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Accountability: An MSF Perspective
The general drive for accountability of humanitarian organizations is necessary and timely. Aid organizations have to both ‘give account’ and ‘be answerable’ for the choices they make. However, there are different ways of approaching accountability and each organization has to find its own way based on its field of activity, mission and principles.
Since the early 1990s, the ‘humanitarian sector’ has embraced increasingly ambitious efforts to measure humanitarian assistance. There has been a significant increase in the number of initiatives trying to ensure degrees of accountability. These initiatives started by trying to define common principles of action (ie: The Red Cross Red Crescent Code of Conduct). They continued to focus on promoting evaluation (ALNAP) and standardizing methods for project planning (logical framework) and creating common standards (Sphere) and consistent methods for information gathering.
An important driver was the desire of governmental donor agencies to better account for their funds, and to bring order to a sector seen as largely unregulated (it effectively remains so). The drive for greater accountability was also shaped by a desire to exert greater governmental control over aid delivery to ensure that aid contributed to the greater goal of coherence in terms of humanitarian assistance to countries in need. This integrated approach requires that all sectors act in synergy to promote for example the peace-building priorities of the donor community in a given country. They consider humanitarianism more as a technical action rather than as a principles-based political challenge.
Being an aid organization firmly attached to principles such as impartiality and independence MSF has been cautious in approaching the accountability issue as framed in the humanitarian sector.
Being an aid organization firmly attached to principles such as impartiality and independence MSF has been cautious in approaching the accountability issue as framed in the humanitarian sector. There is a need for appropriate, innovative and adaptable tools to monitor and evaluate the effectiveness of aid deployed, to avoid the development of bureaucratic mechanisms that will not improve our standards or relevance.
The way we look at accountability in MSF, assessing the results of our action in order to improve our operations and the quality of medical assistance to patients, is our main objective.
For example, as an early protagonist of artesunate combination therapy to alleviate malaria and anti-retroviral therapy for people living with AIDS in resource-poor settings, MSF has developed careful program monitoring tools to be able to publish the results of these interventions in order to effect wider change. Subsequent advocacy efforts led to some national health priorities and protocols being modified after the release of this data, to the benefit of previously neglected patients.
MSF has increasingly sought to give a strong scientific base to its field work; through initiatives such as its epidemiology center, known as “Epicentre”, which carries out research and training in latest epidemiology practices. This initiative aims to increase the capacity to monitor and evaluate the effectiveness of interventions through mortality and morbidity surveys.
MSF’s approach to accountability is based on several principles. We consider that we are accountable for what we set out to achieve and the means that we use to do this. In that respect, our action is primarily to be assessed in terms of its relevance, meaning the extent to which our interventions reach and correspond to the actual needs of the most affected populations in a crisis, as well as to our scope and competence as a medical humanitarian organization.
Our action should also be assessed in terms of its effectiveness, meaning the extent to which our programs achieve expected results based on their objectives.
Thirdly, our action should be assessed on its efficiency, meaning the way in which inputs (human, material and financial resources) are used to achieve intended outputs.
Beyond these three key criteria, the intervention’s broader impact, meaning its effects, both direct and indirect, intended and unintended, should also be considered.
Our approach to accountability aims to be realistic, taking into consideration the fact that the often highly volatile and insecure contexts in which we work offer ‘only bad choices’.
We seek to recognize the diversity of constituencies, at local, national and international levels, that have a stake in our medical humanitarian work and aim to address their particular needs and interests.
Finally, we view our assessments as an ongoing learning process. Mistakes will continue to be made and failures will occur, due to the fact that humanitarian aid is a real-time response to acute needs in exceptional circumstances that require risk-taking, innovative approaches and difficult judgment calls.
In conclusion, accountability for MSF could be defined as a proactive process of deeper “engagement” with those who we define as our stakeholders, reporting the reasons for our choices, the results of our actions and the limits, challenges and dilemmas inherent in our work, based on our responsibilities as a medical and humanitarian organization in order to change and improve our response.
Accountability to beneficiaries is still in its infancy and it is the hardest to achieve. The example of Angola given here concerns the effectiveness and impact of MSF’s intervention during the massive 2006 cholera epidemic. The Angola report is part of a mutual accountability drive whereby critical reviews of interventions are conducted and debated within MSF.