Marco de Análisis de Necesidades

Un Marco de Análisis de Necesidades o Needs Analysis Framework (NAF) permita el análisis de las necesidades humanitarias en un país, para así poder construir una estrategia de respuesta por parte de la comunidad humanitaria. Se entiende que el NAF es un primer paso en la construcción de un Consolidated Appeals Process (CAP), aunque se puede utilizar como una herramienta en la construcción de cualquier estrategia de respuesta por parte de un Equipo País. Es una herramienta específicamente dirigida a los Coordinadores Humanitarios y las Agencias miembros de la planeación humanitaria.

Preguntas Frecuentes sobre el Marco de Análisis de Necesidades

¿Qué es un Marco de Análisis de Necesidades (NAF)?

Este Marco sirve como una herramienta diseñada a ayudar a los Coordinadores Humanitarios y los Equipos País del IASC organizarse y presentar a la información existente sobre las necesidades humanitarias de una manera coherente y consistente. Esto ayudará a fortalecer el análisis de las necesidades humanitarias.

¿Por qué fortalecer la presentación y análisis de las necesidades?

La disponibilidad de una información consolidada sobre los requerimientos humanitarios dará las herramientas a los Coordinadores Humanitarios y Equipos País IASC identificar las brechas en la información y acordar en expandir o repetir evaluaciones. Esto ayudará en el desarrollo de estrategias y programas que enfocan sobre las necesidades priorizadas.

¿Cuales son los incentivos para que las Agencias participan?

• El proceso aumenta la contabilidad
• Aumenta el profesionalismo
• Da evidencia para la incidencia
• Elementos concretos que se puede utilizar para aumentar la financiación está incluídas

¿Qué deben hacer los Coordindaroes Humanitarios y Equipos País IASC con el Marco?

Los Coordinadores Humanitarios y Equipos País IASC deben utilizar el marco como un borrador para consolidar evaluaciones de necesidades existentes y otra información de base y analizarlos anterior al desarrollo de un plan de respuesta. Para este fín, un serie de pasos deben ser tomados (ver Plan de Implementación de Muestra). Los Equipos País IASC (incluyendo las ONG y Movimiento de la Cruz Roja), donantes y autoridades locales pueden ser involucrados en el proceso. El CH, apoyado por OCHA, asegurará la coordinación a tiempo y compartir información con otras agencias involucradas en el ejercicios de evaluación y recogida de información existente.

NO se espera que:

• Se rellena el marco 100%, dado que alguna información que se sugiere puede ser no disponible. Los indicadores y descriptores son sugerencias que ayudan en sistematizar la información existente.
• Se lleva a cabo evaluaciones adicionales. Sin embargo, un Equipo País puede decidir hacerlo, si hay grandes cantidades de datos que hacen falta y se podría obtener.
• Se modifique las metodologías de evaluaciones de necesidades ya utilizadas por agencias particulares. Sin embargo, en lo posible las agencias deben involucrar a otras agencias, ONG y donantes en sus evaluaciones, discuten y acordarse sobre Terminos de Referencia y metodolíga y utilizar el NAF como una herramienta de referencia.

Cómo avanzar:

• Las agencias deben ser organizados por sectores o tema transversal y planear el proceso para consolidar y analizar la información conjuntamente. Esto requiere tiempo del personal.
• Las agencias deben compartir todas sus evaluaciones de su área de experticia.
• Las agencias deben sintetizar la información disponible, acordar sobre un análisis compartido y conclusiones, y poner sus conclusiones en un informe coordinado por OCHA. Este informe final no debe pasar los 25 páginas, con un resumen de no más de dos páginas. Esto se incorporá luego en un Plan Estratégico.

¿Qué papel juega el NAF en el monitoreo y evaluación, y en la recuperación?

El CH, apoyado por OCHA, fomenta el enlace entre el NAF y otras herramientas utilizadas para el monitoreo y evaluación, igual que otras herramientas que responden a la recuperación temprana y el desarrollo.

Resumen del NAF

El Marco no es más ni menos que una estructura para documentar los resultados y conclusiones de información de una manera sistemática entre un país. Tiene la intención de asistir en la recolección de la información para construir las necesidades generales y sectoriales.

Las secciones, indicadores y descriptores relacionadas a cada área de trabajo en el marco, son sugerencias que ayudan en describir la situación de una manera sistemática. Esto también permite análisis de tendencias, comparación entre poblaciones y zonas en un contexto de crisis, y mostrar la información agregada en un nivel de contexto.

Se entiende que el NAF puede ser formulado de la información ya disponible. Los equipos país pueden adaptar el Marco a su contexto, ajustandolo por sección para que sea más útil.

Si la información requerida es relevante pero no disponible, esto debe ser explicado (e.g., restricciones de seguridad, falta de capacidad para nuevas evaluaciones, etc.). Las brechas en la información pueden causar nuevas evaluaciones para llenar la brecha en el concomiento.

El proceso también puede estimular la sincronización en el tiempo y la coordinación geográfica de evaluaciones específicas por sector hacía la formulación de un marco estratégico. Puede ayudar en identificar a oportunidades en donde una evaluación conjunta entre sectores tendría un valor agregado para el análisis y el entender de las necesidades humanitarias.

Aspectos Técnicos y Control de Calidad

El NAF no entra en el tema de metodologías específicas de evaluaciones, escoger la metodología sigue siendo la opción de las agencias individuales y las necesidades que hay que adaptar a las necesidades en la información en cada sector.

El control de calidad de la información en el marco es fundamental: los equipos rellenando el marco deben indicar la fuente de la información; quien lo recogió; la metodología utilizada (por ejemplo mostreo) y los limites de esta metodología; la población específica a cual se relaciona; el marco de tiempo y su contexto.

Los datos son políticamente sensibles en muchas situaciones y pueden existir discrepancias entre los numeros oficiales y no oficiales (e.g., conteo de refugiados, tasas de malnutrición, etc.). Frecuentemente la información no es disponible o no se puede depender en ella. Las dificultades de obtener datos cuantitativos de calidad, particularmente en contextos de crisis, pueden incluir: problemas de metodología; problemas de acceso a las poblaciones afectadas haciendo la recolección de los datos imposible; problemas de capacidad (tales encuestas requieren tiempo y dinero, y personal calificada); una falta de una linea de base, y datos demográficos básicos.

Marcos de Análisis

Los crisis humanitarios son el resultado de una interacción compleja de una gran cantidad de factores; y estos se representan por las secciones diferentes del NAF. Los elementos subyacentes son interdependientes, y los problemas multi-causales. Estas interacciones pueden diferir en cada contexto. Para establecer una visión relevante en causalidades e interdependencia, cuando las necesidades relacionadas a una área específica han sido defenidas se debe hacer preguntas básicas tales como, '¿qué puede haber causado o contribuido a estas necesidades?', y '¿cómo es que éste factor influye otros áreas de preocupación?'.

Los marcos de análisis se utiliza para mejor entender la intedependencia de estos factores y su impacto en la situación humanitaria en general.

Lo ideal es que para cada crisis, el equipo país debe desarrollar un modelo de análisis, especificando las variables claves y las interrelaciones en un contexto particular. Tal modelo ayuda en enfocar la atención en qué información recoger, la naturaleza de la relación entre los variables, y determinar cómo cada uno contribuye a los resultados humanitarios examinidos. Existen varios ejemplos de modelos utilizados en ciertos sectores, tales como nutrición y seguridad alimentaria.

Modelo NAF

El modelo NAF muestra claramente los entrelazos de distintos factores en un crisis humanitario típico. Cada elemento representado en el diagrama deben ser evaluados tanto en su propio sentido como una parte del análisis completo. El modelo busca ofrecer una estructura sistemática para la información del NAF, y podría ser utilizado como un punto de partida para en análisis causal. El resultado del NAF debe ser una panorama clara de las necesidades y sus causas - resultando en los mejores posibles decisiones para priorizar los recursos para una acción humanitaria efectiva.

