Module 13. Field logistics

Managing supplies and specimens in the field

Field team supervision and monitoring

Coordination and communication in the field

Arranging for travel and accommodation

Data management in the field

Cold chain management and quality control

Shipping specimens

Managing supplies and specimens in the field

Managing the large quantities of supplies and specimens in the field requires rigorous record keeping, tracking, and monitoring at every level. Data collection forms for these management tasks are described in Module 11: Data collection tools, field manual, and database.

Distribution of items to field teams

After training and pilot testing, and immediately prior to departure to the field, all supplies and equipment for the main survey should be assembled and issued to teams. Depending on the field plan and scheduled meetings with regional coordinators, teams should receive the equipment that will be used throughout the survey and enough supplies for the first three to five clusters. The remaining supplies and spare equipment should be split among the regional coordinators, who will need to store them securely for later distribution. This approach reduces the risk of loss or theft during fieldwork, and it also uses less space in the already-crowded survey vehicles. A schedule needs to be drawn up for providing supplies to the field teams and for collecting specimens and survey-generated waste.

As described in Module 9: Survey equipment and supplies,extra equipment and supplies should be purchased in case items get lost, broken, or stolen. These additional items need to be managed in such a way to allow quick dissemination to teams as required. Each team should carry spares of things such as batteries, mobile devices, stationery and plastic bags. Team leaders should also have cash to buy some of these items in the field if needed and available. It is not uncommon for vehicles to break down or become damaged during fieldwork, and a backup plan should be in place in case this happens.

Daily list of supplies and equipment

Every team member should have a checklist of the type and quantity of supplies and equipment required for their daily fieldwork. The checklist should be reviewed in the evening to account for all supplies used, to estimate additional supply needs for the following day, to check that all equipment is present and functioning and that devices are fully charged, as applicable.

An example of a Daily supply list per team can be found in the online tools.

Every evening, the laboratory technician should review the supply stocks and the list of expected supply needs, and make sure that there are sufficient supplies for several days of fieldwork. When there are only about five days’ worth of supplies left, the technician should contact the Regional supervisor to coordinate another delivery. Supply stock-outs could delay fieldwork, with related implications on costs and logistics.

The laboratory technician should also work with the Team leader to ensure that there is sufficient freezer space for the expected number of new specimens, that there are enough frozen gel packs for the next day’s work, and that transport to the central laboratory is scheduled as needed.

Equipment maintenance and transportation during fieldwork

All equipment must be carefully maintained during fieldwork. One team member should be designated to check the working condition of all equipment at the end of each day and to report any concerns to the Team leader. Field equipment items (such as scales and portable photometers) should be stored in their carrying cases when not in use to help protect them from dust and humidity. Special care must be taken to protect equipment from excessive movement during transportation in vehicles. Funds may be set aside in the budget to hire help to transport items when necessary.

Transfer of specimens in the field

Any specimens that need to be transferred must be logged and accounted for at every point of transfer. This includes transfers from the household to the field laboratory, from the field laboratory to the regional laboratory, from the regional laboratory to the central laboratory and, when indicated, from the central laboratory to an international laboratory. The Cluster log form should have spaces to mark when samples have arrived at the next stage of transfer, and the same checks should be used at each transfer point between the cluster and the regional and central laboratories (as appropriate), with space to note the person responsible for the transfer at each stage.

All specimens should be accompanied by a Specimen tracking form that indicates the barcode. In some surveys there are two specimen tracking forms: a Specimen tracking form for the phlebotomist and a Specimen tracking form for the laboratory technician. The barcode contains the unique ID for the specimen that includes a code for the household and cluster number. The total number and type of biological specimens and food samples collected from each household within a cluster should be recorded on the Cluster control form, and then summarized on the Cluster summary sheet for each cluster. These three types of forms are explained in Box 13.1.

