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How to Change the World: Doctors Without Borders Report (Assessment)

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Updated: Jun 22nd, 2021

Doctors Without Borders, also known by its original French name Médecins Sans Frontières (MSF), was officially established in 1971. The organization was formed after a group of French doctors and journalists witnessed the conflicts that devastated the world and decided to help the victims of political and natural disasters (“Founding of MSF,” n.d.). Thus, the idea of medical professionals providing assistance to people regardless of their location was born. In 1971, 13 founders and approximately 300 volunteers began their missions to different corners of the world (“Founding of MSF,” n.d.). Currently, MSF is the leading international nonprofit association in the sphere of healthcare that focuses on medical help to populations suffering from major health-related issues. It has a primarily medical staff, including surgeons, epidemiologists, psychologists, social workers, nurses, and others. The nonprofit relies on contributions from civilians, businesses, and foundations, existing in complete independence from government donations.

MSF has a number of offices and branches in multiple parts of the world. However, its US department, generally recognized by its English name, contributes to the majority of projects and acts as one of the most prominent MSF’s parts. The headquarters of MSF-USA is located in New York, NY. The impact of the nonprofit is global – in 2016, MSF was able to help people from 71 states, and MSF-USA participated in 51 of these projects (Médecins Sans Frontières, 2016). The association’s workers and volunteers annually support people from such countries as the Democratic Republic of Congo, South Sudan, Yemen, Iraq, Ukraine, Russia, India, Afghanistan, France, Italy, Greece, and many others (Médecins Sans Frontières, 2016). In these locations, MSF cares for people who suffer from military conflicts, famine, and natural or human-made disasters. The help that the organization provides also includes healthcare research to find new solutions for expensive medical treatments and advocacy for underserved populations.

Mission and Vision

The core principle of the organization has not changed since its foundation – to provide medical assistance to people who require it. All MSF’s objectives and goals, as well as its mission and vision, are outlined in the association’s official charter. It states that Doctors Without Borders aims to “provide lifesaving medical care to those most in need” including people who suffered from major catastrophes, wars, natural disasters, pandemics, and famine (“Charter,” n.d., para. 1). Similarly, the vision also revolves around health-related concerns, as it states that MSF vows to care for people regardless of their race, gender, political affiliation, or religious beliefs (“Charter,” n.d.). Both statements are simple and easy to understand, although they may not be defined as the organization’s “vision” explicitly. Instead, MSF devotes more attention to the principles of the organization, namely neutrality, impartiality, independence, and its workers, providing their perception of duties and dangers connected to the objectives.

For nonprofits, the mission statement plays a significant role in defining the path that the organization aims to take. For example, if an organization fails to compose a declaration that will correctly show its primary goals and principles, then it can encounter many problems with its everyday activities (Babnik, Breznik, Dermol, & Trunk Širca, 2014). In this case, the vision of the association is clearly stated, and the chosen focus is narrow, making the objectives seem achievable. It helps people with health-related problems only, therefore, maintaining its status as a medical nonprofit. Moreover, the organization highlights the fact that it will help everyone who needs assistance – here, the ethics of the vision are noted and made concrete.

The phrasing of the mission is concise and directly relates to activities that the organization performs on a daily basis. The vision, however, is formulated through the lens of the main principles and is more detailed and complex. As a whole, the statements that the organization makes seem to correspond with its intentions and actions fully. Therefore, it may be difficult to improve upon them. MSF can add a short version of its vision to ensure that no confusion occurs. Nevertheless, the language chosen by the association does not raise any questions about its goals.

Governance

The board of directors in MSF-USA is composed of people who are chosen by the local association’s members (“US board of directors,” n.d.). This means that people who participate in activities and represent the US branch of the organization are allowed to vote for the board’s future members. Then, the chosen representatives elect an executive director and appoint the president and the vice-president (Médecins Sans Frontières, 2016). The board’s primary responsibilities are to develop long-term goals for the organization, choose strategic approaches, delegate tasks to the management, and monitor the activity of MSF. Members meet monthly to review the progress and decide whether the current course needs any improvements or changes.

