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: simran.chaudhri@gmail.com1UNICEF 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

email

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

-WhatsApp

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?

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stheprop

osed

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eacceptance-buildingmeasures?

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life-saving

actio

nor

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atpreserving

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ossiblemeasuresbe

entakento

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edsassessmen

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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

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atelyrespon

sibleforthemanagem

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andthequ

ality

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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

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nde

term

iningwhe

ther

touseremote

managem

ent:

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staffin

the

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acceptable

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facedby

staffor

partne

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nandindividu

als

implem

entin

gtheactivities

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text

analysisandne

edsandsecurity

assessmen

tjustify

remotemanagem

ent

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tcapacity

amon

gstaffand/or

partne

rsto

deliver

theprog

ram

(ortraining

tobu

ildcapacity)

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ram

activities

canbe

implem

ented

followinghu

manitarianprinciples

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adde

dvalueto

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humanitarianne

eds

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implem

ented

-Strategies

formitigatin

grisks:p

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analysis,p

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andpo

licyadaptatio

n,prioritizingstafftraining

andde

velopm

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gand

evaluatio

n,clearcommun

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inform

ationmanagem

enttools,and

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ityaccoun

tabilityproced

ures

tostreng

then

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andprog

ram

supp

ort

Hüls2011

n/a

RemoteManagem

entof

Hum

anitarianAssistance

n/a

n/a

Essay

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e:shiftingriskto

localstaff,

redu

cedqu

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assuranceandtim

elyactio

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creasedknow

ledg

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party

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verification,inform

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ityinvolvem

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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

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entmeasuressuch

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nentsof

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decision

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2005

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anSpace

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RemoteSensingand

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atingavailablewoo

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logies

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impact

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Haitiearthq

uake,

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manitarian

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ssia,Libya

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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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