Lone Ranger No Longer: MSF’s engagement with ministries of health

Research by MSF’s Reflection and Analysis Network
8 December 2020

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Ministries of health (MoH) are Médecins Sans Frontières’ principal collaborators in nearly all contexts. The landscape of this relationship, however, is changing as governments are more willing and able to fulfil their responsibility to lead humanitarian responses, sparking fears among some in MSF about ‘losing space’. This issue requires deeper reflection.

MSF’s Reflection and Analysis Network has conducted a year-long study of how the organisation engages with MoH, which includes: an analysis of the project typology data, country strategies and project proposals; interviews with key informants from MSF, MoH and other health actors; and visits to four countries to see how the engagements are being carried out in practice.

Working directly with an MoH is already the principal way MSF delivers healthcare. Of 82 MSF Operational Centre Amsterdam (OCA) field projects that deliver healthcare services, 78% (n=64) feature a partnership or collaboration with an MoH. In most of the remaining 22% (n=18) of projects, MoH were simply not present in the setting (such as refugee camps).

Yet MSF has placed too little value on the relationship between the two parties and invested too little in more effective partnership approaches. Instead, what we have often seen is a persistent myth—that of MSF as the Lone Ranger, the heroic actor and leader—which is in conflict with, and therefore weakens, an evolving practice that is much more varied, effective and interesting.

The four countries we visited illustrated the variety of experiences.

• In Sierra Leone, MSF is seeking to reduce very high rates of maternal mortality, and so is adopting a ‘light approach’, ‘primarily based on training, mentoring/coaching and supervision’ in partnership with the Ministry of Health and Sanitation (MoHS-SL).
• In Central African Republic, MSF runs large-scale hospital programmes in partnership with the Ministry of Health and Population (MoHP) and is trying to invest more in relationship-building with the ministry at national level.
• In South Sudan, MSF’s programmes are mostly independent of the MoH, but it is thinking about how it can help rather than hinder the ministry’s long-term capacity-building needs.
• In Myanmar, MSF is adopting a ‘lean-in’ strategy towards the Ministry of Health and Sports (MoHS)  for disease-focused vertical programmes in the country’s north, while also partnering with the MoHS to ensure access to vulnerable people in Rakhine.