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health system when crisis hits rather than establishing new and parallel systems with
parallel coordination and communication processes. Otherwise, responses may actually
harm what is already in place, leading to dependency and an even more daunting path to
recovery and transition.
69.
One good practice shared was supporting strong existing, albeit underresourced,
midwifery centres during an emergency. Sustained investment would allow not only for the
training and employment of midwives in areas where there are urgent human resource gaps
and critical needs, but also help rebuild the health system.
70.
Experts also highlighted a need to have a conversation about adequate budgetary
allocations by States at the national level for comprehensive sexual and reproductive health
services during stable periods, in preparatory stages, at the onset and during crises and in
the transition. This will establish stronger baselines and thus resilience to build on and also
help ensure sustainability.
71.
The focus of long-term impact tends to be on quantifiable data, thereby losing sight
of local and community-based interventions, which has had far-reaching and sustainable
impacts. In one example, a project with a community-based organization to address HIVrelated stigma in one village was so successful that it was independently replicated in
neighbouring villages. Community-based interventions and monitoring, as well as womenled organizations, should be adequately financed in a sustainable manner in humanitarian
preparedness, response and transition. Documenting and validating such good practices of
similar rights-based approaches is also key.
E.
Accountability and transparency
72.
Throughout the meeting, experts agreed that ultimately, accountability for
preventable maternal mortality and morbidity must be ensured to all women and girls
affected by crisis.
73.
Many questions were put on the table, including who is accountable at what level;
what does accountability encompass beyond health outcomes; what are the different forms
of accountability; how can accountability be ensured throughout the humanitarian
programme cycle; and how can accountability of the system as a whole be established.
Similarly, it was also recognized that there is a need to unpack what is happening at all
levels of accountability, cascading down from global/system level to cluster level, to
provision and health facility level and to community and first responder level.
74.
As has also been articulated in the technical guidance and by human rights
mechanisms, although the State is primarily accountable for their human rights obligations,
experts agreed that other actors in emergencies, including the private sector, donors, service
providers, civil society organizations and the United Nations, also bear duties and
responsibilities vis-à-vis affected populations.
75.
Moreover, the technical guidance and research conducted in humanitarian settings
highlight that beyond legal and institutional accountability to donors, there are also other
kinds of accountability including financial, political, social and professional. It was
repeatedly emphasized that human rights accountability is holistic, goes beyond individual
liability and has a particular focus on identifying health system failings in order to take
corrective action.
76.
At the global level, different forms of accountability are integrated into humanitarian
frameworks of the Inter-Agency Standing Committee and the Sphere Handbook, for
example. However, these do not explicitly address sexual and reproductive health and
rights, instead highlighting gender and human rights more broadly. Similar to legal
frameworks, there remains a gap in these global commitments and in on-the-ground
implementation. Experts noted that this is often due to a perception among implementers in
emergencies that such frameworks are far removed from reality, with unrealistic
expectations. Ensuring on-the-ground accountability to affected women and girls in
emergencies for their sexual and reproductive health and rights should therefore be
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