No abstract

Background Large international humanitarian actors support and directly deliver health services for millions of people in crises annually, and wield considerable power to decide which health services to provide, how and to whom, across a vast spectrum of health areas. Despite decades of reform aiming to improve accountability in the sector, public health practice among humanitarian actors is not heavily scrutinized in either the countries where they are headquartered or those where they provide healthcare. We surveyed current healthcare governance practice among large international humanitarian actors to better understand what organisations are doing to ensure oversight and accountability for health services in humanitarian responses. Methods The term ‘healthcare governance’ was defined and categorised into seven domains: implementation of health management information systems (HMIS) and use of resulting data; professional development of health sector staff; audits of health service performance; management of clinical incidents; evidence-based practice; pharmaceutical supply; and beneficiary engagement. Senior health professionals at 32 leading international actors providing humanitarian health services were contacted between July and August 2019 to complete a 109-question online survey about their organisation’s practice in these domains. Results Respondents from 13 organisations completed the questionnaire. Healthcare governance practices were undertaken to varying degrees by all organisations but were often driven by donor requirements and external factors rather than improvement of programme performance. Common strengths were the inclusion of governance in organisational policies, high availability of technical guidelines, and close monitoring of pharmaceutical services. Recurring weaknesses were poor beneficiary engagement, inconsistent use of health information for decision making, unsystematic implementation of healthcare audits, inconsistent management of clinical incidents, and lack of training and professional development opportunities. Conclusions To our knowledge, this is the first study to describe healthcare governance practice among humanitarian actors. Leading international humanitarian healthcare providers are already implementing many healthcare governance activities; however, these are inconsistently applied and generally not reflective of systematic policies or earmarked organisational resources. There is a need for sector-wide consensus on how the humanitarian sector defines healthcare governance, the domains that constitute it, which actors in the humanitarian system are implicated, and how malpractice should be systematically addressed.

This paper presents findings from a literature review of methods that explicitly assess the appropriateness of a humanitarian response. We set out to highlight the key features and limitations of each method and introduce a definition and conceptual framework for the measurement and interpretation of the appropriateness of humanitarian responses. This review is part of a broader project to enhance the accountability of humanitarian responses through developing auditing approaches for real-time monitoring. We identified eight methods that explicitly analyse the appropriateness of a humanitarian response. The review revealed that existing methods vary considerably in their definitions of 'appropriateness', provide insufficient guidance on measurement, are vulnerable to interpretive bias and frequently report findings on 'appropriateness' in an ambiguous manner. These findings suggest that, as a matter of accountability, more structured and systematic approaches to measuring the appropriateness of humanitarian response are needed. We propose a definition and conceptual framework for the measurement and interpretation of the appropriateness of humanitarian response that seeks to address the limitations identified in the review. We provide a brief overview of the main components and features of a systematic approach and audit tool for assessing the 'appropriateness' of a humanitarian response. The use of this and other systematic approaches is essential for enhancing governance and accountability in humanitarian responses.

Background Since December 2018, the latest wave of anti-government protests in Sudan has led to deaths, injuries and detentions. We estimated the number of people killed and described patterns of deaths, injuries and detentions up to 9 April 2019. Methods We tabulated data from three publicly available lists maintained by Sudanese civil society sources (the Independent Movement, the Sudan Doctors’ Union and the “Lest We Forget” project), and applied to these a capture-recapture statistical technique that models the overlap among lists to estimate the number of deaths not on any list. Results We estimated that about 117 civilians were killed in demonstrations during the above period, a considerably larger number than hitherto reported. Most decedents and injury victims were shot. Conclusions This analysis demonstrates the importance of real-time data on political violence collected by civil society initiatives. The de facto Sudanese government should immediately cease attacks against peaceful civilian protesters and put in place guarantees for their safety. Electronic supplementary material The online version of this article (10.1186/s13031-019-0199-8) contains supplementary material, which is available to authorized users.