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Section introduction
41. Rapid assessment methodologies: A conference summary
42. Rapping on RAP: Selected comments and responses from the conference
A goal of the International
Conference on Rapid Assessment Methodologies for Planning and
Evaluation of Health and Nutrition Programmes was to provide a
forum for professionals and academics developing and using RAP
and similar qualitative techniques, as well as donor agencies and
other funders of health and nutrition programmes to come together
and discuss the current state of the art. The presentations,
discussion periods and open communication sessions were organized
in such a way as to encourage a free flow of discussion and
debate around several themes. In this section the summary of the
conference is presented along with a set of comments from a wide
variety of participants. Dr. Ngokwey Ndolamb, a medical
anthropologist and a UNICEF Programme Officer in UNICEF service
in Cotonou, Benin demonstrated his own skill in the conference
summary. Both his summary and the summary of conference comments
which follows it are self explanatory. The comments were
abstracted from discussions both of individual papers and general
sessions. While each speaker has been identified, the editors
utilized session notes as the source for this section and thus,
the comments are not direct quotes.
This short section provides evidence that RAP has now entered a stage of development where issues such as its institutionalization and acceptance, and issues regarding training are moving to the fore. As can be expected, experience is leading to further improvements in the methods. The comments, in general, suggest a strong need for orientation within donor organizations and other decision making bodies on RAP despite the potentials for qualitative methods. They also suggest a need to avoid viewing qualitative and quantitative methodologies as mutually exclusive and to derive the choice of method more systematically from the perspective of information needs by decision makers be they in the village or at the level of government and donors.
Lists of
participants and speakers with their addresses and affiliations
at the time of the conference are also provided. These have been
updated as of January 1992 where possible.
Diversity within unity
Constraints and difficulties
Three gaps
Institutionalizing RAP
References
By Ngokwey Ndolamb
Ngokwey Ndolamb, Ph.D., is a staff member of UNICEF in Cotonou, Benin.
The conference summary was presented at the closing session of the conference, having been prepared "rapidly" by Ngokwey Ndolamb. This summary captured both the spirit of the conference and its major points. Participants were reminded that they had heard and discussed a wide range of methodologies within a context that was almost totally operational and problem oriented. He emphasizes that despite the great pluralism in these methods, almost all were developing in the context of real problems and real programmes for real people. He cautions correctly about the gaps between technique and results, methods and theory, and knowledge gained through these methods and its application. The greatest challenges will remain those of institutionalizing RAP within development agencies and academia, developing stronger mechanisms for quality control in training and use, and in developing effective strategies and mechanisms to assure that what is learned through rapid assessment methodologies is well used. - Eds.
THE RICHNESS OF presentations and the intensity of discussions make it difficult to attempt any meaningful summary of this four-day conference. The diversity of participants and of expectations also compounds this difficulty. Indeed, apart from the multiplicity of disciplinary backgrounds (social sciences, health sciences, agricultural sciences, etc.) and professional interests (academics, development planners, programme officers, etc.), there is also a diversity of expectations: some came to exchange ideas about their experience with rapid methodologies, others came to learn about these methodologies; some came to discuss about rapid assessments or rapid appraisals as methods or techniques of data collection and analysis; others came to present the results of their use of these methodologies. This diversity of expectations is well illustrated by one participant who asked: "Is this a method-oriented or a problem-oriented conference?"
The methodology itself is named diversely: rapid assessment procedures, rapid rural appraisals, participatory rural appraisals, rapid ethnographic procedures, etc. The acronym RAP, standing for rapid assessment procedures, was reinterpreted differently to capture what different participants considered the essence of the methodology. "R" as relevant, relaxed, relatively rapid, responsible, role reversals. "A" as anthropological, appraisal, assessment, action. "P" as participatory, procedures, practice, etc. The diversity of participants and expectations partly accounts for discussions around the specificity of rapid assessment methodologies. One could hear questions or comments like: "Is this RAP? What is RAP about this? This is not RAP! Is not RAP just another name for operations research? What is new? This has been done already! What is ethnographic about this? This is a standard method...etc."
