How to do health needs assessment

Health needs assessment (HNA) is all about planning services. Its main purpose is twofold: to inform and drive decisions about which services are needed, and to set priorities. These priorities must be for services, even new services, from which people can derive a health benefit. This is different from what people want and demand.

So HNA should maximise the match between 'demand and supply’ and needs.

HNA methods

The methods for HNA have been honed over many years and are well described. ^{1 2 3} Because of its technical nature, much of the work has been undertaken in specialist departments and units, and has been the domain of full time public health professionals and scientists.

A full health needs assessment typically includes the following steps:

1. A review of the sources of information relevant to your target population
2. A profile of existing services and description of population profile
3. Views of your target population
4. Views of relevant practitioners and service providers
5. Analysis and interpretation of the results in order to draw conclusions
6. Taking action through prioritising the identified needs, appraising the options for meeting those needs, and implementing an action plan including allocation of resources
7. Monitoring and evaluating to check that the changes you have implemented are having the desired effect of meeting the needs of your target population.

The overriding benefit of comprehensive HNA is its ability to take account of all perspectives and generate balanced recommendations.

This comprehensive approach is often impractical because it tends to be time consuming and requires considerable technical expertise. In practice, some organisations limit HNA to one or two of the perspectives, typically public, patient and carer involvement or professional/corporate approach. Restricting HNA to one or two perspectives will inevitably produce only unbalanced and inefficient decisions that do not meet population needs. In the common scenario where decisions still need to be made with less than ideal information, more pragmatic approaches are still possible; a structured process is still required and some essential information must be clear and agreed on from the start:

• Whose needs you need to address, whether those of people living in a specific locality, a whole country or region, or just a few streets, or with a particular disease (such as diabetes), or of a particular age or ethnic background
• What needs are you seeking to address: is the focus on their general needs for health care, or for particular services, or are the wider determinants of health relevant, such as health behaviours, and physical resources?

In addition, there are some questions to answer about the extent of the resources available to undertake the work that will profoundly affect the way the needs assessment is undertaken.

• Why does it need to be done? Is it out of concern for a population?
• When does it needs to be done? Is it to meet a particular financial decision-making timetable?
• Who is concerned about the outcome? It is important to engage all these ‘stakeholders’ (service providers, professionals, representatives of a community) in the needs assessment process, to secure a commitment to change.
• What time and resources are available? What people with skills are available to undertake the work (including data collection, entry and analysis, or report writing)? Or does work need to be externally commissioned and are there are funds to support it?

If any one of these key elements is unclear, the chances of successfully addressing population needs are limited.

The Gateshead Needs Grid

It is easy to get lost in the range of information required to carry out a health needs assessment. To enable others to lead and participate in health needs assessment, different and more open frameworks are required. One example of this is the Gateshead Needs Grid, which allows users to group information under broad headings: the wants of patients, comparative needs, epidemiological needs, and normative needs from a professional perspective (Table 1). ⁴

Using the Needs Grid

The first part of the grid can be completed through the preliminary work outlined above, describing the population and the health need being addressed. Once this is clarified, the four key information boxes can be filled out.

Informing wants of public or patients

There are many quantitative (survey) and qualitative (interview and focus group) methods for obtaining the views of your target population. There can be significant ethical and practical considerations associated with collecting data of this kind. But listening to diverse interests is worthwhile.

Informing comparative needs

A description of the current services available locally is an important starting point, and a comparison with services available in other areas of similar characteristics (comparative data) will be enlightening. This service description will need to analyse both the capacity of the service, and the different elements of quality—its fitness for purpose.

Informing epidemiological needs

The epidemiological depiction of the health issue—its frequency, its significance for the health status of the population—requires some level of description. In the case of meeting the needs of people with diabetes, this would include local information about the disease’s prevalence, as well as summaries of the literature on its natural history and of the costs and effectiveness of the various prevention and treatment alternatives.

Informing normative needs

The views from a professional perspective need to be obtained both from local service providers and from regional and national experts. This is particularly important when talking about needs for services with a high technical component, requiring significant skills and expertise. It is also important to engage busy staff and to allay staff concerns about the commitment to the process and potential changes to services that might ensue.

The information gathered is then assembled in the four key information dimensions of the grid. In some cases, because of the time or resources available, there will be an imbalance, with more or less comprehensive information in each dimension. The HNA team of stakeholders are then presented with this information in summary form. This allows them to consider whether there is sufficient information to make a decision, and whether to seek more information.

The process is completed by drawing up an action plan, with explicit objectives, as well as a plan for monitoring and evaluation. Ideally, this is done in collaboration with the stakeholder team and with input from the target population, whose needs the assessment is addressing.

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