Standardized Monitoring and Assessment of Relief and Transitions (SMART)

ARDHO, in cooperation with Action Against Hunger (AAH/ACF), conducted the SMART and Rapid Survey project in Parwan, Nimroz, and Takhar provinces completed on May 15, 2020. Standardized Monitoring and Assessment of Relief and Transitions (SMART) proposes a way to rapidly collect reliable nutrition data and to address the above-mentioned problems. To emphasize on its strong link with SMART and to differentiate it from the large variety of Rapid Nutrition Assessment (RNA) methods, it is called a “Rapid SMART survey”. SMART is an inter-agency initiative launched in 2002 by a network of organizations and humanitarian practitioners. SMART advocates a multi-partner, systematized approach to provide critical, reliable information for decision-making, and to establish shared systems and resources for host government partners and humanitarian organizations. Since 2012, the Rapid SMART method has been field-tested in several settings, and where possible a full multi-cluster survey was conducted simultaneously to compare the results. The Rapid SMART methodology was tested in South Sudan, Afghanistan, India, Myanmar and Madagascar between November 2012 and July 20132. After each test, the method was readjusted and further improved, orienting the development of the current Rapid SMART methodology. The Rapid SMART methodology was technically endorsed by ACF International, the SMART Initiative at ACF–Canada and by the International Emergency and Refugee Health Branch at the Center for Disease Control and Prevention in Atlanta, US. The SMART Methodology is an improved survey method that balances simplicity (for rapid assessment of acute emergencies) and technical soundness. It draws from the core elements of several methodologies with continuous upgrading informed by research and current best practices. The SMART Methodology is based on the two most vital and basic public health indicators for the assessment of the magnitude and severity of a humanitarian crisis:
1. Nutritional status of children under-five.
2. Mortality rate of the population.
These indicators are useful for prioritizing resources as well as for monitoring the extent to which the relief system is meeting the needs of the population, and therefore the overall impact of relief response.

Advantages of using SMART

SMART ensures that consistent and reliable survey data is collected and analyzed using a single standardized methodology. It provides technical capacity for decision-making and reporting, and comprehensive support for strategic and sustained capacity building. Key SMART Innovations
SMART ensures that consistent and reliable survey data is collected and analyzed using a single standardized methodology. It provides technical capacity for decision-making and reporting, and comprehensive support for strategic and sustained capacity building.
Key SMART Innovations

• • Plausibility Check to verify data quality and flag problems.
• • User-friendly software ENA and manuals that are easy to use even for non-epidemiologists.
• • Flexibility in sample size calculation and cluster sizes, with standardized survey protocols with the use of replacement clusters, household selection techniques, and best field practices (e.g. for absent children or empty households).
• • Rigorous standardization test procedures and analysis.
• • Regularly updated, clear sampling guidance based on field experiences, research and best practices.
• • Improved census procedure for mortality assessments..

The widely used combination of SMART and ENA has improved data quality review and assurance in larger surveys (e.g. Multiple-Indicator Cluster Surveys- MICS and Demographic Household Surveys- DHS) and has also been incorporated into many national nutrition protocols.
The main objectives and contexts in which Rapid SMART surveys are carried out are detailed above. The validity of Rapid SMART surveys is confirmed only after the representativeness, accuracy and precision of the results are evaluated. Assessment should only occur in a clearly delimited zone (e.g. group of villages, IDP/Refugee camps or settlements, urban slums and neighborhoods) whose population has similar patterns (affected by the crisis, having equal access to services, having similar culture, same livelihood zone etc.). For the sake of accurate and precise under-nutrition3 prevalence estimation, a full multi-cluster nutrition survey is recommended as soon as the situation gets stable and the population is accessible. If it is judged that other information such as food security, Infant and Young Child Feeding (IYCF) and care practices as well as WASH situation are more necessary in a given emergency, then other adapted studies have to be prioritized over Rapid SMART surveys.