doi:10.1111/disa.12065
Does need matter? Needs assessments and decision-making among major humanitarian health agencies Martin Gerdin, Patrice Chataigner, Leonie Tax, Anne Kubai, and Johan von Schreeb1
Disasters of physical origin, including earthquakes, floods, landslides, tidal waves, tropical storms, tsunamis, and volcanic eruptions, have affected millions of people globally over the past 100 years. Proportionately, there is far greater likelihood of being affected by such disasters in low-income countries than in high-income countries. Furthermore, low-income countries are in need of international assistance following disasters more often than high-income countries. The funding of international humanitarian assistance has increased from USD 12.9 billion in 2006 to an estimated USD 16.7 billion in 2010. The majority of this funding is channelled through humanitarian agencies and is supposed to be distributed based on the need of those affected, as assessed using needs assessments. Such needs assessments may be used to inform decisions internally, to influence others, to justify response decisions, and to obtain funding. Little is known about the quality of needs assessments in practical applications. Consequently, this paper reports on and analyses the views of operational decision-makers in major health-related humanitarian agencies on needs assessments.
Introduction Disasters of physical origin, including earthquakes, floods, landslides, tidal waves, tropical storms, tsunamis, and volcanic eruptions, have affected millions of people globally over the past 100 years (Centre for Research on the Epidemiology of Disasters, 2012). Proportionately, there is far greater likelihood of being affected by such disasters in low-income countries (gross domestic product (GDP) less than USD 976 per capita) than in high-income countries (GDP greater than USD 11,905 per capita) (Guha-Sapir, Hargi, and Hoyois, 2004). Furthermore, low-income countries are in need of international assistance following disasters more often than high-income countries. The need for international humanitarian assistance depends on the pre-disaster socioeconomic context as well as on the disaster’s intensity, location, and the number of people affected. The funding of international humanitarian assistance has increased from USD 12.9 billion in 2006 to an estimated USD 16.7 billion in 2010 (Kellett, Walmsley, and Poole, 2011). The majority of this funding is channelled through humanitarian agencies and is supposed to be distributed based on the need of those affected (de Geoffroy and Grunewald, 2008). With regard to needs-based humanitarian funding, three of the most well-known international policy documents are: Disasters, 2014, 38(3): 451−464. © 2014 The Author(s). Disasters © Overseas Development Institute, 2014 Published by John Wiley & Sons Ltd, 9600 Garsington Road, Oxford, OX4 2DQ, UK and 350 Main Street, Malden, MA 02148, USA
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• the Code of Conduct for The International Red Cross and Red Crescent Movement and NGOs in Disaster Relief; • the Principles and Good Practice of Humanitarian Donorship; and • the Sphere Project’s Humanitarian Charter and Minimum Standards in Humanitarian Response. The Red Cross Code of Conduct was released in 1994 and includes 10 principles to be followed by the International Red Cross and Red Crescent Movement and other humanitarian agencies involved in disaster response (International Red Cross and Red Crescent Movement, 2012). The Good Humanitarian Donorship (GHD) document was released by governments, non-governmental organisations (NGO), and others in 2003 (Good Humanitarian Donorship, 2011, 2003). The Humanitarian Charter and Minimum Standards in Humanitarian Response is a handbook first produced in 2001 by the Sphere Project that provides minimum and core standards for international humanitarian assistance following disasters (Greaney, Pfiffner, and Wilson, 2011). These international policy documents argue that international humanitarian assistance should be guided by information on the needs of the affected population. This information should be gathered through timely, reliable, and applicable needs assessments in order to plan the type and quantity of assistance adequately. Needs assessments commonly refer to the systematic collection of information on the magnitude of the disaster and on the human needs to be addressed. Information for needs assessments can be collected via internet and literature searches, key informant and focusgroup interviews, and systematic observations using checklists and quantitative surveys (von Schreeb, 2007). Needs assessments may be used to inform decisions internally, to influence others, to justify response decisions, and to obtain funding (Darcy, Anderson, and Majid, 2007). In recent years, international initiatives (Health and Nutrition Tracking Service, Sphere, the Standardized Monitoring and Assessment of Relief and Transition) have developed indicators and proposed ways to collect and disseminate needs assessment information (Mock and Garfield, 2007). Several internet platforms (AlertNet, Relief Web) facilitate the sharing of needs assessment results. A 2009 study by the United Nations (UN) Office for the Coordination of Humanitarian Affairs (OCHA) identified 19 different initiatives relevant to needs assessment (Office for the Coordination of Humanitarian Affairs, 2009). The UN Inter-Agency Standing Committee (IASC) created the IASC Needs Assessment Task Force (NATF) shortly after the publication of the OCHA study. OCHA was appointed as the chair to ‘harmonize and promote cross-sector needs assessment initiatives’ (Inter-Agency Standing Committee, 2011a). The Assessment Capacities Project (ACAPS) was started by a consortium of three NGOs and collaborates with the NATF to develop methodologies and tools for better coordinated assessments (Assessment Capacities Project, 2012). Little is known about the quality of needs assessments in practical applications. Consequently, this paper reports on and analyses the views of operational decisionmakers in major health-related humanitarian agencies on needs assessments. They were
Does need matter? Needs assessments and decision-making among major humanitarian health agencies
asked to evaluate the information needed to perform needs assessments and how such assessments are used to decide whether to deploy relief following disasters. The analysis is based on two interview studies with key informants. The objective of Study I was to determine what information is needed by operational decision-makers in the immediate aftermath of a disaster. The objective of Study II was to determine to what extent needs assessment information is employed by operational decision-makers in their judgments to deploy health relief post disaster.
Methods Definitions This study used the Centre for Research on the Epidemiology of Disasters (CRED)’s definition of a disaster: ‘a situation or event which overwhelms local capacity, necessitating a request to a national or international level for external assistance; an unforeseen and often sudden event that causes great damage, destruction and human suffering’ (Guha-Sapir et al., 2011, p. 7). According to CRED, a disaster of physical origin can be biological, climatological, geophysical, hydrological, or meteorological. Data was defined as the raw material—counts, observations, and statements—that when put in context or organised, becomes information (Ackoff, 1989). Needs assessment was defined as an initial and rapid procedure that is used to gain information on the situation and the needs of the disaster-affected population (von Schreeb, 2007). Purposeful sampling In both studies we adopted ‘typical case sampling’, a purposeful sampling method for selecting respondents (Patton, 1990). We based our selection of respondents on extensive personal experience of working in and researching the humanitarian relief sector. In total, 17 representatives from 13 major health-related humanitarian agencies were interviewed. To perform further in-depth analyses and detect interagency variations, we interviewed two or more representatives from three agencies. Interview Study I The objective of this study was to determine what information is needed by operational decision-makers in the immediate aftermath of a disaster. We interviewed a total of 11 representatives from eight non-governmental humanitarian agencies (see Table 1) by telephone or face-to-face, using a semi-structured open-ended questionnaire. Two respondents were at field level, one at regional level, and eight at global level. Field level was defined as working in an office located in the country of operations. Regional level was defined as working in an office providing regional support to field offices in several countries. Global level was defined as working in a headquarters office, providing global support to several regional- and field-level offices. Interviews were conducted between November and December 2010 in the native language of the respondents, either English or French. The interviews were transcribed
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Table 1. Major health-related humanitarian agencies for Study I and Study II and the number and level of the respondents (in brackets) Study I
Study II
French Red Cross [1 global]
Action Against Hunger [1 global]
Global Nutrition Cluster [1 global]
International Rescue Committee [1 global]
Off ice for the Coordination of Humanitarian Affairs (OCHA) [1 field]
Médecins Sans Frontières Operational Centre Brussels [2 global]
OXFAM [1 global, 1 regional]
Médecins Sans Frontières Operational Centre Amsterdam [1 global]
Solidarités [3 global]
Merlin [1 global]
United Nations Children’s Fund (UNICEF) [1 global] Water Sanitation Hygiene (WASH) Cluster Congo [1 field]
as they were performed. Responses were analysed after condensing the transcripts. The answers were arranged thematically, based on positive or negative connotations. Interview Study II The objective of this study was to reveal to what extent needs assessment information is used by operational decision makers in their judgments to deploy health relief post disaster. We interviewed six representatives from five major health-related humanitarian agencies using a semi-structured interview guide with open-ended questions between December 2008 and June 2009. Interviews were conducted in English by telephone, and included questions about how decisions to deploy health relief after disasters were taken, which types of information influenced the decision, and sources of information. The interview guide was used to structure the interviews, while still allowing enough flexibility for the interviewer to generate additional questions in the course of the interviews (Bernard, 1995). Additional questions were used only in the interview in which they were generated. All respondents were at the global level. Four were from agencies headquartered in Europe and one was from an agency headquartered in the United States. Each interview lasted between one and two hours and was tape-recorded, transcribed, and analysed using thematic coding (Potter and Wetherall, 1987). Words and paragraphs in all transcripts that appeared to relate to the same aspect of needs assessments were assigned a common code. As the analysis progressed, we used these codes to generate themes that captured central issues expressed by the respondents on needs assessments. We focused our analyses on communication and on the relationship between emotions and available information and its impact on the decision to deploy relief.
