Table 1 Coding frequencies of ethical obligations, including the top coded challenges
Discrete ethical obligations (nodes) | Sources | Coding instances |
• Challenges to their fulfillment (subnodes) | ||
Provide highest attainable quality of care and services | 52 | 301 |
• Disruption of supplies and services | ||
• Difficulty getting supplies and services to the front lines | ||
• Poor quality due to lack of accountability for care quality | ||
Appropriate acquisition and management of assets | 43 | 264 |
• Difficulty securing and protecting informational assets | ||
• Mismanagement other difficulties with financial assets | ||
• Problems with recruitment, effective retention strategies, and fair management practices of human assets (e.g., emigration of skilled workers) | ||
Protect and care for health workers | 44 | 237 |
• Direct attacks on facilities and/or workers | ||
• Inability to make contingency or safety plans | ||
• “Risk transfers” (i.e., when international or non-local actors transfer dangerous and/or risky assignments to local workers and volunteers) | ||
Support a locally led response | 45 | 149 |
• Lack of trust in the local authorities | ||
• Difficulty in identifying a local leader/partner | ||
Distribute benefits and burdens equitably | 39 | 118 |
• Inability to access the most vulnerable populations | ||
• Perceived pressure to preferentially care for certain groups | ||
Incorporation of local knowledge and recognition of cultural norms | 30 | 112 |
• Multiple social groups with differing cultural norms | ||
• Urgency makes respecting cultural norms impractical | ||
Minimize harms of response | 35 | 106 |
• Inability to accurately measure or estimate harms | ||
Honesty and transparency in communication and interactions | 17 | 47 |
• Risk perceived in being transparent (e.g., subjecting facilities to future attacks by publicizing locations) | ||