In mid-2014, the Coverage Monitoring Network coordinated an independent, participatory review of the three (3) available coverage methodologies; Semi-Quantitative Evaluation of Access and Coverage (SQUEAC), Simplified LQAS Evaluation of Access and Coverage (SLEAC) and Simple Spatial Survey Method (S3M). The CMN commissioned this review in order to increase understanding, ownership and uptake of the different methodologies. Click below to view and download the full review: In recent years, the profile of coverage methodologies has amplified. Due to increased implementation by a wide variety of organisations, an increased amount of challenges have been encountered and doubts arisen, with some questions remaining unanswered. As a result, to help clarify confusions and issues, the present review was commissioned by the CMN with the explicit objective of improving existing coverage methodologies through participatory review with users of the methodologies.

METHOD

A Call for Review was issued in July 2014 by Epicentre, subcontracted to organize this review, with a one-month open review period. All questions were sent directly to Epicentre, who collated these questions and responded to each question individually. Epicentre responded to these questions either through reference to methodologies, consultations with recognized experts, or through additional research. In addressing the questions raised however, the review referred exclusively to information publicly available at the time of writing. Review of the coverage methodologies herein does not reflect validation of the methods but rather a directed response to individual questions and comments received during the review period".

RESULTS

Overall Epicentre received a total of 73 separate questions, comments or queries from a variety of organisations including the Centers for Disease Control and Prevention, Concern Worldwide, the World Food Program, UNICEF, the International Rescue Committee as well as participants from unspecified affiliations. The main questions posed focussed around the following topics;

• Practical issues regarding the method’s guideline and resources
• Practical issues regarding survey timing and context of implementation
• Methodological questions and comments including questions on; case-finding methods, spatial sampling, mapping, homogeneity assumption vs clustering, anthropometry, questionnaire and qualitative information, LQAS hypothesis, Bayesian approach and calculating the prior, “Point coverage” and “period coverage"
• Aggregated value and interpretation of results at district or national level
• Validity and comparability of results
• Adaptability of methods
• Data quality and reporting
• Direct and indirect estimations

MAIN FINDINGS

The review highlights that “a number of comments received … do not raise substantial concerns but rather represent solvable misunderstandings that require clarification from the methods developers.” The review also highlights that “…the fundamental components of these methodologies (e.g. spatial sampling, LQAS, Bayesian methods), are used across a variety of fields in public health, nutrition and medical programs, (but) in order to ensure that the discussion about their combination and adaptation to the nutrition field is shared with a wider audience, publications in more generalist scientific journals as well as an open forum for debate on these questions would be helpful.

RECOMMENDATIONS

As a result of the above conclusion, Epicentre proposed a set of recommendations in order to facilitate greater understanding and higher quality implementation of the methodologies. These included; More guidance and methodological background on Active & Adaptive Case Finding should be furnished by the methods developers to guide implementation.

1. More guidance and methodological background on Active & Adaptive Case Finding should be furnished by the methods developers to guide implementation.
2. Increased guidance on developing the prior estimation in a SQUEAC survey
3. Further guide users on which coverage indicator (point or period) to use, and/or report on both indicators
4. Develop easy-to-follow guidelines for assessment implementation
5. Improving understanding and communication with stakeholders, donors and the scientific community
6. Provide clearer guidance on when it is possible to use an aggregated coverage value
7. Further methodological review of LQAS
8. Publication of a finalised methodology for S3M

NEXT STEPS

The CMN has already engaged in developing and finalising documentation responding to recommendations 1 – 5. Parts of this documentation are already publically available. Notably the CMN has been compiling training tools and materials which can be found here: www.toolkit.coverage-monioring.org. On this webpage you will find step-by-step guidance on the SQUEAC and SLEAC methodologies as well as FAQ and Case Studies on survey implementation.