Through collective action, grounded in humanitarian norms, and more efficient and effective coordination, the Health Cluster aims to increase access to essential health services, increase the lifesaving impact of humanitarian assistance, and achieve better health outcomes.

Increasingly, crisis-affected populations are hard to reach, due to access and security constraints in complex conflict environments. The lack of unhindered access to communities with high humanitarian needs can prevent aid agencies from applying their standard operating model (“direct operation”). Consequently, alternative modes of operation must be employed.

This document provides practical, step-by-step guidance to health actors involved in programming in access-constrained environments. It covers all phases, from inception through programme design, operation, and programme closure or return to direct management.

The operational framework for Programming in Access-Constrained Environments (the PACE framework) provides a visual overview of the steps involved in making the decision to begin remote operation, and planning, implementing and concluding the programme. The guidance document is organized to follow the steps given in the framework, and will provide instruction on each phase, along with examples drawn from actual situations, tools and references, and helpful tips.

The guidance here is not necessarily meant to be read from beginning to end; individual sections can be consulted for guidance on specific issues.