In the last decade, while facing increasingly complex “projects”, MSF-OCP has chosen to add means to improve its interventions. This results in the actual growth syndrome of MSF-OCP HQ departments, which is also significantly impacting country coordination (CC) set-ups and means. New scenarios should be tested, notably for mono-projects (to revise), the idea being to reduce CC set-ups whenever possible. Resources' analyses highlight the importance of competent persons to follow (coordinators & key positions), including PCs, with a clearer career path. While the field has coped most of the time with MSF's functioning difficulties (gaps, turn over, internal crises, growth etc), a number of key managerial aspects to consider for the next strategic plan (2014-16) are pointed out. New strategies proposed to control growth should be shared transversally (between departments), respecting immediate priorities versus longer term strategies.