Does need matter? Needs assessments and decision-making among major humanitarian health agencies
Results Study I We asked respondents to list what type of decisions they make during the first 72 hours of a crisis. Their answers were categorised into two types: strategic decisions and operational decisions. The most frequent strategic decisions taken by respondents include the identification of the target population for assessment or intervention, priority areas in terms of geography and sectors for assessment and intervention, and whether or not to deploy relief supplies based on an estimation of the scale and scope of an emergency. Often, the decision also involved country-level internal and external political processes. Our respondents indicated that main operational decisions concerned the type of operation and the resources needed for the operation, including required budget, equipment, skills, and staff. According to our respondents, the specific information required in the decisionmaking process could be divided into categories. The first category was information that should be collected prior to disasters, that is, pre-disaster information. Almost all respondents noted that having baseline, pre-disaster data (including demographic data) is important. The second category was specific information that relates directly to the disaster event and its impact, that is, disaster-specific information. Ideally, disaster-specific information will focus on the effect of the disaster on the population.
Information gaps and needs All respondents at the global level recognised the lack of sufficient and accurate information in the immediate aftermath of a disaster and stated that they needed faster access to information. To make decisions within the first 72 hours of a disaster, they predominantly relied on pre-disaster information—if available—and on the limited amount of obtainable post-disaster information. However, pre- and post-disaster information was only useful if it was well classified, accurate, and reliable. Respondents stated that both pre- and post-disaster information frequently needed to be more detailed than is typically the case. Our respondents did not specify, though, the level of detail needed. They also noted that the methods used to obtain the information must be clearly stated, and that information on the reliability of data would be appreciated.
Process of information collection The majority of respondents said that information is not sufficiently gathered prior to crises and disasters. However, a few indicated that internal processes to pre-gather information are under development within their respective agencies. Together these statements suggest that baseline and pre-disaster information are neither sufficiently collected nor fully utilised in humanitarian crises. Respondents both at the field and the global level use information produced by other NGOs and UN agencies as information sources. In-country sources such as key informants, local partners, and relevant ministries also were mentioned as information
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sources. In addition, respondents at the global level, who relied less on in-country sources, used news reports and internet resources, such as reports on Relief Web, as key information sources. Furthermore, satellite images and donor information are important sources for several global-level respondents. A few respondents at the global level used internal monitoring and information systems. We were told that, although collection of information took place at both the field and the global level, the information analysis occurred primarily at the global level. A majority of respondents used triangulation to verify information from different sources. Only one respondent stated that no crosschecking took place. In addition, one respondent cited the use of experience to assess the credibility of information. Our findings suggest that information is collected using many different sources. The information is then verified by triangulation. Sources of information used at headquarters seem to differ from those used on the ground. At the global level, official resources and the internet are used, whereas personal communication and key informants are more important at the field level. Respondents at the global level indicated that once the people on the ground switched into operational mode, they have limited capacity to follow and analyse conditions.
Factors affecting the decision to deploy health relief Respondents indicated that the decision to deploy health relief following a disaster depends on several factors. On a global level, respondents mentioned potential added value of their intervention, capacity of the agency, risk of disease or shortage of food and fuel, and the scale of the crisis as factors that influence the decision. In addition, factors such as strategic interests and requests by local partners were noted. At the field and regional level, respondents highlighted the scale of the crisis, the agency’s current capacity, and security risks as key factors influencing the decision. A majority of respondents indicated that in-country presence plays a critical role in decisionmaking. Respondents reported that if field offices relay information to their headquarters, this provides increased credibility and confidence in the information. The presence of field offices also denotes a level of existing in-country capacity, a principal factor in deciding whether or not to deploy health relief. All respondents at the field level said that their agencies use specific platforms to support decisions, such as the Global Disaster Alert and Coordination System and the Virtual On-Site Operations Coordination Center. These are online systems that allow their users to share realtime information on disasters and to receive disaster alerts. The majority of respondents at the global level stated that their agency did not use a decision-making tool. Thus, decisions seem to be based primarily on personal experience and presence incountry. The use of decision-making tools is limited to the field level but no validated framework appears to exist. Respondents at the field and regional level noted that decisions had to be taken faster, in the majority of the cases within 48 hours. Respondents at the global level claimed that decision time frames ranged from six hours to seven days, depending on the on-ground presence.
Does need matter? Needs assessments and decision-making among major humanitarian health agencies
Study II
Sources of information Respondents indicated that no standard checklists existed for systematically collecting and analysing information to assess the needs of the affected population. One respondent said that both local people and observations by agency representatives are important sources of information: We go there, we make our medical analysis and prognosis and we see the situation, and we diagnose what is going on . . . and we mix basically our analysis together with the testimonies of the victim. The media, electronic and print, was a major source of information. In addition, ‘any other kind of source of information’ is acceptable, including ‘informal sources’. All respondents answered consistently the question about the type of information needed to plan a deployment rapidly. Such information included the type of disaster, the number of people affected, the death toll, the extent of general damage, and precrisis information on the size of the area and the population. How important this information was varied between agencies, and no respondent was able to articulate the extent to which available information influenced decisions. One respondent explained: It is important that you have information about every sector because you do not know which sectors are affected. Respondents did not feel that it was necessary to change initial deployment decisions if early (24–72 hours) information was unavailable or uncertain. Instead, initial decisions can be based on assumptions, as demonstrated in the following quote: We need to be there to know what is happening on real terms basis and you have to make certain levels of assumptions during 24–72 hours, but after 72 hours things will become clearer. After six-seven days, it can change drastically.
Pressure to decide Respondents gave varying descriptions of how operational decisions to deploy health relief following disasters are taken. One said that decisions depend on the scale of the disaster, the number of people affected, the effect on health care accessibility, how quickly it affects the national health care system, and the possible long-term effect of the disaster. Another stated that ‘for any natural disasters, decisions and processes will be different’. One respondent pointed out how decisions and processes can differ depending on the disaster: If it is an earthquake we will look at the magnitude of the earthquake . . . the time of the day. If it is during the night we know that there are more injured than that if it is during the day; the type of buildings – if it is a city or small villages with light construction it is quite different . . . if it is dispersed or not.
