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The notion that humanitarian response should center on the people it serves, rather than the aid agencies serving them, has been repeatedly codified in humanitarian commitments as far back as the early 1990s. Yet the mainstream humanitarian system has struggled to translate these commitments into practice: corresponding reform efforts have failed to systemically broaden accountability to and participation of aid recipients in response efforts. Major constraints have included misaligned incentive structures between donors and aid agencies, power imbalances between aid providers and aid recipients, and operational and political complexities arising at field level. To produce real systemic change, the aid system must move beyond technical and rhetorical approaches to accountability and begin reshaping the power and incentive structures that influence aid decision-making. This paper proposes a set of mutually reinforcing recommendations centered around three imperatives: enshrining the influence of aid recipients at all levels of aid decision-making; developing independent channels for soliciting the priorities and perspectives of crisis-affected people; and institutionalizing a set of enabling changes to humanitarian operational and personnel practices.