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Cox's Bazar Refugee Settlements: Coverage assessment methodology

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Hugh Lort-Phillips

Global Coverage Advisor

Normal user

28 Mar 2019, 14:49

Hello,
I am supporting partners with assessing the coverage of OTP and TSFP in the Rohingya camps in Cox's Bazar, Bangladesh.

In August 2018, the camps (35 in total) were divided into 5 zones and a SLEAC assessment was conducted in each zone. This provided coverage classifications for OTP and coverage estimates for TSFP per zone and overall coverage estimates for all camps along with some barrier and booster information based on the responses provided by carers of cases. A qualitative investigation was also conducted in parallel with Rohingya community members to gather information about community perceptions of malnutrition and about the nutrition services available.

Partners are planning another coverage assessment in the camps in 2019. However they would like to follow a different methodology which yields more detailed qualitative information which can help improve CMAM service delivery, in addition to providing updated coverage estimates or classifications (if possible disaggregated to camp level).

Given the context and above objectives, partners are reluctant to do another SLEAC.
However I have reservations about conducting a SQUEAC in this context (or even a number of SQUEACs) which would be the logical methodology to use to achieve such objectives. So I would like to ask if anyone recommends other methods or approaches? Or if anyone has learnings from similar experiences to share?

Context: There are 35 camps which include 35 TSFPs (operated by 8 partners) and 60 OTPs (operated by 6 partners). Single camps will often have multiple partners delivering SAM treatment through OTPs. Community outreach is conducted by teams associated to each individual organisation. For both programmes, admission is by MUAC, Oedema and/or WFH. During community screening, all children with a MUAC of less than 135mm are referred to centres for full WFH measurement.

There is sufficient budget for 12 data collection teams to conduct approximately 15 days of data collection to complete the assessment objectives.

My primary reservation with SQUEAC is that considering the variation in service delivery between partners (particularly the community outreach strategy), it would be difficult for a survey team to formulate a prior belief of coverage in a specific area. The barriers and boosters list would also be relevant for the area surveyed and not necessarily for the individual service providers. Therefore developing recommendations for individual service providers to improve coverage would be difficult.

Also owing to the time that a single SQUEAC survey takes to complete it would be possible to complete a maximum of three SQUEACs (in parallel) during the allocated time therefore limiting the disaggregation of data to maximum of three areas.

So, does anyone have any ideas of alternative methodologies to use? Or ideas of how partners could adapt the SQUEAC/SLEAC to achieve the aims?

Thanks in advance,
Hugh

Ernest Guevarra

Valid International

Technical expert

13 May 2019, 12:11

Hugh,

I think doing SLEAC as you have done before would still be your best approach given the context and limitations that you describe. Then, to be able to address the requirements of the partners of more detailed qualitative information, you and your team can add SQUEAC investigations within the SLEAC process to look into the various elements of coverage and performance. The SQUEAC I propose here will be done not for the purpose of building a prior but to elucidate the various factors affecting coverage. The SQUEAC can be very focused to answer either area-specific and/or provider-specific issues in service delivery.

Does this seem compatible with your requirements?

Hugh Lort-Phillips

Global Coverage Advisor

Normal user

16 May 2019, 10:01

Hello Ernest,
Thanks for your reply. I agree, I feel that SLEAC is the most appropriate method to use in order to get an impression of coverage across the camps. And then, as you say, use elements of SQUEAC to conduct more detailed investigations. I also think it would be too much to ask of an investigation team to estimate a prior across an area with different implementing partners.
I shall go back to partners to propose this option.
Thanks again for your response,
Hugh

Paul

Frequent user

16 May 2019, 10:42

Hi Hugh,
Just a couple of thoughts on community assessments. A lot has been learned about the proper use of language / terminology. Enumerators often speak Chittogonian which is a similar language in some ways but terminology often does not translate well.

The enumerators should speak Rohingya (not Chittogonian) or should have language support on terminology. Translators Without Borders will be publishing a sectoral glossary for nutrition and language guidance for the Rohingya response in the near future. See:

https://translatorswithoutborders.org/rohingya-refugee-crisis-response/

In country language support and further details can be obtained from: bangladesh@translatorswithoutborders.org

I have a couple of language / nutrition documents you may be interested in; I will email them to you.

Cheers
Paul

Hugh Lort-Phillips

Global Coverage Advisor

Normal user

16 May 2019, 13:42

Many thanks Paul.
Really useful advice - I'll follow up with the Translators Without Borders team when I travel to Cox's. I'll also put them in touch with the Action Against Hunger surveillance there who conduct many nutritional surveys in the Rohingya refugee camps.
Regards,
Hugh

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