Module
1 | Assessment
Overview
Assessment answers the question:
A Definition of Assessment
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Assessment is an evidence-based process to better understand the status of the HIV/AIDS epidemic and program responses to it in a specific time and place. Generally, it involves gathering, synthesizing, and analyzing information with enough objectivity and detail to support credible recommendations for management decisions. The process works to make the best use of resources in a specific setting by gathering and analyzing objective and detailed information to make sound decisions concerning program objectives and interventions. It is the first step and the first module in the Synergy Programming Cycle. This first step is crucial because it describes the situation you hope to address, including the activities and priorities of other stakeholders, and provides a social, economic, and cultural context for the situation.
An assessment should result in a comprehensive profile of the HIV/AIDS situation in a country, province, district, or community. It helps us understand the people at risk for HIV, the gender differences in vulnerability, and those affected by it. It helps us recognize ongoing efforts and resources and to uncover critical gaps in the response. It also helps us address the social, gender, cultural, political, legal, and resource issues that affect a program. The information collected in the assessment process support our ability to make good decisions about the best ways to contribute to the fight against HIV and AIDS.
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Unlike a classic research study, which extracts one part of a complex causal picture in order to isolate and explain it, an assessment has the difficult task of presenting a snapshot of the epidemiological and intervention picture, and of the crucial causal factors that are known or believed to affect HIV/AIDS rates and responses by people infected or affected by HIV.
A situation assessment does not have to prove anything. That is the task of research studies and evaluation [I-Link Module 5]. Assessments can be performed quickly (2-12 weeks) because their task is to assemble and analyze existing knowledge.
An assessment describes the magnitude and dynamics of the problem as well as the response. It generally includes two components:
- A situation assessment
- A response assessment
A situation assessment (also known as a situation analysis or a needs assessment) produces:
- A map of the people who are most vulnerable to infection; noting age and gender differences in vulnerability
- A description of why they are vulnerable
- An approximation of the number of vulnerable people
- A description of how and where they interact in ways that increase their vulnerability to HIV infection
- A description of the social, economic, political, cultural, and legal issues associated with the epidemic
- An understanding of how women and men, and girls and boys, differ in how they are affected by the epidemic
A situation assessment helps us understand the magnitude and dynamics of the HIV/AIDS situation in a particular country (or province, district, or community). It helps us recognize important needs and identify actions that will be required to meet those needs in the next step in the program cycle, strategic planning. [I-Link Module 2]
What
if you have a short time frame to conduct assessment? Rapid assessment is an approach
to assessment that uses the same methodologies, but allows
you to gather information in a shorter time frame. Rapid assessment
focuses on collecting relevant and applicable information
in a relatively short period of time. Follow this pathway for more on
rapid
assessment.
"A situation analysis puts the HIV epidemic
in its social, economic, and cultural context in a given country. It looks
at who is infected or is vulnerable to infection, and tries to explain
why.
It looks for explanations not just in people's behavior, but also in the
social, economic and cultural situations that underlie that behavior.
A situation analysis looks specifically at situations that may be relevant
to HIV, the facets that favor or impede its spread, and the factors that
favor
or impede achieving the best possible quality of life for those living
with HIV and for their families. Since the analysis explains the current
situation, it helps to identify opportunities for changing that situation."
UNAIDS Guide to the Strategic Planning
Process for a National Response to HIV/AIDS: Situation Analysis. http://www.unaids.org
A response assessment (also referred to as a response
analysis) produces:
- A map of the ongoing (and past) activities that have addressed HIV/AIDS (i.e., what organizations and groups are doing and not doing about HIV/AIDS in a particular area)
- A determination of what interventions are working, which ones are not, what needs improvement, and where the gaps have appeared in the response to date
- An examination of the problems faced by people living with HIV/AIDS, which may reveal the services that people are using and the services they need, and should reveal any differences in the experience of women and men
"Response analysis looks at the responses specifically
as they relate to the priorities areas identified in the situational analysis…
It asks: Does the response tackle the roots of the HIV-related situation
in the priority area? Does the response take into account the obstacles
to achieving its goals? Does the response take advantage of the opportunities
that might help drive the country towards the target of less transmission
of HIV with a less drastic impact?" UNAIDS Guide to the Strategic
Planning Process for a National Response to HIV/AIDS: Response Analysis.
http://www.unaids.org
The Outcome of a Good Assessment
The results of a good assessment will likely include a clearer identification of vulnerable populations, including their size and location, an understanding of why they are vulnerable, including how gender, politics, and poverty affect the HIV epidemic and are impacted by the epidemic. It will ensure lessons are learned from past experience, and recognize on-going efforts by all key sectors: government, civil society (including communities and NGOs), the private commercial sector, international donors and agencies, so that new efforts build upon and strengthen what is already in place. It also will provide an up-to-date analysis of gaps in the current response, and of opportunities and resources that can be drawn upon in your project and by others. This information creates a strong platform for decision-making in the next phase of the programming cycle.
