| 1. Introduction
The WHO Regional Office for South-East Asia,
through its Water, Sanitation and Health (WSH) and Emergency and Humanitarian
Action (EHA) Units, has conducted a regional situational analysis on water
and sanitation in emergencies in 2003. Covering six Member countries, a
Regional Strategy on Water and Sanitation in Emergencies was a product of
this exercise. As part of the recommendations in that initiative, developing
these assessment tools is one of the main products in strengthening the
preparedness and response capacity of WHO regional and country offices to
address water and sanitation needs in an emergency.
The initial drafts were then brought to Bangladesh
through the auspices of the WHO EHA and WSH focal points in the country office
for pilot testing. This was done through a workshop, which involved
representatives from concerned national and international institutions who
are responsible for addressing water and sanitation needs in emergency
situations. After incorporating several suggestions, the final product is
composed of the following:
1. The
Needs Assessment Tool: A comprehensive and easy to use tool to be able to
obtain a complete an overview with the essential details for water and
sanitation needs in an emergency
2. Guidance
Notes: Summarized information to enhance use of the needs assessment tool
which includes methods that can be used to collect and process information.
This also includes the possible issues that one may face when conducting a
needs assessment exercise and how to avoid or deal with them
3. Reporting
Form: A format to summarize the findings from the needs assessment is
provided
4. Flash
Proposal Format: As part of every emergency situation flash appeals are
necessary to find the resources to address the needs that have been
ascertained.
Together, these documents form a package which will be
used in the WHO Country Offices in the South-East Asia Region. It is hoped
that the tools in this compilation will assist not only WHO, but also UN
Agencies, NGOs, and Ministries involved in water, sanitation and health to
better address this primary issue in emergencies. In the future, it is
envisioned that these tools will continue to evolve particularly for the
various contexts in which they will be used in the Member
States and emergency situations.
2. Disaster Needs Assessments & Emergency Response
2.1 Purpose of
disaster needs assessments
A good assessment is the key to a successful emergency
response. A disaster needs assessment serves two primary purposes. First, it
will inform the response priorities and plans. Second, it can support the
flash appeal for outside assistance should the disaster be of such a
magnitude that the humanitarian obligations cannot be met within the limits
of budgeted resources. The proposal format given in chapter 7 can be used to
form the basis of a flash appeal for assistance. Even when an appeal is not
required, the disaster needs assessment will help WHO SEARO emergency
response decision makers determine and implement appropriate emergency
response measures.
To plan effective response efforts, decision makers need
to know:
 Whether or not an emergency exists
The demographics of the affected population
and the number of people affected
The details of the emergency (cause, location,
magnitude of disaster, etc.)
The condition of the affected population
(mortality and morbidity rates)
The local response capacities and available
resources, including organizational and logistical capabilities
The extent and type of life-saving needs and
priorities
The likelihood of additional future problems
or needs
Any rapid assessment is as good as its reporting – the output
from a rapid assessment is a report on the disaster situation and a set of
recommendations on whether and how best to respond in the first phase. It is
therefore important to identify the eventual users of the information and
their particular information needs. Data, which include perceptions, numbers
and facts, only become useful information when they are meaningful, relevant
and understandable at particular times and places, for specific purposes.
2.2 Emergency
response priorities
Disaster emergency response is aimed at addressing the
critical and priority needs resulting from a disaster. Generally, the common
priority emergency needs following a disaster will include the following, and
the disaster assessment will need to determine the existence of these needs
as well as their scope.
1. First priority should be to save the lives of
people who are affected due to the disaster.
2. Provide
basic life support needs: drinking water and sanitation, adequate food,
appropriate medical assistance, shelter (through housing and clothing) and
fuel (for cooking and heating)
3. Protect
disaster victims from physical violence and aggression, particularly in
disasters involving refugees and internally displaced persons.
4. Address
the psychological and social stress caused by the disaster, providing the
victims with psychological and social support.
2.3 Emergency response
based on emergency assessments
The emergency situation needs to be assessed properly and
objectives formulated before any emergency response is launched. A disaster
response program implemented without first assessing the disaster impact, the
resulting needs, and the local response capacities will most likely offer
assistance that is unnecessary and inappropriate and which supplants local
efforts. Ideally, an emergency response should consist of the following three
stages: assessing the situation, choosing objectives and identifying
intervention alternatives, and implementing response based on the objectives and alternatives 1.
As the diagram implies, disaster assessment should be an
ongoing and repetitive process. This reflects that accuracy and nature of
data availability as well as needs vary as the post disaster situation
unfolds. There will be need to carry out subsequent assessments following a
first rapid assessment. The frequency and extent of these assessments will
vary with situations and type of disaster, availability of resources or any
critical developments like a secondary disaster, new population movements or
an epidemic outbreak.