Elementos NAF:Factores Subyacentes

Gobernanza

La situación general

• Situación política
• Descripción del contexto, sus antecedentes
• Funcionamiento del gobierno nacional y sus ministerios, en el nivel central y regional
• ¿Qué es la opinión pública hacía la asistencia y presencia internacional? ¿Hacía el gobierno y las partes en el conflicto?
• Capacidad del gobierno responder a las necesidades de la población
• Marcos legales para enfrentar a emergencias, el desplazamiento, etc.
• Aspectos del contexto regional e internacional que podrían afectar al contexto nacional, e.g., inestabilidad, expansión del conflicto, tensiones fronterizos, etc.
• Medioambiente y recursos naturales: si existe una degradación de los recursos naturales o una escasez es un factor contribuyente a una situación humanitaria, ¿qué es la capacidad del gobierno para enfrentar el problema? Si las condiciones medioambientales causan altos niveles de vulnerabilidad, ¿cuál es la capacidad nacional para respuesta a desastres?

Coordinación

• La existencia de un mecanismo de coordinación
• La calidad del mecanismo de coordinación

Situación de seguridad

• Descripción general: conflicto abierto, minas antipersona, desalojos y secuestros
• Impacto sobre la población, en terminos de libertad de movimiento; acceso a alimentos (cultivos, ganadería...), agua, servicios de salud, mercados.
• Respuesta de seguridad: ¿quien asegura la seguridad de la población (militares, policía, milicias, fuerzas de paz)?
• ¿Quién asegura el desminado humanitario? ¿La respuesta general es suficiente y apropiada?
• ¿Estos actores de seguridad involucrados ponen a la población en mayor riesgo - por su propio comportamiento, o por su presencia?
• Hacer una lista de las amenazas potenciales de seguridad a la acción humanitaria
• Un estimado del porcentaje de la zona o de la población afectada que pueden ser alcanzadas:
  • sin preocupaciones de seguridad, y
  • con medidas/procedimientos adecuados de seguridad (MOSS, etc.)
• Otros factores relevantes de contexto

Demografía

Descripción de grupos:

• Población total
• Poblaciones de desplazados, refugiados, patrones de migraciones, lugares de origen
• Poblaciones nomádicas
• Tasa de nacimiento, tasa de fertilidad
• Estátus legal
• Ubicación geográfica
• Número de personas desaparecidas
• Tamaño promedio de hogar
• Hogares con mujeres jefe de hogar
• Racios de dependencia a jefe de hogar
• Números de huerfanos y/o niños abandonados
• Otros factores relevantes del contexto

Medioambiente y recursos naturales: Los indicadores demográficos también deben incluir el porcentaje de la población nacional u objeto viviendo en zonas urbanas o rurales tanto como la proporción de la población involucrada en agricultura y producción de ganadería. Esto indica la dependencia potencial de la población sobre los recursos naturales - y la vulnerabilidad potencial frente a una escasez de recursos naturales o una degradación o fluctuaciones de mercado.

Los datos deben ser desagregados por edad y sexo hasta dónde se puede (racio de sexo), % debajo de la edad de 5, % de mujeres edad 15-49, % de la población edad 15-19, mayor de 65)

Contexto Económico

• Situación económica, PIB per capita, Crecimiento PIB
• % del PIB gastado en salud y educación
• Costo de la canasta de comida mínima
• Proporción de la población debajo de US$ (Paridad de Poder Adquisitivo) diario
• Racio de empleo de la población frente a edad de trabajo
• Tasa de desempleo
• Empleo en el sector informal como porcentaje de empleo total
• Otros factores relevantes al contexto

Medioambiente y recursos naturales: El porcentaje del PIB representado por los sectores de agricultura y ganadería. Esto también indica la dependencia potencial de la población sobre los recursos naturales y sus potencial vulnerabilidad frente a una escasez de los recursos naturales o su degradación tanto como fluctuaciones de mercado.

Contexto sociocultural

• Una descripción breve del contexto social y cultural al nivel comunitario
• Índice de desarrollo humano
• Clases
• Grupos étnicos
• Grupos políticos
• Grupos linguísticos
• Diversidad religiosa
• Otros factores relevantes al contexto

Medioambiente y recursos naturales: Si una degradación o escasez de los recursos naturales es un factor contribuyente a la situación humanitaria, esta sección debe incluir alguna información básica sobre los sistemas de tenencia de la tierra, patrones de uso de tierras, y cualquier dimensión de genero en el uso de los recursos naturales.

Contexto ambiental

1. Ambiente físico: Un perfil general del ambiente físico y rasgos claves en presentar los riesgos presentes:
   1. Geografía
   2. Clima
   3. Amenazas naturales recurrentes (e.g., inundaciones, terramotos, sequía, incendios)
   4. Vulnerabilidades ambientales (desforestación, erosión de la tierra, contaminación de fuentes de agua)
2. Causas principales y conflicto: describe cómo la escasez de los recursos naturales, la degradación medioambiental o las condiciones físicas ambientales están contribuyendo a la situación humanitaria como causas principales. ¿Cuales son los principales tendencias? Describe si un conflicto significativo existe sobre usos competitivos de recursos naturales escazos, y si este conflicto podría resultar en una inestabilidad al nivel nacional o local. Describe zonas claves que presentan riesgos en particular a las poblaciones (e.g., inundaciones súbitas, sequía, erosión, etc.)
3. Presiones y vulnerabilidades: ¿Cuales recursos naturales o bienes y servicios medioambientales están siendo utilizados para alcanzar las necesidades humanitarias? ¿Qué es la disponibilidad de estos recursos para alcanzar demandas del momento? ¿Los niveles de extracción en el momento son sostenibles sin crear nuevas fuentes de vulnerabilidad en el corto y mediano plazo (e.g., erosión de tierras, inundaciones, deslizamiento, sequía, impactos en la calidad/cantidad de agua)? Si no, ¿cual es el riesgo de desplazamiento humano o conflicto?
4. Impactos medioambientales: En el caso de una emergencia súbita, ¿cuales recursos naturales o servicios ambientales han sido impactados y cómo exacerberá la situación humanitaria o aumentar las vulnerabilidades? ¿Cuál es el tiempo de recuperación o rehabilitación estimado?
5. Amenazas humanas: describe cualquier sitios industriales de gran tamaño, instalaciones o infraestructura que puede ser vulnerable a los efectos de los desastres naturales o cuales son amenazas contínuas a poblaciones.
6. Recuperación: ¿Cuál recurso natural estará en alta demanda para alcanzar las necesidades en la recuperación? ¿Cuál es la disponibilidad de estos recursos para responder a necesidades en el futuro? ¿Qué es la probabilidad de que las demandas en el futuro puede ser sostenidos sin crear nuevas fuentes de vulnerabilidad en el corto y mediano plazo (e.g., erosión de tierra, inundaciones, deslizamientos, sequía, impactos en cantidad/calidad de agua)? Si no, ¿cuál es el riesgo para el desplazamiento humano o conflicto?

Elementos del NAF: Factores Específicos por Sector

Protección

• Estátus de la ratificación de, reservaciones a, obligaciones de reporte debajo, instrumentos internacionales de derechos humanos.
• Estátus de seguimiento a las conclusiones de las observaciones de los cuerpos de tratados de las Naciones Unidas.
• Descripción del marco institucional ofreciendo protección a individuos incluyendo a estructura, acceso y funcionamiento de órganos de seguridad, judicatura tanto como instituciones de derechos humanos, tales como defensoría
• Descripción del progreso hecho y déficits que quedan en la protección del derecho a la vida y libertad de tortura, incluyendo actos de genocidio, ejecuciones extra-judiciales, nivel de protección frente a crimenes cometidos por actores no estatales.
• Descripción de violaciones de derecho internacional humanitario
• Descripción de violaciones del principio de non-refoulement de refugiados
• ¿Son los ciudadanos, personas sin estado, buscadores de asilo y refugiados, personas desplazadas y retornados sujetos a arresto o detención arbitrario? Da indicaciones sobre el tiempo, dureza e impacto de la detención sobre las comunidades.
• ¿Existen deficits en el registro individual y documentación de personas quedando en el país? Especifique quien está afectada y ofrece indicaciones sobre el impacto de tales deficits para los individuos en cuestión.
• ¿Los buscadores de asilo, refugiados y personas sin estado quedando en el país tienen un estátus legal claro? ¿Los derechos acordados a ellos están de acuerdo al derecho internacional?
• Describe la existencia de legislación o prácticas discriminatorias.
• ¿Qué tendencias existen? Toma en cuenta la situación pre-crisis si sea posible o relevante.