Box 13.1 Forms for specimen transfer

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Specimen tracking form The specimen tracking form is used to provide detailed information on the number of aliquots that were generated from each biological specimen. It indicates where they are stored during transport, by cryovial box number and by a unique identifier such as the barcode. The specimen tracking form contains individual-level information, while the cluster log form contains summarized information. Depending on the design of the forms, they can be a single form.
Cluster log form The cluster log form may also be called a “transmittal form”. This is the document that records signatures and the number of biological specimens or food samples to ensure accountability and prevent specimen loss in transit.
Cluster summary sheet The cluster control form tracks the number of interviews, the number of biological specimens and the number of food samples that are collected by target population (or per household) per household. This information is consolidated in the cluster summary sheet.
Cluster summary sheet The cluster summary sheet tracks the number of interviews, the number of biological specimens and the number of food samples that are collected by target population (or per household) per cluster.

When specimens are received at the field laboratory, they should be checked against the transmittal form (cluster log form) for matching barcodes. When they do not match, the Team leader should work with the individuals who did the collection or processing to find and correct errors. Any remaining discrepancies between the transfer form and the specimens should be noted on the cluster summary sheet and explained.

Field team supervision and monitoring

The Team leader provides overall quality control for the team by monitoring the performance of each member and ensuring that he or she is doing the job according to protocol and within expected timelines. The Team leader guides the team members respectfully and helps solve problems when they are not performing adequately. Roles for team members are clearly defined in their terms of reference, performance standards are set by the Survey coordinator, and expectations should be clearly communicated during training. The Cluster control form can be used to monitor the tasks of each individual (such as the number of interviews completed or blood draws conducted) and can help the Team leader assess and monitor individual and team progress.

As described in Module 8, Survey supervision and personnel, supervision should take place at multiple levels. Field visits by major stakeholders should be encouraged. They can help motivate teams to maintain a high quality of data collection despite potentially challenging conditions, and reinforce the importance of their work. These visits should be made mainly by people who participated in developing the survey protocol or in the training. Members of the Technical committee are likely to be able to detect and resolve any issues with survey implementation. Anyone making survey site visits should give feedback to the Survey coordinator. Where issues are identified, the Survey coordinator can then ensure that all teams are aware of the issues and that uniform corrections can be made as needed. The following paragraphs describe specific tasks for supervising and monitoring interviewers, phlebotomists and field laboratory technicians.

Supervising and monitoring interviewers

Supervising and monitoring interviewers require a number of tasks: observing each interviewer regularly, re-conducting interviews with participants when needed and reviewing the quality of all data collected. These actions are critical throughout the training, the pilot test, the beginning of the survey implementation, and during data collection. In the beginning of the data collection period, interviewers are still learning how best to collect data and conduct their interviews, and may need extra support to ensure a high level of quality. At the end of the survey, data quality risks decreasing due to fatigue.

When observing interviews, the Team leader should sit close to the interviewer without disturbing the participant. The Team leader needs to assess whether the interviewer is interpreting the responses correctly, recording the correct responses, following skip patterns and following the recommended rules of conduct. The interview should not be interrupted unless there is a serious mistake or a problem with the equipment. Feedback, both positive and negative, should be provided to the interviewer in private, away from the interview setting and after the interview is over.

Spot-checks are useful to ensure that interviewers actually interviewed all selected members in a household. Following up and re-interviewing appropriate household members by asking certain critical questions (such as the number of individuals in the household, dates of birth, and other questions that could falsely create skip patterns to make the interview time shorter) can help identify instances when interviewers are not interviewing a particular household member selected for interview. Reasons for this error could include accidentally interviewing the wrong household member, entering the wrong age for a household member (thus making that individual ineligible for interview) or making other data entry errors. Re-interviews should be done in approximately 10% of households. If possible, the re-interview should be conducted on the same day or at least while working in the same cluster to ensure that the household members and any visitors to the house are still present. If omissions are found, the Team leader should discuss the mistake with the interviewer, who should then return to conduct interviews with any respondents missed. Errors made by an interviewer should be followed by a verbal or written warning, and the case should be documented and reported up the line of command. In order to prevent additional errors, the Team leader should observe the interviewer more frequently. In cases where the interviewer repeats errors, the Team leader should discuss the situation again with the interviewer and may decide that the errors are grounds for dismissal.

