Rethinking humanitarian accountability: Implementation of sexual and reproductive health services in two complex emergencies

Abstract

Background: The UN estimates that 51.2 million people were displaced by conflict at the end of 2013. These communities have a right to reproductive health (RH) care, which is a minimum standard for humanitarian health service delivery. Yet implementation of RH services in crises remains sporadic and effective accountability mechanisms to enable provision are weak.

Methodology: This qualitative study explored the implementation of RH care after the 2008 Myanmar cyclone and 2010 Haiti earthquake. It applied a constructivist grounded theory approach to case study data. Three iterative phases of data collection were undertaken. The first explored barriers and enablers to RH implementation and identified socialising accountability, which refers to informal, interpersonal norms and behaviours among interdependent actors, as a key enabler. A second phase examined in more detail the role of socialising accountability within the two case studies and identified accountability to personal ethics as an additional critical enabler. The third phase explored the findings with humanitarian experts to assess the potential value and practical application of socialising and personal accountabilities in advancing effective humanitarian action.

Methods: Semi-structured interviews were held with 98 humanitarian staff representing 47 organisations. 15 focus group discussions were conducted with 349 displaced persons, and 11 medical facilities were evaluated using inter-agency assessment tools. Participant selection was identified through chain-referral and purposive sampling. Data were analysed using NVivo 10.

Results: The lack of effective formal humanitarian accountability mechanisms undermined RH implementation in both case studies. Socialising and personal accountabilities in part compensated for these gaps and helped to strengthen accountability processes as well as facilitate RH service implementation. This study proposes an ecological approach to humanitarian accountability that reframes accountability as an interdependent, contextualised process and practice rather than a static system focused on measurement.

Conclusion: Socialising and personal accountabilities play critical roles in humanitarian action. Practical application of the ecological approach, which engages formal, socialising, and personal accountabilities, could help augment a culture of “intelligent” accountability and enable effective humanitarian response. This warrants further exploration.