Para completar este capitulo, cuando esto sea relevante, se recomienda utilizar los informes de cuerpos de tratados tales como informes nacionales presentados de acuerdo a convenciones internacionales.

Protección de Niñez

1. ¿Qué riesgos y amenazas se enfrentan los niños, niñas y adolescentes frente a abuso, explotación, violencia y deprivación de cuidado de padres? Cuando sea posible da números (cuando esto sea relevante). De otra manera da indicaciones sobre la naturaleza y tamaño del problema.
   1. Niños sin cuidado primario (incluyendo niños separados y no acompañados)
   2. Abuso doméstico y negligencia
   3. Reclutamiento en las fuerzas armadas
   4. Secuestro
   5. Tráfico
   6. Deprivación arbitraria e ilegal de su libertad
   7. Abuso sexual, explotación y violencia
   8. Castigo corporal
   9. Riesgos a la seguridad o heridos, incluyendo minas antipersonal, municiones no explotados y armas pequeñas; bajas de menores de edad en conflicto armado
   10. Bodas tempranas y arregladas
   11. Mutilación genital de mujeres
   12. Consecuencias psicológicas y sociales de situaciones de emergencia
   13. Otros factores específicos al contexto
2. ¿Cuáles grupos de menores están en mayor riesgo de abuso, explotación y violencia en general, y con respecto a los riesgos y amenazas mencionadas en particular?
3. Mapeo de elementos claves de un ambiente protectivo para niños

Protección de violencia basada en género (violación, explotación y abuso sexual, tráfico, violencia doméstica)

• Consideraciones de VSBG en la provisión de albergue, alimentos, aguas y estructuras y manejo de saneamiento, y recogida de comustibles. Recordar la vulnerabilidad de personas descapacitadas.
• Monitoreo de seguridad y estrategia de protección definida, incluyendo el establecimiento de un grupo de coordinación que también incluyendo a representante de grupos de mujeres
• Redes con jueces, fiscales, policía y sistemas tradicionales establecidas para asegurar que leyes existentes relacionadas a la violencia sexual se mantiene, y que la protección se da de acuerdo a las necesidades
• Incidencia hecho para cumplimiento e implementación de instrumentos internacionales
• Un mecanismo confidencial de informe puesto y servicios de referencias disponibles incluyendo albergues, consejería, rehabilitación y servicios de apoyo para mujeres víctimas de violencia o en riesgo de violencia
• Servicios uniformados, lideres culturales, autoridades y grupos de mujeres sensibilizados sobre VSBG y la disponibilidad de servicios y mecanismos de reporte, grupos armados informados/entrenados sobre el DIH
• Consideraciones de balance de genero en el reclutamiento de personal y manejo de recursos humanos

Educación

• Racio neto de matricula en educación primaria (por género)
• Proporción de alumnos empezando grado 1 quienes llegan a grado 5 (por género)
• Tasa de alfabetismo edad 15-24 (por género)
• Matricula en educación secundaria como porcentaje por grupo de edad correspondiente
• Número de instituciones, estudiantes (niño y niñas) y profesores en diferentes niveles:
  • Pre-escolar
  • Primaria
  • Secundaria
  • Vocacional
  • Otro
• ¿Cuántos individuos participan en 'espacios amigables a la niñez'?

How many individuals participate in ‘child friendly spaces’? Describe the state of schools and schools supplies? • Potable water in school area • Latrines • Building condition • Furniture • Textbooks • School supplies Describe the extent to which education needs of this specific population are met (e.g. percentage and/or number of people enrolled in what type of education, student/teacher ratio)

CVA/gender: using disaggregated data, are there any significant differences between and within groups and/or locations (e.g. groups most affected due to gender, age, disability, people living with HIV/AIDS, ethnicity, poverty, etc)? Specific protection concerns: e.g. abuse by teachers, rebel attacks, exploitation, which compromises the ability to have equal access to education due to potential vulnerability factors (e.g. gender, age, disability, people living with HIV/AIDS, ethnicity, discrimination and/or special needs relating to legal status or displacement, e.g. language barriers and religious freedom, etc.) Conclusion: Judgement of the severity and associated risks for potential consequences with regard to education. What are the most vulnerable groups, which areas are most affected? Compared to which reference values? What are the trends? Over what time frame (including reference to the pre-crisis situation if possible or relevant)?

Availability and Adequacy of Shelter and Settlement Describe the availability and adequacy of shelter and settlement Covered living space • Do people have sufficient covered space to provide dignified accommodation? • Can essential household activities be satisfactorily undertaken, and livelihood support activities can be pursued as required? • Number of persons per room, or average floor area per person Design Is the design of the shelter acceptable to the affected population and provides sufficient thermal comfort, fresh air and protection from the climate to ensure their dignity, health, safety and well-being? Clothing and bedding Do people affected by the disaster have sufficient clothing, blankets and bedding to ensure their dignity, safety and well-being? Cooking and eating utensils Is there access to cooking and eating utensils for disaster-affected households? CVA/gender: using disaggregated data, are there any significant differences between and within groups and/or locations (e.g. groups most affected due to gender, age, disability, people living with HIV/AIDS, ethnicity, poverty, etc)? Environment and natural resources: Are shelter or energy needs being supplied by forests, woodlands, or ground vegetation and are harvest rates sustainable? Will continued extraction lead to new vulnerabilities in the short and medium terms (e.g. erosion, flooding, landslides)? Are any hazardous materials being used to meet shelter needs (e.g. asbestos) ? Specific protection concerns, e.g. abuse, violence and/or exploitation, which compromises the ability to have equal access to shelter and safe settlement due to potential vulnerability factors (e.g. gender, age, disability, people living with HIV/AIDS, ethnicity, discrimination related to citizenship, refugee or other legal status, etc.) Conclusion: Judgement of the severity and associated risks for potential consequences with regard to shelter and settlement. What are the most vulnerable groups, which areas are most affected? Compared to which reference values? What are the trends? Over what time frame (including reference to the pre-crisis situation if possible or relevant)?

Food Security Situation Analysis Purpose: To determine the current and evolving food security situation based on available current secondary information e.g. early warning, vulnerability baseline and assessment information, including an analysis of underlying causes. The situation analysis provides a synthesis of the food security situation. It can be informed by a livelihoods approach addressing access to and control of assets, as well as the potential for livelihood recovery. Protection and security concerns may also be critical. Dimensions and Causes of Food Insecurity The analysis examines the underlying causes of food insecurity based on the following dimensions (to the extent possible): Food availability: Levels of local and national food stocks; food production forecasts; expected levels of imports; main areas of surplus/deficit; and degree of market integration; staple food price trends; price trends of other essential goods and services (cooking fuel, rents, taxes); administrative regulations inhibiting the movement of goods and/or influencing staple food prices; capacity of the markets to meet the demand for food now and in the future. Food Access: General situation/impact of the crisis on the local economies including employment opportunities and demand for local products and services; when and to what extent economic activity and the demand for local products and services are expected to recover. This includes the impact on the main sources of food and income; level of obligatory expenditures and/or proportions of obligatory expenditures out of total expenditures; estimated degree of food access shortfall; estimated access shortfall of essential goods and services. (MDG Food and Nutrition indicator: if available include proportion of household income spent on food for the poorest quintile; MDG Poverty and Hunger: Refer to section on Economic context for indicators related to proportion of population under poverty line and poverty gap ratio – the latter just been introduced) Food Utilization: Current food consumption patterns (diversity, frequency) for each distinct population group; their ability/constraints to prepare food; intra-household food consumption practices (children, adult women and men, the elderly and most vulnerable individuals); current nutritional status and main causes (food consumption, health, care); mortality rates (disease-related and from other causes); water, sanitation and other public health concerns threatening lives and nutritional status . (MDG Food and Nutrition Indicators: Refer to previous section on Nutrition for indicators related to prevalence of underweight children under five years of age and proportion of population below minimum level of dietary energy consumption.) Environment and natural resources: Are food security issues related to declining productive capacity of local soils due to overuse or soil erosion? Are current water extraction levels for irrigation or livestock sustainable? If not, will unsustainable extraction levels lead to permanent damage to groundwater aquifers or downstream resources? Do competition and the potential for conflict exist between water demands for food production, livestock, domestic consumption and industrial production? Are agricultural chemicals (pesticides and fertilizers) causing significant soil or water contamination that could threaten human health or soil productivity? Are energy needs for cooking being supplied from local forests, woodlands or ground vegetation and are extraction rates sustainable? Will continued extraction lead to new vulnerabilities in the short and medium term (e.g. erosion, landslides and flooding)?

