Thematic coding results.

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.

背景
向下问责（downward accountability）指需对受益方就相关行动负责，并赋予受影响群体在援助流程中的话语权，该概念在人道主义领域仍缺乏统一标准且投入不足。目前，低收入和中等收入国家（low- and middle-income countries, LMICs）的人道主义非政府组织（non-governmental organizations, NGOs）已采用多种问责机制。然而，由于实施过程中存在显著的障碍或优势，不同机制在为受影响群体提供真正的问责服务方面效果参差不齐。
研究目标
本研究旨在开展一项定性系统综述，探究低收入和中等收入国家非政府组织所采用的各类向下问责机制，并评估这些机制在资源匮乏场景下为受影响群体落实向下问责的效果。
研究结果
我们于2008年至2023年间检索了10个数据库，包括PubMed、Medline、Embase、Ovid、Web of Science、Global Health、EBSCO SocINDEX、ABI/INFORM、ALNAP以及Sociological Abstracts，并在Google Scholar中检索灰色文献。为补充获取相关文献，我们于2024年11月更新了检索策略。本次检索共得到1521篇文献，经排除标准与筛选后，最终纳入38篇文献组成本研究的最终数据集。每篇文献均报告了5种向下问责机制的实施效果，包括参与、归属权、透明度、项目审计与社会审计。与问责相关的障碍包括实施层面的问题、权力不对称以及人道主义领域内的碎片化现象。
结论
目前针对低收入和中等收入国家人道主义非政府组织向下问责机制实施效果的研究存在显著缺口。这一研究不足对地方发展项目的可持续性产生负面影响，从更宏观层面而言，还会削弱组织整体效能。构建能够推动权力关系平等的均衡问责机制，对于为受影响群体取得切实成效至关重要。