Needs Assessment January 6th 2011 Dr Jane Buxton
Consider what do we mean by need • What is need? • How is it different from want? • What is demand? • How does supply fit in the picture?
What is need? • A need is something that is necessary for organisms to live a healthy life • Need = factors which must be addressed to improve the health of the population
Why are the determinants of health important? • Health care influences whether people get well when they are sick • Determinants of health influence why some people are healthy and others not • Consistent correlation between life expectancy & health status with measures of social status (Evans et 1994)
The Determinants of Health • Social environment • Income and social status • Social support networks • Healthy child development • Education • Employment and working conditions • Physical environment • Biology and genetic endowment • Personal health practices and coping skills • Health and social services Gender and culture have cross cutting, influential effects on all the other determinants (Health Canada, 2001)
Wants - services the public request not knowing the costs Demands – services requested when costs are known; What the patient asks for Needs – expert opinion what ought to be provided Use: health services actually used Supply:What is provided
A/B for URT viral infections Health promotion, some screening Waiting list e.g. TOP
Death rates UK Q. Why the decline?
Thomas McKeown 1979 • Decrease mortality infectious disease E & W 1938-70 was not due to medical intervention alone • Nutrition • Living conditions • Birth spacing
How has life expectancy changed over time globally? Hans Rosling's 200 Countries, 200 Years, The Joy of Stats - BBC 4 http://www.youtube.com/watch?v=jbkSRLYSojo
What is a needs assessment • Is a process for determining and addressing needs, or "gaps" between current conditions and desired conditions • Why do a needs assessment? • Discuss
Why do health needs assessment? • Provides a rational basis for planning services and allocating limited resources • Including med student time and efforts • Identifies: • Service needs of community/population • Utilization patterns • Gaps in service provision • Permits involvement of users of the health service in planning & avoids over-reliance on care providers’ perceptions • Identifies alternatives for meeting these needs.
Consider this scenario: • You are part of a team visiting a remote village in India. You are working with the local boarding school to improve the health of the children. • What steps would you take to assess the needs of this group? • How would you ensure that your actions are culturally sensitive? • How would you ensure your actions are sustainable?
Over 400 children (kindergarten – grade 10) • Children stay in hostels, monitored by house mothers • Closest hospital 8 km away
Enter GHI • To improve health care in a culturally sensitive and sustainable way • 2006: 3 UBC medical students and a family physician performed first needs assessment (and have continued doing so annually)
Spiti Project: AnemiaIntegrated approach looking at linked causes • Researched all linked causes of anemia (as per WHO guidelines and resources) • Community surveys & focus groups: • Toileting behaviours • Vaccination practices • Hygiene practices • Water access • Greenhouse interest and knowledge • Women's health • Healthcare access in summer and winter • Nutrition analysis.
Spiti Project: AnemiaIntegrated approach looking at linked causes • Explored cultural and religious issues • Consulted Tibetan experts in Vancouver (Ph.D student at UBC), and local community members • Explored gov't involvement in water and sanitation, food subsidy • Took in suggestions from locals on how to address individual causes of anemia
Types needs assessment Subtypes/terminology • Rapid needs assessment • Health needs assessment • Community needs assessment
Health needs assessment systematic approach to ensuring the health services use its resources to improve the health of the population most efficiently Community needs assessment evaluate possible solutions taking problems/deficits/ weaknesses and advantages/opportunities /strengths into consideration* *Gupta, Kavita; Sleezer, Catherine M.; Russ-Eft, Darlene F. (2007-01-16). A Practical Guide to Needs Assessment (2 ed.).
If we don’t know where we are, we don’t know where to go next If we don’t know where we are going, we’ll get lost
Framework for planning* • Working through Precede-Proceed model is like solving a mystery • Start with vision desired end, work back to identify forces influence attaining the vision • Phase 1: Social assess. & situational analysis; hopes, concerns, engagement, cultural relevance • Phase 2: Epidemiologic assessment;indicators, determinants of health, behaviour, life style. Environmental-economic, services • Phase 3:Educational and ecologic;predisposing, reinforcing & enabling; KAB, values, rewards and feedback *Health program planning; An educational and ecological approach. 4th ed. Green & Kreuter pub McGraw Hill
Population Health • Community assessment/diagnosis • Identify determinants of health problem ↓ • Intervention/program options • Appraise, decide, implement ↓ • Evaluate
Who is the data for? • Whose perspective / who funds? • Government, regional or local public health and healthcare organizations • Disaster relief organizations (Red Cross) • Law enforcement • Utilities (e.g. electricity, water) • Media, etc. • Medical students to develop program
Process – Questions to be addressed • Why? What is the purpose of the needs assessment? • Who are the stakeholders? • What types of data are required? • How will the data be collected? • How will the data be analysed?
Community engagement • Who are the experts? • Nothing about us without us • Not just service provision • Accessibility; acceptability, culturally appropriate • E.g. well • Community engagement in Spiti Valley
Context: micro/meso/macro Global Region Literature search Community Medical students Clinic/school/church Pop. Family Individual client Community intervention:
Who are the stakeholders? • Current or potential consumers of service • Service providers • Health care providers • Professional organizations & decision makers • School principal, community elders, pastors • Government organizations • Medical students
Types of data; how collected PRE-VISIT • Literature searches • Medline, targeted sources WHO, UN Country Teams, OECD, Google, feedback from medical students DURING: • Qualitative • Observation, Key informant interviews, Focus groups • Quantitative • Local details, service utilization etc • Survey POST VISIT
Qualitative • Why? Identify issues • How • Observation, field work • Key informant interviews • Focus groups Methods/principles/theory • Grounded theory, narrative inquiry • Semi-structured interviews • open ended Q, Interview guide, probes • Less is more • Descriptive, not generalizeable
Quantitative -survey Numeric; How? • In person • Interviewer administered (literacy levels) • Pen and paper (assisted) • By phone • RDD • Computer assisted • On computer • E-mail etc What type of questions? Y/N, Likert scale, open ended. Reflect purpose, what to do with answers. Pilot, valid. Theoretically based. HBM, Prochaska Who? Sampling frame
Sampling Rapid Needs Assessment • Based on WHO Expanded programme on immunization (EPI) • Used to estimate community impact of Hurricane Andrew in South Florida in 1992 • Also used after the Sept 11, 2001 attacks in NYC to assess needs in residents of Lower Manhattan
Cluster Sampling Methods • Systematic sampling of 30 ‘clusters’ • Create a grid over the area to be sampled • ¼ mile squares on street map • Assign each square or ‘cluster’ a number • Determine interval e.g. 120 squares interval 4 (120/30) • Random start (btw 1 & 4) • Select 30 clusters
Cluster Sampling Methods • Go to the centre of the first cluster (i.e. square) • Determine sampling unit (Us. people/ households) • Determine # of units to be sampled in each cluster (e.g. 10 households) • Proceed in a randomly picked direction to the first occupied household • Interview the first adult at the occupied residence • Go consecutively to the next occupied household until you have reached 10 in that cluster • If a multi-unit dwelling or apartment building pick first occupied unit for interview • Move to next selected cluster
Systematic sampling; e.g. every 8th Source: D. Coulombier, Epicentre