Oxfam: People making change

Oxfam is working to ensure that people’s basic rights are protected, that they have the opportunity to make a living, and that citizens are included in the decisions that affect their lives, especially in gaining access to reliable public services.

Protection means ensuring that the basic rights of civilians are secured in the midst of conflict or other disaster. This is why we are helping communities in the Palestinian Territories to gain access to the clean water and sanitation systems they need.

Increasing economic opportunities means that people begin to see their standard of living rise and can enjoy the dignity of being employed. Some entrepreneurs have started up businesses from scratch, which have turned their situation around. Other small business-owners are creating vital jobs for members of their community who are desperately seeking the chance to work.

Inclusion means that all citizens have a right to be involved in the processes of public decision-making that affect their everyday lives. In Georgia, for example, ordinary people are monitoring local budgets to make sure that state resources are spent properly in their communities.

Source;
www.oxfam.org.uk
Oxfam in Middle East, Eastern Europe and the Commonwealth of Independent States region

Aid agencies unite to call for ceasefire in Middle East

The Prime Minister must reverse his current policy and urgently call for an immediate ceasefire by all sides in the current Middle East crisis, said a group of aid agencies working in the region today.

Christian Aid, Save the Children, Oxfam, Islamic Relief, CAFOD, World Vision and CARE International UK have come together as the situation in the Middle East continues to deteriorate and Prime Minister’s policy seems increasingly at odds with the rest of the international community. So far the British Government is one of only a handful of governments who has yet to back calls for a ceasefire.

Oxfam International fear that escalating violence in Gaza will lead to a humanitarian crisis for over 1.3 million Palestinians. Without electricity, following the military strike on Gaza’s sole power station, three key sewage treatments plants are now out of action and over one hundred municipal water wells can no longer operate normally. The agencies warn of an increasing scarcity of clean water, an increase in water -borne diseases from untreated sewage, and of a health system under extreme stress without stable power supplies.

Action must be taken by both Israel and the Palestinians to stop this deteriorating situation and bring a peaceful end to the crisis. All parties, including the international community, have a responsibility to protect civilians from violence.

The Government of Israel must end its continuing destruction of civilian infrastructure, including electrical generators and water pipelines necessary for survival and immediately restore supplies of food, medicine, electricity, fuel and water as well as opening the Karni crossing for goods. Palestinian armed groups must stop indiscriminate attacks on Israel that harm civilians, including firing Qassam rockets into Israel. The international community also has a duty under international law to ensure the protection of all civilians.

Adam Leach, Regional Director from Oxfam said:

"Ordinary Palestinians are suffering from the destruction of bridges, water pipelines and electricity supplies - all things that civilians are entitled to and depend upon. Hundreds of thousands of people are without a regular supply of water. Many of our vital water projects had already been interrupted because of prolonged Israeli restrictions stopping supplies entering Gaza. People’s basic rights are being denied - this does nothing to secure a just and lasting peace in the region.”

Mr Leach said: “The crisis comes as tens of thousands of families in Gaza and the West Bank are struggling to survive without an income because of the suspension of tax payments by the Government of Israel and aid by the international community to the Palestinian Authority.”

Jasmine Whitbread, Chief Executive of Save the Children added:

"In May, Save the Children warned of a rapidly deteriorating humanitarian situation in Gaza. Today we fear that the situation is sliding towards a humanitarian catastrophe. Children are suffering from acute anxiety and fear from ongoing Israeli military attacks and aerial bombardment. These attacks have also targeted civilian structures, including schools. Families, warned of new incursions, are already preparing to flee from targeted areas. Children as always are most affected."

Christian Aid works with local NGOs in Gaza and one of their partners, the Culture and Free Thought Association (CFTA) which works in Khan Younis, has warned how people are being affected living without water and electricity.

Majeda al Saqqa of CFTA said:

"Gaza is now very hot and humid with temperatures constantly over thirty degrees. Without power, people cannot pump water up to their flats. Old people cannot reach hospital if they live in high buildings. At least 200 surgical operations have been cancelled.”

“The situation on the ground is grim and getting worse. All sides need to stop fighting now if we are to pull this situation back from the brink and protect civilians. The Prime Minister has in the past provided admirable leadership on humanitarian crises, we can’t understand why he has got this one so horribly wrong. We urge him to rethink and urgently,” said, Janet Symes, Christian Aid’s Regional Manager for the Middle East, talking on behalf of the group.

According to the aid agencies the continued attacks are not only causing widespread suffering, the targeting of civilian infrastructure is making the aid operation much harder.

“Civilians are the main victims of this and a ceasefire would be in all their interests. While British civilians may have been lucky enough to escape, millions of people just like them but without a British passport are left in the region to suffer. All sides must guarantee humanitarian access to all those left behind, so that help reaches those in urgent need of assistance,” said, Geoffrey Dennis, Chief Executive of CARE International UK, talking on behalf of the group.

www.oxfam.org.uk

British Foreign Relation

British Foreign Relation

In the afternoon of 19 July 1906 more than 50 community leaders comprising of clergies and businessmen took sanctuary in the British Embassy in Tehran spending the night inside the premise. The numbers escalated everyday. In the morning of 2 Sept, people taking sanctuaries summed up as many as 14,000. They had extremely organized behaviour by keeping order in their day-to-day affairs. The reason for that was because of community leaders did not allow corrupt and dubious individuals infiltrate into the crowd. Thousands tents were set up in the Embassy allowing timely and orderly supply of basic needs which were funded by campaigners. Colonel Douglass the British Military Attaché was taking precautionary measures to safeguard the premises, although there was no need for that while everyone were extremely watchful of their behaviour.

Ultimately the campaign proved to be successful when it obliged the State to respond to nation’s demands issuing concession order. The British Charge d’Affaire in Tehran was kindly requested to read the letter sent by the Government for the crowd. However, since people did not have faith in any of decrees issued by the State, therefore a selected team was assigned to meet the Shah in person to resume negotiation. In the meantime, those who took sanctuary declared manifest of clarification that unless all their demands are met they will continue their lodge in the British Embassy.

At the same time, one of top military figure informed the Government that his soldiers do not take firm stand against people who take sanctuary in the Embassy. It is likely that Army join the crowd as well, he added. This was a dangerous alert to both the Prime Minister and the Court Minister. Soon after the PM resigned, Azadollmolk the Chief of ruling tribe Qajar left Tehran for Qom holy city to inform top clergies that Shah has accepted all demands set forth by the nation for ratification of constitution, the establishment of the National Assembly and Judiciary system.

Nonetheless, since the whole nation were highly suspicious of the State, the community leaders involved in the campaign claimed that pledges are nothing more than empty words; they are acceptable only if British Government expresses its support and guarantees the process in full. The request rendered significant amount of pressure on the British diplomat who had guidelines not to involve his country into the matter. Therefore, addressing the crowd he stated that the British Government can never interfere in Iran’s internal affairs, however, I personally assure you the reliability of pledges made by the Shah.

18 August 1907 saw a historical High Council taking momentum in one of the buildings of Royal palaces. This was the preliminary Council that paved the way for the establishment of the parliamentary system in Iran.