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A majority of respondents made reference to ‘the experience and feelings’ of agency team members as an important factor influencing the decision to deploy health relief. Taken together, our findings show that information is gathered through both electronic and print media as well as through direct observations. However, although the respondents agreed on what information they were searching for, it is not clear to what degree this information affected their decision to deploy relief. Instead it seems that an initial decision to deploy at least part of a team is made without much information to hand. This decision may then be modified when more information is available.
‘Making assumptions . . . most of the time’ Although the respondents claimed to try to obtain information, many assumptions have to be made when deciding to deploy health relief. One respondent said that, sometimes: we go with the assumption that all the population has been affected. In what way it has been affected . . . displaced population, are the people relocating to another site? To the question on how information was crosschecked and validated, this respondent replied: You have a very rough idea and you make decisions based on that. You cannot wait to cross-check everything . . . if you do that, it will be one week . . . it will be another thing. Another respondent highlighted the difference between information that is ‘requested in order to send the team to the field’ and the ‘information necessary to build an operation’, which suggests a two-stage analysis process. Another provided a document that was used to structure needs assessments. This document also supplied instructions on how to write the various documents that are ‘published at external level’. The respondent from this agency said that: There is no systematic way to deal with this information because not all the information is initially available. We may have access to the information in the course of the first week. There is no mathematical or scientific way to analyse this information because the type of information collected is not good enough most of the time, to allow appropriate decisions.
Other factors Respondents indicated that being able to rely on the capacity of individuals trained to collect needs assessment information was a critical factor in getting accurate, detailed, and fast information. Respondents said that, even in cases where assessment manuals, checklists, and standard reporting procedures were fairly developed, sometimes they are not used because of the situation in which they find themselves, as exemplified in the following quote:
Does need matter? Needs assessments and decision-making among major humanitarian health agencies
On the seashore of experience . . . the staff who are dispatched use their own experience and come up with their own conclusions. Here the ‘experience, presence, and ability’ of the individual members of an assessment team ‘to understand the situation’ is crucial; yet, in many instances, the teams ‘are limited in terms of knowing the terrain and knowing the population and knowing the needs’. Thus, activities are mobilised around limited information, regardless of how it is obtained, and, more importantly, as one respondent put it, there is ‘a willingness or ability to basically do the assessment on the back of an envelope, if the situation so demands’. Some respondents stated that the presence of other agencies in the area affected by the disaster was an important factor when taking decisions to deploy health relief. All said that, usually, they ‘look also at the number of NGOs present in the field, both international and local NGOs’. One added that ‘what we are looking for in the second phase is assessment of the local capacity’. Therefore, they go where capacity is weak. In addition, all respondents said that the ‘added value’ of the presence of their agencies is an important factor. One pointed out that ‘you go where your agency would be an added value. So we are looking at, not only where the needs are but what your added value could be’. To summarise, decisions to send relief currently are made on the basis of little available field-based information. Systematic methods for collecting, processing, and analysing the information for decision-making are not employed. Detailed needs assessment information is not considered vital to relief deployment decisions. Rather, deployment decisions frequently are made through interpersonal processes and consensus-building among experienced relief teams. In the absence of a systematic approach, media reports, and public opinion appear to have a major influence on the decision to deploy relief. In addition, personal knowledge of relief team members and the long-term presence of national agencies in a given country influence the level and type of assistance provided.
Discussion This study illustrates that current processes of deciding about deployment of assistance following disasters of physical origin can be rapid, subjective, and highly personalised in the absence of reliable information. Unfortunately, we were unable to fulfil our second objective, because no decision-maker was able to articulate the extent to which available information influences decisions. Instead, this finding suggests that the value of specific information in the early decision-making process may be over-estimated. To improve these processes, better information pre and post disaster is needed. Ideally, such information should be reliable, accurate, detailed, systematic, and coordinated. It is not possible to generalise our results to all international humanitarian agencies and to the UN system. In addition, it is difficult to determine how representative the respondents are of their respective agencies. Therefore,
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we warrant caution when using our findings to draw conclusions for the agency rather than the respondent level. One should remember that this paper is a presentation of an in-depth analysis of how decision-makers in a sample of major health-related humanitarian agencies use needs assessments and what information they are looking for when deciding on whether or not they should deploy relief. Our results correspond well with the findings of others. According to studies by Darcy and Hofmann (2003) and de Ville de Goyet and Morinière (2006), needs assessments play a very limited role in the decision-making of agencies and donors. Needs assessments are not objective. Rather, they involve estimation, interpretation, and judgment, in addition to measurement, observation, and analysis (Darcy, Anderson, and Majid, 2007). No systematic approach exists to collect data and to analyse it. Indeed, obtaining sufficient data and analysing and cross-referencing it for a detailed needs assessment are considered time-consuming tasks in a situation where time is very important. Our findings indicate that the little information available is not considered sufficient and accurate enough to serve as the basis for decisions on health relief deployment in a timely manner. Several international projects and many operational agencies are working to improve the timeliness and accuracy of information Table 2. Initial needs assessment model for the first 48–72 hours following a disaster of physical origin The three main considerations for the assessing agency and concrete measures to achieve them: 1
Focus on the big picture Categorise collected information according to area of interest, such as group and sector concerned, capacity, risk, and whether the information is need- or response-related, to facilitate the information flow throughout the process. Research primarily life-saving sectors such as food security, health, protection, shelter/ non-food items, and water and sanitation. Then extend to other sectors (education, early recovery, etc.). Use information that is ‘good enough’, do not seek more detail or precision than is needed. At this stage, sufficiently well-informed decision-making is the aim. There has to be a balance between accuracy of the data and speed of response. Look for disaggregated data for the population group or geographic area(s) affected by the disaster.
2
Collate secondary information post-disaster Consider all secondary information produced post disaster by NGOs, news media, government, crowd sourcing, etc. Use your network to triangulate and confirm information. Keep in mind that all information has a bias. Use snowball effects (through contact or reference documents) to guide more in-depth research when necessary. Collect only what you know you will use.
3
Use pre-disaster information to develop assumptions Look for important and relevant quantitative information, such as census, pre-disaster data sets, epidemiological profile, demographic data, etc. Statistics may provide useful indications on the evolution of exogenous factors, patterns, and trends. Know the likely impact of disasters. Identify risks and aggravating factors that may be exacerbated by the disaster and on which you will base your assumptions and recommendations. Pre-disaster information must be collected as a preparedness activity in a way that allows for fast and easy access to the information that is most crucial and that can be digested easily by an emergency decisionmaker who does not have time to read lots of reports.
Does need matter? Needs assessments and decision-making among major humanitarian health agencies
on humanitarian needs in different sectors (Office for the Coordination of Humanitarian Affairs, 2009). However, none of these projects have been able yet to provide needs assessments of a general standard that are agreed on and endorsed by all stakeholders and that are to be updated regularly. The lack of a general standard means that needs assessment approaches vary substantially between agencies, despite them being an integral component of many agencies’ programmes. For example, Australia’s Disaster Medical Assistance Teams (DMAT) use so-called forward teams to perform early and rapid needs assessments. These forward teams are composed of between one and four people. They should be on site and supply information preferably within 24 hours of the onset of a disaster. This information is then supposed to guide later response by a full DMAT (Robertson et al., 2011). In contrast, the International Committee of the Red Cross and the International Federation of the Red Cross and Red Crescent Societies rely to a large extent on national Red Cross and Red Crescent Societies for early and rapid needs assessments. Their initial needs assessment may take up to a week (ICRC and IFRC, 2008). This heterogeneity in needs assessment approaches in combination with insufficient coordination and information-sharing between agencies leads to duplication of efforts and limited effectiveness (Deitchman, 2005).
