humanitarian health programming and monitoring in ... · simran chaudhri1*, kristina cordes2,...
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RESEARCH ARTICLE Open Access
Humanitarian health programming andmonitoring in inaccessible conflict settings:a literature reviewSimran Chaudhri1* , Kristina Cordes2, Nathan Miller1 and the Global Health Cluster Remote Programming andMonitoring Task Team
Abstract
Increasing global conflicts and risk to humanitarian aid workers have necessitated innovative approaches to deliverhumanitarian assistance. Remotely managed operations aim to continue the provision of services where grave riskto expatriate staff and restrictions by authorities inhibit access. This review of peer-reviewed and gray literatureidentified these remote approaches and collated lessons learned and best practices for humanitarian healthprogramming and monitoring in inaccessible conflict settings. Analysis identified key principles, including theimportance of capacity building and frequent communication, comprehensively assessing and addressing the risksto national staff, increasing monitoring and evaluation efforts despite difficult conditions, and planning for thepossibility of a transition to remote programming and having an exit strategy to prevent falling into the remoteoperations trap. Evidence on how to effectively carry out remote operations is limited; rigorous documentation andevaluation of remotely managed humanitarian operations are required to further build the evidence base.
Keywords: Remote management, Remote operations, Inaccessible, Conflict, Emergency, Program, Monitor
BackgroundWhile the end of the Cold War saw a decline in conflictsaffecting multiple countries, since 2013 there has been arise in both number of conflicts and battle casualties(Gates et al. 2016). Humanitarian aid workers have beenincreasingly targeted in conflict; there were 190 attackson aid workers in 2014, resulting in 121 deaths. This isthree times the 2004 number of 63 incidents (with 56deaths) (Aid Worker Security Database 2014). Inter-national actors are often preferred as kidnapping victimsas they provide both a higher ransom and a more visiblepolitical statement (Stoddard et al. 2009). Adherence tohumanitarian principles and relying on the strategy of“acceptance” no longer ensure safe access for humanitar-ian actors (Cunningham 2017; Donini and Maxwell2013). The need to maximize the safety of staff results inreduced access for humanitarian programming andmonitoring. This access is further limited by restrictionsimposed by both governments and non-state actors
seeking to exercise control over territories (Stoddardet al. 2010).When the risk to international organizations working
in conflict zones becomes too great or access is severelyrestricted, they are often left no other choice than to re-move themselves from the situation. Retreat to fortifiedcompounds or withdrawal from the field results in sig-nificant gaps in programs and services, as well as agrowing divide between international organizations andlocal communities (Duffield 2012). This has a harmfuleffect on local populations who are forced to remainwithout any support. To address this gap, internationalorganizations may turn to remote management of pro-grams. Remote management has previously been definedas “the withdrawal of senior international or national hu-manitarian managers from the location of the provisionof assistance or other humanitarian action which repre-sents an adaptation to insecurity and a deviation from‘normal’ programming practice ” (Donini and Maxwell2013, p. 384). Remote programming aims to continuethe provision of services while operating under the as-sumption that local actors, through their greater
© The Author(s). 2019 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, andreproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link tothe Creative Commons license, and indicate if changes were made.
* Correspondence: [email protected] New York 3 United Nations Plaza, New York, NY 10017, USAFull list of author information is available at the end of the article
Journal of International Humanitarian Action
Chaudhri et al. Journal of International Humanitarian Action (2019) 4:9 https://doi.org/10.1186/s41018-019-0055-x
knowledge of local context and acceptance in the com-munity, and with the continued support from inter-national organizations, are able to provide services at areduced level of risk than that faced by internationalstaff (Donini and Maxwell 2013; Kalkman 2018). Insome situations where grave risk prevents access for ex-patriate staff from international organizations and na-tional staff from national and internationalorganizations, remote programs are executed and man-aged by local actors from communities.This review was conducted in response to an urgent
request from the Global Health Cluster to provide evi-dence on health and nutrition programming and moni-toring in inaccessible conflict-affected areas and aims toidentify these remote approaches, collating lessonslearned, and best practices. While humanitarian pro-gramming and monitoring in inaccessible areas has beenrequired in several recent conflicts, it is has largely beengoverned by trial and error due to lack of comprehensiveinstruction and detailed strategy. The increasing use ofremote operations has shifted the perception of risk andhas normalized remote approaches to some extent. Thishas led to novel challenges and can maintain or widenthe divide between aid agencies and recipients (Anders-son and Weigand 2015; Duffield 2012; Fisher 2017; Kalk-man 2018). This review hopes to inform the creation offormal evidence-based guidance to support future hu-manitarian initiatives in these settings.
MethodsThis literature review was completed in two parts: a sys-tematic review of peer-reviewed published articles and asearch of gray literature sources. Both parts were com-pleted using consensus methodology by two independ-ent researchers from the United Nations Children’sFund (UNICEF) and the US Centers for Disease Controland Prevention (CDC).
Inclusion and exclusion criteriaEnglish language articles published in peer-reviewedjournals between January 1, 1990 and March 1, 2016 (in-clusive) were included. Included studies met the follow-ing criteria: described real-world humanitarianoperations delivering health and nutrition interventions,and took place in an inaccessible location in conflict ornatural disaster. Humanitarian programming in naturaldisasters was included with the aim of identifying novelstrategies that could be translated to an inaccessible con-flict setting; however, none were identified. Exclusioncriteria were as follows: technology or methods de-scribed as having a potential humanitarian applicationbut not yet implemented (including simulations), tech-nology or methods used in an inaccessible developmentcontext (rather than in response to an emergency),
studies with no specific intervention or outcomes, stud-ies that examine preparedness or resilience not linked toresponse, and review papers; however, references of re-view papers were screened for primary data sources.Given the burgeoning nature of this field and the limitedpublished literature on the topic, all study designs wereconsidered.
Systematic review of published peer-reviewed literatureSearch strategy and resultsOne search string (Table 1) was entered into six searchengines: PubMed, Scopus, MEDLINE/Ovid, Web of Sci-ence, Cochrane, and EMBASE. All search results wereexported to the online systematic review organizer Covi-dence. Then, 1853 titles and abstracts were screened,followed by the full text screening of 63 studies. Refer-ences of all 63 studies that progressed to full text reviewwere also screened to identify primary sources.Fourteen papers were identified as meeting all criteria
and included in this review (Fig. 1). The breakdown bystudy design was as follows: four retrospective analysesof programs, one retrospective analysis of populations,five descriptive case studies, one case series, twocross-sectional surveys, and one before-and-after study.
Quality assessmentA checklist adapted from the Strengthening the Report-ing of Observational Studies in Epidemiology (STROBE)criteria was used for quality assessment of observationalstudies, resulting in a rating of high, moderate, or lowquality (Blanchet and Roberts 2015). The one qualitativestudy (Kevany et al. 2014) was assessed using the CriticalAppraisals Skills Programme (CASP) checklist (CASP2013), with a score of 1–4 considered low, 5–8 moder-ate, and 9–10 (out of 10) high. The case series study(-Shanks et al. 2012) was assessed using the NIH QualityAssessment Tool for Case Series (NIH 2014), with ascore of 1–3 considered low, 4–6 moderate, and 7–9high (out of 9). Given the lack of a validated tool, thequality of descriptive case studies could not be formallyassessed.Upon quality assessment, two studies were found to
be low, six were moderate, and one was high; five studieswere not assessed due to the lack of an appropriate vali-dated tool. Assessment was performed in order to drawconclusions about the quality of the current evidence;given the limited number of published studies, nonewere excluded based on rating. A table summarizing the
Table 1 Peer-reviewed literature search strings
1. (humanitarian OR crisis OR conflict OR disaster) AND (remote ORinaccessible) AND (Health OR nutrition OR polio OR wash OR trauma ORobstetric)
Chaudhri et al. Journal of International Humanitarian Action (2019) 4:9 Page 2 of 45
articles included and their corresponding quality assess-ments can be found in Table 2.
Review of gray literatureSearch strategy and resultsThe gray literature search included all sources that werenot published in peer-reviewed journals, some examplesof document types are organizational guidelines, pro-gramming notes, program evaluations, presentations,and meeting notes. In addition to a Google search, a callfor resources was sent out to humanitarian organiza-tions, with additional contacts obtained via snowballsampling. Contacts were asked to provide any gray lit-erature sources pertaining to humanitarian program-ming and monitoring in inaccessible areas from theirorganization or elsewhere. References of documents re-ceived were also screened for additional primarysources.Two researchers screened all resources and consensus
was reached on which were relevant and would be in-cluded. Then, 131 total documents were reviewed usingthe same inclusion and exclusion criteria as the peerreviewed literature, with 55 documents proceeding toin-depth analysis and included in the final report. Themain reasons for exclusion were documents pertained toemergency settings but did not specifically discuss oper-ations in inaccessible contexts within these settings, doc-uments cited longer term development interventionsthat were not immediate aid relief, and documents out-lined remote operations but not within emergencysettings.
AnalysisBoth researchers performed thematic analysis independ-ently. Documents were reviewed and coded based on adefined set of codes created following the initial review;code conflicts were discussed until consensus on whichcode to include was reached. For example, after a docu-ment was reviewed and manually coded by reviewers 1and 2 independently, it was exchanged between the re-viewers who then compared codes and noted discrepan-cies. The reviewers then met online using a videophoneapplication to review and reach consensus on all dis-crepancies. Examples and excerpts where then groupedinto themes and included in the relevant sub-sections ofthe final report.
ResultsCauses and motivators of remote operationsThe main causes of reduced access include general inse-curity or a specific security incident, and restrictions onthe movement of aid workers imposed by authorities inpower. Additional factors that contribute to limited ac-cess include weak international support or pressure tonegotiate access with host states, tendency toward riskavoidance over risk management, and poor infrastruc-ture requiring expensive airlift capacity (Stoddard et al.2006).Several studies identified factors that need to be con-
sidered when determining whether to switch to remoteoperations. The first is the level and predicted length ofinsecurity; if the security risk is perceived as temporary,it may be more feasible to close the program and resumewhen the setting has become secured. The size of theprogram must be considered, with large programsharder to hand over than smaller programs. This maycause an organization to reduce services and hand overa scaled-back version of the program in order to main-tain presence in a location. Feasibility also plays a role inchoosing to operate remotely; activities for certain sec-tors can be more or less feasible based on security orcapacity of local staff (for example, highly insecure roadtravel may make distribution of food aid less feasible).Feasibility will also be governed by an organization’s op-erational history in a specific context. This ties into con-text considerations where the range, quality, andcapacity of local partners must be considered, as well astheir ability to operate freely in a region. Finally, thelevel of vulnerability and need is also a major consider-ation when debating the shift to remote programming,with organizations frequently opting to provide a pro-gram with reduced quality, monitoring and impact, ra-ther than no support at all (Rogers 2006; Stoddard et al.2006; Stoddard et al. 2010).The primary benefit of remote programming and
monitoring is the continuation of assistance, services,
Fig. 1 Study selection flowchart
Chaudhri et al. Journal of International Humanitarian Action (2019) 4:9 Page 3 of 45
Table
2Summaryof
peer-reviewed
articles
Autho
rOrganization
Title
Locatio
nandtype
ofcrisis
Interven
tion
Goalo
finterven
tion
Stud
yde
sign
Results
Add
ition
alde
tails
Quality
CDC2008
WHO
Prog
ress
towards
poliomyelitis
eradication—
Pakistan
andAfghanistan
2007
Afghanistan
andPakistan,
ongo
ing
conflict
Large-scaleho
use-to-
housesupp
lemen
tary
immun
izationactiv-
ities
(SIAs)with
oral
polio
vaccine
-4x
natio
nal
immun
izationdays
-7x
subn
ational
immun
izationdays
Interrup
ttransm
ission
ofWPV
inPakistan
and
Afghanistan
Descriptivecase
stud
y-Po
st-SIA
coverage
below
districtaverage
-Subo
ptim
alcoverage
ininsecure
and
remoteareasin
both
coun
tries
-Upto
20%
ofchildren
missedin
areasof
southw
estAfghanistan
-In
2007,A
fghanistan
andPakistan
repo
rted
17and32
casesof
confirm
edpo
lio,
respectively
-Extensivecrossbo
rder
movem
ent
necessitatin
gSIA
synchron
ization
-Indirect
contactmade
with
anti-go
vernmen
tgrou
psin
anattempt
toceaseho
stilities;in-
creasedareasaccess-
ibleto
vaccinators
-Supp
ortfro
mtribal
andreligious
leaders,
andlocalcom
mun
ities
necessaryforreaching
insecure
areas
N/A
Balfour
2015
UNICEF
Somalia
CLTSin
fragileand
insecure
contexts
Somalia,
ongo
ing
conflict
Com
mun
ity-ledtotal
sanitatio
nIm
provesanitatio
naccess
inruralareas
and
smalltow
nsand
describ
eadaptatio
nsne
cessaryto
adjustto
insecure
setting
Descriptivecase
stud
yInitiallyineffective;gaps
andbarriersto
CLTS
approach
iden
tified
durin
gtraining
ofim
plem
entersin
2014
-Training
in2015
(emph
asison
NGOs
that
stay
incommun
ities
for)
-Decen
tralized
approach
allowed
implem
entatio
nin
presen
ceof
weak
centralg
overnm
ent
-Im
plem
entedby
local
NGOsbe
causeof
their
access
tocommun
ities
inconflict-affected
areas
-Thede
velopm
entof
adapted,
context-
specificprotocolses-
sentialfor
effective
rollout
infragile
contexts
-Involvem
entof
key
tradition
aland
religious
leadersfoun
dto
becriticald
uring
trigge
ringand
implem
entatio
n
N/A
Bhartiet
al.2015
Partof
the
human
mob
ility
mapping
project
Remotelymeasurin
gpo
pulatio
nsdu
ringa
crisisby
overlaying
twodata
sources
Côted’Ivoire,
internal
political
conflict
2010–2012
Nighttim
elights
satellite
imageryand
mob
ileph
onecall
detailrecords(CDRs)
-Com
pared
compo
sitedstable
nigh
ttim
elights
values
from
2012
and2010,the
density
ofph
one
towerspresen
t,and
thede
nsity
ofSIMs
-Assessedaverage
popu
latio
nsize
and
dynamicchange
s
Rapid,
large-scalemea-
suresof
displacedpo
p-ulations
andmovem
ent
Retrospe
ctive
analysis
-Agreemen
tin
average
measuresof
popu
latio
nsizes
-Ableto
obtain
measuremen
tsin
long
-andshort-term
popu
latio
ndynamics
byusingtw
osources
CDRs
didno
tprovide
long
-term
data
onpo
pulatio
nmovem
ents,
apre-conflictbaseline
ormovem
entacross
na-
tionalb
ound
aries
-Satellite
images
did
notprovidehigh
-resolutio
nmob
ility
traces
andweresensi-
tiveto
environm
ental
factors
-Usedtw
ocomplem
entary
data
setsto
overcomethe
Low
Chaudhri et al. Journal of International Humanitarian Action (2019) 4:9 Page 4 of 45
Table
2Summaryof
peer-reviewed
articles(Con
tinued)
Autho
rOrganization
Title
Locatio
nandtype
ofcrisis
Interven
tion
Goalo
finterven
tion
Stud
yde
sign
Results
Add
ition
alde
tails
Quality
across
spatialand
tempo
ralscales
limitatio
nsof
each;
strong
estcorrelation
inecon
omicregion
s(not
administrative
region
swith
varying
wealth
)
Chu
etal.
2011
MSF
Providingsurgical
care
inSomalia:a
mod
elof
task
shifting
Somalia,
ongo
ing
conflict
Task
shifting
-Expatpresen
ceen
dedJan2008
due
toincreased
insecurity
-Surgicalprog
ram
runremotelyby
coordinatio
nteam
inNairobi;visitsite
2x/
year
toen
sure
standardsbe
ingmet
-Services
provided
byon
eSomalid
ocwith
surgicalskills(trained
unde
rexpatsurgeo
nfor2years),one
surgicalnu
rse,and
oneanestheticnu
rse
-Surgicalconsult
availableby
Con
tinue
provisionof
surgicalcare
bylocal
doctorsandnu
rses
followingevacuatio
nof
expatriate
staff
Before
andafter
stud
y-2086
operations
were
perfo
rmed
betw
een
Oct
2006
and
Decem
ber2009
-After
Jan2008,all
proced
ures
(1433)
werepe
rform
edby
non-surgeo
ns(doctor
with
surgicalskillsand
surgicalnu
rse)
-Peri-op
erativemortal-
itywas
lower
whe
nproced
ures
werepe
r-form
edby
non-
surgeo
ns(0.2%,2
cases)be
tween2008
and2009,versus
2006–2007whe
nsur-
geon
swerepresen
t(1.7%,6
cases,P<
0.001)
-Low
ratesof
spinal
anesthesiadu
eto
lack
oftraining
ofanestheticnu
rse(m
ost
gene
ralane
sthe
sia);
extratraining
for
Somalistaffrequ
ired
-Vide
ocon
ferencing
wou
ldbe
bene
ficial
Mod
erate
Enen
kel
etal.2015
-MSF
-Vienna
University
ofTechno
logy
(TUW)
-International
Institu
tefor
App
lied
System
sAnalysis
(IIASA
)
Food
security
mon
itorin
gvia
mob
iledata
collectionandremote
sensing:
results
from
theCen
tralAfrican
Repu
blic(CAR)
CAR,violen
tconflict
Mob
iledata
collection
andremotesensing
-SA
TIDA
COLLEC
T:android
applicationthat
facilitates
rapidand
simpledata
collection
-LocalC
HWsworking
with
MSF
used
mob
iledata
collection
applicationon
smart
phon
esto
cond
uct
nutrition
assessmen
tsand
interviewsin
the
locallangu
age
-Inpu
tsfro
msatellite
derived
drou
ght
indicators
Collect
inform
ation
abou
tsocio-econ
omic
vulnerabilitiesrelatedto
malnu
trition
,accessto
resourcesandcoping
capacitiesusingsm
art
phon
es;tocapturelocal
cond
ition
sas
situations
evolve
onthegrou
nd(earlywarning
related
tofood
insecurity)
Cross-sectio
nal
survey
-May
2015:hou
seho
lds
consum
ed0.9meals
perday;average
househ
oldsize
was
morethan
nine
peop
le;d
espite
this,
childrenbe
tween6
and59
mon
thswere
notmalno
urishe
d-Satellite-derived
infor-
mationabou
trainfall/
soilmoisturecond
i-tio
nsandtheStan-
dardized
Precipitatio
nEvapotranspiratio
nInde
xconfirm
edthat
thefood
insecurity
situationin
2013/2014
was
relatedto
violen
tconflictsrather
than
toaclim
aticshock
-Recordingthelocatio
nof
assessmen
tsviathe
smartph
ones’G
PSreceiver
enabled
analysisanddisplayof
coup
lingbe
tween
drou
ghtriskand
impacts(direct
linkto
satellite
derived
info)
-Com
plem
entary
useof
inform
ationfro
msatellitesandSA
TIDA
COLLEC
Tcansupp
ort
thetranslationof
early
warning
sinto
actio
n,redu
cing
falsealarms
andstreng
then
ing
disaster
prep
ared
ness
Low
Chaudhri et al. Journal of International Humanitarian Action (2019) 4:9 Page 5 of 45
Table
2Summaryof
peer-reviewed
articles(Con
tinued)
Autho
rOrganization
Title
Locatio
nandtype
ofcrisis
Interven
tion
Goalo
finterven
tion
Stud
yde
sign
Results
Add
ition
alde
tails
Quality
Kevany
etal.2014
-Theglob
alfund
-Afghanistan
Ministryof
Health
-National
Malariaand
Leishm
aniasis
Con
trol
Prog
ramme
(NMLC
P)
Globalh
ealth
diplom
acy
investmen
tsin
Afghanistan:
adaptatio
nsand
outcom
esof
glob
alfund
malaria
prog
rams
Afghanistan,
ongo
ing
conflict
Adaptationof
glob
alfund
-sup
ported
mal-
ariatreatm
entand
preven
tionprog
rams:
1-am
endm
entof
educationalm
aterials
forruralp
opulations
2-religious
awaren
ess
inge
nder
grou
ping
sforhe
alth
educational
interven
tions
3-recruitm
entof
local
staff,forqu
ality
assuranceandservice
delivery
4-alignm
entwith
diplom
aticprinciples
andavoidanceof
confusionwith
broade
rstrategicand
military
initiatives
5-am
endm
entsto
prog
ram
“brand
ing”
proced
ures
-Ensure
securityof
staff
-Im
provelocal
acceptability,
coverage
,and
service
utilizatio
n
Qualitative
stud
yand
retrospe
ctive
prog
ram
evaluatio
n
-Serviceutilizatio
nim
provem
ents,
improved
access
ofservicede
liveryin
insecure
region
s-Tempo
ralassociatio
nno
tedbe
tween
interven
tionand
improved
uptake
ofne
ts-Interven
tion
implem
entatio
nand
safe
passagefor
prog
ram
staff
facilitated
byne
gotiatio
nswith
commun
ityelde
rs-Prestig
eand
acceptability
ofinternationald
onor
activities
were
observed
toim
prove
-Successful
adaptatio
nof
interven
tions
toinsecure
region
smay
help
build
internationalp
resence
inothe
rwise-
inaccessibleareas,
which
wou
ld,inturn,
beim
possiblewith
out
approp
riate
adjust-
men
tsto
prog
ram
de-
sign
,selectio
nand
delivery
-Mustmaintainexplicit
distinctions
betw
een
developm
ent,military
andpo
liticalagen
das
Mod
erate
Leeet
al.