Source: (translation from)
Blue Book, Confidential Correspondences of British Foreign Ministry on Iran Constitutional Revolution (1906-1908), first Vol., Initiated by Ahmad Bashiri, Nashr-e-now, Tehran, 1984

Inspiring Commitment and Motivation

The question put to groups of staff to learn what actually motivates them. What management actions do they respond to positively? What caused or helped them to be more motivated to do a good job? The qualitative research carried out at eight high performing organisations, six in the public sector and two in the private sector, revealed no difference between the public and private sector sites - when it comes to motivating staff the issues are common to both sectors.

The common requirements for a highly motivated workforce identified in this work are:
a strategic framework that includes an inspirational vision, transparent
values, effective performance measures and HR functions that are central
to the business; a supportive culture, that provides for delegation, recognition and
effective communication within a friendly informal environment in which
people are respected and supported; a strong emphasis on line managers’ interpersonal skills, their ability to feel connected to the leadership, values and direction and consistent action to translate and communicate this to their staff.

These factors do not work in isolation and at all the sites senior managers were
seen by staff at all levels to be accessible and visibly to practise what they preached.

“They’ll watch what you do, not what you say.”

Motivated employees do not appear by chance and there are real costs for organisations that fail to motivate their staff. This report recommends that organisations need to assess:

the motivation (and morale) of their staff regularly, and to act on the findings; the people management skill of their managers regularly, and act on the findings. Public services, in common with the private sector, face a challenging improvement agenda, to which they must respond if they are to provide the high-quality services that users demand. It is a truism that most organisations claim to value their people as their greatest asset. But it is less clear how to turn good intentions into the reality of committed employees who are performing to the best of their abilities. All the organisations involved in the research place a premium on highly motivated staff as a key to their success. The research identified the things that motivate staff at these organisations, and how these organisations have sought to build and maintain the commitment of their staff.

The links between motivation and performance are complex, and easier to assert than to prove with precision. But there was universal agreement among senior managers and staff that highly motivated staff will offer the extra effort upon which effective public service delivery often depends. People want to take responsibility for their work to ‘make a difference’, ‘achieve something’. This echoes the findings of other recent research in this area, which demonstrates a strong link between organisational commitment, work satisfaction and effort.1

The need to manage change effectively, in response to a range of Government reforms is one of the major demands on public services. This is a challenge for the public sector. As one senior executive pointed out, ‘…in the public sector there is a corporate history, people have been in post longer and have been through all the hoops before, they have become cynical to change and therefore it is harder to grab their heart as well as their mind.’ The research indicated that change can be delivered most effectively with well motivated staff who are constructive, flexible, creative and who work as a team.


‘We introduced best value ‘hit squads’. They are litter pickers who go out to an area to clean it up in one go. We have had the (best value) inspectors in and they went out to see one of these squads. They said they had never seen litter pickers more proud and motivated than this lot…They saw themselves as specialists do, the ‘best value’ team going out doing a special job. The only thing that has changed is the way they operate and their title, they still pick litter. What made the difference was that the squads were acknowledged to be something different and something special.’ Stockton-on-Tees Borough Council

What motivates people at work?
The Panel’s research focused on how employees can be motivated so that they
focus their efforts in ways which enhance the performance of the organisation
overall.

It is therefore about how organisations can:
win the commitment of employees;
channel that commitment in ways that serve the needs of the
organisation, its customers, and staff, by encouraging risk taking,
innovation and learning; and
recognise that commitment to ensure a virtuous circle of commitment,
high performance, and improved service outcomes.


The work identifies the common principles that should be at the core of strategies to improve motivation. But perhaps most powerfully, the research reveals a fundamental conviction that people will deliver if you enthuse, coach, support and listen to them. People are central to improved productivity, better customer service, and rising to the challenge of modernisation.

What motivates staff?

Staff Emphasised
’Relationships’
Delegation
Recognition
‘Making a difference’
Communication
Clear direction
Participation


Senior Executives Emphasized
Recognition
Delegation
Communication
Career development
‘Making a difference’
Participation
Learning and development

Most of these terms are self-explanatory. ‘Delegation’ refers to staff autonomy to experiment and innovate in carrying out work tasks, and the mutual trust that this implies. ‘Recognition’ refers to both formal and informal acknowledgement of staff effort, and celebration and praise of achievements. ‘Making a difference’ was variously used to describe notions of making a contribution to the community, providing high standards of service to users, and taking pride in the organisation’s social or commercial role. ‘Communication’ refers to how effectively communication channels allow a two-way dialogue between managers and staff. ‘Participation’ describes the extent to which staff felt able to influence decisions affecting them or the organisation. The presence or absence of a ‘public service ethos’ unique to the public sector, and its implications for public service management, has been the subject of much discussion in this area. This research did not specifically try to identify this. But it did find evidence of the importance to staff of feeling that they could ‘make a difference’ – often expressed as a desire to serve the community. This supports other research in this area which found similar evidence, including the Public Management Foundation’s report Wasted Values (1999), Hackney Press, London.

There was strong consensus within these two groups across all the organizations involved. What motivates staff in central government is also emphasised by staff in local authorities, as well as in private sector organisations. But two issues were emphasised by staff that were not mentioned at all by senior executives. Relationships refers to a range of ‘soft’ management issues, including treating staff with courtesy and respect, and developing an informal friendly workplace atmosphere, ‘walking the talk’. ‘Clear direction’ refers to the extent to which staff have a sense of the organisation’s aspirations and goals.

Almost all staff from across the research sites emphasised how demotivating it would be to have a manager who didn’t, for example, treat them with respect, listen to their views, and encourage a positive working environment – elements of the kind of relationship that appear to act as the most important motivator for employees. By contrast, senior executives stressed that line management plays a crucial role in translating strategies to boost motivation into practice. Pay was rarely mentioned at all by staff as a motivator. Indeed, public sector staff frequently pointed out that they were not ‘in it for the money’. It cannot be inferred from this that pay and benefits are unimportant in motivating staff. Pay is clearly part of the basic contract between employers and employees. Perceptions of unfairness in basic pay levels were mentioned as a big potential demotivator, for example. What this does suggest is that pay and benefits form one part of a much broader range of measures to build and maintain staff motivation. This should include attention to developing more positive interpersonal behaviours, greater staff autonomy and the development of line management capacity.

The ‘demotivators’ most often mentioned included:
- having little or no control over the way in which they work;
- being treated in an impersonal, remote way;
- a lack of recognition and praise for individuals’ contribution;
- poor internal communications;
- resource shortages;
- negative press, bad image;
- concerns about pay and benefits; and
- weak line management.





1 Conway, N. & Guest, D. (2000) The Psychological Contract in the Public Sector, Chartered Institute of Personnel and Development.
2 See for example Foster, A. (2000) Customers in the Driving Seat, Public Service Productivity Panel (PSPP).

Source: www.h-treasury.gov.uk




Survey of civil society organisations’ governance arrangements

To be effective in promoting beneficial change, Civil Society Organisations (CSOs) must have rigorous procedures in place for transparency and accountability purposes. In addition, in order for CSOs to advocate for better governance, we would expect them to conform to good governance practices themselves. Our expectations for what comprises good governance in the CSO sector are largely drawn from ACEVO et al. 1 (2005), which sets out a code of best practice.
A survey was carried out on the corporate governance of the 18 CSOs who hold Partnership Programme Agreements (PPAs) with DFID. We asked for information regarding roles and responsibilities, recruitment, board representation and monitoring arrangements.