Implications for policy and practice As outlined in Evidence-based Decision-making in Humanitarian Assistance (Bradt, 2009), humanitarian agencies should recognise their mission to do the most good for the most people. Yet, as seen in this study, the decision to deploy relief seems to be highly subjective. Presently, mandate and the capacity of agencies appear to have priority over need. Based on these and other similar findings, such as those following the Indian Ocean tsunami of 2004 (de Ville de Goyet and Morinière, 2006), it is time that considerable political and economic effort is put into developing more permanent, regional, and/or international capacity to conduct initial rapid needs assessments. Without this capacity in place and it being fully functional, the idea of international agencies assessing accurately the needs of affected populations fast enough to guide initial response may have to be abandoned (Bradt, 2009). Importantly, this study found that no decision-maker was able to articulate the extent to which available information influenced decisions. We believe that this finding opens the way for new research to find the link between information and decisions. Humanitarian agencies need to consider a number of issues for effective and informative initial rapid needs assessments. These are also valid for the development of a standardised needs assessment system as an international capacity (see Table 2). Initial needs assessments should be conducted in the first 72 hours of a disaster. Our respondents highlighted that it is during this phase that agencies make their first decision to deploy relief. We suggest the following three key considerations for initial needs assessments:
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• Focus on the big picture. • Concentrate on secondary information. It is readily available and may be collected remotely while primary information-gathering will be too time-consuming to generate a needs assessment quickly enough to guide initial decisions. • Place more emphasis on pre-disaster information than on post-disaster information. The former will provide the basis for the contextual understanding needed to develop assumptions on the likely impact of the disaster. In addition, any assumptions need to combine as a minimum expert judgment, experience, lessons learnt from past disasters, and facts. Finally, one should remember that the need for assistance for the affected population does not disappear after the first 72 hours. Members of the affected population are the ones who best know their own needs. Efforts to include the affected population in needs assessment are long overdue and should be accorded priority. One should also remember that needs are not only health-related. Even though this paper focuses on needs assessments by major health-related humanitarian agencies, many of the concepts discussed here apply to other sectors as well (Deitchman, 2005). While needs assessments in other sectors is beyond the scope of this paper, the multi-sector approach initiated by the NATF is much needed and welcomed by the international humanitarian community (Inter-Agency Standing Committee, 2011b). To conclude, needs really should matter. Regardless of type.
Acknowledgements This study was funded by the Swedish National Board of Health and Welfare and the Assessment Capacities Project. The funders had no influence on the content of the manuscript or the decision to submit it. Moreover, the authors declare no conflicts of interest with respect to the authorship and/or the publication of this paper. Finally, the authors would like to thank Dr Angelika Hofmann and Dr Richard Garfield for critically reading and editing the paper.
Correspondence Martin Gerdin, Health Systems and Policy, Department of Public Health Sciences, Karolinska Institutet, 171 77 Stockholm, Sweden. E-mail: [email protected]
Endnotes 1
Martin Gerdin is a PhD student at the Centre for Research on Health Care in Disasters, Health Systems and Policy Research Group, Department of Public Health Sciences, Karolinska Institutet, Sweden; Patrice Chataigner is Head of Analysis at the Assessment Capacities Project, Switzerland; Leonie Tax is an Information Analyst at the Norwegian Refugee Council, Norway; Anne Kubai
Does need matter? Needs assessments and decision-making among major humanitarian health agencies
is Associate Professor, Department of Theology, Studies of Mission, Uppsala Universitetet, Sweden; and Johan von Schreeb is Associate Professor, Centre for Research on Health Care in Disasters, Health Systems and Policy Research Group, Department of Public Health Sciences, Karolinska Institutet, Sweden.
References Ackoff, R. (1989) ‘From data to wisdom’. Journal of Applies Systems Analysis. 16. pp. 3–9. Assessment Capacities Project (2012) ‘The Assessment Capacities Project ACAPS’. Assessment Capacities Project, Geneva. Bernard, H.R. (1995) Research Methodology in Anthropology: Qualitative and Quantitative Approaches. SAGE Publications, London. Bradt, D.A. (2009) Evidence-based Decision-making in Humanitarian Assistance. Network Papers. 67. Humanitarian Practice Network, Overseas Development Institute, London. Centre for Research on the Epidemiology of Disasters (2012) ‘EM-DAT: The International Disaster Database’. http://www.emdat.be (accessed on 18 January 2012). Darcy, D. and C. Hofmann (2003) According to Need? Needs Assessment and Decision-making in the Humanitarian Sector. HPG Report. 15. Humanitarian Policy Group, Overseas Development Institute, London. Darcy, J., S. Anderson, and N. Majid (2007) A Review of the Links between Needs Assessment and Decisionmaking in Response to Food Crises. HPG Commissioned Reports. May. Humanitarian Policy Group, Overseas Development Institute, London. de Geoffroy, V. and F. Grunewald (2008) Principle 6 of Good Humanitarian Donorship Initiative. Groupe URD, Paris. de Ville de Goyet, C. and L.C. Morinière (2006) The Role of Needs Assessment in the Tsunami Response. Tsunami Evaluation Coalition, London. Deitchman, S. (2005) ‘What have we learned? Needs assessment’. Prehospital and Disaster Medicine. 20(6). pp. 468–470. Good Humanitarian Donorship (2003) Principles and Good Practice of Humanitarian Donorship. Good Humanitarian Donorship, Stockholm. Good Humanitarian Donorship (2011) ‘Taking Stock of GHD – 2003 to date’. Good Humanitarian Donorship, Stockholm. Greaney, P., S. Pfiffner, and D. Wilson (2011) Humanitarian Charter and Minimum Standards in Humanitarian Response. Sphere Project, Rugby. Guha-Sapir, D., D. Hargi, and P. Hoyois (2004) Thirty Years of Natural Disasters 1974–2003: The Numbers. University of Louvain Presses, Louvain. Guha-Sapir, D., F. Vos, R. Below, and S. Ponserre (2011) Annual Disaster Statistical Review 2010: The Numbers and Trends. Centre for Research on the Epidemiology of Disasters, Brussels. ICRC and IFRC (International Committee of the Red Cross and International Federation of Red Cross and Red Crescent Societies) (2008) Guidelines for Assessment in Emergencies. ICRC and IFRC, Geneva. Inter-Agency Standing Committee (2011a) IASC Task Force on Needs Assessment Terms of Reference. Inter-Agency Standing Committee, Geneva Inter-Agency Standing Committee (2011b) Provisional Version as of 1 December 2011: The Multi Cluster/ Sector Initial Rapid Assessment (MIRA) Approach: Process, Methodologies and Tools. Inter-Agency Standing Committee, Geneva International Red Cross and Red Crescent Movement (2012) Code of Conduct. http://www.ifrc.org: http://www.ifrc.org/en/publications-and-reports/code-of-conduct/ (accessed on 27 March 2012).
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Kellett, J., L. Walmsley, and L. Poole (2011) GHA Report 2011. Global Humanitarian Assistance, Wells. Mock, N. and R. Garfield (2007) ‘Health tracking for improved humanitarian performance’. Prehospital and Disaster Medicine. 22(5). pp. 377–383. Office for the Coordination of Humanitarian Affairs (2009) Assessment and Classification of Emergencies (ACE) Project: Mapping of Key Emergency Neds Assessment and Analysis Initiatives. Office for the Coordination of Humanitarian Affairs, Geneva Patton, M.Q. (1990) Qualitative Evaluation and Research Methods. Sage Publications, Newbury Park, CA. Potter, J. and M. Wetherall (1987) Discourse Analysis in Social Psychology: Beyond Attitudes and Behaviour. Sage Publications, London. Robertson, A.G., E.K. Griffiths, I. Norton, and T.S. Weeramanthri (2011) ‘Disaster response from Australia: what is the role of forward teams?’. Travel Medicine and Infectious Disease. 9(5). pp. 249–252.
