Background: Downward accountability, defined as being answerable to beneficiaries for actions and giving affected populations influence in aid processes, remains unstandardized and underinvested across the humanitarian sector. Currently, numerous accountability mechanisms are being utilized by humanitarian non-governmental organizations (NGOs) in low- and middle-income countries (LMICs). However, the different mechanisms have varying degrees of effectiveness in providing true accountability to affected populations due to significant barriers or strengths in implementation. Objective: To conduct a qualitative systematic review investigating the various downward accountability mechanisms employed by non-governmental organizations in LMICs, and to assess the effectiveness of these mechanisms in delivering downward accountability for populations in low-resource settings. Results: We searched 10 databases, including PubMed, Medline, Embase, Ovid, Web of Science, Global Health, EBSCO SocINDEX, ABI/INFORM, ALNAP, and Sociological Abstracts from 2008–2023. Grey literature was searched on Google Scholar. To capture any additional articles, the search was updated in November 2024. Our search produced 1521 articles. After applying our exclusion criteria and screening, 38 articles comprised our final dataset. Each article reported on the effectiveness of five downward accountability mechanisms, including participation, ownership, transparency, program auditing, and social auditing. Associated barriers to accountability included implementation, power asymmetry, and fragmentation within the humanitarian sector. Conclusions: There are significant gaps in research on the effectiveness of downward accountability mechanisms amongst humanitarian NGOs in LMICs. This research deficit adversely affects the sustainability of local development initiatives and, on a broader scale, undermines overall organizational effectiveness. Implementing balanced accountability mechanisms that promote equality in power dynamics is pivotal to achieving meaningful outcomes for affected populations.

Background: Sickle cell disease (SCD) stands as one of the most prevalent genetic disorders in the United States (U.S.) that causes severe consequences such as organ damage and excruciating pain. Alarmingly, recent literature indicates a decline in the number of people living with SCD (PLWSCD) seeking professional care – hinting at an avoidance of the healthcare system. Therefore, this scoping review synthesizes the evidence regarding barriers and facilitators influencing healthcare utilization among PLWSCD within the U.S. Methods: To map the current literature on SCD management and provide a comprehensive overview of the current knowledge gaps regarding healthcare utilization for PLWSCD, a scoping review was conducted. A systematic search of articles reporting on the utilization of healthcare among PLWSCD in the U.S using seven data sources was conducted on March 24, 2023, without any restrictions on publication date and language. To capture any additional articles, the search was updated on March 4, 2024. Two reviewers independently assessed studies for inclusion, data extraction, and risk of bias (RoB). Main results: A total of 708 articles were screened; 70 met the study criteria. Results indicated that the four most common barriers were social ( n = 25) interpersonal ( n = 23), economic ( n = 15), and institutional level factors ( n = 11). The top four most common facilitators were technology ( n = 9), education ( n = 7), autonomy ( n = 6), and a positive patient-provider relationship ( n = 6). The most common forms of healthcare utilization were inpatient or hospital admissions ( n = 19) and emergency department (ED) visits ( n = 18). Evidence-based interventions (EBI) found to decrease healthcare avoidance included individualized pain plans (IPPs) ( n = 4) and quality improvement (QI) strategies ( n = 3). Conclusion: This scoping review identified complex multilevel barriers that impede healthcare utilization, and facilitators likely to promote healthcare utilization among PLWSCD in the U.S. Future research should prioritize developing and evaluating comprehensive, multi-level interventions that address identified barriers while leveraging facilitators to improve healthcare engagement and outcomes for this vulnerable population. Healthcare systems and health policies must urgently adopt and integrate evidence-based strategies to rebuild trust and ensure equitable, accessible care for PLWSCD.

The COVID-19 pandemic has further aggravated the burden of mental health and presents an opportunity for public health research to focus on evidence-based interventions appropriate for populations residing in resource-constrained, post-conflict settings. Post-conflict settings have a higher service gap in mental health and fewer protective factors, such as economic and domestic security. Post-conflict settings are defined as locations where open warfare has ended but resulting challenges have remained for years. A strong emphasis on the engagement of diverse stakeholders is needed to arrive at sustainable and scalable solutions to mental health service delivery. This review discusses mental health service delivery gaps in post-conflict settings, highlights the urgency of the matter in the context of the COVID-19 pandemic, and provides recommendations for service gaps from evidence-based case study exemplars with an implementation science lens using the Consolidated Framework for Implementation Research (CFIR) as guide to improving adaptation and uptake.