These
questions and comments illustrate diverging views of these
methodologies. For the sake of simplification, we may distinguish
a restricted view and an extended one. The restricted view,
claiming scientific basis, considers RAP as a set of well-defined
techniques; the extended view on the other hand considers RAP as
an approach, even an attitude, and focuses on whatever
characteristics it chooses to. Proponents of the restricted view
of RAP set clear-cut standards in determining what is or is not
RAP. They are afraid that if anything can be RAP, the whole
methodology might be discredited. Proponents of the extended view
tend to suggest that RAP is many things to many people and that
what is important is not so much the conformity to a particular
set of techniques, but rather the conformity to a general
participatory methodology. Needless to say, although these two
views are presented here as dichotomous, in fact, they are just
two endpoints of a continuum.
One of the most striking
characteristics of qualitative methodologies revealed by this
conference is their diversify within a coherent unity. Indeed,
whatever phrases are used to name these methodologies, whatever
terms are used for the acronym RAP, or whatever views are adopted
(restricted or extended), most participants would agree at least
on the following basic premises of these methodologies: the
participatory approach, methodological pluralism, and
action-orientation.
The participatory approach is at the heart of these methodologies; not only the traditional participant observation of anthropologists, but the actual involvement of the community members themselves in the process of data gathering, analysis, or project design in order to correct the common bias of development ventriloquism when so-called experts speak for community members.
Methodological pluralism is both internal and external. Internally, it refers to a combination and convergence of methods and techniques, very often with synergetic effects. Externally, it is an acknowledgment of other methodologies, of the fact that RAP techniques are not a panacea, that they are just one more tool in the tool box, that we should thus not consider everything a nail just because we have a hammer.
Action-orientation is the third premise, referring to the imperative of practical application of knowledge obtained through these methodologies. RAP is not only a technique or method for data gathering and analysis. It is also a catalyst for intervention, and can itself be an intervention, through consensus or commitment building or in establishing rapport. From the beginning of any RAP study, there should be a commitment to use the findings, or to take action on the problems identified. The example of the Yanomani Indians, one of the most studied people in the world who do not benefit from these studies was cited.
From these three premises result most of the principles of RAP. Many examples of the use and usefulness of these premises were given. Examples of mapping, seasonal analysis, ranking, and scoring by community members in India [1] were illustrative of the potentialities of the participatory approach, the idea being to "learn from and with rural people."
The papers presented during the conference are a good illustration of the explosive growth and diversification of rapid assessment procedures mentioned by Cernea, especially with regard to use in various sectors and subsectors: health, nutrition, water and sanitation, rural development, urban services. Topics ranged from coping response to AIDS to apparent food consumption, from risk assessment of schistosomiasis to hunger eradication programmes, from high risk behaviour among long distance truck drivers to human water contacts, watershed management, forestry and credit.
The papers
presented experiences and data from over 20 countries, a sample
of the tremendous geographical broadening of rapid assessment
methodologies. These methodologies, as one participant put it,
know no boundaries. Indeed, they have been used in the United
Kingdom in health [2] and in Switzerland and Australia in
agriculture.
Difficulties encountered in
the use of RAP or of its results were discussed. Some are
institutional, others methodological or ideological.
Institutional difficulties have to do with training, reward
mechanisms, top-down bureaucratic planning methods, and the
macro-level nature of national policies and programmes. As Watson
[31 notes for this last issue, "in its focus on indepth
analysis of problems perceived by particular communities, the RAP
methodology leaves many seeking to conceptualize and implement
national programmes asking about its relevance to them."
Similarly, the sensitivity of the RAP approach to culture and cultural diversity may be at times incompatible with political efforts at nation-building, which often tend to ignore the cultural specificities, or in any case do not consider them in national planning, even though regional planning is an accepted strategy in national development. Methodological difficulties include among others the balance between quantitative techniques and qualitative appraisals and the issue of the rapidity of the methodology. In conformity with the methodological pluralism that characterizes RAP, there was a consensus on the "complementary use of qualitative assessment and quantitative survey methods for programme planning and evaluation" [4]. This complementarily between the "quantified bones of the survey with the qualitative flesh of rapid assessment" [5] was compared by one participant to the paradigm of ying and yang, where "qualitative is yang, feminine and soft like the moon; and quantitative is ying, masculine and strong, like the sun." Another participant noted that qualitative results are the "flavouring of quantitative results."
On the issue of the rapidity of the methodology, there was a general agreement that RAP is indeed more rapid than traditional anthropological fieldwork or some highly formalized survey methods, and that "the more you RAP, the faster you RAP." However, it was also noted that, in fact, RAP can be long, especially if one considers the initial time put in preparing the assessments or the needed background knowledge and experience with the communities being studied. The issue is then to know when rapid is too rapid or not slow enough for the data must not only be "soon enough, but also good enough" [6]. Rapid but relaxed was the title of one of the presentations. This idea is well captured by the Latin saying, "festina lente" (rush slowly)!
