Health Assessment follow up - Instructions
This form has been designed to help you collect health and health-related information in a follow-up mission following the recommendations of the initial inter-agency assessment.
It can also be used if no inter-agency assessment has been previously carried out, when there are reports or rumours of a health emergency, the security conditions are good and there is enough time (see below) and health professionals for undertaking the assessment.
It is assumed that, on average, a team of 2-3 health professionals should be able to undertake the assessment in one daylight mission, including return trip. Of course, the area and population sizes can vary, as well as access (distance, conditions of roads, transport means), the number and expertise of team members, the number of health facilities, the severity of the emergency, etc. If time is insufficient for collecting all the information, the team leader should decide which priority information to collect, which health facilities to visit, etc.
Specific Identification, page 1:
- P code: is a code that identifies the geographical position of the area, this information can be provided after the RHA by the Humanitarian Information Centre. If you have a GPS (Global Positioning System) device, record the coordinates and check the information with HIC;
- Form progressive number: number the form, to easily retrieve it if different visits will be undertaken (01, 02, etc)
1. Summary findings, page 1-2
- This section mirrors the corresponding one in the initial RHA form: it focuses on changes in needs and additional requirements, as compared to the ones identified in previous missions;
- 1.2: clarify which are the assumptions, the timeframe and the sources of information for the evolution of the emergency that you are foreseeing; refer to questions under 3.1 (the context)
- 1.3: Current response capacity: e.g response to major trauma or mine incidents, outbreaks such as cholera or meningitis; additional requirements: e.g. food, fuel, transport to access areas etc.
- 1.4: if recommendations were not implemented, try to explain why: the same constraints can still be there.
2. Recommendations, page 2-3
This section should also be completed at the end. Recommendations need to be realistic, with a clear order of priority of resources and activities required. Recommendations must be clearly linked to timeframes and precise responsibilities: if too generic, they are useless.
3. Findings, page 4-5
- 3.3 affected populations: information on population -size, age and sex breakdown and movements- is difficult to collect and it is unlikely that you will have the time to undertake a mini-census or use sampling techniques (such as area sampling, the square method), etc. A useful source of data could be the NIDs (National Immunization Days), adjusting for coverage and age, or projections from previous census. Other agencies (e.g. WFP or UNHCR) may have good data on their beneficiaries. If you are not confident on population estimates, present a range rather than a figure. Always present the source of information, the method used for getting the information and the timeframe the data refer to.
4. HIS, page 6-7
- since the HIS is an important source of information, this sections precedes those on health status and sector capacity;
- if possible, you should verify the availability of records for each sub-component of the HIS; there may be instances that you need to rely on information provided by a health worker. Use the last column of the table to indicate your source of information;
- the form is designed to collect information in up to 6 health facilities (but you will seldom find such a number of h.facilities in a small area, nor have enough time to visit all of them);
- table page 6: if you visit more than one h.unit, use one + or > for each facility in the corresponding cell;
- 4.2, page 7: this is a qualitative information, based on your judgement on the quality and completeness of HIS records and/or information provided by h.workers of the h.facilities.
5. Health impact, page 8-10
- 5.1, page 8:
- for the 5 main causes of morbidity you should preferentially use the out-patient h.unit’s books; if these are lacking, you should ask the h.workers. For mortality, use information provided by h.workers (using only medical records you will have information about intra-hospital mortality, which has different meanings and uses); hospital records may be important for injury-related and severe disease deaths, as the population will preferentially access this level of care;
- 5.2 - 5.4, page 8: you can only answer these questions if mortality surveys have been carried out in the recent past or some sort of mortality registry is maintained at community level with a good coverage. Remember that in an emergency (where population movements can be important and the overall situation is fluid), mortality data referring to the past often has limited value
- 5.6, page 9: you will have no time to carry out a nutritional survey and MUAC screening of un-sampled populations is not particularly useful. Refer, therefore, to your direct observation (both at community and h.facility level) supplemented by medical records (growth monitoring, hospital admissions, etc) and interviews with h.workers;
- 5.10, page 9: pre-emergency baseline data are seldom available; you can refer to data from the previous assessment to determine what is the trend in morbidity
- 5.12, page 10: see instructions at p.1.2.
6. Health response capacity, page 11-14
- 6.1 page 11: list the health facilities you are visiting in the first table: the identification code nr. (1-6) will be used for filling the other tables. Tables in page 11-12 list main functions and resources of the facilities visited.
- The fourth table (bottom of page 12) lists, under staff number, three categories of personnel: doctors, medical assistants and nurses: you may need to change the categories according to the staffing patterns and titles prevailing at local level (up to 5 different categories of staff)
- 6.2, page 13: drugs supply. The list (source: WHO, How to investigate drug use in health facilities) may need to be adapted according to the type of health facility (it is designed for a PHC unit, not for a hospital) and formularies in use;
- 6.3, page 14: you are required to draw conclusions on the capacity of the local health sector to face the emergency, based on the assessment on available resources and needs (section 5). Questions 6.3.1 – 6.3.7 should be able to identify the main shortages in the sector at local level.
7. Health activities, page 15-20
- 7.1 page 15-17: for each health facility, depending on the availability of medical records and number of consultations, hospital admissions, etc, choose a manageable period (1-4 weeks) for collecting activity data and compare them with a past period of the same interval (you should take seasonality into account, choosing, the same period one year before). If you record important changes, discuss with the health workers the possible reasons. Note: information on nutritional status can be obtained from CCCUs (centres where volunteers from different government offices and NGOs work).;
- 7.2.2 page 18: this question refers to information on supplementary feeding programmes (services given to moderately malnourished children between -2SD and -3SD weight-for-height) and therapeutic feeding programmes (services given to severely malnourished children under -3SD weight-for-height). Note: CCCUs refer moderately malnourished children to PHC centres and severely malnourished children to Nutrition Rehabilitation Centres (NRUs)
- 7.2.3 page 18: this question refers to information obtained from hospitals.
- 7.4.2, page 20: the lead agencies eg for health, water and sanitation, etc.
- 7.5.3 page 20: this question refers to warehousing capacity outside health facilities, which can be used if substantial additional health supplies are needed and have to be stored.
Other vital needs, page 21-22
- 8.1, 8.2 & 8.3 page 20-21: the questions may require multiple answers: please indicate the priority order with numbers in the box (1 the most prevalent water source, etc)