Responsible exit of humanitarian aid agencies at the end of programmes: a scoping review protocol

Abstract

Introduction

In humanitarian settings, aid agencies are constantly challenged by difficult decisions such as when and how to terminate aid without harming the aid recipients, local institutions, staff members and the organisation. Despite important efforts devoted to responsibly leaving a setting, hurtful exits are still common in contemporary relief aid. Moreover, debates on how humanitarian aid agencies exit are limited, with no previous comprehensive evidence synthesis on the concept of ‘responsible exit’. The objective of this scoping review is to map evidence and knowledge gaps, to identify and describe concepts, theories and existing frameworks related to ‘responsible exit’ of humanitarian aid agencies.

Methods and analysis

Our search uses searches of several bibliographic databases (CAB Direct (including Global Health), Web of Science, PubMed and Google Scholar) as well as manual searches of specific journals and retrieval of grey literature through searches of organisational websites and direct contact with experts and organisations. Reference tracking will be used to identify additional sources. Searches will cover papers available up to the dates of the searches (December 2022 to January 2023), with no date restrictions applied to the literature search. To be included, published or unpublished papers must explicitly discuss the exit of humanitarian aid agencies from humanitarian settings and be accessible. We will exclude all exits related to military, local and governmental humanitarian operations, education, development, employment, and business sectors. Only papers written in English and French will be considered. Three reviewers will conduct the selection process against the predefined criteria. Data will be extracted in an iterative process following pre-established items and the results will be presented in a Preferred Reporting Items for Systematic Reviews Extension for Scoping Reviews flow chart, tables and/or graphs, and descriptive formats.

Ethics and dissemination

Being a review, conducted on publicly available information, no ethical approval is required. The results will be disseminated through publication in an open access journal, scientific conferences, workshops, and via humanitarian aid agencies to facilitate further research and possible practical translations of generated knowledge.

Strengths and limitations of this study.

• This review adheres to the Joanna Briggs Institute’s scoping review guidance, ensuring systematisation, traceability and reproducibility of the process.

• To enhance transparency, the current project has been registered with Open Science Framework.

• Although no time limitation will be applied for paper inclusion, limiting the screening to papers published in English or French and publicly available or accessible to the authors through the Institute of Tropical Medicine’s Library of Antwerp’s library databases is a major limitation to the project.

Introduction

Amid increasing funding gaps, the global humanitarian aid system struggles to effectively respond to crises. Although the funding of humanitarian action has doubled in the last decade, it reached a ceiling in the past 4 years while the global humanitarian needs have risen steadily. Moreover, this trend is expected to worsen in a context of increasing conflicts and political instability, pandemics, climate change and reversed development gains in employment, food security, education and healthcare.^1–3 Furthermore, the above factors, in an intersectional fashion, can weaken health systems in humanitarian settings in all their building blocks.^{4 5} Consequently, humanitarian aid agencies, designed to deploy temporary interventions, are challenged with difficult decisions concerning when to prolong or terminate projects.^6–8 Exiting from humanitarian settings is known to be a challenging and highly complex process, influenced by a wide range of factors, since contemporary relief aid can be considered as a complicated set of operations undertaken in an often highly politicised and insecure context, and involving multiple actors with diverging interests.⁶

Unsuccessful exits are common and often find their root causes in poorly planned and implemented processes. This can lead to a range of detrimental outcomes for the aid recipients, the local health system, the national staff, the departing organisation and other partners.2 7 9–11 Several international initiatives, toolkits and guidance documents, such as the ‘Sphere project’ and ‘The Agenda for Humanity’,2 6 12 13 emphasise that strategic planning is essential to ensure positive long-term effects and to reduce the risk of dependency. Yet, exiting responsibly from humanitarian settings is not straightforward.⁶

Diverse definitions and terminologies are used by organisations and academics to define what means a ‘good exit strategy’. Consequently, there is no unique way of defining ‘good exit’ since different meanings may arise from diverse perspectives. Furthermore, different terminologies are interchangeably used to indicate ‘success’. For example, while Hunt et al⁷ or Pal et al² use ‘ethical exit’, Tull, British Red Cross and Rachel et al advance the term ‘responsible exit’ and Lee promotes the term ‘viable exit’. Despite various terms used, some commonalities have been associated with the term, such as sustainability, inclusive participation, effective coordination, right timing, responsible planning, capacity building.2 9 14–17 For consistency, the term ‘responsible exit’ will be used in this study.