The organization’s structure of governance, as well as its activities, is regulated by the state Not-For-Profit Corporation Law (“US board of directors,” n.d.). As the headquarters of MSF is located in New York, this state’s legal system applies to all organization’s practices. This particular law states that members of a nonprofit should meet to elect their directors annually (NY State Senate, n.d.). It also provides information about financial, organizational, legal, and other spheres of managing a nonprofit (Hopkins, 2017). Changes in the board are annual, with some directors leaving or staying for another term. Overall, 13 members should be chosen every year to form the board. In 2016, Dr. John Lawrence was elected as the association’s president, and he holds this title to this day (Médecins Sans Frontières, 2016; “US board of directors,” n.d.). Before occupying this position, he served in MSF as its vice-president (“US board of directors,” n.d.). The current vice-president is Kassia Echavarri-Queen, a long-time member of MSF who participated in numerous missions (“US board of directors,” n.d.). The board also includes a secretary, a treasurer, the president of MSF France, and other chosen representatives.

Most members of the board have a similar history as its president and vice-president – they worked as employees or volunteers for several years before being elected. Thus, the organization’s leadership is comprised of the people who have field experience and are skilled medical professionals. The state legal system requires the members to choose their directors. This process greatly benefits the organization because it is guided by people who can employ their practical knowledge to manage the association. Therefore, their commitment levels are already high. Nevertheless, to increase their involvement, they may participate in some ongoing programs. This active engagement can benefit their performance as leaders (Hopkins, 2017). The current members can also communicate with people from projects with which they are not familiar personally to expand their understanding of the organization’s strategy and goals.

Ethics

The concern about people in need of health care is the issue that sparked the idea for MSF. Therefore, ethical behavior and principles play a major role in all its activities and choices. The charter mentioned above describes the attitude that MSF members have to adhere to while working with other people. For example, any type of discrimination or bias is not tolerated by the organization. MSF doctors treat individuals of all genders, ages, and races. However, this it is also a principle of all medical facilities. MSF’s beliefs also consider communities who cannot receive any help from their government or businesses. People from underserved populations and impoverished regions where no doctors are available for free receive assistance from MSF. The organization was established because of an ethical problem – a number of countries in Africa were suffering from conflicts and disasters that involved military actions from other nations (Fox, 2014). The founders of MSF did not want to be bound by their residency and created the association to travel to such locations.

Currently, the ethical issue of helping everyone in need still complicated the work of MSF in many regions. The organization does not want to ask for any government support to protect itself from outside influences. This especially related to the programs targeted at nations in the state of war. If MSF were to receive money from the government, its members might have been persuaded not to interfere with some conflicts (Fox, 2014; Neumayr, Schneider, & Meyer, 2015). The organization’s latest reports note that it is becoming more difficult for them to acquire permissions to enter other countries for help (Médecins Sans Frontières, 2016). Armed conflicts create tensions among nations’ governments to which they respond with isolation and mistrust. MSF is unlikely to resolve this ethical issue on its own, as it is a problem of international scale. Nonetheless, it can continue to advocate for people’s rights to health care as it has been doing for years.

MSF also demands that governments of counties with a growing number of refugees show support for their migrants and accommodate their health-related needs (Médecins Sans Frontières, 2016). This position puts the organization in a strained position in many places, as it often clashes with the stance of some states (Neumayr et al., 2015). Nevertheless, this is also an issue that can be resolved only by political associations and not by MSF. Aside from these problems, MSF’s principles help its members maintain an ethically-sound position in all activities. Thus, MSF’s only concerns are to keep its course and continue advocating for affordable care, a broader reach of healthcare professionals, and new medicine for diseases that go untreated in many regions.

Management and Leadership

The board of directors mentioned above is responsible for establishing long-term strategies of the organization. These 13 people, including the president, the vice-president, the secretary, the treasurer, and other members also delegate some smaller responsibilities to managers who form a team as well (“US management team,” n.d.). This group of people is led by an executive director chosen by the board of directors. Currently, this position is held by Jason Cone, a former communications director and a long-time member of MSF-USA (“US management team,” n.d.). Other managers are responsible for such spheres as field human resources, communications, domestic human resources, development, operations, and medical research. Each director has started working with MSF as a regular member – either as an office clerk or healthcare professional. For example, the director of communications, Michael Goldfarb, started his career at MSF as a press officer and visited more than 15 countries interacting with media and MSF’s patients (“US management team,” n.d.). Other managers have similar field experiences.