There are
also ideological obstacles, mainly related to attitudes of
development planners or experts who still "do not take
people seriously, "do not" put people first" [7].
Three main gaps in the use
of these methodologies and of the results can be distinguished.
There is first the gap between techniques and results. Some
presentations focused on the techniques themselves, describing
the particular combination of methods used, while others insisted
on the results, subsuming the uniqueness of RAP in obtaining
them. Not enough presentations explored both the techniques and
the results as well as the links between the two. This gap
between techniques and the results is partly related to the issue
of the main conference focus itself, which, as noted previously,
led one participant to ask: "Is this a method or a
problem-oriented conference?"
The second gap is the one between method and theory. There is indeed the danger that an excessive focus on methods and techniques will slight the theoretical dimensions of this approach. Yet, the method itself is related implicitly or explicitly to theory, be it the theory of the specific sectors or aspects being investigated (farming systems, health seeking behaviour, sociocultural change, etc.) or the theory of the method itself (e.g. theories of group dynamics for focus group discussions, ethnoscience or cognitive anthropology for mapping, sampling theory for sampling, etc.). Without a sound theoretical basis, rapid assessment methodologies may not gain much credibility in the academic world; more importantly, they may not contribute to theory-building or to an effective "re-tooling in applied social investigation for development planning" [8] both of which have theoretical and epistemological conditions.
Theory, it seems, is unavoidable. There are no techniques without methodology, no methodology without theoretical orientation, and probably no theory without an ideological bias. It is true that not all RAP practitioners need to have a theoretical knowledge of the techniques they are using. In the same vein, one needs not know theory of electricity before turning on the light. However, it seems reasonable to expect that trainers of trainers, for example, will need to be more conscious of the theoretical background, underpinnings and implications of what they are doing. If there are acceptable levels of theoretical ignorance for some, a total theoretical nonchalance under the pretense of methodological purism is misleading at best.
There is also a gap between the knowledge accumulated and its application. In spite of the fundamental action-orientation of these methodologies, it is not always clear how the results are used or can be used. "So what?" is the ever-present question when it seems that knowledge is not being translated into action. It is not sufficient to know that pregnant women think that taking iron tablets will result in overweight babies and complicated deliveries. The issue is not to put the knowledge to use in MCH services. Similarly, the issue is not to determine whether or not the peasants have cognitive or analytical skills, but rather to use their skills in community development programmes. After all, one participant asked, "What is knowledge if it cannot be replicated either in theory or in action?"
Health
education seems to be one of the main areas of application of
rapid assessment methodologies in health. Although this shows
that it is possible to narrow the gap between knowledge and
application, the long-term nature of health education and the
limited results of most health education programmes raise some
questions. More importantly, conventional health education, as a
strategy of teaching people what is good for them seems at times
incompatible with the participatory approach which focuses on
learning from the people.
This conference has also
raised the issue of the institutionalization of RAP.
Institutionalization is a long-term process involving various
actors at different levels and various actions. The actors
include not only community members themselves, but also the
intermediary cadres, the service providers and the top leaders,
the decision-makers and the decision-takers. It is particularly
important not to ignore the leaders who make decisions on
priorities and resource allocation.
It is important to know their information needs and the types of decisions they have to make in order to be able to advise them on the relevance of RAP in policy formulation or programme planning. These actors could be either with governments, public administrations, development agencies, private voluntary organizations, etc.
Among the actions needed for the institutionalization of RAP, the application of results is certainly one of the most important, not only because it is intrinsic in the methodology itself, but also because the relevance of RAP and of RAP results can be a key element in the institutional adoption of these methodologies. Another critical action is the sensitization and information of all members concerned, decision-makers, service providers, community members, etc. Each one of these categories needs to have an understanding of the perspectives and constraints of the others. Central to the institutionalization of RAP is training; training in health or agricultural institutions, training of health personnel, and training of community agents. Even anthropologists themselves could benefit from training in rapid assessment procedures, even though these procedures are largely based on anthropological techniques. Training should also aim at developing local level expertise. In fact, capacity building should be imperative whenever foreign researchers are involved in developing countries. In this context, training of trainers becomes urgent.