Affected Area and Population The analysis identifies areas and population groups affected by food insecurity. For each population group the following information should be considered: • Location; • Profile; • Approximate number; • Severity of food insecurity.

The situation analysis should also consider future food security scenarios. The likely change in the food security situation over time i.e. risk, vulnerability and stability factors. Ensuring availability and access to food "at all times" requires the analysis of the dynamics of the context and seasonality.

Response Options Analysis and Recommendations Purpose: To identify immediate and longer term response options that are appropriate and feasible and to make recommendations concerning what specific food security responses should be undertaken. Response Options Analysis The section will identify: • Immediate food security responses i.e. those that provide direct and immediate response to food availability , access and utilization; • Longer term food security responses that strengthen livelihood options.

The appropriateness and feasibility of each response should be assessed considering: • Review of ongoing food security responses; • Overview of implementation capacities by government and other relevant agencies; • Complementarities between immediate and longer term food security responses; • Synergies between food security response options and other sectoral responses; • Pros and cons of various response options. Recommended Responses Specification of appropriate and feasible food security responses for affected populations/groups requiring assistance.

Monitoring and further assessment Purpose: To monitor responses adopted and determine their adequacy to meet assessed needs, as the situation evolves. This will provide guidance with respect to the appropriateness of the responses undertaken. The following aspects should be identified: • Specific aspects/indicators to be monitored during the next 3/6/12 months, particularly those indicators expected to change; • Arrangements (or responsibilities) for monitoring including funding implications; • Recommendations for follow-up assessments based on identified information gaps gained from the situational analysis, if appropriate; • Linkages to the UNDAF Common Country Assessment Tool.

Access to and Performance of the Health System, Reproductive Health, Nutrition and Mental Health/ Psychosocial Services What information is available to describe the health system? • How is the health system organised? • What is the capacity and availability of the health infrastructure? • What is the situation with regards to human resources in the health and nutrition sector? • How is the health system financed? • How are medicines procured? Are health services adequately coordinated, also with other sectors, to achieve coherence and maximum effectiveness? How does the Health Information System function, including surveillance, early warning mechanisms, etc? Are services guided by ongoing coordinated collection, analysis and utilisation of public health data? What is the national capacity for disaster/outbreak preparedness and response? • Are there contingency plans and/or other measures to be prepared for and respond to the known hazards in the country, including outbreaks of infectious diseases? • Do people have access to information and services that are designed to prevent communicable disease? • Are there adequate services to diagnose and treat large numbers of the potentially epidemic infectious diseases?

Access to health services • Do people have equitable access to adequate preventive and curative health services to address the most important causes for mortality and morbidity? • Are there barriers to access to health care? Physical distance? User-fees?

Performance of health services Describe the performance of the health services. • Are services based on appropriate standards, protocols and guidelines? • Are there adequate referral mechanisms?

Mental health/psychosocial services Describe availability and performance of social and mental health services to reduce mental health morbidity, disability and social problems Do people have access to psychosocial and mental health services to reduce mental health morbidity and social problems?

Other non-communicable diseases • Are there adequate services for people with disabilities, injuries and/or physical trauma • Are there adequate services for people with chronic diseases?

Reproductive health Describe the reproductive health services available • Are there services for care of pregnant women? Antenatal care, normal deliveries, emergency obstetric care? • Do people have access to a Minimal Service Package to respond to their reproductive health needs? • Are health services able to detect and address gender based violence? • Is there good coverage for Essential and Emergency Obstetric Care?

Nutrition programs Describe the availability and performance of nutritional programs to reduce malnutrition and correct micronutrient deficiencies • Do people have access to adequate services correcting Moderate Malnutrition? • Do people have access to adequate services correcting Severe Malnutrition? • Do people have access to adequate services correcting Micronutrient Malnutrition? CVA/gender: using disaggregated data by gender and age, are there any significant differences between and within groups and/or locations that make certain people more vulnerable for specific health problems, and/or reduce their access to available services? (e.g. describe groups most affected and/or excluded from services either due to gender and gender roles, age, pregnant or post-partum women, disability, people living with HIV/AIDS, ethnicity, poverty, socio-cultural aspects, etc.)? If so, what makes people vulnerable, what capacities exist among these groups? Are there specific target groups and/or areas that should receive prioritised attention? Environment and natural resources: How is medical waste disposed? Are current medical waste disposal practices leading to significant health risks or significant environmental contamination? Specific protection concerns, violence, deliberate exclusion, stigmatisation, etc, which compromises the ability to have equal access to services due to potential vulnerability factors Conclusion: Judgement on performance of the health system and nutrition services, if they are adequately organised and managed to deliver prioritised services. What are constraints that prevent the delivery of, or access to services? Do the health services effectively prevent and/or addresses the most important health needs (causes of Mortality, morbidity, malnutrition, etc), with adequate coverage. What are most important gaps and/or constraints? Compared to which reference values? What are the trends? Over what time frame (including reference to the pre-crisis situation if possible or relevant)? What are the most vulnerable groups, which areas are most affected?

Nutritional Status and Nutrition Related Morbidity What information is available on the nutritional status of the affected population? • For example for children aged 6-59 months: • Acute malnutrition rate, wasting (<-2 Z scores Weight/Height, or <80% median Weight for Height, and/or oedema), • Severe malnutrition (<-3 Z scores Weight/height or <70% median Weight for height), and oedema • Chronic malnutrition rates, stunting (< -2 Z scores Height/age or <80% median height/age) • Prevalence of underweight children under five years of age (<-2 Z scores Weight/age or <80% median Weight/age • Proportion of population below minimum level of dietary energy consumption • For adults; % underweight BMI <18.5 • Micro-nutrient deficiencies (e.g. any cases of scurvy, pellagra, beriberi; rates of xerophthalmia, Vitamin A, and iodine deficiency disorders; anaemia). • Anaemia in pregnant and lactating women • What are the trends? Over what timeframe? CVA/gender: using disaggregated data, are there any significant differences between and within groups and/or locations (e.g. groups most affected due to gender, age, disability, people living with HIV/AIDS, ethnicity, poverty, etc.)? If so, why?

Environment and natural resources: Comment on the nutrient quality and productive capacity of the soils were local agricultural products are produced. Has soil nutrient quality declined overtime due to non-sustainable production practices? Protection concerns which affect malnutrition due to potential vulnerability factors, deliberate exclusion or marginalisation, etc Conclusion: Judgement of the severity. Compared to reference values, trends, seasonal influences, within context of food security, links with diseases, etc. What are the most vulnerable groups, which areas are most affected?

