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The original RAP Manual [3]
developed under the auspices of the UNU World Hunger Programme
was aimed at the broad goal of assessing the impact of primary
health care programmes. Subsequent developments, such as the RAP
manual for epilepsy or AIDS, are like the WHO ARI protocol, in
which the focus is much narrower and targeted to a delimited set
of questions. Also, the emphasis is shifted from evaluation to
programme planning. One of the hallmarks of public
health-oriented ethnographic studies, such as those conducted
with the aid of the RAP Manuals or the FES on ARI, which
distinguish them from KAP surveys or formative research in
communications, is the use of multiple methods. The ethnographic
approach detailed in these manuals involves a progression of
research methods from key informant interviewing to more
structured, quantifiable data-gathering. Moreover, both provide
formats or "templates" for specific areas of
data-gathering.
Like the RAP project, the development of the FES has been based on substantial field testing in several widely divergent cultural contexts. Thus, the utility of research guidelines such as these has emerged from an inductive, pragmatic approach.
The idea of developing guidelines for applied ethnographic research for health care and nutrition spread rapidly during the 1980s. The intent of all these efforts is to provide programmes with more effective tools for research and development. It is likely that these efforts will continue throughout the final decade of the century, with the production of research protocols for international health problems such as malaria and vitamin A.
A number of questions will need to be addressed concerning the conduct of the research. Are workshops the most cost-effective way to impart the needed training? How much of the complexities of ethnographic methodology can be transferred and effectively used by persons primarily involved in service activities? Will a new type of "applied social science researcher" emerge?
The next
steps in these efforts must also include careful evaluation of
the utility of such protocols for public health interventions. It
seems likely that a number of different types of protocols and
approaches will emerge, reflecting the wide variety of research
contexts and needs in different parts of the world. More research
and creative experimentation will be needed to establish the most
effective means for communicating the results to intended users.
1. Programme for Control of
Acute Respiratory Infections. Interim programme report. Geneva,
Switzerland: WHO, 1990.
2. Trostle J. Anthropology and epidemiology in the twentieth century: a selective history of collaborative projects and theoretical affinities, 1920-1970. In: Janes CR, Stall R. Gifford SM, eds. Anthropology and epidemiology. Dordrecht: D. Reidel Publishing Co., 1986: 59-96.
3. Scrimshaw SCM and Hurtado E. Rapid Assessment Procedures for Nutrition and Primary Health Care. Anthropological Approaches to Improving Programme Effectiveness. Los Angeles: UCLA Latin American Center, 1987.
4. Nichter M. Acute respiratory infection. Abstracts of the 88th Annual Meeting. Washington, D.C. American Anthropological Association, 1989.
S. Sison-Castillo MS. An Ethnographic Study of Acute Respiratory Infection in Oriental Mindoro, Philippines. Metro Manila, Philippines: Research Institute for Tropical Medicine, 1990.
6. Young J.
Medical Choice in a Mexican Village. New Brunswick, NJ: Rutgers
University Press, 1981.
Project setting
Preparations for the uses of RAP
Uses of RAP
Situation study
Planning
Annex A: RAP guidelines for rural water supply and sanitation project evaluation in Nepal
Annex B: Outline of format for situation study report
By Vijaya L. Shrestha
V.L. Shrestha is affiliated with the Rural Water Supply and Sanitation Project in Butwal, Nepal.
This paper describes the application of RAP to a rural water supply and sanitation programme in Nepal. This is a good example of the adaptability of the RAP approach since the author, V. J. Shrestha, is one of the original group of anthropologists that pioneered the RAP approach. RAP has proved useful because needed data are often nonexistent and conventional quantitative data collection methods are too expensive and time consuming. The author also affirms the relevance and sustainability of data on social dynamics that cannot be obtained through quantitative methods and states that RAP spontaneously elicited participatory development of the programme. - Eds.
RAP WAS DEVELOPED as a methodology especially for health workers and social scientists in fields other than anthropology/sociology and to give anthropologists and sociologists guidelines for conducting rapid, reliable assessments of health seeking behaviour of people, including primary health care (PHC), nutrition and family planning, and maternal and child health (MCH) programmes.