The objectives of the assessment and the data-gathering
techniques will change as the response evolves. Initial rapid assessments can
be quick and unrefined, but should improve as more time and data become
available.
It is also important to understand that effective
interventions are time-critical and rely greatly on resources already present
in the affected area. For earthquakes, in particular, search and rescue and
early emergency medical care must rely substantially on local resources.
Accurate and credible information telling decision-makers what is not needed
can help reduce the overall complexity of the logistical response.
2.4 Assessing the
situation
At the outset of any emergency, the rapid assessments
should be timely and inform emergency responders about critical and immediate
life-saving needs. In disasters—especially rapid onset disasters or sudden
population influxes—there will be great uncertainty about the actual
problems. Therefore, decision makers should use a systematic assessment
approach to develop a picture of where people are, what condition they are
in, what they are doing, what their needs and resources are, and what
services are still available to them. After an initial assessment, more
in-depth emergency needs assessments need to be conducted to collect
information related to critical sectors and technical areas of concern.
2.5 Choosing
objectives and identifying alternatives
Initially, this stage requires analysis and interpretation
of the data with a focus on
identifying the risks to various populations. It is
important to have a detailed understanding of the general risks associated
with a particular type of emergency and how these may change. Some general
risks frequently present in the emergency phase are:
Continuing presence of hazard agents—secondary
flooding, fire, landslides, extreme cold, chemical pollution, etc.
Loss of “lifeline services”—clean water, waste
disposal, medical treatment
Inadequate supply of emergency clinical
services
Inadequate supply of essential foods
Effects of severe climatic conditions
exacerbated by lack of shelter, warm clothing or heating fuel
A second important element in this stage is forecasting—
this is an attempt to study the existing situation and develop a set of
predictions based on various likely scenarios. In particular it is important
for an assessor to judge whether resources, sometimes essential for
particular problems can actually be made available before their importance
fades. For example, decisions on emergency medical care and search and rescue
during earthquakes are so time-sensitive that even a few hours delay can lead
to an almost total waste of resources. These factors are hence very critical
especially in first phase emergency. There will also be a need to identify
major secondary threats to survivors, such as secondary flooding or
landslides, damage to chemical plants or fuel storage fires, etc.
3. Tools of Assessment 3.1 Sources of information
Existing
information
Existing information may be available from many sources,
including the following:
Satellite data, geographical information, rainfall, soil,
and geological maps and aerial photographs can provide a lot of background
information on land use, terrain, vegetation, soil, water resources etc., but
this kind of information is not always easy to get hold of and may not be
available at the time it is needed. Other agencies, government departments,
universities etc. may have reports relevant to the situation, from field
assessments, projects or desk studies. Background information from these
sources can be vital in helping plan and implement any possible response, and
may be sufficient for preparing an outline plan of action, but there is no
substitute for a field visit for up to date and verifiable information.
3.2 Relying on
secondary sources
The situations sometime may force the assessor to depend
on government agencies, non-governmental organizations or community groups
for their information. When relying on information provided by another
organization, it is important to carefully consider its accuracy and whether
information from one source contradicts information from another. Especially,
when using secondary data, check for consistency between multiple sources of
similar data if possible. Following questions may be useful when evaluating
assessment information:
Who did the assessment? What
experience/expertise do they have in this area?
How much time did the assessment team spend
on-site? Did they visit the site?
Whom did the assessment team interview? What
important beneficiary groups did they fail to consider?
If the assessment report contains statistical
data, are they primary or secondary data? If they are secondary data, what is
the original source? Does the team have the expertise to judge the validity
of statistical information? If not, which experts should they consult?
What is the possibility of a segment of the
population (e.g. an ethnic, class, national, geographic, religious, or
vulnerable group) being inadequately assessed?
Considering the source of information, what
biases may be reflected in the assessment findings?
Does the organization, whose data is being
used, have an interest in presenting biased information?
3.3. Field assessments
However experienced the field assessors are and however
well developed their intuitive understanding of emergency situations, it is
helpful to use checklists for assessments, to ensure that all the relevant
questions are asked and that information is gathered in a way to allow it to
be reported and communicated in a structured form, and analyzed in way which
facilitates decision making. Information should be collected on the following
areas for planning public health interventions:
* Demography * Environment * Logistics * Shelter * Water
Supply and Sanitation * Food and Nutrition * Health Status and Medical Care *
Psycho-Social Issues * Security
For assessing water supply sanitation and hygiene needs in
particular, use the checklist in Chapter 4 to decide what action, if any, is
needed.
