Rapid Assessment Procedures - Qualitative Methodologies for Planning and Evaluation of Health Related Programmes

Table of contents

Nevin S. Scrimshaw and Gary R. Gleason, Editors

(c) Copyright 1992 International Nutrition Foundation for Developing Countries (INFDC), Boston, MA. USA. All rights reserved.

Library of Congress Cataloging-in-Publication-Data

Main entry under the title:

Rapid assessment procedures - qualitative methodologies for planning and evaluation of health related programs, edited by Nevin S. Scrimshaw and Gary R. Gleason

1. Anthropology I. Title
Library of Congress Catalog Card Number: 92-82978
ISBN 0-9635522-0-1

The International Conference on Rapid Assessment Methodologies for Planning and Evaluation Health Related Programmes, was the forum for the presentation that served as the basis for most chapters in this book. The conference, organized by the United Nations University and held at the Pan American Health Organization headquarters in November 1990, explored anthropologically based methodologies for the design, evaluation, and improvement of programmes of nutrition and primary health care.

The 42 chapters on Rapid Assessment Procedures (RAP), Rapid Rural Appraisal (RRA) and related approaches in this volume deal with research tools that offer strong potential both in national and international public health and other areas.

These approaches investigate household and individual health-related behaviours within their complex, rational matrix of personal, organizational, and social realities. They search for opinions and attitudes, behaviour, and motivations of both the clients of development programmes and also those who deliver services. These tools lead to the type of understanding of both groups that is essential both to planning and evaluating health, nutrition and other social development programmes.

A wide range of RAP and RRA applications is provided along with insight into the core concepts on which they rest and the methods that are used. This book presents new tool kits that are badly needed to meet the challenges of national and international development in the 1990s.

Nevin S. Scrimshaw, Ph.D., M.D. Institute Professor Emeritus Massachusetts Institute of Technology is Director of the United Nations University Food and Nutrition Programme for Human and Social Development. He is the 1991 World Food Prize Laureate.

Gary R. Gleason, Ph.D. is Vice President at Intercultural Communication, Inc.

This book may be ordered from the International Nutrition Foundation for Developing Countries (INFDC) by writing to:

P.O. Box 500
Charles Street Station
Boston, MA 02114-0500 USA.

The digitalization of this publication was made possible by a grant from the Nestlé Foundation






Section I: The expanding role of qualitative research in international development

Section introduction
1. Re-tooling in applied social investigation for development. Planning: Some methodological issues

Twin changes: In planning of projects and in social research
Twin epistemological risks in RAPs
The place of RAP within broader research strategies
Additional reading

2. Adaptation of anthropological methodologies to rapid assessment of nutrition and primary health care

The UNU sixteen country study
Additional applications of the RAP guidelines

3. Qualitative and quantitative: Two styles of viewing the world or two categories of reality?

The origins of survey research
The problems and limitations of survey research
Qualitative or quantitative: Two styles of viewing the world or two categories of reality?
Combining quantitative and qualitative methods: Triangulation
The pros and cons of rapid assessment methodologies (RAM)

4. The role of qualitative methodologies in nutritional surveillance

Nutritional surveillance: Objectives, principles, and lessons
The role of qualitative methodologies in nutritional surveillance


5. The coming revolution in methods for rural development research

The questionnaire syndrome
Case 1: Limitations of revealing relations (Philippine storage case)
Case 2: The leap frog problem (Mantaro Valley Project, Peru)
Case 3: Eliciting quantified data without the questionnaire (Potatoes in Nepal)
Case 4: Meeting a specific need (Identifying fallow periods in Bhutan)
Keeping the questionnaire in perspective
The cafeteria is now open: A diverse selection of methods

Section II: Development and applications of rapid assessment procedures in Africa, Asia and the Americas

6. Rapid assessment methodologies: Application to health and nutrition programmes in Africa

Main features of RAP
Users of RAP
Applications of RAP to primary health care programmes
RAP as a tool for formative research
RAP for baseline data collection
RAP for monitoring and evaluation
RAP in academic research
The future of RAP methodologies
List of acronyms