The establishment and exploitation of networks of RAP researchers and users is also important for the diffusion of techniques and results, and for information and experience sharing. Effective communication of research results needs to be promoted.
For its institutionalization, RAP needs to become an integral part of the programming process, in all its phases: situation analysis, planning, implementation, monitoring and evaluation.
As I
pointed out at the beginning, no summary can do justice to this
rich and successful conference. I have indicated some of the key
issues that were discussed as well as some thoughts on these
issues, especially with regard to the methodological pluralism,
the participatory approach and the action-orientation which are
the specificity of RAP methodology. Some of the difficulties,
constraints and gaps in the application of these methods and/or
of their results were discussed. Actors involved in and actions
needed for the institutionalization of RAP were also examined. If
this conference has helped us "to analyze critically our new
tools, their strengths and weaknesses, with warm hearts and cold
heads" [8]; if it has helped us establish
"rapport" among various qualitative methodologies; if
it has helped us adopt an attitude of humility, a greater
sensibility to culture in development, a greater respect of
people, and methodological pluralism; if this conference has
drawn our attention to the conceptual load of the techniques we
are using; if this conference has helped us consider that
whatever we gather and analyse, we must try to apply, then it
will have succeeded. For after all, "what is knowledge if it
cannot be replicated either theoretically or practically?"
1. Chambers R. Rapid but
relaxed and participatory rural appraisal: towards applications
in health and nutrition. In: Scrimshaw NS, Gleason GR, eds. Rapid
assessment procedures: qualitative methodologies for planning and
evaluation of health related programmes. Boston, MA:
International Nutrition Foundation for Developing Countries
(INFDC), 1992: 295-306.
2. Rifkin S. Annett H. Tabibzadeh 1. Rapid appraisal to assess community health needs: a focus on the urban poor. In: Scrimshaw NS, Gleason GR, eds. Rapid assessment procedures: qualitative methodologies for planning and evaluation of health related programmes. Boston, MA: International Nutrition Foundation for Developing Countries (INFDC), 1992: 357-364.
3. Watson C. RAPing in Chad. In: Scrimshaw NS, Gleason GR, eds. Rapid assessment procedures: qualitative methodologies for planning and evaluation of health related programmes. Boston, MA: International Nutrition Foundation for Developing Countries (INFDC), 1992: 409-416.
4. Pedersen D. Qualitative and quantitative: Two styles of viewing the world or two categories of reality? In: Scrimshaw NS, Gleason GR, eds. Rapid assessment procedures: qualitative methodologies for planning and evaluation of health related programmes. Boston, MA: International Nutrition Foundation for Developing Countries (INFDC), 1992: 39-50.
5. Green E. The planning of health education strategies in Swaziland. In: Wulff R. Fiske S. eds. Anthropological praxis. Boulder, CO: Westview Press, 1987.
6. Murphy J. Institutionalizing the use or rapid assessment procedures in rural service agencies. In: Scrimshaw NS, Gleason GR, eds. Rapid assessment procedures: qualitative methodologies for planning and evaluation of health related programmes. Boston, MA: International Nutrition Foundation for Developing Countries (INFDC), 1992: 403-408.
7. Cernea M. Putting people first. New York: Oxford University Press, 1985.
8. Cernea
M. Re-tooling in applied social investigation for development
planning: some methodological issues. In: Scrimshaw NS, Gleason
GR, eds. Rapid assessment procedures: qualitative methodologies
for planning and evaluation of health related programmes. Boston,
MA: International Nutrition Foundation for Developing Countries
(INFDC), 1992: 11-24.
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
All
plenary sessions of the conference including most comments by
participants were audio taped by PAHO technicians. A selection of
the comments made after individual sessions was placed without
attribution throughout this volume. However, when these comments
were reviewed, a number of recurrent themes surfaced across the
various sessions and panels. In order to provide the reader with
additional insight as gained from the participants, major themes
were listed in this chapter and a selection of relevant comments
placed under each. What were originally oral comments have been
shortened in many cases and edited. Thus, these comments should
not be seen as direct quotes but rather synopses of the ideas
brought to these themes by various participants. - Eds.
David Nyamwaya, AMREF, Nairobi:
RAP should be seen not as a replacement but rather as a complementary approach to KAP and other methods. Where it has been misunderstood as a replacement for other methods, it has been vigorously attacked.
Susan Scrimshaw, School of Public Health, University of California, Los Angeles:
Operations research is more specific than RAP in that it is used primarily to test interventions. Operations research does not usually use an anthropological approach but there is some overlap.
