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HCCT – Session 2.3: Key Questions Worksheet of 24

Public health information for needs assessment and analysis: Key Questions Worksheet

Version: 4 November 2016

General guidance

Context and scope

Relation to other documents and processes

This document presents a worksheet that facilitates completion of the Key Questions on Public

Health Information for Needs Assessment and Analysis, initially to fulfil the Secondary Data

Review service described in the Global Health Cluster (GHC) Public Health Information (PHIS)

Standards. The Key Questions, in turn, pertain to each domain of the Framework of Public Health Information for Needs Assessment and Analysis.

This Worksheet is the main basis for the Public Health Situation Analysis (PHSA), which summarises

needs assessment and analysis for the health sector. The PHSA Template is structurally related to

the above documents. Finally, the PHSA is the basis for the health sector’s contribut ion to the

OCHA-led Humanitarian Needs Overview:

Types of information

The range of answers to the Key Questions may require sourcing the following types of information:

Statistics and data: estimates of demographic and health indicators, disease burden,

numbers of affected people, incidence of disease, numbers and locations of health resources, health service coverage or quality indicators, etc.

Perceptions and experiences: qualitative information on the experienced or perceived needs and priorities of the affected population, health staff, humanitarian staff, etc.

Events and other facts: Attacks and other acts of war, damage to health facilities, how the health system works, what is happening to the health system.

Guidance on completing the worksheet

Time available for completing the worksheet

This set of questions should be completed within a very short timeframe, in order to issue an

initial Public Health Situation Analysis (PHSA), based primarily on secondary data review, within

approximately the first 48h of crisis onset (see GHC PHIS Standards). Practically, this means that

questions need to be answered rapidly (about one working day) . There may not be time to

conduct key informant interviews, or thorough information searches, for all questions. One

Public Health Information Framework

Key Questions and Sources

Questions Worksheet

PHSA HNO


should exercise judgment about which questions are more important given the typology of crisis

and the local epidemiological profile, and accept that some questions initially may just not be

answered at all, or may receive a tentative answer based on careful, plausible assumptions and knowledge from prior similar crises.

On the other hand, the PHIS Standards also specify that the PHSA (and therefore Secondary

Data Review based on the Key Questions) should, whenever possible, be conducted prior to a

crisis, as part of emergency preparedness. If the latter is done, there may be an opportunity to

take more time to research the questions (e.g. conduct a more thorough literature rev iew or talk to more informants).

Answering the questions

The question should be answered with figures, where appropriate, and/or with some qualitative

description of the situation. It is important however to provide succinct answers – about 50-100

words, if not less. Answers should as much as possible use consistent language and follow the structure of the question.

How precise should quantitative answers be?

It is understood that needs assessment, at least initially, takes place in a dynamic, information-

poor environment. As such, it is acceptable and indeed preferable to provide rough ranges for

percentages, totals and other statistics, whenever this would be a more honest way of

portraying the actual accuracy of available data, than by reporting a misleadingly precise single figure.

Triangulation in case of multiple sources

If more than one source is available, it is advisable to first grade the quality of each, and exclude any that are graded F (see below).

For statistics and data, a minimum to maximum range based on all the available sources should

be provided, as well as a central (most likely) estimate that approximately gives more weight to

higher-quality sources (e.g. “measles vaccination coverage was most probably around 45-50%, but individual estimates ranged from 34% to 65%”).

For perceptions and experiences as well as events and other facts, summary statements of the

evidence should be provided, that reflect the degree of agreement among sources, and/or

point out major disagreements (e.g. “sources agree that beneficiaries are most concerned with

the inability to access hospitals”, or “some sources reported drug stock -outs at all major hospitals, though one source denied this was happening”).

Identifying and recording sources

Internet browser searches

When searching Google or other internet search engines for data-rich or assessment reports (as

opposed to news reports), it is useful to rely on the advanced search feature of the search

engine, and search for files with typical extensions (e.g. .doc, .docx, .ppt, .pdf). Several

searches with alternative key terms are better than only a single search. Search terms used should be recorded.


