Surveillance

1. Surveillance Food Security Pre Departure Training

2. Surveillance : Objectives and Principles • Surveillance systems can have various differences in their objectives and designs, but they share a common function of : “monitoring and analyzing the food security situation (and nutritional status) of the population/targeted areas, and sharing findings/recommendations in order to enable decision makers to define adequate food security strategies and have timely responses”(ACFIN, 2005).

3. Surveillance : Objectives and Principles • Use the nutritional causal analysis as its analytical framework. • Be actively transversal, taking into account the different nutrition, water and sanitation, food security and health components. • Be based on a comprehensive reference (or preliminary) analysis of the food security situation. • Be based on a set of indicators, defined from the reference analysis, for information collection and analysis. • Use several levels and sources of information and analysis (households, communities, regional, primary and secondary information).

4. Surveillance : Objectives and Principles • Be as objective as possible and always triangulate information (through other sources and local contacts such as INGO, LNGO, authorities, key contacts on the field etc). • Be designed as a tool for internal and external communication with minimal time delays between collection and distribution of information. • Fall within the mandate of ACFIN. • Be seen in all its stages to answer the what, why, when, where, who and how of a given and changing situation.

5. Considerations Prior to Setting up a Surveillance System: • Is there a lack of information regarding the food security situation and changes in this at a country/regional/local level, within ACFIN or with other actors? • Is the context evolving? Is the environment insecure? • Is there a risk of degradation of the food security situation of the population in a given area? What is the expected time scale of this degradation? • Is food security directly related to climatic conditions (expected rains fail and thus may impact heavily on food insecurity)? • Are there normal seasonal changes in the food security situation? • Is there a lack of precise information concerning the evolution of the food security situation? Is enough information available to make timely decisions according to the evolution of the situation?

6. Considerations Prior to Setting up a Surveillance System: • Is there a need to understand and follow changes especially increases in admissions in nutrition feeding centers? • Is there a demand for information that cannot be addressed either internally or externally? • Who will use the information? • How will the information be used? • Have interventions continued when no longer pertinent because there was not enough information available to make informed decisions regarding changes? • Responses to the above questions need to be analyzed and where there is a risk of degradation of a food security situation and very little regular or formalized information exists, it could be appropriate to set up a surveillance system.

7. Surveillance : Methodologies • There are two main methodologies employed in surveillance systems operating within the ACFIN network : • One uses as its basis sentinel sites with information collected from these sites on a regular basis. This tends to be used in reasonably stable situations (Malawi, Philippines) or where there are cyclical crises with accompanying high risks of malnutrition (Mali/Niger). Using this methodology, we will have a series of data monitoring the development of food security over time. • The other is based on a more ad hoc methodology and is implemented when the situation changes rapidly in time and space, which often corresponds to emergency and unstable situations (Somalia, Sudan). It can include rapid assessments, thematic assessments (refugee/displaced camps, food aid) as well as regular information collection such as market surveys. It does not focus on tracking the changes in one area, but rather responds to alerts and is thus more specific to one population group at one given time.

8. Surveillance : Sentinel sites Methodologies • Sentinel sites (which can be villages, communities, urban blocks, etc.) are fixed at the outset in the area of surveillance according to the initial zoning of the area and representative families are selected according to the household typology established in the preliminary information collection. The sentinel site must be representative of the relatively homogeneous zone in which it is situated. • These sentinel sites are tracked over time to monitor the evolution of the situation. The same (closed, direct and fixed) questionnaire is delivered on a regular basis (often monthly or seasonally) to the same households or to another household in the same typology grouping in the sentinel site; • From the initiation of the sentinel sites, the questionnaire and methodology must be validated by pilot tests. As the objective is to track changes in the situation, only minimal modifications should be made in the design and information collection and therefore must be as accurate as possible from the outset. • This methodology is usually implemented in coordination with other organizations or government systems, thus there is a greater centralization and sharing of information.

