Standards And Guidelines To Support Human Dignity In Cross-Cultural Healthcare

Standards and Guidelines to Support Human Dignity in Cross-Cultural Healthcare

As I prepare to release the second edition of When Healthcare Hurts, I have had a chance to revisit much of the literature around best practices in global health work. It is clear that standards and guidelines around patient safety can be extrapolated from WHO, UNICEF, Institute for Healthcare Improvement, and International Joint Commission. However, one thing I did not clearly identify in the first version of When Healthcare Hurts, was what standards and guidelines already exist around supporting and promoting human dignity while responding to human needs. For this reason, I did include some content on Sphere Standards, which does address this idea of supporting human dignity in cross-cultural relief and development work.

The Relief and Development Community Sets the Standard

The relief and development community has created a set of comprehensive minimum standards for humanitarian response, although they have been slow to make significant progress in the USA. These standards, known as the Sphere Standards, are a set of principles and minimum standards created to improve quality and accountability of humanitarian response in four technical areas: Water Supply, Sanitation and Hygiene Promotion (WASH), Food Security and Nutrition, Shelter and Settlement, and last but not least, Health.

Where Did Sphere Come From?

Sphere was founded in 1997 as a collaborative effort amongst more than 300 relief and development agencies. This unprecedented effort came about after the humanitarian community recognized that better organization and collaboration could have saved thousands of lives during the Rwandan genocide of the 1990’s. Today, the Sphere Standards have become the foundation of disaster and refugee response globally. The Sphere Handbook is the primary reference tool in humanitarian crisis used by relief and development organizations, advocacy groups, governments, Red Cross Red Crescent, United Nations, World Food Program, etc. It puts all the organizations responding to an international crisis in the same playbook, and holds them all accountable to the same agreed-upon minimum standards.

The Humanitarian Charter and the Protection Principles

There are multiple standards in each technical sector: Water Supply, Sanitation and Hygiene Promotion (WASH), Food Security and Nutrition, Shelter and Settlement, and Health. Each standard has a list of key actions, key indicators, and guidance notes recognizing it is not always possible to achieve the standards fully. All of the standards were created around the Humanitarian Charter and the Protection Principles. The Humanitarian Charter is part statement of established legal rights and obligations, and part a statement of shared beliefs of the relief and development community. The Charter is the legal and ethical framework for the Protection Principles, the Core Humanitarian Standard, and the Minimum Standards that are outlined by Sphere. The Humanitarian Charter is centered around three primary human rights, and applies broadly to all types of relief and development work, including medical work. These rights are: the right to life with dignity, the right to receive humanitarian assistance, and the right to protection and security.

There are four Protection Principles, and they apply to all humanitarian action by any and all humanitarian actors.

The principles are:

1) Enhance the safety, dignity, and rights of people, and avoid exposing them to harm.

2) Ensure people’s access to assistance according to need and without discrimination.

3) Assist people to recover from the physical and psychological effects of threatened or actual violence, coercion, or deliberate deprivation.

4) Help people claim their rights

(Sphere Association, 2018).

These rights and principles were created for relief and development organizations working primarily in crisis situations, but they also apply to any global health activities. Response to human need in any context requires guidance and intentionality to support human dignity, not diminish it. (Sphere Association, 2018)

The International Red Cross Red Crescent Code of Conduct

Another core document upon which the sphere standards are built is the International Red Cross Red Crescent Code of Conduct (Sphere Association, 2018). This code was created to establish standards of conduct and behavior to which all organizations should adhere. It was also developed with input from a large portion of the relief and development community. Most non-governmental organizations (NGO’s) responding to disasters have signed the Code of Conduct, which applies to both faith-based and secular organizations. There is much within the Sphere Minimum Standards, the Humanitarian Charter, the Protection Principles, and the International Code of Conduct that applies to global health work. They provide a foundational understanding of how to respond to human needs in a way that supports and promotes human dignity. Understanding the Humanitarian Charter, the Protection Principles, and the Health Sector Minimum Standards is a good starting place for entry into global health initiatives.

These principles apply in global health initiatives and cross-cultural medical work. In fact, Principle 1 (Enhance the safety, dignity, and rights of people, and avoid exposing them to harm) is the foundation upon which the best practice guidelines in this book were created. Building on this foundation, the following guidelines are meant to address the most critical aspects of global health initiatives, i.e., those with the highest potential for harm. As a side note, there are relatively few Sphere Minimum Standards training courses offered in the USA. Christian Health Service Corps (CHSC) training department does at least one course per year at our international operations center in Grand Saline, Texas. You can find out more on the training section of our website.

Sphere Association. (2018). The Sphere Handbook: Humanitarian Charter and Minimum Standards in Humanitarian Response, fourth edition. Geneva, Switzerland: Sphere Association. Retrieved from


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