Researchers and humanitarian actors: moving from mistrust to efficiency

V. Ridde

Valéry Ridde • Director of Research at the Institut de recherche pour le développement (IRD, France) on secondment to the Institut Santé et Développement (ISED)/Université Cheikh Anta Diop (UCAD) (Senegal), joint editor of this issue’s Focus with Boris Martin, Editor-in-Chief

In spite of some notable bridge-building efforts and much joint work carried out in recent years, researchers and humanitarian actors continue to regard each other too often with suspicion rooted in a mutual lack of understanding. The former are still sometimes perceived as preaching from the comfort of their ivory tower while the latter are seen as hard-pressed when it comes to thinking before acting and deciding how to use the most recent evidence-based findings to shape their actions. For all that, few of them would refute the respective qualities they bring, although more on an individual than an organisational level. Everyone recognises that research teams provide methodological rigour and a knowledge of theory, effective action (in nutrition, health, transport, cities, etc.) and of specific contexts (an area, a country, a society, etc.) nurtured over long years of involvement. No one disputes the considerable skills of humanitarian actors when it comes to action and reaction, their long-standing partnerships in the field or their expertise in project management and monitoring. The issue lies rather in how these qualities can be combined in order to collaborate and work together, classic challenges of partnership. This dichotomy between the skills, knowledge and values of the two worlds is all the more caricatural in that still too often it contributes to a mutual lack of understanding or the undervaluing of work carried out jointly.

Those who know both these worlds are well aware that these simplistic views are outdated. Many people from one or other of them move between these two communities and many of today’s humanitarian researchers were yesterday’s volunteers or worked for non-governmental organisations (NGOs). Partnerships between research teams and NGOs have proved successful. We can recall, for example, the ten-year collaboration between a coalition of NGOs and research teams working on tackling malnutrition, funded notably by the European Commission’s Directorate-General for European Civil Protection and Humanitarian Aid Operations (ECHO) and its contribution to the institutionalisation of free healthcare in Burkina Faso, a necessary stage in ensuring its permanency(1)Valéry Ridde and Pierre Yaméogo, “How Burkina Faso used evidence in deciding to launch its policy of free healthcare for children under five and women in 2016”, Palgrave Communications, 4(1), December 2018, http://www.nature.com/articles/s41599-018-0173-x. It took several years for an NGO (HELP) to embrace the research culture and the need to have recourse to independent academics(2)Léna D’Ostie-Racine, Christian Dagenais and Valéry Ridde, “Examining Conditions that Influence Evaluation use within a Humanitarian Non-Governmental Organization in Burkina Faso (West Africa)” Systemic Practice and Action Research, 34(2), 21 November 2019, http://link.springer.com/10.1007/s11213-019-09504-w. But it also took all the personal commitment of ECHO’s experts to convince them – without unduly publicising it – of the pertinence of producing scientific knowledge on a humanitarian intervention with the aim of changing health policy. By the outsourcing of expertise, the model was different but equally effective as that presented by Christine Jamet and Duncan McLean in this Focus, where the choice of NGO is based above all on insourcing knowledge production. This is illustrative of the old debate on the relative value of using people from within or from outside organisations(3)Arnold J. Love (ed.), Developing effective internal evaluation: new directions for program evaluation, Jossey-Bass, 1983.. We have even seen examples of universities creating units (international health, nutrition, etc.) or associations in order to implement humanitarian operations, while there are countless cases of NGOs setting up departments or foundations for humanitarian research, even if we are still astonished to see some NGOs recruiting research managers without experience or training in this field when PhD holders looking for work are so numerous. Indeed, this sector could also give opportunities for these young researchers at a time when the number of academic positions is outrageously low compared with the number of doctoral students. The articles by Camilo Coral and Maritza Pedreros – both by coincidence originally from Colombia, where the humanitarian and political situation is currently worrying – confirm the importance of collaboration between humanitarian organisations and the academic world in the fields of psychology and mental health. The Covid-19 pandemic has only exacerbated the need to provide health workers with psychological support, which is well known to be sorely lacking in most hospitals(4)Mark Sheraton et al., “Psychological effects of the Covid-19 pandemic on healthcare workers globally: a systematic review”, Psychiatry Research, 292:113360, October 2020, https://pubmed.ncbi.nlm.nih.gov/32771837/. Today, many universities are trying to show they also have a social role to play, not only in their local environment, as might be expected, but also internationally. However, they are increasingly confronted with the financialisation of education (which is reflected in particular in the increase in academic training programmes on humanitarian subjects) which then undermines this desire for social involvement without financial fallout. The humanitarian sector is one of the best vectors for this rising concern. The traditional boundaries between these two worlds, whether real or artificially maintained, have indeed become permeable, especially if we focus less on the institutions and more on the way the people from these two spheres collaborate.

