Chapter 10. Needs Assessment in Public Health and Organising Public Health Programmes (Priority Setting)
Dr. Fantu Lombamo Untiso, Public Health Specialist Medical Doctor · St. Paul's Hospital Millennium Medical College
Programmes fail when they answer the wrong question. A needs assessment helps you find out what a community needs, which problems matter most, and what can realistically be done. This final chapter turns the course into a practical method that you will use in your term project.
Chapter 10 of 11 · Week 3 · 2 contact hours
Learning objectives for this chapter
- Distinguish types of need and explain the purpose of a community health needs assessment.
- Describe the steps of the assessment, planning, action and evaluation cycle.
- Use data collection methods and prioritisation tools (for example the Hanlon method and a weighted scoring matrix).
- Draft SMART objectives and a simple action plan for a priority health problem.
1. What is a health needs assessment?
A community health needs assessment (also called community diagnosis) is a systematic process of describing the health status and health needs of a defined population, the assets and services available, and the community’s own views, in order to agree priorities and plan action that improves health and reduces inequalities. It answers four questions: What is the health of our community? What are the causes? What resources do we have? What should we do first?
Bradshaw’s four types of need help to look at a problem from different sides:
| Type | Meaning | Example |
|---|---|---|
| Normative need | Defined by experts against a standard | A health officer finds that only 60 percent of children are fully vaccinated against a target of 90 percent |
| Felt need | What people say they want or feel | Mothers say they want a closer health post |
| Expressed need (demand) | Felt need turned into action | Mothers walk long distances to a clinic, or sign a petition |
| Comparative need | Comparing similar groups | A neighbouring woreda with similar people has half the child mortality |
A problem may be present in one type and absent in another: communities may not feel a need for something that experts judge urgent (for example hypertension screening), and the reverse can occur. Good planning looks at all four.
2. The cycle: assess, plan, act, evaluate
| Stage | Key tasks |
|---|---|
| 1. Prepare and engage | Define the purpose, scope and boundaries; identify stakeholders; form a team with community members, local government and partners; agree ethics and roles |
| 2. Gather data (assess) | Collect and review data on demography, health status, determinants, services and assets, and community perceptions |
| 3. Analyse and interpret | Calculate rates, trends and inequalities; compare with targets and with other places; identify gaps |
| 4. Set priorities | Use agreed criteria and a transparent method; involve the community |
| 5. Analyse the priority problem and plan | Problem tree; goals and SMART objectives; choose evidence-based interventions; action plan, budget, indicators, risks |
| 6. Implement | Assign roles; mobilise resources; communicate; train; monitor |
| 7. Evaluate and review | Process, outcome and impact; feed results back to the community; start the cycle again |
Planning frameworks such as MAPP (Mobilizing for Action through Planning and Partnerships) describe the same logic of partnership, assessment, strategy and action. The cycle is not a straight line: you may return to an earlier stage as you learn more.
3. Collecting data
| Method | Use | Notes |
|---|---|---|
| Secondary data review | Census, DHS, HMIS/DHIS2, surveillance reports, school records, woreda plans | Fast and cheap; check quality and age |
| Household or community survey | Prevalence, coverage and behaviours | Needs sampling and trained data collectors; use mobile data tools |
| Key informant interviews | Views of leaders, teachers, health workers, traditional healers | Rich insights; choose varied informants |
| Focus group discussions | Shared community views and norms | 6 to 10 people; separate groups for women, men and youth |
| Observation, ‘transect walk’, community mapping, windshield survey | Water points, sanitation, housing, food markets, facilities | Shows the physical environment |
| Participatory rural appraisal tools (ranking, seasonal calendars, photovoice) | Involve people who may not be heard | Good for felt needs; supports ownership |
| Asset mapping | Identify resources: groups, schools, faith leaders, volunteers, traditional associations | Shifts attention from deficits to strengths |
Triangulate: use more than one source and method. Disaggregate data by sex, age, wealth, disability and location so that inequity can be seen. Follow ethical rules: informed consent, privacy, safe storage and return of results to the community.
4. Setting priorities
Many problems compete for limited resources. Choose criteria and use a transparent method. Common criteria are:
- Size (how many are affected) and severity (how serious: deaths, disability, cost).
- Trend (getting worse?) and inequity (does it fall on the disadvantaged?).
- Effectiveness of interventions (is there something that works?) and preventability.
- Feasibility (resources, skills, time, political support) and cost.
- Community concern and acceptability.
Methods. Weighted scoring matrix: score each problem on each criterion (for example 1 to 5), multiply by a weight and add. Hanlon method (Basic Priority Rating): BPR = (A + B) × C ÷ 3 × D, where A is size (0 to 10), B seriousness (0 to 20), C effectiveness of solutions (0 to 10), and the PEARL test gives D as 1 if the answer is yes for each of Propriety, Economics, Acceptability, Resources and Legality (and 0 if any is no). Other methods include nominal group technique, multi-voting, and Delphi consensus. Try the scoring tool in the Activities tab.
5. From priority to plan
Problem analysis: a problem tree places the problem in the trunk, causes in the roots and effects in the branches. Turn it into an objective tree. Check the evidence (Chapter 8) for interventions that address the causes, and choose options that are effective, feasible and equitable.
Goals and objectives: a goal is the long-term aim; objectives are SMART: Specific, Measurable, Achievable, Relevant and Time-bound. Example: ‘By December 2027, increase the proportion of children aged 12 to 23 months fully vaccinated in Woreda X from 62 to 80 percent.’
Logic model: inputs (money, staff, vaccines) → activities (outreach sessions, community mobilisation) → outputs (sessions held, children reached) → outcomes (coverage rises, dropout falls) → impact (fewer vaccine-preventable deaths).
Action plan: list activities, responsible persons, timeline, budget, indicators (with baseline and target), data sources and risks, and how the community will be informed and involved. Plan monitoring from the start.
6. Evaluating and sustaining
- Process evaluation: were activities delivered as planned and to whom?
- Outcome and impact evaluation: did coverage, behaviour or health change, and did inequality narrow?
- Learning and sharing: report results to the community, partners and decision makers; adapt the plan.
- Sustainability: integrate into woreda plans and budgets, build local skills, and avoid parallel structures.
የኮርሱ አካል: Fundamentals of Public Health
በዚህ ንጥል ላይ ያለ ችግር ሪፖርት ያድርጉ
ደረጃ ይስጡ
እስካሁን በቂ ደረጃ አልተሰጠም።
ጥያቄዎችና አስተያየቶች (0)
እስካሁን አስተያየት የለም። አስተማሪውን ጥያቄ ይጠይቁ።
ጥያቄ ወይም አስተያየት ይጻፉ
ለፈቃድ ላላቸው ባለሙያዎችና ተማሪዎች። የትምህርት መረጃ ብቻ ነው፦ ሁልጊዜ የወቅቱን ብሔራዊ መመሪያዎች (የኢትዮጵያ ምግብና መድኃኒት ባለሥልጣን፣ ጤና ሚኒስቴር)፣ የምርቱን መለያና የተቋምዎን አሠራር ይከተሉ።