The organization also has a number of associations that separate its branches according to the region. Thus, the MSF-USA department represents members who work in New York or travel to other locations under the name of MSF-USA. While the nonprofit itself is international, this division allows it to manage fewer employees and volunteers and have offices in multiple locations. The current structure shows that any member of MSF can progress through the ranks if he/she has enough qualifications. Moreover, MSF benefits from elevating its most experienced employees, as they understand the difficulties of every member’s tasks (Hopkins, Meyer, Shera, & Peters, 2014). The organization’s system of choosing managers seems dynamic and open to highly-skilled professionals. Nonetheless, the assurance in one’s future in such positions is unclear. It is possible that the organization values younger employees more than older ones. The management team should work on developing a structure of support for its members.

Volunteers and Staff

Volunteers and paid workers take up the largest part of all MSF members. A person can volunteer for both medical and non-medical positions if he/she is prepared to arrive in New York, has necessary qualifications, and is ready to travel to a remote location. Other persons can work in the organization’s office, dealing with maps, human resources, coordination, communications, and research. Students can also enter an internship program which is usually focused on a particular discipline (“Volunteer,” n.d.). According to the volunteer position’s description, office-based volunteers have to be local to New York and be over 18 years old (“Volunteer,” n.d.).

MSF also recruits people to work in the field, although such positions require a set of specific characteristics. For example, all medical professionals should have more than 2 or 3 years of relevant experience in their field of work and travel. Therefore, knowledgeable volunteers who have already visited developing countries have more chances to be selected. The programs offered to volunteers start from 9 or 12 months, thus requiring people to be available for long periods of time. MSF makes an exception for a number of clinicians who may be approved for a shorter period – anesthesiologists, obstetrics-gynecologists, surgeons, and nurse anesthetics. These workers can work on assignments that are six to eight weeks long. Language skills also become a requirement for understandable reasons. One of the main languages that are used in developing countries is French. Therefore, French speakers can be accepted to a wider variety of projects.

Volunteers and paid staff are the ones who travel to remote locations and assist people. MSF provides its workers with ongoing training opportunities, language classes, medical and non-medical skills acquisition, and management education. Moreover, paid workers have a monthly salary and benefits such as a paid vacation, leave package, retirement plan, and insurance. Due to the specification of some missions, traveling employees and volunteers can get access to psychological care providers and a peer support network. Some expenses’ reimbursements are included in the conditions as well. Overall, the system of benefits offers paid and non-paid participants many opportunities for training and development. While the salary may not be high for workers, the organization ensures that it does not overlook people’s professional expertise, while focusing on the humanitarian notion of helping people. Thus, MSF members are supported by non-monetary benefits and a community of peers.

The organization also provides all new members with orientation programs. MSF compensates all traveling and lodging expenses to people who arrive in New York from other cities for their first meeting – Information Days. However, as the organization has to respond to urgent situations as opposed to working on a specific schedule, many volunteers are not able to participate right after their recruitment. Therefore, their availability has to stay open which is a drawback of the system. The processes of employment and pool formation have to be more flexible and fast to accommodate new members in time for the new operation. Nonprofits rely on their volunteers, and the adaptability of both parties is especially crucial for MSF’s activities (Congress, Luks, & Petit, 2016). The procedure for finding participants in cases of emergency should be created to assure that MSF will not have a shortage of volunteers.

Organizational Budget

Nonprofits do not acquire money from marketing goods or offering paid services. Therefore, choosing sources of revenue and assuring their stability are actions that are essential for a nonprofit organization to stay sustainable. In most cases, revenue comes from supporting individuals, communities, and the government. The size of the organization also plays a role in its stability – smaller nonprofits may be less known by society, thus lacking recognition (Grizzle, Sloan, & Kim, 2015). Nonetheless, if a nonprofit has a specific cause that resonates with people, they are likely to support it. Usually, such organizations offer an option of yearly contributions, thus aiming to establish a stable source of money. However, one-time donations, gifts, and other sources of support are also possible. All types of funding are important for nonprofits, although financial sources are the most valuable because of their versatility. For example, MSF separates its resources to go towards nutrition and water, medication, salaries, transportation, and other expenditures.

