Measuring results of humanitarian action: Adapting public health indicators to different contexts

This paper explores adapting public health indicators, addressing measurement challenges, and discussing limitations to improve evaluations of health outcomes and the effectiveness of humanitarian actions in various contexts.

In this paper, Altare et al. (2022) address the public health risks posed by humanitarian crises, emphasizing the need for reliable information on health status and services for affected populations to prioritize public health actions, mobilize funds, and monitor humanitarian performance. The authors highlight the challenge of measuring health outcomes in these settings due to difficulties in implementing gold-standard methods. They advocate for the use of alternative, robust, and feasible indicators to measure health outcomes despite these challenges. The paper proposes an approach based on existing literature, expert judgment, and operational experience, categorizing contexts into four scenarios based on access to populations and resources. This framework suggests varying methods, from large surveys to rapid assessments, to better measure and improve the impact of humanitarian programs on health outcomes.

Key content

Key takeaways from the resource include:

Background

Humanitarian crises pose significant public health risks by exacerbating mortality, morbidity, and reducing access to quality healthcare. Reliable and timely information on health status and services provided to affected populations is essential for establishing public health priorities, mobilizing funds, and monitoring the performance of humanitarian action. Despite efforts to standardize public health information, measuring health outcomes in humanitarian settings remains challenging due to resource constraints and limited access to affected populations.

Public health indicators in use

Current public health monitoring frameworks in humanitarian settings often focus on process and output indicators rather than outcome and impact indicators. These frameworks provide adequate information on resources and activities but fall short in measuring the effectiveness of humanitarian actions. The review identified 800 unique indicators categorized into health status, quality, and coverage, highlighting the need for robust and practical measures in varying contexts.

Alternative indicators or methods according to various humanitarian contexts

The article proposes adapting public health indicators and methods to different humanitarian contexts, defined by two main parameters: access to the population or health facilities and availability of resources. Four scenarios are outlined:

• Scenario A: Accessible populations with available resources.
• Scenario B: Available resources but limited access to populations.
• Scenario C: Accessible populations but limited resources.
• Scenario D: Both limited access and resources.

Operationalization of indicators for various humanitarian contexts

The article presents a 2 × 2 table framework to guide the selection of appropriate methods for measuring key constructs in each context. For example, antenatal care coverage can be measured through population-based surveys when resources and access are available, or through sentinel health facilities when both are limited. This approach aims to ensure that performance indicators are feasible and practical, even in challenging environments.

Methodological issues and limitations

The article discusses several methodological considerations:

• Feasibility vs. representativeness: There is often a trade-off between the feasibility of a measurement method and the representativeness and comparability of results.
• Interpretation and aggregation: Different methods require different approaches to interpretation and aggregation. Estimates from surveys and health facility data should not be directly compared but can provide useful information when contextualized.
• Transition between methods: Transitioning between methods as contexts change can be challenging. The article suggests analyzing results at the sub-construct level and integrating qualitative appraisals to provide a comprehensive understanding of performance.

Conclusion

Monitoring health service coverage, quality, and population health status is critical for evaluating the effectiveness of humanitarian assistance. Adapting measurement methods to each context allows humanitarian actors to gain insights into key health constructs, improving accountability and response effectiveness. The proposed approach aims to enhance consistency in measuring humanitarian action performance, ultimately better meeting the health needs of affected populations. Future efforts will focus on the practical implementation of this approach and developing guidance for interpreting and using data in humanitarian settings.