh heavily in the determination of
Downloaded from sjp.sagepub.com at SIMON FRASER LIBRARY on June 3, 2015
Identification of needs 105 needs. What will be the best methods for transporting the injured or for importing essential resources into the affected area? Would they vary if the affected area was desert or mountains?
synthesis. These factors are factored into the ultimate determination of needs.
Politics
Importantly, there are costs associated with the transformation of information into needs. Transformation processes require resources, consume human time, have opportunity costs, and use supplies and equipment, physical space, and organisational costs. Consumption of available resources by the process may have substantial opportunity costs that may prevent the provision of other processes required in the provision of interventions.
Politics should have no role in the determination of needs. However, this rarely is the case, and the sociopolitical setting may play heavily into the determination of needs. Such attempts always must be annotated. However, politics often play significantly into plans and their implementation. Synthesis process Each of the above factors must be integrated into the identification of needs. Unlike the concepts generally held, the assessments that help to identify needs are not straightforward. Identification of needs involves the synthesis of many factors. Often, integration of some of these factors seems intuitive, but their integration must occur at a conscious level. Severe errors have occurred when it is assumed that needs can be readily assessed. The conversion of the information obtained from assessments (monitoring) into needs constitutes a transformation/production process. The synthesis is conducted for specific BSFs as well as for the overall picture. The identification of overall needs requires knowledge of the interrelationships between the BSFs. The process requires expertise, which is a learned ability/skill. It requires knowledge of the BSFs and their interdependencies. Such expertise must be obtained through education and experience using the synthesis process during actual disasters or obtained during drills and exercises that are critiqued. The process, which is a part of overall disaster management, yields outputs that are the needs. An important part of preparedness is the identification of expected/anticipated requirements given the hazards to which a given society is at risk. Knowledge of the history of previous events and the prevailing science associated with the responses to the losses of functions that occurred during such events, facilitates anticipation of the requirements that will occur with similar types of events. Thus, inclusion of the anticipated requirements enhance disaster response plans and colour the identification of potential needs. Identification of anticipated needs requires information from the management of previous disasters/crises. Preparedness is based on history and available resources. Lastly, the synthesis requires the knowledge, insight, and experience of persons providing the
Costs
Priorities The assignment of priorities has been detailed elsewhere and is discussed in further detail in the next chapter on strategic planning. Suffice it to say here that all needs must be prioritised by their order of importance. Critical needs must have the highest priority. Furthermore, during times of severely limited available resources, higher priorities may be assigned to the needs in some BSFs, while sacrificing others. All needs are not equal. Summary Identification of needs is a complex process and requires special expertise and experience. The process is an exercise in integration of many factors, each of which has different weights. Thus, it is not possible to directly assess needs, and it is important to understand the processes that play into the determination of actual needs. Based on the identified needs, strategic plans are developed to meet the current and future needs. The interventions selected require prioritisation by experts. References [1] Task Force on Quality Control of Disaster Management, World Association for Disaster and Emergency Medicine and Nordic Society for Disaster Medicine. Health disaster management: guidelines for evaluation and research in the Utstein style. Sundnes KO and Birnbaum ML (eds). Prehosp Disaster Med 2003;17(Suppl 3). [2] Thompson D (ed). The concise Oxford dictionary of current English, 9th ed, Clarendon Press: Oxford. 1995. [3] Emergency and Humanitarian Action, World Health Organization and Regional Office for South East Asia. Tsunami 2004: a comprehensive analysis, NLM classification number HC79. D45. India: SEARO, 2013. [4] Rubin M, Heuvelmans JH, Tomic-Cica A, et al. Healthrelated relief in the former Yugoslavia: needs, demands, and supplies. Prehosp Disaster Med 2000;15:1–11.
Downloaded from sjp.sagepub.com at SIMON FRASER LIBRARY on June 3, 2015