MSF’s sources of revenue include donations and grants from nongovernmental foundations, companies, and individuals. Many nonprofits have to rely on government support in order to stay operational (Beaton & Hwang, 2017). As a contrast, MSF publicly states that it will not accept any state donations because it does not correspond with the principles of the association (“Charter,” n.d.; Médecins Sans Frontières, 2016). As a result, its revenue sources are limited to contributions. However, MSF also receives nonmonetary gifts – equipment, supplies, food, and medicine (MSF, 2016). In 2015, the total revenue (including gifts) of MSF was $347,544,509, while, in 2016, the organization received $374,217,005 (Médecins Sans Frontières, 2016, p. 81). Although it appears that MSF gained more money the next year, it should be noted that the organization’s expenses rose as well, increasing from $297,732,715 to $364,908,674 (Médecins Sans Frontières, 2016, p. 81).

Such a significant change can be explained by the number of projects in which the nonprofit engaged, as environmental factors (disasters and wars) affect the activity of MSF (Prentice, 2016). Nevertheless, MSF had stable cash flow and managed to support all projects without any major issues. While MSF already utilizes a versified revenue system, the organization can consider other sources. For example, it can devote more attention to creating goods and collecting fees for them. Different types of financing seem to be covered by the nonprofit already.

Strategic Planning

As a contrast to some other organizations, MSF works on a case-by-case basis because its mission is to assist people in emergencies. Therefore, strategic planning is only partially effective in this case. While MSF can plan for some situations, its principle to respond fast to unforeseen natural disasters requires short-term decision-making. For instance, the organization has a strategy for finding a more affordable medicine to treat tuberculosis – this plan was developed several years ago and is still in progress (Médecins Sans Frontières, 2016). Similarly, some projects are ongoing and are monitored annually. The board of directors is responsible for both long-term and short-term strategies. As all its members have field experience, they can adequately assess each situation and see which decision would be the most logical.

Strategic planning is the board of directors’ main duty. Then, after the organization’s leaders choose a long-term direction (research, ongoing projects) and make predictions about possible crises, they delegate smaller tasks to the board of management. There, directors take on their separate responsibilities to work with people, finances, and resources. Thus, MSF still uses strategic planning to some extent, making unforeseen events the most flexible part. For nonprofits, strategic planning can significantly improve the financial state of the organization, redistribute its revenue, and lower expenses. For example, MSF’s change in cash flow in 2015 and 2016 shows, how crucial a thought-out plan can be. If the rate of crises continues to rise, MSF should update its long-term objectives to cover more possible problems in the following years.

Social Change Impact

MSF’s influence is both local and global. First of all, it contributes to the health of many people, providing care to impoverished populations and victims of disasters. This activity also contributes to the rate of pandemics and malnutrition and improves people’s quality of life. Moreover, the research that MSF sponsors can change how the world treats diseases such as tuberculosis if a cheaper vaccine is found. On a local scale, whole communities may progress because of MSF – better health can contribute to education, economy, and politics in the area (Ebrahim & Rangan, 2014). Engagement in political conflicts also shows that people on both sides deserve fair treatment. This message of peace contributes to nations’ worldview development as well.

Conclusion

Doctors Without Borders (MSF) is a nonprofit with specific principles and a clear mission. It has a system in which each member can become a director, and all current board members have experience working as MSF volunteers or paid employees. The organization has a strong ethical foundation – it maintains independence from government support and implores other countries to improve their current policies. Employees and volunteers are supported with benefits and training, along with mental health assistance and a community network. MSF has a diverse system of revenue sources, and its budget seems to be stable enough to cover unforeseen situations. Overall, the global social impact of MSF can be explained by its consistent and persistent activity that adheres to its strong morals.

References

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Beaton, E., & Hwang, H. (2017). Increasing the size of the pie: The impact of crowding on nonprofit sector resources. Nonprofit Policy Forum, 8(3), 211-235.

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Hopkins, B. R. (2017). Starting and managing a nonprofit organization: A legal guide (7th ed.). Hoboken, NJ: John Wiley & Sons.

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Prentice, C. R. (2016). Understanding nonprofit financial health: Exploring the effects of organizational and environmental variables. Nonprofit and Voluntary Sector Quarterly, 45(5), 888-909.

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