Recording the source(s)

The sources used for each answer should be recorded. For each source, this record should include:

The author(s) (agencies or individuals) or person interviewed; if the interviewee asked to

remain anonymous, record the author as “Anonymous” and ensure that the person’s

name or any other information that could be used to identify him/her (e.g. place of

interview, professional role, agency, initials, etc.) is not recorded on any document, paper or electronic;

The year of publication, for a report;

The title of the report or database; if informants are interviewed, use the designation

“Pers. comm.”

The date on which the person was interviewed, if appropriate;

The date(s) to which the source refers to (years for baseline information, months or weeks for crisis-emergent information), if appropriate;

A URL if the source is available online;

The quality grade for the source (see below);

The file of the report, downloaded to a secure folder. Files could be named starting with the number of the question, for easy retrieval.

The following are examples:

“World Humanitarian Relief Agency (2016). Health behaviours survey in Martello Tower camp (dates: Apr-May 2016). www.whra-madeup.org/martello_survey.pdf . [-4]”

“Buck Mulligan. Pers. Comm. Interviewed 3 Nov 2016. [+10]”

Guidance on appraising the strength of information

Grading the quality of each source

The quality of each source that is used to answer any of the Key Questions should be graded,

for at least three reasons: (i) to interpret evidence for any question with due caution; (ii) if

multiple sources are available for the same question, to know which to give more weight

(credence) to; (iii) to identify information gaps needing to be filled, e.g. through field assessment.

Table 1 shows a system for grading the quality of different types of sources used to answer any question.

Table 1. System for grading the quality of sources, by type of infor mation.

Score (possible range)

Statistics and data Perceptions and

experiences Events and other facts

Robustness criteria

-5 (worst) to +5 (best). If unknown, score a 0.

Do the statistics or data result from an

established appropriate

methodology or data

collection system (see Annex, Table 6)?

If not, were they

collected through some

Was the information collected through a

structured ethnographic

study inv olv ing

recognised methods in qualitativ e research?

If not, was some form of

qualitativ e methodology

To what extent is the source a direct witness of the

ev ent, or someone with

intimate, first-hand

knowledge of what is happening?

http://www.whra-madeup.org/martello_survey.pdf


Score

(possible range) Statistics and data

Perceptions and

experiences Events and other facts

form of rapid purposiv e

or conv enient sampling?

If not, are they just an

educated guess? If not, an unqualified report?

used (e.g. key informant

interv iews, focus

groups)?

If not, is this just an unqualified report?

-2 (worst) to +2 (best).

If unknown, score a 0.

How precise is the

statistic? If it is deriv ed from a sample, did the

authors remember to

report a confidence

interv al? Is the

confidence interv al or range sufficiently narrow

for meaningful

interpretation?

How consistent are

themes expressed by the respondents? Do

some clear patterns

emerge from the data?

Does it seem like

‘saturation’ was achiev ed (i.e. further

data collection would

not hav e yielded much

new information)?

What credentials (e.g.

subject expertise) does the source hav e?



Could the respondents

hav e had a motiv e for

exaggerating, under-

reporting, or distorting their answers? What is

the relationship between

the persons or agency

collecting data, and the

respondents?

Could the respondents

hav e had a motiv e for

exaggerating, under-

reporting, or distorting their answers? What is

the relationship between

the persons or agency

collecting data, and the

respondents?

Could the source hav e had

a motiv e for exaggerating

or under-reporting? How

independent is the source from combatants or other

opposing stakeholders in

the crisis?



Hav e the data been

collected and analysed

by a reputable, independent institution,

with a track record of

such work?

Hav e the data been

collected and analysed

by a reputable, independent institution,

with a track record of

such work?

What is the source’s

reputation for prev iously

prov iding unbiased, accurate information?



Do the statistics or data

appear plausible, giv en

what is known about the

crisis and similar crises of this typology?

Do the perceptions or

experiences appear

plausible, giv en what is

known about the crisis and similar crises of this

typology?

Does the ev ent or fact

appear plausible, giv en

what is known about the

crisis and similar crises of this typology?

Representativeness criteria -5 (worst) to +5 (best).


To what extent are the data geographically

representativ e of the affected population? If the

data are regional or national, how likely is it that the

affected population is close to the regional / national av erage?