7. Understanding infant feeding practices: Qualitative research methodologies used in the weaning project

Historical perspective
Sample results

8. The use of RAP in the assessment of growth monitoring and promotion in north Sulawesi: Indonesia

The concept of monthly weighing
Differences among villages
Management of growth monitoring

9. Applying RAP in Cape Verde, Africa and in poor areas of Rio de Janeiro, Brazil

The Cape Verde experience
RAPing in the periphery of Rio de Janeiro: Application of anthropological procedures to the assessment of programmes of nutrition and primary health care

10. Application of rapid assessment procedures in the context of women's morbidity: Experiences of a non-government organization in India

Sample selection
The ethnographic methods
Computer analysis of data
Preliminary analysis of free listing and pile sort data

11. Beyond data collection: Facilitating the application and use of ethnographic information to guide health programmes and further research

Designing manuals to promote optimal ignorance and active application
Identifying "possible approaches"
Exploring possible approaches

12. Adaptation of RAP to monitoring settlement trends in areas covered by successful disease control programmes: Onchocerciasis

The land settlement review
The Burkina Faso case study

13. Rapid assessment procedures and the Latinas and AIDS research project

The Latinas and AIDS research project
AIDS prevention workshops for Latinas
Implications for future research and application
Additional reading
Annex A: Summary of workshop illustrated fact and fiction card data
Annex B: Individual card responses for Latina subset, workshop data

14. Rapid anthropological procedures in the early planning for control of paediatric acute respiratory infections: Lesotho, 1989

Methodology and design
Other findings
Appendix I: ARI interview guide

15. Transcultural epilepsy services

The transcultural epilepsy demonstration project
General findings
Utilization of epilepsy specific health services
Psychosocial concerns
Educational campaign

16. Developing a focused ethnographic study for the who acute respiratory infection (ARI) control programme

Background: The WHO ARI programme
Requirements for effective FES research on ARI
Some commonalties in the results of the ARI FES studies
Summary and conclusions

17. Rapid assessment procedures in the context of a rural water supply and sanitation programme

Project setting
Preparations for the uses of RAP
Uses of RAP
Situation study
Annex A: RAP guidelines for rural water supply and sanitation project evaluation in Nepal
Annex B: Outline of format for situation study report

18. Use of qualitative research methodologies for women's reproductive health data in India

Building social science research for women's health in India
Workshops and consultant visits
The protocol: Investigating women's reproductive health in India

19. The application of RAP and RRA techniques in emergency relief programmes

The state of the art
RRA techniques appropriate to relief operations
RRA information as a complement to quantitative data

20. The need for rapid ethnographic procedures for environmental contaminant assessments with indigenous people

Examples of rapid assessment data needed
Examples of techniques used to gather needed data
Examples of difficulties with research on food contaminants among indigenous people

21. Interview-based diagnosis of illness and causes of death in children

The basis for interview diagnosis
Structure of interviews
Validation of verbal autopsy
Neonatal tetanus
Perinatal deaths, prematurity, and low birth weight
Diarrhoea and dysentery
Acute lower respiratory infection (ALRI)
Pertussis (whooping cough)
Chronic illnesses: malnutrition, tuberculosis, and AIDS
Injury and violence
Summary and conclusions

22. The relevance of rapid assessment procedures for overcoming hunger in the 1990s

Ending hunger in the 1990s: the Bellagio declaration of 1989
Eliminate famine deaths
Ending hunger in one-half of the poorest households
Cutting malnutrition among women and children by half
Eliminate iodine and vitamin a deficiencies as public health problems

Section III: Community participation and rapid rural appraisal (RRA)

Section introduction
23. Some thoughts on development, people's participation, and research


24. Rapid but relaxed and participatory rural appraisal: Towards applications in health and nutrition

Principles of RRA
A menu of RRA methods
Participatory rural appraisal
Strengths of RRA
Applications of PRA in health and nutrition-related programmes
The future

25. Participatory rural appraisal and participatory learning methods: Recent experiences from MYRADA and South India

Rapid vs participatory
The PALM experience
Annex I: Time line
Annex II: Social mapping
Annex III: Sweeping transect
Annex IV: Historical transect
Annex IV: Historical transects
Annex V: Seasonality diagramming
Annex VI: Ranking
Annex VII: Livelihood ranking
Annex VIII: Diagrams