Access to Improved Water Sources, Sanitation and Hygiene Practices What information is available to describe the Water Supply System? Describe the water distribution system available • Water distribution system available to each population group (small town system, boreholes, hand dug wells, gravity supply, spring catchment, rainwater, river/lake/stream, etc) • Percentage of population that has access to what distribution system. Describe the access to quality and quantity of water and water use facilities and goods • Do people have safe and equitable access to a sufficient quantity of water for drinking, cooking and personal and domestic hygiene? • Are public water points sufficiently close to households to enable use of the minimum water requirement? • Is the water palatable, and of sufficient quality to be drunk and used for personal and domestic hygiene without causing significant risk to health? • Do people have adequate facilities and supplies to collect, store and use sufficient quantities of water for drinking, cooking and personal hygiene, and to ensure that drinking water remains safe until it is consumed? • Is chlorine (bleach) available on the local market? • Proportion of population with sustainable access to an improved water source, urban and rural CVA/gender: using disaggregated data, are there any significant differences between and within groups and/or locations (e.g. accessibility of groups most affected due to gender, age, disability, people living with HIV/AIDS, ethnicity, poverty, etc)? Environment and natural resources: Are upstream and downstream, as well as surface and groundwater dynamics known? Are current extraction levels sustainable? If not, will unsustainable extraction levels lead to permanent damage to groundwater aquifers or downstream resources? Do competition and the potential for conflict exist between water demands for food production, livestock, domestic consumption and industrial production? Are total water consumption needs considered in an integrated way? Protection concerns: e.g. abuse, violence and/or exploitation, which compromises the ability to have equal access to water due to potential vulnerability factors (e.g. gender, age, disability, people living with HIV/AIDS, ethnicity, discrimination related to citizenship, refugee or other legal status, etc.) Conclusion: Judgement of the severity and associated risks for potential consequences with regard to water supply. Which are the most vulnerable groups? Which areas are most affected? Compared to what reference values? What are the trends? Over what time frame (including reference to the pre-crisis situation if possible or relevant)?

What information is available to describe Sanitation and Hygiene Practices? Describe the excreta disposal systems available • Excreta disposal system available to each population group (piped sewage system, septic tanks, flush & pit latrines, dry pit latrines, compost latrines) • Percentage of population that has access to what excreta disposal system Describe access to, number, design and use of toilets • Do people have adequate numbers of toilets, sufficiently close to their dwellings, to allow them rapid, safe & acceptable access at all times? • Are they sited, designed, constructed and maintained in such a way as to be comfortable, hygienic and safe to use? • Proportion of population with access to improved sanitation Vector control • Do people have the knowledge and means to protect themselves from disease and nuisance vectors that are likely to represent a significant risk to health? • Are numbers of disease vectors that pose a risk to people’s health kept at an acceptable level? Solid Waste management • Do people have an environment that is acceptably uncontaminated by solid waste, including medical waste? • Do people have the means to dispose of their domestic waste conveniently and effectively? Hygiene • Availability of soap for personal hygiene and for washing clothes etc. • Is chlorine (bleach) available? • Availability of culturally appropriate sanitary napkins and underwear for menstruation age women and girls CVA/gender: using disaggregated data, are there any significant differences between and within groups and/or locations (e.g. groups most affected due to gender, age, disability, people living with HIV/AIDS, ethnicity, poverty, etc)? Environment and natural resources: What are the risks to human health from current sources of waste (solid, liquid, hazardous) and disposal practices (landfill, burning, dilution, etc). Is waste being disposed near waste sources (surface/ground), productive agricultural areas or in environmentally sensitive areas? Is any hazardous waste being re-used to meet shelter needs? Specific protection concerns, e.g. abuse and/or exploitation, which compromises the ability to have equal access to sanitation and to practise safe hygiene due to potential vulnerability factors (e.g. gender roles, age, disability, people living with HIV/AIDS, ethnicity, discrimination related to citizenship, refugee or other legal status, etc.) Conclusion: Judgement of the severity and associated risks for potential consequences with regard to sanitation and hygiene practices. What are the most vulnerable groups, which areas are most affected? Compared to which reference values? What are the trends? Over what time frame (including reference to the pre-crisis situation if possible or relevant)?

NAF Elements: Community Capacity

Community Vulnerability, Coping Strategies and Capacities Using the CVA matrix of the CHAP, describe the key capacities and vulnerabilities at national and community level: Capacities: Describe the existing strengths in individual and social groups. What are people’s materials and physical resources, their social resources and their beliefs and attitudes? What is the ability of people to cope with crises and recover from it? Vulnerabilities: describe the long-term factors that weaken the ability of people to cope with sudden onset or drawn-out emergencies. What makes people more susceptible to disasters? Capacities and Vulnerabilities can be categorised into material/physical, social /organisational and attitudinal/ motivational. A. Physical/Material Health and disability Livelihoods/ Vocational skills Livestock Access to markets Transport Staple crops Housing Technologies Water supply Food supply Access to capital or other assets Relative poverty and wealth Features of land, climate, environment What physical/material resources exist in the community? What are the access and control patterns for these resources? How do these patterns change in crisis? B. Social/Organizational Family structures Kinship groups, clans Formal social and political organizations Informal social gatherings Divisions of: gender, race, ethnicity, class, caste, religion Social capital (systems of support and power) Education Systems for distributing goods and services What social/organizational institutions and relationships exist in the community? How does crisis impact these structures? How do these structures transform during crisis? What are the opportunities and challenges to people’s capacities provided by this transformation?

C. Motivational Attitudinal Psycho social profile History of crisis Expectation of emergency relief Existing coping strategy Cultural and psychological factors Change in power structures and relations How does the community perceive the crisis? What are the capacities for coping strategies in the community? Specific protection concerns: i.e. abuse and/or exploitation, which influences capacity and vulnerability factors (e.g. gender, age, disability, people living with HIV/AIDS, ethnicity, discrimination related to citizenship, refugee or other legal status, or situation of displacement and/or return- if population of concern has been defined other than in these terms, etc.): Conclusion: What are the key capacities and vulnerabilities relevant for priority setting and targeting, support to longer-term development programmes in addressing underlying vulnerabilities of the population, and support to and maximize local capacities and coping strategies for humanitarian response?

Community Participation Describe briefly the existing forms of participation in the ongoing humanitarian programmes. The most important reasons for participation: note these. Who participates: With whom will we work? Stakeholder analysis, including issues of representation, and consideration of the humanitarian principles of impartiality, independence and neutrality How people participate: Practically non existent – people are not even informed of what is going to occur People are informed People participate by supplying information People are consulted in setting priorities but have no decision-making power People participate in implementation of responses by supplying materials/labour People are actively involved in the decision making process, monitoring and evaluations of the relief programmes CVA/gender: using disaggregated data by gender and age, are there any significant differences in participation between and within groups? Conclusion: What are the most appropriate approaches to participation in this particular context (with which potential partners, how, why)?

NAF Elements - Outcomes

Mortality What information is available on the mortality of the affected population? • Life expectancy in years (Male/Female) • Crude mortality rate (CMR per 10,000/day, and/or per 1,000/month,) • Under five mortality rate (U-5MR per 10,000/day, and/or per 1,000/month) • Infant mortality rate • Maternal mortality ratio (per 100,000 live births) • One or more of the following (per 1000 births)  Neonatal mortality rate (0-4 weeks)  Perinatal mortality rate (22 weeks-7 days)  Stillbirth rate • Main causes of death or cause specific mortality rates (CSMR, % of total deaths) • Other mortality related information like grave counts, # of orphan-headed households, etc • Magnitude of civilian casualties. • What are the trends? Over what timeframe? CVA/gender: using disaggregated data by gender and age, are there any significant differences between and within groups and/or locations (e.g. groups most affected due to gender, age, disability, people living with HIV/AIDS, ethnicity, poverty, etc)? Protection concerns: e.g. executions, reports of massacres, deaths from landmines and violence, suicides, etc. Conclusion: Judgment on mortality. Compare to reference values, estimates of excess death if possible. What are the most vulnerable groups with the highest mortality rates, which areas are most affected? What development is expected the coming year? Morbidity Provide information on the morbidity pattern of the most important and/or life threatening diseases and/or health conditions: • What is the morbidity pattern? (list the % most common diseases in order of importance, provide information on incidence, prevalence and/or number of episodes of illness during the last 2 weeks at household level) Separate for children under 5, adults above 60. • What are the trends? Over what timeframe? Possible evolutions? • Other endemic important diseases? • Diseases known to have caused epidemics? • Reproductive health, including maternal and neonatal health • Mental health • Description of the HIV/AIDS situation (usually prevalence % female population 15-49 years, who is at risk, why, etc) CVA/gender: using disaggregated data by gender and age, are there any significant differences between and within groups and/or locations (e.g. groups most affected due to gender, age, disability, people living with HIV/AIDS, ethnicity, poverty, etc.)? Environment and natural resources: Is the area known to host vectors of disease? Are there conditions of environmental pollution (air, soil, water) that contribute to morbidity? Can point and non-point sources of hazardous pollution be identified? Do natural hazardous exist in the soil or water supplies that cause sickness or disease (e.g. radioactivity, arsenic, lead, etc). Protection concerns: (e.g. non-accidental injuries resulting from violence or landmines, sexual and gender based violence, stigmatisation, neglect of people in institutions etc.) Conclusion: Judgement of the severity and risks for morbidity. Compare to time/seasonal trends, epidemic threshold levels, neighbouring countries, links to food security, nutrition, environment, watsan, etc. What are the most vulnerable groups, which areas are most affected? What are the most important risks for increased morbidity the coming year?

