title: Implementation of evidence-based humanitarian programs in military-led missions: part I. Qualitative gap analysis of current military and international aid programs.
abstract: BACKGROUND
  A recent Department of Defense instruction mandates country-specific assessments, identification of interventions, and development of guidance for Department of Defense to plan, train, and prepare for the provision of humanitarian assistance in stability operations. It also directs the use of outcome-based measures of effectiveness and the establishment of processes facilitating transparency of information. Whereas this would align military-led projects closer to the standards of the international aid community, how this process will be developed and implemented within the military has not yet been determined.
  
  
  METHODS
  To begin developing an evidence-based program for military-led humanitarian aid, we conducted a qualitative gap analysis comparing information from a Web search of Department of Defense medical after-action reports, lessons learned, and expert interviews with the internationally accepted standards in humanitarian assistance impact assessment.
  
  
  RESULTS
  There is a major gap in the ability of the Department of Defense to assess the impact of humanitarian assistance in stability operations compared with international development standards. Of the 1000 Department of Defense after-action reports and lessons learned reviewed, only 7 (0.7%) reports refer to, but do not discuss, impact assessment or outcome-based measures of effectiveness.
  
  
  CONCLUSIONS
  This investigation shows that the Department of Defense humanitarian assistance operations are, historically, recorded without documentation using quantifiable health data identifying which aid activities contributed directly to desired outcomes or favorable public opinion, and rarely are analyzed for effectiveness. As humanitarian assistance operations assume an ever greater role in US military strategy, it is imperative that we investigate useful impact assessment models to meet mission directives and, more important, to maximize coordination in a necessarily integrated and cooperative development environment. These findings provide baseline knowledge for the implementation of an evidence-based impact assessment process to validate future Department of Defense humanitarian assistance operations.
authors.affiliation: Department of Preventive Medicine and Biometrics, Uniformed Services University of Health Sciences, USA. ereaves@usuhs.mil
authors.forename: Erik J
authors.initials: EJ
authors.lastname: Reaves
authors.forename: Kenneth W
authors.initials: KW
authors.lastname: Schor
authors.forename: Frederick M
authors.initials: FM
authors.lastname: Burkle
mesh_terms: D000533:Altruism; D004189:Disaster Planning / Q000379:methods / Q000458:organization & administration*; D004190:Disasters; D055416:Evidence-Based Emergency Medicine / Q000458:organization & administration*; D014943:Global Health; D006801:Humans; D007391:International Cooperation; D008493:Medical Missions; D008887:Military Medicine; D008889:Military Personnel; D036301:Qualitative Research; D012066:Relief Work / Q000458:organization & administration*; D014481:United States