The Role of Assessment in Building PartnershipsIn addition to providing the building blocks for the formulation of a strategic plan, the assessment process is an opportunity to involkey stakeholders and partners at an early stage in the programming cycle. To believe and accept the findings, stakeholders must see that their issues have been addressed and their sources consulted. One obvious way to ensure this is to include stakeholders as team members or resource persons, or as sources of information and referral in the assessment process.
Partnerships with other organizations or agencies can also create buy-in that can lead to a stronger program. Partners might include:- Implementation partners (local and international NGOs, private-sector and public-sector agencies)
- Members of donor organizations
- UN system organizations
The Role of Assessment in Implementation Monitoring and Evaluation
Evaluation and assessment are integrally linked and
support
one another. Previous evaluations of existing programs are one source
of data for assessment. Likewise, results of assessment activities support
the analysis and decision-making processes in the strategic planning phase,
and so they shape monitoring and evaluation activities, which in turn,
contribute to future assessments (see graphic).
Data collected as part of an assessment can contribute to creating a baseline that is used for midpoint and final evaluations. Data can also add to the general knowledge about the HIV/AIDS situation in an area and can ultimately help with a variety of evaluation activities. [I-LINK Module 5]
Assessment Tools and Resources
The following are some comprehensive assessment tools and resources taken from a broad range of sources:
[LINK] UNAIDS
Guide to the Strategic Planning Process for a National Response to HIV/AIDS:
Situation Analysis.
UNAIDS has developed a set of four modules on strategic planning. This
first in the set covers situation analysis at the national level and in
decentralized settings. The guide uses hypothetical examples and a clear,
linear, and simplified framework to guide readers through the basic steps
of conceptualizing, collecting, analyzing, and presenting social, economic,
and cultural information that affect HIV/AIDS program planning at the
national level. Users will identify the following factors: cultural mores,
political factors, social and faith-based attitudes, local fraternal organizations,
NGOs, governmental departments, private sector businesses, educational
curricula and practices, media representatives, and prominent individuals
who can either help or harm the current HIV/AIDS situation and intervention
approaches. The guide strongly emphasizes the benefits of identifying
and involving new stakeholders. This pertinent guide, introductory in
tone and broad in scope, can be used in tandem with more detailed and
in-depth resources. The bibliography contains a detailed listing of assessment-related
publications and relevant UNAIDS resources.
[LINK] UNAIDS
Guide to the Strategic Planning Process for a National Response to HIV/AIDS:
Response Analysis.
UNAIDS has developed four modules on strategic planning for programs at
the national level or in decentralized settings. This second of the series
covers response analysis: the process of critically reviewing all ongoing
intervention strategies by communities, academia, the private sector,
NGOs, and the government for an identified high-priority area. This guide
builds on Module 1, the situation analysis, and lays the groundwork for
Module 3, strategic plan formulation. The response analysis findings will
help program planners identify successful strategies for addressing underlying
social, economic, cultural, and political factors and assess why they
are successful; reveal points at which programs are being blocked by factors
such as affordability and sustainability, or which programs could benefit
from more inclusive partnerships; and pinpoint programming gaps. In its
design, the review process acknowledges the fluid and dynamic nature of
the HIV/AIDS epidemic and subsequent changing needs, as well as the necessity
of thoughtfully designating scarce dollars where they are best spent.
Written in nontechnical language, the guide leads readers through the
basic steps involved in response analysis and describes several response
areas, or groups of intervention strategies, in detail. A hypothetical
example of reducing HIV transmission in young people illuminates the scope
of findings in the response analysis process. This document is too general
to be used alone, but would complement a list that includes other, more
detailed resources.
[LINK] Assessing the
Need for HIV Prevention Services: A Guide for Community Planning Groups
Academy for Educational Development, Center for Community-Based Health
Strategies.
http://www.healthstrategies.org/pubs/publications/needs_assessment_all.pdf
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file
This document introduces the entire process of needs assessment.
This is a guide to HIV prevention for community groups that wish to undertake
a needs assessment. It was funded by the Centers for Disease Control and
Prevention (CDC) and adheres to CDC recommendations. Although it was written
for community planning groups, consultants, and local health departments
in the United States, the guide is applicable in other countries. The
steps for planning and conducting a needs assessment are covered in a
friendly and clear way, with minimal jargon. The guide explains how the
assessment process is used to identify and prioritize unmet HIV prevention
service needs in vulnerable populations using a three-part process of
conducting the actual needs assessment, building a community resource
inventory, and performing a gap analysis. The guide contains several useful
resources. Worksheets at the end of each chapter can be used to review
information or as a planning tool, and a sample time line, work plan,
and resource inventory matrix are included. Comprehensive glossaries define
needs assessment and statistical terminology. The steps for planning and
conducting surveys, focus groups, key informant interviews, and community
forums are included as appendices, along with information on the preparation
stages for qualitative data analysis. The document is useful for community
groups, local NGOs, and district departments, although, as with many needs
assessment guides, technical information specific to data analysis that
is qualitative, quantitative, or both must be sought elsewhere.