26. Rapid rural appraisal (RRA) methodology and its use in nutrition surveys

What is rapid rural appraisal?
The fundamental principles of RRA
Techniques for data collection
Specific research issues
Future needs
Summary and conclusions

27. Rapid rural appraisal and rapid assessment procedures: A comparison

Rapid rural appraisal (RRA)
Rapid assessment procedures (RAP)
Similarities and differences

28. Rapid rural appraisal applications in Africa: Achievements and problems

Rapid rural appraisal (RRA) in East and Southern Africa
RRA in West Africa

29. Rapid appraisal to assess community health needs: A focus on the urban poor

Data collection and analysis
The final workshop: Planning processes and plan of action
Application of the methodology in other national experiences
Strengths and weaknesses of the methodology

30. The relationship between rapid rural appraisal (RRA) and development market research (DMR)

The beginnings of rapid rural appraisal (RRA)
Development market research (DMR) and its evolution
In what sense is DMR complementary to RRA?

31. The use of rapid rural appraisal methodologies in development research: The experience of the centre regional pour le développement et la Santé Republic of Benin

Objectives of the study
The use of RRA in development research: Potentials and limitations of the approach
Problems faced by team members during the RRA exercise

Section IV: Institutionalization of rapid assessment; procedures (RAP)

Section introduction
32. Use of rapid assessment procedures for evaluation by UNICEF

Background on the evolution of RAP and its uses in UNICEF
Use of RAP in evaluation in UNICEF

33. Institutionalizing the use of rapid assessment procedures in rural service agencies

Constraints to the institutionalization of rapid assessment procedures
The need for support from senior management
Steps required to alleviate these constraints
The role of development agencies

34. RAPing in Chad

Operational research programme
Projects begun in 1990 include the following:
Other studies under consideration included:
Initial resistance to RAP
Positive potential

35. From qualitative community data collection to programme design: Health education planning in Niger

Data base for programme planning
Responsibility for data collection and programme planning
Contact between programme planners and target communities
Concept of the planning process
The Niger programme planning experience

36. Use of rapid assessment procedures for nutrition programme planning, project reorientation, and training in Malawi

Characteristics of the areas to be studied: Malawi's rural areas and needs
The save the children plan: Use of RAP for information gathering as part of needs assessment for programme planning
Rapid assessment procedures for reorientation of the Ntchisi child survival and development project

Section V: Training for RAP and other qualitative methods

Section introduction
37. Synopsis of the training panel from the international conference on rapid assessment procedures for planning and evaluating health and nutrition programmes

1. How did RAP training evolve?
2. Is RAP training needed by everyone wishing to use the methodology?
3. How have researchers and others come to know and begin using concepts and skills associated with RAP?
4. Who should be trained in RAP?
5. What training materials exist for RAP?
6. Why has the training manual taken so long to produce?
7. Who are the most difficult groups to train in RAP?
8. How is training of those with a professional background in anthropology, sociology or public health different from training community level personnel?
9. How can training be improved?
10. Issues raised and comments made by the audience of the training panel:

Section VI: Bringing RAP to the decision-making realm: Effective communication and use

Section introduction
38. Research communication for RAP: Planning for optimal use of communication opportunities throughout the research process and effective use of findings

Case study demonstrating planned research communication: The "contagion route" in Afghanistan1
Elements of the research communication system
Using the research communication overlays to the optimal dissemination of data
Training in research communication
Audiences for training
Training in research communication
Training in source and audience segmentation
Training in research communication planning
Evaluating research communication

39. Visualizing data collection and the presentation of RAP findings: Enhancing qualitative research


40. A summary of the conference panel: Effective communication of research data to decision makers

Section VII: Conference summary, comments, speakers and participants

Section introduction
41. Rapid assessment methodologies: A conference summary

Diversity within unity
Constraints and difficulties
Three gaps
Institutionalizing RAP

42. Rapping on RAP: Selected comments and responses from the conference

Qualitative vs quantitative: Is there really a debate?
Who can do RAP: How low can you go?
Linking RAP to action and policy
Theoretical foundations: Why are they important?
Training: How much, how long and who?
Sampling theory and RAP
RAP's expanding uses and dimensions
How rapid is RAP?
Speaker and participant list