Affordable Access

Justified commitments? Considering resource allocation and fairness in Medecins sans Frontieres-Holland.

Authors
  • Fuller, Lisa1
  • 1 Department of Philosophy, University of Toronto, 215 Huron Street, Toronto ON, Canada M5S 1A1. [email protected] , (Canada)
Type
Published Article
Journal
Developing world bioethics
Publication Date
May 2006
Volume
6
Issue
2
Pages
59–70
Identifiers
PMID: 16594968
Source
Medline
Keywords
License
Unknown

Abstract

Non-governmental aid programs are an important source of health care for many people in the developing world. Despite the central role non-governmental organizations (NGOs) play in the delivery of these vital services, for the most part they either lack formal systems of accountability to their recipients altogether, or have only very weak requirements in this regard. This is because most NGOs are both self-mandating and self-regulating. What is needed in terms of accountability is some means by which all the relevant stakeholders can have their interests represented and considered. An ideally accountable decision-making process for NGOs should identify acceptable justifications and rule out unacceptable ones. Thus, the point of this paper is to evaluate three prominent types of justification given for decisions taken at the Dutch headquarters of Médecins sans Frontières. They are: population health justifications, mandate-based justifications and advocacy-based justifications. The central question at issue is whether these justifications are sufficiently robust to answer the concerns and objections that various stakeholders may have. I am particularly concerned with the legitimacy these justifications have in the eyes of project beneficiaries. I argue that special responsibilities to certain communities can arise out of long-term engagement with them, but that this type of priority needs to be constrained such that it does not exclude other potential beneficiaries to an undesirable extent. Finally, I suggest several new institutional mechanisms that would enhance the overall equity of decisions and so would ultimately contribute to the legitimacy of the organization as a whole.

Report this publication

Statistics

Seen <100 times