The HESPER Scale: a tool to assess perceived needs in humanitarian emergencies

The Humanitarian Emergency Settings Perceived Needs (HESPER) Scale is a new needs assessment tool that provides a quick, scientifically robust way of assessing the perceived serious needs of people affected by large-scale humanitarian emergencies.[1] Perceived needs are needs which are felt or expressed by people themselves, and are problem areas with which they would like help. The HESPER Scale is applicable to a wide range of humanitarian settings in low- and middle-income countries, including acute or chronic situations, and urban or rural settings. The scale focuses on needs as perceived by adults, which may include concerns for their children. The scale can be accessed online via the HESPER manual and is available on request in Arabic, English, French, Haitian Creole, Nepali, Spanish and Urdu.

Why was the HESPER Scale developed?

Needs assessments are vital to inform humanitarian responses. There have been repeated recommendations for increased participation by affected people in assessment, because participation is seen as essential in avoiding basic mistakes in resource allocation, programme design and accountability, as well as supporting psychosocial well-being.

In the humanitarian field, needs assessments tend to use either population-based ‘objective’ indicators (for example malnutrition or mortality indicators) or qualitative data based on convenience samples (for example through focus groups or key informant interviews). While the latter method is not able to paint a full population picture, the former is not able to gather information on people’s subjective perceptions.

The HESPER Scale was developed to fill this gap. It aims to provide a method for assessing perceived needs in representative samples of populations in a valid and reliable manner. It thus combines the strengths of survey research (i.e. representative samples) with those of participatory methods (i.e. identifying perceived needs). See Box 1 for some further advantages of the HESPER Scale and Box 2 for disadvantages.

What does the HESPER Scale look like?

The HESPER Scale assesses a wide range of physical, social and psychological problem areas. Perceived needs are assessed across 26 core items, which each include a short item heading as well as an accompanying question. Examples of items include ‘Place to live in’ (‘Do you have a serious problem because you do not have an adequate place to live in?’), ‘Education for your children’ (‘Do you have a serious problem because your children are not in school or are not getting a good enough education?’), and ‘Mental illness in your community’ (‘Is there a serious problem in your community because people have a mental illness?’). Ratings are then made for each item according to unmet need (or serious problem: ‘1’ rating), no need (or no serious problem: ‘0’ rating) or no answer (i.e. refused, not known, or not applicable: ‘9’ rating).

Among items that they have rated as unmet needs, participants are asked to rank their three most serious problems. Participants are also asked to name any additional unmet needs not already listed. A total score of unmet needs can be calculated by adding up the number of items rated as serious problems.

How was the HESPER Scale developed?

The HESPER Scale was developed as follows.[2]

Phase 1 (2008): Items for inclusion in the scale were generated by conducting a literature review of grey and peer-reviewed sources which directly dealt with emergency-affected people’s views of perceived needs. Items were then reduced to a scale through a survey with 43 general and psychosocial humanitarian experts across the world.

Phase 2 (2009): The draft scale was then pre-tested in the United Kingdom with
refugees from the Democratic Republic of Congo, and was next pilot-tested in small samples (122 participants in total) in Jordan with displaced Iraqis, and in Gaza and South Sudan. Pilot-testing helped in understanding the scale’s feasibility, intelligibility, comprehensiveness and cultural applicability, as well as the suitability of training materials. It also helped establish the validity (see Box 1 for definition) of the scale. A small expert survey on the ideal length of the scale was also conducted.

Phase 3 (2010): The revised draft scale was then field-tested in larger samples (817 participants in total) in Jordan with displaced Iraqis, in Haiti with people living in displacement camps following the 2010 earthquake and in Nepal with Bhutanese refugees. The aim of this field-testing was to assess the level of perceived needs in these populations, and to assess the HESPER Scale’s reliability (see Box 1 for definition). Generally, the HESPER Scale was able to produce useful information on perceived needs in these settings (see Box 3 on Haiti). Only a few minor changes were made to the wording of seven HESPER items following field-testing.

How can the HESPER Scale be used?

The HESPER Scale enables needs assessments to be based directly on the views of affected people. It does this by facilitating the rapid identification of broad problem areas with which people are likely to want help. It is possible to disaggregate the results and provide population profiles according to gender, age, ethnicity and other relevant groupings.

