2. Assessment checklist
In large emergencies the health cluster or another coordinating mechanism is frequently put in place and organizations are encouraged to coordinate their assessments with all implementing partners. The IASC developed Multi Sector Initial Rapid Assessment (MIRA) tool to be used for initial rapid assessment within 24-48 hours. The tool may be modified to contextual relevance. Guidance on the use of the tool is provided in MIRA Guidance July 2015. http://interagencystandingcommittee.org/system/files/mira_2015_final.pdf . Please refer to Chapter 13 Assessment for tools for a link to the MIRA field assessment tool.
The following checklist is adapted from the Sphere health services assessment checklist and may be used to help prioritise health issues and to consider what interventions the country office may contribute to the overall health response.
Checklist for emergency preparedness and planning for SRHR services
- Participate in country office emergency preparedness planning (EPP) process. This process highlights key items to be reviewed organized for a country office before embarking on providing services.
- Integrate preparedness for health or specific aspects of health based upon the capacity of the country office and current programming.
- Identify health and sexual, reproductive health (SRHR) interventions based upon the most likely types of scenarios (i.e. natural disaster such as flooding, earthquake, civil conflict, or other public health emergencies of international concern).
- Ensure CO staff are represented and participating in UN/WHO Health Cluster related coordinating activities such as SRH and GBV sub-working groups
- Prepare and complete the CARE SRHR EPP Matrix as part of the planning process. Annex 26.15.19
- Preposition RH supplies identified in the EPP
Preparation for Humanitarian Response
- Obtain available information on the crisis-affected population and resources from the host country and international sources.
- Obtain available maps and aerial photographs of the affected areas.
- Obtain demographic and health data from the host country and international sources.
Security and access
- Determine the existence of ongoing natural or human-generated hazards.
- Determine the overall security situation, including the presence of armed forces or militia.
- Determine the access that humanitarian agencies have to the affected population.
Demographics and social structure
- Determine the total disaster-affected population and proportion of children under five years of age.
- Determine the age and sex breakdown of the population.
- Identify the groups at increased risk, for example, women, children, older people, disabled people, people living with HIV/AIDS, people who identify as LGBT, members of certain ethnic or social groups.
- Determine the average household size and estimates of female- and child-headed households.
- Determine the existing social structure, including positions of authority/influence and the role of women.
Background health information
- Identify pre-existing health problems and priorities in the crisis-affected area before the humanitarian crisis. Find out local disease epidemiology.
- Identify pre-existing health problems and priorities in the country of origin if refugees are involved. Find out disease epidemiology in the country of origin.
- Identify existing risks to health, for example, potential epidemic diseases.
- Identify previous sources of health care in crisis affected areas.
- Determine the strengths and coverage of local public health programs for the affected community, internally displaced populations (IDPs) as well as in refugees’ country of origin.
For populations affected by the emergency (affected community, IDPs or refugees):
- Calculate the crude mortality rate (CMR).
- Calculate the ‘under 5′ mortality rate (U5MR: age-specific mortality rate for children under five years of age).
- Calculate cause-specific mortality rates including number of maternal deaths.
- Calculate the proportional mortality rate by dividing cause-specific mortality by total mortality.
- Determine the incidence rates of major diseases that have public health importance.
- Determine age- and sex-specific incidence rates of major diseases.
Sector Specific Assessment
- After the initial rapid assessment (IRA) during the first stage of an emergency, sector-specific assessments should occur to ensure key health, especially sexual and reproductive health needs are addressed.
- The CARE SRHR program tool for health facility assessment helps to get a more focused information on SRH capacity. See Annex 26.5.18
- The CDC Reproductive Health Assessment Toolkit includes a useful RH assessment titled “CDC REPRODUCTIVE HEALTH ASSESSMENT QUESTIONNAIRE FOR CONFLICT-AFFECTED WOMEN 2011.” See Annex 26.5.17
- This assessment can inform the following indicators:
Sexual, reproductive, maternal health indicators
- Safe Motherhood
- # of visibly pregnant and lactating women in crisis-affected area
- % of pregnant women receiving ANC (2+ visits)
- # of clean delivery kits distributed
- % of pregnant women who deliver assisted by a skilled birth attendant at a health facility
- % of health facilities that provide emergency obstetric care.
- Voluntary Contraception/Family Planning
- # of contraceptive users receiving a modern method per month
- Contraceptive prevalence rate – how many people at any given moment are protected?
- % of health facilities providing contraceptive services
- Sexual violence incidence
- # of cases of sexual violence reported, formally or informally
- % of health facilities offering clinical management of rape for survivors.
Note: Refer to the Sphere Manual Minimum Standards in Health Action for information on how to calculate mortality and morbidity rates and refer to Annex 26.5.11 for information on how to calculate UN process indicators to track provision of emergency obstetric and neonatal care (EmONC)
Capacity Assessment of SRHR and health systems
The following information may be collected by CARE, UN agencies, Ministry of Health or other organizations responding to the emergencies:
- Determine the status of sexual reproductive health practices and services (including maternal and newborn health).
- Determine the capacity of and the response by the Ministry of Health of the country/countries affected by the disaster.
- Determine the status of national health facilities, including total number, classification and levels of care provided, physical status, functional status and access.
- Determine the numbers and skills of available health staff.
- Determine the capacity and functional status of existing public health programmes, for example, Expanded Programme on Immunization (EPI), maternal and child health services, and HIV/AIDS.
- Determine the availability of standardised protocols, essential drugs, supplies and equipment.
- Determine the status of existing referral systems.
- Determine the status of the existing health information system (HIS).
- Determine the capacity of existing logistics systems, especially as they relate to procurement, distribution and storage of essential drugs, contraceptive commodities, vaccines and medical supplies.
Data from other relevant sectors
- Use findings from the multi-sectoral assessment and refer to relevant chapters in the Sphere guidelines to ensure health and SRH programming takes into account the population’s nutritional and food security status, hygiene and sanitary conditions, risk of gender based violence, and housing situation.
- Determine the needs of AIDS patients who may be experiencing ART treatment interruption and HIV+ pregnant women who will need PMTCT services.
Source: Adapted from Sphere handbook-Health Services Assessment Checklist. http://www.spherehandbook.org/en/appendix-11/
*Note: The Sphere handbook is undergoing revisions in 2017.