The fact remains that such collaborations are not exploited to their full potential or ignoring any lingering prejudices. This means that the organisation of partnerships between the humanitarian and research communities is never easy. However, this collaboration will only become truly successful if the respective parties realise that it would enable them to achieve far more than they have done so far. Research can in fact empower stakeholders to use tried-and-tested theories and evidence as a basis for their actions, thus both maximising their effectiveness in the field and helping to achieve greater equity. Theories and conceptual frameworks are more than just the whims of researchers concerned with writing books or speaking at conferences. They are also highly relevant when deciding on which activities to source funding for. Camille Balcou explains how invaluable science can be in enabling humanitarian stakeholders to anticipate the needs of future emergencies. We will not go so far as to say that future donors would select projects to back solely in terms of how embedded they are in theory or science. In fact, this would not be desirable insofar as stakeholders’ perspectives and expertise must also, but not only, drive these projects. It is their combinations of skills which must form the basis of funders’ decisions. However, research can also lead to an understanding of the humanitarian actions themselves. It can provide the knowledge and methods to move beyond the mere reporting of accounts required for monitoring and evaluation purposes by financial backers, this being delegated to assessment teams who are themselves, admittedly, sometimes drawn from the ranks of cash-strapped academics.

One of the great challenges for the humanitarian sector, as noted by Jeremy Allouche and Camille Maubert, lies in collaborating with academics in the countries where their actions are carried out. In the stable countries of the Global South, collaboration between NGOs and academics is still too rare an occurrence, apart from in the case of consultants who – with all due respect to some and without underestimating the value of the work done by many – do not conduct research. So how can we expect to find strong scientific collaboration in countries ruined by war or other disasters? The need to train and support actors in the field over the long term, even if far from ground-breaking, undoubtedly remains one of the solutions(5)Rania Mansour et al., “Health research capacity building of health workers in fragile and conflict-affected settings: a scoping review of challenges, strengths, and recommendations”, Health Research Policy and Systems, 19(1), December 2021, https://health-policy-systems.biomedcentral.com/articles/10.1186/s12961-021-00725-x. But how to work with research teams undertaking genuine scientific work and not just consultations of a more or less lucrative nature(6)Jean-Pierre Olivier de Sardan, « Promouvoir la recherche face à la consultance. Autour de l’expérience du Lasdel (Niger-Bénin) », Cahiers d’études africaines, n° 202-203, 2011, p. 511-528. in which the quality of reports is too often assessed in terms of number of pages rather than their theoretical basis or methodological rigour. Not to mention the issue of independence(7)Katerini T. Storeng et al., “Action to protect the independence and integrity of global health research”, BMJ Global Health, 4(3), June 2019, http://dx.doi.org/10.1136/bmjgh-2019-001746 that should nonetheless appeal as much to the humanitarians as the funders. How can NGOs possibly work with researchers from the Global North when the latter are not authorised to travel in so-called red zones (in the Sahel(8)Valéry Ridde et Emmanuel Bonnet, « Sahel : l’incohérence des zones sécuritaires », Analyse Opinion Critique, 5 novembre 2019. for example) while taking into account the current moves to decolonise research in the Global South and thus, especially, the need to involve teams from these countries without endangering them in these same areas? Yet research can lead, through these self-same humanitarian actions, to the increased generalisation and therefore wider sharing of lessons learnt and a greater capitalisation of experience. But the lessons learned must be high-quality ones: research and action in the field, with the unrivalled contextualisation they provide, are the key ingredients to achieving this quality(9)Michael Quinn Patton, “Evaluation, knowledge management, best practices, and high quality lessons learned”, American Journal of Evaluation, 22(3), 2001, p.329-336..