2006
Backpack
Health
Worker
Team
(BPH
WT)
Mortalityratesin
conflictzone
sin
Karen,Karenn
i,and
Mon
states
ineastern
Burm
a
Burm
a(M
yanm
ar),
ongo
ing
conflict
-Cluster
surveys
cond
uctedby
indige
nous
mob
ilehe
alth
workers
-Interviewed
headsof
househ
olds
over
3mon
thtim
epe
riods
in2002
and
2003
Estim
atemortalityrates
inconflict-affected
areas
ineasternBu
rmain-
accessibleto
inter-
natio
nalo
rganizations
Cross-sectio
nal
mortalitysurvey
Com
pleted
surveys
from
1290
(64.5%
)ho
useh
olds
in2002
and
1609
(80.5%
)ho
useh
olds
in2003.
-Estim
ates
ofvital
statisticsfor2002
and
2003
respectively:
infant
mortalityrate:
135(95%
CI96–181)
and122(95%
CI70–
175)
per1000
live
births;und
er-five
mor-
talityrate:291
(95%
CI
238–348)
and276
(95%
CI190–361)pe
r1000
livebirths;crude
mortalityrate:25(95%
CI21–29)and21
(95%
CI15–27)pe
r1000
person
spe
ryear
-Noother
governmen
talo
rinternational
organizatio
nsworking
with
thispo
pulatio
nfro
mwith
inBu
rma.
-Use
ofindige
nous
mob
ilehe
alth
workers
provides
means
ofmeasurin
ghe
alth
status
amon
gpo
pulatio
nsno
rmally
beinaccessibledu
eto
conflict;advantages:
familiarity
with
local
commun
ities,are
high
lytrustedby
the
village
rs,and
visit
commun
ities
inthe
course
oftheirno
rmal
work
-Low
respon
selikely
unde
restim
ated
mortality
Mod
erate
Chaudhri et al. Journal of International Humanitarian Action (2019) 4:9 Page 6 of 45
Table
2Summaryof
peer-reviewed
articles(Con
tinued)
Autho
rOrganization
Title
Locatio
nandtype
ofcrisis
Interven
tion
Goalo
finterven
tion
Stud
yde
sign
Results
Add
ition
alde
tails
Quality
Mahnet
al.2008
-Back
Pack
Health
Worker
Team
(BPH
WT)
-Karen
Dep
artm
ent
ofHealth
and
Welfare
(KDHW)
-Localethnic
organizatio
ns-Region
aland
international
partne
rs
Multi-level
partne
rships
toprom
otehe
alth
services
amon
ginternallydisplacedin
easternBu
rma
Burm
a(M
yanm
ar),
civilcon
flict
and
governmen
trestrictio
ns
Cross-borde
rlocal-
glob
alpartne
rships
-BPHWTindige
nous
health
workerstravel
tovillage
sto
providege
neral
med
ical,m
aternal,
andchild
health
care;p
rovide
education
worksho
ps-BPHTW
partne
rswith
KDHW,village
leadersandvillage
health
volunteers,
Burm
aMed
ical
Associatio
n,the
NationalH
ealth
and
Education
Com
mittee,the
Mae
TaoClinic,the
Cen
ter
forPu
blicHealth
and
Hum
anRigh
tsat
the
John
sHop
kins
Bloo
mbe
rgScho
olof
Public
Health
-InternationalN
GOs
providetechnical
supp
ort
-Tw
iceannu
ally,
BPHWTteam
leaders
crossfro
mBu
rma
into
Thailand
toprog
ram’s
administrative
headqu
arters,to
resupp
ly,receive
training
,and
compilecollected
health
inform
ation
Providecriticalh
ealth
services
toIDPs
ineasternBu
rma
Descriptivecase
stud
yIn
2005:
-HWshad95%
diagno
sisaccuracy
and85%
treatm
ent
accuracy
forcommon
illne
sses
-Treatedne
arly78,000
casesthroug
hout
their
IDPserviceareas
-Adm
inisteredne
arly
43,000
dosesof
Vitamin
A,aswellas
deworming
treatm
ents,tochildren
andpo
stpartum
wom
en-Thelocal-g
lobalp
art-
nershipwas
ableto
providecare
toin-
accessibleIDPs
Keyfactorscontrib
uting
totheirsuccess:
-Localaccess
-Multi-ethn
iccollabo
ratio
n-Coo
rdination(ofw
hode
liverswhatservices,
supp
lyprocurem
ent
andde
livery,etc.)
-Standard
data
collection;inform
ation
used
foradvocacy
N/A
Martin
ez-
Garcia
2014
MSF
Aretrospe
ctive
analysisof
pediatric
caseshand
ledby
the
MSF
tele-expertise
system
28coun
tries,
conflictor
unstable
locatio
ns
Telemed
icine
-threetelemed
icine
netw
orks
combine
dinto
sing
lemultilingu
alsystem
,telemed
.msf.org
-Case-coordinator
Providespecialized
pediatric
med
ical
consultatio
nsin
remote
areas
Retrospe
ctive
prog
ram
analysis
-Pediatric
cases
referred
toMSF
telemed
icine
-Meanratin
gforthe
quality
ofinform
ation
provided
bythe
referrer
was
2.8(ona
scalefro
m1(very
poor)to
5(verygo
od);
meanratin
gfor
Mod
erate
Chaudhri et al. Journal of International Humanitarian Action (2019) 4:9 Page 7 of 45
Table
2Summaryof
peer-reviewed
articles(Con
tinued)
Autho
rOrganization
Title
Locatio
nandtype
ofcrisis
Interven
tion
Goalo
finterven
tion
Stud
yde
sign
Results
Add
ition
alde
tails
Quality
receives
referraland
allocatesto
special-
ist;individu
alcase
follow-up(progress
repo
rt)automatically
requ
estedfro
mre-
ferrerssinceOct
2013
platform
from
April2010
toMarch
2014
inclusive
-467casestotal,
48then
rand
omly
selected
approp
riatene
ssof
the
respon
sewas
3.3
(sam
escale)
-2/3of
respon
seswere
useful
tothepatient,
3/4respon
seswere
useful
tothemed
ical
team
Mattli
and
Gasser
2008
ICRC
Ane
utral,im
partial
andinde
pend
ent
approach:key
toICRC
’sacceptance
inIraq
Iraq,
ongo
ing
conflict
-Reinforced
assistance
prog
rams
throug
hremote-
controlm
echanism
s:workwith
trusted
implem
entin
gpart-
ners,p
eriodicshort
visitsby
ICRC
ex-
patriate
staff
-Moved
staffto
Amman,Jordanand
kept
onlyacore
staff
inIraq
-Remote-controlfor
WASH
:mob
ilizatio
nof
netw
orkof
local
contractorsandcon-
sultantsworking
with
ICRC
engine
ers
-New
operational
framew
orkin
2006:
•Minim
ized
movem
entsto
redu
cestaff
expo
sure
•Increased
netw
orking
toprom
oteacceptance
-Im
plem
entprog
rams
ofincreasing
scop
eandsize
andbu
ildacceptance
throug
hne
tworking
and
commun
icationwith
low-visibility
presen
ce-Increase
levelo
fcompe
tenceand
respon
sibilityof
ICRC
localstaff
Descriptivecase
stud
y-2.7millionpe
ople
directlybe
nefitted
from
ICRC
W&S
activities
in2007
-In
2007,54water
and
sanitatio
nprojects
werecarriedou
tun
derdirect
ICRC
supe
rvisionand78
projectsun
derremote
control
Keys
tothesuccessof
theremote-control
mod
el:
-Highlyexpe
rienced
,motivated
and
committed
ICRC
Iraqi
employees;
–Strong
collabo
ratio
nwith
andow
nership
bylocalautho
rities;
–Anextensivene
twork
oflocalcon
tractors/
consultants
throug
hout
the
coun
try;
–Strong
control
mechanism
sforne
eds
assessmen
tand
projectde
sign
,im
plem
entatio
n,mon
itorin
gand
evaluatio
n-Dow
nside:lim
ited
contacts,lim
ited
capacity
for
coordinatio
n
N/A
Richardet
al.2009
-Karen
Dep
artm
ent
ofHealth
and
Welfare
(KDHW)
-Back
Pack
Health
Worker
Team
(BPH
WT)
Essentialtraum
amanagem
enttraining
:addressing
service
deliveryne
edsin
activeconflictzone
sin
easternMyanm
ar
Myanm
ar,
civilcon
flict
Traumamanagem
ent
prog
ram
-4-6-daytrauma
course
forhe
alth
workers
-Partof
CBO
-run
health
system
pro-
viding
care
for
approxim
ately
250,000IDPs
andwar-
affected
reside
nts
Improvethecapacity
ofindige
nous
health
workersto
deliver
effectivetraumacare
Retrospe
ctive
analysisof
prog
ram
-Since2000,aroun
d300he
alth
workers
have
received
Training
-Betw
eenJune
2005
andJune
2007,m
ore
than
200patients
recorded
inthe
traumapatient
registry;m
ajority
were
victim
sof
weapo
ns-
relatedtrauma.
Mod
erate
Chaudhri et al. Journal of International Humanitarian Action (2019) 4:9 Page 8 of 45
Table
2Summaryof
peer-reviewed
articles(Con
tinued)
Autho
rOrganization
Title
Locatio
nandtype
ofcrisis
Interven
tion
Goalo
finterven
tion
Stud
yde
sign
Results
Add
ition
alde
tails
Quality
-Traumavictim
streated
byhe
alth
workers
survived
in91%
ofcases
Shanks
etal.2012
MSF
Treatm
entof
multid
rug-resistanttu-
berculosisin
are-
mote,conflict-
affected
area
ofthe
Dem
ocratic
Repu
blic
ofCon
go
DRC
,on
going
conflict
-Remotesupp
ortof
non-TB
clinicians
byTB
specialistviamo-
bileph
one
-Use
ofsimplified
mon
itorin
gprotocols
-Add
ressed
stigmato
supp
ortadhe
rence
Provideremotesupp
ort
from
TBspecialistto
non-TB
clinicians
using
simplified
mon
itorin
gprotocol
Caseseries
-Ableto
successfully
treatpatientswith
simplified
protocol
-AllthreeDR-TB
pa-
tientscompleted
treatm
ent
-Standardized
form
she
lpfulinmaintaining
overview
oftreatm
ent
despite
multip
lestaff
changing
;how
ever,
suscep
tibleto
transcrip
tionerror
-Com
mun
ication
betw
eentreatin
gstaff
andhe
adqu
arterswas
achalleng
e
Mod
erate
Tong
etal.2011
MSF
Challeng
esof
controlling
sleeping
sickne
ssin
areasof
violen
tconflict:
expe
riencein
the
Dem
ocratic
Repu
blic
ofCon
go
DRC
,violent
conflict
HATde
tectionand
treatm
entcampaign
Targeted
med
ical
interven
tions
toaddress
operationaland
med
ical
challeng
esof
managing
HATin
conflictareas
Descriptivecase
stud
y-2007:46,000screen
edand1570
treatedfor
HAT
-2009:2
centersforced
toclosed
dueto
insecurity;reop
ened
early
2010
-Com
plexity
ofHAT
diagno
sisand
treatm
entpreven
ted
anyem
erge
ncy
hand
over
tolocal
partne
rs;ope
ratio
nssuspen
ded
-2010:770
patients
treated
-Activescreen
ingand
follow
upcomprom
ised
inconflict
-Com
mun
ityaw
aren
ess
andacceptance
necessaryforhe
alth
prog
ram
-Displacem
ent
potentially
creates
new
fociof
transm
ission
inpreviouslycleared
areas
-Insufficien
tinternationalsup
port
andfund
ing
N/A
Zachariah
etal.2012
MSF
Practicingmed
icine
with
outbo
rders:tele-
consultatio
nsand
tele-m
entorin
gfor
improvingpe
diatric
care
inaconflictset-
tingin
Somalia?
Somalia,
ongo
ing
conflict
Tele-con
sultatio
nsand
tele-m
onito
ring
-To
supp
ortSomali
clinicians
whe
nexpatriate
staffwere
nolong
erableto
beph
ysicallyon
site
-Specificriskcriteria
requ
iring
mandatory
referralde
fined
-Con
sultatio
nswith
specialistin
Nairobi
sche
duledevery
afternoo
n-“Tele-
men
torin
g”
Improvequ
ality
ofpe
diatric
care
inremote
conflictsetting
Retrospe
ctive
analysisof
prog
ram
data
with
historical
control
(2010data
prior
to implem
entatio
nof
telemed
icine)
-Of3920
pediatric
admission
s,346(9%)
werereferred
for
telemed
icine.
-In
222(64%
)children,
asign
ificant
change
was
madeto
initial
case
managem
ent
-In
88(25%
),alife-
threaten
ingcond
ition
was
detected
that
had
been
initiallymissed
-Adverse
outcom
esfell
from
7.6%
in2010
(with
outtelemed
icine)
-Heldmeetin
gswith
commun
ityelde
rsto
raiseaw
aren
essand
unde
rstand
ingof
new
techno
logy;led
toacceptance
oftechno
logy
incommun
itywith
cultu
ralb
eliefsthat
negate
theuseof
cameras
-Reason
sclinicians
foun
ditto
beof
high
value:he
lped
toim
proverecogn
ition
High
Chaudhri et al. Journal of International Humanitarian Action (2019) 4:9 Page 9 of 45
Table
2Summaryof
peer-reviewed
articles(Con
tinued)
Autho
rOrganization
Title
Locatio
nandtype
ofcrisis
Interven
tion
Goalo
finterven
tion
Stud
yde
sign
Results
Add
ition
alde
tails
Quality
(edu
catio
n)also
provided
byspecialist
to5.4%
in2011
(with
telemed
icine);30%
redu
ction,od
dsratio
0.70,95%
CI0.57–0.88,
P=0.001
-All7clinicians
involved
rateditto
beof
high
value
ofrisksign
s(7/7),
improved
managem
ent
protocolsand
prescriptio
npractices
(6/7),bu
ilta
relatio
nshipof
solidarity
throug
hdirect
contactwith
distantspecialist
colleagues(5/7)
Chaudhri et al. Journal of International Humanitarian Action (2019) 4:9 Page 10 of 45
and flow of funding. It allows the retention of localknowledge, making it easier to return to traditional pro-gramming when access is restored, and provides oppor-tunities for closer community involvement and localownership. Remote operations increase the capacity offield staff, which contributes to sustainability. Addition-ally, the continued visibility of an organization will in-crease local acceptance of both current and futureprogramming (Kjaerum 2015; Stoddard et al. 2006). Des-pite these benefits, programming and monitoring qual-ity, neutrality, and impartiality tend to suffer with lack ofinternational non-governmental organization (INGO) orinternational organization (IO) presence and all optionsfor keeping staff on the ground should be consideredprior to moving to remote operations as a last resort(Stoddard et al. 2006; UNHCR 2016). The potential ben-efits and challenges of shifting a program to remotemode require full consideration to inform the decision;challenges and considerations will be discussed in detailbelow.
Traditional modalities of remote operationsThe literature identified four modalities of remote pro-gramming that exist on a spectrum, varying by depth ofroles and responsibilities of both international and localstaff. They are:
1. Remote control: commonly a reactive stance (actionin response to a situation that has already occurred)and a last resort with the least amount of delegationof authority to field staff, and little capacitydevelopment or skills transfer (GOAL 2016; Hansen2008b; Zyck 2012).
2. Remote management: a reactive stance with somedelegation of authority to national implementers,moderate investment in capacity building, andprocedures in place for better monitoring andquality. Assumes that decision-making and author-ity will revert back to internationals following res-toration of security (GOAL 2016; Hansen 2008b;Zyck 2012).
3. Remote support: a proactive strategy (action inpreparation for a situation that has yet to takeplace) with full investment in national staff capacitybuilding, mentoring, and planning for eventual fullhandover of authority (GOAL 2016; Hansen 2008b;Zyck 2012).
