This section of the I-Kit provides an approach to assessing health providers’ needs, barriers and facilitators to quality service provision at the organizational, regional or national level. The approach includes a needs analysis framework and implementation tools that engage health service delivery stakeholders in the identification of capacity strengthening needs, as well as guidance on identifying interventions that address them. Throughout this section and the case study, Community Health Workers (CHWs) are used as an example. However, this framework and corresponding tools can be used for health providers at any level of the health system, including Facility-Based Providers.
To provide individuals and organizations a systematic approach to assess provider needs and change provider behavior. This approach situates the provider as someone who performs within a holistic context and regards the provider as a professional to be influenced and supported, rather than as a problem to be fixed. Moreover, it builds the capacity of individuals and organizations in social and behavior change communication (SBCC) as a strategy to improve provider performance.
Caveats and Limitations
One of the key focus areas for the framework is the use of SBCC to influence provider motivation, beliefs and attitudes that affect their performance. However, a variety of needs are likely to surface that cannot be addressed solely through communication interventions. It is recommended that the assessment be conducted with full engagement of community stakeholders in both the data collection and in the ownership to ensure action is taken against all identified needs. This will help ensure that communities come together to address all factors affecting the performance of health providers and the health of the communities in which they serve.
Gender Transformative Approaches
This framework and its tools were created in accordance with USAID preference for inclusion of gender considerations in capacity-building, advocacy and integration in reproductive health. Therefore, as a “gender aware” approach, these tools deliberately include gender-related outcomes as part of the investigative process. All factors that impact the performance of health providers are also examined through a gender equity lens for analysis, needs identification, and intervention planning.
The needs assessment is structured around the major steps of the needs analysis framework. The first section reviews the framework itself, including some of the major activities required and the desired output of each framework step. The sections that follow provide tools to support the completion of each step and guidance for completing the needs analysis.
The intended users of this needs analysis framework and its tools are government health agencies, NGOs, and concerned civil society organizations interested in improving health provider performance and thereby improving the health of communities. Keys to success include: engagement of key stakeholders, availability and access to individuals and information, sound project planning and management, representative data collection and analysis, and a willingness to address the many different needs that may be identified to support better provider performance.
A needs assessment is best accomplished by a team of individuals with both an interest in improving the performance of health providers, and the resources to conduct the assessment. Specific individuals to include on the team are defined below.
- Facilitator – this individual is the primary owner and driver of the overall needs analysis process from conception, through analysis, intervention identification, and impact measurement
- Stakeholder – these individuals have an interest in the analysis itself and are willing to help guide and support the analysis; these can be healthcare providers, supervisors, or patients, or any individual who helps create public health targets or fulfill them—including funders, suppliers, measurement specialists or clinic managers
- Measurement & Evaluation Specialist – where possible, it is helpful to have the support of individuals with expertise in data collection and analysis
- Steering Committee – this is a group of stakeholders who serve as the board of guidance and management of the needs analysis. Ideally, it will be as diverse a group as possible and should include individuals with sufficient access to the providers, their supervisors, and local communities. Subgroups of this committee will take on specific responsibilities during the needs analysis.
This framework and tool set will uncover a variety of needs that, when addressed, will support performance. These needs will include both environmental influences, and those associated directly with the performers themselves, such as skills and knowledge and personal motivation to perform. The Design and Resources sections of this I-Kit provide a variety of tools to help address providers’ motivational needs.
Two main categories of motivation are explored in the I-Kit:
- Internal Motivation, which includes personal needs (e.g. status, perceived social support, self efficacy, personal rewards), and a feeling of connectedness to the community and the health system.
- External Motivation, which includes adequate availability of resources, supportive policies, effective links to health facilities and respect from health systems, availability of training, timely and appropriate feedback from supervisors, and supportive social and gender norms.
A needs analysis framework outlines a process for identifying gaps between the expectations of individual or organizational performance, and the reality of their current delivery on those expectations. What follows is a generic seven-step framework for conducting a needs analysis on any group. This high-level framework becomes applied through the sections that follow, which introduce tools for implementing the framework with a team of stakeholders who are committed to the improvement of community health through support of health providers in their area.
The 7 Steps of the Needs Analysis Framework
1 Identify Goals and Performers – working with the community or organization, clarify what you are trying to achieve and who is involved in reaching those achievements
Input: community (or organization) vision, mission, and plans for achievement; identification of performers who are key to achieving goals
- What are the goals and objectives for the performance overall?
- How are the goals and objectives currently measured? What is the status of those measures?
- Who are the key stakeholders in identifying the goals and objectives, and in tracking their achievement?
- Who are the key groups involved in taking action to achieve these objectives?
- How does the action of the groups lead to the achieved objectives and community goal?
