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In: RAP: Rapid Assessment Procedures. Qualitative methodologies for planning and evaluation of health related programmes, edited by Nevin S. Scrimshaw and Gary R. Gleason. Boston, Massachusetts, International Nutrition Foundation for Developing Countries, 1992. 51-9.The objectives of nutritional surveillance were published in 1976 by the World Health Organization and subsequently elaborated upon by the Cornell Nutritional Surveillance Program (CNSP) in 1984. The uses of nutritional surveillance are: 1) problem identification and political sensitization; 2) policy formulation and planning; 3) program management and evaluation; and 4) timely warning and intervention. The vast majority of countries embarking on nutritional surveillance did so without having performed the prior steps of identifying decision-makers and the type of surveillance systems required. The most common type was nutritional monitoring, which could not facilitate decisions on immediate action. Ancillary data were adequate only for confirming that locations with a high prevalence of protein-energy malnutrition (PEM) also have a high prevalence of socioeconomic deprivation without pinpointing specific factors. Rapid assessment procedures (RAP) face similar problems, which could be improved by the development of guidelines. Another reason for linking qualitative methodologies to nutritional surveillance is that the infectious disease model of surveillance is not the most appropriate one for nutritional surveillance because of the complex etiology of chronic PEM. Timely warning and intervention systems (TWIS) are relevant in warding off possible food crises, as the case of Central Lombok District of Indonesia illustrated. Qualitative information methods were used in collecting agro-meteorological indicators by extension workers; assessing household food consumption patterns; alerting of district officials to an impending food crisis; and evaluating the extent to which this system triggered decisions. Nutritional surveillance for policy and planning is difficult to implement, as the examples of Costa Rica and Kenya showed. In the former, a national sample survey of low-weight-for-age children stratified according to father's occupation revealed the highest rate of malnutrition in sugar cane and banana plantations because of poor water and high food prices. This finding led to legislative action.
Adaptation of anthropological methodologies to rapid assessment of nutrition and primary health care.
In: RAP: Rapid Assessment Procedures. Qualitative methodologies for planning and evaluation of health related programmes, edited by Nevin S. Scrimshaw and Gary R. Gleason. Boston, Massachusetts, International Nutrition Foundation for Developing Countries, 1992. 25-38.The history and current status of rapid assessment procedures (RAP) are reviewed from the perspective of one of the most well-known leaders of the methodological approach. Both the accomplishments of RAP to date and its limitations are described. The first methodology for rapid assessment came from rural sociology, called rapid rural appraisal, primarily applied to agriculture and rural development. Anthropologists working in public health also began to systematize their own practical approach to program planning, which led to the UN University 16 Country Study and to the development of the RAP field manuals. The objective of the 16 country health studies was to assess nutrition and primary health care programs from the household perspective and as rapidly as possible. The application of anthropology to program planning assumes that there are other tools than the large survey and field trips. These include observation, participant observation, formal and informal interviews, conversation, and group discussion (focus groups) to evaluate health programs. The traditional approach of one person or a team at a site for 1 year had to be altered for the evaluation of nutrition and primary health care programs. The UN study plan was contingent on 1) researchers already familiar with the language and the culture and 2) working with a limited list of objectives or data collection guidelines. The RAP guidelines were designed to allow anthropologists to spend 6 weeks in a community where primary health care was in place and to obtain household views on the health service. The beliefs and behaviors across 514 households in 42 communities in 16 countries were described, indicating that all used indigenous practitioners and various indigenous and Western biomedical health resources. The mother was the primary diagnostician of health-seeking behavior; and all used herbs for prevention and treatment. RAP does not replace traditional anthropology, it is an additional method.
In: RAP: Rapid Assessment Procedures. Qualitative methodologies for planning and evaluation of health related programmes, edited by Nevin S. Scrimshaw and Gary R. Gleason. Boston, Massachusetts, International Nutrition Foundation for Developing Countries, 1992. 11-23.Rapid assessment procedures (RAP) grew explosively in the 1980s in the social investigation of development work, with four main trends to be distinguished: 1) fast repertoire enrichment with new and imaginative procedures; 2) application of RAP in new sectors through content-adaptation and cross-fertilization (rapid rural appraisal by Chambers); 3) geographic broadening in both elaboration and application of RAP (from Sussex, England, to Thailand, Kenya, and India); and 4) the growing shift from technique to substance. There has been compelling demonstration of RAP's potential for changing and improving the planning of development. RAP can increase the planners' ability to put people first in the development projects. Furthermore, a decade of RAP work has launched some social sciences on a path of methodological retooling. Some major development agencies (the World Bank, USAID, ODA) have started to use RAP. The World Bank has been striving to promote the use of sociological/anthropological investigation methods for generating social information needed in projects. The RAP field work of a medical anthropologist who had received a 2-year contract from USAID to conduct research in Swaziland within a water-borne disease project illustrates the value of RAP. He questioned the lengthy sample survey and carried out an informal study of the health beliefs and behavior among traditional healers and rural health motivators. Within 6 months he collected sociocultural information and specific health-related data which led to significant improvement in the public health network via cooperation between traditional and modern health practitioners. The epistemological risks of RAPs result from the limitations intrinsic to the procedures themselves: accuracy, representativeness, cultural appropriateness, and subjectivity. The extrinsic risks are an improper contextual place or weight within the research strategy. These limitations can be overcome by professional training of RAP practitioners. Nevertheless, RAPs are not a universal cure for gaps in social information, and long-term social research is still essential.