4. Remote partnership: a proactive strategy whereequal partnership is fostered with a local partnerthat already has significant internal capacity, andtherefore does not require capacity developmentsupport from the international organization. Theinternational organization supports viaadministration, resource mobilization, and
advocacy, while the operational partner focuses oncontext and implementation (GOAL 2016; Hansen2008b; Oxfam International and Merlin 2009; Zyck2012).
A summary of remote operation modalities is pre-sented in Table 3. This table is a synthesis of the re-sources cited and describes trends and qualities inrelation to the other modalities; the descriptions are notintended to be absolute. The modality chosen for a spe-cific operation will be based not only on desired charac-teristics (such as flexibility, quality, or sustainability) butwill also be constrained by available resources andcollaborations.
Other remote approachesOther remote approaches include community partner-ship arrangements, government partnership arrange-ments, and outsourcing to commercial contractors;however, no reports analyzed their implementation indetail, preventing their inclusion in Table 3.
Remote operations challenges, considerations, andapproachesAnalysis of the studies identified a number of factorsthat must be considered when implementing remote op-erations, including the need to maintain humanitarianprinciples; the selection and capacity of, and the com-munication, trust, and sustainability within partnerships;coordination and collaboration among stakeholders; ac-ceptance of the intervention by both implementers andbeneficiaries; risks and risk management, especiallythose associated with local actors; advocacy; monitoringand evaluation methods and technological support; pre-venting the “remote operations trap”; and the need forplanning and guidance. These will be discussed in turnbelow.
Need to maintain humanitarian principlesThe humanitarian principles of humanity, neutrality, im-partiality, and independence (OCHA 2012) are necessaryto ensure the safety of staff and communities. However,they are difficult to maintain during remote operations.Many IOs give little consideration as to whether or notlocal partners seek to uphold these principles (Stoddardet al. 2006). Neutrality can be affected through partner-ing with military forces to deliver aid (Polio OversightBoard 2014; UNICEF EMOPS 2011c), while impartialitycan be compromised by religious, ethnic, or political dy-namics that put pressure on local staff (Belliveau 2013;Stoddard et al. 2010). One example of compromisedhumanitarian principles was the UNICEF operationin Afghanistan between 2007 and 2010. Militarypartners were relied upon to access southern
Chaudhri et al. Journal of International Humanitarian Action (2019) 4:9 Page 11 of 45
provinces and meetings with populations and stake-holders were held in military-controlled ProvincialReconstruction Team facilities; while this was themost feasible option at the time, it severely com-promised their stance as an impartial and neutralactor (UNICEF EMOPS 2011a). Ensuring nationaland local staff have a sound understanding of hu-manitarian principles is necessary for programmingand monitoring to be delivered in keeping with glo-bal standards (Egeland et al. 2011).Some discussion posits that while impartiality and
neutrality are important in these contexts, the coreprinciple that deserves emphasis is the humanitarian im-perative: the need to get critical assistance to those inneed regardless of the method. This argument impliesthat a “by any means necessary” approach should be fa-vored over attempts to maintain humanitarian principlesin these settings (Stoddard et al. 2010).
PartnershipsSeveral studies described the necessity of effective part-nerships supported by clearly delineated responsibilities,
a defined supervision structure with a variety of focalpoints, and transparent policies that allow all parties tomake informed choices and adequately fulfill their roles(IMC 2016b; Stoddard et al. 2006). Four sub-themesemerged throughout the partnership discussion, theseare selection, capacity, communication and trust, andsustainability.
Selection Selecting a suitable partner to implement re-mote operations requires protocols and checks in place toensure partners have sufficient capacity and experience inthe context, and are not influenced by alternate agendas(Stoddard et al. 2010). Hiring third party accounting firms,deferring to community elders, and identification throughcontacts have all been described as potential partner selec-tion methods (Howe et al. 2015). Ultimately, selectionmust be transparent and benefits from more active re-cruitment methods such as consulting local experts andutilizing pre-conflict networks (UNICEF EMOPS 2011b).
Capacity Several studies consider building the capacityof local staff important to ensuring the fidelity of remote
Table 3 Summary of remote operation modalities (Hansen 2008b; Oxfam International and Merlin 2009; Stoddard et al. 2006; Zyck2012)
Remote control Remote management Remote support Remote partnership
Nature Reactive Reactive Proactive Proactive
International staff authority High/complete Moderate Low Low/none
National staff authority Low/none Moderate High High/complete
National staff capacitydevelopment
Little Moderate Full Unnecessary
Longitudinal monitoring Little Some Full Full
Flexibility Little Some Very Very
Quality Low Moderate High High
Sustainability Low Moderate High High
Time-line Short term Medium term Long term Long term
Vulnerable to staff turnover High High Low (investment in localstaff capacity developmentlimits turnover)
Low (highly developedlocal organizationslimits turnover)(Minimal local capacity development increases vulnerability to
turnover)
Required experience incontext and infrastructureby local organization
Minimal Some Yes Yes
Potential benefits - Continuity of program- Better initial oversight givenprimarily controlled byinternational organization
- Continuity of program- Better initial oversight givenprimarily controlled byinternational organization
- Capacity building
- Continuation of programlong term, sustainable
- Tailored to changingcontext
- Continuation ofprogram long term,sustainable
- Tailored to changingcontext
Potential weaknesses - Communication problems- National staff bear much ofresponsibility and risk withlittle authority
- Unsustainable
- Communication problems- National staff bear much ofresponsibility and risk withlittle authority
- Corruption risk- Lack of oversight- Scarcity of experiencednational staff
- Corruption risk- Lack of oversight- Scarcity ofexperienced nationalstaff
- Reduced funding dueto donor reluctance
Chaudhri et al. Journal of International Humanitarian Action (2019) 4:9 Page 12 of 45
operations, autonomy, and project ownership. Whiletraining needs (operational methods, security protocols,etc.) and methods (planned site visits, staff secondments,etc.) are varied and complex, these studies emphasizethat training should be prioritized before remote opera-tions take effect, acknowledge cultural and linguistic dif-ferences, and include follow-up and feedback to ensureretention and continuous improvement (GOAL 2016;Jansury et al. 2015; Stoddard et al. 2010). National staffcan be experienced, and assuming all nationals requiretraining can create an unequal relationship and shouldbe avoided (Collinson and Duffield 2013). While capacitybuilding is important, it is a long-term goal that can alsolead to a short-term loss in efficiency; this trade-off re-quires consideration and needs to be evaluated againstthe urgency and needs of the context (UNICEF EMOPS2012).
Communication and trust Building trust is consideredkey for partnerships and intrinsically linked to commu-nication, a crucial trust-building strategy when workingremotely; useful trust building mechanisms includemaximizing face-to-face contact, regular sharing of ideasand information, enhanced interactions (for example,videoconferencing), transparent decision making, andjoint agenda setting, among others (Anonymous 2015;Balslev-Olesen and Hüls 2011; GOAL 2016; Howe et al.2015; Norman 2012). Communication strategies shouldspecify the frequency, mode, and type of information tobe shared (GOAL 2016). A minimum level offace-to-face contact between senior staff and implemen-ters is required to build trust and capacity.
Sustainability Sustainability is a growing concern wherenational staff is relied upon to deliver services for in-creasing lengths of time. Prioritizing the sustainability oflocal partners involves focusing on operational andorganizational capacity building of entire institutions,supporting long-term projects, providing core funds,and supporting alliances among local groups, therebybuilding a strong civil society (Howe et al. 2015). Sus-tainability is also supported by rapid decentralization toskilled staff and flexibility in rapidly changing contexts,versus hierarchical management structures and proce-dures (Hansen 2008b).A 2006 dissertation paper that examined cases in a
number of countries highlighted both the advantagesand disadvantages of partnerships that relied on commu-nities to implement projects in Uganda. An anonymousNGO developed program activities and implementationtime lines with community representatives in a neigh-boring town. Community members implemented theprogram (with some private contractors) and docu-mented implementation using field journals and digital
photographs. The NGO supported the community im-plementers with supplies, training, and regular guidanceand feedback following review of documentation. Thecommunity was aware that the NGO would be monitor-ing activities, and independent monitors from the com-munities were recruited to triangulate information. Achange in the security situation, which permitted theNGO to visit the project area with government escorts,found that this monitoring system was unreliable. Workwas of poor quality and in some cases not carried out atall, despite payments being made and verification of thework by the NGO’s national staff. Community memberswere found to be providing information that theythought the NGO wanted to hear, instead of reportingon the realities on the ground (Rogers 2006).
Coordination and collaborationCoordination and collaboration are considered essential toensuring cohesive remote programming; however, certaincoordination structures can also compromise an organiza-tion’s independence and capacity. Structures should berooted in the cultural context, with coordinating bodiesand leadership carefully selected to promote neutralityand local ownership (Stoddard et al. 2010). There is a needfor coordination mechanisms and standards to be adaptedto the realities of operating in conflict contexts, and to im-prove the efficacy of the cluster approach for remote pro-gramming (UNICEF EMOPS 2011a). Good practicesexist, but are generally confined within an organizationand need to be shared (Norman 2012).One example of effective coordination is the shura
(council) system in Afghanistan developed by Tearfund tomimic the local decision-making structure based aroundgroup consultation. Following insecurity that forced co-ordination activities to relocate from Kandahar to Kabul,the lack of an expatriate program manager was feared tounleash tribal differences among Afghan staff members.In an attempt to preempt these tensions from causingproblems, a shura was developed with the five programheads from the Kandahar office, each taking turns to co-ordinate the shura; all other staff members were invited toparticipate in deliberations as well. The inclusiveness to allopinions and lack of one controlling member helped tomanage conflict and tensions between staff and preventedfraud or corruption as all members worked together andmonitored each other. While this process was slow todevelop and resulted in slow decision making initially, itwas important given the cultural context and demon-strated respect for local governance mechanisms. Theshura system led to programming that was highlyaccepted by the community, well-coordinated, and fairlyimplemented, while building sustainable local capacityand ownership (Souness 2011; Stoddard et al. 2010;UNHCR 2014; Zyck 2012).
Chaudhri et al. Journal of International Humanitarian Action (2019) 4:9 Page 13 of 45
AcceptanceAcceptance is important to ensure the fidelity, execu-tion, and uptake of remote operations; activities need tobe accepted by both the national/local staff implement-ing them and the communities they aim to serve, withprogram ownership strongly linked to program success(Belliveau 2013). Acceptance is both a security measureand used to eventually regain access (Souness 2011;Steets et al. 2012). However, it should never be solely re-lied upon to reduce security risk.Regular contact and participatory management styles
that include national staff in decision making increasetrust and acceptance by local staff, while selecting cul-turally appropriate staff, using diaspora nationals, andcommunity outreach and participation increase benefi-ciary acceptance (Oxfam International 2007; Rogers2006; Stoddard et al. 2006). The fundamental prerequis-ite to acceptance is competent and committed humani-tarian programming with tangible results (Egeland et al.2011).
Risks and risk management
Risks to local actors Remote operations involve thetransfer of risk from international to local actors, whoare assumed to be at lower risk for targeting and there-fore safer when implementing (GOAL 2016; Hüls 2011).This is often a false assumption as they face uniquethreats that are often not acknowledged in securityassessments (Egeland et al. 2011) and may accept agreater degree of risk than is deemed appropriate(Stoddard et al. 2006). Additionally, local actors are in-frequently present at trainings on security, and are oftenleft with minimal security-related equipment when expa-triates evacuate (Collinson and Duffield 2013).Mitigation of this risk can be achieved via conducting
thorough risk assessments (GOAL 2016; UNHCR 2016),preparedness planning that decentralizes authority andtransfers security equipment to nationals (Stoddard et al.2006), (Schreter and Harmer 2013), capacity building onsecurity issues and protocols, and additional monitoringand triangulation with community members for risk up-dates (GOAL 2016; Norman 2011; Stoddard et al. 2010).
General risks General risks in remote operations aremany and include inadequate and poor quality informa-tion management, credibility, communication, coordin-ation, monitoring, and programming; inciting conflict;casualties and fatalities; insufficient impact; limited or noprogram expansion or adaptation; compromised neutral-ity and impartiality; corruption and fund diversion; andreduced advocacy or speaking out on behalf of affectedpopulations (Belliveau 2013; Rivas 2015; Stoddard et al.2006; Stoddard et al. 2010). Risks can also vary
depending on which staff are removed from the pro-gram; removal of only expatriate staff may expose themto higher risks when visiting, and may expose nationalstaff to higher risks when they are absent, due to lack ofsecurity infrastructure. Removal of nearly all staff maybe more acceptable but can reduce program quality andplace more risk on the beneficiary when accessing assist-ance (Stoddard et al. 2006). These risks are exacerbatedby inadequate risk perception and a decreased sense ofurgency from remote managers who lose touch with thesituation on the ground (Cunningham 2016; GOAL2016). Policies need to be implemented that acknow-ledge the realities of fraud and corruption on theground.General strategies for reducing risk include building
strong relationships with communities, strategic coord-ination with partners, and detailed monitoring, amongothers (GOAL 2016; UNICEF n.d.). Additionally, donorand organizational reporting requirements need to en-sure they do not put national staff at increased risk andclear contingency plans are required prior to deterior-ation in security in order to maximize risk management(Howe et al. 2015; UNICEF EMOPS 2012).
AdvocacyAdvocacy is thought to suffer in remote operations, as itis highly dependent on the presence of internationalstaff. The legitimacy of the message is directly related topresence in the field, and cannot be substituted by thatof local NGOs (LNGOs), who usually do not have thesame influence as their international counterparts. Re-mote operations were found to weaken protection activ-ities in Afghanistan that were dependent on advocacyfrom INGO/IOs (Stoddard et al. 2010). Communicationand advocacy efforts are also critical to there-enforcement of community ownership and programacceptance, thus despite the restrictions, they should beincreased when shifting to remote operations (UNICEFEMOPS 2011a). UNICEF Iraq found that implementingpartners could be used to deliver messages on theground. However, policy and decision messaging had tocome from UNICEF directly to be effective (UNICEFEMOPS 2011b).
Monitoring and evaluationAccountability in remote operations is multifaceted andincludes both upward accountability to donors anddownward accountability to beneficiaries. It is a crucialcomponent of risk mitigation and management, with in-creased monitoring and reporting requirements thantraditional programming due to the lack of field pres-ence and direct oversight by INGO/IOs. Accountabilityis further compromised by limited opportunities for datacollection, poor quality data and inaccurate information,
Chaudhri et al. Journal of International Humanitarian Action (2019) 4:9 Page 14 of 45
lack of monitoring skills and capacity of local staff, lackof good baseline data for performance indicators, issueswith safely sharing information, rapid aid influxes thatnecessitate immediate action and prevent monitoringand evaluation (M&E) from being built in at the onset,and difficulty gaining support from local staff who mayfeel money is better spent on delivery of aid (Jansury etal. 2015; Norman 2011, 2012; Rivas 2015; Souness 2011;Zyck 2012). One study found that only 8 out of the 20INGO/IOs interviewed had an organizational M&Eframework (Norman 2011).
Upward accountability Upward accountability to do-nors is the focus of the majority of monitoring activities(Stoddard et al. 2010). However, donor expectations areoften not well-suited to fragile settings, can increase riskto local partners (Howe et al. 2015), and can detractneeded funds from programming; increased flexibilityand realism is required (Rivas 2015; UNICEF EMOPS2011a).
Downward accountability Downward accountability tobeneficiaries ensures target population needs are beingmet and aid is delivered equitably and as intended. How-ever, it is often forgotten by organizations (Faubert et al.2010; GOAL 2016). Methods for monitoring of down-ward accountability include beneficiary rapid assessmentsurveys (IOM 2008), feedback forms (GOAL 2016;Oxfam International 2007; Rivas 2015), hotlines(UNHCR 2014), meetings and discussions with commu-nities (Rivas 2015; Souness 2011), systems of complaintsredress (GOAL 2016; Norman 2012; Stoddard et al.2010), structures that promote beneficiary participation(Norman 2012), and prioritizing beneficiary accountabil-ity within senior management (Kjaerum 2015).
General methods A clear plan for M&E must be de-signed; monitoring in remote operations may need to bemore intensive and can require significant resources andtools beyond those used in direct management settings(GOAL 2016). Several general methods exist to supportinternal and external M&E initiatives in remote opera-tions; internal M&E is considered less rigorous than ex-ternal due to reduced transparency, neutrality,objectivity, and impartiality (Jansury et al. 2015).Internal monitoring methods include having clear
monitoring and reporting structures delineated in ad-vance (CDC 2016; GOAL 2016; Stoddard et al. 2010),specific monitoring capacity within an organization, andregular communication, written reports, and strict dead-lines for field staff (Rogers 2006; Stoddard et al. 2010).External monitoring methods include contracting localfirms for independent third party monitoring (Balslev-O-lesen and Hüls 2011; Egeland et al. 2011; IOM 2008;
Rivas 2015; Stoddard et al. 2010; UNICEF 2016; UNICEFEMOPS 2011b), cross checking information with fieldand community contacts (Balslev-Olesen and Hüls 2011;ECHO 2013; Egeland et al. 2011; GOAL 2016; Schreterand Harmer 2013; Stoddard et al. 2010; UNICEF 2016),and sharing monitoring capacity with other organiza-tions (UNICEF EMOPS 2012).
Technological support Technology has been employedin a variety of facets to enable electronic or web-basedmonitoring (Balslev-Olesen and Hüls 2011; GOAL 2016;Howe et al. 2015; Schreter and Harmer 2013; UNICEFEMOPS 2012). Examples include mobile phone monitor-ing applications, satellite imagery, barcode tracking sys-tems, and mapping software, among others. Furtherresearch and investment in data collection and analysis,and communications technology is required with theaim of streamlining its incorporation across programs.Save the Children Somalia experimented with simu-
lated technical field visits to provide support to their nu-trition operations in Hiran, Somalia; the first visit wascompleted over Skype in October 2015. The objectiveswere to monitor the nutrition programs and verify theirexistence, assess quality against benchmarks, identifygaps and areas for capacity development, and motivatethe field teams via establishing rapport. Standards andbenchmarks were agreed upon and the field team pro-vided electronic evidence (scanned patient cards andstock records, focus group discussion notes, completedchecklists, photographs, etc.) for the international staffto review prior to the call. The call then allowed for ajoint review of the documents with the field, provisionof feedback, and development of an action plan. A re-cent simulated field visit found that the mean upper armcircumference measurement was performed incorrectlyand outpatient cards were improperly filled out, indicat-ing further training was required. They were also able toassess the site via photographs, noting the buildings didnot provide a shaded waiting area for mothers andlacked adequate furniture. The lessons learned from thisprocess include prior preparation and extensive commu-nication is required to ensure a complete set of docu-ments is delivered for assessment, taking representativephotographs is a skill that must be taught, quality check-lists were very useful, and strict discipline was requiredto set aside uninterrupted time to complete the visit.However, the utility of this process remains in questiongiven the limited control over what the team chooses topresent (Zikusooka et al. 2015).
The “remote operations trap”The “remote operations trap”1 refers to the inability totransition back to a traditional management mode aftera program has been implemented remotely for some
Chaudhri et al. Journal of International Humanitarian Action (2019) 4:9 Page 15 of 45
time (ECHO 2015; Stoddard et al. 2010). This is causedby a number of factors and effects including reducedground-level information, less credibility of the agency,and increased risk for local partners. One NGO reportedthat after a year of programming remotely in Somalia,national staff became identified as decision makers andresource handlers and threats against them increased(Stoddard et al. 2009); this made it more difficult forthem to reengage later by traditional means. Additionalcontributors to the resistance to returning to regular op-erating mechanisms are the potentially outdated percep-tion of dangerous areas and risk secondary to a loss offamiliarity with the operating environment, aprotection-oriented security culture, security costs allo-cating resources away from more comprehensive pro-gramming, and bureaucratic inertia (Kjaerum 2015;Stoddard et al. 2010). The best way to avoid the remotemanagement trap is continuous reassessment and apre-planned exit strategy.
Planning and guidanceThere is a significant need for proactive planning andguidance on when to employ remote methods, how tooperate effectively remotely, and when to exit remoteoperations. While considering the potential need for re-mote operations early in every program would be ideal,most agencies lack specific criteria to assess risk andguide these transitions (including an exit strategy) (Stod-dard et al. 2006), plans for potential partnerships, andappropriate situation specific risk transfer practices tosupport decision making (Collinson and Duffield 2013),resulting in them often being used as a last resort. Guid-ance should cover all these topics, include indicatorsand checklists, and be integrated into the initial programplanning documents in order to promote consideredphasing into and out of remote operations (IMC 2016b;Steets et al. 2012; UNHCR 2016; UNICEF EMOPS2011c). When original remote operation guidance hasnot been produced, adapting protocols to the new con-text must be prioritized; it should not be assumed thatstrategies outlined for regular operations would be ap-propriate in an inaccessible conflict setting (Zyck 2012).It is up to donors to provide flexible funding that is ableto adapt to changes in implementation secondary to in-security (Oxfam International 2007).
DiscussionThe descriptive nature of the literature and the focus ondefining concepts highlights that this field is in a rela-tively nascent stage. This review provides conceptualbackground and definitions that will aid in future discus-sions of remote operations using a common understand-ing and language. The themes identified in this revieware consistent with those of other reviews and critical
reports (Donini and Maxwell 2013; Kalkman 2018). Theinformation in this review provides a foundation of ex-amples of and lessons learned from experiences with re-mote operations in conflict-affected areas. This review isdistinct from other review articles on remote operations(Donini and Maxwell 2013; Rivas 2015) as it employedrobust systematic review methods and performed an ex-tensive search of both peer-reviewed and gray literature.Together, this approach gathered a vast collection of ex-periences, methods, tools, and lessons learned from avariety of organizations, resulting in findings and con-clusions that aim to limit bias and have broad relevance.The collection of tools that have been developed for re-mote programming and monitoring should also be help-ful to other stakeholders as they work to develop theirown tools.The literature demonstrates that although many orga-
nizations are participating in remote programming ormonitoring, few have documented their experiences sothat lessons learned can be disseminated to other orga-nizations or stakeholders. Of the documentation that ex-ists, case studies were the predominant form ofliterature available; the lack of rigorous operational re-search measuring robust outcomes limits the ability todraw strong conclusions on the effectiveness of differentapproaches. The imbalance between peer-reviewed andgray literature sources demonstrates that while some or-ganizations are documenting their work for internal re-view, despite their potential external utility, they facebarriers in publishing these more experiential reports fora wider audience. More comprehensive tools, such asevidence-based best practice guidelines, remain difficultto create for a number of reasons, including the near im-possible conditions that surround robust outcome datacollection in insecure environments and thecontext-specific nature of many interventions that limitsthe ability to draw generalizable conclusions.The nature of the remote operations model is wrought
with difficult circumstances that demand frequent sacri-fice, making the creation of and adherence to rigorousguidelines difficult. Despite this, there are a number ofkey principles that can be taken away from this review.The importance of capacity building and effective com-munication is crucial to develop trust between partnerswhen working remotely. Capacity building and increas-ing partnerships with local staff have been found to be abenefit of remote operations but are also an essentialcomponent of risk mitigation in this setting (Donini andMaxwell 2013). The assumption that national staff are ata reduced risk is often false; the threats faced by nationalstaff must be comprehensively assessed and addressed.This should be completed before the implementation ofremote operations and ensure that national and localstaff have a greater part in decision-making (Kalkman
Chaudhri et al. Journal of International Humanitarian Action (2019) 4:9 Page 16 of 45
2018). M&E methods must be reinforced and may re-quire more intensity and resources than in direct man-agement settings. And finally, planning remains crucialfor all phases of remote operations, from creating con-tingency plans to support regular programs in the eventa transition to remote operations is required, through toexit planning to guide the transition back to standardprogram methods and ensure they are not remotelymanaged for longer than necessary.The movement toward the localization of humanitar-
ian action supports the shift toward a more balanced hu-manitarian system where national and local actors arevalued, supported, recognized, and reinforced by donorsand INGOs. Remote operations have overlap with andcan learn from localization principles and methods, suchas prioritizing partnership management, supporting andstrengthening the capacity of local and national organi-zations, and updating INGO policies and procedures toreinforce accountability, among others (Emmens andClayton 2017).
Limitations of the literatureThis review of gray and peer-reviewed literature on hu-manitarian health programming and monitoring in in-accessible conflict settings highlighted many themes andissues spanning multiple domains: humanitarian princi-ples, partnerships, risks, advocacy, accountability, the“remote operations trap,” and planning and guidance.While thorough in its analysis of content, one of themain limitations found throughout this review was thatthe literature focused on INGO/IO perspectives, with lit-tle information on the experiences of other players in-cluding national and local staff, religious andcommunity-based organizations, and communitiesthemselves. While remoteness from national and localpartners is a defining characteristic of remote opera-tions, their experience and perspective are invaluableand can greatly inform future guidelines and operations(Kalkman 2018).The literature was also focused on service delivery and
lessons learned but lacked detail on how interventionswere implemented, what gaps need to be filled, and howthey would have liked to do things differently, making itdifficult to replicate these efforts and to think criticallyabout which strategies were effective or how they couldbe improved. There is also limited discussion of theneeds of the population or incorporation of a humanrights framework, or of ethical issues other than risktransfer, such as confidential beneficiary data manage-ment, appropriate engagement strategies in high-risk en-vironments, and the dissemination of monitoring data(Rivas 2015).An additional limitation was the general lack of dis-
cussion on the costs of remote operations; specifically,
what is sacrificed and lost when one is forced to pro-gram or monitor remotely. Only one peer-reviewedstudy reported on these drawbacks, citing limited coord-ination capacity resulting from reduced contact withlocal implementers (Mattli and Gasser 2008) and whileit was mentioned in the gray literature, the responseswere based more on observation than rigorous analysis.Further examination of the potential losses in programquality and fidelity are necessary to obtain a completepicture that can then be fully addressed; this cost-benefitanalysis is an important avenue for future research inthis field.The majority of documents pertaining to this subject
were neither published nor peer-reviewed and withinthe peer-reviewed literature, over one-third of the stud-ies were case studies. This is consistent with other re-views which found most of the humanitarian evidenceis from programmatic evaluations or reports, ratherthan peer-reviewed articles or academic studies (Krys-talli 2017). Further, the majority of the documentsfound were descriptive in nature, with no quantitativeassessments of the impact on program processes orhealth outcomes, demonstrating the difficulty of col-lecting high-quality data in remotely operated humani-tarian emergencies. A major difficulty in conductingreviews of evidence from humanitarian settings is theconvention of only including rigorous evidence-basedstudies and discounting studies that do not conform tothese strict criteria (Krystalli 2017). Additionally, a lackof detail was prevalent throughout the literature, whichwas often attributed to organizations not wanting todiscuss specific methods for fear of increasing securityrisk. In addition to the lack of rigorous research andevaluation of remote operations, there is an absence ofguidelines or recommendations on best practices. Al-though some tools exist and are shared in this review,there do not seem to be any harmonized tools that re-flect the variety of experiences or that have been vettedby the different agencies working in the field. As theevidence base for remote programming and monitoringis extremely limited, further information is needed onall aspects of this field of work (Donini and Maxwell2013), including piloting and validating guidelines andtools and incorporating areas of operational researchfrom the onset of remote programming and monitoringactivities (Table 4).
Limitations of this studyA limitation of this review is the focus on remote pro-gramming and monitoring for health-specific interven-tions. While there are many principles and findings thatcan apply to other types of humanitarian interventions,generalizability remains restricted.
Chaudhri et al. Journal of International Humanitarian Action (2019) 4:9 Page 17 of 45
Table
4Summaryof
gray
literaturearticles
Autho
rOrganization
Title
Locatio
nProg
ram
details
Type
ofpape
rResults
Schreter
and
Harmer
2013
Hum
anitarian
Outcomes
Deliveringaidin
high
lyinsecure
environm
ents:
Acriticalreview
ofthe
literature2001–2012
n/a
n/a
Literature
Review
Literature
high
lightsarang
eof
good
practices
inremotemanagem
ent,includ
ing:
-Establishing
high
lylocalized
,and
static,staffing
which
may
involvean
increase
rather
than
ade
crease
ofnatio
nalstaffbe
causeredu
ced
mob
ility
results
inthene
edformorestaffin
moreplaces
-Theuseof
diaspo
ranatio
nalsas
international
staff
-“Soft”remotemanagem
entwhich
involves
senior
internationalstaffhaving
aregu
lar,bu
tno
tfull-tim
e,presen
ce-Metho
dsto
enhanceaccoun
tabilityand
mitigate
quality
deficits
forremote
prog
ramming,
such
asweb
-based
mon
itorin
gandprojectverificationthroug
hthird
-party
triang
ulation
Literature
sugg
eststhat
good
practicein
prep
ared
ness
andplanning
involves
decentralizingorganizatio
nalautho
rity.Thiscan
bringbe
nefitsforim
proved
internalmon
itorin
g,be
neficiary
accoun
tabilityandacceptance,
thereb
yincreasing
staffsecurity.
Literature
falls
shortin
documen
tingand
providinggu
idance
onim
plem
entin
gprog
ram
byremotemanagem
ent,particularlyto
ensure
greaterprep
ared
ness
andplanning
:patchy
literature,ne
edforgu
idance
ongo
odpractice;
lack
ofevaluatio
ns,especially
inWASH
and
protectio
n;lim
itedsharingof
know
ledg
eon
targeting.
Stod
dard
etal.
2006
Cen
teron
International
Coo
peratio
n
Providingaidin
insecure
environm
ents:trend
sin
policyandop
erations
n/a
n/a
Hum
anitarianPo
licy
Group
(HPG
)Repo
rtQualitativestud
y
-Remotemanagem
ent=de
volutio
nof
respon
sibilityto
localactors
-Other
factorsthat
canlim
itaccess
tothosein
need
,which
areno
tne
cessarily
related
securitycond
ition
s:1-
Poor
infrastructurerequ
iring
expe
nsiveairlift
capacity
2-Po
liticalandmilitary
controlson
movem
ent
3-Weakinternationalsup
port
4-Shift
from
refuge
eto
internaldisplacemen
tsituations
➔complex
aideffortsthat
requ
irepo
liticalne
gotiatio
nswith
hoststate
Motivatorsto
consider
remotemanagem
ent:
1-Insecurity;iftempo
rary
may
closeprog
ram
andresumethereafter
2-Size
ofprog
ram:lesslikelyto
hand
over
largeprog
ram;needto
maintainpresen
cefor
solidarity/visibility
encourages
remote
managem
ent
Chaudhri et al. Journal of International Humanitarian Action (2019) 4:9 Page 18 of 45
Table
4Summaryof
gray
literaturearticles(Con
tinued)
Autho
rOrganization
Title
Locatio
nProg
ram
details
Type
ofpape
rResults
3-Sector
andfeasibility
ofwhatyouaretrying
todo
(ifgo
odswillbe
secure,ifsubcon
tractor
hasthecapacity
tomovethem
,etc.)
4-Levelo
fvulnerability
andne
ed5-
Con
text:range
oflocalp
artners,qu
ality
ofnatio
nalstaff,capacity
toop
eratein
aregion
-“Softservices”moreeasilyun
dertaken
bylocalentities
(psychosocial)than
infrastructure
orfood
aid
-Bene
fits:avoids
completeclosure,allows
fund
ingto
continue
toflow,security
environm
entcanbe
better
upon
re-entry
becauselocalkno
wledg
ehasno
tbe
encompletelylost,opp
ortunity
forcloser
commun
ityinvolvem
ent
-Challeng
es:establishtrustwith
localstaff;
cultu
raland
lingu
istic
differences
need
tobe
acknow
ledg
edin
training
andsupp
ort➔
mob
ile/emailh
elps,needto
preven
toverrelianceon
tech;d
ifficulty
maintaining
strategicdirectiondu
eto
inability
tocond
uct
need
sassessmen
tsor
measure
impact
-Challeng
e:tend
ency
tomaintainstatus
quo
insteadof
respon
ding
toacuteissues;
movem
entandaccess
restrictio
ns,
low-profilesecurityapproach,cautio
usremotemanagers,coordinatio
nchalleng
es-Challeng
es:accou
ntability,advocacystrategies,
staffingcapacity
-Mostagen
cies
dono
thave
setcriteria
toassess
riskor
togu
idethede
cision
toshift
toremotemanagem
ent;mostgu
idelines
andpracticedo
notfully
take
into
accoun
ttheun
ique
threats,incentives
and
circum
stancesfacedby
natio
nalstaff
-Internationalage
nciesne
edto
increase
effortsto
ensure
securityof
alllevelsof
staff
equally,assessing
each
level’s
unique
risks
andhaving
transparen
tpo
liciesthat
accommod
atethem
Stod
dard
etal.
2009
Providingaidin
insecure
environm
ents:2009Upd
ate.
Tren
dsin
violen
ceagainst
aidworkersandthe
operationalrespo
nse
n/a
n/a
HPG
Policybrief
Qualitativestud
y-Kidn
apping
ofaidworkershasincreasedby
over
350%
inthepastthreeyears,
-Remotemanagem
enteffectsthat
makeit
difficultto
shift
back
toregu
larprog
ramming:
redu
cedgrou
nd-levelinformation,less
cred
ibility
andtrustin
theagen
cy,increased
risks
forlocalimplem
entin
gactors
-Nationalstaffrequ
iresspecificsecurity
measuresthat
areprop
ortio
nate
to,b
utno
tthesameas,tho
seprovided
tointernationalstaff.
Chaudhri et al. Journal of International Humanitarian Action (2019) 4:9 Page 19 of 45
Table
4Summaryof
gray
literaturearticles(Con
tinued)
Autho
rOrganization
Title
Locatio
nProg
ram
details
Type
ofpape
rResults
-Securityincide
ntsno
tdo
cumen
tedas
system
aticallyfornatio
nals,p
artly
because
theriskto
theorganizatio
nvaries
(differen
tinsurancepo
liciesandliability).
-UNOffice
fortheCoo
rdinationof
Hum
anitarian
Assistance(OCH
A)d
evelop
edtracking
system
tomon
itorandrepo
rtaccess
constraints;
beingpilotedin
sixinsecure
contexts.
Collinsonand
Duffield
2013
Parado
xesof
presen
ce.Risk
managem
entand
aidcultu
rein
challeng
ing
environm
ents.
Hum
anitarianPo
licyGroup
GlobalInsecurities
Cen
tre
n/a
n/a
Com
mission
edrepo
rt-Lack
ofcommon
framew
orkto
supp
ort
decision
making
-Localstaff’sability
toassess
riskcanbe
influen
cedby
financialor
othe
rcompe
ting
prioritiesandincentives
that
encourage
risk-taking
;distin
ctthreatsrarely
acknow
ledg
edandhave
less
access
tosecuritymeasures,inform
ation,andsupp
ort
-Pervasivelevelsof
distrust:d
istrustbe
tween
peop
lewith
inagen
cies,b
etweenagen
cies,
betw
eenagen
cies
andtheirallege
d“ben
eficiaries”;d
ueto
distance,d
ifferen
ces
inpay,lack
oflocalp
resenceor
contact
with
localp
eople
Rivas2015
-Integrity
research
andconsultin
g-Axiom
M&E
-UKAID
NoLong
eraLastResort:
AReview
oftheRemote
Prog
rammingLand
scape
Somalia,Ken
yan/a
Literature
review
(Partof
aDFID
evaluatio
n)
-Remoteprog
rammingisno
long
ertempo
rary
oralastresort,b
ecom
inglong
term
-Literature
focuseson
international
organizatio
ns:littleinform
ationon
the
expe
riences
ofothe
rbo
dies
-Talkof
risktransfer
butno
tothe
rethical
prob
lems,such
as:the
transfer
ofbe
neficiary
data
tothird
parties,approp
riate
engage
men
tstrategies
inhigh
-risk
environm
ents,and
how
mon
itorin
ginform
ationisused
.-Mostcommon
risks:inade
quateinform
ation
managem
ent/cred
ibility/quality,corrup
tion,
incitin
gconflict,causalities
andfatalities,
insufficien
tim
pact,p
oormon
itorin
g,inform
altaxatio
n,securitychalleng
es,and
fund
diversion
-Mostcommon
mon
itorin
gmetho
ds:third
partymon
itorin
g,be
neficiary
feed
back
forums,evaluatio
nsandinde
pend
ent
analysis,and
commun
itymeetin
gs-Don
oraccoun
tabilityexpe
ctations
often
unrealistic
inthesecontexts;d
onor
flexibility
andrealism
requ
ired
-Bestpractices
includ
e:remotemanagem
ent
planning
;onthegrou
ndne
tworks
to
Chaudhri et al. Journal of International Humanitarian Action (2019) 4:9 Page 20 of 45
Table
4Summaryof
gray
literaturearticles(Con
tinued)
Autho
rOrganization
Title
Locatio
nProg
ram
details
Type
ofpape
rResults
enableaccoun
tability;third
partyM&E
;capacity
buildingfocusing
ontech
supp
ort,
prob
lem
solving,
andmanagem
entskills
-Planne
dsite-visits
from
remotemanagem
ent
prom
otelocalcapacity
andautono
my,
coordinatio
n,inform
ation-sharing,
andtrust
(SAVE),S.A.i.
