Justified Commitments? Considering Resource Allocation and Fairness in Médecins Sans Frontières‐holland

Abstract

Non-governmental aid programs are an important source of health care for many people in the developing world. Despite the central role non-governmental organizations (NGOs) play in the delivery of these vital services, for the most part they either lack formal systems of accountability to their recipients altogether, or have only very weak requirements in this regard. This is because most NGOs are both self-mandating and self-regulating. What is needed in terms of accountability is some means by which all the relevant stakeholders can have their interests represented and considered. An ideally accountable decision-making process for NGOs should identify acceptable justifications and rule out unacceptable ones. Thus, the point of this paper is to evaluate three prominent types of justification given for decisions taken at the Dutch headquarters of Médecins sans Frontières. They are: population health justifications, mandate-based justifications and advocacy-based justifications. The central question at issue is whether these justifications are sufficiently robust to answer the concerns and objections that various stakeholders may have. I am particularly concerned with the legitimacy these justifications have in the eyes of project beneficiaries. I argue that special responsibilities to certain communities can arise out of long-term engagement with them, but that this type of priority needs to be constrained such that it does not exclude other potential beneficiaries to an undesirable extent. Finally, I suggest several new institutional mechanisms that would enhance the overall equity of decisions and so would ultimately contribute to the legitimacy of the organization as a whole.

Establishing moral bearings: ethics and expatriate health care professionals in humanitarian work

“…For example, the presence of humanitarian agencies may inadvertently contribute to the perpetuation of conflict or aid may be coopted to promote the war aims of bellig erents (Horton, 2008). Other aspects of this analysis include the place of fundamental humanitarian principles in guiding organisational decisions during relief work (Leader, 1998), interactions between militaries and humanitarian organisations (Wheeler and Harmer, 2006), organisational approaches to resource allocation (Fuller, 2006;Hurst, Mezger and Mauron, 2009), the promotion of accountability (Humanitarian Accountability Partnership-International, 2007) and the influence of foreign policy objectives on relief work (Frangonikolopoulus, 2005). This discussion has led to a number of international initiatives designed to provide standards of best practice for humanitarian actors, evaluate outcomes, and increase the accountability of aid organisations (Sphere Project, 2004;Humanitarian Accountability Partnership-International, 2007).…”

Ethical considerations for closing humanitarian projects: a scoping review

“…Although there has been a discussion of ethical issues related to closing humanitarian projects (Fuller 2006;Hunt and Miao 2018;Hurst et al 2009;Rubenstein 2015), there has yet to be a comprehensive review focusing on ethics and humanitarian project closure. We therefore conducted a scoping review to identify how academic and gray literature sources discuss ethical considerations in relation to the closure of humanitarian projects.…”

'Playing God Because you Have to': Health Professionals' Narratives of Rationing Care in Humanitarian and Development Work

“…Priority setting is especially consequential where medicines, equipment, health services and health professionals are scarce, as they often are in the global south (Wikler, 2003). Non-governmental aid organizations are significant players in health care provision in many low-income countries (Fuller, 2006) and fair allocation in humanitarian medicine raises ethical difficulties distinct from those encountered in other health care contexts (Hurst et al, 2009). Scholarly attention to the principles and practices of resource allocation in such organizations is however relatively rare.…”

“…Focusing on Médecins Sans Frontières (MSF) Holland, Fuller (2006) evaluated justifications for decisions to open, close, or substantially revamp a project (Fuller, 2006). Michael and Zwi (2002), exploring the ethical challenges that arose for the International Committee of the Red Cross (ICRC), discuss whether relief activities can legitimately focus on a narrow range of needs or a single component of health care.…”