Altare Chiara, Weiss William, Ramadan Marwa, Tappis Hannah, Spiegel Paul B
Center for Humanitarian Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Jhpiego, Baltimore, MD, USA.
Confl Health. 2022 Oct 14;16(1):54. doi: 10.1186/s13031-022-00487-5.
Humanitarian crises represent a significant public health risk factor for affected populations exacerbating mortality, morbidity, disabilities, and reducing access to and quality of health care. Reliable and timely information on the health status of and services provided to crisis-affected populations is crucial to establish public health priorities, mobilize funds, and monitor the performance of humanitarian action. Numerous efforts have contributed to standardizing and presenting timely public health information in humanitarian settings over the last two decades. While the prominence of process and output (rather than outcome and impact) indicators in monitoring frameworks leads to adequate information on resources and activities, health outcomes are rarely measured due to the challenges of measuring them using gold-standard methods that are difficult to implement in humanitarian settings.We argue that challenges in collecting the gold-standard performance measures should not be a rationale for neglecting outcome measures for critical health and nutrition programs in humanitarian emergencies. Alternative indicators or measurement methods that are robust, practical, and feasible in varying contexts should be used in the interim while acknowledging limitations or interpretation constraints. In this paper, we draw from existing literature, expert judgment, and operational experience to propose an approach to adapt public health indicators for measuring performance of the humanitarian response across varied contexts.Contexts were defined in terms of parameters that capture two of the main constraints affecting the capacity to obtain performance information in humanitarian settings: (i) access to population or health facilities; and (ii) availability of resources for measurement. Consequently, 2 × 2 tables depict four possible scenarios: (A) a situation with accessible populations and with available resources; (B) a situation with available resources but limited access to affected populations; (C) a situation with accessible populations and limited resources; and (D) a situation with both limited access and limited resources.Methods and data sources can vary from large population-based surveys, rapid assessments of populations or health facilities, routine health management information systems, or data from sentinel sites in the community or among facilities. Adapting indicators and methods to specific contexts of humanitarian settings increases the potential for measuring the performance of humanitarian programs beyond inputs and outputs by assessing health outcomes, and consequently improving program impact, reducing morbidity and mortality, and improving the quality of lives amongst persons affected by humanitarian emergencies.
人道主义危机对受影响人群而言是一个重大的公共卫生风险因素，会加剧死亡率、发病率、残疾情况，并减少获得医疗保健的机会以及降低医疗保健质量。有关危机受影响人群的健康状况和所提供服务的可靠且及时的信息，对于确定公共卫生优先事项、筹集资金以及监督人道主义行动的绩效至关重要。在过去二十年里，众多努力推动了在人道主义环境中规范并及时提供公共卫生信息。虽然监测框架中过程和产出（而非结果和影响）指标的突出地位带来了关于资源和活动的充分信息，但由于使用在人道主义环境中难以实施的金标准方法来衡量健康结果存在挑战，健康结果很少得到测量。我们认为，收集金标准绩效指标时面临的挑战不应成为忽视人道主义紧急情况下关键健康和营养项目结果指标的理由。在此期间，应使用在不同背景下稳健、实用且可行的替代指标或测量方法，同时承认其局限性或解释限制。在本文中，我们借鉴现有文献、专家判断和业务经验，提出一种方法，以调整公共卫生指标来衡量不同背景下人道主义应对行动的绩效。背景是根据一些参数来定义的，这些参数抓住了影响在人道主义环境中获取绩效信息能力的两个主要限制因素：（i）接触人群或卫生设施的机会；（ii）测量资源的可用性。因此，2×2表格描绘了四种可能的情况：（A）人群可接触且资源可用的情况；（B）资源可用但接触受影响人群机会有限的情况；（C）人群可接触但资源有限的情况；以及（D）接触机会和资源都有限的情况。方法和数据来源可以从基于大量人群的调查、对人群或卫生设施的快速评估、常规健康管理信息系统，或社区或设施中哨点的数据中选取。使指标和方法适应人道主义环境的特定背景，通过评估健康结果，增加了衡量人道主义项目投入和产出之外绩效的可能性，从而提高项目影响、降低发病率和死亡率，并改善受人道主义紧急情况影响人群的生活质量。