V.E2016
BriefingNote,April2016
Afghanistan,Som
alia,
SouthSudan,Syria
3year
research
prog
ram
exploringeffective
respon
sede
liveryam
idhigh
insecurity
Briefingno
teMix-m
etho
dsstud
y(850
interviews
with
aidactors,
4000
surveysof
affected
peop
le)
-Aid
agen
cies
tend
toclusterin
saferareas;
presen
cecanbe
deceptivelyshallow
-Localb
eneficiariesrepo
rted
that
aidreceived
was
oftenno
twhatwas
mostne
eded
-Con
cessions
includ
ed:Payingforaccess
and
grantin
gconcession
sarecommon
place,yet
gene
rally
tabo
oas
subjectsof
discussion
.Practices
includ
epaying
mon
eyat
checkpointsand;
paying
unofficialtaxes,;
alterin
gtargetingcriteria,;em
ployinglocal
militia,;andavoiding
someareasso
asno
tto
antago
nize
localautho
rity,armed
actoror
dominantcommun
ity;zerotoleranceon
corrup
tionpo
liciesareun
realistic
inwar
zone
s-Manyhu
manitarianactorsareun
certainabou
twhe
ther
orho
wto
engage
with
non-state
armed
actors;localstaffne
edspecificskills
inne
gotiatio
n,context,andne
tworking
Steetset
al.
2012
GlobalP
ublic
PolicyInstitu
te(GPPi)
Evaluatio
nandreview
ofhu
manitarianaccess
strategies
inDGEC
HO
fund
edinterven
tions
n/a
n/a
Literature
Lirt
review
+qu
aland
Qualitativestud
y(388
interviews)
-3metho
dsto
tackleaccess
constraints:
persuade
controllersto
allow
moreaccess,
mitigate
andmanagesecurityrisks
tocontinue
assistance,rem
otemanagem
ent
-Thereiswidespreadagreem
entthat
thetask
ofne
gotiatin
ghu
manitarianaccess
with
non-statearmed
grou
psshou
ldbe
leftto
implem
entin
gorganizatio
ns.
-DGEC
HOshou
ldconsider
sevenkeyissues.
First,organizatio
nsmustavoidun
duerisk
transfer
tofield
staff,partne
rsandbe
neficiaries.
Second
,partnersprop
osingremote
approaches
shou
ldde
scrib
eho
wthey
intend
tobu
ildacceptance.Third,the
yne
edto
specify
thelevelo
fexperienceandtechnical
capacity
ofrespon
siblefield
staff.Fourth,
whe
reprojectsareim
plem
entedin
volatile
areas,organizatio
nsshou
ldhave
continge
ncy
plansforho
wto
switchto
remotemod
ewhe
naccess
deterio
rates.Fifth,mon
itorin
gproced
ures
have
tobe
adaptedto
the
challeng
esof
remotemanagem
ent.Sixth,
DGEC
HOshou
ldgive
preced
ence
toorganizatio
nsthat
have
locatedsenior
staffas
closeas
securitycond
ition
spe
rmitto
Chaudhri et al. Journal of International Humanitarian Action (2019) 4:9 Page 21 of 45
Table
4Summaryof
gray
literaturearticles(Con
tinued)
Autho
rOrganization
Title
Locatio
nProg
ram
details
Type
ofpape
rResults
theprop
osed
area
ofinterven
tion.Finally,D
GEC
HOshou
ldgive
preced
ence
toorganizatio
nsthat
seek
tode
liver
outputs
directlyor
limitthechainof
sub-contractors
forprojectim
plem
entatio
n.-DGEC
HOne
edsto
improveits
ability
tomon
itorprojectsdirectly.Itshou
ldrecruit
senior
staffwho
canmoreeasily“blend
in”
with
therespectivelocalenviro
nmen
tand
who
areless
encumbe
redto
travelby
administrativerestrictio
ns.
-Theseapproaches
entailrisks
that
need
tobe
carefully
review
edin
each
case
byDG
ECHOandpartne
rs.Rem
otelymanaged
operations
canbringabou
taloss
ofcontrol
andoversigh
t.Furthe
r,remoteapproaches
potentially
lead
toatransfer
ofriskto
natio
nal
staffandrecipien
ts-Sw
itchto
remotemod
ecanredu
ceproject
complexity
andqu
ality;sho
uldbe
alastresort
Stod
dard
etal.
2010
Hum
anitarian
Outcomes
Lesson
sandchalleng
esin
remotemanagem
ent
ofhu
manitarian
operations
forinsecure
areas
AfganistanA
fghanistan
case
stud
ywith
+comparison
sto
Iraq,
Somalia,SriLanka,and
Sudan
n/a
Repo
rtforC
entero
fInternational
Coop
eration
Mixed
metho
dsstud
y(58interviews
field
visitto
Afghanistan
andde
skreview
)
-Themostsuccessful
exam
ples
ofremote
managem
entfoun
dinvolved
coordinatio
nstructures
rooted
inthelocalcon
text,w
ithpo
tentialfor
buildingsustainablelocal
capacity
-NCCI(NGOcoordinatin
gcommittingin
Iraq)
Fieldfocalp
oint
netw
ork:24
LNGOsacross
coun
try,sharesecurity/po
liticalinfo,receive
training
onho
wto
collect/disseminateinfo,
advocacy,rights/law;share
info
and
expe
riences
with
othe
rLN
GOs;civilsociety
empo
wermen
t-Shurasystem
develope
dwith
headsof
prog
ram
andalln
ationstaffmem
bers:each
mem
bercoordinatedcoun
cilfor
1mon
thin
absenceof
expatriate,p
ermanen
tcoordinatoreven
tuallyagreed
on;shu
ramem
bersinvolved
inallimpo
rtantde
cision
s;do
wnside:slow
tode
velop,
slow
decision
making
-Po
tentialp
itfalls:rem
otemanagem
enttrap,
risktransfer
tonatio
nalswith
few
resources
andtraining
;red
uced
prog
ram
quality
and
effectiven
ess;redu
cedefficacyand
accoun
tability;im
partialityof
localactors
-Needbe
tter/m
oredifferentiatedrisk
assessmen
tfornatio
nalstaff,capacity
buildingon
implem
entatio
nandsecurity,
andcoordinatio
nstructures
rooted
inlocal
context
Chaudhri et al. Journal of International Humanitarian Action (2019) 4:9 Page 22 of 45
Table
4Summaryof
gray
literaturearticles(Con
tinued)
Autho
rOrganization
Title
Locatio
nProg
ram
details
Type
ofpape
rResults
-Reason
sforshift
toremotemod
e:security,
political,solidarity,visibility,d
evelop
capacity
oflocalactors,do
norsupp
ort,sustainability
-Factorsthat
govern
shift:range
oflocal
partne
rorganizatio
ns,q
ualityof
natio
nalstaff,
andtheirfre
edom
andcapacity
toop
eratein
agivencoun
tryor
region
-Despite
beingconsidered
tempo
rary,few
organizatio
nshave
exitstrategy
orcriteria
togu
ideshift
back
from
remotemanagem
ent
-Remotemanagem
enttrap
shaped
by:
potentially
outdated
percep
tionof
no-go
areas,costpressures,ne
edto
follow
protective
stance
ofothe
rorganizatio
ns,b
ureaucratic
inertia
-Risk
issues:transferred
tonatio
nalstaff,may
change
afterinternationalsleaveanddifficult
toassess
remotely
-Managem
entandcommun
icationin
remote
operations
arehe
lped
byface-to-face
interactions;impo
rtantfortrust
-Metho
dsto
mitigate
quality
deficits:clear
proced
ures
andinstructions
formon
itorin
gandrepo
rting;
maintainregu
lar
commun
icationbe
tweenfield
staffand
externalmanagers;bringim
plem
entersto
remotearea
regu
larly
fordiscussion
and
planning
;spo
tchecks;crosscheckinform
ation
with
othe
rfield
contacts;third
party
mon
itorin
g;anden
sure
bene
ficiariesknow
whatthey
shou
ldbe
receiving
-Guide
lines
forim
provingRM
:planforit,
adop
talong
-term
view
,develop
practical
andpo
licygu
idance,avoid
risktransfer,
investin
relatio
nships
with
localstaff/partne
rsandcommun
ityauthorities
priorto
shift,
coordinate
policyde
velopm
ent,andshare
lesson
slearne
dam
ongagen
cies
anddo
nors
Herbe
rt2013
GSD
RCRemotemanagem
entof
projectsin
fragilestates
n/a
n/a
Helpd
eskresearch
repo
rt-Keyfactorsthat
canfoster
successin
remote
managem
entprojectsinclud
e:acceptance
ofactivities
bylocalcom
mun
ities;effectivestaff
recruitm
ent,training
andretention;flexibility
inprog
rammingandbu
dgeting;
proxim
ityto
bene
ficiaries;visibility;mob
ility;and
effective
prep
arationforfastchanging
environm
ents
UNICEF
EMOPS
2011a
UNICEF
Unicefa
ndRemote
Prog
ramming:
Afghanistan
case
stud
y
Afghanistan
n/a
EMOPS
guidance
onremoteprog
ramming
backgrou
ndpape
rsCasestud
y
-Reliedon
military
partne
rsto
access
southe
rnprovinces;im
partialityissue
-Selectionof
cred
ibleandcompe
tent
partne
rswas
critical;localaccou
ntingpartyhiredto
Chaudhri et al. Journal of International Humanitarian Action (2019) 4:9 Page 23 of 45
Table
4Summaryof
gray
literaturearticles(Con
tinued)
Autho
rOrganization
Title
Locatio
nProg
ram
details
Type
ofpape
rResults
assess
allp
oten
tialand
curren
tpartne
rs(skills
andfinances)
-Kand
ahar
risk:hadto
transfer
fund
sto
the
governmen
tto
managelong
term
capacity
streng
then
inginitiatives;g
overnm
entknow
nto
becorrup
tyetwereun
ableto
mon
itor
governmen
tactivities
-Usedremotemon
itorin
gcapacity
ofWFP;
jointmon
itorin
gredu
cedcosts
-Needto
consider
effectiveclusterapproach
inremoteprog
ramming
-Com
mun
icationandadvocacy
effortsshou
ldbe
streng
then
edwhe
nmovingto
remote
prog
ramming;
criticaltopro-actively
re-enforce
commun
ityow
nershipand
acceptance
oftheprog
ram
-Needforconstructivedialog
with
dono
rsto
establishrealistic
benchm
arks
UNICEF
EMOPS
2011b
UNICEF
UNICEF
andRemote
Prog
ramming:
Iraq
case
stud
y
Iraq
-Gradu
alshift
toremote
mod
etrigge
redby
2003
CanalHotelbo
mbing
;relocatedto
Amman
-Remotemanagem
ent
intensified
from
2008
to2009
assecurity
deterio
rated
EMOPS
guidance
onremoteprog
ramming
backgrou
ndpape
rsCasestud
yQualitative
2004—3rdpartymon
itorin
gcontract
sign
edw
Iraqi
company
(Al-Sam
i);mon
itors
recruitedfro
mcommun
ities
andableto
movearou
ndwith
outincide
nt;g
roup
assign
edto
each
sectorialp
riority
2006—mon
itorsroleexpand
edandbe
came
facilitators,du
tiesinclud
ed:service
delivery,
prog
ram
planning
andcoordinatio
nwith
governmen
tandothe
rpartne
rs;
-Remotemod
edidno
tresultin
increased
collabo
ratio
nbe
tweentheUNsystem
;cluster
system
notinclusiveto
NGOs
-Partne
rships:m
usten
sure
transparen
cyin
selectionandterm
sof
employmen
t,involve
contractorsin
planning
,and
maintainsing
lepo
intof
contact
-Com
mun
icationandAdvocacy:im
plem
entin
gpartne
rscanbe
used
inpracticaladvocacy
onthegrou
nd,how
ever
policyde
cision
and
messaging
hasto
remainwith
inUNICEF
control
UNICEF
EMOPS
2011c
UNICEF
UNICEF
andRemote
Prog
ramming:
Pakistan
case
stud
y
Pakistan
2009
moveto
remote
mod
efollowing
kidn
apping
EMOPS
guidance
onremoteprog
ramming
backgrou
ndpape
rsCasestud
y
-KPKandFede
rally
Adm
inisteredTribalAreas
(FATA
)high
lyvolatile;2010
remoteprog
ram
intheseregion
sin
respon
seto
flood
s-Prog
ram
criticalityexercise
cond
uctedprior
toshift;resultedin
decreasedactivities
with
afocuson
immun
ization
-Con
ducted
orientationsessions
onremote
operations
tobu
ildpartne
rcapacity,how
ever,
largelylearning
bydo
ing
-Removed
alllog
os
Chaudhri et al. Journal of International Humanitarian Action (2019) 4:9 Page 24 of 45
Table
4Summaryof
gray
literaturearticles(Con
tinued)
Autho
rOrganization
Title
Locatio
nProg
ram
details
Type
ofpape
rResults
-Third
partymon
itorin
gfoun
dprog
ram
tobe
below
standard;resultantly,investedin
natio
nalcapacity
building,
coaching
,and
training
-Issues:involvemen
tof
military
tode
liver
aid,
low
collabo
ratio
nbe
tweenUNsystem
,lack
ofform
algu
idance
andcheckliststo
guide
prog
ramming
-Needforflexibleprog
ram
policyand
proced
urein
changing
environm
ent
UNICEF
EMOPS
2011d
UNICEF
UNICEF
andRemote
Prog
ramming:
Somalia
case
stud
y
Somalia:p
rotracted
crisiswith
annu
alflood
cycles
EMOPS
guidance
onremoteprog
ramming
backgrou
ndpape
rsCasestud
y
-Presen
ceover
18years,strong
partne
rship
with
localN
GOsandgo
vernmen
tallows
mainten
ance
ofgo
odde
liveryin
redu
ced
access
settings
-Efficacyandsecuritymay
been
hanced
byaUNICEF
system
that
works
closelywith
that
oftheothe
rhu
manitarianagen
cies,
rather
than
beinglocked
into
UNDSS
structures
-Issues
with
largeNairobi-based
remote
supp
ortcenter:ind
ecisivecultu
re,p
rocesses
dominateover
results
anddivertsresources
from
field
offices,habitof
riskavoidance
rather
than
managem
ent,have
preven
ted
seizingaccess
oppo
rtun
ities
andne
wim
plem
entatio
nmod
alities
-Opp
ortunity
tobu
ildinde
pend
entmon
itorin
gsystem
throug
hpartne
rsandcontractorswas
notseized
whe
nlocalaccesswou
ldhave
allowed
nego
tiatio
ns;resultedin
poor
feed
back
onaidde
liveryandrelianceon
externalpartne
rsto
setup
smaller/weaker
mon
itorin
gstructures
(accou
ntability
and
repu
tatio
nrisk)
-Lesson
s:stay
focused/do
notstretchtoothin;
bede
cisive
andusestrategicop
portun
ities;try
new
deliverymetho
ds;unite
andhave
sectors
worktoge
ther;reg
ular
andho
nestdialog
with
partne
rsanddo
norsbu
ildstrust
Belliveau
2013
MSF
“Rem
otemanagem
ent”
inSomalia
Somalia
-Remotemod
efollowing
2008
roadside
bomband
deaths
of3MSF
employees
-Cou
ntry
managem
ent
team
inNairobi
-2ne
who
spitalw
ards
open
ed
Hum
anitarianPractice
NetworkPape
r-Internationalstaffbe
nefits:bringou
tside
expe
rienceandtechnicalskills,increased
legitim
acyof
advocacy,increased
ability
toresistlocalp
ressures
forresource
diversion
-Risksof
remotemod
e:redu
cedcontrolo
ver
resources,de
cliningqu
ality,lim
itedor
noprog
ram
expansionor
adaptatio
n,increased
riskto
natio
nalstaff,po
tentiallossof
impartialityandability
towitn
ess/speakou
ton
behalfof
affected
popu
latio
n
Chaudhri et al. Journal of International Humanitarian Action (2019) 4:9 Page 25 of 45
Table
4Summaryof
gray
literaturearticles(Con
tinued)
Autho
rOrganization
Title
Locatio
nProg
ram
details
Type
ofpape
rResults
-Keyconcep
tsof
mod
el:cen
tralized
decision
making,
micro-m
anagem
entand
cross-checking
,sup
portandtraining
(increasedfre
quen
cyandwider
rang
e)-Localadm
inistrationor
commun
ityelde
rsaid
recruitm
entof
unskilled
workersto
ensure
approp
riate
clan
balanceandde
flect
potential
dissatisfaction
-Externalevaluatio
nconclude
dthat
strong
remotemanagem
entproced
ureandextra
scrutin
yworkwell,no
system
aticleakageor
noticeablecorrup
tion,high
standard
ofstock
managem
entandfinancialcontrol
-Successdu
eto:rigorou
scontrolsystem,
compe
tenceof
natio
nalfield
staff,their
familiarity
with
MSF’sprinciples
andwaysof
working
,highde
gree
ofnatio
nalstaff
owne
rship
How
eet
al.
