MOTION 4 - 2018 - FEEDBACK

2018 MOTION 4 - 

Operational orientations and decisions

 

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MOTION 

We ask the OCB Board to ensure that the health needs of beneficiaries and the potential impact on these health needs should be placed at the centre of MSF’s operations and leverage interventions, in order to preserve impartiality as one of MSF’s important fundamental principles.

This through:

A critical review of the current operational portfolio and a strengthened monitoring of risks and missed opportunities for changes in health status of people in the existing contexts, in particular the most vulnerable ones. Aspirations of MSF presence in a certain region cannot side-line MSF actions to improve significantly health gaps for beneficiaries.

The organisation of real, meaningful and inclusive associative debates on mid-term strategic orientations of OCB, such as the Vision paper and the Prospects 2018, and in particular the medical operational choices, as these orientations have a profound impact on MSF-OCB’s (medical) identity, the healthy balance in the OCB portfolio and risks and opportunities for MSF’s added value in terms of medical expertise and impact.

We ask the OCB board to report back on this exercise to the GA/Gathering in 2019.

Operational choices group discussion - mini-AG in Belgium

 

 

EXPLANATION AND BACKGROUND

Motion following Mini AG Belgium concerning operational orientations and decisions

While MSF is supposedly the child of a medical doctor and a journalist - reflecting the two fundamental parts of the personality of our organisation- both MSF’s medical action and témoignage roles seem to be crowded out by geopolitical considerations.

Medical interventions seem to be tailored to increase our negotiation capacity to be present in certain contexts or enhance our institutional profile. Beneficiaries and their health needs seem rarely the starting point of determining MSF’s response; other motives shape operational choices.

The 2017 budget cut exercise disproportionately affected projects and missions with medical objectives versus those with ‘strategic presence’, leading to a further disbalance in the ops portfolio and risks of reputational damage.

The priority setting applies a hierarchy of suffering: lives lost by victims of conflict are considered of more value than lives lost as consequence of a health crisis. Preferred medical interventions are excessively focusing on hospitals and technical specialised interventions. Immesurate investments are made in a few privileged projects with high technicity or interest for MSF profiling. A lack of value is given to impact objectives, illustrated by rejection of concepts such as coverage, public health, primary health care.

As a consequence, loss of meaning impacts staff motivation and retention at all levels (HQ and field). A feeling of lack of accountability about operational choices (towards our beneficiaries, donors) is prevailing, with a risk to lose individual input and initiative, as well as the associative fibre of MSF.

The lack of diverse and meaningful medical operations as learning environments risks undermining MSF’s medical expertise. The dominance of institutional interests impacts negatively on MSF’s reputation. Impartiality, a fundamental value of the MSF identity and charter, is undermined due to the lack of proportionality of MSF’s actions to people’s needs (compared to other interests).

Purpose of the motion: We want to bring back the health needs of our beneficiaries at the center of our operational choices. We are concerned about the risk to undermine the core principles of MSF and our main credibility i.e. our medical expertise and action in response to and with a tangible impact on people’s health needs -especially for the most vulnerable. We think it’s therefor important to review and revise both the strategic orientations and the dynamics within operations.

 

FEEDBACK (Final draft)

The OCB Board organized several meetings and initiated discussions with the motion writers and the management team at OCB. The OCB Board acknowledges that the motion is important and raised important issues on management, inclusiveness of teams (mainly the field), clarity and strategy when it comes to operational choices. 

The OCB Board reaffirms that Needs are always at the centre of our operations. A series of steps were taken by the executive this year:

The operations department has completed a review of the current operational portfolio and has developed an in depth analysis of the type of projects that we have within the OCB operations. The results have been sent to the HoM’s and MedCo’s and have been analysed collectively during the co-days. The review shows that OCB has a diversity in its operational portfolio which the executive wants to maintain. Some of elements are worth mentioning out of this typology exercise:  

• In regards to the geographic dynamic of our portfolio, The majority of our operations continue to be on the African continent where the needs are the most prevalent.  54% of our total ops budget goes to Africa, 47% of our project are in Africa.

• Default projects and emergency envelope OCB represent 2/3 of our portfolio. We are aiming to increase our emergency envelope to 15% of our financial resource within that default/emergency part versus 10% currently.
• 64% of our projects are located in stable contexts. Whereas it was a key priority in the former prospects, conflict settings represent 13% of our current portfolio. This shows the challenge to access such contexts and to develop operational capacities to meet these populations in distress. Our efforts need to be sustained if not increased in the future.
• Almost 70% of our projects deliver first line care. We recognize the importance of the continuum of care and we need to better connect our secondary health care projects to primary care and community-based efforts and primary care projects need a referral system in place.
• 49% of the population targeted in our projects is the general population, migrants/refugees/IDPs account for almost 40%
• 70% of our budget goes to projects lasting for more than 5 years. This means that we need to keep space to open new projects and react to emergencies.

The recentralisation process got launched this year. The main objective being to increase the autonomy of field decision at project level (closest to the patients) and to remove bureaucratic layers in our operational chain. This is a promising step in ensuring that medical needs remain at the centre of our decision making.

In addition, the executive has taken the following steps to promote inclusive debates:

1. Since the beginning of the process of constructing the new strategic orientations the field has been represented. Indeed, on average, per discussion paper; 0,5 Associative members, 20 Field, 4 Partner Section and 18 Operational Center staff (total 45) contributed as part of the core writing team, through consultation by interview, survey or helping to review. Extrapolating this for 31 papers, we can assume that approximately 16 Associative members, 742 Field, 145 Partner Section and 608 Operational Center staff (total 1494) contributed to the process, though of course many Operational Center staff contributed to more than one discussion paper.  Over 1000 OCB staff members have directly contributed to the process so far. The field received most of the papers several weeks before the co-days and the Gathering and have organized discussions. A selection decision papers have been debated during the Coordination week[1]. Those that will not be discussed during the Coordination week will be discussed during webinars ensuring that the field is able to discuss all of the topics.
2. A Foot print analysis got requested and conducted by the field. The objective of this exercise was to get a deeper knowledge on the ambitions of the projects and of their cycle. We have as well asked all the teams to qualify the added value of the OCB projects in contexts where different OCs are present. The analysis is ongoing, and it will help to define the future operational strategies and priorities.  
3. COPRO[2] info is now sent with more advanced notice and some improvement in the quality of the documentations being submitted. Debates have been promoted but the debate capacity still needs to be encouraged.  A CoPro revision is being discussed.  
4. An OPS Newsletter is now sent monthly to the field and HQ. We need to make sure that the field mailing list be enlarged (PMR[3]/Fieldco)
5. Quarterly monitoring meetings are held with the DO[4] & cells and now include: Analysis Dept and Medical Dept
6. Promotion of the Quality Framework tool[5], of which 3 indicators refer to patient centeredness and community inclusion in the preparation phase and during the running of the project. Tools need further promotion at field level. The quality framework is a part of the Dashboard which will be used (once finalised) during the QMM

WAY FORWARD

The motion asks requires long term work so it is not be possible to close the motion or to give a final response at this OCB Gathering. The motion is asking for an attitudinal change – approach towards decisions and how to reach those. The Board will continue the dialogue, to monitor the process and evaluate the impact on operational decisions.

 

 

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