The localisation of humanitarian response to conflict and displacement: a scoping review from a health systems perspective.

introductionThe Grand Bargain Agreement at the 2016 World Humanitarian Summit emphasised the need to reform the humanitarian system. Central to these reforms were commitments to localise humanitarian assistance by increasing funding and decision-making for local and national responders and shifting control away from international actors. Localisation has the potential to improve the operational effectiveness of humanitarian assistance, strengthen local health systems and empower affected communities; however, progress has been slow. We aimed to identify the barriers, facilitators and outcomes of localised humanitarian health response for populations affected by conflict and displacement.

methodsWe searched six academic databases for empirical studies published between January 2016 and May 2024 describing localised or locally led health organisations, workers or service delivery for populations affected by conflict and displacement in low- and middle-income countries. We adopt a health systems perspective and results are presented as a narrative summary using the WHO Health System Building Blocks framework.

resultsOf the 48 included studies, 32 used qualitative methodologies. Efforts to localise humanitarian responses were hampered by multiple challenges relating to funding, leadership and relationships with international actors. Locally led humanitarian response improved the coverage, reach and responsiveness of health interventions, as well as the speed and efficiency of service delivery in conflict and displacement settings. However, there was little evidence of an increase in the meaningful participation or empowerment of affected communities and other local actors. Instead, international actors leveraged these operational advantages while retaining control over funding and decision-making. This dynamic increased workforce stressors for local staff and undermined local leadership and structures.

conclusionFor genuine localisation to be achieved, the humanitarian system must foster equitable partnerships and funding mechanisms that empower local organisations and address the structural barriers that perpetuate their exclusion.