By administering the HESPER Scale multiple times, the scale may also be used to monitor the degree to which the humanitarian response is perceived by affected people to be meeting their needs. The scale is therefore in line with the aim of increased accountability towards and participation of crisis-affected populations in assessments. Although the HESPER Scale was developed for use in representative samples, the scale may also be used in convenience samples. In addition, the scale could be used during mental health and social care service delivery.

The HESPER Scale does not provide an answer as to whether to offer help, or how to do so. It simply aims to identify serious perceived problems that are common in a population. These problems then need to be assessed and addressed in more detail (for example through focus groups or key informant interviews) to understand the expressed needs and decide exactly what interventions and support would be helpful. The scale therefore complements, rather than replaces, existing participatory assessment methodologies.

Using the HESPER Scale in rapid assessments

Informed decision-making early on in humanitarian emergencies is challenging. There is usually little time or access to allow for a systematic assessment of affected communities. Other challenges stem from the lack of complementarity and comparability among assessment approaches across sectors.

To address these challenges, the Inter-Agency Standing Committee (IASC) Needs Assessment Task Force has developed the Multi-Sector/Cluster Initial Rapid Assessment (MIRA) approach.[3] The objectives of the MIRA, initially confined to the early phases of sudden-onset disasters, include reaching a common understanding of needs, agreeing on strategic humanitarian priorities and guiding the design of subsequent sectoral assessments by identifying information gaps and priority issues in need of further investigation.

The MIRA approach emphasises the importance of collating and analysing secondary data in the early phase of emergencies (e.g. the first two weeks) when primary data collection tends to be limited by time and access constraints. Secondary data analysis is expected to provide a large part of the information needed to build a common understanding of needs and priorities. In addition, the MIRA approach recommends that primary data collection, referred to as Community Level Assessment, be seen as an opportunity to include an assessment of perceived needs.

However, there have been challenges with primary data collection using inter-sectoral questionnaires, such as the Initial Rapid Assessment (IRA) form.[4] Approaches for compiling inter-sectoral questionnaires can be inefficient due to repeated questions or themes and a lack of coherence across sectors. Assessments are often too long – due to each sector proposing too many questions – reducing the efficiency, quality and speed of the overall assessment. Such questionnaires have thus far been better at assessing objective needs than assessing perceived needs.

Based on the objectives of the MIRA primary data collection approach as well as the common constraints of inter-sectoral questionnaires, the authors believe that using the HESPER Scale as a backbone for MIRA primary data collection would be a promising way forward. Consistent with the MIRA approach, the HESPER Scale is cross-sectoral by nature. In addition, by providing a systematic, tested and reliable way of assessing perceived needs and priorities (in line with the objectives of MIRA primary data collection), it approaches problems from the point of view of affected communities. This cross-sectoral breakdown of the HESPER Scale prevents discussions being driven by sectoral components of the questionnaire (with sectors competing with one other for ‘space’ in multi-sectoral surveys), and provides efficient answers to the challenges inherent to the design of multi-sectoral questionnaires in the early phase of an emergency.

There have been several attempts to incorporate the HESPER Scale into MIRA primary data collection, including in Yemen (see Box 4) and India. Further work is needed to look into the use of the HESPER Scale as a component of MIRAs undertaken by the humanitarian community.

The HESPER Scale and humanitarian response monitoring

Currently, monitoring of humanitarian response is focused on the delivery of services to affected communities. What is often missing is a tracking of the evolution of people’s needs. The results of the HESPER Scale over the course of a humanitarian emergency could provide a useful measure of the efficiency of the humanitarian response in the eyes of affected communities. A reduction of the overall number of issues perceived as being serious problems would demonstrate that the situation of affected communities is indeed improving. Similarly, changes in the priorities identified by these communities may justify changing priorities within the response. Integrating the HESPER Scale in early assessments as well as within response monitoring could therefore help in understanding the evolution of a crisis.

Maya Semrau is a post-doctoral researcher at the Institute of Psychiatry, King’s College London. Samuel Petragallo, Andre Griekspoor and Xavier de Radigues are with the Department of Emergency Risk Management and Humanitarian Response at the World Health Organisation (WHO). Mark van Ommeren is a scientist at the Department of Mental Health and Substance Abuse, WHO. The opinions expressed in this article are those of the authors only and do not necessarily represent the decisions, policies, or views of the WHO, King’s College London or any IASC subsidiary bodies.