title: Assessments of health services availability in humanitarian emergencies: a review of assessments in Haiti and Sudan using a health systems approach.
abstract: BACKGROUND
  Assessing the availability of health services during humanitarian emergencies is essential for understanding the capacities and weaknesses of disrupted health systems. To improve the consistency of health facilities assessments, the World Health Organization has proposed the use of the Health Resources Availability Mapping System (HeRAMS) developed in Darfur, Sudan as a standardized assessment tool for use in future acute and protracted crises. This study provides an evaluation of HeRAMS' comprehensiveness, and investigates the methods, quality and comprehensiveness of health facilities data and tools in Haiti, where HeRAMS was not used.
  
  
  RESULTS
  Tools and databases containing health facilities data in Haiti were collected using a snowball sampling technique, while HeRAMS was purposefully evaluated in Sudan. All collected tools were assessed for quality and comprehensiveness using a coding scheme based on the World Health Organization's health systems building blocks, the Global Health Cluster Suggested Set of Core Indicators and Benchmarks by Category, and the Sphere Humanitarian Charter and Minimum Standards in Humanitarian Response. Eight assessments and databases were located in Haiti, and covered a median of 3.5 of the 6 health system building blocks, 4.5 of the 14 Sphere standards, and 2 of the 9 Health Cluster indicators. None of the assessments covered all of the indicators in any of the assessment criteria and many lacked basic data, limiting the detail of analysis possible for calculating standardized benchmarks and indicators. In Sudan, HeRAMS collected data on 5 of the 6 health system building blocks, 13 of the 14 Sphere Standards, and collected data to allow the calculation of 7 of the 9 Health Cluster Core Indicators and Benchmarks.
  
  
  CONCLUSIONS
  There is a need to agree upon essential health facilities data in disrupted health systems during humanitarian emergencies. Although the quality of the assessments in Haiti was generally poor, the large number of platforms and assessment tools deployed suggests that health facilities data can be collected even during acute emergencies. Further consensus is needed to establish essential criteria for data collection and to establish a core group of health systems assessment experts to be deployed during future emergencies.
authors.affiliation: Bruyère Research Institute, 85 Primrose Ave, Room 308-B, Ottawa, ON K1R 6M1 Canada ; Institute of Population Health, University of Ottawa, Ottawa, ON Canada ; WHO Collaborating Centre for Knowledge Translation and Health Technology Assessment in Health Equity, Bruyère Research Institute, Ottawa, ON K1R 6M1 Canada.
authors.forename: Jason W
authors.initials: JW
authors.lastname: Nickerson
authors.affiliation: WHO Collaborating Centre for Knowledge Translation and Health Technology Assessment in Health Equity, Bruyère Research Institute, Ottawa, ON K1R 6M1 Canada.
authors.forename: Janet
authors.initials: J
authors.lastname: Hatcher-Roberts
authors.affiliation: Orvill Adams and Associates, Ottawa, ON Canada.
authors.forename: Orvill
authors.initials: O
authors.lastname: Adams
authors.affiliation: Faculties of Law and Medicine, University of Ottawa, Ottawa, ON Canada.
authors.forename: Amir
authors.initials: A
authors.lastname: Attaran
authors.affiliation: WHO Collaborating Centre for Knowledge Translation and Health Technology Assessment in Health Equity, Bruyère Research Institute, Ottawa, ON K1R 6M1 Canada ; Department of Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON K1H 8M5 Canada.
authors.forename: Peter
authors.initials: P
authors.lastname: Tugwell