Tan Y S Andrew, von Schreeb Johan
1Yong Loo Lin School of Medicine,National University of Singapore,Singapore.
2Centre for Research on Health Care in Disasters,Health Systems and Policy,Department of Public Health Sciences,Karolinska Institutet,Stockholm,Sweden.
Prehosp Disaster Med. 2015 Jun;30(3):264-70. doi: 10.1017/S1049023X15000254. Epub 2015 Mar 18.
In the past two decades, there has been a worldwide increase in the number of disasters, as well as the number of people affected, along with the number of foreign medical teams (FMTs) deployed to provide assistance. However, in the wake of the 2010 Haiti earthquake, multiple reports and anecdotes questioned the actual, positive contribution of such FMTs and even the intentions behind these aid efforts. This brought on a renewed interest in the humanitarian community towards accountability. Between 2000 and 2012, the number of "Quality and Accountability" initiatives and instruments more than tripled from 42 to 147. Yet, to date, there is no single accepted definition of accountability in the humanitarian context.
The aim of this report was to explore and assess how accountability in the humanitarian context is used and/or defined in the literature.
The electronic database PubMed and a predefined list of grey literature comprising 46 organizations were searched for articles that discussed or provided a definition of accountability in the humanitarian context. The definitions found in these articles were analyzed qualitatively using a framework analysis method based on principles of grounded theory as well as using a summative content analysis method.
A total of 85 articles were reviewed in-depth. Fifteen organizations had formal definitions of accountability or explained what it meant to them. Accountability was generally seen in two paradigms: as a "process" or as a "goal." A total of 16 different concepts were identified amongst the definitions. Accountability to aid recipients had four main themes: empowering aid recipients, being in an optimal position to do the greatest good, meeting expectations, and being liable. The concepts of "enforcement/enforceability" under the last theme of "being liable" received the least mention.
The concept of accountability is defined poorly in many humanitarian organizations. Humanitarian providers often refer to different concepts when talking about accountability in general. The lack of a common understanding is contributed by the semantic and practical complexities of the term. The lack of emphasis on "enforcement/enforceability" is noteworthy. Other aspects of accountability, such as its "measurability" and by whom, similarly lack a common understanding and community-wide consensus. To what extent these vague definitions of accountability affect agencies' work in the field remains to be documented.
在过去二十年中,全球范围内灾害数量、受灾人数以及部署提供援助的外国医疗队数量均有所增加。然而,在2010年海地地震之后,多份报告和轶事对这些外国医疗队的实际积极贡献乃至这些援助行动背后的意图提出了质疑。这引发了人道主义界对问责制的新关注。2000年至2012年间,“质量与问责制”倡议和工具的数量从42项增至147项,增长了两倍多。然而,迄今为止,在人道主义背景下尚无一个被广泛接受的问责制定义。
本报告旨在探讨和评估人道主义背景下的问责制在文献中是如何被使用和/或定义的。
在电子数据库PubMed以及一份由46个组织构成的预定义灰色文献列表中搜索讨论或提供人道主义背景下问责制定义的文章。使用基于扎根理论原则的框架分析方法以及总结性内容分析方法对这些文章中找到的定义进行定性分析。
共深入审查了85篇文章。15个组织对问责制有正式定义或解释了其对自身的意义。问责制通常在两种范式中被看待:作为一个“过程”或作为一个“目标”。在这些定义中总共识别出16个不同概念。对援助接受者的问责有四个主要主题:赋予援助接受者权力、处于能带来最大益处的最佳位置、满足期望以及承担责任。在“承担责任”这一最后主题下的“执行/可执行性”概念提及最少。
许多人道主义组织对问责制概念的定义不明确。人道主义援助提供者在总体谈论问责制时常常提及不同概念。该术语在语义和实践上的复杂性导致缺乏共同理解。对“执行/可执行性”缺乏强调值得注意。问责制的其他方面,如“可衡量性”以及由谁来衡量,同样缺乏共同理解和全行业共识。这些对问责制的模糊定义在多大程度上影响机构在实地的工作仍有待记录。