A needs assessment has the potential to be a dusty document, produced with good intentions and then forgotten. Not so for the collaboration between NHS Highland and partners in Ghana and Zambia who are reducing health harm caused by alcohol.

Staff from NHS Highland, along with allied professionals and volunteers, work with partners in Ghana and Zambia. Projects include reducing health harm caused by alcohol in the Upper West Region of Ghana, and working with mental health nurses in Zambia. Anne Mason is the project co-ordinator in Scotland, Randi Agbodo is the coordinator in Ghana and Pearson Moyo is the coordinator in Zambia.

Needs assessment is a process

A needs assessment has the potential to be a dusty document, produced with good intentions and then forgotten. Not so for this partnership: Anne describes needs assessment as a process, continuous and ongoing, evolving and developing over time.

In Anne’s experience, developing an understanding of needs within a partnership requires good relationships to be built, so that partners feel comfortable talking honestly with one another – about the limitations and challenges of the health care environment they are working in, and the partnership itself.

Sometimes, starting work on one topic will uncover a need in a different area. In Ghana, conversations with midwives around maternity and children highlighted the issue of alcohol use, which ultimately led to a larger project about alcohol harm throughout the community.

Consult widely on need…

Randi says, “If I could share one piece of advice with someone working on a needs assessment, it would be to get in touch and in tune with the people who are really affected by the problems that you want to solve.” At the outset of this partnership, a small UK team went to Ghana with the aim of involving as many stakeholders as possible, including consumer groups, listening to needs, and developing an awareness of local politics and tensions.

The reality of getting people involved, particularly in a remote and rural area, requires determination and a head for logistics – not just engaging with the people who are easy to access, but actively making an effort to reach out to people. In this case, that meant coping with the limitations of public transport and helping people get to meeting venues. Budgets need to be carefully considered to ensure there is money to help pay for transport and sometimes an overnight stay when people have to travel in from rural areas to attend meetings and training events.

The effort that went into consulting widely with stakeholders paid off in the creation of a sense of ownership and laid strong foundations for the project.

In Zambia, focus groups revealed that participants wanted individuals from their own communities to have training in mental health issues, so they would feel comfortable and confident going to someone for advice and guidance. As a result, this type of training has been included in plans for the current project.

…then focus on plans

Finding time and headspace to think about planning a project is important too. Anne describes a successful planning process that involved all three project leads. Pearson and Randi travelled to Scotland for a health conference and a small study tour, and stayed in Anne’s home. They discussed whether and how the project should continue, and the common denominators between the three partners.

All three spent time reading around the subjects they were interested in, and looking at the context they were working in – including reading the action plans and assessments for the hospitals, to see if their thinking matched that of the hospital leadership.

Towards the end of the visit, the group had intense, focused discussions, to work out the next phase of the partnership. They identified where the partners had needs and skills which matched up, and interests in common. Anne says, “We looked at what matched, what would be realistic and interesting outcomes for us all to have, what kind of methods might support the push to put this plan into place – lots and lots of conversations, lots of levels of assessing needs.”

In addition to the health issues identified by the partnership, the partners had some health system issues in common, in relation to working in a remote area – such as retention of staff, and developing continuing health education.

At the end of the study visit, Anne took the lead in pulling all the thinking together into plans which were then sent to all partners for review.

This example highlights elements that are common to many successful planning processes – wide consultation, intense focus from a small group, key lead person to draft, and wider review.

Needs assessment is part of a bigger picture

In the planning process for a project, the needs assessment will be one key element, but it will often overlap with and complement other documents. Pearson explains that, in Zambia, the planning stages involved looking at state-level action plans and local hospital statistics, as well as drawing on his own awareness of mental health knowledge gaps among healthcare staff and in the wider community. He drew inspiration from his counterpart in Ghana, where community mental health nursing is more established.

People are another important factor – the people involved in both sides of a partnership bring skills and experience to the table, and will have particular interests, passions and motivations. It’s important to acknowledge these things, as they will influence the partnership and what can be achieved and sustained through its plans. Anne says, “There’s no point in pretending you go in with an empty head. You have to say ‘I have these skills and experiences, are they of any interest to you?’”

Health system capacity building often includes developing softer skills, like active listening. Anne highlights the importance of encouraging leadership in partners. “It’s about encouraging people to shine in that way, to be able to engage at grass roots level. That’s where you get your needs assessment from.”

Here more from Randi Agbodo in this exclusive interview for THET: