Refugee Reproductive Health Needs Assessment Field Tools
General Overview
Background
Reproductive Health Issues
The provision of reproductive health services is a critical component of any health care initiative in a refugee setting. There are several basic reproductive health provisions that should be put in place to lower excess mortality and morbidity in the initial stage of a refugee emergency. This can be done without having conducted a reproductive health needs assessment due to the overwhelming and well-documented demand for basic reproductive health services among the world's refugee populations.
The provision of basic reproductive health services is referred
to as the Minimum Initial Service Package (MISP) and includes
guaranteeing free availability of condoms, organizing safe delivery
and newborn care, enforcing respect for universal precautions to
prevent the spread of HIV/AIDS, preventing and managing sexual violence
and its consequences (including the provision of emergency postcoital
contraception), attending complications of deliveries and unsafe
abortions and planning the full reproductive health component to
be integrated into primary health care services. After the initial
stage of a refugee emergency, a comprehensive reproductive health
needs assessment should be conducted, ideally within the context
of an overall assessment of refugee health needs.
Reproductive Health for Refugees (RHR) Consortium
Over the past year, the Reproductive Health for Refugees (RHR) Consortium has field tested a "Refugee Reproductive Health: Guide to Needs Assessment and Evaluation" in over 15 refugee situations worldwide. Field test participants met in April 1997 to discuss the field test process and how best to prepare a final document that would aid field workers conducting refugee reproductive health needs assessments. The consensus from field testers was to focus attention on the development of some key field-ready tools to assist in needs assessment. This document, "Refugee Reproductive Health Needs Assessment Field Tools" is the result of field testing the "Guide" and completes the field test process.
Purpose of the Field Tools
Five reproductive health needs assessments tools have been developed. These are:
- Refugee Leader Questions
- Group Discussion Questions
- Survey (for analysis by computer)
- Survey (for analysis by hand)
- Health Facility Questionnaire and Checklist
The purpose of these tools is to assist relief workers in refugee and displaced person settings in gathering information to assess attitudes toward reproductive health practices and local medical practices/policies, the extent of needed service and the degree to which current services provide what is needed.
It is important to note that not all tools will be appropriate for all refugee situations. The order in which the tools are used may also vary. In general, refugee leaders are consulted before any information is gathered from the larger population. This is often followed by group discussions, key informant interviews and facilities review. In some situations, a survey may be conducted but this is often dependent upon resources, time, skills of available staff and whether or not the level of effort required by a quantitative survey is warranted. A clear needs assessment objective will help field workers decide which tools are appropriate for their particular situation.
The information provided by the tools must be reviewed in the context of the broader needs assessment objective. Any tool used should be adapted to the local situation and resources available. Judgement is required by those applying the tools. In many cases, other resources may exist to support the needs assessment and these should be used. Examples of additional strategies for collecting information include: camp registration records (information on women's ages, marital status, and sometimes pregnancy); clinic, health center and/or traditional birth attendant records; in-depth interviews with representatives from UNHCR, UNFPA, Ministry of Health and NGO staff; camp health coordinating committees and NGO logistics officers; and structured observation at different times of the day and night in the refugee community.
Using the Field Tools
Layout
There are six chapters in this document in addition to the general overview. Each chapter is identified by a colored tab. The first chapter provides an example of an assessment site basic information form which should be completed for each location where the needs assessment is conducted. All the basic information requested may not be available in all situations, however, to the extent possible, it is important to gather this general information.
Subsequent chapters include one needs assessment tool each accompanied by an introduction that describes:
- the purpose of the tool;
- planning steps necessary prior to using the tool;
- suggestions for using the tool;
- data processing and analysis tips; and
- ideas on how to best provide feedback and disseminate results to the refugee community and others.
The tools are designed to be used by people with field management experience and/or reproductive health experience who are working to design a new reproductive health program, assess existing capacity and/or monitor services. Field workers should involve the refugee community from the beginning of the needs assessment process and through the project cycle in areas such as: conceptualization of the needs assessment framework, site selection, translation/interpretation, interviewing, data analysis/interpretation, feedback to the community, design/redesign of the project, implementation/management of the project, monitoring and evaluation, and financing issues (in kind/cash). Field workers who negotiate the refugee community's role and contribution to the needs assessment process are generally rewarded with information that leads to better decisions about next steps.
Each agency must be clear about its institutional position on participatory programming. It is important to acknowledge that institutional values will be reflected in the level of participation experienced by the refugee community. Especially in refugee settings, one must be aware that a participatory approach is political and creates new power dynamics. Refugees involved in the needs assessment process may face threats and certainly reproductive health discussions require great sensitivity and attention to the important issue of confidentiality. Organizations must be accountable to the refugee community and be prepared to face the challenges a participatory approach will generate.
Participatory techniques such as Participatory Learning and Action (PLA), Training for Transformation (TFT) and the UNDP SARAR approach can be applied in refugee situations. For more information, please refer below to additional resources.
Additional Resources
Participatory techniques:
Ford, Richard, Adm, Hussein, Abubaker Adan Yusuf, Farah, Ahmed and Barre, Osman Hirad. "PRA with Somali Pastoralists: Building Community Institutions for Africa's Twenty-First Century." Available from the Program for International Development, Clark University, Worcester, MA 01610 USA (Fax: 1-508-793-8820).
Hope, Anne and Timmel, Sally. Training for Transformation: Volumes 1 through 3. Gweru, Zimbabwe: Mambo Press, 1984.
Leurs, Robert. A Resource Guide for Trainers and Facilitators of Participatory Learning and Action. Birmingham, England: Development Administration Group, University of Birmingham, 1996.
J. Pretty, I. Guijt, J. Thompson, I. Scoones. Participatory Learning & Action: A Trainer's Guide. London: IIED, Participatory Methodology Series, 1995.
Srinivasan, Lyra. Tools for Community Participation: A Manual for Training Trainers in Participatory Techniques. Washington, D.C.: PROWESS/UNDP Technical Series, 1990.
Theis, Joachim and Grady, Heather M. Participatory Rapid Appraisal for Community Development: A Training Manual Based on Experiences in the Middle East and North Africa. London: IIED, 1991.
Other resources are listed at the end of the introduction section for most of the tools.
