One of the main outputs of a SQUEAC assessment is a list of barriers that carers of malnourished children face in accessing treatment at health centres. The assessment also identifies positive factors, or “boosters”, which encourage carers to take their children to health centres for treatment. Surveyors therefore need to undertake a community assessment in order to understand the social, cultural or medical contexts in which the malnourished children live using a variety of qualitative data collection techniques. A more detailed guide on how to conduct a community assessement is available in the Tools section.

The next page, Qualitative Data Analysis, provides guidance and tools on how to organise and analyse the information that is collected.

1. Preparing for a community assessment
2. Qualitative data collection methods
3. Selecting key informants
4. Collecting additional qualitative information

1. Preparing for a community assessment:

It is recommended that individual team members have a good understanding of the geographical, sociocultural and linguistic context of the area in which the study will be carried out. We recommend the following points for teams to gain such understanding:

• Gather comprehensive information about the CMAM programme (what kind of support is needed, is it a short term intervention or a permanent support structure?)
• Map out existing community volunteer networks, their main activities and their quality.
• Identify existing community actors such as traditional leaders, opinion leaders, health committees, CBOs, women organisations, etc.

The team itself should also pay special attention to its composition, particularly to gender balance. Assuring a representation of women of at least 30%, aiming for 50%, is a good way of addressing the issue if circumstances allow. Also, the participation of community members and/or health district representatives will not only enrich the collection of data and the interpretation of results but it will also allow for a live transfer of competencies and spur follow-up actions within each party’s limits.

To conduct a community assessment, surveyors need to speak to a number of key informants from the community in and around each service delivery unit within a health district. Bearing in mind that all SDUs will need to be visited within a limited number of days, the activities of the surveyors therefore need to be carefully planned in the days before the start of the survey. It is also important that the enumerators are trained in the various data collection methods.

Preparation before undertaking a community assessment is therefore critical. The following should be considered:

2. Qualitative data collection methods:

Before a community assessment is launched, a CMAM programme manager needs to organise a comprehensive training on the qualitative data collection, which will permit all data collectors to familiarise themselves with the objectives, methods and tools of the study. The CMN has developed a complete training guideline including recommended activities, introducing the teams to data collection tools and simulating assessments. These guidelines are available in Annex 1 of the Community Assessments Guidelines.

The main methods of qualitative data collection during a community assessment include:

• Key informant interviews, which include:
  1. Semi-structured interviews with one person using interview guides (available in Tools). The facilitator engages in a conversation with one person using a guide prepared in advance. However, the facilitator is free to add or skip questions depending on the circumstances.
  2. Informal interviews (with one person without an interview guide), during which the facilitator engages in a casual conversation with one person with a choice of questions at the facilitator's discretion.
• Group discussions (guide available here), where an interview guide prepared in advance is loosely followed. This tool is used to identify collective mindsets and reflections about one or more subjects.
• Focus group discussions are used when a facilitator wishes to guide a group through a series of questions on a specific topic.
• Observations of diagnosis and treatment at Service Delivery Units (SDU). Observation form available in Tools.

3. Selecting key informants:

Surveyors should try to go to each SDU in the Health District and, at each, interview or meet with at least four of the following:

• Community members (Male and female)
• Carers of SAM children (M/F)
• Teachers
• Traditional birth attendants / midwifes
• Traditional healers
• Religious leaders
• Community chiefs (village or district chiefs)
• Community based organisations / associations / cooperatives
• Community health workers / volunteers
• Health centre personnel
• NGO professionals

Interview guides for different individuals are available in Tools.

4. Collecting additional qualitative information:

Additional qualitative information should be gathered and then compiled when survey teams come together at the end of Stage 1:

• A seasonal calendar, tracking  peaks and troughs in agricultural activities, disease outbreaks, food prices and labour demand throughout the year, should be developed by the assessment group. The interview guides should therefore include questions on the timing of key activities and events during the year. A template for the development of a seasonal calendar is available in Tools.
• The social mapping and relationship identification exercise helps to identify the key stakeholders in a community and the relationships between them. Here is a guide on how to carry out this exercise.
• The communication channel exercise helps to identify the means by which different communicators in a community diffuse information. Here is a guide on how to carry out this exercise. A template for the communication channel matrix is also available below.

Overall:

Community assessment guidelines 

Preparing for a community assessment:

Community assessment training and simulation guide

Community assessment training presentation 

Sampling framework and calendar of assessment

Team composition template

Conducting a community assessment:

Interview guides for key informants:

Carers of malnourished children

Community based organisations

Community health workers

District and NGO representatives

Health centre personnel

Community members (Men)

Community members (Women)

Traditional healers and birth attendants

Additional qualitative data collection forms:

Health centre observation form

Seasonal calendar template

Communication channels matrix template (with explanations)

Visual aids:

Photos of SAM children to aid case finding in communities