A Proposed Framework for Improving the Quality of Humanitarian Response
Authors: Tom Kirsch and Paul Perrin
With the swelling number of displaced people and limited global funding, it is increasingly important to support the most efficient and highest quality humanitarian response programs. Measuring the quality and efficiency of a response has become essential. Currently responders are often more accountable to the donors than the affected population.
Traditionally, accountability measures in humanitarian have tended to focus on meeting output benchmarks (e.g. number of tents provided, or meals served), rather than demonstrating outcomes or impact. Evaluation should also focus on quality, impact (needs met), and learning. In a supply-driven industry such as disaster relief, quality must be actively pursued through standard quality assurance methodologies.
A Proposal for a Quality Framework
Quality assurance methods usually assess three components: Structure; Process; Outcomes that can define, analyze, and measure the quality of a response. Despite common practice, a single component in isolation cannot be taken as a surrogate measure for overall quality. Within this framework, ‘quality of response’ refers to the degree to which all these quality components are present.
STRUCTURE is the logistics of service provision, such as the adequacy of facilities, equipment and supplies; staff qualifications; administrative structure and operations; fiscal accountability, etc. Structure measures include:
- Service access – removing geographic, economic, social, organizational, linguistic barriers to services
- Professionalism – the trust, respect, confidentiality, and responsiveness established between responders and affected populations
- Physical infrastructure (‘amenities’) – where facilities or other forms of physical infrastructure are involved in response efforts, this includes a facility’s physical appearance, and the comfort and privacy afforded end users
- Managerial infrastructure – the experience and sufficiency of staff, communications and transportation infrastructure and other infrastructure
PROCESS involves interactions between affected populations and the humanitarian system or, the actual delivery and receipt of services. Process measures include:
- Technical performance – the degree to which tasks are carried out in accordance with accepted standards and current professional practice (e.g., the Sphere standards)
- Efficiency of service delivery – the maximization of impact with a minimum of resources used
- Continuity of services – the delivery of ongoing and consistent assistance, including timely referrals for other needed services
- Sustainability – the degree to which the humanitarian program can be maintained by the local community after the response ends
- Safety – the degree to which the risks of injury/harmful side effects from receiving assistance are minimized
- Participation – the degree of involvement of affected communities and vulnerable groups in the response process
- Choice of services – the degree to which end users have the information and ability to make an informed choice about a provider or assistance program, as appropriate and feasible
- Appropriateness – the adaptation of services to the needs of the affected population, including vulnerable subgroups
OUTCOMES are the ultimate quality measure, but often the least used in humanitarian settings, particularly in sudden-onset emergencies, because they are hard to define, and it is difficult to measure actual impact when short response timeframes limit the ability to observe change in some outcomes. Some quality outcome measures that can be used include:
- Effectiveness of services – the degree to which desired results or outcomes are achieved
- User satisfaction – Understanding how end-users perceive the response is an important outcome and their evaluation of goods and services received provides information on the entire conceptual framework of structure/process/outcomes.
Many definitions of quality stress meeting the need of the end-user (affected population) but existing humanitarian quality initiatives often focus on institutions and systems (structure and process components) rather than individual outcomes. User satisfaction and assessments of the response by end users are essential components of quality assessment. However, we need an evidence-based methodology and instrument to measure the quality of humanitarian/disaster response from the end-user’s perspective. Such a population-based approach would represent a fully-anonymous and proactive assessment that mixes measures of effectiveness and impact with levels of satisfaction.
Thomas D. Kirsch, MD, MPH is the Professor and Director, Center for Refugee and Disaster Response Johns Hopkins University Department of Emergency Medicine, School of Medicine Department of International Health, Bloomberg School of Public Health Department of Civil Engineering, Whiting School of Engineering
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