Yongyout Kachondham, Mahidol University, Thailand:
RAP is usually done within a specified, limited area and is at best indicative of the situation in that area. RAP is not a substitute for survey research, but RAP is very helpful in formulating working hypotheses. RAP can be used to help survey researchers in fine tuning their questionnaires to better achieve validity and reliability. RAP can also explain what statistical significance has to do with the real world.
Suriya Smurkupt, Khon Kaen University, Thailand:
RAP is inductive rather than deductive, it starts with facts. The amount of time a RAP study will take to complete depends on the issue. For example, I used RAP to try and understand why compliance of pregnant women taking iron is so low. I found out important information that could never have been obtained through a survey or questionnaire. Sometimes critical information may be obtained quite easily using this very different approach.
Yongyout Kachondham, Mahidol University, Thailand:
From the perspective of the paradigm of ying and yang, qualitative research is like yang, feminine, soft, like the moon. Quantitative research is like ying: masculine, strong, like the sun. We need to have both to solve the complex questions involved in development.
Scarlett Epstein, Innovative Development Research, U.K:
Is it possible that we may face a danger of moving from macro-economics being the dominant form of data for planning to a stage where qualitative information is dominant and quantitative data is pushed under the carpet?
Michael Cernea, World Bank:
Much as I
support the value and use of qualitative data and the increased
use of RAP, I do not see changing the predominance of
quantitative data on the agenda of the World Bank at this time.
David Nyamwaya, AMREF, Nairobi:
What purpose is served by involving health workers in data collection? If they are involved, shouldn't they be involved from the beginning and participate in the decision as to whether the research was necessary? This raises the question of who owns the results of the study.
Robert Chambers, Administrative Staff College of India:
How far down through the system can the information gathering be pushed? How do you do data interpretation at the village level? We find the villagers to be highly knowledgeable and efficient data gatherers if given appropriate tools.
Judi Aubel, Senegal:
The process needs to be pushed further down through the system. There is a role for personnel at lower levels. However, the time framework dictated by consultancies does not usually allow going as far down into the system as should be the case. In a shortened time frame the objective can be to get programme planners to go into the community to take community opinion into their planning process. The process is seldom perfect but it shows a different approach than the normal planning from behind the desk.
Health
staff involvement is important for several reasons. Involvement
by decision makers gives them better ownership of the data. The
involvement within the community setting by the service providers
was important because the data gatherers were women who work on a
day-to-day basis in the community, and they enhanced the
interpretation of data obtained by the sociologists.
Michael Cernea, World Bank:
The use of RAP appears to focus on information needs by project leaders. But there are also higher levels of decision makers. What in the "tool box" of methods is most useful for these higher cadres?
Josette Murphy, World Bank:
The agencies using RAP must first focus on what are the key information needs of top decision makers for management and resource allocation. Then we ask what are the optimal tools for gathering the information. What are the tools that will give you information with sufficient precision and within the proper time frame?
The "Murphy paradigm" states that information should be good enough and soon enough; good enough to use for what you need to do with it and soon enough so it is available when decisions must be made.
Susi Kessler, UNICEF, New York:
One use of RAP, particularly with UNICEF, may also serve to generate commitment.
Shubhada Kanani, University of Baroda, India:
There is a need to develop better link RAP to interventions for programme and project monitoring, and evaluation. We need better guidelines in this area.
Charles Teller, Pragma Corporation:
One of the important uses of this methodology is that it is a participatory approach with the potential to link the community with decision makers. What would be useful to know is what changes have been made by the decision makers and by the community participants on the basis of their participation in or exposure to RAP studies and data generated in this manner.
Susi Kessler, UNICEF, New York:
There may be a way to begin a sub-network on the use of RAP in the service of environmental questions.
Josette Murphy, World Bank, Washington:
As institutions concerned with development assistance we should encourage local institutions to coordinate and undertake whatever research is needed. But I am concerned that foreign research teams often do work in a country and then leave, without building capacity. The decision on types of research and major information needs should be done by the national decision makers in cooperation with their own technical staff and with their superiors. Then the technical staff in charge of efforts such as RAP should make the decisions on what type of methods should be used and in what form and in what time frame. They should also consider how to package results so that it will be clear and useful to the decision makers.