The 16 CSOs which responded to the survey are: Action Aid, Action on Disability and Development, International HIV/AIDS Alliance, Care International UK, Christian Aid, Catholic Institute for International Relations, International Service, Overseas Development Institute, Oxfam, Panos, Practical Action, Save the Children UK, Skillshare International, Voluntary Service Overseas, Water Aid and WWF-UK. Skills, roles, responsibilities and recruitment


Key points:
􀂃 11 respondents provided documents detailing roles and responsibilities of the Board of Trustees
􀂃 14 Boards met at least quarterly, and most met regularly with the Chief Executive, but fewer consulted regularly with staff
􀂃 A range of skills and experience are represented on the majority of Boards of trustees
􀂃 Nearly all organisations stated they had a strategy for recruitment of new Board members, and all organisations surveyed had at least one measure in place to promote open recruitment
􀂃 Fewer than half of organisations have a code of ethics or code of conduct, on-going
training for existing members, or provide experienced mentoring to new members
􀂃 9 organisations had no developing country representation on their board, although a minority of organisations had a significant proportion of such members.

Survey results: Skills, roles and responsibilities, and recruitment
Frequency (of a possible 16 CSOs)
How Boards meet roles and responsibilities:
Through regular meetings with sub-committees 16
Through regular meetings 15
Through receiving regular performance monitoring reports 15
Through regular meetings with the chief executive 15
Through regular meetings with staff 5
How sub-committees meet roles and responsibilities:
Through regular meetings 15
Through receiving regular performance monitoring reports 14
Through regular meetings with the chief executive 9
Through regular meetings with staff 8
Skills and experience represented on the Boards:
Strategic leadership, management 16
Finance 15
Direct knowledge of beneficiary group 14
Governance, human resources & diversity 14
Measures taken by the Board to ensure open recruitment:
Role profile setting out the skills and knowledge required 15
Interview with panel 9
Diversity monitoring 9
Consistent criteria for evaluating candidates 8
Advertising in a wide range of publications 7
Involvement of an external expert 0
Arrangements to ensure members understand responsibilities/ functions:
Briefings/information pack/statement of responsibilities 16
Conflicts of interest policy 12
Formal induction process including training 12
Code of ethics or code of conduct 7
Ongoing training for existing members 6
Experienced mentor provided to new members


1 ACEVO, Charity trustee Networks, ICSA, NCVO (2005) “Good Governance: A code for the voluntary and community sector,” NCVO on behalf of the National Hub of Expertise in Governance. A good source of information on good governance practice in non-profit organisations is http://www.npgoodpractice.org/Governance




LIVLIHOOD

Land policy must respond to population growth and economic development. As cities expand and non-agricultural economies grow the pressure to convert land to new uses increases. Land policies and land institutions need to keep pace, establishing an equitable basis for investment and land development, whilst ensuring that poor people gain new livelihood opportunities and that their rights are protected.

Land institutions are a vital element of effective governance. Where they are weak, the rights of the poor are particularly at risk. Well functioning property rights and land institutions underpin economic development and help reduce corruption and social conflict. Efficient land administration that is accessible to ordinary people and recognises the complexity of land rights on the ground is crucial. The legal recognition of informal land rights is a powerful tool for social inclusion. Land markets must help the poor gain access to land. Land use planning needs to be democratic in order to mediate effectively between competing interests amongst land users.

Land reform is a long-term process that requires sustained support. It is an issue of central political importance and considerable sensitivity. Governments need to win support for reform through broad-based consultative processes. For their part, donors should avoid stand alone, technically driven land programmes and work instead with Governments through poverty reduction strategies and co-ordinated sector-wide approaches.

A rights-based approach to land translates into advocacy and representation of the poor in land management. The idea is strongly supported that land is a key factor in poverty reduction. If people have uncertain rights to their land, they have little incentive to invest in or conserve it. However, if the Millennium Development Goals are to be achieved rights must be converted into livelihood opportunities. Land policy and reform need to be considered in the wider context of poor people’s productivity and livelihoods, provision of services (health, education, advice, technologies) and access to markets.




 Security of tenure, whether the right to occupy a room or to develop a plot of land, plays a large part in determining access to basic infrastructure, services, employment opportunities and credit.
 People who are safe from eviction feel secure to improve their homes and neighbourhoods.
 The legal recognition of extra-legal settlements and enterprises of the poor are powerful tools for social inclusion, and an essential basis for establishing the rule of law and more socially legitimate government in urban areas.
 Urban planning strategies provide an important means of enabling poor people to live close to their sources of livelihood
 Participatory planning can strengthen the confidence in the development process and property rights, and help to direct investment to areas where it will be of greatest social benefit.


Source:
Oxfam GB, Issues we work on, Livlihood, 2006
S. Johnson and B. Rogaly, Microfinance and poverty reduction, Oxfam and Actionaid, London, 1997
DFID Urban Strategy, DFID 2001
BETTER LIVELIHOODS FOR POOR PEOPLE:THE ROLE OF LAND POLICY, DFID 2003


Poverty analysis

Widening the scope of assessment of poverty, little is found on acknowledgment and documentation about people fallen poor out of sudden loss or adversities which is distinct from suffering regular and persistent deprivation. The argument is to study tolerance and coping mechanism of those poor that in the past experienced higher standards of living and suffer additionally from falling in poverty and the humiliation that it entails. Since poverty can not be irrespective to societal standards, there are remarks about the sense of deprivation or unhappiness caused by poverty that is greatly influenced by average societal standards. But increasingly these individual’s sense of belonging to a particular class and income come under question.

“Factors like “aspiration” and the standards adopted in defining one’s own condition plays a role in differentiating the classes more than the “poverty itself”’(Booth). In this respect their aspiration equals the trauma of their loss. The focus is on the analysis of difficulties to adapt unprecedented condition of loosing social status in addition to suffering from poverty itself. The causes of loss range from natural or manmade disasters, heavy debts, long term unemployment, severe sickness, loss of legal battles, and state-grounded loss of rights, as well as political and revolution that shuffles social fabrics where past noble poor rub better offs from their assets and continue to claim for more seizure, causing insecure environment.

In terms of rhetoric of social exclusion, those referred to as excluded are people not protected by the welfare state and are considered social misfits. But those misfits are marked out as mentally and physically handicapped, the aged and invalid, drug users, delinquents, suicidal people and so on. None defines this type of poor fallen in poverty due to sudden loss who might never recover.

Although the term ‘exclusion’ has been extended to include the rise in long term and recurrent unemployment, as well as the growing instability of social relations, since it has been recognised that employment is not just about income, but also about social networks, and a sense of self-worth and that the unemployed were ‘excluded’ from participation in the normal activities of society.

The similarity to engagement in class struggle is misleading since these deprived individuals are strangers in their new outfit and their mental capacity and past experiences do not match imposed condition to adapt for survival among underclassed. Particularities of strain imposed on this category of poor to integrate and adapt to the new arrangement and manage their social relation should be studied. They have to cope with precarious changes in their consumption, saving, social, political activities.

