Ethics and the closure of humanitarian healthcare projects

“While many project closures unfold smoothly, in other cases they are contested and give rise to ethically challenging situations for humanitarian organizations, their partners, and local communities.”

Context:

Non-governmental organizations routinely make and enact decisions to close humanitarian health projects. Doing so is unavoidable, and a necessary component of humanitarian action. However, ethical questions may arise related to why a project is selected to be closed and how closure is implemented. Moreover, these decisions, and the process and impact of closing projects, are likely to be perceived differently from the perspectives of those involved in and affected by them. Different models of closing projects have been utilized, including phasing down (gradually decreasing the project in size, sometimes leaving a small presence in place in case the project needs to be reactivated in the future), phasing over (gradually shifting it to local actors), handing over (transfer of the project to local actors), and ‘cut and run’ (sudden termination of a project). From an ethics perspective, some of the considerations that have been identified include clarifying what responsibilities humanitarian organizations have during and after project closure towards communities with whom they have been working, the intrinsic as well as instrumental value of humanitarian projects, and the ways that structural features can augment or reduce health vulnerabilities during situations of war, disaster or public health emergency and how these relate to project closure. Questions have also been asked about how closure can be accomplished in ways that are consistent with commitments including minimizing harm, being accountable, upholding impartiality, and demonstrating respect.  

Our work on this topic has included two studies (described in greater detail below):

Ethics of Closing Projects (ECP1) (2018-19): In this first study we conducted a scoping literature review, interviewed national and international humanitarian workers, and developed a resource to support discussion and reflection about what it means to ‘close well.’ This study included a partnership with Médecins du Monde-Canada. 

Ethics of Closing Projects (ECP2) (2020-23): Building on ECP1, we have extended our research on project closure to focus on how closures are experienced by communities in the Philippines. This study is a collaboration between the Centre for Disaster Preparedness in Manila and the HHE Research Group.  

Ethics of Closing Projects (ECP1) (2018-19)

In this project we partnered with the non-governmental organization Médecins du Monde-Canada. The study aimed to explore what values and approaches can support ethical project closures by non-governmental organizations when they decide to close a humanitarian project. We used an integrated study design that combined qualitative interviews and a literature review, with ethical analysis. Combining these approaches, we developed a ‘guidance note’ that highlights ethical capacities and principles, in addition to questions that can support reflection around project closure. The development process included further interviews and a feedback workshop. Our aim through this project is to spark further discussion and debate around this important topic, with study outputs providing insights regarding the process of making and implementing decisions to close humanitarian projects. 

* In ECP2, we are widening the perspectives that are included in our research through inquiries in six communities in the Philippines where humanitarian projects have been closed. 

Literature review:

As part of the project, we conducted a literature review of gray and academic sources. It highlights how ethical considerations are reflected in documents about project closure. It is available open-access from https://link.springer.com/article/10.1186/s41018-019-0064-9

This list includes all the documents that were included in the review:: Ethics of closing humanitarian projects_scoping lit review_full reference list

Interviews with national and international humanitarian workers:

We conducted an exploratory qualitative study in which we interviewed national and international humanitarian workers. We identified features across the timeline of humanitarian projects (from the early design phase, to after a closure has occurred) that participants identified as important ethical considerations for project closure, including: respectfully engaging with partners and stakeholders, planning responsively, communicating transparently, demonstrating care for local communities and staff during project closure, anticipating and acting to minimize harms, and attending to sustainability and project legacy. These features are discussed in relation to project phases. It is available open-access from https://jhumanitarianaction.springeropen.com/articles/10.1186/s41018-020-00082-4

Resources to Support Reflection and Discussion

Building on the components above, we created a set of resources to support reflection and discussion related to ethics and project closure. They were refined through a second round of interviews and during a feedback workshop following which we elected to create two versions of the document (a condensed and extended version – so that readers can choose a more or less detailed version) and a one-pager that excerpted key questions (if readers are seeking key highlights). Their goal is to spark reflection and discussion around ethics and project closure. These documents are accessible here:

Project Summaries with Tools and Resources

The team:

Ryoa Chung, Lisa Eckenwiler, Matthew Hunt , John Pringle, Nicole Pal and Shelley-Rose Hyppolite

Partner: Médecins du Monde-Canada

Funding: RRSPQ Public Health Ethics Axis, 2018-19

Ethics of Closing Projects (ECP2) (2020-23)

We worked with the Center for Disaster Preparedness (Manila, the Philippines) to develop a second project on project closure which builds on and extends our earlier work. The primary aim of the study is to examine the topic of humanitarian project closure from the perspectives of people living in communities where projects have been or are being closed, as well as project partners. This study is entitled “A qualitative inquiry into the ethics of closing humanitarian projects in the Philippines, focusing on moral experiences of community stakeholders”  

The project has three interconnecting phases: 1) preparation (including partnership activities, articulation of a shared conceptual account, and establishment of a community advisory board), 2) interviews and focus groups in six communities in the Philippines affected by disaster or conflict and where projects are being or have been closed, and 3) co-development of workshops tailored for local communities and humanitarian organizations. 

Summaries on the project’s development:

Preparation Phase:

In the prepatory phase of the project, we have worked to lay the groundwork for the project. This has involved regular team meetings to refine project plans. A major focus has also been to establish a Community Advisory Board for the project. We have also undertaken a collective process to identify and discuss concepts related to ethics and project closure. This process helped us to create a shared vision amongst the team for some of the conceptual terrain surrounding the study. Some of these elements included considering how project closure relates to concerns of justice, solidarity, care, epistemic injustice, and localization.  We developed a concept map to explore interconnections, and in relation to the idea of ‘an ethics of the temporary’. If you are interested, you can see an illustration of some of the ideas that we reflected on as a team here (created by I Munoz Beaulieu). Also available is a list of readings that are related to some of these concepts. 

Team: Elyse Rafeala Conde, Jan Jay Louise Crismo, Lisa Eckenwiler, Matthew Hunt, Shelley-Rose Hyppolite, Mayfourth Luneta, Isabel Munoz Beaulieu, Handreen Mohamed Saaed, John Pringle, Lisa Schwartz