By Julius Agyei Okanta and Candela Iglesias Chiesa
Imagine dedicating six months to planning and launching a $5 million maternal and child health project, only to discover in your first year of implementation that it’s not addressing the community’s most pressing needs.
Unfortunately, as global or public health professionals, we have all seen cases similar to this example. Time and money wasted in projects that miss the mark. Communities rejecting initiatives that we thought were needed. Leaders blocking a project’s progress in a myriad small ways.
We all know what is needed to ensure a project is well-targeted to the needs on the ground and has a good chance of success from the start. However, this crucial piece of work is still sometimes skipped, overlooked, or carried out in a perfunctory way only.
We are talking, of course, of the humble “needs assessment” (or initial diagnosis, or whatever you would like to call it!)
At Alanda Health, we have seen first hand how health needs assessment can boost a project’s chances of success. In this post, we talk about what good needs assessments look like, and how to carry out a successful one.
Why are needs assessments needed?
Before launching any project, it’s essential to understand the landscape. Needs assessments provide invaluable insights that shape project design and implementation. Here’s are some reasons that make them so critical:
1) Checking for evidence: This is the literature review part of a needs assessment, and some organizations address this as a separate exercise. Regardless, it is important to become familiar with any available evidence that your proposed intervention works to attain the goals you’re aiming for, and in what contexts or under which conditions it works.
Otherwise, we risk replicating initiatives that have no or weak evidence of impact (or effectiveness).
Case in point: Some years ago we carried out a strategic evaluation in a subset of countries to understand what type of community interventions helped the most with health promotion and behavioural change. We were surprised to learn that properly trained and supervised Community Health Workers had good evidence of working, while other interventions such as health awareness and health promotion campaigns had much less available evidence of impact.
2) Alignment with Priority Needs: Rather than relying on assumptions, needs assessments ensure your project addresses the most pressing issues on the ground, based on recent data obtained directly from the people who will benefit from the project (aka target group or beneficiaries).
Case in point: a colleague recently explained how a needs assessment for a maternal health project in a remote community allowed them to talk to women and better understand their challenges. The women’s top priority was support with pushing back against early marriage for girls, not support for maternal health issues.
3) Understanding the local context: Needs assessments provide crucial information about local geography, and the so-called PESTLE (political, economic, social, technological, legal and environmental) conditions, which are crucial to adjust your project and determine potential risks
They also help you gather data about local health variables (which are hard to come by remotely, as most data available online is usually only disaggregated at the district level for many countries), and understand which are the vulnerable populations in this particular setting.
Lastly, you get to understand who the local players and key stakeholders are, and obtain an early mapping of potential partners, supporters, people who might be against the project, etc.
4) Getting clear on existing capacities, strengths and best practices that could be supported, scaled, and improved. Too many projects come in with a solution without even bothering to check if any locally developed solutions exist.
Usually, when there is a problem, someone in the community has either developed a solution or has found a way to not be affected by the problem (e.g. is an “outlier”), because they are doing things differently. By identifying local capacities and best practices, you can build upon what’s already working instead of reinventing the wheel.
Can I skip the needs assessment if I know the community/locality/country well?
I sometimes talk to organizations who have been working in a particular country, locality or community for a long time and think they can skip the needs assessment. My recommendation is always to carry one out, even if it’s a “ lighter” version. Why?
- Because things change quickly on the ground. Priorities for your target communities might look different today than what they did even a year ago. The same goes for potential roadblocks and key stakeholders.
- You might be very familiar with the country or the district, but if you are expanding or scaling an existing program, different districts or localities might have different needs, and there would definitely be different risks and stakeholders to map out, even in the next-door village.
- Any opportunity to engage with your target audience or beneficiaries is a great opportunity to take. This can allow for co-creation if you use the right participatory approaches, and for a project design that is user-centered.
How does a needs assessment work in practice?
At Alanda, one of our favorite needs assessments (and we’ve done a few!) was the one we conducted in Guyana some years ago. We were lucky to be able to partner with a public health specialist in Guyana, who knew the country and the players well.
We were supporting an international organization aiming to set up an ambitious project in health and climate change, and they needed the assessment to add to the project proposal they were sending to a donor.
What did we do?
1) We read and analyzed a big pile of documents to understand Guyana’s epidemiological situation, health risks, vulnerability to natural disasters, and climate change risks, taken into consideration the country’s geography, population needs, and infrastructure.
2) We Interviewed key stakeholders to fill gaps in the document review, compare data, determine if the project was relevant and feasible, identify necessary stakeholders for project success and determine where the roadblocks may appear.
3) We carried out focus group discussions with key groups to gather information on people’s views and perspectives to understand what could realistically be achieved.
4) We brought all of this data together, analyzed it and weaved it into a coherent and reader-friendly report that answered the key questions asked by our partner organization and helped them improve and refine their project.
A better diagnostic for better results
By ensuring we conduct a strong needs assessment, we can significantly enhance the impact of our global health projects. This ensures that projects are well-designed and truly beneficial to the communities they serve.
Source: Alanda Health
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