Integrating severity and diagnosis in needs assessment: A participatory framework

Needs assessment is widely acknowledged as a cornerstone of program planning, yet it is often treated as a compartmentalized, pre-evaluative exercise. In complex and inequitable contexts, this fragmentation can undermine the development of grounded program theory.

This article proposes an integrated, beneficiary-centered framework for needs assessment that specifically combines severity documentation and causal diagnosis into a single participatory inquiry that directly informs program theory development.

Building on Davidson's (2005) three-phase model, we developed a five-step framework comprising: (1) orientation and stakeholder engagement; (2) integrated severity-diagnosis inquiry; (3) participatory data analysis and prioritization; (4) co-development of program theory; and (5) validation and advocacy with wider stakeholders.

We found the application of the framework useful in simultaneously generating evidence of the severity of need (widespread, high-intensity care burdens) and causal mechanisms (structural, spatial, and gendered drivers). This culminated in a collaboratively developed program theory linking multi-sectoral strategies to desired outcomes.

The framework reduces disunity across need assessment phases, strengthens alignment between evidence and program theory, and creates stronger pathways for stakeholder engagement and program design. It offers evaluators a practical approach for integrating beneficiary perspectives and systemic diagnosis into theory-driven program design.