If using paper-based surveys, every questionnaire must be thoroughly checked in the field prior to leaving the community so that any errors can be corrected. This is a long process and may require that a data editor be included in each field team. Small errors can cause significant problems during analysis.

Editing paper questionnaires in the field must be done with a pen of a different colour than was used by the interviewer. Missing responses, unreadable responses, and inconsistent or incorrect responses should not be corrected by the editor. Instead, using the different colour, a question mark should be put next to the item concerned. The page number or question number should be written on the front or back of the questionnaire for ease of finding the problem. The error should be discussed with the interviewer, and feedback (both positive and negative) provided. Each error should be brought to the attention of the Team leader, who will decide how to proceed. It may be that the interviewer can make a correction immediately without contacting the respondent, otherwise, the interviewer needs to return to the household to obtain the correct data. Errors that come from multiple interviewers need to be addressed by the whole team. The interviewer, field data editor or Team leader should never make up an answer.

Phlebotomists and field laboratory technicians

The Laboratory supervisor (or Team leader, if there is no Laboratory supervisor) needs to observe the performance of all phlebotomists and laboratory technicians to ensure that they are following the protocol and standard operating procedures. The most critical times to observe phlebotomy and to provide quality control on specific tasks is during the training and the pilot test, as well as at the beginning of implementation. These tasks, known as quality control points, include labelling correctly, taking appropriate time to draw blood, demonstrating the ability to collect blood, collecting the correct amount of blood, properly maintaining the cold chain, and storing and transporting blood and other specimens correctly. If the number of specimens is not consistent with the number of household members who were eligible for specimen collection, the reasons for the inconsistencies need to be verified.

Accidental errors should be corrected. Purposeful errors are more difficult to identify, but if the same phlebotomist has a higher frequency of problems with specimen collection or field readings, it could indicate a problem with their performance. Spot-checking and observing work in the field are the best ways to detect mistakes.

Coordination and communication in the field

Communication is used to share field experiences, give feedback to teams, obtain permissions at different levels and mobilize communities. Regular communication is essential, within field teams and between the field teams and the Regional supervisors and Survey coordinator. Before fieldwork starts, a communication plan should be established for routine coordination and for emergencies. The rules should specify who should communicate with whom and on which topics. A reliable means of communication, usually mobile phones, should be provided. SIM cards for multiple networks may be needed where coverage is known to be irregular. The rules will vary by survey and by the national context related to expected network coverage and ease of communication.

Box 13.2 describes examples of routine communication.

Box 13.2. Examples of routine communication

Routine communication between Team leaders and Regional supervisors usually concerns:

  • managing timely payments to team members;
  • managing transport of supplies and equipment to the field as well as transport of paper-based forms and specimens from the field;
  • providing a daily progress update, for example the cluster, number of households surveyed, and the number and type of specimens collected; and
  • raising questions about any issues experienced.

The Regional supervisor manages the information received in accordance with his or her role and provides an overall update on a regular basis to the Survey coordinator.

Routine communication between the Team leader and team members usually includes verifying progress and safety, including alerts from team members when:

  • they are moving to another location
  • difficulties arise, such as problems in locating a household or in using equipment.

In general, phones should not be answered during an interview, as this disrupts the flow of the conversation. It is recommended that communication from Team leaders be done by text messaging, requesting a call back when the interview is finished.

Sharing field experiences through messaging and chats

Communication between teams is also essential, and can help teams troubleshoot common problems that arise. Fieldwork experiences can be shared with the entire survey field team in real time using a forum set up on a mobile messaging or chat application. All field team members can be encouraged to share their observations, challenges, and questions. Feedback can then be provided by all members of the technical team and by other field teams, with summary recommendations and clarification from the supervisors or coordinators. Applications can be used to set up various forums that are specific to each field team, to different roles within a team (such as interviewers or laboratory personnel), and for different levels of survey management.