Scarlett Epstein, Innovative Development Research, U.K.:
While we've all done our work as anthropologists, we do not include very much discussion on our ability to effectively communicate. This is an area where we make many assumptions but need to discuss.
Josette Murphy, World Bank:
It would be useful to add another set of actors in the context of using RAP. In addition to the researchers, the methodological specialists, and in addition to the people themselves to act as key participants, we should not forget the decision makers in the developing countries in which we work. It is those people who decide on priorities and resource allocations within their own countries. Such decision makers may be from the governmental or nongovernmental institutions who are providing health services to the rural client.
• We need to remember that they are making the decisions, on the basis of whatever information is available to them at the time.
• It is important that the methodological specialists remember to work with them first, to define what information they need, when they will need it and for the types of operational and political decisions.
• We should talk to them about the choice of methods we will use to gather information in relation to what types they will find acceptable and can use.
• We need to show them that the information gathering "tool kit" is much wider than they may have supposed. We need to show them that RAP may be valuable to them, in complement to other types of methods.
• It is the decision makers that should be foremost in our minds as we consider the choice of problems and questions that will be asked.
• It is consideration of the decision makers also that will help us at the other end of the research process to tell us what approaches to use to communicate the information we gain clearly and effectively into the decision making arena.
• The development agencies have an important role to play in helping decision makers in this area, and in showing the researchers and decision makers how to use RAP for themselves wherever appropriate.
• There is a need to show that the RAP method can be used, not in a quick and dirty fashion, but in a manner that is both rapid and useful.
Scarlett Epstein, Innovative Development Research, U.K.:
It appears we are speaking of using RAP to serve two very different masters: the community, and planners and managers. Is it possible to serve both with the same methods and same approach?
Ellen Messer, Brown University:
RAP was originally seen as serving three masters, the community, planners and providers. Part of RAP's usefulness is in sensitizing each of these groups. This should also include letting the community know what the constraints of the other levels are.
Susan Scrimshaw, School of Public Health, University of California, Los Angeles:
Just
because RAP uses some anthropological techniques does not mean
that all anthropologists will embrace RAP. Anthropologists around
the world want funding for traditional anthropology and may
resent funding for RAP. In using RAP you cannot just grab the
nearest anthropologist.
Suriya Smutkupt, Khon Kaen University, Thailand:
Because there are normally scientists from different disciplines on a RAP team, there need to be some theoretical guidelines that help bring them together.
Susan Scrimshaw, School of Public Health, University of California, Los Angeles:
Sociology,
public health, psychology, applied anthropology, and economics
may all come together in RAP. There has been some feedback into
the disciplines but we need to develop it further.
David Nyamwaya, AMREF, Nairobi:
It is critical to stress the need for proper training in RAP both for non-anthropologists and for anthropologists. Some non-anthropologists seem to wake up one morning thinking that they can go out and begin using RAP methods such as focus groups effectively. For them, there is a need to understand the basic methods used for data collection in anthropology. It is dangerous to use methods like focus groups without proper training. Second, there is often an assumption by anthropologists that because they are anthropologists, they can by definition use RAP. Because RAP is itself a subculture method, developed over time, anthropologists need to have more humility in this area and accept that they can benefit also by some training.
Charles Teller, Pragma Corporation:
A big issue in RAP methods and techniques is the level of training of those who do RAP. Probably many do not need a graduate degree in anthropology. Defining the involvement of grass roots and action groups seems important.
Joseph Valadez, Harvard Institute for International Development:
There are some portions of RAP methods which can be used to gain knowledge which can inform policy and plan interventions. There are also methods which can be used to identify families which in turn can identify families who are at risk for various health problems. The protocols for these would be very useful. How specialized is the training for those who become RAPers? Do the persons have a specialization? This would be important in organizing work within a Ministry of Health. Can RAP be used within a decentralized system or do people have to be a specialized vertical group within a ministry?
Susan Scrimshaw, School of Public Health, University of California, Los Angeles:
Based on the achievements so far and some of the work that has gone on in the field, there is now a readiness to develop better systematic guidelines on using RAP for intervention related work.
Nevin Scrimshaw, United Nations University:
RAP does have a disciplinary base and there are pitfalls that are not self evident to the untrained.
Joseph Valadez, Harvard Institute for International Development:
There is
reluctance of public health practitioners to go to the field and
talk to the people. This implies a problem of pedagogy in public
health and suggests that an apprenticeship should be included.
Maybe UNICEF could help fund such efforts.