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5 Results for Contextual Factors

5.2 Accountability to end-users

5.2.3 Recommendations for future research


  • Accountability to end-users has become a core value in the humanitarian sector but represents an area relatively devoid of high quality evidence and needs more research.
  • High quality comparative studies are needed to inform how accountability influences health interventions and outcomes, in particular comparing health interventions of varying levels of accountability, and comparing different mechanisms of healthcare accountability (e.g. international vs. purely local or domestic accountability mechanism).
  • More evidence is needed on (i) the role and methods of informed consent of end-users in crisis settings, (ii) the perception of end-users regarding humanitarian healthcare delivery, (iii) the asymmetry of power between end- users and humanitarian agencies on public health interventions, (iv) the role and methods of behavioural change of end-users in improving the impact of humanitarian healthcare delivery, and (v) mechanisms and policies which safeguard or improve accountability to end-users during humanitarian crises.


  • Current evidence on this contextual factor focuses primarily on descriptions of the different aspects of accountability to end users in healthcare provision during crises such as availability, acceptability, quality, but does not assess the influence of accountability on public health interventions.


  • In order to facilitate the generation of more relevant evidence, research into the development of standardised methods or indicators to measure the different aspects of accountability in health interventions would be most useful.
View Publication View Executive Summary View Executive Summary - French HHER 2021 Update

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