ANNEX I: Further Guidance

This annex provides some further clarifications, suggested indicators or descriptors, and references to relevant guidelines and standards, including the Sphere handbook. It does not claim to be comprehensive. Governance Legal frameworks for addressing emergencies, displacement, etc. This includes: a) the international legal framework(accession to human rights and International Humanitarian Law instruments such as ICCPR, CESCR , CERD, CAT, CRC , CEDAW, Migrant Workers Convention, Geneva Conventions relative to the Protection of Civilian Persons in Time of War of 12 August 1949, Protocol I, Protocol II, 1951 Convention relating to the Status of Refugees, its 1967 Protocol, Convention relating to the Status of Stateless Persons, 1954, Convention on the Reduction of Statelessness, 1961 Protocol relating to the Status of Refugees, 1967, Accession to regional human rights instruments, etc.); b) the national protection framework and legislation (constitutional framework, declaration of a state of emergency, application of emergency legislation, minority protection legislation, anti-discrimination legislation, legislation related to registration or limitation of freedom of movement, etc.); and c) the human rights situation in the country as addressed by specific resolutions of the UN General Assembly or Commission on Human Rights, group-specific protection consideration and challenges, in particular as reflected in observations and recommendations of treaty monitoring bodies and reports of special rapporteurs. Environmental Context Humanitarian emergencies have numerous drivers, including both proximate and root causes. While many lie in state failures and systemic poverty, mismanagement of natural resources as well as the physical environmental conditions can also be important contributing factors. Furthermore, major disasters have significant environmental effects, some of which may affect human life, health and well-being in the immediate and medium-longer term. In this regard, any comprehensive needs analysis framework must ensure that the natural resource and environmental dimensions of a particular humanitarian crisis are well understood in order to determine durable solutions. Protection Child protection The following groups of children should be given special attention in the assessment and analysis: • children deprived of primary caregivers, including separated children and children living in foster families • children deprived of liberty • children with disabilities • children without birth certificates • children involved in armed forces • children from minority groups • children living in single parents households • refugee and displaced children • street and working children • children born out of wedlock • children affected by HIV/AIDS or whose parents are affected • (Others) The mapping of key elements of a protective environment for children should include following elements:

• Obligations of the parties under human rights law, humanitarian law and refugee law • Degree of respect for and enforcement of the principles and provisions of relevance to children • Ability and willingness of the government to take the lead in coordinating child protection interventions, including resources allocated to child protection • Laws, policies, structures, services, mechanisms and programmes pertaining to abuse, exploitation, violence and deprivation of parental care, including prevention, detection, referral, rehabilitation and reintegration, at the national and/or sub-national levels • How efficiently are they protecting children and their families during emergency situations - Any specific discrimination in the targeting? • Traditions, customs, beliefs, practices, attitudes and values within the community that are strengthening -- or weakening -- the protection of children against abuse, exploitation, violence and deprivation of parental care. Any traditional way within the community to prevent and respond to abuse, exploitation and violence and deprivation of parental care. • Any formal or informal monitoring mechanism in place to identify children who are victims of abuse, exploitation and violence • Awareness in the concerned population of the issue of child abuse, exploitation and violence -- willingness/readiness to discuss these issues openly • Awareness by children and adolescents of their rights to be protected against abuse, exploitation and violence and of how to protect themselves • Type of training received by professionals who are working with children pertaining to abuse, exploitation and violence, including on detection and response

Education No further guidance.

Availability and Adequacy of Shelter and Settlement The chapter in the Sphere handbook on “Minimum standards in shelter, settlement and non food items" (pages 203-248) provides additional guidance for this sector. Note that all standards must be read in conjunction with the identified indicators and the guidance notes throughout the chapter.

Food Security Food Security Analysis and Possible Information Requirements

1. Effects on food supplies/ availability Normal pre-crisis (e.g. last 5 years average) data on: • in-country food stock levels • cultivated area, yields & production of main crops • imports (gov’t, commercial, food aid) of main food items

Current data on: • in-country food stocks

and forecasts for: • cultivated area, yield & production • imports (gov’t, commercial, food aid)

2. Effects on markets

Normal trade flows for main food items (map).

Pre-crisis data on: • volumes of food commodities traded into/out of the area(s) now in crisis and the country • prices of main food items and other essentials in markets

Current data on: • estimated volumes of food moving into/out of the areas now in crisis and the country • prices of main food items and other essentials in markets • areas where there is no longer any exchange of goods with other areas

and, for projection purposes: • trends in trade flows • trends in prices • perspectives of traders and relevant authorities

3. Effects on households’ access to food

Pre-crisis data on: • Normal diets/food habits, food and income sources, essential expenditures of different population subgroups. • Usual coping strategies of different population subgroups at times of stress.

For estimation of food assess shortfalls based on proxy indicators: current data on: • Diet diversity, food frequency and/or other proxies for food consumption

and, for projection purposes: • Qualitative changes in food and income sources and essential expenditures of different population subgroups • Prospects for household food production, employment, other income generation activities, food or cash receipts

For estimation of food assess shortfalls based on economic analysis: current data on: • Quantified changes in food and income sources and essential expenditures of different population subgroups. • Prospects for household food production, employment, other income generation activities, food or cash receipts

For rough estimation of food assess shortfalls in the days following a sudden catastrophe: • The proportion of 2100 kcal/person/day that people are able to provide for themselves.

4. Effects on households’ food use and consumption

Pre-crisis data on: • Normal food storage and preparation habits, and any taboos. • Normal feeding practices for young children, sick and elderly people, and pregnant and lactating women.

Current data on: • The quantity and quality of water available to households for cooking and domestic hygiene purposes. • The utensils, cooking stoves and cooking fuel available to households. • If cooking facilities and fuel are scarce, the appropriateness of shared or communal cooking facilities. • Changes in feeding practices for young children, sick and elderly people, and pregnant and lactating women.

5. Effects on the nutritional situation (and mortality)

Pre-crisis data on: • Normal rates of global malnutrition and seasonal variations. • Endemic micronutrient deficiencies, if any. • Causes of malnutrition. • Epidemiology of the area – normal disease patterns and seasonal variations.

Current data on: • Moderate and severe acute malnutrition rates. • Clinically diagnosed micronutrient deficiencies. • Diets and any associated risks of micronutrient deficiencies.

6. Effects on livelihoods

Pre-crisis data on: • Normal food and income sources of different population subgroups. • Livelihood assets of different population subgroups. • Main sources of paid employment in the area. • The natural resource base on which livelihoods depend. • Markets and trade patterns on which livelihoods depend.

Current data on: • Changes in livelihood assets of different population subgroups. • Changes in employment opportunities, the natural resource base, markets and trade patterns on which livelihoods depend.

7. Contextual factors influencing food security response options

Pre-crisis data on: • Human and other productive resources of households in different population groups. • Social structures and relationships, including underlying ethnic or social tensions, if any. • Gender roles. • Logistics capacity.

Current data on: • Changes in the human and other productive resources of households in different population groups. • Social structures and relationships, including ethnic or social tensions, if any. • Changes in gender roles and the effects of this on food security. • Current logistics capacity.

Reference Materials:

Save the Children, The Household Economy Approach: A resource Manual for Practitioners, 2000

Shoham, Jeremy and Jaspars, Susanne: A Critical Review of Approaches to Assessing and monitoring Livelihoods in Situations of Chronic Conflict and Political Instability, ODI Working Paper 191, December 2002.