If the data are representativ e of only a sub-area

within the affected population, how likely is it that

this sub-area is close to the affected population

av erage? Think about urban v s. rural differences, or reasons

why the sub-area was selected.

n/a

-5 (worst) to +5 (best). If unknown, score a 0.

How recent are the data? To what extent do they still reflect conditions (either right before the crisis for

baseline information, or current for crisis-emergent

information)?

Think about what has changed since data

collection. Before the crisis, such changes might hav e occurred ov er years. Howev er, during a crisis

the situation is v ery dynamic, and thus data may

become outdated only days to weeks after they

were collected.

n/a


Sub-scores should be summed, and a grade should be attributed to each source, as per Table 2.

Table 2. Suggested grades for a source of information, based on sub-scores.

Grade A B C D F (exclude)

Statistics and data +26 to +17 +16 to +6 +5 to -5 -6 to -16 -17 to -26

Perceptions and experiences +26 to +17 +16 to +6 +5 to -5 -6 to -16 -17 to -26

Ev ents and other facts +16 to +11 +10 to +4 +3 to -3 -4 to -10 -11 to -16

Overall strength of information

Once all the sources for a given question have been graded, the overall strength of information

available for the question should be graded, as per Table 3. Often this grading will be straightforward, as only one source will be available.

Table 3. System for grading the overall strength of information for answers to any question.

Strength of information Criteria

High At least one A-graded source or

at least two B- or C-graded sources that deriv e from mutually independent data

collection, and whose findings are reasonably consistent.

Intermediate No A-graded sources, but

at least one B-graded source

or

at least two C- or D-graded sources that deriv e from mutually independent data collection, and whose findings are reasonably consistent.

Low No A- or B-graded sources, but at least one C- or D-graded source.

None No source, or only F-graded sources.

The overall strength of information for entire set of Key Questions is also a useful index of the

extent of available information for needs assessment and analysis in the crisis, compared to

other crises. This can be computed by calculating the percentages of questions for which the

strength of information is High, Intermediate, Low or None, respectively, among all questions that were relevant for the crisis in question.

Scoring the extent of disruptions, threats or needs

Scoring the extent of disruption

Answers to questions in the Crisis-emergent Health Resources and Availability and Health System

Performance sections should be scored in terms of the extent to which the health system

component or parameter the question relates to (parameter, e.g. quality of health services, or

health system component, e.g. the existing epidemic alert and response system) is known or

may be assumed to undergo crisis-attributable disruptions. Alternatively, the extent to which


people are without feasible access to certain health services, or to which health system performance may be declining, should be scored. Table 4 provides guidance for this scoring.

Table 4. Guidance for scoring the extent of disruption or lack of access to a given health system feature or service.

Extent of disruption Meaning

High

The majority of the health system feature / health serv ice has been or could be rendered non-functional.

Most people / patients do not hav e access to healthcare.

A major reduction in health serv ice cov erage or quality could occur.

Intermediate A substantial minority of the health system feature / health serv ice has been or

could be rendered non-functional.

A substantial minority of people / patients do not hav e access to healthcare.

A moderate reduction in health serv ice cov erage or quality could occur.

Low

A small minority of the health system feature / health serv ice has been or could be

rendered non-functional.

A small minority of people / patients do not hav e access to healthcare.

A small reduction in health serv ice cov erage or quality could occur.

None

The v ast majority or entirety of the health system feature / serv ice is v ery probably

still as functional as before the crisis.

No risk factors for reduction in health serv ice cov erage or quality hav e been identified.

Unclear

No plausible assessment can be made at this time.

It is important, while scoring, to remember that:

1. This extent of disruption is time-dependent. It may increase as new crisis risk factors emerge, or vice versa. See below for timing of disruptions.

2. For the vast majority of questions, one should be able to at least make a plausible

assumption about what could happen as a result of the crisis. Only a few questions should be scored as ‘Unclear’.

3. All scores should express the effect of the crisis, not the baseline situation, however

challenging the latter may have been. In other words, a health system feature (e.g.

pharmaceutical supply) that is weak at baseline should not automatically be scored ‘High’, unless the crisis has severely disrupted it.

4. One should provide a score without thinking about the mitigating impact of the

humanitarian health response. At this stage, one analysing needs for the health sector and pointing out what could happen in the absence of an adequate response.

Scoring the magnitude of health threats / needs

Answers to questions in the Crisis-emergent Health Status and Threats section should be scored

in terms of the extent to which the health problem or group of diseases could result in health

impacts, i.e. the magnitude of crisis-attributable excess mortality and/or excess mental health

problems.

Such a scoring is essential to establish health sector priorities, but is objectively difficult to do, as

it requires putting together information from all sections of the Key Questions, and considering

various causal pathways and interactions among risk factors and even disease groups. Figure 1 (Key Questions document) is useful to keep all of these in mind.


In order to undertake the scoring, the following parameters should be considered together:

The baseline burden of disease (think of how many DALYs lost this disease or group of

diseases was responsible for before the crisis). The baseline disease burden is however

irrelevant for crisis-emergent health problems, including trauma injuries or combatant -

perpetrated SGBV. It is also relatively unimportant for epidemic-prone diseases (see Key Questions guidance tables and notes);

The extent to which crisis-emergent risk factors could increase this burden of disease. To

what extent could different risk factors occur? What is their risk grading, i.e. relevance to

this particular disease or group of diseases (see e.g. guidance tables in the Key

Questions document)? Note that the combination of different risk factors has a multiplicative effect;

What is known or can be assumed now about access to curative and preventive health services relevant to this disease or group of diseases;

What further disruptions to the health system could occur, and the effect they would have on this disease or group of diseases, in addition to the above.

Table 5 provides guidance on how to attribute scores.

Table 5. Guidance for scoring the magnitude of health threat or need for different groups of health problems.

Magnitude of threat /

need Meaning Notes

High

Could result in high lev els of excess

mortality and/or mental health

problems.

Could be one of the top driv ers of worsened

health status, and single-handedly result in a

substantial increase in all-cause mortality, or

substantial worsening of mental health and

functioning. Think of a v ery sev ere epidemic; a large

proportion of cases of life-threatening

disease going without treatment; huge

increases in infectious disease burden due

to combinations of important risk factors (ov ercrowding, malnutrition, poor WASH).

Intermediate Could result in considerable lev els

of excess mortality and/or mental health problems.

Could single-handedly result in a moderate

increase in all-cause mortality, or moderate worsening of mental health and functioning.

Low

Could make a minor contribution

to excess mortality and/or mental health problems.

Small but non-negligible increase.

None

Will v ery probably not result in any

excess mortality or mental health

problems.

Whatev er the baseline, no crisis-emergent

risk factors could occur that the pre-crisis

health system wouldn’t be able to cope

with. Alternativ ely, the number of trauma injuries

or combatant-perpetrated SGBV cases is

v ery likely to be zero or extremely low.

Unclear

No plausible assessment can be

made at this time.

Either the baseline is unknown, or it is

impossible to say at this stage how the crisis

could affect it, if at all.

Alternativ ely, it is impossible to know whether

there hav e been any trauma injuries or combatant-perpetrated SGBV cases.

Three important points to remember while scoring are:


1. The magnitude of threat / need is time-dependent. It may increase as new crisis risk

factors emerge, or vice versa. This should be reflected in the Worksheet (i.e. different

magnitudes of threat should be reported, corresponding to different times). See below for timing of threat / need.

2. For the vast majority of questions, one should be able to at least make a plausible

assumption about what could happen as a result of the crisis. Only a few questions should be scored as ‘Unclear’.

3. One should resist the temptation to score every question as ‘High’, unless this is truly

warranted. Remember that scoring all or most questions as ‘High’ would imply

catastrophic levels of excess mortality: is this really a plausible development?

Differentiating between different magnitudes of threat / need, on the other hand, helps to identify relative priorities for the humanitarian health response.

4. One should provide a score without thinking about the mitigating impact of the

humanitarian health response. At this stage, one analysing needs for the health sector and pointing out what could happen in the absence of an adequate response.

