Currencies of Influence
This chapter introduces the ways inequality runs through MSF. It then describes six attributes that tend to contribute to influence in the organisation: time in ‘the field’, friends in high places, whiteness, English language skills, masculinity and medical experience.
Key Findings
MSF is built around inequality and power imbalances – between patients and humanitarians, volunteers and employees.
‘Internationally mobile’ versus ‘locally recruited’ is the biggest inequality mentioned by staff.
There are several informal ‘currencies of influence’ that interact and evolve, and they can help people advance their careers as well as shape MSF’s agenda.
Chapter overview
MSF is structured around inequalities: power imbalances (such as those between patients and humanitarians, and between volunteers and employees), are central to how MSF was founded and how it operates today. This is in common with wider aid practices based on the idea of ‘universal humanity’ that can reproduce post-colonial power relations.
The biggest inequality in the eyes of staff: the privileges of ‘internationally mobile’ compared to ‘locally recruited’ employees. The distinction between these two categories impacts people’s experience of working for MSF, including their access to opportunities, leadership positions, mobility, pay and allowance policies and healthcare.
“People who are not leaders, they have no influence on the community. If you choose someone who is not a leader, it cannot give any influence on the community and so we need to choose the people who are going to understand what we are talking about and make a change with them and then they can go in the community and speak to the community or to us who have been discussing and then the message can be very well understood.”
Decision-making power is still concentrated in a hierarchical structure of line management and accountability – and the majority of MSF employees (as well as those who receive MSF aid) are still excluded from participation and are largely invisible in the organisation’s public voice and story.
Locally recruited staff find it hard to progress in their careers beyond a certain level. There are barriers to them taking on senior roles – particularly the idea that outsiders are neutral in a way that ‘locals’ can’t be. Supervisor roles often go to staff with ‘international’ status, even if they don’t have the relevant previous experience.
On the flip side, “community leaders and a lot of the context where we speak are already the power holders in the community.” Hence the approach taken by MSF risks a perpetuation of already existing power imbalances within the community.
There are six major attributes affecting who has influence, authority, opportunities and even a voice in MSF. These don’t necessarily stay the same – they evolve and may take different forms in different places. They are:
Time in ‘the field’
According to people interviewed for the study, this gives you “street credibility” and gets you “the stripes on your shoulder” that legitimise you to represent MSF externally and “join the conversation” internally. However, being ‘from’ the field doesn’t give you the influence that having visited it does, and length of service of locally recruited staff doesn’t carry the same weight.
Friends in high places
Being well connected, especially with senior decision-makers, enables people to show themselves as legitimate and important, and affects their ability to access different opportunities, as well as safety and support.
Whiteness
Some employees described how whiteness is still a marker of power and competency in MSF, with ‘expat’ often equated with whiteness – and whiteness with a racialised stereotype of the humanitarian worker. Racialised colonial views inform assumed hierarchies of competency and expertise, with examples suggesting that black African staff face the strongest cases of ‘othering’.
English language skills
These are a route for accessing positions of power, particularly in OCA programs. Without English, employees in a Congolese case study described being blocked from decision-making posts, international jobs or training only provided in English. The working language is often determined by the smaller number of senior staff who speak English, rather than by the vast majority of staff and patients whose mother tongue is often something else.
Masculinity
Or the ability to conform to a ‘macho’ persona. Locally recruited staff also contend with gendered power dynamics in country teams, where in some cases interviewees highlighted that the majority of female locally recruited staff “are in either housekeeping or caregiving. Men occupy all the other positions.”
Medical expertise
Enables people to exert influence and set and shape agendas. In some cases, it’s formally recognised and given a privileged position.
“Globally, there is a power imbalance between the healthcare staff and patients, or communities. That is reflected, I think, in MSF as well. We’re not any different to that. I guess, for us, it’s complicated even more so, or worsened, by the kind of colonial roots that we have, as well. I don’t think we’ve perhaps, reflected enough yet on just how imbalances and inequality and the power that medicine, the medical profession has.”
Across the board, different currencies of influence overlap and intersect with inequalities within MSF. Some relate to demographic factors like race, gender, ethnicity, which are a reflection of wider societal structures. MSF may play a role to either accentuate or alleviate inequalities depending on the stance it takes. Others are part of MSF’s own systems and cultures, and sometimes also shared with other humanitarian organisations. In the later chapters there are examples of how the currencies of influence play out in practice.
Delve deeper
Image credit:
7. Ria Kristina Torrente
8. Isaac Buay/MSF