Does need matter? Needs assessments and decision-making among major humanitarian health agencies Martin Gerdin, Patrice Chataigner, Leonie Tax, Anne Kubai, and Johan von Schreeb1
Disasters of physical origin, including earthquakes, floods, landslides, tidal waves, tropical storms, tsunamis, and volcanic eruptions, have affected millions of people globally over the past 100 years. Proportionately, there is far greater likelihood of being affected by such disasters in low-income countries than in high-income countries. Furthermore, low-income countries are in need of international assistance following disasters more often than high-income countries. The funding of international humanitarian assistance has increased from USD 12.9 billion in 2006 to an estimated USD 16.7 billion in 2010. The majority of this funding is channelled through humanitarian agencies and is supposed to be distributed based on the need of those affected, as assessed using needs assessments. Such needs assessments may be used to inform decisions internally, to influence others, to justify response decisions, and to obtain funding. Little is known about the quality of needs assessments in practical applications. Consequently, this paper reports on and analyses the views of operational decision-makers in major health-related humanitarian agencies on needs assessments.
Introduction Disasters of physical origin, including earthquakes, floods, landslides, tidal waves, tropical storms, tsunamis, and volcanic eruptions, have affected millions of people globally over the past 100 years (Centre for Research on the Epidemiology of Disasters, 2012). Proportionately, there is far greater likelihood of being affected by such disasters in low-income countries (gross domestic product (GDP) less than USD 976 per capita) than in high-income countries (GDP greater than USD 11,905 per capita) (Guha-Sapir, Hargi, and Hoyois, 2004). Furthermore, low-income countries are in need of international assistance following disasters more often than high-income countries. The need for international humanitarian assistance depends on the pre-disaster socioeconomic context as well as on the disaster’s intensity, location, and the number of people affected. The funding of international humanitarian assistance has increased from USD 12.9 billion in 2006 to an estimated USD 16.7 billion in 2010 (Kellett, Walmsley, and Poole, 2011). The majority of this funding is channelled through humanitarian agencies and is supposed to be distributed based on the need of those affected (de Geoffroy and Grunewald, 2008). With regard to needs-based humanitarian funding, three of the most well-known international policy documents are: Disasters, 2014, 38(3): 451−464. © 2014 The Author(s). Disasters © Overseas Development Institute, 2014 Published by John Wiley & Sons Ltd, 9600 Garsington Road, Oxford, OX4 2DQ, UK and 350 Main Street, Malden, MA 02148, USA
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• the Code of Conduct for The International Red Cross and Red Crescent Movement and NGOs in Disaster Relief; • the Principles and Good Practice of Humanitarian Donorship; and • the Sphere Project’s Humanitarian Charter and Minimum Standards in Humanitarian Response. The Red Cross Code of Conduct was released in 1994 and includes 10 principles to be followed by the International Red Cross and Red Crescent Movement and other humanitarian agencies involved in disaster response (International Red Cross and Red Crescent Movement, 2012). The Good Humanitarian Donorship (GHD) document was released by governments, non-governmental organisations (NGO), and others in 2003 (Good Humanitarian Donorship, 2011, 2003). The Humanitarian Charter and Minimum Standards in Humanitarian Response is a handbook first produced in 2001 by the Sphere Project that provides minimum and core standards for international humanitarian assistance following disasters (Greaney, Pfiffner, and Wilson, 2011). These international policy documents argue that international humanitarian assistance should be guided by information on the needs of the affected population. This information should be gathered through timely, reliable, and applicable needs assessments in order to plan the type and quantity of assistance adequately. Needs assessments commonly refer to the systematic collection of information on the magnitude of the disaster and on the human needs to be addressed. Information for needs assessments can be collected via internet and literature searches, key informant and focusgroup interviews, and systematic observations using checklists and quantitative surveys (von Schreeb, 2007). Needs assessments may be used to inform decisions internally, to influence others, to justify response decisions, and to obtain funding (Darcy, Anderson, and Majid, 2007). In recent years, international initiatives (Health and Nutrition Tracking Service, Sphere, the Standardized Monitoring and Assessment of Relief and Transition) have developed indicators and proposed ways to collect and disseminate needs assessment information (Mock and Garfield, 2007). Several internet platforms (AlertNet, Relief Web) facilitate the sharing of needs assessment results. A 2009 study by the United Nations (UN) Office for the Coordination of Humanitarian Affairs (OCHA) identified 19 different initiatives relevant to needs assessment (Office for the Coordination of Humanitarian Affairs, 2009). The UN Inter-Agency Standing Committee (IASC) created the IASC Needs Assessment Task Force (NATF) shortly after the publication of the OCHA study. OCHA was appointed as the chair to ‘harmonize and promote cross-sector needs assessment initiatives’ (Inter-Agency Standing Committee, 2011a). The Assessment Capacities Project (ACAPS) was started by a consortium of three NGOs and collaborates with the NATF to develop methodologies and tools for better coordinated assessments (Assessment Capacities Project, 2012). Little is known about the quality of needs assessments in practical applications. Consequently, this paper reports on and analyses the views of operational decisionmakers in major health-related humanitarian agencies on needs assessments. They were
Does need matter? Needs assessments and decision-making among major humanitarian health agencies
asked to evaluate the information needed to perform needs assessments and how such assessments are used to decide whether to deploy relief following disasters. The analysis is based on two interview studies with key informants. The objective of Study I was to determine what information is needed by operational decision-makers in the immediate aftermath of a disaster. The objective of Study II was to determine to what extent needs assessment information is employed by operational decision-makers in their judgments to deploy health relief post disaster.
Methods Definitions This study used the Centre for Research on the Epidemiology of Disasters (CRED)’s definition of a disaster: ‘a situation or event which overwhelms local capacity, necessitating a request to a national or international level for external assistance; an unforeseen and often sudden event that causes great damage, destruction and human suffering’ (Guha-Sapir et al., 2011, p. 7). According to CRED, a disaster of physical origin can be biological, climatological, geophysical, hydrological, or meteorological. Data was defined as the raw material—counts, observations, and statements—that when put in context or organised, becomes information (Ackoff, 1989). Needs assessment was defined as an initial and rapid procedure that is used to gain information on the situation and the needs of the disaster-affected population (von Schreeb, 2007). Purposeful sampling In both studies we adopted ‘typical case sampling’, a purposeful sampling method for selecting respondents (Patton, 1990). We based our selection of respondents on extensive personal experience of working in and researching the humanitarian relief sector. In total, 17 representatives from 13 major health-related humanitarian agencies were interviewed. To perform further in-depth analyses and detect interagency variations, we interviewed two or more representatives from three agencies. Interview Study I The objective of this study was to determine what information is needed by operational decision-makers in the immediate aftermath of a disaster. We interviewed a total of 11 representatives from eight non-governmental humanitarian agencies (see Table 1) by telephone or face-to-face, using a semi-structured open-ended questionnaire. Two respondents were at field level, one at regional level, and eight at global level. Field level was defined as working in an office located in the country of operations. Regional level was defined as working in an office providing regional support to field offices in several countries. Global level was defined as working in a headquarters office, providing global support to several regional- and field-level offices. Interviews were conducted between November and December 2010 in the native language of the respondents, either English or French. The interviews were transcribed
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Table 1. Major health-related humanitarian agencies for Study I and Study II and the number and level of the respondents (in brackets) Study I
Study II
French Red Cross [1 global]
Action Against Hunger [1 global]
Global Nutrition Cluster [1 global]
International Rescue Committee [1 global]
Off ice for the Coordination of Humanitarian Affairs (OCHA) [1 field]
Médecins Sans Frontières Operational Centre Brussels [2 global]
OXFAM [1 global, 1 regional]
Médecins Sans Frontières Operational Centre Amsterdam [1 global]
Solidarités [3 global]
Merlin [1 global]
United Nations Children’s Fund (UNICEF) [1 global] Water Sanitation Hygiene (WASH) Cluster Congo [1 field]
as they were performed. Responses were analysed after condensing the transcripts. The answers were arranged thematically, based on positive or negative connotations. Interview Study II The objective of this study was to reveal to what extent needs assessment information is used by operational decision makers in their judgments to deploy health relief post disaster. We interviewed six representatives from five major health-related humanitarian agencies using a semi-structured interview guide with open-ended questions between December 2008 and June 2009. Interviews were conducted in English by telephone, and included questions about how decisions to deploy health relief after disasters were taken, which types of information influenced the decision, and sources of information. The interview guide was used to structure the interviews, while still allowing enough flexibility for the interviewer to generate additional questions in the course of the interviews (Bernard, 1995). Additional questions were used only in the interview in which they were generated. All respondents were at the global level. Four were from agencies headquartered in Europe and one was from an agency headquartered in the United States. Each interview lasted between one and two hours and was tape-recorded, transcribed, and analysed using thematic coding (Potter and Wetherall, 1987). Words and paragraphs in all transcripts that appeared to relate to the same aspect of needs assessments were assigned a common code. As the analysis progressed, we used these codes to generate themes that captured central issues expressed by the respondents on needs assessments. We focused our analyses on communication and on the relationship between emotions and available information and its impact on the decision to deploy relief.