2015
TuftsUniversity
Breaking
theHou
rglass:
Partne
rships
inRemote
Managem
entSettings—
TheCases
ofSyria
and
Iraqi
Kurdistan
Turkish-Syrian
boarde
r2013
Remoteop
erations
from
outset
inSyria
dueto
governmen
tregu
latio
n
Historicalanalysis
Qualitativestud
y(123
interviewswith
46organizatio
ns)
-Accessde
pend
enton
localn
etworks
and
repu
tatio
ns;p
artnersiden
tifiedthroug
hcontacts,coo
rdinationmeetin
gswith
LNGOs,
andLN
GOswho
reache
dou
tto
INGO
(passive
andbias
towardLN
GOswith
skills
andcontacts,activemetho
dsof
recruitm
ent
preferred)
-Techniqu
esforcapacity
building:
training
s,worksho
ps,p
artnership
focalp
oints,staff
second
men
ts,p
ilotprojects
-Inno
vativeM&E
approaches:callcen
ters,
GPS
shipmen
ttracking
,deb
riefingmeetin
gwith
localp
artners;localm
etho
ds:p
hotosand
vide
osof
distrib
utions,w
eb-based
remote
projectmon
itorin
g,daily
verbalrepo
rts,pe
erob
servations;3rd
partymon
itorin
g=go
ldstandard
-Don
orscanprioritizelong
er-term
sustainability
oflocalp
artnersvia:organizatio
naland
operationalcapacity
building,
afocuson
the
capacity
oftheinstitu
tion,supp
ortin
glong
er-term
projects,p
roviding
core
fund
s,andsupp
ortin
galliances
amon
glocalg
roup
s-Trustbu
ildingkeyforlocalp
artnerships;bu
ildtrustvia:regu
larin-personmeetin
gs,
transparen
tde
cision
-making,
robu
stfeed
back
mechanism
s,jointagen
dasetting,
and
open
ness
topartne
rpe
rspe
ctives
-Needto
prioritizesecurityforbo
thnatio
nals
andinternationalswith
clearcontinge
ncy
plansanden
surin
glocalsecurity
costsare
includ
edin
budg
et
Chaudhri et al. Journal of International Humanitarian Action (2019) 4:9 Page 26 of 45
Table
4Summaryof
gray
literaturearticles(Con
tinued)
Autho
rOrganization
Title
Locatio
nProg
ram
details
Type
ofpape
rResults
Samestud
ySyria
case
n/a
Mod
esem
ployed
:direct
implem
entatio
nfully
orpartially
byINGOSwith
hiredSyrianstaff;
Sub-contract,sho
rtterm
andlogistical
(exdistrib
utionof
food
aid);
Partnerships
-Inability
toen
gage
incoordinatedrespon
seledto
disharmon
ized
approach
toworking
with
smallp
oolo
forganizations;neg
atively
affected
theabsorptivecapacity
oflocal
organizatio
nsandultim
atelycomprom
ised
humanitarianactivities
-Partne
rselectionistw
o-way
street;INGOS
need
tohave
good
relatio
nships
with
repu
tablepartne
rsifthey
wantto
bechosen
byLN
GOsin
future
-LN
GOsprefer
tailoredsm
allertraining
son
mutually
selected
topics;d
edicated
focal
pointpe
rson
canhe
lpto
addresslocal
partne
rsne
eds
-Issues
with
third
partymon
itorin
g:resource
intensive,expe
nsive,repe
ated
useof
same
firm
cancomprom
iseob
jectivity
and
neutrality,firm
accoun
tableto
same
organizatio
nthat
hiredthem
(limits
objectivity)
-Don
orrequ
iremen
tscanbe
securityriskand
proh
ibitive
toprog
ramming;
toprovide
internationalo
rganizations
with
bene
ficiary
listsfro
mun
der-sieg
earea,localpartne
rswereob
liged
topaysm
ugglersto
move
peop
leanddo
cumen
tatio
nacross
sieg
elines
-Sustainabilityin
theface
ofdo
norwith
draw
al:
LNGOssw
itche
dto
less
capital-inten
sive
activities
whe
naccess
redu
ced,
diversified
,andapproached
othe
rdo
norsforfund
ing
-Lack
ofINGOsupp
ortof
core
costs(ope
ratin
g,salaries)of
localp
artnersinhibitstrustand
sustainability
Samestud
yIraqi
KurdistanCase
n/a
n/a
LNGOcoping
strategies
towith
draw
al:
dorm
ancy,d
ownsizing(re
lianceon
volunteers),
privatesector
andincomege
neratio
n,
Ham
mon
dand
Vaug
han-Lee
2012
HPG
ODI
Hum
anitarianspacein
Somalia:a
scarce
commod
ity
Somalia
-Remotelymanaged
out
ofNairobi
orMog
adishu
sincelate
90s;increased
whe
nsecurityrisks
sign
ificantlyincreasedin
2007–2009
Working
Pape
r-Use
ofdiaspo
rareturnees;advantages:
technicalskills
andmoreacceptablethan
westerners;disadvantage
s:resented
bylocals
forlargesalariesandbe
ingou
tof
touchwith
realities
onthegrou
nd-Havepu
lledaw
ayfro
mconven
tional
coordinatio
nmechanism
(cluster
system
)to
workinde
pend
ently:som
ecasesim
proved
access
butno
unde
rstand
ingof
whatothe
ractorsaredo
ingor
common
standard
for
dealingwith
demands
-2007–2008de
velopm
entof
OCHAjoint
Chaudhri et al. Journal of International Humanitarian Action (2019) 4:9 Page 27 of 45
Table
4Summaryof
gray
literaturearticles(Con
tinued)
Autho
rOrganization
Title
Locatio
nProg
ram
details
Type
ofpape
rResults
operatingprincipalsforSomalia:never
form
ally
operationalized
;likelyworriedthat
ifthey
followed
internationalh
umanitarianstandards
wou
ldno
tbe
ableto
operate
IMC2016a
IMC
Detailsfro
mIMCSomalia
Prog
ramming(e-m
ail)
Somalia
n/a
Emailcom
mun
ication
-Increase
bene
ficiary
access
via:mob
ileteam
s,commun
itymessaging
advertisingservice
availability,de
mandge
neratio
nvia“spreading
word”
(discharging
patientswith
literature
andsimplerepe
atablemessaging
),used
Com
mun
ityHealth
Com
mittees(elected
respectedvolunteers)as
bridge
betw
eenIMC
andcommun
ity-Usedne
arly100%
localstaffwith
approp
riate
clan-balance,resultedin
good
localp
erception
andminim
albribes
atcheckpo
ints,
confiscatio
ns,raids,and
threats
-M&E
metho
ds:spo
ntaneo
usvisitsand
planne
d-capacity-building-visits,third
party
mon
itorin
g-Transparen
cy:sharedrepo
rtswith
employees
tovalidateworkandjustify
visits
IOM
2008
IOM
Prog
rammeManagem
ent
by“Rem
oteCon
trol”
Iraq
-Remotelymanaged
from
Amman
-Atleast2im
plem
entin
gpartne
rspe
rprog
ram
Book
chapter
-Coo
rdinationwith
governmen
tof
Iraqand
internationalcom
mun
ityviaIDPworking
grou
p(NGOs,NCC
I,UN)toavoiddu
plication
-Type
sof
mon
itorin
gused
:direct
byIOM
stafftravelingto
sites;IOM
staffandthird
party;IOM-con
tractedexternalconsultants;
mon
itorin
gof
NGO-im
plem
entedprojects
byexternalorganizatio
nswho
visitevery
2weeks
-Mon
itorin
gprocurem
entsystem
hasseveral
filters:p
rogram
unitgo
esthroug
hchecks,
logisticsun
itthat
doub
lechecks
prices/
contract
term
s/authen
ticity
ofrequ
ests,
also
doun
anno
uncedspot
checks
Kjaerum
2015
DanishRefuge
eCou
ncil
RemoteManagem
entin
Hum
anitarianOpe
ratio
ns:
Lesson
slearne
dfro
mLibya
andbe
yond
Libya
12mon
thArm
edViolen
ceRedu
ctionprog
ram
inSabh
aRemotelymanaged
from
July2014
totodayfro
mTunisia
Evaluatio
nandLearning
Brief
Qualitativestud
y
-Noremotemanagem
entcontinge
ncyplan
despite
ongo
ingtensions
incoun
tryprior
toplanning
,resultedin
standstillo
fproject
activities
durin
gshift
-Capacity
issue:severalactivities
requ
ired
presen
ceof
internationaltechn
icalexpe
rtandwerecanceled
;trainings
bylocalstaff
(non
-experts)no
twellreceived
-Bu
nkerisationcontrib
utes
tobe
neficiary
mistrustandremotemanagem
enttrap
-Bene
fitsof
remotemod
e:increasedlocal
owne
rship,
decision
making,
increased
capacity/sustainability
offield
staff;continued
engage
men
tbu
ildstrustam
ongcommun
ities/
Chaudhri et al. Journal of International Humanitarian Action (2019) 4:9 Page 28 of 45
Table
4Summaryof
gray
literaturearticles(Con
tinued)
Autho
rOrganization
Title
Locatio
nProg
ram
details
Type
ofpape
rResults
stakeh
olde
rsmakingiteasier
toshift
back
tono
rmalop
erations
-Needforcoun
tryoffices
tode
velopremote
managem
entplans,training
plansfor
natio
nalstaff,andassessmen
tof
key
operationalg
apsthat
wou
ldoccurfollowing
shift
toremotemod
e
Cun
ning
ham
2016
MSF
Emerge
ncyGap
Series02:
ToStay
andDeliver?The
Yemen
Hum
anitarian
Crisis2015
Yemen
2015
Managed
from
Amman
Qualitativestud
y-Remotemanagershadinadeq
uate
risk
percep
tionandde
creasedsenseof
urge
ncy
tothene
edson
thegrou
nd-Locusof
securityde
cision
-makingmisplaced
:de
cision
makingshou
ldbe
inhand
sof
operationalm
anagersrather
than
security
person
nel
-Dep
ende
nceon
theUNforlogisticsismajor
issue:locksINGOsinto
decision
smade,or
not
made,by
UN,and
affectsINGOinde
pend
ence,
capacity,and
mindset
Hansen2008b
NGOCoo
rdination
Com
mittee
inIraq
Ope
ratio
nalM
odalities
inIraq
Iraq
n/a
Briefingpape
r-Needforacceptance:achievedover
time
throug
hdialog
andstaffactio
ns-Needforflexibility:rapidlychanging
context;
rapidde
centralizationto
skilled
field
staff
givesmoreop
tions
forcontinuing
prog
ramming
-Needforproxim
ityto
victim
s:increasesqu
ality
ofhu
manitariandata,safeaccess,aid
effectiven
ess
-Needforvisibility:ne
cessaryforacceptance
inlong
term
butjeop
ardizeseffectiven
essshort
term
-Needto
expand
operations:expansion
shou
ldbe
gradualand
controlledin
orde
rto
groo
mpartne
rswith
outbe
comingatarget;sud
den
increase
inresourcesinterfe
reswith
team
dynamicsandcontrib
utes
toloss
ofcontrol
onho
wthey
areused
Hansen2008a
NGOCoo
rdination
Com
mittee
inIraq
Adaptingto
Insecurity
inIraq
Iraq
n/a
Briefingno
te-With
draw
alof
internationalstaffandmob
ility
constraintson
natio
nalstaffresultin
increm
entalincreases
inge
ograph
icand
psycho
logicalg
apsbe
tweenbe
neficiaries
andproviders
-Flexiblemanagem
entwhe
reremote
managersplay
supp
ortin
groleto
skilled
team
s;authority
delegatedto
field
staffto
makede
cision
sabou
top
erations
andsafety
-Iden
tificationat
distrib
utions
viaremovable
sign
ageor
viamed
iauseful
forbu
ilding
repu
tatio
nof
organizatio
nandacceptance
Chaudhri et al. Journal of International Humanitarian Action (2019) 4:9 Page 29 of 45
Table
4Summaryof
gray
literaturearticles(Con
tinued)
Autho
rOrganization
Title
Locatio
nProg
ram
details
Type
ofpape
rResults
Oxfam
International
andMerlin
2009
NGOCon
sortium
RemoteProg
ramming
Mod
alities
inSomalia
Somalia
(Insecurityand
drou
ght)
Remotelymanaged
from
Nairobi
orHarge
isa
Discussionpape
r-Remotecontrolu
sedfordistrib
utionof
good
s;issues:inflexible,lim
itedde
legatio
nof
authority,increased
localstaffsecurityrisks,
loss
ofaccess
toadeq
uate
inform
ationabou
tne
edandcontext
-Remotesupp
ort:natio
nalm
anagersreceive
additio
naltrainingthat
enableshand
over;
senior
staffwellrespe
cted
,goo
drelatio
nswith
commun
ities
andde
cision
-making
autono
my.Issue:working
throug
hspecific
institu
tions
canbe
seen
astaking
side
sand
haspo
tentialtoincrease
securitythreats
-Remotepartne
rship:
strong
riskmanagem
ent
need
ed,fun
ding
anissuedu
eto
dono
rreluctance,lim
itednu
mbe
rof
sufficien
tlystrong
partne
rs-M&E
need
s:minim
umsetof
clearsimple
indicatorsforbasicstandards;transparen
cywith
dono
rsabou
tchalleng
es;b
uild
capacity
tocollect
data;verificatio
nmechanism
s:staff
visits,activity
mon
itorin
g,third
party
mon
itorin
g;triang
ulationand
commun
ications
techno
logy
Polio
Oversight
Board2014
PGEI
DecisionPape
r:Streng
then
ingProg
ram
Leadership
&Managem
ent
inPakistan
Pakistan
n/a
Decisionpape
r-Prim
arystrategy:neg
otiatedaccess
with
commun
ity/religious
leaders,military/law
enforcem
ent,andarmed
grou
ps-Usedmilitary
andlaw
enforcem
entprotected
vaccinationcampaigns
-Increasedacceptability
viacommun
ityen
gage
men
tviamed
ia,interpe
rson
alcommun
ication
Jeen
e2014
Save
theChildren
Integrated
Com
mun
ityCase
Managem
entIn
aPastoral
Society
Karkaarregion
,Pu
ntland
State,
Somalia
-ICCM
arou
ndwatering
pointsservingsm
all
settledandlarge
transien
tpo
pulatio
ns-Remotelymanaged
from
Kenya
Casestud
ywith
Survey
data
-Highstaffturnover
andlong
vacancies
contrib
uted
tosupp
lychaindisrup
tions
and
stockou
ts-Long
timeto
take
actio
nwhe
nsupp
lychain
failed;
need
forim
provem
entin
quality
ofsupp
ortsystem
s-Issues:increased
costandredu
ced
effectiven
ess
UNHCR2014
UNHCR
RemoteManagem
entin
High-riskOpe
ratio
nsGoo
dPracticeandLesson
sLearne
d
Somalia
Multip
leprog
rams
Casestud
yQualitativestud
y-UNcoun
tryteam
form
edRisk
Managem
ent
Unit:maintains
directoryof
aidandlocal
actors,m
onito
rsandanalyzes
financial
prog
rammaticandrepu
tatio
nalrisks
toadvise
operations
ofallage
ncies
-Facilitatingface-to-face
meetin
gswith
local
actorsandbe
neficiarieshe
lpsto
maintain
closen
essandsupe
rvision
-Transparen
trepo
rtingraised
cred
ibility
amon
gdo
nors
Chaudhri et al. Journal of International Humanitarian Action (2019) 4:9 Page 30 of 45
Table
4Summaryof
gray
literaturearticles(Con
tinued)
Autho
rOrganization
Title
Locatio
nProg
ram
details
Type
ofpape
rResults
-Con
side
redun
acceptablein
remotemod
e,resulting
insuspen
sion
orclosureof
prog
ram:
direct
paym
ent(m
aterialo
rcash)foraccess
tope
oplein
need
;paymen
tof
taxes,
registratio
nfees,any
form
ofpaym
entto
armed
grou
ps;transferof
humanitariango
ods
toanypartyto
theconflictfordistrib
ution
Samestud
yIraq
-Recruitedandtraine
dnatio
nalN
GOs,vetted
usingUSProvincialReconstructio
nteam
andothe
rs’listsof
partne
rs-Establishe
dProjectTracking
Database:GPS
encryptedandtim
e-stam
peddigital
photog
raph
stakenby
localp
artnersto
mon
itorprog
rams;data
uploaded
and
paym
entstiedto
photog
raph
iceviden
ce.
Issues:costly,labor
intensive,constant
mainten
ance
requ
ired
Samestud
yAfghanistan
-Workedcloselywith
Shuras
(cou
ncils)and
Com
mun
ityDevelop
men
tCom
mitteesto
ensure
fairn
essin
implem
entatio
nof
shelter
assistance
andincomege
neratin
gactivities.
Ensuredlocalo
wne
rship,
accoun
tability,
checks
andbalances,b
utde
cision
making
andlocalcapacity
buildingwereslow
-M&E
metho
ds:b
eneficiary
hotline
s,inform
alcontactswith
othe
ragen
cies,implem
entin
gpartne
rs;chang
edmon
itorin
gpartne
rsevery
2mon
thsto
avoidconflictof
interestand
collusion
-Com
mun
ityou
treach
team
with
mullah
establishe
dby
anINGOto
build
relatio
ns,
discussedsimilaritiesbe
tweenIslamic
teaching
sandICRC
code
ofcond
uct
-Triang
ulatingmon
itorin
gtechniqu
esby
one
NGO:usedvend
ors,localg
overnm
ent
officials,and
commun
itymem
bersto
mon
itorprojectou
tputsandqu
ality
Samestud
yPakistan
-Neg
otiatedwith
localtrib
esto
deliver
aidto
remotecommun
ities,raisedvisibilityand
built
confiden
cewith
locals
-Metho
dsto
addressfraud
:com
plaint
mechanism
forrefuge
es;implem
entin
gpartne
rselectionandpe
rform
ance
review
committee;g
rievancecommittee
offield
staff;multi-functio
nteam
toassess
implem
entin
gpartne
rprocesseson
procurem
ent,recruitm
ent,andfinancial
mon
itorin
g
Chaudhri et al. Journal of International Humanitarian Action (2019) 4:9 Page 31 of 45
Table
4Summaryof
gray
literaturearticles(Con
tinued)
Autho
rOrganization
Title
Locatio
nProg
ram
details
Type
ofpape
rResults
Samestud
ySyria
-Relieson
localstaffandcreatedne
tworks
ofvolunteersto
assistwith
operations
UNICEF
2016
UNICEF
(Uno
fficialtitle:Syriaand
Yemen
lesson
slearne
d)Syria
n/a
E-mailcorrespon
dence
-Inaccessible/arm
edgrou
pcontrolledareas:
prog
ramsplanne
dandde
velope
djointly
with
implem
entin
gNGOsandlocal
commun
ities.
-M&E
viathird
partymon
itorswho
provide
weeklyrepo
rts,data,and
photos;
telecommun
icationwith
inside
inform
ants;
repo
rtsfro
mUNhu
manitarianconvoys
whe
nallowed
access
Samestud
yYemen
-Com
mun
itymidwives
inisolated
conflict
areassetup
makeshift
prim
arycare
clinics
intheirho
mes;U
NICEF
supp
ortedwith
provisionof
supp
lies
-Em
powered
femalehe
alth
workerin
conservativecommun
ities
Oxfam
International
2007
NCC
IOxfam
Rising
tothehu
manitarian
challeng
ein
Iraq
Iraq
n/a
Briefingpape
r-Prep
osition
ingof
emerge
ncysupp
lies
supp
ortseffortsin
hot-spots
-Don
orsmustprovideflexibleem
erge
ncy
prog
rammingandovercomereluctance
tofund
remotelymanaged
prog
rams
-Strategies:using
localcon
tact
netw
orks
tomap
securitysituation;makingsure
staff
working
inparticularlysensitive
areasare
from
approp
riate
religious,cultural,or
geog
raph
icbackgrou
ndandhave
expe
rience
ininsecure
environm
ents;and
keep
inglow
profile
(ope
ratin
gin
unmarkedvehicles,
varyingroutines,not
usingpe
rmanen
toffices
whe
repo
ssible,and
restrictin
gaccumulationof
assets)
-One
NGOreliedon
person
alcontactsin
different
projectlocatio
nsto
mon
itor,
evaluate,assessim
pact
oftheprojects;
includ
edsurveysof
bene
ficiaries
-Previouslyestablishe
drelatio
nships
with
localsleadersandcommun
ities
enabled
rapidassessmen
tsandmon
itorin
g
Afghanistan,
M.o.P.H
.o.
t.I.R.o2015
Ministryof
Public
Health
Afghanistan
Ann
ualR
eport2015
Polio
Eradication
InitiativeAfghanistan
Afghanistan
n/a
Governm
entrepo
rt-Perm
anen
ttransitteam
s(PPT)e
stablishe
dat
entrypo
intsof
inaccessiblearea
tovaccinate
childrencomingandgo
ing
-Atleaston
edistrictpo
lioofficer
employed
inallcon
flict
affected
districtsforsurveillance
andcase
respon
sevaccinations
-Partne
redwith
NGOsthat
have
access
toinaccessibleareasforde
liveryof
vaccineand
campaignmon
itorin
g
Chaudhri et al. Journal of International Humanitarian Action (2019) 4:9 Page 32 of 45
Table
4Summaryof
gray
literaturearticles(Con
tinued)
Autho
rOrganization
Title
Locatio
nProg
ram
details
Type
ofpape
rResults
-Neg
otiatedthroug
hpartne
rs(suchas
ICRC
)forfullaccess
inhigh
-riskareas
Roge
rs2006
University
ofYo
rkAccessing
theInaccessible.
