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5 Results for Contextual Factors

5.2 Accountability to end-users

5.2.2 Expert Interviews

Key findings from the expert interviews were as follows:

PRIORITY GAPS IN THE AVAILABLE EVIDENCE ON ACCOUNTABILITY TO END-USERS WHICH NEED TO BE FILLED INCLUDE:

  • Role and methods of informed consent of end-users in crisis settings.
  • Perception of end-users regarding humanitarian healthcare delivery.
  • Validation of assumptions concerning end-users.
  • Nexus of human rights and humanitarian public health interventions.
  • Impact of the asymmetry of power between end-users and humanitarian agencies on public health interventions.
  • Quality of healthcare delivered to end-users in crisis.
  • Cost-benefit analyses of interventions and humanitarian health economics.
  • Role and methods of behavioural change of end-users in improving the impact of humanitarian healthcare delivery.
  • Ethical guidelines for humanitarian public health policy making.
  • Certain populations experiencing crisis, including adolescents, the disabled, the elderly, those with chronic disease, and the LGBT community.

ISSUES RELATED TO THE TYPE OF CRISIS AND ACCOUNTABILITY TO END-USERS:

  • Gathering evidence and the study of this contextual factor is difficult and has been limited in all types of crises largely due to a lack of consensus on appropriate measures of accountability and optimal endpoints.

TYPE OF STUDIES NEEDED:

  • Randomised and controlled trials would be an impractical, unfeasible and unethical means of seeking evidence on this contextual factor.
  • The greatest source of shared knowledge likely lies within the grey literature but the extent to which this can be used as scientific evidence is highly variable and its usefulness is seen to be dependent on the reputation of the agency producing it.
  • By nature, innovations aimed at systemic transformative change need to transcend evidence-based interventions and therefore the quest for evidence must itself be carefully directed.
  • The most useful contribution towards the progress of this contextual factor is likely to come from debate and consensus building around moral, philosophical and professional considerations rather than from scientific evidence.

USE OF GUIDELINES AND STANDARDS IN THE STUDY OR PROGRAMMATIC DEVELOPMENT OF ACCOUNTABILITY TO END-USERS:

  • The Sphere Project standards are the most widely used standards for this contextual factor.
  • Other guidelines and standards which are particularly useful include: (i) ALNAP guidelines, (ii) CDC guidelines, (iii) UNICEF guidelines, (iv) WHO guidelines, (v) International Crisis Group (ICG) reports, (vi) existing institutional guidelines, (vii) policy statements of agencies, and (viii) informal peer advice.
  • Other than the Institutional Review Board (IRB) process, there are very few standardised ethical guidelines in the field of humanitarian research and programmatic development.

There was excellent consensus on the perceived research gaps in this contextual factor among the humanitarian experts interviewed.

View Publication View Executive Summary View Executive Summary - French

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