The data collected from routine program data and qualitative data, when combined, provide information about where coverage is likely to be satisfactory and where coverage is likely to be unsatisfactory, as well as information about the likely barriers to service access and uptake that exist within a programme. This information can be considered or stated as a set of hypotheses that can be tested.

This page outlines how hypotheses are formulated and the small study and sample methods used to test them. The next page (Stage 2: Analysis of findings) outlines how the results of these can validate or disprove the hypotheses set.

1. Setting hypotheses
2. Testing hypotheses
3. In-community case finding

1. Setting hypotheses:

Surveyors should set their hypotheses based on the information and data gathered during Stage 1. Hypotheses should always be stated before starting the survey or sampling.

For example, if, during Stage 1, an area of low coverage was identified by mapping beneficiary home locations, analysis of outreach activities, defaulter follow-up, and qualitative data, the hypothesis would be:

Coverage is below the Sphere standard of 50% of OTPs in rural settings due to:

• A mismatch between the program’s definition of malnutrition (i.e., anthropometric criteria and problems of food-security) and the community’s definition of malnutrition (i.e., as a consequence of illness, particularly diarrhoea with fever).
• Patchy coverage of outreach services, particularly with regard to the ongoing follow-up of children with marginal anthropometric status.
• Distance to program sites and other opportunity costs.

Based on this overarching hypothesis, the assessment team should therefore set two hypotheses:

1. Coverage in villages located more than 10 km from health centres will be below 50%.
2. Coverage in villages located less than 10 km from health centres will be above 50%.

In order to test these hypotheses, the team should then purposively select at least two villages or communities located more than 10 km from their local OTP site and two areas or communities located less than 10 km from their local OTP site.

This technical note provides more information about the scope of hypothesis tests during SQUEAC surveys.

2. Testing hypotheses:

The hypotheses set will determine the sampling or survey method to be used. Hypotheses can be tested in three different ways:

• If a hypothesis states that certain locations (eg. villages close to health centres and far from health centres) are likely to have high or low coverage, then a small-area survey can be done by visiting the different locations, locating all SAM children in the location and determining which ones are and which ones are not enrolled in the CMAM programme.
• If a hypothesis states that certain population groups (eg. Christians and Muslims or pastoralists and agrarians) are likely to have high or low coverage, then a small survey can be done by visiting the same number of families in each population group and determining how many SAM children in each are and are not enrolled in the CMAM programme.
• If a hypothesis states that a certain process relating to coverage is operating well in one area type and not operating well in another area type (eg. outreach services are better in villages close to health centres than in those further away), then a small study can be conducted in both areas which investigates the process in the same way.

More information about the sampling and survey methods is available here. Also concise quality assurance guidelines for Stage 2 are available in Tools.

3. In-community case finding

Once in the communities, survey teams can use two in-community case finding techniques to locate cases in each village:

• Active and adaptive case finding
• Door-to-door case finding

Here is a guide on how to carry out each technique. The findings of the interviews with carers of acutely malnourished children and results of the sampling should be recorded on forms. Templates for these are available in Tools.

The next section, Stage 2: Analysis of findings, outlines how to analyse the findings of the surveys or studies in order to validate or disprove the hypotheses.

Tools:

Quality assurance guidelines for Stage 2

Tools for small surveys and small-area surveys:

Case finding procedure

Questionnaire for covered cases 

Questionnaire for non-covered cases

Active case finding data collection form

Sources:

• Myatt. M, Guevarra. E, Fieschi. L, Norris. A, Guerrero. S, Schofield. L, Jones. D, Emru. E and Sadler. K , 2012. Semi-Quantitative Evaluation of Access and Coverage (SQUEAC) / Simplified Lot Quality Assurance Sampling Evaluation of Access and Coverage (SLEAC) Technical Reference, available to download here.