Who should be undertaking population-based surveys in humanitarian emergencies?

BACKGROUND: Timely and accurate data are necessary to prioritise and effectively respond to humanitarian emergencies. 30-by-30 cluster surveys are commonly used in humanitarian emergencies because of their purported simplicity and reasonable validity and precision. Agencies have increasingly used 30-by-30 cluster surveys to undertake measurements beyond immunisation coverage and nutritional status. Methodological errors in cluster surveys have likely occurred for decades in humanitarian emergencies, often with unknown or unevaluated consequences. DISCUSSION: Most surveys in humanitarian emergencies are done by non-governmental organisations (NGOs). Some undertake good quality surveys while others have an already overburdened staff with limited epidemiological skills. Manuals explaining cluster survey methodology are available and in use. However, it is debatable as to whether using standardised, 'cookbook' survey methodologies are appropriate. Coordination of surveys is often lacking. If a coordinating body is established, as recommended, it is questionable whether it should have sole authority to release surveys due to insufficient independence. Donors should provide sufficient funding for personnel, training, and survey implementation, and not solely for direct programme implementation. SUMMARY: A dedicated corps of trained epidemiologists needs to be identified and made available to undertake surveys in humanitarian emergencies. NGOs in the field may need to form an alliance with certain specialised agencies or pool technically capable personnel. If NGOs continue to do surveys by themselves, a simple training manual with sample survey questionnaires, methodology, standardised files for data entry and analysis, and manual for interpretation should be developed and modified locally for each situation. At the beginning of an emergency, a central coordinating body should be established that has sufficient authority to set survey standards, coordinate when and where surveys should be undertaken and act as a survey repository. Technical expertise is expensive and donors must pay for it. As donors increasingly demand evidence-based programming, they have an obligation to ensure that sufficient funds are provided so organisations have adequate technical staff.