Transcript IFE RAPID ASSESSMENTS

IFE RAPID ASSESSMENTS
(Sector specific rapid assessments)
Common challenges &
potential solutions
Ali Maclaine
Consultant Public Health Nutritionist
IFE Regional Meeting, Bali, Indonesia 10-13 March, 2008
IFE Assessments in general:
What are main questions / issues people
face?
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When should an assessment be
done?
What type of assessment should be
done at that time?
What is the correct methodology?
What questions should be asked?
What is the correct way to ask
them?
Emergency
Immediate
Pre-Crisis
Response Phase
Increasing depth
Preparedness
data collection
Beyond the
Immediate Response
Tracking
Initial
Mulit-sectoral
Rapid
Assessment
Rapid
(qualitative &
secondary
Assessment
quantitative)
(qualitative &
secondary
quantitative)
Sector-specific rapid
assessments
Early warning systems
Surveillance
Multi-sectoral survey
Follow-up survey:
Health/Nutr/
Food/WASH/etc
(probability sample):
Health/Nutr/
Food/WASH/etc
Periodic surveys
In-depth sector studies
Existing research/studies
(quantitative/qualitative)
Preparedness Monitoring
Sudden 1 wk
onset
Performance Monitoring
6-8 wks
3-6 mo
1 year
IFE SSRA
The problem…
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NO set guidelines on how to do IFE
SSRAs in rapid onset emergencies.
No generic tools
Everyone tackles same questions /
issues / problems
People doing it wrong / could do it better
2002 paper on IFE indicators & suggested review………..
(Marie McGrath et al. Infant feeding indicators for use in emergencies: an analysis of
current recommendations and practice. Pub Health Nut 2002, 5(3) 365-372)
IFE SSRA
First question people worry about is?
What am I going to do?
Should be:
What are the objectives?
IFE SSRA
Main objectives:
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Related to assessing CHANGE due to the crisis
Reduction / Increase in exclusive breastfeeding
Mothers’ stopping breastfeeding early
Reduction / increase in mothers’ mix feeding
(breast & formula)
Earlier / later introduction of complementary
foods
Poorer / better complementary foods being
used
WHY there a change e.g. breastfeeding myths,
donations
Information used for programming, advocacy,
etc.
IFE SSRA
What is the correct methodology?
- Qualitative / Quantitative / mix?
- FGDs / Key informants / Household visits /
Transect walk – one best or mix?
- Sampling method: Cluster fixated but
convenience more appropriate – purposive
sampling
- Numbers needed to make outcome
‘significant’, are numbers feasible?
- Anthropometry included (< 6 months?)?
IFE SSRA
What questions should be asked?
How should questions be phrased?
IYCF standard core indicators:
• Early initiation of breastfeeding
• Exclusive breastfeeding under 6 months
• Continued breastfeeding at 1 year
• Timely complementary food (New guidelines: Introduction of solid,
semi-solid or soft foods)
• Minimum dietary diversity (i)
• Minimum meal frequency (ii)
• Minimum acceptable diet (composed of (i) + (ii))
• Consumption of iron-rich or iron-fortified foods
 Are they all relevant and needed in IFE SSRA?
 How should they be asked in a crisis? (24hr recall v. quick
question = when trying to get rapid over-view)
IFE SSRA
What OTHER questions are essential for
an IFE SSRA?
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Main objective of SSRA to assess
CHANGE
Type
Level (to some extent)
Reason
Need to determine the key questions required to assess ‘change’
Establish ‘best’ phrasing of question…
IFE SSRA
ASSESSING ARTIFICIAL
FEEDING IN EMERGENCIES
Need to assess the extent & nature of artificial
feeding in emergencies
– BUT NO agreed guidelines on what data is
‘key’, or ‘correct’ phrasing of questions to get
the ‘best’ information in a SSRA
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What is the key data?
What is ‘best’ phrasing of questions?
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Due to high risk related to donations (BMS,
milk powder, bottles/teats) need to assess
their impact
Need to determine the key questions required to get required detail.
Establish ‘best’ phrasing of question…
IFE SSRA
ASSESSING COMPLEMENTARY
FEEDING IN EMERGENCIES
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Need to assess need for complementary
food aid
Local foods, fortified foods, micronutrient
‘sprinkles’
Need to assess impact
What are the key questions?
What is ‘best’ phrasing of questions?
IFE SSRA
PROGRAMMING DECISIONS
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Need to establish what is required to support
appropriate IFE in the area
Need to establish acceptability and requirement
of specific interventions e.g. wet nursing,
‘breastfeeding support groups’, etc
What are the key questions?
What is ‘best’ phrasing of questions?
So how are IFE sector
specific rapid
assessments being
done?
BANGLADESH
Cyclone hit:
15th November 2007
Districts: 30
Sub-districts: 200
Unions: 1,950
Population affected: 8.9 mill
Families affected: 2 mill.