Does need matter? Needs assessments and decision-making among major humanitarian health agencies
Results Study I We asked respondents to list what type of decisions they make during the first 72 hours of a crisis. Their answers were categorised into two types: strategic decisions and operational decisions. The most frequent strategic decisions taken by respondents include the identification of the target population for assessment or intervention, priority areas in terms of geography and sectors for assessment and intervention, and whether or not to deploy relief supplies based on an estimation of the scale and scope of an emergency. Often, the decision also involved country-level internal and external political processes. Our respondents indicated that main operational decisions concerned the type of operation and the resources needed for the operation, including required budget, equipment, skills, and staff. According to our respondents, the specific information required in the decisionmaking process could be divided into categories. The first category was information that should be collected prior to disasters, that is, pre-disaster information. Almost all respondents noted that having baseline, pre-disaster data (including demographic data) is important. The second category was specific information that relates directly to the disaster event and its impact, that is, disaster-specific information. Ideally, disaster-specific information will focus on the effect of the disaster on the population.
Information gaps and needs All respondents at the global level recognised the lack of sufficient and accurate information in the immediate aftermath of a disaster and stated that they needed faster access to information. To make decisions within the first 72 hours of a disaster, they predominantly relied on pre-disaster information—if available—and on the limited amount of obtainable post-disaster information. However, pre- and post-disaster information was only useful if it was well classified, accurate, and reliable. Respondents stated that both pre- and post-disaster information frequently needed to be more detailed than is typically the case. Our respondents did not specify, though, the level of detail needed. They also noted that the methods used to obtain the information must be clearly stated, and that information on the reliability of data would be appreciated.
Process of information collection The majority of respondents said that information is not sufficiently gathered prior to crises and disasters. However, a few indicated that internal processes to pre-gather information are under development within their respective agencies. Together these statements suggest that baseline and pre-disaster information are neither sufficiently collected nor fully utilised in humanitarian crises. Respondents both at the field and the global level use information produced by other NGOs and UN agencies as information sources. In-country sources such as key informants, local partners, and relevant ministries also were mentioned as information
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sources. In addition, respondents at the global level, who relied less on in-country sources, used news reports and internet resources, such as reports on Relief Web, as key information sources. Furthermore, satellite images and donor information are important sources for several global-level respondents. A few respondents at the global level used internal monitoring and information systems. We were told that, although collection of information took place at both the field and the global level, the information analysis occurred primarily at the global level. A majority of respondents used triangulation to verify information from different sources. Only one respondent stated that no crosschecking took place. In addition, one respondent cited the use of experience to assess the credibility of information. Our findings suggest that information is collected using many different sources. The information is then verified by triangulation. Sources of information used at headquarters seem to differ from those used on the ground. At the global level, official resources and the internet are used, whereas personal communication and key informants are more important at the field level. Respondents at the global level indicated that once the people on the ground switched into operational mode, they have limited capacity to follow and analyse conditions.
Factors affecting the decision to deploy health relief Respondents indicated that the decision to deploy health relief following a disaster depends on several factors. On a global level, respondents mentioned potential added value of their intervention, capacity of the agency, risk of disease or shortage of food and fuel, and the scale of the crisis as factors that influence the decision. In addition, factors such as strategic interests and requests by local partners were noted. At the field and regional level, respondents highlighted the scale of the crisis, the agency’s current capacity, and security risks as key factors influencing the decision. A majority of respondents indicated that in-country presence plays a critical role in decisionmaking. Respondents reported that if field offices relay information to their headquarters, this provides increased credibility and confidence in the information. The presence of field offices also denotes a level of existing in-country capacity, a principal factor in deciding whether or not to deploy health relief. All respondents at the field level said that their agencies use specific platforms to support decisions, such as the Global Disaster Alert and Coordination System and the Virtual On-Site Operations Coordination Center. These are online systems that allow their users to share realtime information on disasters and to receive disaster alerts. The majority of respondents at the global level stated that their agency did not use a decision-making tool. Thus, decisions seem to be based primarily on personal experience and presence incountry. The use of decision-making tools is limited to the field level but no validated framework appears to exist. Respondents at the field and regional level noted that decisions had to be taken faster, in the majority of the cases within 48 hours. Respondents at the global level claimed that decision time frames ranged from six hours to seven days, depending on the on-ground presence.
Does need matter? Needs assessments and decision-making among major humanitarian health agencies
Study II
Sources of information Respondents indicated that no standard checklists existed for systematically collecting and analysing information to assess the needs of the affected population. One respondent said that both local people and observations by agency representatives are important sources of information: We go there, we make our medical analysis and prognosis and we see the situation, and we diagnose what is going on . . . and we mix basically our analysis together with the testimonies of the victim. The media, electronic and print, was a major source of information. In addition, ‘any other kind of source of information’ is acceptable, including ‘informal sources’. All respondents answered consistently the question about the type of information needed to plan a deployment rapidly. Such information included the type of disaster, the number of people affected, the death toll, the extent of general damage, and precrisis information on the size of the area and the population. How important this information was varied between agencies, and no respondent was able to articulate the extent to which available information influenced decisions. One respondent explained: It is important that you have information about every sector because you do not know which sectors are affected. Respondents did not feel that it was necessary to change initial deployment decisions if early (24–72 hours) information was unavailable or uncertain. Instead, initial decisions can be based on assumptions, as demonstrated in the following quote: We need to be there to know what is happening on real terms basis and you have to make certain levels of assumptions during 24–72 hours, but after 72 hours things will become clearer. After six-seven days, it can change drastically.
Pressure to decide Respondents gave varying descriptions of how operational decisions to deploy health relief following disasters are taken. One said that decisions depend on the scale of the disaster, the number of people affected, the effect on health care accessibility, how quickly it affects the national health care system, and the possible long-term effect of the disaster. Another stated that ‘for any natural disasters, decisions and processes will be different’. One respondent pointed out how decisions and processes can differ depending on the disaster: If it is an earthquake we will look at the magnitude of the earthquake . . . the time of the day. If it is during the night we know that there are more injured than that if it is during the day; the type of buildings – if it is a city or small villages with light construction it is quite different . . . if it is dispersed or not.
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A majority of respondents made reference to ‘the experience and feelings’ of agency team members as an important factor influencing the decision to deploy health relief. Taken together, our findings show that information is gathered through both electronic and print media as well as through direct observations. However, although the respondents agreed on what information they were searching for, it is not clear to what degree this information affected their decision to deploy relief. Instead it seems that an initial decision to deploy at least part of a team is made without much information to hand. This decision may then be modified when more information is available.