RAP techniques are new phenomena in Nepal water supply and sanitation programmes. Their usage has been encouraged because the requisite data have been non-existent, conventional data collection methods are expensive, and field work for baseline surveys usually takes several months to do and twice as long to analyze. There is also a lack of data collection infrastructure and professionals to collect and analyze the data. Furthermore, our emphasis on a participatory approach, and on relevancy and sustainability of data on social dynamics and historical perspective cannot be obtained through quantitative methods.
RAP, in the context of the Lumbini Rural Water Supply and Sanitation Project, is a semi-structured process of learning with and from village people about their needs, problems/conditions, local resources, expertise, capabilities, experience and pertinent social information. This progresses into participatory planning, development and implementation of remedial activities that are relevant, acceptable, manageable and sustainable by the villagers. This process has led. to a direct rapport that has stimulated activities not otherwise envisaged.
This paper
discusses the applications of RAP to programmes of rural water
supply and sanitation in Western Nepal. It describes the
preparation for, and usage of, RAP in the planning and management
of project activities and shows how these RAP findings strengthen
and enrich water supply and sanitation public support programmes.
The Rural Water Supply and
Sanitation Project (RWSSP) is a project funded by His Majesty's
Government of Nepal and FINNIDA. The agreement between His
Majesty's Government of Nepal and the Finnish International
Development Agency (FINNIDA) was signed in November 1990.
The twin emphases of the Rural Water Supply and Sanitation Project are to: 1) ensure access to a safe and adequate water supply, and 2) promote health education and sanitation activities based on local realities, resources, and active beneficiary participation.
The projects include three major components involving both the provision of services and strengthening and upgrading of relevant government infrastructure, including beneficiary groups and institutions. The three major components are water supply; health education and sanitation; and training and research. Relevancy, continuity, and integration are the guiding principles for the planning and implementation of the project activities of the many facets of any water supply scheme. The two particularly difficult components are the promotion of participatory development and linking safe water with sound health in people's perceptions.
These
principles can be translated into action through reliable and
rapid assessment of needs; active participation of the
beneficiaries in identification, and the development and
implementation of the water and health schemes, including active
involvement of the relevant mainstream government services
(Drinking Water, Health and Educational Sectors) and indigenous
institutions that are permanent and well established, located at
the village/community and district level. In addition, the
project has a variety of complementary activities. Community
health volunteers are provided training in health, hygiene and
sanitation. At the end of training, they are given a set of basic
tools and medicines for first-aid treatment. The water users
committee members are also provided with training designed to
increase their perception of the benefits of safe water, better
management, operation and maintenance of the community water
supply system and improved health and sanitation practices.
School teachers are trained to upgrade their health teachings and
provisions are made to improve school sanitation environment.
A data collection guide was
developed and from it an open-ended set of questions evolved (see
Annex A).
To a large extent, utilization of data depends upon how they are presented and interpreted. When interpretation is complicated (technical, not easily understandable or isolated from planning needs) and the presentation is long and confusing, the findings are under-utilized and may be shelved. Hence, the second step in this study was to prepare formats for reporting information that would be directly relevant, precise and easy to understand (Annex B). The check list and report formats were pretested during the introductory training workshop on RAP methodology and revised after the workshop.
Training workshop
In the process of preparation, the third step was to prepare manpower who would develop skills and confidence in using RAP techniques. Overseers were the first group to be given intensive 10-day training in RAP during which they were required to go out to the village and apply various RAP data collection techniques, in particular observation, participant observation, informal dialogues, focus group discussions, personal interviews, walkabout surveys, and collection and use of secondary data, including recording and presentation of reports.
This exercise proved rewarding both for us and the trainees. It made the technicians/overseers realize the research is not necessarily a costly, time-consuming academic exercise, but that it could be a way to plan and develop the water supply and sanitation programme. Also, the trainees' interest and enthusiasm in the exercise continued with the wealth of information it brought in such a short period of time, and they were amazed to find things so different from what they otherwise had taken for granted. Two of the participant overseers had been in the same village where field work had been organized several times in connection with earlier water supply schemes, yet they had never been aware that the village community was so well organized or had well-established irrigation schemes, a client-patron system for agricultural and drinking water, village security, and so on.