3.4 Field assessment techniques
Below are some examples of techniques, which are presented
in an order which reflects an increasing level of participation of the
affected community. They range from techniques such as aerial observation and
site inspection which involve the community only as the subject of
observation or counting through surveys, to techniques borrowed from
Participatory Rural Appraisal (PRA) and Rapid Rural Appraisal (RRA) practice,
such as ranking and discussing, which involve the affected people as active
participants in the assessment and analysis of problems and possible
solutions. The degree to which different types of techniques are appropriate
depends on the sort of information required, the time available and the
extent to which it is considered necessary to involve people in analysis and
decision-making. It is generally appropriate to use less participatory and
more rapid techniques for initial assessments to gather basic data on the
size and nature of the emergency and to make estimates of the scale and type
of response needed, if at all. But as soon as conditions allow, more
participatory techniques should be used to ensure that solutions considered
are acceptable to and appropriate for the mix of people in the population
concerned, and that they are suitable for the longer term.
As with any technique, the value of the information they
produce depends very much on the skill and organization of the assessment
team, and on its interpretation.
3.5 Remote / technical
This includes fly-overs in aircraft, views from high
points (hills, vehicle roofs, high buildings), and photographs taken from all
these vantage points. This is a very rapid method to assess the scale of a
disaster, to prospect for possible sites for emergency settlements and to
assess the movements of displaced populations. It does not however give any
detailed information on specific needs of the affected population, which can
only be carried out by actual field assessments.
3.6 On-site visual
assessment
This can be combined with mapping and photography for
documenting conditions and providing information for analysis and planning.
An on-site visual assessment is usually done on foot or in a vehicle. This
may be a structured and focused process, such as a health walk or structured
observation, in which a number of particular issues are observed during
progress around the site, such as the number and location of water sources,
their condition and intensity of use, what parents do when their children
defecate on the ground etc. It may also include a sanitary survey to assess
the likely risk of contamination of a water source and measures needed to
reduce that risk. This is perhaps the most useful in carrying out first phase
assessments, they should always be used with checklists in order to cover all
the relevant issues.
3.7 Expert
measurements and testing
This includes processes such as water sampling and
analysis, inspection of sewers or pumps, or identifying disease vectors,
which require specialist knowledge and experience. This is commonly combined
with advice from key informants and may be backed up by previous records.
These techniques are useful in generating more specific information once
broad areas requiring further information are identified. They are also
useful in monitoring data.
3.8 Surveys
Surveys are used to gather statistically valid information
from a representative sample of the population or of a sector of the
population. Three stages are involved:
1. Establishing the
survey technique
This involves establishing the population from which the
sample is to be randomly selected (e.g. the total population, the population
in one part of the settlement, the population of mothers of children under 5
years old etc.); and establishing the sampling method and number of
individuals in the sample. The number in the sample is typically between 100
and 200 people, but the number chosen will depend on the degree of accuracy
and reliability that is sought, the time and resources available and the
sampling technique chosen. The sample size does not depend on the size of the
total population. There are a number of sampling techniques, suitable for
different types of survey.
2. Carrying out the
survey
This involves selecting individuals or households
according to the sampling technique chosen, conducting interviews,
measurements or observations of the sample, recording and collating
information. This can be a major undertaking, involving training and
mobilizing significant numbers of staff. On the other hand, it could be
relatively simple, for instance interviewing patients leaving a clinic to
find out what disease they are suffering from and what water supply and
sanitation problems they face.
3. Processing and interpreting
the results:
This involves processing the information recorded using
standard statistical techniques, depending on the survey technique chosen, in
order to assign figures to the results. The key figures are a percentage or
proportion, the likely range of the true figure - a measure of accuracy -
(usually the range which corresponds within which it is 95% probable that the
real figure is found) and a measure of statistical significance or
reliability.
Surveys have been used in assessments for water supply and
sanitation programmes in a number of situations, and can provide rapid
information on things like water consumption (including the variation in
consumption between households and sections of a settlement), access to water
containers, access to toilets, hygiene knowledge, attitude and practice and
prevalence of water and sanitation-related disease. This statistical
information is a powerful tool for advocacy, planning and measuring impact
later on. For more information on survey techniques and applications, see
Simmonds, Vaughan and Gunn (1983), chapter 4.
