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Conclusion

This chapter concludes the research with reflections on efforts to make meaningful change, different ideas about how that could or should happen, and the combination of faith and dismay that appears to shape how employees in OCA and MSF relate to the organisation.

Key Findings

‘Emergency’ shapes what reform initiatives are deemed possible.

The moral appeal to saving lives in an emergency is used to justify the organisation’s structures, and the inherent inequalities they reproduce.

Formal and informal inequalities are interconnected and interact in complex ways – they can’t be addressed separately.

If there is indeed a shift underway, or momentum building, efforts to foster it will need to confront not only the practical obstacles to structural change but also institutional and attitudinal ones.

More radical change may need not only to diversify who carries out MSF’s work, but also give people the power to shape and conceptualise what MSF is fundamentally about.

What's next?

Discussions & Reflections

The research presents many ideas, and to help you engage with its findings you may find it useful to discuss the issues it raises with colleagues. Arranged by chapter, the following questions provide a starting point for your own reflection and discussion.

Emergency Culture

What is an ‘emergency’?
How does this shape OCA’s systems and structures, and its everyday work?
Is responding to an emergency more important than thinking about the structural inequalities MSF might be reproducing?
Are these things in competition?

Currencies of Influence

What ‘currencies of influence’ have you observed in your time with OCA or MSF?
Have they changed over time?
What is their relationship with ‘emergency’?
How might this be linked to inequalities between MSF and its patients, and within the organisation?

MSF Identity

What is MSF identity?
What are some of the markers of ‘being MSF’?
Who can best embody these and how does this shape participation in the organisation?
What are the roles of locally recruited staff in MSF’s operational decision making and associative life?

Filters & Circuit Breakers

Do locally recruited staff manage internationally mobile staff in the contexts where you have worked?
What are the advantages and disadvantages of powerful coordination roles?
What are the limits of security provision and health care for different contract types?
Where should such decisions be made, and what might accountability look like?

Keeping the Flame

What are the key attributes through which people gain legitimacy in MSF?
Do you think this is evolving?
Do you agree or disagree with the argument that by investing in DEI we take resources away from the medical mission?
In your experience, how important is the idea of volunteerism to MSF, and what are its impacts?

Diagnostic Disconnect

Do attitudes to leadership shape what is it possible to do within MSF?
Do you think MSF’s principles and values are universal? If so, in what ways?
What is the role of patients in decision making?
What would you do to try to influence a change in how MSF works?

Delve deeper

View the full research report

Image credit:

20. MSF 

 

What's next?

https://MSFUK.unbounddocs.com/power-analysis/diagnostic-disconnects/,https://MSFUK.unbounddocs.com/power-analysis/whats-next/