Refugee Reproductive Health Needs Assessment Field Tools
Introduction to the Health Facility Questionnaire and Checklist
Purpose of the Tool
The purpose of the Health Facility Checklist is to assess existing facility capacity to meet the reproductive health needs of refugees. Use of the checklist should promote better project design by suggesting what material and human resources are needed to upgrade the service delivery. In addition, the checklist can be used for monitoring and management purposes by establishing a baseline from which changes in the capacity can be measured. This tool is meant to be used in conjunction with the other tools, as this tool alone will not sufficiently determine what services are needed by a particular refugee population.
Planning to Use the Facility Checklist
The facility checklist can be used at any level of health facility. If fewer than 10 facilities in the area serve refugees then it is recommended that all sites be visited. If there are more than 10 facilities in the area, then visit some of each type (this is called a stratified sample.) For instance, you could visit four of eight health posts, two of the three clinics, and the referral hospital. Visiting a facility that offers reproductive health services to the local population will provide an insight into what is locally determined to be an adequate standard of care.
In preparing to use the tool, meet with the facility management team. They need to understand why you want the information and how you intend to use it, as well as whether they can expect any support from your organization to improve the service delivery capacity. Permission should be sought to work with facility staff. Share the checklist with the management so they are not surprised during the site visit. Transparency will help increase trust.
It can be helpful for NGOs to have the written support of the lead refugee organizing agency, such as a letter from the UNHCR requesting NGO access to facilities. It is important to know the schedule of what services are scheduled each day so that the team tries to visit on a day when reproductive health services are provided. With prior approval of the top administration it may be possible to arrange spontaneous visits to observe the facility as it would function on an average day.
Using the Facility Checklist
Ideally, the facility assessments would be conducted by a team which would include those with clinical, research, management and public health skills. Participation by refugee representatives and facility staff is encouraged. Including representatives of those affected by the health services, (such as staff, refugee leaders, or women's groups) will help engender their trust and ownership of the health initiatives.
Try to spend time observing the general flow of patients and, if time permits, follow at least one patient through an entire visit to observe the patient-provider interaction. The patient must consent to being observed, especially if a physical exam of any type is involved. This observation will provide insights into how patients are treated and what equipment, health education materials, and exams are actually used.
This facility checklist is intended for use after the initial emergency phase.
Data Processing and Analysis
The data processing and analysis involves comparing the services that are offered with the services demanded by refugees to meet their reproductive health needs. The analysis will illustrate which services need to be introduced, expanded, or improved.
The assessment team should work with facility staff to determine what inputs are needed to improve the quality of care and breadth of reproductive health services provided. Have the providers prioritize/rank the recommended interventions.
After completing each section, reflect on what you believe to be the priority needs identified by your observations and discussions. This is best done as soon as possible otherwise the details are lost. It can be done individually or collaboratively by the assessment team.
Feedback and Dissemination of Results to the Community and Others
It is critical that the facility management and staff receive at least a synopsis of your key findings. Otherwise, they may be reluctant to collaborate with NGOs in the provision of services to refugees. Likewise, refugee representatives who take part in the assessment would be entitled to receive the key findings. UNHCR and other agencies serving the health needs of the refugees will also appreciate knowing the findings of the assessment.
Follow-up discussions should be held with all concerned parties to determine the resource priorities and funding sources for addressing barriers to high quality reproductive health service delivery. The agency conducting the assessment is responsible for getting the results out to policy makers and donors who can use the information in their planning for resource allocation.
Additional Resources
WHO Maternal and Newborn Care Equipment and Supply Lists, WHO/FHE.MSM/94.11
Sloan N, Quimby C, Winikoff B, and Schwalbe N, Guidelines and Instruments for a Situation Analysis of Obstetric Services, The Population Council.
WHO Reproductive Health Services During Conflict and Displacement: Guide for Programme Managers, 1997.
Download the Health Facility
Questionnaire and Checklist 
