Assessing Needs: Are You Asking the Right Questions?

Published on December 16, 2015
A healthcare project in Tijuana highlighted the need for NGOs to begin with an accurate and thorough needs assessment. Only then can an emergency medicine team enter into a local context in a helpful and lasting way.

The delivery of medical care in developing countries by volunteers should always face the challenge of being honest with itself. The goal is to provide a population with resources it normally cannot access, but too often there is a lack of rigor in the allocation of said resources and a lack of reassessment through outcome measurements. This is an all-too familiar scenario—both on a local and a global level. Owing perhaps to the good intentions always at the forefront of these projects, it is often easy to deliver redundant, unneeded services or to misappropriate funds and resources. A recent example of this can be found in post-civil war Rwanda, when several NGOs were found to be delivering superfluous services with no quality measurements or assessments of their respective benefit to the communities they served. The Rwandan government ultimately established regulatory standards for NGOs to ensure their efforts were more suited to the needs of the people.

Recently, in southern California, we had the opportunity to work with a local NGO that makes frequent trips to the border city of Tijuana, Mexico in order to deliver primary and urgent care in several low-income neighborhoods, including slum areas. The population served by this NGO has evolved over the course of the past decade, the neighborhoods have improved, and the healthcare system in Mexico has also expanded public health coverage. While the initial need of these populations was patent at the inception of this NGO, a brief inquiry revealed that they had not organized a needs assessment to evaluate and adjust their interventions in response to the changes around them.

We built a volunteer team of pre-health students to perform a needs assessment and demographic survey of all the patients seen at these clinics. This has given new energy within the group to adapt to the current needs of this community, and likely changes will include expanding to new neighborhoods and seeking new interventions with lasting effects, such as lead testing in children, and addressing barriers to the primary care system. From this initial survey will also follow several more assessments to better evaluate subsets of the population that come to the clinic. Volunteers conducting the survey expressed how it enriched their interaction with patients, as it created an opportunity to speak to the patients about their lives and their difficulties. The patients themselves enthusiastically engaged the survey, because it gave them a chance to express their gratitude for the services provided.

This collaboration was a good reminder of how medical providers can be of use to these local organizations, which often have resources but may lack information or knowledge on how to apply them most effectively and efficiently. In our case, it has been a rewarding experience for both the members of this local organization and the emergency physicians involved. We believe that this type of partnership between community organizations and international emergency medicine endeavors is a great model for the future. This model can lead not only to effective change abroad but reduces redundant, parallel, and at times competing work.

A MODEL FOR ESTABLISHING A NEEDS ASSESSMENT TO IMPROVE VOLUNTEER MEDICAL CARE

  • Establish the goal of the needs assessment. Our goal was to characterize the demographics, socioeconomic status, public health status, and health care access of people living in the zones served by a free clinic in order to help identify needed interventions and guide resource allotment by the clinic’s management.
  • Create targeted questions for the needs assessment. Questions were either created de novo or copied from publicly available household surveys, and adapted to fit the setting and limitations of our interview setting.
  • Collect the data. Bilingual volunteers interviewed all willing clinic patients during all hours the clinic was open. One person per household was interviewed, and our goal was to conduct the survey in 10 minutes.
  • Analyze the data. The surveys from the various sites were analyzed and compared to extract the information we were interested in.
  • Use the data to create a focused a secondary survey. The secondary survey should focus on a health need in the population identified on the previous survey e.g. diarrheal disease, which can be targeted with an intervention in the subsequent step. The goal should be to demonstrate the foundation for an implementation.
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