TheUse
ofRemote
Prog
rammingStrategies
inHighlyInsecure
Cou
ntriesto
Ensure
theProvisionof
Hum
anitarianAssistance.Iraq:
ACaseStud
y
Afghanistan
Prog
ram
assistedreturnees
tobu
ildashelter
Master’s
Thesis
Casestud
y-Processof
transitio
ning
toremotemod
e:he
ldmeetin
gwith
commun
itymem
bersand
supp
orters;outlined
teaching
sof
Qur’anlinked
tohu
manitarianism
-Close
relatio
nshipwith
commun
ities
and
operationalh
istory
increasedacceptance
-Unann
ounced
mon
itorin
gvisitswhe
nsecurity
improved
;nomajor
prob
lemsiden
tified,
bene
ficiariesandcommun
itymem
bersdid
notrepo
rtanyprob
lemswhe
ninterviewed
individu
ally
-Highlyexpe
rienced
Afghanstaff,with
out
who
mop
erationwou
ldhave
been
suspen
ded
Samestud
yNorthernUgand
aCasestud
yIDPcamps
-Com
mun
ityrepresen
tatives
workedin
collabo
ratio
nwith
theagen
cyto
develop
prog
ram
activities
andtim
elines
for
implem
entatio
n;gu
idance
onactivities
provided
throug
huseof
field
journalsby
commun
itymem
bersim
plem
entin
gthework
anddigitalcam
eras
torecord
activities.
-NGOvisitedon
ceaweekwhe
nsecurity
improved
;fou
ndthat
workwas
notbe
ing
completed
asexpe
cted
bycommun
ityor
contractors
-Inde
pend
entmem
bersof
commun
ityused
formon
itorin
gandtriang
ulation;mon
itorin
gsystem
proved
tobe
unreliableas
they
provided
inform
ationthat
they
thou
ght
agen
cywantedto
hear,not
reality
Samestud
yIraq
Remote
prog
ramming
since2004
Remotelymanaged
from
Jordan
-Lack
offace-to-face
contactledto
misun
derstand
ings
anddifficulty
maintaining
relatio
nships
-Needmoresupp
ortde
partmen
tscentralized
inIraqto
improvefunctio
n,coordinatio
n,andcohe
rence
-Training
sinclud
ed:security
relatedcourses,
administration,projectmanagem
ent,finance
andconflictresolutio
n;be
tter
whe
nshadow
edinternationalstaff
•Leng
thof
operationalh
istory
incoun
try
enabledagen
cies
tomovefro
mmore
directiveremotecontrolstrateg
yto
more
supp
ortiverole
•Strong
unde
rstand
ingandaw
aren
essof
local
cultu
reandreligionrequ
ired
•Greater
useof
participatorymanagem
ent
Chaudhri et al. Journal of International Humanitarian Action (2019) 4:9 Page 33 of 45
Table
4Summaryof
gray
literaturearticles(Con
tinued)
Autho
rOrganization
Title
Locatio
nProg
ram
details
Type
ofpape
rResults
styles
isrequ
ired
Faub
ertet
al.
2010
UNDP
Assessm
entof
Develop
men
tResults.Evaluationof
UNDP
Con
tributionSomalia
Somalia
Remotelymanaged
from
Nairobi
Evaluatio
nrepo
rt-Insufficien
twritteninstitu
tionalg
uidancefor
prog
ramsop
eratingin
complex
circum
stances;coun
tryofficeno
tproactive
enou
ghin
seekinggu
idance
andtapp
ing
institu
tionalresou
rces.
-Strategicpartne
rshipagreem
entde
velope
dwith
Bureau
forCrisisPreven
tionand
Recovery
(BCPR),providingresourcesand
technicalsup
port
-Increasedexpo
sure
toop
erationalrisks
regardingeffectiven
ess,costefficiency,and
accoun
tability
-Hightravelandpe
rdiem
costsforlim
ited
staffvisits,settin
gup
expe
nsivene
tworkof
NGOs,andliaisingwith
Somalip
artners;
administrativecostsne
edto
bemoreclearly
defined
andplanne
d
Ano
nymou
s2015
Ano
nymou
sRemotePartne
rManagem
ent—
Mon
itorin
gandAccou
ntability
System
sforLimiting
Aid
Diversion
Syria,Leb
anon
,Egypt,
Iraq,
Sudan
n/a
Qualitativestud
y12
interviewswith
staff
-Syria:localgrou
psprovidesupp
ortin
inaccessibleareas(m
onthlymon
itorin
grepo
rts)
-Iraq:
involved
both
IDPs
andtheirho
stcommun
ities
inplanning
andim
plem
entatio
nof
interven
tions;eased
tensions
betw
een
thecommun
ities
andincreasedup
take
ofservices
-Egypt:de
ployed
Syrians
asou
treach
workers
todo
referralsandspread
awaren
ess;go
oden
trypo
intinto
Syriancommun
ityin
Egypt
andcultivatedtrustwith
commun
itymem
bers.
-Capacity
oflocalp
artnersqu
itelow,needto
investalotin
training
Zyck
2012
n/a
RemoteCon
trol
Project
Managem
ent
Afghanistan
n/a
-Needforremotemod
econtinge
ncyplan
which
canbe
activated
whe
nde
sign
ing
prog
ramsin
orde
rto
accoun
tforrequ
ired
simplificatio
n-Needto
developaccoun
tabilityne
tworks:
establishrelatio
nships
with
stakeh
olde
rsthat
caninde
pend
ently
verifyprojects;and
build
partne
rships
forthird
partymon
itorin
gand
evaluatio
n-Needto
build
capacity
oflocalp
artnersto
enabledaily
decision
making
-Needforcoordinatio
nto
sharego
odpractices
andlesson
slearnt
-Issues
with
M&E
:site
visitsrare,external
mon
itorsno
tgivenaccurate
inform
ation,
localstaffrequ
iretraining
onmon
itorin
gand
Chaudhri et al. Journal of International Humanitarian Action (2019) 4:9 Page 34 of 45
Table
4Summaryof
gray
literaturearticles(Con
tinued)
Autho
rOrganization
Title
Locatio
nProg
ram
details
Type
ofpape
rResults
repo
rting,
lack
ofinde
pend
entbe
neficiary
feed
back
mechanism
s
Benini
etal.
2016
ACAPS
Inform
ationgaps
inmultip
lene
edsassessmen
tsin
disaster
andconflictareas
Syria
Syria
Needs
Assessm
ent
Project2012
Repo
rt-In
situations
oflack
ofaccess
andpatchy
indicators,severity
ofsituations
andqu
ality
ofassessmen
tinform
ationbe
stmeasuredon
simpleordinalscales;assessmen
tgaps
and
prioritiesestablishe
dby
comparin
gthevalues
ofgo
vernorates,d
istricts,etc.onthesescales.
-Assessm
entinform
ationallowsfor
prioritization
IFRC
2016
IFRC
Globalfun
dCen
tralAfricanRepu
blicand
RAMPHow
techno
logy
istransforminghe
alth
facility
repo
rtingin
acomplex
operatingen
vironm
ent
CAR
RAMPmob
ileph
one
repo
rtingsystem
throug
hout
coun
try
Repo
rt-RA
MPisamon
itorin
gandevaluatio
ntool
usingmob
ileph
ones
andsimpleto
use
pre-de
sign
edform
s-Health
care
workerstraine
dto
send
routine
health
data
from
health
centersviamob
ileph
ones
-Rapidfield
intellige
nceandcommun
ication
resultedin
theexpansionof
malariaservices,
preven
tedstockou
ts,allowed
formon
itorin
gof
malariaprevalen
ceandtren
ds
CDC2016
CDC
CDCremotemon
itorin
gsummary
Varietyof
coun
tries
n/a
Excelspreadshe
et(unp
ublishe
d)-Staffrequ
iredtraining
dueto
varying
capacitiesandsomehireddu
eto
bureaucratic/politicalreasons
rather
than
skillor
abilities
-Due
tolack
ofcommitm
entfro
mlead
agen
cy,surveillance
staffdidno
treceive
salariesor
fund
sto
carryou
tactivities,and
system
couldno
long
erfunctio
n.-With
insurvey
duplicationanddu
plication
over
timebe
tweenrepe
ated
surveysshou
ldbe
checkedforpo
tentialfraud
;pre-program
med
algo
rithm
sarean
essentialtoo
linde
tecting
survey
quality
consistentlyandrapidly
allowed
fordaily
commun
ication
with
team
sin
Syria;how
ever,com
mun
ication
ofmoretechnicalcon
ceptswas
challeng
ing
-Ensurin
gdata
quality
was
thebigg
est
challeng
e;training
andworking
with
staffprior
todata
collectionhe
lpsto
ensure
quality
and
consistencyof
data
Balslev-Olesen
andHüls2011
IRC
Thailand
Burm
aBo
rder
Con
sortium
Con
sultancy.Streng
then
ing
Mon
itorin
gin
Eastern
Burm
aFinalR
eport
EasternBu
rma
n/a
Inde
pend
entevaluatio
n(18interviews)
-Regu
larandstrategicsurveyshave
allowed
remotemanagersto
beless
cautious;sets
prog
rammingin
reality
-Strong
commun
ityconn
ectio
nsresultedin
strong
participatoryplanning
,implem
entatio
n,andmon
itorin
g-Recommen
datio
ns:systematicbu
tvoluntary
horizon
tald
ataexchange
,sup
portpartne
rs
Chaudhri et al. Journal of International Humanitarian Action (2019) 4:9 Page 35 of 45
Table
4Summaryof
gray
literaturearticles(Con
tinued)
Autho
rOrganization
Title
Locatio
nProg
ram
details
Type
ofpape
rResults
with
common
standard
incollecting
mon
itorin
ginfo;con
sisten
tandregu
lar
mechanism
sforclient/com
mun
ityfeed
back;
cross-mon
itorin
g;common
protocolsand
glob
alstandards;consistentlyanalyzeand
correlatedata;harmon
ized
andcoordinated
inho
usesupp
ortformon
itorin
g;training
onhu
manitarianprinciples
andsample
techniqu
esto
mon
itorpe
rform
ance
against
principles;d
irect
investmen
tin
M&E
-M&E
metho
dsused
curren
tly:w
eb-based
(project
activities
verifiedthroug
hvisual
eviden
ce,g
eo-referen
ced),q
ualityassurance
team
s(nationalstafftravelingto
mon
itor
prog
ram
activities,ind
icator-based
term
sof
reference);triang
ulated
localm
onito
ring;
third
partymon
itorin
g
IRCn.d.
IRC
ProjectforLocal
Empo
wermen
t(PLE)
REMOTE
MONITORING
EasternBu
rma
SHIELD
prog
ram
-6localp
artners
-Thaibasedoffice
PowerPointpresentatio
n-Challeng
es:log
bookssent
toThaibased
office,somemissing
,severallang
uage
sand
form
at(cou
ldno
tbe
review
edfro
mallethnic
health
organizatio
ns)
-Lesson
slearne
d:ne
edformulti-lingu
aldata
entrystaff,standardized
case
definition
s,and
check-listsforlogbo
okreview
;activities
shou
ldno
tbe
dono
rdriven
;needto
streng
then
technicalsup
portto
partne
rsvia
team
ofexpe
rts;prog
ram
implem
entatio
nteam
andmon
itorin
gteam
shou
ldbe
separate
butworkclosely
Jansuryet
al.
2015
International
Busine
ss&
Technical
Con
sultantsInc.
(IBTC
I)Geo
rge
Washing
ton
University
Find
ings
inMon
itorin
gand
Evaluatio
nsPractices
During
Hum
anitarianEm
erge
ncies
n/a
n/a
Situationalanalysis
Literature
review
Interviews
-Challeng
es:lackof
good
baselinedata
for
perfo
rmance
indicatorsmakeitdifficultfor
third
partyevaluatorsto
measure
impact;
rapidinfluxesof
aidrequ
iredproh
ibitM&E
practices
from
beingbu
iltin
from
onset;
explaining
tolocalstaffwhy
M&E
isne
cessary;
coordinatio
ndifficultdu
eto
distrustbe
tween
orgs
andlack
oftransparen
cy(dup
licationof
effortsandhard
toen
sure
accuracy)
-InternalM&E
tend
sto
beless
rigorou
sthan
externalconsultants,increasedtransparen
cyandthereforelegitim
acy
-Bu
ildinglocalcapacity
(ideally
priorto
emerge
ncy)leadsto
trustandmore
autono
myby
implem
entin
gpartne
rs-Needto
mainstream
M&E
andincorporate
into
planning
phase
Zikusookaet
al.2015
Save
theChildren
Simulated
TechnicalSup
port
Visitto
Inaccessiblelocatio
nsin
somalia
Somalia
Simulated
field
visit
Oct
2015
PowerPointpresentatio
n-Aim
s:providesupp
ortto
inaccessibleprog
ram,
mon
itornu
trition
prog
ram
andverifyexistence,
assess
prog
ram
perfo
rmance
againstqu
ality
Chaudhri et al. Journal of International Humanitarian Action (2019) 4:9 Page 36 of 45
Table
4Summaryof
gray
literaturearticles(Con
tinued)
Autho
rOrganization
Title
Locatio
nProg
ram
details
Type
ofpape
rResults
benchm
arks,ide
ntify
gaps
andareasfor
capacity
developm
ent;conn
ectwith
field
team
s-Metho
dology:m
inim
umstandards/qu
ality
benchm
arks
agreed
➔do
cumen
tsand
photos
provided
byfield
(pho
toswith
GPS
encryptio
n,scansof
patient
cardsandstock
records,etc.)➔
Skype/ph
onecalls
with
field
➔jointreview
ofdo
cumen
tswith
field
➔feed
back
andactio
nplanning
-Analysis:was
card
filledin
correctly?Was
correctam
ount
ofmed
sprovided
?Was
follow-uptrackedcorrectly?Etc.
-Lesson
slearne
d:priorprep
requ
iredto
ensure
completesetof
supp
ortin
gdo
cumen
tsare
received
;musttrainteam
totake
quality
photos;d
isciplinerequ
iredto
setup
uninterrup
tedtim
eto
completewho
leprocess
Soun
ess2011
Tearfund
Mon
itorin
g&be
neficiary
Accou
ntability
inRemote
Managed
Locatio
nsAnassessmen
tof
Tearfund
’sMon
itorin
g&accoun
tability
practices
(apartof
larger
Tearfund
repo
rt,b
elow
)
Kand
ahar,
Afghanistan
Relocatedcoordinatio
nto
Kabu
lin2008
following
kidn
apping
ofexpatNGO
worker
Independ
entassessment
Qualitativestud
y(interviews,ob
servations,
documen
tanalysis)
-3type
sof
mon
itorin
gin
Kand
ahar:d
irect
mon
itorin
gin
thefield,ope
ratio
nal
mon
itorin
gandrepo
rt,and
activities
tobu
ildM&E
capacity
-M&E
metho
ds:field
data
collection,mon
itorin
gby
AfghanKabu
l-based
specialists,b
eneficiary
feed
back,storiesof
transformation(collected
byfield
staff),mon
thlyprog
ram
repo
rts,
projectevaluatio
ns,office
Shura,weekly
prog
ress
repo
rts,pe
ermon
itorin
g-Relianceon
natio
nalstaffresultedin
lower
quality
repo
rting
-Recommen
datio
ns:establishclear
metho
dology;improverig
orof
qualitativeand
quantitativemetho
ds,KAPsurvey
totrack
change
sover
time;pe
ermon
itorin
g-M
&Eofficer
men
torsprojectmanagersand
trains
staffto
build
capacity
inmon
itorin
g-Strong
relatio
nships
with
commun
ities
and
acceptance
necessaryforsecuritydu
ringfield
visits
-Allowingfield
staffandcommun
ities
totell
theirstoriesisim
portantmetho
dof
mon
itorin
g;mixed
-metho
dmon
itorin
grequ
ired
Norman
2011
Tearfund
EffectiveMon
itorin
gand
Bene
ficiary
Accou
ntability
Practices
forProjects
Implem
entedRemotelyin
Insecure
Environm
ents
(Interim
repo
rt)
Afghanistant,
Pakistan,Som
alia,
Sudan,SouthSudan
Prog
ramsim
plem
ented
in42
locatio
nsthat
use
someremotemod
eapproach
QualitativeStud
y(Interviewsandfocus
grou
pswith
28organizatio
ns)
-RemoteMon
itorin
gissues:q
uality,en
surin
grig
orou
smon
itorin
gsystem
,red
uced
regu
larity
ofvisitsto
implem
entatio
nareas,inaccuracy
ofprojectdata
andrepo
rting,
limitedcapacity
ofstaff,weaktechnicalo
versight
ofim
plem
entatio
n,po
orcommun
ication
betw
eenhe
adofficeandfield,increased
risk
Chaudhri et al. Journal of International Humanitarian Action (2019) 4:9 Page 37 of 45
Table
4Summaryof
gray
literaturearticles(Con
tinued)
Autho
rOrganization
Title
Locatio
nProg
ram
details
Type
ofpape
rResults
tostaffandbe
neficiaries,increasedpressure
onlocalstaff,increasedriskof
corrup
tion
andfraud
Norman
2012
Tearfund
Mon
itorin
gandaccoun
tability
practices
forremotely
managed
projects
implem
entedin
volatile
operatingen
vironm
ents
(finalrep
ort)
Afghanistan,Iraq,
SouthSudan,
Pakistan,Sud
an,
Srilanka,Som
alia,
Prog
ramsim
plem
ented
in42
locatio
nsthat
use
someremotemod
eapproach
QualitativeStud
y(Interviewsandfocus
grou
pswith
28organizatio
ns)
-Existin
ggo
odpracticeconfined
tosing
leorgandno
tshared
-RemoteProjectmon
itorin
ggo
odpractice
recommen
datio
ns:lim
iting
size
andscop
eof
prog
rams,bu
ildingpo
sitivecommun
ityrelatio
nships,targe
tedrecruitm
entof
local
recruitm
ent,capacity
buildingof
localstaff,
regu
larface-to-face
meetin
gs,p
romoting
organizatio
nvalues,d
evelop
ingaremote
managem
entstrategy,b
uilding
micro-m
anagem
entapproaches
tomon
itorin
g,en
surin
gde
dicatedmon
itorin
gandevaluatio
ncapacity,d
evelop
ingan
M&E
framew
ork,
investingin
inform
ationandcommun
ication
techno
logies,p
eer-mon
itorin
g,be
neficiary
led
mon
itorin
g,increasing
collabo
ratio
nbe
tween
humanitarianandde
velopm
entcommun
ities
-Essentialsforbe
neficiary
accoun
tabilitygo
odpractice:establishing
andde
liveringon
commitm
ents,staffcompe
tency,sharing
inform
ation,participation,hand
lingcomplaints,
learning
andcontinualimprovem
ent
ACF2015
ActionCon
trela
Faim
Beprep
ared
tosw
itchto
remoteop
erations
n/a
n/a
Power
pointpresentatio
n-Lesson
slearne
d:focuson
buildingstaff
capabilities,bu
ildrelatio
nships
with
commun
itystakeh
olde
rs,sim
plify
repo
rting,
transfer
repo
rtingrespon
sibilityto
field
staff,
form
alizecurren
t/target
rolesand
respon
sibilitiesforallactivities
-Better
commun
icationwith
field:promote
proactiveregu
lartim
elycommun
ication,make
remotesupe
rvisorsliableto
field
staffas
well,
proveutility
ofmon
itorin
gsystem
sto
field
staffby
providingtim
elymeaning
fuld
ata
interpretatio
n,regu
larly
contactallstaffto
boostmorale,commun
icateface-to-face
asmuchas
possible
ECHO2013
ECHO
Instructionno
teforEC
HO
staffon
RemoteManagem
ent
n/a
n/a
Organizationalg
uidance
note
-Bu
ildingacceptance
amon
ggo
vernmen
ts,
non-stateauthorities,and
bene
ficiariesismost
sustainableandeffectiveway
ofgainingand
maintaining
access
-Crosschecking
localstaffassessmen
tsthroug
htrustedthird
partiesisessential
-Recruitnatio
nalp
artnerswith
expe
rience,train
andbu
ildcapacity
-Minim
umface-to-face
contactbe
tweensenior
staffandfield
staff/be
neficiariesrequ
ired
Chaudhri et al. Journal of International Humanitarian Action (2019) 4:9 Page 38 of 45
Table
4Summaryof
gray
literaturearticles(Con
tinued)
Autho
rOrganization
Title
Locatio
nProg
ram
details
Type
ofpape
rResults
-Mon
itorin
gmechanism
s:ph
oto,teleph
one
complaint
system
forbe
neficiaries,
triang
ulation,pe
ermon
itorin
g,third
partymon
itors
IMC2016b
IMC
Fieldpractices
forremote
managem
ent
n/a
n/a
Emailcorrespon
dence
-Com
mun
ication:maintainregu
lar
commun
icationby
whatevermeans
possible,
design
atefield
focalp
oint,com
mun
icate
valueof
workto
team
-Con
tinge
ncyplanning
:ensurethereison
eforbo
thforeseen
challeng
esandpo
tential
emerge
ncies
-Training
andcapacity
building:
ensure
tools
andsupp
ortto
implem
entactivities
isprovided
beforehand
,trainingof
traine
rswith
keyfield
staff
-Dataandinform
ationmanagem
ent:
triang
ulateinfo,third
partymon
itors,explore
mob
iletechno
logies,d
evelop
strong
protocols
-Person
nelstructure:ensureclearfield
supe
rvisionwith
specificfocalp
oints
-Po
liciesandproced
ure:have
written
proced
ures
onwhich
tocond
uctinternal
training
priorto
deploymen
t-Nationalp
artners:consider
working
with
natio
nalN
GOsearly,h
avealistof
vetted
partne
rs
Egelandet
al.