Health Survey

Cost-sharing initiatives, in the form of fees for services and revolving drug funds, have been implemented in Yemen by the government and international agencies throughout the 1990s, in response to severe economic crisis and a decline in government revenue, which had led to under funding of the health-care system. The primary reason for introducing cost sharing in the public sector in Yemen and elsewhere, is to improve quality of care and attract more users. Cost sharing has been associated by its proponents with a number of advantages, most importantly, improved availability and quality of essential health services and drugs. It is also argued that if designed carefully, a system of cost sharing could enhance access to health care, and improve equity and community participation. Examples of mechanisms to achieve positive outcomes include: effective protection of poor and marginalised sections of the population; local retention and use of revenue from cost sharing; and involving communities in decision making.

Oxfam conducted a study from April to July 2000 to explore the current cost-sharing practices and their impact on the population in Yemen, particularly on poor and vulnerable people; and to highlight those features of cost-sharing policies likely to hamper equitable access to services, quality improvements, and sustainability.

The study shows that overall utilisation has increased slightly under cost sharing, which is a distinctly positive development. The geo-graphical coverage of public health facilities in rural
Yemen is extremely limited, with only 30 per cent of the rural population having access to care (MoPH 1998). Real access, as measured by the presence of essential drugs and services within the existing health facilities, is thought to be substantially lower. It has been argued that the added cost of transport and drugs, rather than the user fees alone, is a significant deterrent to health-service use (Beatty and Al Kohlani 1997; De Regt and Exterkate 1996). It is vitally important that health services are brought closer to the communities, to minimise transport costs and encourage utilisation.

Once services are geographically accessible, important factors promoting utilisation appear to be: a visible improvement in the availability and quality of drugs; new services (e.g. laboratory tests); the presence of qualified (especially female) staff; services and drugs priced below the market average; and good staff attitude. The use of services by the poorer sections of the community is critically dependent on the availability of affordable drugs and services in close proximity to their home, and exemption systems to provide protection for the most vulnerable. More significant increases in utilisation were seen in facilities where cost sharing was linked with poverty alleviation programmes, such as the FAO programme.
These results should be interpreted with caution for several reasons. First, utilisation was assessed mainly qualitatively (that is, as perceived by different stakeholders) due to the incomplete records and baseline data in many facilities. Records data were available in about a third of facilities studied, and in most of them there was an increase in utilisation. Second, it should be noted that the perceived increase was in net utilisation. Thus, the better-off groups started to use certain publicsector services much more often, in addition to using the private sector, while the poor and disadvantaged groups used services less, mainly due to their unaffordability. The study shows that due to non-functional exemption systems, poor people unable to obtain exemption tend to stay at home, or seek non-conventional methods to alleviate their symptoms. Third, it is also possible that higher utilisation following the introduction of cost sharing could have been random, related to increase in population numbers, epidemics, and the closure of other facilities nearby, which naturally boosted visits to the scheme facilities.

The results from this study are broadly in line with findings from elsewhere: that cost sharing
could either produce an increase in utilisation after tangible quality improvement (Chawla and Ellis 2000; Litvack and Bodart 1993), or have no significant impact on total utilisation of care (Heller 1992).

There are indications that the poor people in this study have been deterred from seeking care due to unaffordability. Apart from unaffordability, other reasons for low utilisation included unavailability and the low quality of drugs, the lack of qualified (especially female) staff, poor service or staff attitude, mismanagement, and inconvenient access. The priorities for poor people were: free or cheap drugs and service, exemptions, and a nearby facility. As one poor user said,
‘We would go if we could get drugs free or at least with some subsidies’. Cost sharing also lost out to competition from the private sector, which was perceived to be of higher quality and to provide better value for money.

This study shows that both unaffordability and discrimination by health providers could be serious barriers to gaining access to services in the public facilities. While issues related to cost are likely to be influenced by cost sharing, the provider attitudes are only indirectly related to cost sharing. In fact, negative provider attitudes may be counterproductive for the operation of the system. A wide range of coping strategies was reported, mainly around deferring treatment or using self-help strategies (traditional healers, borrowing, selling assets, donations from the community, incurring debt to health staff, and analgesics purchased at the pharmacy).

The study findings show that the poorest and most vulnerable people are disproportionately affected by unaffordability of basic health care, demonstrated by their frequent use of coping strategies as an alternative to facility-based health care. For example, 83 per cent of poor people did not seek treatment at some point in relation to their own or a close relative’s illness. Poor people also tended to stay at home or seek non-conventional methods to treat their illnesses (for example, traditional healers and self medication), more often than less poor people. Even though the latter were less likely to use coping strategies, if they did use such strategies, these were similar to the ones used by poor people. This shows that in the context of widespread poverty in many rural areas, and structural poverty apart, many people move in and out of poverty.
This study also corroborates the findings that self-medication is widely practised in Yemen (Ateef et al. 1997). The main reasons for this, indicated by this study, are that drugs are often unavailable in the public facilities, or are of poor quality, and that the RDF system does not offer payment on credit. Private drug stores, on the other hand, are seen to provide quick and convenient service, flexible working hours, and a wide range of drugs, without the need to pay a fee for the consultation, as in the public health facilities operating cost-sharing schemes. Recent reports from Yemen have stressed the dangers of self-medication, such as creating drug resistance to antimalarial drugs (Alssabri et al. 2001a) and antibiotic resistance (Alssabri et al. 2001b), which could impose an additional burden on the health system.

This study shows conceptually and methodologically, that in order to arrive at meaningful results, willingness to pay, ability to pay, and perceived quality of care should be analysed in conjunction. Although this study outlines key areas where interventions in improving quality could increase the willingness to pay under cost sharing, cost remains a major factor in people’s decision to seek care. Strong financial management of revenue and clear administrative rules are a prerequisite for the success of the cost-sharing system. The unclear management lines and weak supervision by government and donors found by this study may be the single most important factor undermining the operation of the cost-sharing system. The study found that in most cases, the financial systems and procedures are unclear. In some government and donor-supported facilities where cost sharing is run in a relatively effective manner, this is more likely to be due to particular staff, rather than to functioning systems.

Fewer than half of fee-for-service facilities and RDFs had a bank account for revenue; policy and decisions on use of revenue were not transparent, and often taken solely by the director; and accounts were often incomplete. This is surprising, given the emphasis by donors on improving financial management. Facility directors and health managers at higher levels of the system need to see the effect of the decisions they make about revenue handling, expenditure and exemption on service quality, affordability, and utilisation. There are currently no management systems in place that would allow this. Despite some basic training, the skills of the administrative staff are insufficient. Health information is one of the weakest areas of the health system; one of the findings of this study is the conspicuous gap in facility documentation, preventing regular evaluation and monitoring.