Output: established needs analysis Steering Committee, clear performer expectations and a model of how performer actions are measured in pursuit of goals
2 Create Needs Analysis Investigative Questions – these are the questions your needs analysis is being designed to answer; they should be balanced across the four essential factors that support performance
- Expectation – I understand the performance expected: for each group of providers determine if performance is defined in a clear and detailed manner
- Ability – I am able to do it: for each group of providers, determine if they have the skills and knowledge to perform well
- Opportunity – I have the opportunity to do it: for each group of providers, determine if the environment allows and resources are available to support their performance
- Motivation – I want to do it: for each group of providers, determine if there is sufficient motivation, reward, lack of negative consequences, and supportive attitudes and beliefs to support performance
Output: identified questions for the investigation and the corresponding data sources or audiences that might have information or evidence to help answer them
3 Develop Data Collection Plan – identify which individuals or data sources can provide information to answer your questions and how will you engage with them.
- Who or what has insight or information to help answer each of your investigative questions?
- What will you accept as evidence to support their input? Will this evidence be credible to all stakeholders?
- Are there multiple sources of information for each investigative question?
- Are there sources of contradictory information for each investigative question?
- What is the best way to collect information from each data source?
Output: full data collection plan, including data sources, methods of collection, storage, and access for analysis4 Create instruments for Collection and Capture of Data.
- Take inventory of all data sources and proposed collection methods
- Test each data collection approach for all data sources against factors of collection and choose those appropriate to limitations
- Create instruments for all self-administered methods; pilot with appropriate members of target population and update where necessary
- Create instruments for all administered methods; pilot with data collectors and members of target data source populations and update where necessary
- Test data capture instruments (electronic or paper) and housing methods in all pertinent physical locations
- Train data collectors for all methods (live interviews, document reviews, questionnaire delivery, etc.)
- Identify sample populations for each instrument
- Establish schedule and tracking plan to ensure data is collected as intended
Output: full suite of tested data collection instruments and methods; plan for scheduling and tracking data collection
5 Collect Data
- Implement data collection plan
- Ensure captured data are flowing appropriately into electronic or paper based housing structures
- Thank data sources as appropriate for participation
- Inform stakeholders as needed
Output: data fully collected and all contributors and stakeholders aware of progress; data housed in accessible format, ready for analysis
6 Analyze data and identify needs
- Conduct analysis for each method and data instrument as appropriate; assure inter-rater reliability and validity of data where appropriate
- Combine data from all sources and summarize how it answers each of the investigation’s questions
- Note areas of gap between data reported and acceptable performance
Output: draft analysis and results for major investigative questions; list of identified needs for performer excellence
7 Summarize findings and report
- Share analysis and identified gaps with key stakeholders
- Agree on prioritized needs to be addressed and action to be taken
- Determine methods, resources and timeline for implementation
- Identify leads for each prioritized action
- Establish timing for check-in and impact measurement
- Determine cycle for future round of needs analysis
Process Overview - Needs Analysis and Action Planning
Below is a view of the process “at a glance” to assist with planning and stakeholder engagement.
|Step||Key Players||Approximate Elapsed Time||Keys to Success|
|1. Identify goals and performers||Facilitator and Steering Committee||½ day||Committed diverse team|
|2. Create needs analysis investigative questions||Facilitator and Steering Committee||1 day||Broad perspective on factors affecting performance|
Decision Point: (A) high M&E resource setting? or (B) Adapted Success Case approach?
|3. Develop data collection plan||Facilitator, Steering Sub-Committee, M&E Specialist||1-2 days||Knowledge of data sources and collection methods|
|4. Create and pilot instruments for data collection||M&E Specialist||1 week ↑ M&E or 1 day Adapted Success Case||Audience access and representative sampling|
|5. Collect data||M&E Specialist||2-3 weeks ↑ M&E or 3-5 weeks Adapted Success Case||Consistency|
|6. Analyze data and identify needs||Facilitator, Steering Sub-Committee, M&E Specialist||1-2 weeks||Valid methods and sound conclusions|
|7. Summarize findings and report||Facilitator, Steering Committee||2 days||Action identification and clear ownership|
Once the needs have been identified, guidance and support on motivational needs is available through the Designing an SBCC Intervention for CHW Behavior Change and the Designing an SBCC Intervention for FBP Behavior Change I-Kits.
Throughout this needs assessment, many tools will be introduced to help you conduct a needs analysis. Each tool will first be presented and explained, and then will be shown in use through an example based on the following general case:
Cecilia is the Project Director of a nonprofit initiative supporting CHWs in the remote, tropical community where she grew up. Her project is looking specifically at child and maternal health issues, with targets that support governmental public health goals. Cecilia is aware of several other projects operating locally and nationally that all touch upon reproductive health in the region.
All of these groups are interested in how to best support CHWs at every level and ensure they have what they need to perform their best. Cecilia has met with the directors of several of these projects and with local Ministry of Health officials to work together in identifying what issues and barriers are keeping CHWs from performing at their best on the job. As a result, a Steering Committee has been created to oversee a formal Needs Analysis of CHWs in the region. Cecilia is proud and excited to have been chosen as the facilitator of the process and looks forward to working with the Steering Committee to complete the analysis.