Indicating the timing of disruptions and threats / needs

Along with the above scores, the timing of any disruption or threat / need should be specified,

with a time horizon of 12mo. Here, timing refers to the earliest possible time point after the onset

of the crisis at which the disruption, or health threat / need, could change magnitude from its

default baseline of ‘None’. Therefore, one should combine all information throughout the Key

Questions and decide which relevant risk factors, if any, could occur the earliest, and when.

As previously mentioned, if it is clear that the extent of disruption or magnitude of threat / need

could vary considerably during this time horizon, different extents / magnitudes, and associated

timings, should be specified. For example, the extent of disruption in the pharmaceutical supply system could be:

Extent Timing

Low 1-2mo

Medium 3-5mo

High 6-12mo

Similarly, for trauma injuries after a sudden-onset natural disaster, the timing of need would be

immediate, and indeed would dramatically decrease after one week, since the window for treatment (though not rehabilitation) is very short for most life-threatening injuries.


Annex: Appropriate methods for statistics and data

Table 6. Appropriate methods for collection of statistics and data, by type of information. From Checchi et al., Lancet.

Type of information Prospective

surveillance

Population sample

survey

Analysis of

programme data Other methods

Affected population

size and composition

Community-based

demographic

surveillance

Residential structure

tally plus structure

occupancy

estimation

Vaccination or

nutritional screening

data combined w ith

expected age

structure

Area estimation plus

population density

estimation

Various qualitative or

convenience methods

Exposure to armed

attacks

Facility-based

surveillance of injuries

and attacks against

health

Retrospective survey

of individual

exposure to injury

Conflict analysis

(tracking of media and

other informant reports)

Sexual and gender

based violence

Facility-based

surveillance of SGBV

cases

Retrospective survey

of individual

exposure to SGBV

Conflict analysis

(tracking of media and

other informant reports)

Food security and

feeding practices

Household

livelihoods, resilience

and coping, food

access, food

consumption and

feeding practices

survey

Agricultural production

monitoring

M arket analysis

Household focus

groups

Desk-based food

security risk assessment

Nutritional status Repeated

anthropometric

sampling from sentinel

communities

Anthropometric

survey

Trend analysis from

community- or facility-

based

anthropometric

screening, and

CM AM admissions

Desk-based nutritional

risk assessment

Physical health Early Warning Alert

and Response

Netw ork system

(EWARS) for epidemic

alert and response

Survey to measure

point prevalence of

chronic diseases or

retrospective

incidence of acute

disease syndromes

Analysis of facility-

based morbidity and

mortality data

Desk-based disease risk

assessment and

situation analysis

Tracing and tracking of

people in need of

treatment continuation

Mental health Collecting data

covering serious

mental health

symptoms as part of

general facility-based

health surveillance.

Adding questions

covering serious

mental health

symptoms to general

health surveys

Analysis of HM IS

morbidity data

Literature (desk) review

Services mapping

Participatory

assessment

Service availability

and functionality

HeRAM S (w ith

updated

geographical

database of facilities)

Who What Where

When (4W)

Service coverage Coverage survey

(vaccination, health

services, nutritional

programme, etc.)

Comparison of actual

programme outputs

vs. target

beneficiaries

Focus groups, other

qualitative methods for

exploring service

utilisation and barriers

Service effectiveness Analysis of HM IS data

(e.g. on cure rates)

Facility audits and spot

checks, patient ex it

interviews

Population mortality Community-based

demographic

surveillance

Passive “body count”

surveillance

Retrospective

mortality survey

(verbal autopsies as

add-on to explore

causes of death)

Census (post-w ar) and

demographic

modelling

Capture-recapture

analysis

Indirect (model-based)

estimation

NEEDS ASSESSMENT AND ANALYSIS Cluster / response: Cluster name

KEY QUESTIONS WORKSHEET Date of last update: [Publish Date] Date of next scheduled update: [Publish Date]


Baseline (pre-crisis) information questions

Health status and threats

Population mortality and relative burden of disease, by main cause (epidemiological profile)

Question Answer / notes Source(s)

[quality grade]

Overall strength of

information 1. What was the population crude death rate?