Community involvement
The Health Sector Reform (HSR) strategy predicts that community involvement in health financing will lead to an improvement in quality, and will force health managers and staff to be more responsive and more accountable to their clients (MoPH 1998). One of the challenges in planning and delivering health care is to find ways of optimising community involvement. Community involvement is often seen as only involving participation in the financing of services, rather than health services being accountable to the communities they serve. Community involvement should also be considered in identifying health needs, monitoring services, and in decisions on the allocation of funds to reflect the priorities of the community. The significance of community involvement in improving ownership, utilisation, and accountability under cost-sharing schemes is recognised by the government and donors in Yemen, hence the setting up of health facility committees. This is a success in itself. However, the findings of this study show that these representative structures are sometimes not present at all, and when they are present have mainly an advisory role for exemptions and are rarely involved in decision making on the important areas of facility management, fee setting, and use of revenue. In general, a cost-sharing system will reflect existing patterns of local decision making, and the formal and informal roles of the various stakeholders. It is likely that inequalities in the community will be perpetuated, despite efforts to ensure participation of all community members. Community involvement does not necessarily imply that poor people are sufficiently represented. Members of the elite, officials, men, or people in positions of power may be more vocal in expressing their views or be better represented in health facility committees, leading to bias in decision making that is against the interest of the whole community. This is shown in the current study, where members of the elite were able to obtain exemptions, or were not asked to pay at the facility. When such committees are present, no extra resources or incentives for their members have been allowed. Given that the voluntary sector in Yemen is still in the early stages of development, the amount of time and effort needed for an HFC member to be actively involved in a cost-sharing policy needs to be revised. It was found that in many sites with an HFC, only a few of their members were interested and participated actively. An extreme example was found in one site where up to 75 per cent of the members elected resigned soon after setting up the committee, due not only to the lack of incentives, but because they had to pay themselves for their transport, photocopying and other expenses.

www.oxfam.org.uk



Monitoring and evaluation in hygiene education programmes

Monitoring and evaluation are important tools for programme management and improvement. Monitoring is an ongoing activity to provide a continuous oversight on whether a programme is proceeding according to plan. Evaluation is carried out at intervals, either in response to a problem or when a project phase or project period is completed. M&E are important tools because any project should be interested in how to improve performance (quality and efficiency of activities) and results (effectiveness). M&E efforts in hygiene education programmes tend to be focused more on results (whether or not behaviour was changed) than on inputs and performance, that is the process leading to change in behaviour. There is confusion as to whether or not the M&E of an integrated water supply, sanitation and hygienic education project should include the study of health impact, -ie the reduction in water and sanitation related diseases as a result of the project. Health impact studies try to ascertain whether because of the project, people suffer less from diarrhoea or from hookworm. It is not easy to establish relation between water, sanitation and health, because there may be a lo tof influencing factors. For example, there may be improvements not only in water and sanitation, but also in health care or changes in rainfall and food supply. Most important is to know whether water supply and sanitation facilities are functioning properly and fully used, hygiene conditions and practices are improving and whether these improvements are sustained over time.

Monitoring is a management tool, and therefore should provide relevant and timely information to the people who need this information for planning and implementation of the hygiene education programme and the sustaining of results. A first requirement in setting up a monitoring system is to decide who needs what information for what purpose (s). Usually there will be at least three management levels and thus three levels of information needs: community level, hygiene education programme level, and general project management level (plus higher levels).

In setting up a monitoring system it may be worthwhile to use a workshop approach, involving the various management levels, to arrive at a system that is as simple and useful as possible, and that allows essential information to climb up and down the institutional hierarchy without too much adaptation or need for the collection of additional data.

Monitoring of integrated hygiene education will be more useful when the following points are kept in mind.

• Check progress against objectives and unexpected results – the focus may be on progress of the programme in relation to the work plan and the identified target groups. Monitoring items may include, for example; inputs in manpower, money and materials; implementation of tasks; the number and type of hygiene education activities. This will allow for a better control of the timing of activities and of the use of resources.
• Learn from experience and adapt projects to optimise their impact - learning revolves around adaptations and changes in conditions and behaviour related to water use, sanitation and community management, and their sustainability over time. Monitoring items for this field may include, functioning and use of water supply and sanitation facilities, clean environment, personal and household hygiene, functioning of water and sanitation committees.
• Provide information and learning to stakeholders and be accountable for our actions and the resources we manage


Oxfam is doing this through six inter-linked processes. By using these in combination, checks can be made about the similarities and differences in the conclusions and learning coming from the different processes, and this makes approach to assessing performance and impact more robust.



Seven questions about performance and impact
Each of the six processes should contribute to answering seven questions, which lie at the heart of Oxfam’s monitoring and evaluation framework:
1. What significant changes have occurred in the lives of poor women, men and children?
2. How far has greater equity been achieved between women and men and between other groups?
3. What changes in policies, practices, ideas, and beliefs have happened?
4. Have those we hope will benefit and those who support us been appropriately involved at all stages and empowered through the process?
5. Are the changes which have been achieved likely to be sustained?
6. How cost-effective has the intervention been?
7. To what degree have we learned from this experience and shared the learning?


www.oxfam.org.uk



Health and Hygiene in Emergencies

Teaching people about health and hygiene is a vital part of humanitarian work in an emergency. After a disaster, people may lose their homes, access to any health care, the essentials for food preparation, and domestic hygiene products and infrastructure. Loss of loved ones, the trauma that follows, and a deteriorating environment turning life to an unfamiliar condition, all are extremely difficult to tolerate. This drives affected population astray where they need assistance to regain their sense of life and adapt to new meanings.
In the cramped, often in sanitary conditions of a refugee camp, it is extremely difficult to keep healthy and to stop disease from spreading. However, simply providing people with clean water, toilets, mosquito nets and insecticides does not necessarily ensure that they will use these resources effectively.
Oxfam trains Health Promotors, usually from within affected people and refugees themselves, to teach others about good hygiene practice. Good health promotion combines insider knowledge (what people already know, and how they behave) with outsider knowledge (risks of specific diseases according to the conditions people are currently living in). Regular hand washing, food protection, good domestic hygiene, and safe waste disposal, have been shown to reduce diarrhoeal diseases far more than clean water alone can do.

To help them stay healthy, people are given hygiene kits which consist of an Oxfam bucket, scrubbing brush, soap, toothpaste, detergent, shampoo, candles, matches, sanitary items and a measuring jug for making oral-rehydration solution (a cheap and effective treatment for diarrhoea) that can itself save lives. The kits hold enough supplies to last a family of five for up to three months.

Oxfam focuses predominantly on controlling diarrhoeal diseases and malaria – two of the biggest potential killers. Malaria is a disease that flourishes in conditions of crisis, when health services have broken down, and people are concentrated in potentially high-risk areas in a weakened state of health. Floods in particular create ideal conditions for mosquito larvae to breed. Malaria kills one million people every year, one third of whom are in emergency situations at the time

http://www.oxfam.org.uk/what_we_do/emergencies/
how_we_work/health_promotion.htm


Hygiene Education Budgetary Decisions

Personnel and costs of an integrated hygiene education programme are very much neglected aspects in many water supply and sanitation programmes. For a hygiene education programme to have any chance of being effective, much more attention is needed to provide enough qualified staff, appropriate manpower training and supervision, and adequate funding. Personnel and costs considerations should be taken into account from the very start of a project, during identification and formulation. These factors are the subject of discussion in greater detail because of their interplay with project organisation, project objectives and hygiene education programming.

There should be at least one person in the project who has overall responsibility for the planning, preparation, implementation and monitoring of the hygienic education programme as Education participation coordinator. It might be best to have responsibility for community participation and hygiene education coordination unified in one person, because of the close interrelationships between the two. Often it is argued that a woman is needed for this position, to increase the chance of women’s involvement in the planning, implementation and follow up of the project activities. Without denying the importance of such influence, it would be wrong to select a person solely on the criterion of being a woman. More important is that the project creates conditions for women to participate in the programme on an equal basis.