Further analysis and application of these reports in programme planning were found to be very meaningful, as this brought the trainees closer to the people and gave them greater confidence in talking and working with them.
Social
scientists and community-based health educators who had been
trained in survey research methodology benefited greatly from a
brief exposure to RAP techniques, especially its
socio-ethnographic methods and focus group discussions. Their
early training enabled them to understand and appreciate the
usefulness of RAP methodologies, and they mastered the skill
rather quickly. However, one-short training session for technical
persons who are not social scientists is insufficient. Such
persons usually need several practice training sessions under
close supervision before they are able to master the skills
necessary to apply RAP, and they must also possess the aptitude
to teach.
In the context of the rural
water supply and sanitation programme, Rapid Assessment
Procedures and techniques were adapted and developed specifically
to assess the need for water supply schemes, prospects and
possibilities for participatory planning, implementation
strategies, relevancy, and appropriateness of health education
and sanitation activities in a reliable, rapid way. Preliminary
results from these assessments were available to the project
within a period of two to 15 days. RAP was used at several stages
of programme planning.
In the first stage, RAP was
used to assess the needs for a drinking water scheme. Each
village or community that had requested a drinking water scheme
was visited for a day or two, depending upon the size of the
village. This was a Situation Study in which social scientists
did a walk-about survey, made observations, and held brief
informal dialogues with villagers individually and in groups in a
random fashion to:
• learn the villagers' knowledge about the request;
• assess the conditions of drinking water facilities in terms of adequacy, distance, type, and quality; and
• obtain some information on villagers' previous cooperative efforts and experiences.
When it was
found that villagers were aware of the need and eager for a
sanitary water supply, a detailed sociocultural, economic and
health feasibility was undertaken, again using RAP. This was
usually done between four to 15 days after initial contact. This
phase of RAP involved the prospective beneficiaries in several
ways, i.e. focus group discussions, informal discussions,
participant observation, data on village records, water sources,
village experience in participatory development, and so on (see
Annex B). The duration of this phase was again determined by the
number and size of the villages to be covered. This process of
data collection not only entailed in depth information on
relevant software issues of water supply, but also made
participatory planning natural and truly meaningful.
After the feasibility study
of the future course of action had been charted, the team and
villagers gathered information on the health education,
sanitation, and water supply scheme. A Water Users Committee was
formed and community health volunteers were identified to train
health workers and volunteers. The feasibility of additional
sources of support and alternative courses of action was
explored.
The use of RAP began with identification followed by detailed socioeconomic technical feasibility, followed by sharing our findings with the concerned villagers/beneficiary groups making them feel and act as true partners in planning a water supply and sanitation initiation programme with a sense of pride and confidence.
This encouraged open discussion between the project personnel and the villagers. As a result, such sticky problems as financial support using locally available materials and labour contribution, the location of tap stands or dugwells, formation of the Users' Committee and nomination of community health volunteers were all done by villagers, not by just a few village leaders or influential persons.
Likewise, information on health- and sanitation-related behaviour of the villagers and the sharing of this information in village meetings have been a tremendous help in making people understand the link between water and disease/illness. Knowledge of hygiene and health status has thereby increased interest and commitment in participation in village-based health education and sanitation activities. Within a period of twelve weeks and less, RAP enabled us to gather a wealth of information on health and sanitation behaviour, food habits, health and illness beliefs and practices, and to provide training to a group of community health volunteers in the water supply scheme areas.
The use of Rapid Assessment Procedures has confirmed that, given the opportunity, acknowledgement of people and application of their skills, abilities and indigenous institutions and management systems will provide much greater ability to create, understand, and analyze the plans and situations. This not only creates rapport, but also paves the way for self-reliance, commitment and true partnership in development.
Finally,
proper use of Rapid Assessment Procedures and techniques will
help to demystify social science research in terms of cost,
relevancy, timely availability and direct linkages with programme
planning and management, and thereby make research an affordable
and integral part of planning public assistance programmes.