3.9 Interviews
Interviews are used to collect detailed information about
specific issues, which cannot be gathered by simple observation. For
instance, many practices to do with hygiene are not easy to observe, as they
are carried out in private when possible. Interviews may be more or less
structured, depending on the sort of information to be collected and how it
is to be interpreted and presented. Interviews may be held with:
key informants - to
gather information rapidly on a particular topic, such as the location of
wells, seasonal variations in surface water levels or common practices
regarding defecation. There is always a risk that the information is
unreliable because of the possible personal interests or perspective of the
informant, and their information should be verified. Key informants are often
people who speak the language of the field worker or who are easy to approach
for other reasons, and they may be very unrepresentative of the general
population.
formal leadership
structures: - to gather information about community structures and to
encourage participation in programme implementation. Formal leaders may or
may not be representative of the general population and may or may not have
the population’s interests at heart. Again, verification is necessary.
general groups: - to
gather general information about how the disaster has affected people and
what their intentions and ideas are
focus groups: -
these are groups of people with a particular interest in the topic on which
information is sought, or whose views might otherwise not be noticed in the
collection of information on a more general level. For instance they may be a
group of people collecting water, or a group of children, or a group of women
at an ante-natal clinic, who may have particular needs or preoccupations.
households and
individuals: - to ask about access to water supply and sanitation
services and resources and hygiene issues at the household and individual
level. Household interviews may be used to gather detailed information with
in-depth discussions, or may be the basis of household surveys, where a large
number of households are visited. Household visits are also an opportunity
for visual inspection of toilets, water storage and use, food hygiene etc.
Most of these techniques can be combined in one way or
another. For instance, a visual assessment on site is usually combined with
key informant interviews or focus group discussions (for instance talking with
a local technician during the visual assessment, stopping along the way to
talk with people collecting water etc.). Many of the techniques are ones that
field workers may already use informally. The purpose of giving names and
structures to the techniques is to enable them to be used in a consistent and
comparable way and for results to be recorded and communicated clearly and
effectively. However, it is important that survey design, implementation and
interpretation techniques are sound, or there is a risk that unreliable
information will be given false respectability simply because it is presented
in a quantified form.
3.10 PRA and RRA techniques
These are typically highly interactive techniques, which
demand time and patience from assessors, but which allow people from the
affected community to express their own opinions on their situation and
contribute to analysis and decision making. For agencies with a commitment to
working in a participatory way these assessment techniques are a means to
build this approach into the programme from the beginning. As with all
assessment techniques based on information gathering from a sample of the population, care should be
taken to ensure that a range of views are noted and that general conclusions
are not drawn from an unrepresentative group of informants. These techniques
are particularly useful for getting an understanding of how resources and
activities are shared within the community, how different sections of the
community are affected by the disaster and what the likely impact of the
proposed water supply and sanitation activities will be in detail. Some
examples of PRA and RRA techniques are:
Ranking - in
which participants are asked to rank various elements of their situation,
such as the need for washing facilities, the need for taps closer to shelters
or the need for more water storage vessels, symbolising them with long or
short sticks, for instance. This can help field staff understand what people
feel their priorities are and also give an opportunity for them to discuss
programme options and possible constraints, and explain what the agency views
as the major priorities.
Diagramming -
using maps, charts or other visual means of portraying relationships in time
(calendars of activities), space (maps and transects), resources
(relationship diagrams) and others. These are very useful fo0r collecting
information - for instance on the location of local water sources, seasonal
variations in disease incidence or availability of labour - and for gaining
an understanding of how people in the affected community view their
situation. It can also be a means of understanding how thw agency itself is
perceived.
Discussing -
the various forms of discussion described above can be used as part of a
participatory assessment, and are a good way to cover general issues and find
out what to explore in more detail.
3.11 Checklists
Checklists are perhaps the easiest and most complete tools
for a rapid initial assessment. A checklist is an abbreviated list that
prompts assessors to remember key points and ask certain questions; they can
also be useful for documenting responses.
Rapid assessment checklists for water sanitation and
hygiene assessments have been developed and are given in chapter 4. Tips and
guidance notes on the checklists have been detailed in chapter 5.
3.12
Minimizing assessment bias
All data collection methods are subject to the problem of
bias. Bias leads to misinterpretation of answers or mistaken analysis that
draws conclusions from information which is not representative of the
affected population. Bias can result from leading questions (those which
propose an answer), poorly worded or poorly understood questions, poor
sampling techniques, or the particular bias of the assessors or reviewers.
Specific forms of bias include:
Spatial bias
Issues of comfort and ease for the assessors determine the
assessment site. Rather than travel into an area, the assessors conduct a
"windshield" survey, never leaving the comfort or straying far from
their truck.
Project bias
The assessor is drawn toward sites where contacts and
information are readily available and may have been assessed before by many
others.