9. Surveillance : Ad-Hoc Methodologies • This is usually based on thematic issues relevant to the particular context and time in which the system is operating. The themes can be adapted to contextual or situational changes and can be increased or reduced within the capacities of the surveillance team. It can be highly reactive to new situations and can launch an assessment very rapidly after an alert. The assessment may last only a few hours but gives invaluable information for planners. • Such systems rely heavily on qualitative information collected through semi-structured questionnaires or guidelines delivered to key informants and focus groups as well as individual households. They are particularly relevant when the situation changes in time and space and where populations are likely to move (such as in emergencies). Ad hoc surveillance systems can be transversal in nature and easily adapted to each situation. Generally the ad hoc systems are implemented by only one organization; however sometimes joint collaboration assessments can be managed with other agencies for one-off assessments or for information sharing and advocacy.

10. Attributes of the different surveillance methodologies Sentinel sites : Positive attributes • The interviewer and the household develop a relationship of confidence. • The interviewer can detect false information. • The area covered can be increased. • It’s easier for the team to establish a routine. • Once the system is set up it does not change.

11. Attributes of the different surveillance methodologies Sentinel sites : Negative attributes • Sample sizes are not sufficiently representative. • The same household every time results in: • (i) errors in the preliminary information will be followed through in the questionnaire, without being picked up; • (ii) fatigue of the interviewees • resulting in aberrant data which limits the validity of the information • (iii) personal security of the interviewers (aggression from interviewees/communities who are fed up of teams visiting them and giving nothing in return) • (iv) household cannot be expected to be available every time • (v) people are used to the questionnaire – could lead to lack of interest but also inaccurate information • The proportion of households per province is different. • No adaptation of the questionnaire for provincial/area contextual differences.

12. Attributes of the different surveillance methodologies Ad-Hoc : Positive attributes • Wide range of information, because of no limit to questionnaire (questionnaires are designed for the specific situation). The flexibility of the system: • (i) one can delete or include information as necessary; • (ii) areas of operation can be changed; • (iii) villages and households will not have repeated visits; • (iv) there is no bottom or top limit on the number of households to get valid information; • (v) absent staff or unfilled positions does not affect the system –the system can adapt to the constraints

13. Attributes of the different surveillance methodologies Ad-Hoc : Negative attributes • Limited time – to complete all the interviews. • Analysis of the findings is long and complex with a large aspect of subjectivity due to the qualitative nature of the information. • Planning is difficult as the system needs to be reactive (cars, staff, time, questionnaire, objectives...). • Staff training is long: • (i) needs to be continuous • (ii) the questionnaire needs adapting to contextual changes • Interviewee fatigue. • Difficult to compare one situation/time period with another.

14. Indicators: • As highlighted in the principles, all surveillance systems are based on a set of indicators for information collection and analysis. The indicators are set up after the reference information has been collected and analyzed and are based on the key issues which can lead to food insecurity in the particular context under study. • The indicators can be static or dynamic and give contextual information or information linked more directly to programs. They should include transversal information relevant to the other technical departments and actors. The same indicator when used in different contexts could be static or dynamic. Population figures is such an indicator where in a stable zone of intervention this remains fairly static or in an unstable zone where it is dynamic and can be considered as a key indicator of negative change in the humanitarian situation of a given population.

15. Indicators

16. Main Indicators identified by ACF-IN

17. Indicators • As the indicators are based on reference (preliminary) information, they are not fixed in stone. They are selected according to the context and should not be too ambitious. Each context may require more or less indicators in order to be relevant and may not include all of the above. There will always be some indispensable indicators which may also change over time as a result of contextual changes, or which may change in terms of regularity of the information collection. • Whatever the indicator, it must be simple, reproducible, measurable, specific and comparable. It can be based on qualitative or quantitative information and must allow for analysis to determine whether a situation is changing (for the better or for worse) and what impact this change is likely to have on the population in the zones under study. • The definition of the indicators rests on the reference information collected; subsequent follow-up of these indicators is thus completely related to the analysis of this reference information. The importance of good quality reference information cannot be emphasized enough in order to have as accurate an analysis as possible of changes in the food security situation of the population.

18. Detailed Macro Indicators • Static • - administrative information: number, name, and situation of the administrative ‘sub-entities’ (district, village) • - demographic and socio-cultural information (numbers) • - compilation of sanitary information (health centers, hospitals…) • - compilation of economic information (cities, economic poles, non-agricultural natural resources, transport networks, markets, flow of merchandise…) • - agro-ecological information: relief, climate, soils & types of vegetation, principle crops (%), agricultural returns… • - security information • - humanitarian information (cover by programs of ACFIN and other agencies) • Dynamic • - demographic information (population movements) • - agro-ecological information (rain fall…) • - security events • - evolution of market prices • - household food basket

19. Detailed Meso and Micro Indicators At the village (or camp) level: • administrative characteristics (province, commune, section, etc.) • number (proportion) of residents/displaced/refugee etc.(demographic characteristics) • zone (in reference to the initial division) • existence of a health center (type = clinic, hospital, health center, patient population radius, number people, maximum commute, etc.) • existence of a market (type, size, client population radius, commute, etc.) • access to water: structures such as wells, pumps, networks, etc. (according to the water quality, number of water points / habitants, etc.) • level of destruction of village (estimated in total percentage, or in number of houses…) • majority religion / ethnicities … • Static or dynamic depending on the context: • total number of inhabitants • number of households

20. Detailed Meso and Micro Indicators At the household level • Dynamic composition • implementation of coping mechanisms (ex: sale of certain goods) / or by contrast, re-capitalization • follow-up of food consumption • food resources • expenses/revenues • agricultural activities: harvests, availability of seeds… • exterior assistance • health-related information • main sources of food (for different household types) • main sources of income (for different household types)

21. Surveillance Team Training • Training is vital to ensure the best quality of output from the team but it also helps enormously in maintaining motivation levels. De-motivation has often been seen in surveillance teams for many different reasons: lack of involvement in setting objectives, designing the questionnaire, analyzing the information, reporting and knowing what happens as a result of the data collection. • It remains paradoxical that in most cases surveillance personnel are extremely dedicated to their work but pass through periods when motivation is reduced. It is important that the surveillance teams sees the tangible results of their work and understands the impact that this work has on the population.

22. Data Analysis The analytical system in place must allow us to follow the food security situation with ease. The analysis must stay within the framework of the nutritional causal analysis upon which the whole system is based and must indicate: • if a situation has generally improved, deteriorated or remained stable • for whom the situation has changed • where and when this change has taken place • what new/continuing needs should be addressed • for how long the new situation is predicted to continue Data analysis is undertaken in 2 main ways: • use of software packages (Sphynx preferably or Excel) • team de-briefings or analytical workshops

23. Dissemination of Surveillance Results

24. Regularity for the Diffusion of Surveillance Results

25. Potential Users of Information • ACFIN • International NGO’s • National/Local NGO’s • UN agencies • Government/Line Ministries • Community (translation may be needed) • Donors • International Bodies • Universities and research institutions • Media, public

26. Follow-up of information disseminated • It is often not enough just to give someone a report and hope that the person reads and then acts on it. A follow-up meeting or phone call can be a very effective way to ensure that your information has been read and taken into account. Other advantages are: • Measure the reach and the impact of our system • Receive feed back (constructive criticism) • Validation of dissemination tools • Measure the level of understanding by the users • Follow-up can therefore be done through: • Questionnaires • Formal and informal meetings • Phone conversations • Follow-up of stakeholders interventions

27. Summary of Surveillance • Surveillance systems monitor and analyze the food security situation (and nutritional status) of the population/targeted areas, and share the findings/recommendations in order to enable decision makers to define adequate food security strategies and have timely responses. • The needs, methodology, uses of the information and capacities of the teams must all be carefully considered when developing a surveillance system. • The two types of surveillance systems can be classified as sentinel site and ad hoc systems; each with specific characteristics adapted to the given contexts. • Surveillance systems should be transversal in nature and should constantly refer to the nutrition causal analysis. • The definition and identification of indicators is the base for monitoring the evolution of the situation. The indicators can be static or dynamic in nature, depending upon the specific context and should consider the macro, meso and micro characteristics. • Data analysis is the often the limiting factor in many programs; however the timeliness and degree of analysis are the key factors for ensuring results from the surveillance systems. • Many surveillance programs are faced with a variety of problems that can affect the quality and impact of the program. These problems should be considered from the initial stages in order to reduce the potential risks.