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Adaptation of anthropological methodologies to rapid assessment of nutrition and primary health care.

Scrimshaw SC
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.

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