Noncommunicable disease STEPs survey of Ethiopia: challenges and adaptive strategies

Progress in public health requires focused policy attention informed by reliable evidence; hence survey is essential to guide improvements in health systems and develop new initiatives. However, there is little published evidence that guides health surveyors who have difficulties while conducting surveys in geographically and culturally diversified populations. This paper aims to describe the implementation of Ethiopia's 2015 Noncommunicable Disease (NCD) steps survey and highlight the overall operation of the survey to elucidate best practices and guide surveyors who conduct related studies in other settings.

 Field experiences and notes from debriefing sessions with senior surveyers leading the survey were systematically reviewed and interpreted. The discussion was approached by asking about the survey ‘How operated?’, ‘What went well?’, ‘What did not go well?’, ‘What alternative strategies were devised to solve the challenges?’ and ‘How might this be done differently in the future?’ Considering these questions, we have explored the best field experiences from experienced surveyers, recognizing that it is never too late to learn to replicate best field practices.

The study was the first nationally representative community-based survey for non-communicable diseases. As planned, assessment results were published in national reports and summarized factsheets informing the magnitude of specific risk factors to establish baseline evidence for the planning and monitoring of policies and programs on NCD. The implementation of the survey faced methodological matters, geographic and logistical constraints, field operation challenges, and other technical concerns. No matter the extent of the challenges that arise during fieldwork, creating adaptive strategies on a timely basis will enable us to overcome them.

Though executing the NCD steps survey was hampered by several factors, the assessment was successful in achieving the intended objectives by addressing more than 96% of the expected households in general. Though field challenges are common in surveys, responding timely to fieldwork challenges with locally relevant solutions is essential.