The Sphere Project - Chapter 3 Minimum Standard in Food Security and Nutrition, Page 103

Taylor, A and Seaman, J "Targeting Food Aid in Emergencies", ENN Special Supplement, July 2004

UNHCR, UNICEF, WFP and WHO, Food and Nutrition Needs in Emergencies

UNHCR and WFP, Joint Assessment Guidelines, June 2004

WFP Provisional EFSA Handbook, February 2005

FAO- Emergency Needs Assessment Guidelines, (draft version) August 2003

FAO – Food and Nutrition Division, Protecting and promoting good nutrition in crisis and recovery: a resource guide, February 2005

Young, Helen and Jaspars, Susanne. 2001. Food security assessments in emergencies: a livelihoods approach. Humanitarian Practice Network (HPN) Paper No. 36, 2001

Access to and Performance of the Health System, Reproductive Health, Nutrition and Mental Health/Psychosocial Services

Chapter 5 in the Sphere handbook on “minimum standards in health services (pages. 249-308) provides additional guidance for this sector. Note that all standards must be read in conjunction with the identified indicators and the guidance notes throughout the chapter. Find below a range of suggested indicators and/descriptors

Organisation of the health system • How is health sector organised nationally, MoH, # health district, zones, management structures, district health committees, etc • Numbers and coverage of health structures supported by humanitarian agencies • How are different health programs organised nationally, • Existence of national health policies • Existence of PRSPs

Capacity and availability of the health infrastructure: • Numbers and types of health facilities in a health district/zone, (e.g. hospital, health centres, health posts, specialised institution like for mental health, etc) • Population per zone/ catchment area per facility • Types of services for each level • Public vs. Private/faith based

Human resources for health: • Numbers of key health workers per 100,000 population and/or per health facility (include skilled birth attendants, community health workers, psychosocial workers, etc) • Distribution of health workers in the country • Describe capacity and quality of the health education system • Salaries

Health financing: • Budgets per capita • Government expenditures, % of GDP • Out of pocket payment/cost recovery • Insurance schemes • Humanitarian budget vs. developmental budget

Procurement of medicines: • Essential medicines guidelines • Quality control • Distribution mechanisms (Ministry of Health, private, etc)

Performance of health services • Accessibility of health services • Geographic coverage (% of population within 5 Km radius of a Primary Health Care facility • Financial accessibility • Other factors influencing access • Existence of minimum packages of curative and preventive services, extend to which it is introduced and functioning • Utilisation rates, # new consultations per capita per year • Measles and other vaccine preventable diseases: vaccination coverage • Proportion of one year old children immunized against measles • Coverage of DTP3 vaccination • Proportion of health facilities with adequate supplies to carry out universal precautions to prevent iatrogenic transmission of diseases, incl. HIV. • Use and quality of protocols and guidelines • Performance of second/referral level services • Referral mechanisms, and accessibility of secondary care • Blood transfusion practices, safety, proportion of units of blood transfused that are screened for HIV, Hepatitis • Health promotion activities, IEC programs, knowledge of healthy behaviour, etc • Health seeking behaviour (of episodes of illness, when and where did the patient seek treatment) • User fee mechanisms for first and second level of health care • Availability of essential drugs, medical store/pharmacy management • Physical condition of the infrastructure, • Availability of adequate water and sanitation facilities • Communication options, transport, electricity, etc.

Examples of common health programs • Prevalence and death rates associated with malaria • Proportion of population in malaria risk areas using effective malaria prevention and treatment measures • Malaria: what is known about current national malaria treatment protocol and adherence to that protocol, drug/insecticide efficacy studies, availability of drugs, diagnostics (use of RDTs, microscopy), coverage of ITNs and IRS. Other vector control programs? • Prevalence and death rates associated with tuberculosis • Proportion of tuberculosis cases detected and cured under directly observed treatment short course (DOTS) • Diarrhoea • ARI • HIV/AIDS • HIV prevalence among 15-24 year old pregnant women

• Condom use rate of the contraceptive prevalence rate a. Condom use at last high-risk sex b. Percentage of population aged 15-24 with comprehensive correct knowledge of HIV/AIDS • Ratio of school attendance of orphans to school attendance of non-orphans aged 10-14 • Proportion of one year old children immunized against measles • Specific disease control programs for other endemic important diseases?

Reproductive health and HIV/AIDS • Fertility rates • Antenatal care: proportion of pregnant women who attend at least one antenatal visit, blood pressure was checked, counselled for Voluntary Counselling and Testing (if available), distribution of ITNs to pregnant women registered for ante natal care, malaria prophylaxis, syphilis tests, iron tablets, TT coverage (% of pregnant women), anaemia in pregnant women • Delivery care: availability and training of midwifes, Traditional Birth Attendants, health workers who can perform EOC, % home deliveries, • Proportion of births attended by skilled health personnel • Emergency Obstetric care: % of complicated deliveries received EOC • Low birth Weight (<2500 g) (%) • Crude birth rate (per 1000 population) • GBV related morbidity: description of types of GBV, number of incidents of SV reported in the specified time period per 10,000 population, numbers of GBV victims (rape, incest) referred to appropriate services • Ability of health services to provide medical and psychosocial support to victims of sexual violence • Admission for abortions (% of all admissions) and post abortion care • STI diagnosis and treatment • Adults living with HIV/AIDS (number of %) • HIV prevalence among 15-24 year old pregnant women • Percentage of population aged 15-24 with comprehensive correct knowledge of HIV/AIDS • Pregnant women (15-25) with positive syphilis test (%) • Men reporting (15-49) urethritis in last year (%) • Coverage PMTCT • VCT services available, • ART coverage • Family planning: Contraceptive prevalence rate (all methods (% of women 15-49), contraceptive methods, condom use, Number of condoms distributed in the specified time period/10,000 population or target groups. Condoms use at last high-risk sex • Privacy, youth friendliness, male/female health staff culturally appropriate to patients

Mental health/psychosocial services • Accessibility of mental health/psychosocial services • Mental health care available within general health services? (are staff trained? Essential psychotropics available?) • Mental health/ psychosocial care available outside general health services but elsewhere in the community? (e.g. through schools, youth centres, at people’s homes, mental health mobile clinics etc.)? • Number of psychiatry beds per 100,000 (number of psychiatry beds in general hospital and in mental hospital) (include distribution of beds in different districts/health zones) • Utilisation rates of mental health care in primary and secondary care • Utilisation of mental health/psychosocial care services outside the general health care system • Use and quality of protocols and guidelines • Performance of second/referral level services • Mental health promotion activities, IEC programs, etc • Help seeking behaviour

Nutrition services: • Types and design of nutritional services available (supplementary and therapeutic feeding programmes, micronutrient supplementation, community-based therapeutic care, growth monitoring and promotion activities etc) • Indicators for supplementary feeding programmes: e.g. Number of targeted beneficiaries; number of actual beneficiaries; quantity and quality of food being provided; admission and discharge rates). • Indicators for therapeutic feeding programmes: e.g. criteria for set-up and closure of programme; coverage; referral and defaulter rates; mean weight gain; average length of stay in programme; staffing. • Health inputs in nutrition programmes (e.g. provision of antihelminths, vitamin A supplementation, immunization). • Breastfeeding and psychosocial support given • Counselling as part of growth monitoring and referral systems in place

The following references also have useful information: The management of nutrition in major emergencies. WHO, Geneva, 2000. Field guide on rapid nutritional assessment in emergencies. WHO, EMRO, 1995. http://www.who.int/topics/nutrition/publications/emergencies/en/ Reproductive health during conflict and displacement. A guide for program managers WHO Geneva 2000. WHO/RHR00.13 Checchi F, Roberts L (2005) Interpreting and using mortality data in humanitarian emergencies: A primer for non-epidemiologists. Humanitarian Practice Network (HPN) Network paper no. 52, September 2005. ODI London. http://www.odihpn.org/documents/networkpaper052.pdf Nutritional Status and Nutrition Related Morbidity Further information on measuring malnutrition can be found in Appendix 5 of the Food section of the Sphere handbook. Among others, this gives indications how to measure malnutrition among older children, adolescents, adults, older people and disabled people. The following references also have useful information: The management of nutrition in major emergencies. WHO, Geneva, 2000. Field guide on rapid nutritional assessment in emergencies. WHO, EMRO, 1995. http://www.who.int/topics/nutrition/publications/emergencies/en/

Additional information on measuring malnutrition rates can be found under www.smartindicators.org

Access to Improved Water Sources, Sanitation and Hygiene Practices The chapter in the Sphere handbook on “Access to water and sanitation & hygiene promotion” (pages. 51-99) provides additional guidance for this sector. Note that all standards must be read in conjunction with the identified indicators and the guidance notes throughout the chapter.