2011
OCHA
ToStay
andDeliver
Goo
dpracticefor
humanitarians
incomplex
securityen
vironm
ents
Fieldresearch
in:
Afghanistan,D
RC,
occupied
Palestinian
territo
ries,Pakistan,
Somalia,D
arfur,
Sudan
Deskreview
and
qualitativestud
y(255
interviews,1100
natio
nalstaffsurveyed
)
-Remotemanagem
entgo
odpractices:invest
inhigh
lylocalized
field
staff,recruitstaffin
consultatio
nwith
commun
ities,w
eb-based
mon
itorin
g,qu
ality
assuranceteam
sfor
accoun
tability,third
partymon
itorin
g,triang
ulated
localm
onito
ring
-Metho
dsto
build
acceptance:outreachteam
s,commun
itymem
orandu
msof
unde
rstand
ing
that
stipulates
itsrolein
prog
ram,local
broadcastin
gandpu
blishe
dmaterials,
commun
ityco-owne
rship,
positiveassociations
with
trusteden
tities,on
goinglocal
consultatio
ns-Recommen
datio
ns:add
ress
gaps
tomitigate
riskanden
sure
duty
ofcare
tonatio
nalstaff,
ensure
strong
coop
erationthat
meetsthe
need
sof
partne
rs,ensurede
ployed
staff
unde
rstand
humanitarianprinciples
and
organizatio
nalp
olicies,sharego
odpractices
andlesson
slearne
d
UNHCR2016
UNHCR
Remotemanagem
entin
high
securityriskop
erations
n/a
n/a
Partof
4thed
ition
ofUNHCREm
erge
ncy
Handb
ook
-Guide
lines:con
duct
thorou
ghriskassessmen
tconsideringne
edsof
allp
arties,weigh
whe
ther
partne
rsfully
unde
rstand
and
Chaudhri et al. Journal of International Humanitarian Action (2019) 4:9 Page 39 of 45
Table
4Summaryof
gray
literaturearticles(Con
tinued)
Autho
rOrganization
Title
Locatio
nProg
ram
details
Type
ofpape
rResults
accept
risks,b
uild
partne
rshipne
tworks
-Mon
itorin
ggu
idelines:exploittracking
and
inform
ationtechno
logies;keepmetho
dsandmessage
ssimple;explorepe
ermon
itorin
g,mon
itorin
gby
commun
ities,
natio
naland
localstaff,localautho
rities,
privatecompanies,con
sultants,other
agen
cies;set
upclearandsimplemon
itorin
gandrepo
rtingproced
ures;com
mun
icate
frequ
ently
with
partne
rs-Whe
nregu
larprog
rammingstarts,b
uild
onincreasedcapacity
oflocalp
artnersanddo
notreplacethem
with
internationals
-Risks:less
ableto
mon
itorne
edsand
unde
rstand
localp
erspectives,assistancemay
notreachthoseon
need
,difficultto
detect
fraud
,don
orsmay
beun
willingto
fund
due
tolack
ofdirect
mon
itorin
g,UNHCRless
visiblein
commun
ities
andam
ongdo
nors
UNICEF
EMOPS
2012
UNICEF
RemoteProg
rammingin
Hum
anitarianAction
Prog
ram
guidance
-Step
stowardde
cision
tosw
itchto
remote
mod
e:securityriskassessmen
t,po
litical
context/conflictdynamicsandstakeh
olde
rinterestsanalysis,costanalysisor
optio
ns,m
apno
n-securityrisks,exitstrategies
-Incorporateexitstrategies
into
prog
ram
managem
entcycle;mustreassess
situation
ongrou
ndto
determ
inewhe
nto
return
-Im
plem
entin
gRemoteprog
ramming:
partne
rmapping
andassessmen
tsof
capacity
and
positio
nin
conflictshou
ldinform
partne
rselection
-Musten
gage
partne
rsin
security
managem
entandplanning
activities,b
udge
tforapprop
riate
logisticalandsecurity
commun
ication,andestablishclearproced
ures
forrepo
rtingsecurityincide
nts
ECHO2015
ECHO
ECHO’sApp
roachto
RemoteManagem
ent
n/a
n/a
Organizationgu
idelines
ECHOfund
ingforactio
nsinvolvingremote
managem
entisbasedon
sevenqu
estio
ns:
-Istherean
access
prob
lem
dueto
securityor
administrativeob
stacles?
-Doe
stheprop
osed
actio
ninclud
eacceptance-buildingmeasures?
-Isitadirect
life-saving
actio
nor
anactio
naimed
atpreserving
livelihoo
ds?
-Haveallp
ossiblemeasuresbe
entakento
redu
cetheriskof
losing
thelives
ofthose
unde
rtakingtheworkon
thegrou
nd?
-Whatisthesource
ofthene
edsassessmen
tin
aremotelymanaged
actio
n?
Chaudhri et al. Journal of International Humanitarian Action (2019) 4:9 Page 40 of 45
Table
4Summaryof
gray
literaturearticles(Con
tinued)
Autho
rOrganization
Title
Locatio
nProg
ram
details
Type
ofpape
rResults
-Haverobu
stsystem
sbe
enpu
tin
placeto
allow
staffon
thegrou
ndto
provideallo
ftherelevant
inform
ationto
thosewho
are
ultim
atelyrespon
sibleforthemanagem
ent
andthequ
ality
oftheactio
n?-Are
mon
itorin
garrang
emen
tsadaptedfor
remotemanagem
ent?.
GOAL2016
GOAL
RemoteManagem
ent
Guidancev0.4DRA
FTGen
eral,examples
inSudanandSyria
n/a
Draftgu
idance
document
GOALuses
sevenminim
umcriteria
whe
nde
term
iningwhe
ther
touseremote
managem
ent:
-Accessrestrictio
nsor
theriskto
staffin
the
projectarea
isun
acceptable
-Risk
facedby
staffor
partne
rsisacceptable
totheorganizatio
nandindividu
als
implem
entin
gtheactivities
-Con
text
analysisandne
edsandsecurity
assessmen
tjustify
remotemanagem
ent
-Sufficien
tcapacity
amon
gstaffand/or
partne
rsto
deliver
theprog
ram
(ortraining
tobu
ildcapacity)
-Prog
ram
activities
canbe
implem
ented
followinghu
manitarianprinciples
-GOALprovided
adde
dvalueto
meetin
gthe
humanitarianne
eds
-Minim
umstandard
ofmon
itorin
gcanbe
implem
ented
-Strategies
formitigatin
grisks:p
lann
ing,
risk
analysis,p
rogram
andpo
licyadaptatio
n,prioritizingstafftraining
andde
velopm
ent,
increasing
resourcesformon
itorin
gand
evaluatio
n,clearcommun
icationandstrong
inform
ationmanagem
enttools,and
commun
ityaccoun
tabilityproced
ures
tostreng
then
acceptance
andprog
ram
supp
ort
Hüls2011
n/a
RemoteManagem
entof
Hum
anitarianAssistance
n/a
n/a
Essay
-Risksinclud
e:shiftingriskto
localstaff,
redu
cedqu
ality
assuranceandtim
elyactio
n,de
creasedknow
ledg
etransfer
tolocalstaff,
-Metho
dsof
riskmitigatio
n:third
party
mon
itorin
gor
verification,inform
ationand
commun
icationtechno
logy,com
mun
ityinvolvem
ent
UNICEF
n.d.
UNICEF
Com
pend
ium
ofbe
stpractices:U
NICEF
approach
toCom
preh
ensive
Risk
Managem
entandDue
Dilige
ncein
Com
plex
and
HighThreat
Environm
ents
n/a
n/a
Minim
umstandards
guideline
TheMinim
umCom
pone
ntsof
the
Com
preh
ensive
Risk
Managem
entApp
roach:
-Assessing
theno
n-securityrisks
forUNICEF
prog
rams;
-Linkingsecurityplanning
with
theSRAand
theinter-agen
cyprog
ram
-Com
preh
ensive
multi-source
mon
itorin
gwith
capacity
totriang
ulateandanalyze
Chaudhri et al. Journal of International Humanitarian Action (2019) 4:9 Page 41 of 45
Table
4Summaryof
gray
literaturearticles(Con
tinued)
Autho
rOrganization
Title
Locatio
nProg
ram
details
Type
ofpape
rResults
inform
ation
-Internalmanagem
entmeasuressuch
astraining
,partner
screen
ing,
auditandrisk
managem
entworking
grou
pAdd
ition
alcompo
nentsof
riskmanagem
ent
may
includ
e:-Capacity
buildingforstaff,partne
rs,facilitators
andcontractors
-Agreeingon
andim
plem
entatio
nof
common
UNriskmanagem
enttools
-Con
flict
sensitive
prog
ramming
-Gen
eralstrategies
forredu
cing
residu
alrisk:
buildingstrong
ercommun
ityrelatio
nships,
activelymanagingsecurityrisks,w
eigh
ing
shortversus
long
-term
risks,coo
rdinatingwith
andgainingsupp
ortof
partne
rs,employing
qualified
staff,anden
surin
grecordson
all
decision
saremaintaine
d
Bally
etal.
2005
Europe
anSpace
Age
ncy,
Directorateof
EarthObservatio
nProg
rammes
RemoteSensingand
Hum
anitarianAid—A
life-saving
combinatio
n
n/a
n/a
Review
article
-Europe
anSpaceAge
ncyisutilizing
satellite
imageryto
assisttheEurope
anCom
mun
ityHum
anitarianOffice
toob
tain
inform
ation
regardingtheim
pact
andne
edsof
both
slow
andsudd
enon
sethu
manitarianem
erge
ncies:
developm
entof
adatabase
forusein
GIS,
up-to-date
topo
graphicmapsforrespon
ders,
iden
tifying
approp
riate
locatio
nsforcamps
andfulfilling
camp-settingcriteria,and
aiding
food
andsupp
lydistrib
ution
-Satellite
imageryalso
used
toiden
tifyhidd
enwater
sourcesandsite
new
camps,and
estim
atingavailablewoo
dandallocatin
gcookingfuelresources
Meier
2011
n/a
New
inform
ation
techno
logies
andtheir
impact
onthe
humanitariansector
Haitiearthq
uake,
Russiaforestfires,
Libyahu
manitarian
crisis,Som
alia
complex
emerge
ncy
Crisismapping
anddigital
volunteerne
tworks
Review
article—case
stud
ies
-Articlefocuseson
useof
inform
ationand
commun
icationin
Haiti,Ru
ssia,Libya
and
Somalia,p
articularlycrisismapping
and
crow
d-sourcing
inform
ation
-Therearestillconcerns
over
theethicaland
securityconcerns
ofmapping
user-gen
erated
conten
tdu
ringconflict,theliabilityof
volunteers,d
ataprotectio
nprotocols,verifying
inform
ationin
realtim
e,andthecapacity
ofhu
manitarianorganizatio
nsto
respon
dto
all
inform
ationadde
dto
themaps
Chaudhri et al. Journal of International Humanitarian Action (2019) 4:9 Page 42 of 45
RecommendationsDespite this major drawback in evidence quality, it is im-portant to acknowledge that emergency conflict settings,especially those that are inaccessible, are not conduciveto data collection generally, with randomized controlledtrials being especially difficult. This is true for a numberof reasons including security concerns, ethical consider-ations, limited resources, and the urgency with whichhumanitarian aid needs to be delivered, and remains oneof the core challenges to improving the evidence neededto improve remote operations. Nevertheless, rigorousdata collection and reporting, using both qualitative andquantitative methods, needs to become commonplace inhumanitarian emergencies; it is required, not only toshare lessons learned but also to promote critical ana-lysis of methods, create best practice guidelines, and roothumanitarian action firmly in evidence.Implementation studies are urgently needed to identify
factors that make certain remote programming andmonitoring activities more effective than others, andwhat factors hinder their success. Implementation sci-ence methods that collect process and outcome indica-tors while taking a detailed look at settings andconstraints can be used to elucidate what can and can-not be replicated through a variety of humanitarian con-flict settings and assess key issues such as cost andsustainability.Qualitative studies focusing on beneficiary and na-
tional/local staff perspectives are required to ensure thatremote humanitarian programming is tailored to thetrue needs of the affected population and designed withthe implementers’ and affected populations’ preferencesin mind. Incorporating implementer perspectives fromprogram onset not only facilitates efficient delivery butalso highlights their value, potentially contributing to amore equitable distribution of power.Finally, rigorous research and evaluation of remote pro-
grams should be undertaken to answer questions such as:
� What are the best practices that should be adoptedby agencies carrying out remote operations?
� How effective are various remote operationsinterventions, guidelines, and tools whenimplemented in different contexts?
� What are feasible and effective methods ofmonitoring and evaluating remote programs?
� What are the key criteria for vetting local partnersor local staff to help ensure adherence tohumanitarian standards?
� What are the critical needs and challenges identified bylocal partners implementing programs in conflict settings?What support is needed from their remote partner?
� What is the assessment of remote interventionsfrom the point of view of the affected populations?
ConclusionsThis review highlights the paucity of evidence on how toeffectively carry out remote programming and monitor-ing. Considering the increasingly challenging environ-ments in which humanitarian actors are working, thereis an urgent need for evidence-based guidelines andtools. We can identify key principles for operating re-motely, including the importance of capacity buildingand frequent communication, comprehensively assessingand addressing the risks faced by national staff, increas-ing the intensity and resources of M&E efforts despitethe difficult conditions, and planning for the possibilityof having to move to remote programming and havingan exit strategy to prevent falling into the remote opera-tions trap. To further build the evidence base, we en-courage those implementing remote programs torigorously document and evaluate their work and toshare the findings. The current climate of increasingconflicts and risk to humanitarian aid workers necessi-tates evidence-based strategies to ensure both the safetyof those delivering aid in these harsh conditions and thatquality programming reaches those they are there toserve.
Endnotes1While this was originally referred to as the “remote
management trap” in the literature, it has been changedto ‘remote operations trap’ to maintain consistency withthe terminology used throughout this report.
AcknowledgementsWe would like to acknowledge the Global Health Cluster RemoteProgramming and Monitoring Task Team: Muireann Brennan, Linda Doull,Michelle Gayer, Trina Helderman, Farah Husain, Jolene Nakao, HeatherPapowitz, and Camilo Valderamma.
FundingNo financial or other material support was received for this work.
Availability of data and materialsData sharing is not applicable to this article as no datasets were generatedor analyzed during the current study.
Authors’ contributionsSC and KC analyzed, interpreted, and synthesized the review data. SC and KCwrote the manuscript. SC, KC, and NM, read, edited, and approved the finalmanuscript.
Competing interestsThe authors declare that they have no competing interests.
Publisher’s NoteSpringer Nature remains neutral with regard to jurisdictional claims inpublished maps and institutional affiliations.
Author details1UNICEF New York 3 United Nations Plaza, New York, NY 10017, USA. 2Centerfor Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA 30333, USA.
Chaudhri et al. Journal of International Humanitarian Action (2019) 4:9 Page 43 of 45
Received: 1 July 2018 Accepted: 7 March 2019
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