Person bias
Key informants tend to be those who are in a high position
and have the ability to
communicate in a language known to the assessor. They may
or may not be conscientious, insightful or respected by those they are
purporting to represent.
Season bias
Assessments are conducted during periods of pleasant
weather or areas cut off by bad
weather go unassessed. Thus, many typical problems go
unnoticed.
Mandate or specialty bias
The specialty or mandate of the assessor blinds them to
needs outside of his/her specialty.
For example, a shelter specialist may primarily only
assess shelter needs, neglecting
nutrition and water needs.
Political bias
Informants present information that is skewed toward their
political agenda. Assessors look for information that fits their political or
personal agenda.
Cultural bias
Incorrect assumptions are made based on one’s own cultural
norms. Assessors do not
understand the cultural practices of the affected
populations.
Class/ethnic bias
Needs and resources of different classes of people or
different ethnic groups are not
included in the assessment. Local assessors may have this
ethnic bias, or the key informants may only represent one social class or
ethnic group.
Interviewer or investigator
Assessors may have a tendency to concentrate on
information that confirms preconceived
notions and hypotheses, causing them to seek consistency
too early and overlook evidence inconsistent with earlier findings. Assessors
may also exhibit partiality to the opinions of elite key informants.
Key informant bias
Biases of key informants are carried into assessment
results.
Gender bias
Assessors only speak to men or male interviewers survey
women, or vice versa.
Time of day or schedule
The assessment is conducted at a time of day when certain
segments of the population may be over- or under-represented.
Sampling bias
Respondents are not representative of the population.
Being aware of different types of bias is the first step in minimising its
impact on your assessment.
3.13 Triangulation
Triangulation is one method for minimising bias that
requires the assessors to seek out, compare and correlate several sources of
information. Triangulation is based on the principle that data must be
obtained from at least two other known points. Information for emergency
assessments must come from different sources to provide a relatively accurate
assessment of the situation.
Principle of
Triangulation
Triangulation may be achieved through the use of different
assessment techniques or approaches or by using different indicators of the same
phenomenon and consulting different sources. The different approaches or
indicators may be compared to the two arrows in the diagram above. The key to
using different approaches is to find dissimilar methods or techniques that
will not be subject to the same type of bias. Do not rely on a single method
or a single measure of a problem. Triangulation can be applied to almost all
aspects of the preparation and implementation of an emergency assessment.
3.13 Team and joint assessments
Using a team assessment approach, and paying attention to
the composition of the assessment team is another way to minimise bias. By
including a variety of specialists and generalists on the team and by
striking a gender balance, many types of biases can be avoided. The following
list provides an overview of roles and competencies that might be considered
when composing assessment teams.
Assessment Teams
Team coordinator/liaison
Logistics specialists
Public health—epidemiologist
Food and nutrition specialists
Shelter specialists
Environmental health/water supply specialists.
To add additional perspective and diversity to the team,
the team may also include a mix of local and external team members. Local
people may know the local situation and customs but may also bring certain
types of local biases and preconceptions damaging to the accuracy of the
assessment. The external "outsider," on the other hand, while less
familiar with the situation, may be able to provide the expertise and
perspective of distance that is also needed in making useful assessments.
Tips for field assessments 2
Use all the senses. Environmental health
problems can usually be seen, touched, heard, smelled and even tasted.
Get several opinions on the situation from
different points of view. Ask the same questions in different ways. In
complex situations, try to get beneath the obvious responses.
Be aware of who you represent. This has a
great effect on the quality of information you are likely to receive.
Try to get figures. Reliable quantitative data
is essential for describing the problem, for assessing its severity and the
measures to take, and for establishing baseline information for monitoring
and evaluation.
However, be aware of the limitations of the
data you may collect and the extent of its inaccuracy and/or reliability.
The assessment is only as good as the
reporting of it. The report from a field assessment has to present the
information needed to persuade other people that there really is an
emergency, to start programme design, to set objectives, to write budgets and
to present proposals to donors.
Good communications systems are important to
get reports and information to decision makers fast and to keep people up to
date as the situation changes. Ensure that you can feed back the results of
the assessment quickly to allow speedy and informed decision making within
your organisation.
Use up to date maps. Make them if necessary.
Make and use up to date lists of key contacts
to meet
Try to get an overview before going into the
detail on site
Talk to people and explain what you are doing
and the possibilities and constraints of a possible response by your agency
Share your findings with others
Only collect the information you think you
will need. Don’t waste time on unnecessary surveys, and concentrate on
priority areas
Present your findings with arguments to show
how you reached your conclusions. You may not be present to provide the
details at meetings where programme decisions are taken.
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