Although the exit strategies have been increasingly recognised as an important topic in the humanitarian sector since the beginning of the twenty-first century,² Bolt et al argue that the debate on how humanitarian aid agencies leave at the end of the programme is much smaller compared with the other stages of the project cycle in the humanitarian literature. For instance, projects evaluations tend to focus on other phases of the project cycle (starts, monitoring…), their efficiency, the logistics of the aid delivery.⁸ Even though Pal et al have synthetised the evidence on the ethics of closing humanitarian projects,² their synthesis appears to solely focus on only two phases of the project cycle, namely the exit decision-making and implementation. In contrast, this project aims to go beyond these phases, from the assessment phases to the postexit evaluation phases. Moreover, to our knowledge, there is no comprehensive evidence synthesis on the so-called ‘responsible exit’ of humanitarian aid agencies and the mapping of existing frameworks.

Review question and objectives

Using the Participant-Concept-Context (PCC) framework¹⁸ (table 1), we formulate the review question as follows: What is known from the literature on the ‘responsible exit’ strategies of non-governmental humanitarian organisations. More specifically, this review aims at answering the following questions:

Table 1.

PCC framework—attributes and rationale

PCC framework	Attributes	Rationale
Participant	International non-governmental organisations	Highly debated notions of ‘sustainability’, ‘relief-development nexus’ and the ‘do no harm’ principles in humanitarian operations
Concept	Exit strategy	Complex phenomenon and challenging process for humanitarian aid agencies
Context	Humanitarian settings (natural and man-made disasters, conflicts, postconflict, epidemics, forced displacement)	Natural scene of humanitarian aid agencies

PCC, Participant-Concept-Context.

• What are the characteristics of the exit strategies of international humanitarian aid agencies?

• What are the knowledge gaps concerning the exit strategies of international humanitarian aid agencies?

• What are the attributes and guiding principles of ‘responsible exit’ strategies of international humanitarian aid agencies?

• What ‘responsible exit’ frameworks exist and/or are being used by international humanitarian aid agencies?

First, we aim at mapping the existing evidence regarding ‘responsible exit’ strategies and the knowledge gaps. Second, we will identify and describe the core concepts, theories and existing frameworks related to ‘responsible exit’ of humanitarian aid agencies.

Methods and analysis

The proposed project will be conducted in accordance with the Joanna Briggs Institute methodology for scoping reviews.¹⁸ More specifically, this section first details the processes of identifying and selecting relevant studies and reports. It then looks at the data extraction methodology and finally it presents how the findings will be analysed and presented.

Identifying relevant studies and reports

Types of sources

This scoping review will consider both bibliographic databases and grey literature databases with no limitations to study designs. Literature reviews meeting the inclusion criteria will be considered.

Search strategy

Using the above PCC frameworks, an initial limited keywords search of CAB Direct (including global health) and PubMed was undertaken to identify articles on the topic. The text words contained in the titles and abstracts of relevant articles, keywords and the subject headings used to describe the articles were used to develop a full search strategy. The last was reviewed by a librarian. The search strategy, including all identified keywords and index terms, was adapted for each selected database.

Following discussions with the librarian and using the above keywords and subject headings, we searched the following bibliographic databases: CAB Direct (including Global Health), Web of Science, PubMed and Google Scholar. Moreover, we have carried out manual searches of specific journals, such as the Journal of Humanitarian Affairs, the Journal of Humanitarian Aid, and the Journal of Humanitarian Assistance. To identify grey literature, we first searched humanitarian organisational websites through google, using multiple phrase keywords + ‘site:.org’. Only the first 10 pages, filtered by relevance were screened for relevant documents, uploaded on rayyan.ai. In the second stage, we will directly contact major organisations and expert authors in the humanitarian sector for relevant grey literature. Furthermore, the reference list of relevant studies and reports will be searched for additional sources. Finally, backward and forward reference tracking will be used to search for additional sources. The database searches were conducted between 5 December 2022 and 5 January 2023. The full search strategy in key databases is available as online supplemental material.

Owing to resource limitations, only studies published in English, French and publicly available or accessible to authors through the Institute of Tropical Medicine of Antwerp’s library databases will be included. No time limit (ie, year of publication) was applied to the literature searches.

Selecting relevant papers

Selection process

First, all identified citations will be collated and uploaded onto Rayyan.ai¹⁹ and deduplicated. Second, titles and abstracts will be independently screened by DB, HS and AK for assessment against the eligibility criteria (table 2). Finally, against the same criteria, the full text of selected citations will be assessed in depth. All reasons for exclusion of sources of evidence will be recorded and displayed in the final report. Any disagreements that arise between the reviewers at any stage of the selection process will be resolved through discussion and if no agreement can be reached, BM will step in.

Table 2.