Humanitarian workers can be valuable partners here too for research teams wanting to test in a real-world setting the operations their work has revealed to be potentially effective and fair. This is true for technical innovations but also for social innovations, such as patient navigation and support(10)Valéry Ridde et al., “Demographics in the service of Universal Health Coverage: examples in West Africa”, Humanitarian Alternatives, issue 12, November 2019, p.33-48, https://alternatives-humanitaires.org/en/2019/11/14/demographics-in-the-service-of-universal-health-coverage-examples-in-west-africa; Sarah Louart, Emmanuel Bonnet and Valéry Ridde, “Is patient navigation a solution to the problem of ‘leaving no one behind’? A scoping review of evidence from low-income countries”, Health Policy and Planning, 36(1), 19 November 2020, https://pubmed.ncbi.nlm.nih.gov/33212491/. They can also provide a favourable context for training students and the next generation of both humanitarian workers and academics. How many experts started their careers as interns in humanitarian organisations? Humanitarian workers can also be involved in the process of sharing data and field results but equally in advocacy to bring changes in practices and policies, of which the example from Marine Ricau, Danièle Lantagne and Baptiste Lecuyot is a perfect illustration. Operational research – still not clearly delineated even for humanitarian workers(11)Rony Zachariah et al., “Operational research in low-income countries: what, why, and how?”, The Lancet Infectious Diseases, 9(11), November 2009, p.711-717. – remains an extremely attractive way of engaging actors from both communities in this collaborative process. Like action research(12)Peter Reason and Hilary Bradbury (eds.), The SAGE handbook of action research. Participative inquiry and practice, Thousand Oaks, 2001 ; Bony Roger Sylvestre Aka, Valéry Ridde et Ludovic Queuille, « L’analyse d’une recherche-action. Combinaison d’approches dans le domaine de la santé au Burkina Faso », in Valéry Ridde et Christian Dagenais (dir.), Évaluation des interventions de santé mondiale. Méthodes avancées, Éditions science et bien commun, 2019, p. 125-153. or intervention research(13)Anne-Marie Hamelin and Gilles Paradis, “Population health intervention research training: the value of public health internships and mentorship”, Public Health Reviews, 39(1), December 2018, https://publichealthreviews.biomedcentral.com/articles/10.1186/s40985-018-0084-9, it is still unfortunately not particularly fashionable and finds little support among the traditional research funding bodies. This calls not only for an upgrading of this form of research – the scientific nature of which is second to none –, but above all for agility on the part of researchers and humanitarians seeking funding: after all, resilience, which has long been in fashion, does not only concern structures. Many articles in this Focus point strongly to this: some NGOs finance their own research, as do some donors. But it is also true that some humanitarian bodies obtain funding from Unitaid for example, in order to collaborate with research teams, representing certainly an opportunity but one that is not without its many challenges. As we will see, there is no dearth of obstacles arising from complex partnerships(14)Angèle Bilodeau et al., « L’Outil diagnostique de l’action en partenariat : fondements, élaboration et validation », Canadian Journal of Public Health, 102(4), 5 avril 2011, p. 298-302.. This is what Pascale points out in fascinating detail in her narrative analysis of her own journey between these two worlds (to be read exclusively on the review’s website, with the other articles of this Focus).

The challenges are obviously institutional since these two types of organisations have such different cultures and this hardly facilitates collaboration. Frequently, there is also a distance between the training received by the different organisations’ members. Even though they may often have in common their critical view of the world, they also see its transformation on acutely different time scales, which need to be mutually complementary. “Slow science”, which is not a flaw, comes up against urgency of action, even if the former seems to have become the exception rather than the rule in today’s universities. Ultimately, we must not overlook the fact that there are numerous opportunities for negative influences, or even manipulation, especially when we know how important the financial backers are when it comes to funding actors from both these worlds. And sadly the still insufficient commitment of the nations of the world to both science and humanitarian action is something they have in common. Finally, the recurring issue of the independence and integrity of humanitarian work must inevitably come up during the collaboration process between research teams and members of the humanitarian community. The domination of public and private financers(15)Katerini T. Storeng et al., art.cit., whatever form their presence may take (whether in action research, operational research or interventional research) is a situation that must be constantly considered.

