By Jenny Perry September 8, 2021 Since the Core Humanitarian Standard on Quality and Accountability was introduced in late 2014, many humanitarian organizations have been working to assess and improve their accountability to communities affected by crisis. The Core Humanitarian Standard (CHS) Alliance defines accountability as “the process of using power responsibly, taking account of, and being held accountable by, different stakeholders, and primarily those who are affected by the exercise of such power.” To put it more simply, Medical Teams believes accountability is about putting the communities we serve at the center of all we do. Opportunities for Improving Accountability to Communities In 2019, we conducted our own in-depth self-assessment against the nine CHS commitments. The assessment serves as the basis for our comprehensive three-year Core Humanitarian Standards improvement plan which addresses everything from policy development to creation of practical guidance and tools. In 2020, the CHS Alliance evaluated progress against the nine commitments (since the 2014 launch) and found that, although progress has been made overall, two standards were lagging behind across member organizations. Commitment 4: Communities and people affected by crisis know their rights and entitlements, have access to information and participate in decisions that affect them. Commitment 5: Communities and people affected by crisis have access to safe and responsive mechanisms to handle complaints. According to the report, member organizations have made significant commitments to include communities in decision-making and collect complaints and feedback; however, this hasn’t led to significant changes in how programs are designed. Although community feedback is often collected, it isn’t systematically acted upon. With this in mind, we revised our own activities related to these commitments. The revisions are focused on developing policies and enabling locally designed initiatives to increase community participation and improve how we receive and respond to feedback. Taking Action Toward Accountability to Communities A few key things jumped out as we dug further into what resources already exist as guidance for Commitments 4 and 5. There is a plethora of guidelines, articles and manuals on the topics of community participation and feedback in humanitarian action, but they are often very long and focused on a particular aspect of accountability. Guidance is conceptual and lacks simple, practical tools. Recognizing we work in diverse contexts within and across countries, we needed more “how-to” tools which could be easily adapted to different country programs. To fill the gap for practical guidance and tools, we developed a comprehensive, user-friendly accountability toolkit accessible worldwide. The toolkit provides a succinct overview of the various components of accountability, Medical Teams’ approach and minimum standards, and a set of curated tools, checklists and templates that country programs can use to improve their accountability practices. In addition to these organizational tools, one-on-one support is provided to assess and improve community feedback mechanisms and adapt programs accordingly. The following examples are some of the initiatives that have come out of this work. WhatsApp Messaging and Community Feedback Hotline for Syrian Refugees With government restrictions on movement due to the COVID-19 pandemic, our community health workers were not able to meet as often in person with Syrian refugee households in Lebanon’s Bekaa Valley. As most refugees have access to mobile phones and data connections, the team quickly shifted to delivering key health education messages via WhatsApp groups and opened a phone hotline where community members could reach the team with urgent requests or to raise any concerns. This ensured continuity of information sharing, communication and referrals during the pandemic. Medical Teams staff in Lebanon share health messages via WhatsApp to better connect with communities. Beyond the Suggestion Box: Community Feedback and Accountability Forums Health facility staff in Uganda began moderating regular community feedback sessions and focus groups to provide a platform for communities to raise concerns, highlight successes, and communicate priorities. Health facility staff also provide updates on what actions have been taken to address feedback from previous sessions, highlight recent achievements and alert the community to any public health concerns that require community action. These sessions have resulted in higher utilization of health services even during the pandemic. In our monthly monitoring, patients have reported higher satisfaction with the services received. The sessions have supported positive behavior change as well. For example, in areas where the feedback sessions are held, there has been an increase in partners accompanying mothers for their prenatal care visits, and community members are seeking healthcare earlier for illnesses and pregnancy complications. These positive trends show that community involvement is saving lives. Using Data to Build Community Partnerships and Advocacy After conducting a household survey across 12 communities in Chicaman, Guatemala on health seeking behaviors and practices, program staff led information sessions with community members and leaders to present the findings and ask for input. In particular, the community was asked about how we could work together to reduce malnutrition among children. As a result, community leaders agreed to advocate with local authorities to tackle chronic and acute malnutrition and to promote community nutritional recovery sessions for children under two. They also confirmed their support of the community health volunteers to deliver essential health and nutrition messaging to families in the area. Without involving the community and partners in the interpretation of the survey results and prioritizing activities for the next phase, our efforts to reduce malnutrition and improve access of mothers and young children to essential healthcare would not be as effective. Medical Teams staff in Guatemala ask community leaders for input on the survey recommendations. Dr. Walter Lopez, Guatemala country manager for Medical Teams, shares key survey health data with area governmental agencies and NGOs. Accountability is Putting Communities First Each of these initiatives was designed and led by staff closest to the communities and tailored to each program’s needs. We believe it is through these locally led, small scale innovative actions that we amplify best practice and ensure that accountability is woven throughout our programs. Medical Teams is dedicated to improving our performance against the Core Humanitarian Standard commitments, which is why we will continue to emphasize accountability to communities affected by crisis. Jenny Perry Monitoring, Evaluation, Accountability and Learning (MEAL) Advisor Jenny contributes to the calling of Medical Teams International through the development and implementation of a global strategy, systems and tools for evidence-based monitoring, evaluation, accountability, and learning programs and supports country office teams to integrate these activities throughout all phases of the project life cycle. Connect with her on LinkedIn. Learn more about our ongoing work in communities around the world.