Eligibility criteria

Criteria
Domains	Inclusion criteria	Exclusion criteria
Participants	International non-governmental humanitarian agencies	Military-humanitarian aid, governmental humanitarian aid, local humanitarian agencies development aid, business, employment and education sectors, COVID-19 control measures
Concept	Exit strategy (phase out, phase-down, phase-over, camp closure, transition from relief to rehabilitation)	None
Context	Humanitarian settings (natural and man-made disasters, armed conflicts, postconflict settings, epidemics, forced migration and fragile settings)	Others
Language	English and French	Others
Time restriction	None	None
Type of source	Published and unpublished papers without methodological limitations (journal papers, reports, guidelines, conference proceedings, magazines, newspapers, strategy papers…)	None

Eligibility criteria

To be included in this review, the paper must explicitly discuss the exit of international non-governmental humanitarian aid agencies and be available in full text online, in libraries or through direct contacts. Since we aim to focus on international non-governmental humanitarian organisations, we will exclude all papers focused on military-humanitarian aid, governmental humanitarian aid, local humanitarian aid agencies, development aid, and papers that discuss studies from business, employment and education sectors, as well as papers presenting exit strategies related to COVID-19 measures.

For this review, first, the ‘exit strategy’ is understood as the organisational management practice of how an agency leaves a community after implementing a programme.¹⁷ Second, ‘responsible exit’, the concept of concern, is understood as ‘ensuring that the process of leaving aid recipients, communities, staff, and other stakeholders is conducted in transparent, respectful, and accountable manner’ with the overall objective of ‘ensuring continuity of access to quality services’. Moreover, literature on related concepts such as ‘ethical’, ‘successful’, ‘good’, ‘accountable’, ‘viable’ exit or ‘closing well’ will be included. However, although the term ‘exit’ is widely used in the literature, it is believed to be misleading since it emphasises one point in time, while ‘exiting well’ is described as a mindset and a process.¹¹

We will include situations where a project was closed completely or handed over to another organisation or entity, phased down or transitioned to recovery or development agencies and the camp closure.

The context is humanitarian aid settings, defined by natural and man-made disasters, armed conflicts, postconflict settings, epidemics, situations of forced migration and fragile settings.

Further details of eligibility criteria are presented in table 2.

The results of the search and selection process will be fully reported in the final scoping review and presented in a Preferred Reporting Items for Systematic Reviews Extension for Scoping Reviews (PRISMA-ScR) flow diagram.²⁰

Data extraction

Building on research questions and the prereading of five papers discussing extensively the notion of ‘responsible exit’, a draft extraction form is provided in table 3. It includes bibliometric parameters (authors, types of paper, year of publication or production, country of focus, context, organisation) and thematic items regarding ‘exit’ and ‘responsible exit’ of humanitarian aid agencies. The initial data extraction form will be subject to modifications, in an iterative fashion, during the data extraction process. Any modification will be reported in the scoping review report.

Table 3.

Data extraction form

Domains	Subdomains	Description
Bibliometrics	Author(s)	Last name, first name or name of the organisation
	Year	Year of publication or production (grey literature)
	Type of paper	Journal, book, book section, reports, guideline, conference proceedings, opinion paper…
	Country	Country of focus if any
	Context	Protracted crisis, natural disaster, displacement, pandemic…
	Organisation	Organisation of focus
Thematic items	Definitions	Related to exit
	Exit categories	Types of exit strategies
	Decision-making	Concepts and theories in exit decision-making
	Challenges and outcomes	Challenges to successfully strategise and impacts of unsuccessful exits
	Responsible exit	Key characteristics of responsible exits (definition, goal, attributes and guiding principles)
	Frameworks	Existing or used ‘responsible exit’ frameworks
	Knowledge gaps

After piloting the above form on five randomly selected relevant papers, DB and HS will extract data from selected papers. Extracted data will be extensively and iteratively discussed with all authors and any unclear findings will be subject to further analysis and discussion.

Data analysis and presentation

Extracted data will be collated, analysed and summarised in an iterative manner. First, we aim to organise the analysis of the findings by identifying key attributes and guiding principles throughout the project cycle, namely assessment and project design, project implementation and monitoring, exit decision-making, exit implementation and postexit evaluation. Second, ‘responsible exit’ frameworks (if any) will be analysed for strength and weakness against the background of identified characteristics of ‘responsible exit’. Third, the identification and selection processes will be summarised in a PRISMA-ScR frame, along with a tabulated and/or graphical summary of the included references. Subsequently, in a narrative format, we will summarise the extracted data and report on them according to the review objectives. We anticipate a 9-month timeline, starting from December 2022, to finalise the present project.

Patient and public involvement

None.

Ethics and dissemination

Being a review, conducted on publicly available information, no ethical approval is required. The findings of the review will be submitted for publication in an open access scientific journal. The outcomes of this scoping review will be disseminated through conferences, workshops and via humanitarian aid agencies to facilitate further research and possible practical translations of generated knowledge.

Ethics statements

Patient consent for publication

Not applicable.