2. What was the under 5y (child) mortality ratio?

3. What was the annual burden of disease,

expressed as Disability Adjusted Life Years

(DALYs) lost, for the following groups of

diseases: Nutritional deficiencies

Reproductiv e, maternal, neonatal causes

Infectious diseases

HIV/AIDS Tuberculosis

Non-communicable diseases

Injuries

Mental disorders

Nutritional status and its determinants (food security, feeding practices)


[quality grade]

Overall strength of

information 4. What was the prev alence of acute

malnutrition (sev ere, moderate and global)

among children 6-59mo old?

5. What was the proportion of women aged 15-

49 years with low body mass index (<18.5

kg/m2)?

6. What was the proportion of infants exclusiv ely

breastfed until 6mo of age?

Reproductive, maternal and neonatal health (status and main patterns)


[quality grade] Overall strength of

information





[quality grade]

Overall strength of

information 7. What was the crude birth rate?

8. What was the maternal mortality ratio?

9. What was the neonatal mortality ratio?

10. What was the prev alence of contraceptiv e

use?

11. What is known about the incidence of SGBV,

including during any crises that may occurred

in the same population prev iously?

Burden of the main endemic infectious diseases


[quality grade]

Overall strength of

information 12. What were the top three infectious causes of

outpatient consultation, in order of

proportional morbidity?

Local history of epidemic diseases



information

13. What, if any, confirmed epidemics hav e

occurred in the affected area (in the case of displaced people, both the area of origin and

the host community) ov er the last 10y?

14. What was the sev erity of any epidemics (total known cases and deaths)?

HIV and TB burden


[quality grade]

Overall strength of

information

15. What was the HIV seroprev alence in the general population, and how many people

were in need of antiretrov iral treatment?

16. What was the annual incidence of activ e TB (total number and rate)?




People under HIV and TB treatment


[quality grade]

Overall strength of

information 17. How many people were on antiretrov iral

treatment?

18. How many people were on TB treatment?

Burden of the main non-communicable diseases (NCDs)


[quality grade]

Overall strength of

information

19. What were the most important groups of NCDs?

20. What was the prev alence of diabetes?

21. What was the prev alence of hypertension?

Burden of injuries


[quality grade]

Overall strength of

information [none]

Mental health: socio-cultural context, mental health and psychosocial context


[quality grade]

Overall strength of

information 22. What are the essential concerns, beliefs, and

cultural issues that aid prov iders should be

aware of when prov iding mental health and

psychosocial support?

Health resources and service availability

Key health system features:

Management structure


[quality grade]

Overall strength of

information





[quality grade]

Overall strength of

information 23. Who is in charge of the health system at

different hierarchical lev els? How

decentralised are health policy and resource allocation?

Range of services provided by level (community, outpatient, inpatient)



information

24. What health serv ices are meant to be

prov ided at community lev el?


prov ided at outpatient (primary) lev el?


prov ided at inpatient (secondary) lev el?

Financing model


[quality grade]

Overall strength of

information 27. Which serv ices are free at the point of use, and

which, if any, require user fees?

28. How centralised or decentralised is the health budget? Is there a form of local cost-recov ery?

Role of private / non-state providers, including NGOs



information

29. What proportion of health facilities is reliant on

non-state actor support? Name any piv otal non-state actors.

30. To what extent do people rely on priv ate or

informal sources of healthcare?

Pharmaceutical supply system





[quality grade]

Overall strength of

information 31. How are pharmaceuticals procured, stored

and supplied to public health facilities? Is there

a national pharmaceutical central?

32. How dependent is the health system on locally

produced pharmaceuticals?

Trauma care capability and emergency resilience


[quality grade]

Overall strength of

information 33. In the ev ent of mass casualty ev ents, what

specialised trauma surgery and rehabilitation

facilities can injury cases realistically access?

What is their approximate capacity?

34. What ev idence, if any, is there of emergency

preparedness and resilience in the health

system (e.g. emergency supply stocks; contingency plans; safe hospitals)?

Epidemic alert and response



information

35. What is the name of any epidemic surv eillance

system, and what was its actual functionality in the affected area?

36. How prompt and effectiv e was the health

system’s response to past epidemics?

Health facilities by level in the affected area


[quality grade]

Overall strength of

information

37. How many health facilities, by lev el (primary, EmOC [basic or comprehensiv e emergency

obstetric care], secondary, tertiary) were

functional in the affected area, and where

were they?




Inequity in service availability (pockets of low/no population access to healthcare)



information

38. Were there any population pockets within the

affected area that had no realistic access to health serv ices?

Availability of nurses and doctors (including specialists in surgery, anaesthesia, obs-gyn)


[quality grade]

Overall strength of

information 39. How many nurses were working in the affected

area?

40. How many doctors were working in the affected area?

41. How many specialist doctors (surgeons,

anaesthesiologists, obs-gyn) were working in the affected area?

Health system performance

Coverage / utilisation of routine preventive and curative health services


[quality grade]

Overall strength of

information 42. What was the outpatient utilisation rate

(consultations per person per year)?

43. What was the percentage of births assisted by a skilled attendant?

44. What were the measles (children under 5y)

and DPT3 or pentav alent3 (children under 1y) v accination cov erages?

Quality of service provision and beneficiary satisfaction / perceptions


[quality grade]

Overall strength of

information





[quality grade]

Overall strength of

information 45. What was known about the quality of health

serv ice deliv ery, and competency of human

resources for health?




Crisis-emergent information questions

Health resources and service availability

Key health system disruptions:

Disruption to management


[quality grade]

Overall strength

of information

Extent of

disruption

Timing of

disruption 46. Are health authorities still in

place and/or able to take,

transmit and execute

decisions?

Reduction in financing


[quality grade]

Overall strength

of information

Extent of

disruption

Timing of

disruption 47. To what extent could financial

resources for health serv ices, at

any lev el, be reduced, and

when?

48. To what extent could people’s

ability to afford either the

direct (user fees, drug costs) or indirect (e.g. trav el,

sustenance of patients) costs

of healthcare be curtailed,

and when?

Inability of non-state providers to maintain service provision


[quality grade]

Overall strength

of information

Extent of

disruption

Timing of

disruption 49. To what extent do existing non-

state prov iders, if any, seem

able to maintain serv ice

prov ision?




Disruption to supply chain


[quality grade]

Overall strength

of information

Extent of

disruption

Timing of

disruption

50. What disruptions to the pharmaceutical supply chain

are occurring or likely to occur,

and when?

Degraded alert and response


[quality grade]

Overall strength

of information

Extent of

disruption

Timing of

disruption 51. To what extent has the health

system’s epidemic

surv eillance, alert and

response capability been

compromised?

Extent and pattern of attacks against health services


[quality grade]

Overall strength

of information

Extent of

disruption

Timing of

disruption

52. To what extent hav e any components of health serv ices

(staff, infrastructure, assets)

been attacked or looted, and

what is the pattern of attacks

to date?

Extent of damage to health facilities


[quality grade] Overall strength

of information Extent of

disruption Timing of disruption

53. How many health facilities,

where, and at which lev el (primary, EmOC, secondary,

tertiary) are known or

projected to hav e been

damaged as a result of the

crisis?




Population living without functional health services, by level



of information Extent of

disruption Timing of disruption

54. How many people are known

or projected to be without realistic access to functional

community health serv ices?


or projected to be without realistic access to functional

primary health serv ices?

56. How many pregnant women deliv ering ov er the next 1mo

are known or projected to be

without realistic access to

functional EmOC serv ices?

Immediate


or projected to be without

realistic access to functional secondary or tertiary health

serv ices?

Immediate

58. How many people with trauma injuries are known or projected

to hav e no realistic access to

functional trauma serv ices?

Immediate


or projected to be without

realistic access to functional

mental health serv ices?

Displacement or migration of human resources for health


[quality grade]

Overall strength

of information

Extent of

disruption

Timing of

disruption 60. To what extent is or could

displacement / migration of

human resources for health away from the affected

population occur?

n/a




Health system performance

Key factors resulting in reduced coverage


[quality grade]

Overall strength

of information

Extent of

disruption

Timing of

disruption

61. To what extent could crisis risk factors reduce cov erage /

utilisation of primary curativ e

serv ices, and when?