The person should have working experience at field level and have a sufficient education and age to establish equal working relations with the project manager and heads of cooperating agencies, have communication and management capabilities, have affinity to work with technical staff, and needs sufficient recognition for the importance of integrated hygiene education. Project management and technical staff who consider a hygiene education programme as a troublesome appendix will complicate the work and make it less efficient and effective. Often, special attention has to be given to this aspect. Orientation and training sessions may help, both for management and technical staff to become familiar with the integration of a hygiene education component, and for education/participation staff to become familiar with the integration of a technical component.

Another point to be appreciated is that the education participation coordinator often has a position where interests of various organisations meet, or as easily may be the case, conflict. This is another reason why the work of the education/participation coordinator may be difficult and progress less than desirable. Also here project management can play an active role to smooth problems. One of the mechanisms to be used for this may be a coordination committee consisting of representatives of the various cooperating agencies.

Valued characteristics of a good community hygiene educator are that he or she is considered by the men and women in the community to be: Reliable and trustworthy, a skilful communicator, knowledgeable about water and sanitation, readily approachable by all community groups, liked because of his/her positive personality and motives to support the community, able to cooperate with technical staff and to voice the views and interests of the community to relevant organisations and authorities.

Budgetary decision for integrated hygiene education have to be made in relation to project objectives, the set up of the hygiene education programme, and the actual hygiene education work plan. Cost items predominantly consist of personnel, training, and necessary office equipment and hygiene education materials. Systematic information is scarce on what amount of money is needed for a successful hygiene education programme. It is better to make a safe guess, rather than ending up with a very tight budget.

In hygiene education the major consideration for the budget is personnel. How much effort and time will be required? What kinds of skills and capabilities are needed? What, specifically, are the tasks? Detailed answers to these questions will yield a basic outline of personnel requirements. The next steps then are to decide from where the personnel will be obtained and who is going to pay. For example, if technicians become hygiene educators as well, or when regular staff of the MoH become the hygiene educators, additional personnel costs for the project may be rather limited compared with the situation where the project assigns educational staff itself. Other major cost categories usually are travel, field allowances, materials and supplies.

Quite often the costs for consultants and specific subcontracts are considered separately, and a post for contingencies or indirect costs (eg 15% of the total costs) should be added to allow for unexpected expenditure. A common problem during project implementation is that the budget for hygiene education is the first one to be cut or used for other purposes such as the purchase of hardware or a workshop for other purpose. Where the hygiene education budget proves to be too high compared with actual expenditure, this may be a realistic move, but often this will not be the case, leaving the hygiene education programme within sufficient funds. To make a hygiene education programme work, it will be clear that the project management should prevent the budget from being endangered.

Evaluation of Humanitarian Action (EHA)

Project cycle management

Evaluation is part of Project Cycle Management which consists of the following phases: Assessment - Design - Appraisal - Implementation - Monitoring - Completion – Evaluation. In this cycle assessment, monitoring and evaluation activities each logically flow one into the other. Assessment is the basis for programming while monitoring, and evaluation analyses the outcomes. Although their objectives are similar, different people with different responsibilities might perform the stages or the scope of activities slightly differently. Program managers and decision-makers should view all of these activities as part of an integrated approach to information collection and processing, which is intended to improve the quality of services offered to members of the affected population. there are important differences between the project cycle adopted in a non-crisis context and the one that develops in crisis / unstable situations.


Purposes of evaluation of humanitarian action

An emphasis on learning in an evaluation will help organisations understand why particular aid activities are more or less successful. The aim is to improve future performance. Timeliness is an important factor, since the need and willingness exist to pass on lessons now, not in a year’s time when the final report is eventually published. An emphasis on accountability is the duty to provide an account (by no means a financial account) or reckoning of those actions for which one is held ‘responsible’. Thus accountability involves two responsibilities or duties: the responsibility to undertake certain actions (or forbear from taking actions) and the responsibility to provide an account for those actions” (Gray, 1996). Organisations are often undertaking evaluations to demonstrate their accountability to donors. Traditional virtues of rigour, independence, replicability and efficiency tend to be primary concerns in accountability. Evaluations designed primarily for lesson learning will not necessarily provide sufficient information for accountability and vice versa. The tension and balance between the two need to be explicitly addressed at the evaluation design stage. The two objectives can be incompatible and their target audiences differ.

International Standards and Legal Framework

In the humanitarian sector there are now some major accountability initiatives. They fall into the following categories:

Legislative: International Humanitarian, Human Rights Law, Local and National laws.
Voluntary standards and processes: Sphere, People in Aid, Codes of Conduct and Protocols, the People’s Panel, Evaluations.
Contractual agreements: Memorandum of Understanding, Joint Policy Agreements, Partnerships.

Cross cutting themes underpin HA programming and therefore need to be considered during the evaluation process. Cross cutting themes include: consideration of gender
Differences, promoting co-ordination among stakeholders; providing opportunities for participation of stakeholders, particularly beneficiaries; and attention to rights based approaches, such as protection. The manner in which a programme addresses these themes is critical. If a programme was not designed with these in mind, it is appropriate for an evaluation to ask why.

Background to Sphere
A model set of minimum standards and international human rights and humanitarian law is offered in Sphere Project. The Humanitarian Charter and accompanying minimum standards provide the humanitarian community with a practical tool for more effective and accountable inter-agency.


Types of Evaluation

There are a number of different types of evaluation, which vary, in their primary objective, orientation (independent/self), themes and timing. Different types of evaluation are carried out at different stages of the project cycle. The traditional project-based approach is giving way to broader country programmes with thematic initiatives and sector-wide approaches. The boundaries of these are much harder to define and the process more complex, particularly when it comes to demonstrating aid effectiveness. The attraction of broader-based evaluations is that the lessons learned are likely to be more widely applicable, both in policy and operational terms.

Additional Information
On-going (real time) evaluations are commissioned during project implementation. These are also referred to as interim evaluations. Ex-post evaluations take place after implementation has been completed. A major difference is between independent evaluation and self-evaluation. Independent evaluation involves evaluators who have had no responsibility or involvement in the activity being evaluated. Operational staff may well be involved in the process, but the primary purpose is to achieve an independent assessment. Self-evaluation involves operational staff and beneficiaries evaluating their own activities. The direction of the interactions in an evaluation is also important. Traditional evaluations are more typical and tend to be initiated by the top management with their objectives and use independent outside judgement and technical expertise. They may or may not involve beneficiaries. Participatory evaluations include the stakeholders and have a more bottom-up approach. These stakeholders may participate fully in all or in some phases of the evaluation.


When evaluation briefs are broad and not everything can be done, there is a clear need to discuss with an organisation what its priorities are. To decide on a realistic allocation of time tasks involved should be broken down into: amount of preparation and desk study time/time in field/time in writing up.nitial contact with an organisation gives external consultants insight into how an organization works. Notice the language used, how people are treating insiders/outsiders, their willingness to discuss ‘real’ issues etc.