Capacities and Vulnerabilities Analysis (CVA), and Participation of Affected Population CVA and participation are crosscutting issues that need to be considered when addressing each category of the framework. (When defining humanitarian needs, capacities are one facet of the same coin: i.e. needs exist when there is no local capacity to meet them.) They relate to national capacity (macro-level) and to capacity at the household/individual level (micro-level). Vulnerabilities need to be assessed in order to identify people who are more at risk than others and to understand why this is the case. Capacities and Vulnerabilities Analysis (CVA) is relevant to (a) improve targeting and prioritisation of needs; (b) support longer-term development programmes in addressing underlying vulnerabilities of the population; and (c) support and maximize local capacities and coping strategies in humanitarian response. To better understand humanitarian needs, these should be assessed simultaneously with capacities and vulnerabilities. There is a need for gender analysis supported by disaggregated information (e.g. by gender, age, disability, location, ethnicity, etc). Capacities and vulnerabilities are also included in the framework as a separate area to be assessed at the micro and macro level under the category, ‘Social, Economic and Cultural Context’. For further information on these issues, please consult pp 9-13 of the Sphere handbook. The CVA section of the document should: • Describe the most vulnerable groups, as well as the local capacities and coping mechanisms available to help support the humanitarian response. • Disaggregate data by gender, and age. • What are the primary short-term and longer-term problems facing the affected population? [The discussion on longer-term needs could link with the section, “Complementarity with Other Actors”; i.e. development programmes that seek to address underlying root causes of vulnerability] • What are the projected humanitarian needs of this population over the next year? • How are local capacities contributing to humanitarian response and how have or could such efforts be supported by the international humanitarian community? • Clearly state which vulnerable groups will be the focus of this year’s CHAP.

Writing tip: When preparing this section, it may be possible to draw extensively on existing information available within the CAP Country Team. For example, the following resources—among others—may be available in country: WFP Vulnerability Analysis and Mapping (VAM), WHO Vulnerability Assessment, Socio-Economic and Gender Analysis (SEAGA - FAO), Oxfam’s CVA. You may also refer to the following CVA Matrix (Annex II) as a guide for defining the most vulnerable groups. The Matrix is adapted from M. Anderson and P. Woodrow, Rising from the Ashes: Development Strategies in Times of Disaster (1989). Participation Participation is also an important cross-cutting issue when defining humanitarian needs. Wherever possible the assessments should be done in a participatory way, and the opinion of the affected population on their situation and how they perceive their needs should be taken into consideration. Participation is also addressed as a separate issue to allow analysis of the way affected populations and their representatives participate in ongoing humanitarian programmes, and/or to determine types of participation that may be most suitable in future operations. Thirdly, this would help to identify the best way population representatives can partake when formulating the CHAP. Further support on how to involve affected people in assessments can be found in the Sphere Handbook, Common Standard 1, pp. 28-29. Participation by Crisis Affected Populations in Humanitarian Action. A handbook for practitioners. ALNAP.

Mortality BASELINE REFERENCE MORTALITY DATA BY REGION Region CMR (deaths/10,000/ day) U5MR (deaths/10,000 U5s/day) Sub-Saharan Africa Middle East and North Africa South Asia East Asia and Pacific Latin America and Caribbean Central and Eastern European Region/CIS and Baltic States Industrialised countries Developing countries Least developed countries World 0.44 0.16 0.25 0.19 0.16 0.30 0.25 0.25 0.38 0.25 1 0.36 0.59 0.24 0.19 0.20 0.04 0.53 1.03 0.48

CAUTION: in general, emergency thresholds for mortality are arbitrarily defined as a more than a doubling of baseline rates. For example, for Sub-Saharan Africa, this would be above 1/10,000/day for the CMR. This rate cannot necessarily be applied to other regions and it also poses some important ethical dilemmas (for example, one can argue that entire sub-Saharan Africa is an emergency on this assumption, as CMR is double that of Europe, east Asia, and the America’s). Further information on measuring mortality rates can be found under www.smartindicators.org Morbidity Incidence rates cannot fully reflect severity or true needs as they are influenced by access. Cause-specific mortality (including deaths in community) is therefore crucial as it may reflect those not being able to access health care. The trends and distribution of "clinic attendances or consultations" (stable, decreasing, increasing) of important diseases (major M&M or those with potential to cause major M&M e.g. epidemic-prone), with some alert thresholds for action, are important for priority setting. In some cases the actual number is also important, as whilst they don't indicate the true picture (i.e. they are often an underestimate), they will require priority action because they warn of potential morbidity and mortality to come. This is the case for some (not all) epidemic-prone diseases but also for non-accidental injury including rape (where both incidence and trend are important). Disease trends not only give an indication of severity, but they can also infer the needs of the population. E.g.: • Increasing level of diarrhoea = basic human needs - safe water, adequate sanitation facilities (as specified by Sphere guidelines) • Increasing trend in malnutrition = need for regular, nutritious food. • Increasing trend in malaria cases = need for better shelter and planning, better protection against mosquito vectors, better quality curative health services (for case management) • Increasing respiratory infections = need for shelter (warm, ventilation, no overcrowding); need for clothing • Cases of non-accidental injuries including rape = need for security, law and order, protection of civilians; need to advocate for human rights • One case of measles or pertussis = need for protection of children against vaccine-preventable disease; need for quality preventative health care • Increasing levels (cases) of maternal deaths or maternal morbidity; increasing reproductive tract infection/obstetric fistula = need for better care during pregnancy, child birth • Increased number of STIs/HIV cases among women, girls and young boys= need for security, protection; better family planning services

Confirmation of the existence of an outbreak: it is not always straight forward to determine whether an outbreak is present and clear definitions of outbreak thresholds do not exist for all diseases a. Diseases for which one case may indicate an outbreak: cholera, measles, yellow fever, Shigella, viral haemorrhagic fevers. b. Meningococcal meningitis: for populations above 30,000, 15 cases/100,000 persons/week in one week indicates an outbreak; however, with high outbreak risk (i.e. no outbreak for 3+ years and vaccination coverage <80%), this threshold is reduced to 10 cases/100,000/week. In populations of less than 30,000, an incidence of five cases in one week or a doubling of cases over a three-week period confirms an outbreak. c. Malaria: less specific definitions exist. However, an increase in the number of cases above what is expected for the time of year among a defined population in a defined area may indicate an outbreak.

ANNEX II: ACRONYMS

ARI Acute Respiratory tract Infection ART Anti Retroviral Therapy BMI Body Mass Index CAT Convention Against Torture CCA Common Country Assessment CEDAW Convention on the Elimination of All Forms of Discrimination against Women CERD International Convention on the Elimination of All Forms of Racial Discrimination CESCR International Covenant on Economic, Social and Cultural Rights CHAP Common Humanitarian Action Plan CMR Crude Mortality Rate CRC Convention on the Rights of the Child CSMR Cause Specific Mortality Rate CVA Capacities and Vulnerabilities Analysis EOC Emergency Obstetric Care GBV Gender based Violence GDP Gross Domestic Product ICCPR International Covenant on Civil and Political Rights IDP Internally Displaced Person IEC Information, Education and Communication IHL International Humanitarian Law IRS Indoors Residual Spraying ITN Insecticide Treated Bed Net MDG Millennium Development Goals NAF Needs Analysis Framework PMTCT Prevention of Mother to Child Transmission PPP Parity Purchasing Power PRSP Poverty Reduction Strategy Paper RDT Rapid Diagnostic Test STI Sexually Transmitted Infection SV Sexual Violence TBA Traditional Birth Attendant TT Tetanus Toxoid UXO Unexploded Ordnance