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In 1997, the pursuit of greater accountability and effectiveness in humanitarian response prompted a multi-stakeholder collaboration to develop a set of indicators and standards to guide humanitarian practitioners, published later in the form of the Sphere Handbook. Twenty years after the first edition of the Handbook was developed, and in order to guide the 2018 revision, an assessment of the evidence base for current Water, Sanitation and Hygiene (WASH), Food Security and Nutrition, and Health Action indicators, as compared to evidence collated by the 2015 LSHTM Humanitarian Health Evidence Review (HHER), was conducted.

Of the 159 Sphere indicators intended to guide humanitarian response, only 2 met all of the SMART criteria. The remaining 157 did not provide any time indication for the measurement of the indicator. Furthermore, only 11 standards (23%) and 14 indicators (8%) are supported in part by 33 studies identified in the HHER. Less than one third of studies captured by HHER that explore interventions related to WASH, nutrition, or health could be linked to existing Sphere indicators.

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