‘Making assumptions . . . most of the time’ Although the respondents claimed to try to obtain information, many assumptions have to be made when deciding to deploy health relief. One respondent said that, sometimes: we go with the assumption that all the population has been affected. In what way it has been affected . . . displaced population, are the people relocating to another site? To the question on how information was crosschecked and validated, this respondent replied: You have a very rough idea and you make decisions based on that. You cannot wait to cross-check everything . . . if you do that, it will be one week . . . it will be another thing. Another respondent highlighted the difference between information that is ‘requested in order to send the team to the field’ and the ‘information necessary to build an operation’, which suggests a two-stage analysis process. Another provided a document that was used to structure needs assessments. This document also supplied instructions on how to write the various documents that are ‘published at external level’. The respondent from this agency said that: There is no systematic way to deal with this information because not all the information is initially available. We may have access to the information in the course of the first week. There is no mathematical or scientific way to analyse this information because the type of information collected is not good enough most of the time, to allow appropriate decisions.
Other factors Respondents indicated that being able to rely on the capacity of individuals trained to collect needs assessment information was a critical factor in getting accurate, detailed, and fast information. Respondents said that, even in cases where assessment manuals, checklists, and standard reporting procedures were fairly developed, sometimes they are not used because of the situation in which they find themselves, as exemplified in the following quote:
Does need matter? Needs assessments and decision-making among major humanitarian health agencies
On the seashore of experience . . . the staff who are dispatched use their own experience and come up with their own conclusions. Here the ‘experience, presence, and ability’ of the individual members of an assessment team ‘to understand the situation’ is crucial; yet, in many instances, the teams ‘are limited in terms of knowing the terrain and knowing the population and knowing the needs’. Thus, activities are mobilised around limited information, regardless of how it is obtained, and, more importantly, as one respondent put it, there is ‘a willingness or ability to basically do the assessment on the back of an envelope, if the situation so demands’. Some respondents stated that the presence of other agencies in the area affected by the disaster was an important factor when taking decisions to deploy health relief. All said that, usually, they ‘look also at the number of NGOs present in the field, both international and local NGOs’. One added that ‘what we are looking for in the second phase is assessment of the local capacity’. Therefore, they go where capacity is weak. In addition, all respondents said that the ‘added value’ of the presence of their agencies is an important factor. One pointed out that ‘you go where your agency would be an added value. So we are looking at, not only where the needs are but what your added value could be’. To summarise, decisions to send relief currently are made on the basis of little available field-based information. Systematic methods for collecting, processing, and analysing the information for decision-making are not employed. Detailed needs assessment information is not considered vital to relief deployment decisions. Rather, deployment decisions frequently are made through interpersonal processes and consensus-building among experienced relief teams. In the absence of a systematic approach, media reports, and public opinion appear to have a major influence on the decision to deploy relief. In addition, personal knowledge of relief team members and the long-term presence of national agencies in a given country influence the level and type of assistance provided.
Discussion This study illustrates that current processes of deciding about deployment of assistance following disasters of physical origin can be rapid, subjective, and highly personalised in the absence of reliable information. Unfortunately, we were unable to fulfil our second objective, because no decision-maker was able to articulate the extent to which available information influences decisions. Instead, this finding suggests that the value of specific information in the early decision-making process may be over-estimated. To improve these processes, better information pre and post disaster is needed. Ideally, such information should be reliable, accurate, detailed, systematic, and coordinated. It is not possible to generalise our results to all international humanitarian agencies and to the UN system. In addition, it is difficult to determine how representative the respondents are of their respective agencies. Therefore,
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we warrant caution when using our findings to draw conclusions for the agency rather than the respondent level. One should remember that this paper is a presentation of an in-depth analysis of how decision-makers in a sample of major health-related humanitarian agencies use needs assessments and what information they are looking for when deciding on whether or not they should deploy relief. Our results correspond well with the findings of others. According to studies by Darcy and Hofmann (2003) and de Ville de Goyet and Morinière (2006), needs assessments play a very limited role in the decision-making of agencies and donors. Needs assessments are not objective. Rather, they involve estimation, interpretation, and judgment, in addition to measurement, observation, and analysis (Darcy, Anderson, and Majid, 2007). No systematic approach exists to collect data and to analyse it. Indeed, obtaining sufficient data and analysing and cross-referencing it for a detailed needs assessment are considered time-consuming tasks in a situation where time is very important. Our findings indicate that the little information available is not considered sufficient and accurate enough to serve as the basis for decisions on health relief deployment in a timely manner. Several international projects and many operational agencies are working to improve the timeliness and accuracy of information Table 2. Initial needs assessment model for the first 48–72 hours following a disaster of physical origin The three main considerations for the assessing agency and concrete measures to achieve them: 1
Focus on the big picture Categorise collected information according to area of interest, such as group and sector concerned, capacity, risk, and whether the information is need- or response-related, to facilitate the information flow throughout the process. Research primarily life-saving sectors such as food security, health, protection, shelter/ non-food items, and water and sanitation. Then extend to other sectors (education, early recovery, etc.). Use information that is ‘good enough’, do not seek more detail or precision than is needed. At this stage, sufficiently well-informed decision-making is the aim. There has to be a balance between accuracy of the data and speed of response. Look for disaggregated data for the population group or geographic area(s) affected by the disaster.
2
Collate secondary information post-disaster Consider all secondary information produced post disaster by NGOs, news media, government, crowd sourcing, etc. Use your network to triangulate and confirm information. Keep in mind that all information has a bias. Use snowball effects (through contact or reference documents) to guide more in-depth research when necessary. Collect only what you know you will use.
3
Use pre-disaster information to develop assumptions Look for important and relevant quantitative information, such as census, pre-disaster data sets, epidemiological profile, demographic data, etc. Statistics may provide useful indications on the evolution of exogenous factors, patterns, and trends. Know the likely impact of disasters. Identify risks and aggravating factors that may be exacerbated by the disaster and on which you will base your assumptions and recommendations. Pre-disaster information must be collected as a preparedness activity in a way that allows for fast and easy access to the information that is most crucial and that can be digested easily by an emergency decisionmaker who does not have time to read lots of reports.
Does need matter? Needs assessments and decision-making among major humanitarian health agencies
on humanitarian needs in different sectors (Office for the Coordination of Humanitarian Affairs, 2009). However, none of these projects have been able yet to provide needs assessments of a general standard that are agreed on and endorsed by all stakeholders and that are to be updated regularly. The lack of a general standard means that needs assessment approaches vary substantially between agencies, despite them being an integral component of many agencies’ programmes. For example, Australia’s Disaster Medical Assistance Teams (DMAT) use so-called forward teams to perform early and rapid needs assessments. These forward teams are composed of between one and four people. They should be on site and supply information preferably within 24 hours of the onset of a disaster. This information is then supposed to guide later response by a full DMAT (Robertson et al., 2011). In contrast, the International Committee of the Red Cross and the International Federation of the Red Cross and Red Crescent Societies rely to a large extent on national Red Cross and Red Crescent Societies for early and rapid needs assessments. Their initial needs assessment may take up to a week (ICRC and IFRC, 2008). This heterogeneity in needs assessment approaches in combination with insufficient coordination and information-sharing between agencies leads to duplication of efforts and limited effectiveness (Deitchman, 2005).
Implications for policy and practice As outlined in Evidence-based Decision-making in Humanitarian Assistance (Bradt, 2009), humanitarian agencies should recognise their mission to do the most good for the most people. Yet, as seen in this study, the decision to deploy relief seems to be highly subjective. Presently, mandate and the capacity of agencies appear to have priority over need. Based on these and other similar findings, such as those following the Indian Ocean tsunami of 2004 (de Ville de Goyet and Morinière, 2006), it is time that considerable political and economic effort is put into developing more permanent, regional, and/or international capacity to conduct initial rapid needs assessments. Without this capacity in place and it being fully functional, the idea of international agencies assessing accurately the needs of affected populations fast enough to guide initial response may have to be abandoned (Bradt, 2009). Importantly, this study found that no decision-maker was able to articulate the extent to which available information influenced decisions. We believe that this finding opens the way for new research to find the link between information and decisions. Humanitarian agencies need to consider a number of issues for effective and informative initial rapid needs assessments. These are also valid for the development of a standardised needs assessment system as an international capacity (see Table 2). Initial needs assessments should be conducted in the first 72 hours of a disaster. Our respondents highlighted that it is during this phase that agencies make their first decision to deploy relief. We suggest the following three key considerations for initial needs assessments:
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• Focus on the big picture. • Concentrate on secondary information. It is readily available and may be collected remotely while primary information-gathering will be too time-consuming to generate a needs assessment quickly enough to guide initial decisions. • Place more emphasis on pre-disaster information than on post-disaster information. The former will provide the basis for the contextual understanding needed to develop assumptions on the likely impact of the disaster. In addition, any assumptions need to combine as a minimum expert judgment, experience, lessons learnt from past disasters, and facts. Finally, one should remember that the need for assistance for the affected population does not disappear after the first 72 hours. Members of the affected population are the ones who best know their own needs. Efforts to include the affected population in needs assessment are long overdue and should be accorded priority. One should also remember that needs are not only health-related. Even though this paper focuses on needs assessments by major health-related humanitarian agencies, many of the concepts discussed here apply to other sectors as well (Deitchman, 2005). While needs assessments in other sectors is beyond the scope of this paper, the multi-sector approach initiated by the NATF is much needed and welcomed by the international humanitarian community (Inter-Agency Standing Committee, 2011b). To conclude, needs really should matter. Regardless of type.
Acknowledgements This study was funded by the Swedish National Board of Health and Welfare and the Assessment Capacities Project. The funders had no influence on the content of the manuscript or the decision to submit it. Moreover, the authors declare no conflicts of interest with respect to the authorship and/or the publication of this paper. Finally, the authors would like to thank Dr Angelika Hofmann and Dr Richard Garfield for critically reading and editing the paper.
Correspondence Martin Gerdin, Health Systems and Policy, Department of Public Health Sciences, Karolinska Institutet, 171 77 Stockholm, Sweden. E-mail: [email protected]
Endnotes 1
Martin Gerdin is a PhD student at the Centre for Research on Health Care in Disasters, Health Systems and Policy Research Group, Department of Public Health Sciences, Karolinska Institutet, Sweden; Patrice Chataigner is Head of Analysis at the Assessment Capacities Project, Switzerland; Leonie Tax is an Information Analyst at the Norwegian Refugee Council, Norway; Anne Kubai
Does need matter? Needs assessments and decision-making among major humanitarian health agencies
is Associate Professor, Department of Theology, Studies of Mission, Uppsala Universitetet, Sweden; and Johan von Schreeb is Associate Professor, Centre for Research on Health Care in Disasters, Health Systems and Policy Research Group, Department of Public Health Sciences, Karolinska Institutet, Sweden.
References Ackoff, R. (1989) ‘From data to wisdom’. Journal of Applies Systems Analysis. 16. pp. 3–9. Assessment Capacities Project (2012) ‘The Assessment Capacities Project ACAPS’. Assessment Capacities Project, Geneva. Bernard, H.R. (1995) Research Methodology in Anthropology: Qualitative and Quantitative Approaches. SAGE Publications, London. Bradt, D.A. (2009) Evidence-based Decision-making in Humanitarian Assistance. Network Papers. 67. Humanitarian Practice Network, Overseas Development Institute, London. Centre for Research on the Epidemiology of Disasters (2012) ‘EM-DAT: The International Disaster Database’. http://www.emdat.be (accessed on 18 January 2012). Darcy, D. and C. Hofmann (2003) According to Need? Needs Assessment and Decision-making in the Humanitarian Sector. HPG Report. 15. Humanitarian Policy Group, Overseas Development Institute, London. Darcy, J., S. Anderson, and N. Majid (2007) A Review of the Links between Needs Assessment and Decisionmaking in Response to Food Crises. HPG Commissioned Reports. May. Humanitarian Policy Group, Overseas Development Institute, London. de Geoffroy, V. and F. Grunewald (2008) Principle 6 of Good Humanitarian Donorship Initiative. Groupe URD, Paris. de Ville de Goyet, C. and L.C. Morinière (2006) The Role of Needs Assessment in the Tsunami Response. Tsunami Evaluation Coalition, London. Deitchman, S. (2005) ‘What have we learned? Needs assessment’. Prehospital and Disaster Medicine. 20(6). pp. 468–470. Good Humanitarian Donorship (2003) Principles and Good Practice of Humanitarian Donorship. Good Humanitarian Donorship, Stockholm. Good Humanitarian Donorship (2011) ‘Taking Stock of GHD – 2003 to date’. Good Humanitarian Donorship, Stockholm. Greaney, P., S. Pfiffner, and D. Wilson (2011) Humanitarian Charter and Minimum Standards in Humanitarian Response. Sphere Project, Rugby. Guha-Sapir, D., D. Hargi, and P. Hoyois (2004) Thirty Years of Natural Disasters 1974–2003: The Numbers. University of Louvain Presses, Louvain. Guha-Sapir, D., F. Vos, R. Below, and S. Ponserre (2011) Annual Disaster Statistical Review 2010: The Numbers and Trends. Centre for Research on the Epidemiology of Disasters, Brussels. ICRC and IFRC (International Committee of the Red Cross and International Federation of Red Cross and Red Crescent Societies) (2008) Guidelines for Assessment in Emergencies. ICRC and IFRC, Geneva. Inter-Agency Standing Committee (2011a) IASC Task Force on Needs Assessment Terms of Reference. Inter-Agency Standing Committee, Geneva Inter-Agency Standing Committee (2011b) Provisional Version as of 1 December 2011: The Multi Cluster/ Sector Initial Rapid Assessment (MIRA) Approach: Process, Methodologies and Tools. Inter-Agency Standing Committee, Geneva International Red Cross and Red Crescent Movement (2012) Code of Conduct. http://www.ifrc.org: http://www.ifrc.org/en/publications-and-reports/code-of-conduct/ (accessed on 27 March 2012).
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Martin Gerdin, Patrice Chataigner, Leonie Tax, Anne Kubai, and Johan von Schreeb
Kellett, J., L. Walmsley, and L. Poole (2011) GHA Report 2011. Global Humanitarian Assistance, Wells. Mock, N. and R. Garfield (2007) ‘Health tracking for improved humanitarian performance’. Prehospital and Disaster Medicine. 22(5). pp. 377–383. Office for the Coordination of Humanitarian Affairs (2009) Assessment and Classification of Emergencies (ACE) Project: Mapping of Key Emergency Neds Assessment and Analysis Initiatives. Office for the Coordination of Humanitarian Affairs, Geneva Patton, M.Q. (1990) Qualitative Evaluation and Research Methods. Sage Publications, Newbury Park, CA. Potter, J. and M. Wetherall (1987) Discourse Analysis in Social Psychology: Beyond Attitudes and Behaviour. Sage Publications, London. Robertson, A.G., E.K. Griffiths, I. Norton, and T.S. Weeramanthri (2011) ‘Disaster response from Australia: what is the role of forward teams?’. Travel Medicine and Infectious Disease. 9(5). pp. 249–252.
