Health needs assessment

Emergency Phase

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.

Methodology
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.

• Needs Assessment in Refugee Emergencies (NARE)

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  

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.

Deliverables:

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.