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5 Results for Contextual Factors

5.2 Accountability to end-users

5.2.1 Accountability to end-users

  • The search strategy on this contextual factor captured a large number of related peer-reviewed articles (3876), the vast majority of which (3846) either did not discuss humanitarian crises or did not consider the impact of accountability to end-users on a public health intervention during crisis.
  • There is little available evidence assessing the impact of accountability to end-users on the effectiveness of health interventions during humanitarian crises (30 papers).
  • There is increasing interest in the characterisation of the impact of accountability to end-users on healthcare interventions during humanitarian crises, with 26/30 (87%) of all studies conducted since 1980 being published in the last decade.
  • The majority of available evidence is of low to moderate quality: 12/30 (40%) of papers were from category C evidence; 7/30 (23%) were from category B; and 11/30 (37%) were from category A.
  • All studies were observational. Half of the studies were descriptive in design and none of these were comparative. The other half of the studies were cross-sectional; of these, 6/15 (40%) compared changes over a period of time during a humanitarian crisis.
  • Of the location-identified research on accountability to end-users during humanitarian crises, the most commonly studied region was Asia (10/30, 33%) with Afghanistan and Pakistan being most studied here (three papers each), followed by Africa (6/30, 20%). A further 12/30 (40%) papers considered multiple (more than two) different countries across regions.
  • Evidence for the different types of humanitarian crises focused primarily on armed conflict: 13/30 (43%) considered these; 10/30 (33%) considered both armed conflict and natural disasters; and 7/30 (23%) considered only natural disasters, in particular floods (3) and tsunamis (2).
  • Most papers (20/30, 66%) focused on the general population, 6/30 (20%) considered IDPs only, 3/30 (10%) papers considered refugee populations only, and one paper compared IDPs and refugees.
  • Most papers (17/30, 57%) considered both urban and rural settings, 12/30 (40%) considered only the rural setting, and one paper considered only the urban environment.
  • Of all the available evidence, only 2/30 (7%) studies considered all three aspects of healthcare accountability to end-users, namely its acceptability, availability and quality. 15/30 (50%) of studies considered acceptability; of these four considered one other aspect in addition. 12/30 (40%) of articles considered quality of healthcare; of these six considered one other aspect in addition. 9/30 (30%) of studies considered availability; of these, six considered one other aspect in addition.
  • Regarding the types of public health interventions, 21/30 (70%) articles studied accountability of international medical assistance agencies; of these, 7/30 (23%) considered how they interacted with local existing health services, and 3/30 (10%) others concerned the organisation Médecins San Frontières (MSF) specifically. 6/30 (20%) further articles considered accountability to end-users of existing health services only.
  • Basic, general and primary healthcare services together formed the public healthcare area most studied regarding accountability to end-users (19/30, 63%). 5/30 (17%) papers considered the health topic of communicable diseases, including TB (2 papers), malaria (1), HIV/AIDS (1), and cholera (1). 3/30 (10%) papers considered obstetric services.
  • Concerning the stage of crisis, 4/30 (13%) studies focused on the acute phase, 4/30 (13%) on early recovery, and the vast majority (22/30, 73%) on chronic situations.


View Publication View Executive Summary View Executive Summary - French HHER 2021 Update

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