Stakeholders

The planning process is a time for gaining cooperation from all stakeholders. Priority however should be given to primary stakeholders.
􀁸Stakeholders’ interests power the evaluation. In addition to the decision-makers most directly involved there is often a long list of persons with an interest in the evaluation such as policy makers, donors, operational partners, beneficiaries and various parts of the host government. The extent to which these groups may seek involvement in the evaluation is not always clear. Such aspects however should be given consideration in consultations and planning.

What is a user-focused evaluation? No matter what the type or purpose, the evaluation should aim to be useful to the stakeholders. the philosophy of evaluation, in general, is moving from “evaluate to evolve” instead of “evaluate to control”.

Most projects involve at least four categories of stakeholders. Stakeholders are defined as those who have an interest in the outcome of the project and consequently in the orientation and interpretation of the evaluation e.g., International organisations (donors, NGOs and research foundations); national and sectoral organisations (central government ministries, financial ministries, line ministries local NGOs and national consulting and research groups); project implementing agencies; and, intended beneficiaries. Some or all will affect the fate of the evaluation.

Evaluators and evaluation managers will often find that many parties will be involved in the use of evaluation results and they need to recognise the value in exploring interests and needs underlying positions. Potential reactions to the findings should be borne in mind and cooperation sought. Evaluation managers need to appreciate what will make an EHA ‘relevant’ from a range of perspectives. They need to create a strategic plan to reach the stakeholders.


Content of TOR

TORs provide a formal record of agreement as to what will be done and should outline all obligations of all participants in the evaluation. The TOR should provide sufficient details (including contextual overview, intervention objective and key stakeholders) to inform the evaluation’s analysis. It should, for the purpose of transparency, outline the evaluation budget, preferably as a percentage of the cost of the intervention being evaluated. The evaluator and commissioning organisation need to work together in order to streamline the evaluation. The evaluator must examine the practicality of the planning process, the feasibility of meeting stakeholders needs, the strength of the TOR, the balance within the team, and take steps to influence these variables to make the evaluation more effective. Whether evaluators take part in the core planning activities or not, insight into the planning process is essential. The key components in planning include the identification of stakeholder interests, the budget and resources, feasibility and timing, development of the TOR and formation of the team. Expending adequate time and effort in preparing a good TOR has big payoffs in terms of resulting quality, relevance and usefulness.
The budget and other resources available influence the scope and methods of the evaluation.

Poorly planned evaluations often delegate the more detailed TOR to the consultant/evaluator. In this role they are seldom in a position to interpret the aims and issues to be addressed by the evaluation and the work can easily follow the interests of the consultant rather than the needs of the decision makers


Evaluation Criteria
Evaluation criteria provide a functional tool and checklist. Its use establishes priorities for the evaluation. There are five main criteria: efficiency, effectiveness, impact, relevance/appropriateness, and connectedness (for short-term project impact on long term processes).

Evaluation criteria form the framework or logical approach to examination of the activities to be evaluated. Criteria developed by OECD DAC for development evaluation can be appropriate for humanitarian action.

There are other frameworks. A simple framework may be: What is right, wrong; Why and what needs to be done? Projects evaluated by a logframe can ask: what was the planning target, what are the actual results, what are the weaknesses and reasons for deviation/positive experiences and unplanned results, followed by recommendations.


Team’ Composition

The following are important to consider when putting together an evaluation team: origin of team members – internal/external/mixed; size of team variations – is it a team or a pair; Structure of team variations – single consultant or team, core team, groups. Teams should contain a mix of skills and experience including Professional expertise relating to the issue being evaluated and Knowledge of the country/region cross-disciplinary skills (social economic and institutional). Representatives from the partner country or organisation will improve the quality and the local credibility of the evaluation findings as well as building local capacity. Representatives, however, can find themselves in difficult positions e.g. if the evaluation is reflecting negatively on their organisation or colleagues.
Availability is required for the whole time of the evaluation along with a good leadership.


Preparations by evaluation team

Identifying Objectives mean establishing a set of actions to be taken by the evaluation team at the start of an evaluation. As preparatory action Building in adequate preparation time into TOR enables evaluation team to build relations with the centre and helps to test the TOR. In practice, never enough time allowed. Briefing of team members before fieldwork as to their roles, expectations and ways of working leads to more effective use of time will follow.

Key aspects of preparation include reviewing document, planning country visits and field work as well as maintaining staff security.

For gaining cooperation and foreseeing follow up, the evaluator should know:
- What actions did the evaluation manager undertake prior to the team’s arrival on the scene?
- What decisions were made as to the timing and content of the evaluation?
- What political realities and contextual issues affect the process?
- Was cooperation gained from all stakeholders?
- Are stakeholders aware of how the evaluation will benefit them?
- Was the exercise painted as a contribution to dialogue and not a judgment?
- Were the stakeholders involved in planning – discussing goals, building consensus, planning the evaluation approach – and to what degree?
- Was the TOR submitted to stakeholders for their approval to help in gaining commitment to the evaluation?
- Were the constraints (security, lack of data, etc.) to the evaluation made clear to the stakeholders? Logistical constraints regarding access and security are often underestimated.

Source: ALNAP, ODI, www.alnap.org.uk

Qualitative Research

In-depth interview

In-depth interview is a technique designed to elicit a vivid picture of the participant’s perspective on the subject of study which is an effective way in giving a human face to research. It is a rewarding experience for both participants and interviewers alike. For participants it offers the opportunity to express themselves in a way ordinary life rarely affords them. Many people are pleased with the significance of becoming the subject of study and have someone listen to their opinions and life experiences. For their part, interviewers engaged in in-depth interviews are satisfied to be entrusted with people’s personal issues. The researcher’s interviewing techniques is to establish a sincere dialogue which allows getting a grip on interviewee’s true perceptions on the research topic.

The researcher is motivated to learn everything the participant can share about the subject. Researchers engage with participants in a face-to-face interview by posing questions in a neutral manner, listening attentively to participants’ responses, and asking follow-up questions and probes based on those responses. They do not lead participants according to any preconceived notions, nor do they encourage participants to provide particular answers by expressing approval or disapproval of what they say. In-depth interviews are useful for learning about the perspectives of individuals, to gain insight into how people interpret and order the world, as opposed to, for example, group norms of a community, for which focus groups are more appropriate. We can accomplish this by being attentive to the “causal explanations” participants provide for what they have experienced and believe and by actively probing them about the “connections” and relationships they see between particular events, phenomena, and beliefs.

Interviews are also especially appropriate for addressing sensitive topics that people might be reluctant to discuss in a group setting. Focus group interviews are intended for identifying and eliciting opinions about group norms, and more important discovering variety within a population. While in a face-to-face interview the aim is to elicit in-depth responses, with nuances and contradictions; a focused group discussion aims at acquiring information on a range of norms and opinions in a short period of time.

Data analysis phase of the research follows after data collection by coding transcripts according to participant responses to each question and/or to the most salient themes emerging across the set of interviews. During data collection researchers use expanded interview notes to remind them of questions which needs to be highlighted and adding contextual details to what participants have said. When conducting an in-depth interview, researchers ask mostly open-ended questions – that is, questions that encourage a detailed response rather than “yes,” “no,” or one-word answers – to elicit unstructured talk from participants about their experiences and opinions. It is common to conduct in-depth interviews with several different categories of people as part of a single study. This often involves a separate question guide for each category. For example, in a study about maternal health practices, in-depth interviews might be conducted with health care providers, pregnant women, and women who have given birth within the last year.