62. To what extent could crisis risk

factors reduce cov erage /

utilisation of secondary/tertiary

curativ e serv ices, and when?


factors reduce cov erage /

utilisation of prev entiv e

serv ices (including v accination and antenatal care), and

when?

Key factors resulting in quality deteriorations


[quality grade]

Overall strength

of information

Extent of

disruption

Timing of

disruption 64. To what extent could crisis risk

factors reduce the quality of

health serv ices, and when?

Health status and threats

Deteriorations to food security, feeding practices and thus nutritional status


[quality grade]

Overall strength

of information

Magnitude of

need / threat

Timing of need /

threat 65. To what extent could any

worsening food insecurity have

an effect on nutritional status,

and when?





[quality grade]

Overall strength

of information

Magnitude of

need / threat

Timing of need /

threat 66. To what extent could

worsening feeding and care

practices hav e an effect on nutritional status, and when?

67. To what extent could

nutritional status deteriorate in different age groups (infants,

other children, pregnant and

lactating women, people liv ing

with HIV, general population),

and when?

Increased sexual and gender-based violence (war- or displacement-related)


[quality grade]

Overall strength

of information

Magnitude of

need / threat

Timing of need /

threat

68. Is there ev idence of combatants perpetrating

SGBV on the affected

population?

Immediate

69. To what extent could other

crisis risk factors increase SGBV

frequency, and when?

Factors worsening reproductive, maternal and neonatal health outcomes


[quality grade]

Overall strength

of information

Magnitude of

need / threat

Timing of need /

threat 70. To what extent could crisis risk

factors worsen reproductiv e,

maternal and neonatal health

outcomes, and when?

Factors increasing burden of the main endemic infections


[quality grade]

Overall strength

of information

Magnitude of

need / threat

Timing of need /

threat






[quality grade]

Overall strength

of information

Magnitude of

need / threat

Timing of need /

threat factors increase the burden of

the main endemic infectious

diseases, and when?

Main epidemic threats and their likelihood



of information Magnitude of need / threat

Timing of need / threat

72. Which epidemic-prone

diseases could cause outbreaks, with what attack

rate, sev erity, and when? Are

any happening now?

73. Which local infectious disease

eradication / elimination

programmes could be at risk of

setbacks, and when?

Extent of interruption of HIV and TB treatment





74. How many people’s HIV

treatment has been or may soon be interrupted, and when

could their health outcomes

start to deteriorate?

75. How many people’s TB

treatment has been or may

soon be interrupted, and when

could their health outcomes

start to deteriorate?

Extent of interruption of treatment for the main NCDs


[quality grade]

Overall strength

of information

Magnitude of

need / threat

Timing of need /

threat

76. How many people’s type 1





[quality grade]

Overall strength

of information

Magnitude of

need / threat

Timing of need /

threat (insulin-dependent) and type 2

diabetes treatment has been

or may soon be interrupted, and when could their health

outcomes start to deteriorate?

77. How many people’s hypertension treatment has

been or may soon be

interrupted, and when could

their health outcomes start to

deteriorate?

Number and typology of injuries


[quality grade]

Overall strength

of information

Magnitude of

need / threat

Timing of need /

threat

78. How many people are known or projected to hav e sustained

life-threatening trauma injuries,

and could substantial numbers

of trauma injuries continue to

occur ov er the foreseeable future?

Immediate

79. What is the observ ed or

expected typology of trauma injuries?

n/a

Status of people in mental health care institutions


[quality grade]

Overall strength

of information

Magnitude of

need / threat

Timing of need /

threat 80. What is known about the

safety and ongoing care of

patients in mental health care

institutions?

Immediate




Exposures to mental trauma and community perceptions


[quality grade]

Overall strength

of information

Magnitude of

need / threat

Timing of need /

threat 81. To what extent could the

prev alence and sev erity of

mental health problems

increase, and when?

Increased frequency of addiction





82. To what extent could

substance addictions could become more frequent, and

when?

Overall strength of information

Strength of

information

Number of

questions

% of All

Questions

High

Intermediate

Low

None

TOTAL: 100%

who | world health organization - key questions worksheet...hcct – session 2.3: key questions...

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