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). 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. Considerations include clarifying what is owed to communities with whom an organization has been working, the intrinsic as well as instrumental value of humanitarian projects, and the structured nature of health vulnerabilities during war, disaster or public health emergency. It is thus critical to examine the ethical implications of humanitarian project closure, and consider how closure can be accomplished in ways that take are consistent with ethical 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 guidance note on the topic of ethics and the closure of humanitarian health projects.

Ethics of Closing Projects (ECP2) (2020-23): Building on ECP1, we received funding to conduct ECP2. This grant has three interlinking phases: development of a conceptual framework, qualitative research in three communities in the Philippines where projects have been or are being closed, and development of resources related to project closure.


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

Our interdisciplinary research team (with expertise in global bioethics, political philosophy, humanitarian action, medicine, nursing, rehabilitation and qualitative research methods) worked collaboratively with our study partner, the non-governmental organization Médecins du Monde-Canada , to answer the following research question: What values and approaches support ‘ethical closure strategies’ when humanitarian organizations elect to close a project?

We used an integrated study design that combined qualitative interviews and a literature review, with normative ethical analysis in order to develop a set of ethics guidance notes about humanitarian project closure. This approach allowed us to work ‘up’ from experiences of individuals with first-hand experience of the phenomenon of interest* and to work ‘down’ from normative theories. The combination of these approaches supported the development of ethical guidance that is grounded in experience, and that is also informed and inspired by normative analysis. Our hope is that through this project we will spark further discussion and debate around this important topic within and across humanitarian organizations, and that the study outputs will support organizations as they make and implement decisions to close humanitarian projects.

* in ECP2, we are widening the perspectives that are included in our research through case studies in three 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. 

The review has been published in the International Journal of Humanitarian Action. It is available open-access from https://link.springer.com/article/10.1186/s41018-019-0064-9

The following document includes a list of all the articles that were selected for inclusion 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 considerations for ‘closing well’, 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.

The study has been published in the International Journal of Humanitarian Action. It is available open-access from https://jhumanitarianaction.springeropen.com/articles/10.1186/s41018-020-00082-4

Ethics guidance:

Based on the review of gray and academic literature, qualitative interviews, and wider reading in the areas of bioethics, humanitarian ethics, political philosophy and political science, we created a guidance note related to ethics and project closure. The guidance note was refined through a second round of interviews and during a feedback workshop. Based on these discussions, we elected to create two versions of the document (a condensed and extended version) and a one-pager that excerpted key questions. These documents are accessible here:

The team:

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

Partner: Médecins du Monde-Canada

medecindumonde

Funding: RRSPQ Public Health Ethics Axis, 2018-19

images


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

Building on our previous research, we developed a second project with the goal of examining 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” and is based on a partnership with the Center for Disaster Preparedness based in Manila, the Philippines.

The project has three interconnecting phases: 1) development of a conceptual framework, 2) empirical research in three communities in the Philippines affected by disaster or conflict and where projects are being or have been closed, and 3) co-development of resources tailored for local communities and humanitarian organizations. 

As we progress with this research, we will provide more details here.

Team: Matthew Hunt, Elyse Rafeala Conde, Lisa Eckenwiler,  Shelley-Rose Hyppolite, Mayfourth Luneta, John Pringle,  Lisa Schwartz

Partner: Center for Disaster Preparedness

Emergency clipart disaster risk reduction, Emergency disaster risk  reduction Transparent FREE for download on WebStockReview 2020

Funding: Social Sciences and Humanities Research Council 

SSHRC Talent: Scholarships, fellowships and beyond | Bourses d'études et de  recherche du programme Talent du CRSH | Congress 2019

%d bloggers like this: