Crude mortality has been used by the public health community as a cornerstone for defining a public health emergency. Typically mortality in emergencies is monitored by surveillance processes that are incomplete or surveys which are often done poorly and ignored where that is politically expedient. This project will attempt to establish two different techniques, both simpler than surveys, and less likely to be dismissed by critics. 1) The process of multiple source triangulation, or establishing the sensitivity of IDP and death tallies will draw upon methods used widely in TB programs and the monitoring of homeless populations in large cities, but is rarely used to assess mortality. This process of constructing a summary of all known deaths or IDP's, collecting an independent sample, and examining the overlap between the two listings can be rapid, and can potentially transcend the biases typical in death and registration records. The project will select places to enumerate and measure mortality in at least one population displaced by an acute disaster, and at least one population that is persecuted or associated with significant stigma'. 2) A statistically representative community-based surveillance network was established by RHA with the Ministry of Health in Fizi Health Zone, DRC. Community health workers recorded birth, death, and migration events. Preliminary analyses suggest that the surveillance system detected 93% of births and 87% of deaths, with a specificity >99% for both measures, and positive predictive values of 98% (births) and 91% (deaths). This project will attempt to see if a similar system can be established in the city of Goma, to monitor IDPs in an urban setting. While not applicable to all crises, IDPs in Nairobi and Jordan and other large urban centers where IDPs remain stable over months or years could potentially be monitored with this approach. Once established, collection of other desired information from a statistically representative sample could easily be added into the surveillance process. To maximize policy impact, the later years of the project will involve extensive coordination with CDC, OFDA, and other donors in an attempt to establish procedures for mortality measurement in the locations and with partners of priority to donors. Without a widespread and credible capacity to measure central outcomes like income, malnutrition, and mortality, funding of humanitarian emergencies will continue to be based more on political interests than on public health need, and successful life-saving relief operations will remain indistinguishable from ineffective efforts. By adding two new simple and inexpensive options to the toolbox of the humanitarian community, we can help develop a community focused on outcomes instead of processes.
Mortality is perhaps the most profound and important measure in assessing the need for humanitarian intervention and the efficacy of relief efforts. Without the ability to enumerate beneficiaries or vulnerable groups, it is nearly impossible to assess if services are adequate or working. This project will field test two simple methods to enumerate monitor the mortality of IDPs or other vulnerable subpopulations. The techniques will be employed in a variety of settings in hopes of establishing guidelines for application to humanitarian crises.