The interviewer’s skills have an important influence on the comprehensiveness and complexity of the information that participants provide. The interviewer must be able to lend a sympathetic ear without taking on a counseling role; encourage participants to elaborate on their answers without expressing approval, disapproval, judgment, or bias; keep track of the questions yet let the conversation develop naturally; and manage the interview while still respecting the principle of participant- as-expert. The core skills required to establish positive interviewer/participant dynamics are rapport-building, emphasizing the participant’s perspective, and accommodating different personalities and emotional states Culturally specific manner should be studied before the interview and respected to build rapport such as friendly, impartial approach and remaining humble and patient.

Participants will talk freely, openly, and honestly about the research topic only if they:
- feel comfortable in the interviewer’s presence
-trust the interviewer
- feel secure about confidentiality
-believe the interviewer is interested in their story
- do not feel judged

The interviewer’s perspective on the research issue should be invisible. This avoids the risk that participants will modify their responses to please the interviewer instead of describing their own perspective. Different interviewing styles may be needed for different participants – for example, be able to retain control of a conversation with a dominant personality and to animate a shy participant.
Heightened emotions should be toned down, such as when a participant starts crying or becomes belligerent. Adapting to each individual may require softening the way you broach sensitive issues, adjusting your tone of voice to be more sober or upbeat, or exhibiting increased warmth or social distance.


Key skills for the interviewer include:
- Treating the participant as the expert
- Keeping the participant from interviewing you
- Balancing deference to the participant with control over the interview
- Being an engaged listener
- Demonstrating a neutral attitude

Clarifying roles can also be useful. while interviewer is ultimately responsible for making sure that all questions in the interview guide are addressed during the interview, the participant will play the role of expert and you, the interviewer, will be the student. It should be explained that the interview is about gaining from the participant’s own knowledge about the research topic, not to dispense advice. Therefore the participant should be assured that there are no right or wrong answers; it is his or her personal opinion and perspective that are of interest to the study.

Leading questions such as “Do you agree with the majority of people that the health service is failing?” should be avoided for obvious reasons that any right-minded individual can see. Don’t you agree?

Some general rules can be stated on question wording:
• Be concise and unambiguous
• Avoid double questions
• Avoid questions involving negatives
• Ask for precise answers
• Avoid leading questions

The questionnaire can be tested on a small sample of the subjects or even friends first. The aim here is to detect any flaws in questioning and correct these prior to the main survey. The piloting may enable the researcher to convert an open-ended question in to a closed question by determining the range of possible answers. A trial analysis may also be performed on pilot sample and hence enabling test out of all analysis procedures.
Having done the pilot survey, amendments can be made that will help to maximise response rate and minimise error rate on answers.

Data Analysis
The essential point to analysis is the coding, entry and checking of data. The statistical analysis packages available including e.g. SAS, Minitab and SPSS. In all instances data can either be entered direct or imported from other packages such as Excel, provided the instructions for the receiving package are adhered to. In all cases a similar approach is used for coding and formatting data.
Usually the data is help on the computer in a rectangular data table where each row represents a ‘case’, i.e. a specific respondent and their data. Each column represents a specific variable, i.e. the data for that variable for all respondents. Note that a question on the questionnaire may require more than one variable to specify the data collected by that question.
A variable will have a unique title and a specific level of measurement. The measurement level of a variable is important because it determines the type of analysis that can be undertaken. In ascending order of sophistication these levels are:
Nominal, Ordinal, Scale
For ease of data handling and analysis the values that variables can take are usually designated by numeric codes, even when the variable is a nominal one. For example, gender can take the value male or female, but would usually be coded O and 1 (or 1 and 0) for ease of handling. Putting these data entry codes on the distributed questionnaire can help at data entry time, but obviously has the downside of putting numbers on the questionnaire that are of no relevance to the respondent and therefore could make the questionnaire look messier than it needs to.

Analysis packages usually make arrangements for missing values to be coded automatically; if they do not, this will have to be specifically taken care of when entering data.


Ref.:
Oxford Univ., http://remiss.politics.ox.ac.uk/





Typical Questionnaires Personality Assessment
I constantly feel I am used by other people with different scope of vision.
1 2 3 4 5
I often feel pressured into doing things I do not want to do.
1 2 3 4 5
I feel there is a constant pressure on me to assert standards that do not match my value system.
1 2 3 4 5
I am not frightened of acting independently from the crowd.
1 2 3 4 5
I feel happy only when I am in relationship with like minded.
1 2 3 4 5
I feel threatened by being caught up in situations where I have to go against my own will.
1 2 3 4 5
I worry about being stereotyped as a mass production.
1 2 3 4 5
I feel pressured by others scrutinizing my behaviors with members of the opposite sex. 1 2 3 4 5
I feel pressured to distance my relationship with my close family.
1 2 3 4 5
I feel pressurised into spending free times doing what others prefer.
1 2 3 4 5
I feel free to be myself whilst socialising with a group of likeminded.
1 2 3 4 5
My work is disrupted and blocked by the influence of others.
1 2 3 4 5
I am judged by the views and attitudes held by people around me who are ignorant.
1 2 3 4 5

People do the most amazing things for Oxfam fighting poverty

In 2005, Susan Harrison, along with three intrepid companions, decided they were sufficiently committed to the fight against poverty to take on Trailwalker UK, Oxfam's challenging 100km charity trek across the South Downs.

Just ten days before the event, Susan Harrison was on her way to Great Ormond Street hospital in London, where she works in the operating theatre. Apart from perhaps a few butterflies about the approaching feat of endurance, it was a Thursday morning like any other. 7 July 2005. Then everything changed.

Fifty-two people lost their lives that day in the London bombings. Hundreds more, like Susan, were seriously injured. In her case, she had to have her leg amputated above the knee.

Susan has been determined not to let this catastrophic turn of events affect her life negatively. With the help of some wonderful doctors and nurses, she has learned how to walk on her prosthetic leg, and just one year on has taken the extraordinary decision to take part in Trailwalker 2006. Over to Susan:

"Hi there. I have decided to fulfil my dream of raising lots of money for the work Oxfam does helping poor people around the world. Despite being seriously injured, losing my leg and much against my better judgement I have decided to try and take part this year with some good friends who are willing to carry me along the route. We call ourselves The Hopalongs, so please support us with whatever cash you can."

> Sponsor Susan online: www.oxfam.org.uk

And there's more...

Susan recently accepted Oxfam's invitation to visit some of the primary health care projects we fund in poverty-stricken Georgia. Georgia is a country wrecked by conflict, with a government too poor to afford adequate medical equipment and medicines for its people. The state hospitals are in a shocking state, and doctors and nurses are badly paid and rarely receive training to update their skills.

"On 7 July last year, I was saved by the efficiency of the NHS," says Susan. "Equipped hospitals and trained doctors and nurses saved many lives on the day of the bombings. Because of the dire lack of facilities and doctors and nurses, many poor countries like Georgia are not able to deal with crises like this. I agree with Oxfam that good quality health care should be free and accessible to all."

www.oxfam.org.uk