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An initial rapid health and nutrition needs assessment is essential to inform the design of an effective public health intervention
Initial rapid assessments should be multi-sectoral in character and the teams should include expertise in public health, nutrition, WASH, shelter / site planning and protection
A more detailed sector specific health and nutrition assessment will also be required after the initial rapid assessment to guide the response
Ensure that the local health authorities and partners are engaged throughout the entire process of the initial rapid assessment and subsequent assessments
Process the information gathered in the assessments and share with partners to inform public health programming
Emergency public health interventions must be evidence-based, needs-based and context-specific. Following the Needs Assessment in Refugee Emergencies (NARE) a more detailed health and nutrition assessment should be conducted. This examines refugees' most immediate health problems and needs; reviews public health risks (disease outbreaks, malnutrition, access gaps); and maps the resources that are available and the resources that are needed to deliver effective assistance. The health needs assessments should be carried out by public health technical experts with relevant experience.
Relevance for emergency operations
In order to plan and implement effective health programs in an emergency, it is essential to know the health and nutrition status of the affected population, the status of the existing health system and potential health risks as soon as possible.
Health needs assessments should take place in the first days of an emergency and be coordinated and supervised by an experienced Public Health Officer.
The aim of an initial health assessment is to:
Obtain an overview of the situation.
Identify immediate needs and gaps.
Identify major causes of mortality & morbidity and the nutrition situation (for nutrition assessment see chapter on nutrition needs assessment)
Assess the level of risk of outbreaks of possible disease.
Map availability of, and access to, primary and emergency health care
Map the available health resources and the additional health resources needs.
Map the available partner and services availed by partners.
Establish priority actions.
Data is derived from different sources, requires specific tools and methodologies and is expanded over time.
Health needs assessments (1) use both primary and secondary data, (2) analyze both qualitative and quantitative data. (3) and should Ideally be carried out jointly with partners and led by a public health expert.
There are different types of needs assessments and tools. Initial rapid assessments provide the initial information needed and are then followed with more detailed assessments over time.
The NARE is principally designed to assist UNHCR operations with initial multi-sectoral assessments. NARE highlights information that is derived from pre-crisis and post-crisis secondary data analysis, before the primary data collection begins. For primary data collection, the NARE suggests data elements that can be derived from facility visits, observations, key informants and focus group discussions. It promotes the cross-analysis of information derived from multiple methodologies across multiple sectors to ensure a rapid, relatively complete picture.
The NARE checklist has dedicated sections on public health, nutrition and food security. In the initial phase of an emergency, health assessments should be done as part of the NARE. Where the NARE or similar multisectoral needs assessments are not done, it is required to conduct a health assessment jointly with partners and ensure that the information is shared with other partners and sectors. The NARE public health and nutrition checklist provides an overview of standard questions.
The Multi Sector Initial Rapid Assessment MIRA is a joint multi cluster/ sector assessment that offers an early rapid overview of the situation and determines immediate needs and gaps. It is ideally conducted within the first days (72 hours) of the post-emergency onset to inform the initial emergency response. This can be conducted as part of the NARE or as a standalone assessment.
Detailed Health Sector-Specific Assessments provide a more in-depth analysis of specific health areas. This is usually done following the initial rapid needs assessment, including exploring identified gaps further. A UNHCR Public Health assessment tool has been developed and is available in the UNHCR Public Health Emergency Toolkit.
The table below, extracted from UNHCR NARE health needs assessments, summarizes the health data to be collected, sources and tools available
Health status and risks
Health resources and service availability
Health system performance
The current health status of the affected populations: mortality, morbidity trends. health risks (potential outbreaks), nutrition status
Existing facilities and services of national health authorities, other national and non-state actors, and international partners
Access, coverage, utilization, quality and effectiveness of the services currently available
NARE; Multisector initial rapid assessment (MIRA), UNHCR Public Health assessment; Early warning alert and response (EWARS), UNHCR integrated refugee health information system (iRHIS) Basic Indicator Report (BIR)
UNHCR Public Health assessment; Health Resources and Services Availability Monitoring System (HeRAMS); Who, what, where (and when) (3W/4W); WHO Surveillance System for Attacks on Health Care (SSA)
Health Information System (HIS)or DHIS2 or partner reports
Secondary data from pre-emergency sources;
Primary data collected at provider level;
Secondary data from national authorities;
Coordination mechanism/ information management
Data collection assessments;
Not all the information needed can be obtained by an initial rapid assessment. Adopt a phased approach that starts by collecting key indicators and advances to a more comprehensive assessment.
Identify health priorities
Analysis of the data collected will help to define health priorities and to identify particularly vulnerable groups.
Capacity of health system
The assessment should determine the capacity of the existing health system to meet the needs of refugees and potential gaps.
Presentation of results
The findings of the initial assessment should be synthesized in a report. This should be shared with the authorities, partners and other stakeholders and be used to inform the response plan to address the identified needs.
Monitoring and surveillance
A health information system (HIS) should be put in place from the start of an emergency. The UNHCR integrated refugee health information system (iRHIS) is designed especially for this purpose. It is widely accepted by partners and governments. The objectives of any health information system are to:
Rapidly detect and respond to public health problems and epidemics.
Monitor trends in health status and continually address public health priorities.
Evaluate the effectiveness of interventions and service coverage.
Ensure that resources are correctly targeted to the areas and groups in greatest need.
Evaluate the quality of public health interventions.
Post emergency phase
Health needs assessment is an ongoing process that continues in the post emergency phase. Needs may evolve and change over time and should be monitored through routine HIS data and specific repeated assessments as indicated.
Health needs assessment checklist
Initiate a rapid health needs assessment at the onset of an emergency, usually as part of a multi sectoral assessment.
Coordinate the assessment with national authorities and partners and include the affected community.
Collect the data.
Identify public health priorities, vulnerable groups and health system capacity.
Synthesize findings in a report to be shared with partners.
Use findings to inform and plan the response and priority public health actions.
More detailed public health assessments can be conducted over time.
UNHCR Global Strategy for Public Health 2021-2025 (Strategic Objective 1, result 1)
Health and nutrition assessment
Conduct a joint public health and nutrition needs assessment at the onset of an emergency to guide key and timely actions by relevant stakeholders.