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MSF in Latin America has a history of more than 40 years of implementing a wide range of programs, including neglected diseases (HIV, Tuberculosis and Chagas), urban violence as well as regular emergency responses to acute epidemic and natural disasters.

This report was made by BRAMU, the Brazilian Medical Unit of MSF Brazil at the request of OCBA. It aims to contribute to a comprehensive understanding of socalled “Other Situations of Violence” (OSV). It argues that these situations do have some specificities that need to be understood and integrated to adequately address their medical and mental health consequences. This report also argues that OSV are neglected situations of violence. It ends by advocating for comprehensive, large and flexible MSF projects.

In 2011, MSF Canada decided not to sign a further memorandum of understanding with the operational centre Amsterdam partners, and instead to focus its operational and resource support to the MSF movement as a whole. In their 2012-2016 strategic plan MSF Canada then adopted this movement focus as an overarching principle.

After 10 years of presence in Zinder, the MSF mission is preparing for a successful handover of the project to the national authorities. The handover process, which started 5 years ago, has been well structured and well
planned. It has followed a step-by-step approach, progressively transferring responsibilities to the national authorities, and has thus avoided jeopardizing the quality of care for the beneficiaries.

Médecins sans Frontières Operational Centre Geneva (MSF OCG)’s Initiative for Medical Innovation (2IM) has successfully introduced the beginnings of a change in organisational culture through a number of innovation projects. Every department has now adopted the notion of innovation and risk taking and a mindset of challenging the status quo. We have found evidence that the 2IM Initiative has, with a degree of success, started to address an identified latent risk aversion in OCG.

In recent years, MSF has recognised the need to improve its handover process and outcomes. It is no longer satisfactory for the organisation to enter a country, put in place a programme and leave without some degree of
accountability for what remains after MSF’s departure. This tendency has led the MSF Operational Centre Paris (OCP) to review the handover process of the Homa Bay County Hospital project in Kenya. The main goal of this evaluation is to explore how effective the handover strategy was in contributing to sustainable, comprehensive quality of HIV/TB care in Homa Bay.

The objective of this exercise is to reflect on the recent OCBA Ebola intervention in Province Equateur, DRC, in order to understand the actual in-house capacities in this field. This reflection exercise aims further to serve as the trigger for a broader exercise where, once the main findings and
conclusions are shared and acknowledged by key OCBA stakeholders with regard to VHF response, OCBA ambitions on the domain of Ebola response will be discussed again. Finally, the outcome of that broader exercise could be, considering the result of this capitalization as the baseline situation, the design and implementation of an action plan that should contribute to fulfil those ambitions. This capitalization exercise intended to explore strengths and weaknesses of OCBA’s response; what seems to have worked well and what didn’t regarding the resources deployed; how adequate were the strategies defined and their implementation for the different pillars and aspects of the response.

The various surveys and evaluations carried out on briefings (BG) and debriefings (DG) have shown that the current system of BG/DG was inadequate. This was partly because of the growing number of recruits on international contracts (expatriates) and has resulted in an increase in briefings and debriefings.

This economic evaluation is part of a broader evaluation of “OCA’s 5-priority strategy in DRC South Kivu: Baraka project”. The objective of this economic component is to answer to the following question: “To what extent has the 5-target population strategy improved the manageability of the project in terms of overall project cost (enhanced cost efficiency)?” To do so we propose to compare the costs by nature, the costs by destination and the cost-efficiency
(cost per output) of the Baraka project before and after the change of strategy that started to be implemented by 15 December 2016 with 2-3 months adaptation of activities.

MSF-OCG has been present in Magaria, Niger since 2005. MSF is confronted with yearly peaks of severe acute malnutrition and malaria, which mainly affect children under five-years-old. Despite MSF’s presence mortality rates during these months often rise above MSF standards, while periodically, mortality rates in the community rise above emergency thresholds. Using both qualitative and quantitative data, we found the project to be relevant for MSF, but some changes could be made to ensure greater efficiency and effectiveness. This includes establishing a long-term strategy, the simplification of protocols, exploring innovative ways to treat malnutrition
and malaria, and perhaps using this as an opportunity to revitalise the general interest in malnutrition