[LINK] The Needs
Assessment: Tools for Long-Term Planning. Community-Based Health Program
Tip Sheet and Conference Follow-Up Tools. Annie E. Casey Foundation Conference
Neighborhood Health Partnerships: Building a Strong Future. http://www.healthstrategies.org/pubs/factsheets/NeedsAssessment.pdf
A three-page concise description and overview
of needs assessment and terminology. In a concise and straightforward
manner, this three-page publication defines terminology, outlines the
key steps for a comprehensive needs assessment process, briefly explains
the different sources of data and methodologies for gathering information,
and discusses the value of needs assessment in relation to program planning
for a target population. Although the fact sheet was written for community
groups in the United States, the information is relevant to HIV/AIDS prevention
programs in other parts of the world. It is a useful introduction for
program managers, field staff, and trainers to the process of conducting
a needs assessment. The fact sheet was produced by the Academy for Educational
Development Center for Community-Based Health Strategies.
[LINK] Facilitators'
Guide for Needs Assessments on Access to HIV/AIDS-Related Treatment.
International HIV/AIDS Alliance, December 1999. http://www.aidsmap.com/about/intl_HIV_AIDS/Intl_AIDS
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A resource to support the development of practical tools for NGOs and
community-based organizations working in HIV/AIDS.
[LINK] HIV and
Drug Use: A Toolkit on Participatory Assessment and Response (draft
copy). Allen Greig, March 2001.
http://www.synergyaids.com/documents/3842_IHAA_hiv_druguse.pdf
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file
A draft set of tools designed for use by organizations and groups interested
or involved in planning an assessment of the connections between HIV/AIDS
and drugs and drug users. The document has five sections, each packed
with comprehensive and well-labeled instructions that address important
issues of scale, scope, and stages in the assessment process.
[LINK] HIV/AIDS Rapid
Assessment Guide.
David Wilson and Family Health International. 2001. http://www.synergyaids.com/files.fcgi/3554_fhi_rhapassessmentguide.pdf
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This practical guide is meant to help program managers gather information
and generate reports that explain the spatial, qualitative, and quantitative
overview of a project area. It contains useful worksheets and exercises
to direct users through the rapid assessment process. This resource can
be used in conjunction with other rapid assessment guides that offer detailed
narratives and commentary.
[LINK] Gender and HIV/AIDS
Selected Resources. December 2002.
This CD-ROM is produced by the Interagency Gender Working Group (IGWG),
a network comprising NGOs, the United States Agency for International
Development (USAID), cooperating agencies, and the Bureau for Global Health
of USAID. It contains many useful resources including those providing
a general overview of how gender affects the HIV/AIDS epidemic and is
affected by the epidemic, that will be useful briefing information for
assessment teams. Other resources should guide both strategic planning
and program design to ensure gender issues are addressed, such as voluntary
counselling and testing and gender-based violence, parent-to-child transmission,
and male involvement. The CD-ROM can be obtained by emailing prborders@prb.org
or contacting International Programs, Population Reference Bureau, at
1875 Connecticut Avenue NW Suite 520, Washington, DC 20009, 202-483-1100
or 202-328-3937 (fax). The IGWG Web site can be found at: http://www.measurecommunication.org
[LINK] USAID Support
for Sexually Transmitted Infections and HIV/AIDS Programming in Haiti:
Assessment and Recommendations for Future Action.
The Synergy Project, September 2001.
http://www.synergyaids.com/documents/3117_haitiAssessment_01.pdf
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This report examines the role that USAID could play in Haiti over a two-
to five-year period to combat the HIV/AIDS epidemic. The assessment team,
which included participants from Haiti and the United States, presents
its findings and major recommendations based on field work and an extensive
report and document review. Program managers and development officers
in the Caribbean may find the report useful.
[RESOURCE] The Axios
Mobilization Methodology for Rapid Assessment, Project Design and Implementation.
Dublin, Ireland: Axios International, 2001 (hard copy only).
This report explains the Axios International methodological approach to
project design and implementation. The central principle is that the people
who are asked to assess a problem are also the people who will be responsible
for implementing the solution. The methodology is similar to other stakeholder-centered
approaches, but it offers a good overview of some of the limitations found
in such methods.
[LINK] Lesotho and
Swaziland: HIV/AIDS Risk Assessments at Cross-Border and Migrant Sites
in Southern Africa.
Project Support Group and Family Health International for USAID, by David
Wilson, 2001.
http://www.synergyaids.com/documents/3558_fhi_lesothoandswaziland.pdf
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The focus of the report is on border areas. A number of rich ethnographies
were conducted at sites in both Lesotho and Swaziland. The report will
be useful for program managers and development officers interested in
the Southern African region, and for program managers conducting assessments.
The report is an excellent example of reporting and the use of multiple
assessment methods.
[LINK] A Pilot
Study of a Rapid Assessment Method to Identify Areas for AIDS Prevention
in Cape Town, South Africa.
MEASURE Evaluation, May 2001.
http://www.synergyaids.com/documents/3581_measure_pilot_study.pdf
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This report contains the findings of the first trial of a rapid assessment
methodology developed through the Measure Evaluation project for work
in high-transmission areas. This rapid assessment method is likely to
be most useful to managers working at the scale of the intervention reported,
rather than at the community level.
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