Using lot quality assurance sampling to assess access to water, sanitation and hygiene services in a refugee camp setting in South Sudan: a feasibility study

Abstract

BackgroundHumanitarian agencies working in refugee camp settings require rapid assessment methods to measure the needs of the populations they serve. Due to the high level of dependency of refugees, agencies need to carry out these assessments. Lot Quality Assurance Sampling (LQAS) is a method commonly used in development settings to assess populations living in a project catchment area to identify their greatest needs. LQAS could be well suited to serve the needs of refugee populations, but it has rarely been used in humanitarian settings. We adapted and implemented an LQAS survey design in Batil refugee camp, South Sudan in May 2013 to measure the added value of using it for sub-camp level assessment.MethodsUsing pre-existing divisions within the camp, we divided the Batil catchment area into six contiguous segments, called ‘supervision areas’ (SA). Six teams of two data collectors randomly selected 19 respondents in each SA, who they interviewed to collect information on water, sanitation, hygiene, and diarrhoea prevalence. These findings were aggregated into a stratified random sample of 114 respondents, and the results were analysed to produce a coverage estimate with 95% confidence interval for the camp and to prioritize SAs within the camp.ResultsThe survey provided coverage estimates on WASH indicators as well as evidence that areas of the camp closer to the main road, to clinics and to the market were better served than areas at the periphery of the camp. This assumption did not hold for all services, however, as sanitation services were uniformly high regardless of location. While it was necessary to adapt the standard LQAS protocol used in low-resource communities, the LQAS model proved to be feasible in a refugee camp setting, and program managers found the results useful at both the catchment area and SA level.ConclusionsThis study, one of the few adaptations of LQAS for a camp setting, shows that it is a feasible method for regular monitoring, with the added value of enabling camp managers to identify and advocate for the least served areas within the camp. Feedback on the results from stakeholders was overwhelmingly positive.

Social and geographic inequalities in water, sanitation and hygiene access in 21 refugee camps and settlements in Bangladesh, Kenya, Uganda, South Sudan, and Zimbabwe

“…Handwashing with soap and water has been shown to reduce the risk of diarrheal disease by 23 to 40% [ 11 , 12 ]. Likewise, inconsistent soap availability for hand washing has been shown to be commonplace in refugee settlements and camps in Uganda and South Sudan [ 6 , 13 ].…”

Lessons from humanitarian clusters to strengthen health system responses to mass displacement in low and middle-income countries: A scoping review

“…Harding and Kosonen discussed approaches to identifying requirements during displacement, including Lot Quality Assurance Sampling in Batil refugee camp, South Sudan ( Harding et al . , 2017 ; Kosonen et al .…”

Lot quality assurance sampling survey for water, sanitation and hygiene monitoring and evidence-based advocacy in Bentiu IDP camp, South Sudan

“…The United Nations Humanitarian Charter for Refugees (UNHCR), WASH in emergency handbook and Sphere guidelines, annual knowledge, attitude, and practice (KAP) surveys, and monthly reports are mentioned as means of assessment, monitoring, and evaluation [ 14 ]. Lot quality assurance sampling (LQAS) is an alternative approach for assessing the WASH situation in camp settings [ 15 ]. The method has been used to assess a variety of health services, including vaccination coverage, disease prevalence and health care monitoring [ 16 – 18 ].…”