Feedback to teams

Regional supervisors and the Survey coordinator should provide frequent, helpful feedback to teams. Feedback should always be constructive, even when discussing challenges or improvements that need to be made. Feedback to a specific team member should be done directly in person or over the phone, and not in a public forum.

Permission at national, regional, and district levels

Official permissions to conduct a micronutrient survey should be obtained at national, regional, and district levels by the appropriate members of the Steering committee and the Technical committee. This approval should first come through any specific institutional review board or ethical clearing committee in the country, as discussed in Module 1: Planning and designing a micronutrient survey. The Principal investigator or Chair of the Steering committee should be responsible for officially informing various levels of government about the survey objectives and the implementation plan, and for obtaining approvals from all levels. In administrative areas where the fieldwork will take place, letters of support from the ministry of health should also be obtained to facilitate fieldwork.

Permission at cluster and household levels

Prior to entering a community, and where mapping and household listing are being conducted in advance, the listing team should seek permission from local officials to conduct the survey. The appropriate local community leader should be provided with a letter of support from the district-level health office, with any accompanying letters from other administrative level.

The listing team should also meet with other community leaders to brief them, with clarity and sensitivity, on the aims and objectives of the survey and on the types of information the survey team will collect. These leaders may include local elders, health administrators and personnel from the office of statistics, as well as field focal points including, in some cases, members of households selected for interview. Their understanding and collaboration are crucial for access to households and to maximize consent, especially for the collection of biological specimens. Each interviewer and phlebotomist needs to be courteous and tactful when entering a household. In many settings, team members need an official letter, or a badge and identification from the government to justify the data collection.

The listing team should record contact information for all local leaders. This will allow the survey field team to call in advance to inform the community when they will be arriving and to finalize any necessary local logistical arrangements. This information will also be important in case of any emergency.

Before starting fieldwork, the Team leader should visit local health facilities to discuss the referral process agreed previously with the ministry of health. In this way, preparations can be made to manage referrals as needed.

Mobilizing communities

Team leaders should have a list or map of survey households that, if possible, includes the names of the head of household (see the household listing form template). Team leaders should contact the identified local leaders and health facilities at least one week ahead of the fieldwork to share the plans and to request their presence and assistance. The visit should be confirmed, or amendments made, two days before the expected date. This process also provides the Team leader with advance notice of any community events that might affect data collection, for example, a market day or a wedding, and allows local leaders to plan for the team’s arrival. Local leaders may be requested to alert the selected households about the field team’s arrival and the objectives of the data collection exercise. If the listing includes a phone number for the household head, Team leaders can also call respondents directly to arrange interviews. The first visit of a data collection team into a community is best when accompanied by a local community leader.

Arranging for transport and accommodation

In consultation and coordination with the Regional supervisor, each Team leader is responsible for making travel arrangements for his or her team. This includes ensuring that every vehicle is maintained by the driver, is safe, provides adequate transportation to the work site and is used only for survey purposes.

The Team leader is also responsible for arranging accommodations in a secure location near the survey clusters. Ideally, the accommodations should also provide a central location for team meetings, equipment storage and equipment charging. Logistics are simplified if the lodging can be near the field laboratory processing facility.

Transport and accommodation plans should be shared with the Survey coordinator or administrative assistant, in accordance with the survey communication protocol.

Data management in the field

Electronic data

The Team leader is responsible for managing data collected in the field. Electronic data should be backed up to protect records from accidental loss. Data entry should be set up so that interviewer data are backed up on the device on which they were entered, and uploaded onto the Team leader’s device at the end of each day. Where possible, data should also be uploaded to the server. USB sticks with adapters to fit the device, as needed, can also be used to back up data. This may be an important option in areas where it is not possible to upload data to the server for several days.

All teams should have a global positioning system (GPS) to assist them in finding selected clusters and households. Most mobile phones and tablets come with these systems installed, and they should be used whenever possible to verify the location of data collection and allow for cross-checks with the team number and number of data files received.

Paper-based data collection forms and other records

The most important paper-based forms collected in the field (for example, cluster control forms, specimen tracking forms and questionnaires) should be tracked as they move from the household to the cluster to the region and then to the central data entry point. Where electronic devices are being used for the main questionnaire, any paper-based forms should be photographed and the image uploaded along with the completed questionnaires from the cluster. All forms should be stored securely, using methods to protect confidentiality during fieldwork, while in transit, and at the final data entry point.

Where paper-based data collection is used, there should be a central data entry system to track the data on all types of forms. Typically, information from the cluster control form, which includes the total number and types of specimens collected, is entered by the same personnel who enter the questionnaire data.

Detailed specimen tracking data are typically entered by the central laboratory. Where barcode labels are used, a hand-held barcode reader should be used at the laboratory to record incoming specimens onto a spreadsheet and compare specimens received with the specimen tracking form. The Survey coordinator should be made aware of any inconsistencies. This spreadsheet should be shared with the relevant laboratories for later entry of analysis results.

Labeling

The unique ID should accompany participants throughout the data collection process. For paper-based data collection, a label should be placed on the household and individual questionnaire forms at the time of interview. For electronic data collection, a code is scanned or entered by hand into an electronic collection device. At the time of any sample or specimen collection, a corresponding label should be placed on the food sample or biological specimen and on the specimen control forms, and this number should be checked against the label on the household or individual form. These label codes can be scanned into an electronic device to ensure that they match the ID of the household or survey participant. If there is a discrepancy between a scanned ID (for example it does not match to any household or individual) then the data collection system will generate a warning and block further data entry until the ID does match a household or individual. It is imperative for the quality and reliability of survey results that each team member responsible for handling the labels reads them very carefully so that they are not mixed up or used interchangeably.

Procedures should be in place to ensure that barcode data and linkages are checked and corrected where necessary before leaving any cluster. The unique ID can be scanned by the electronic device used in the field (note that this may require downloading an easy-to-use scanner onto all devices, which is then linked to open at the appropriate point in the data collection modules). For paper-based data collection, the label barcode for questionnaire data (double) entry and for recording sample analysis results at the laboratory can be entered manually. However, barcode scanners that plug into a computer and can insert a scanned code into, for example, a selected database entry field or cell on an electronic spreadsheet are not costly, and these are the recommended option.

Cold chain management and quality control

It is essential to monitor the temperature of cool boxes and freezers and oversee custody of the biological specimens. If specimens are stored at the wrong temperature, even for a short period of time, they may no longer be usable and all the work to collect them could be wasted.

Cold chain management and quality control during specimen transportation and storage ensure that specimens are kept within the correct temperature range. All survey team members must be aware of the planned cold chain logistics, so that they can work together to ensure that the cold chain is properly maintained at all times. The Overview of cold chain logistics online tool provides an example of a good cold chain management system. The example is from a survey that had a comprehensive list of indicators and related biological specimen types (blood, urine and stool) that needed to be kept at temperatures varying from −20°C to approximately 8°C, in field conditions where electricity was not regularly available.

Shipping specimens

In many surveys, selected analyses will take place outside the country. Prior to shipping, specimens need to be properly prepared, which includes labelling and using a reliable system and carrier that will guarantee that the cold chain is maintained. In most cases, dry ice is used to keep specimens frozen. Sometimes obtaining dry ice can be complex and it is important to consider the source well in advance.

More information on instructions for packing specimens, as well as guidelines for labelling and shipping, can be found in the Guidelines for shipping specimens, Labels and markings required for proper shipment, Packaging/shipping specimens using cold packs instructions, and Packaging/shipping specimens using dry ice instructions online tools.