This Focus does not answer all the questions raised on the issue of collaboration between the worlds of research and humanitarian action, but we can only trust it will move along the debate… and actions!

Translated from the French by Fay Guerry

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ISBN of the article (HTML) : 978-2-37704-813-7

References
1 Valéry Ridde and Pierre Yaméogo, “How Burkina Faso used evidence in deciding to launch its policy of free healthcare for children under five and women in 2016”, Palgrave Communications, 4(1), December 2018, http://www.nature.com/articles/s41599-018-0173-x
2 Léna D’Ostie-Racine, Christian Dagenais and Valéry Ridde, “Examining Conditions that Influence Evaluation use within a Humanitarian Non-Governmental Organization in Burkina Faso (West Africa)” Systemic Practice and Action Research, 34(2), 21 November 2019, http://link.springer.com/10.1007/s11213-019-09504-w
3 Arnold J. Love (ed.), Developing effective internal evaluation: new directions for program evaluation, Jossey-Bass, 1983.
4 Mark Sheraton et al., “Psychological effects of the Covid-19 pandemic on healthcare workers globally: a systematic review”, Psychiatry Research, 292:113360, October 2020, https://pubmed.ncbi.nlm.nih.gov/32771837/
5 Rania Mansour et al., “Health research capacity building of health workers in fragile and conflict-affected settings: a scoping review of challenges, strengths, and recommendations”, Health Research Policy and Systems, 19(1), December 2021, https://health-policy-systems.biomedcentral.com/articles/10.1186/s12961-021-00725-x
6 Jean-Pierre Olivier de Sardan, « Promouvoir la recherche face à la consultance. Autour de l’expérience du Lasdel (Niger-Bénin) », Cahiers d’études africaines, n° 202-203, 2011, p. 511-528.
7 Katerini T. Storeng et al., “Action to protect the independence and integrity of global health research”, BMJ Global Health, 4(3), June 2019, http://dx.doi.org/10.1136/bmjgh-2019-001746
8 Valéry Ridde et Emmanuel Bonnet, « Sahel : l’incohérence des zones sécuritaires », Analyse Opinion Critique, 5 novembre 2019.
9 Michael Quinn Patton, “Evaluation, knowledge management, best practices, and high quality lessons learned”, American Journal of Evaluation, 22(3), 2001, p.329-336.
10 Valéry Ridde et al., “Demographics in the service of Universal Health Coverage: examples in West Africa”, Humanitarian Alternatives, issue 12, November 2019, p.33-48, https://alternatives-humanitaires.org/en/2019/11/14/demographics-in-the-service-of-universal-health-coverage-examples-in-west-africa; Sarah Louart, Emmanuel Bonnet and Valéry Ridde, “Is patient navigation a solution to the problem of ‘leaving no one behind’? A scoping review of evidence from low-income countries”, Health Policy and Planning, 36(1), 19 November 2020, https://pubmed.ncbi.nlm.nih.gov/33212491/
11 Rony Zachariah et al., “Operational research in low-income countries: what, why, and how?”, The Lancet Infectious Diseases, 9(11), November 2009, p.711-717.
12 Peter Reason and Hilary Bradbury (eds.), The SAGE handbook of action research. Participative inquiry and practice, Thousand Oaks, 2001 ; Bony Roger Sylvestre Aka, Valéry Ridde et Ludovic Queuille, « L’analyse d’une recherche-action. Combinaison d’approches dans le domaine de la santé au Burkina Faso », in Valéry Ridde et Christian Dagenais (dir.), Évaluation des interventions de santé mondiale. Méthodes avancées, Éditions science et bien commun, 2019, p. 125-153.
13 Anne-Marie Hamelin and Gilles Paradis, “Population health intervention research training: the value of public health internships and mentorship”, Public Health Reviews, 39(1), December 2018, https://publichealthreviews.biomedcentral.com/articles/10.1186/s40985-018-0084-9
14 Angèle Bilodeau et al., « L’Outil diagnostique de l’action en partenariat : fondements, élaboration et validation », Canadian Journal of Public Health, 102(4), 5 avril 2011, p. 298-302.
15 Katerini T. Storeng et al., art.cit.