DeathsDeaths: 3363
: 3363
Photos credit: Ali Maclaine, 2007
Save the Children
• SC great history in IFE
• One of first agencies to actively look into the
issue.
• Always seeking to attain ‘best practice’ in the
field in terms of IFE.
• Should be commended
• NOT an example of a bad IFE rapid
assessment, but a regional example in order to
look at the common challenges and issues.
Save the Children Alliance - Bangladesh
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Rapid IFE assessment to:
determine whether infants and young
children were vulnerable to increased
morbidity and mortality due to poor IYCF
practices..
develop strategies to promote optimal
feeding practices for the emergency areas
The objectives were:
1.
To establish an overview of IYCF patterns precyclone in the assessment area (14 unions)
2. To determine whether there had been changes in
these patterns post-cyclone
3. To establish the reasons for these changes
4. To identify ways to promote and support optimal
IYCF practices for
(i) the breastfeeding infant
(ii) the mix-fed infant
(iii) the non-breastfed infant, and
Available capacity for assessment…
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SC health and nutrition staff – IYCF
experience
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Capability to assess all 14 unions in 2 days
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SC support
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Bangladesh Breastfeeding Foundation and
Dr. Khurshid Talukder, Consultant
Paediatrician and Research Co-ordinator,
Centre for Woman and Child Health
Method (Also looked at secondary data)
Focus Group Discussions (FGD) with caregivers
of children aged 0-24 months (half of group
infants <6 months)
 Key informant interviews with: (i) Government or
NGO health workers (ii) Traders
 Transect walks
 Household interviews with
(i) mothers with infants <6 months exclusively
breastfeeding,
(ii) mothers with infants <6 months who were being
mixed fed or not being breastfed at all
(iii) mothers/caregivers with infants ≥6 months who
were being complementary fed
 Additional unstructured rapid assessments
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Results led to
SC revising its health and nutrition
messages given as part of the emergency
programming.
 SC further engaging with its partner
agencies in IFE at the local and national
level.
 Provided qualitative data to the nutrition
cluster and other agencies as to IFE
situation.
 Bangla translation of the Operational
Guidance.
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What could have been done
better….
Time flies past…
 Early
assessment by SC missed
out IFE
 Due to unavoidable delays
assessment not started until 28th
Dec (5 weeks)
 So not initial rapid assessment or
full assessment (MSS)…..
Having IFE designated support
throughout…
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The IFE SC designated person became
unavailable – important to have a nutrition
person sensitive to IFE issues and local
knowledge.
(Lucky to have BBF to help: Breastfeeding
counsellors, trainers, translators, etc!!!)
Having agreed tools in advance
Tools changed during translation:
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To fit with national IYCF strategies
To include other issues
To fit with local context
Some IFE questions removed / changed
Greater time
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Only a week on the ground
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Team busy
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Added time pressure: Long journeys
teams had to get back to the field in
daylight
Hence:
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No time to discuss issues / decide on
questions needed and the way to ask them
Training of field workers had to start before
team met to finalise assessment tool
Quick discussion & make changes to tools
straight into Bangla
No time to fully discuss changes with
assessment team or field test new forms
No time to back translate to ensure
changes made were correct
Language Challenges
‘Mixed feeding’ is not a Bangla term and is
not well understood
 ‘Child’s milk’ could cover infant formula,
tinned milk, child powdered milk or any
milk (e.g. cow’s milk, milk powder, milk in
cartons) that is drunk by a child whether
suitable or not
 ‘Concerns’ translated as ‘issues’ then
interpreted by assessors/interviewees as
asking about their knowledge of
appropriate IYCF
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Challenges caused by misunderstanding
(found during analysis):
The terms ‘less’ and ‘more’ were
sometimes interpreted as ‘earlier’ and
‘later’
e.g. ‘Since the cyclone are infants
being given complementary foods
earlier, later or at the normal time?
Was answered as ‘later’ when checked
mother meant giving it later during the
day..
 A question such as ‘Are less mothers
breastfeeding?’ was sometimes interpreted
as ‘Are mothers producing less milk?’
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Challenges of assessment method
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FGDs were not always free ranging
conversations - each mother was asked
about her experience on the issue.
Challenges with the rapid assessment
tool…
Long
 Amalgamating qualitative data from
different tools takes time
 Questions not phrased the ‘right’ way
 Some important questions missed out
 It could be done better….
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Overview.
What is needed?
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Determine ‘best’ method of conducting IFE
SSRA.
Review of sampling strategies for infants and
determine agreed numbers for ‘acceptability’
of results
Need to agree:
what data is ‘key’
the ‘best’ method of phrasing questions in
SSRAs to obtain reliable information with a
useful level of detail
Need to field test
Bring it together to form SSRA guidelines and
useable assessment tools based on ‘best
practice’.
Tools need pre-emergency country review &
translation
Your Experiences &Thoughts?
Conducting IFE SSRA
In Bangladesh,
Post-cyclone Sidr
Thank you.