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West and Central Africa Operational Directorate: Changing the Face of Humanitarian Aid

This TIC project developed a plan for a new Operational Directorate in West and Central Africa to strengthen MSF’s operational capability, ensure diverse participation, and enable autonomy at the local level.

Tell us about the problem you are trying to solve.
With the West and Central Africa Operational Directorate (WaCA) initiative, we are addressing specific challenges at MSF:

Ensuring diverse participation in MSF. There are many doctors and other health care providers from West and Central Africa that have worked with MSF for many years and bring tremendous experience. If these individuals want to contribute to MSF’s social mission in a different way, there has been no platform for this until now. From a diversity and inclusion perspective, we believe it is important to bring the experience and expertise of Africans to bear on MSF’s humanitarian action in Africa and around the world.

Fostering active and collaborative contributions to humanitarian ventures. Even if we are not major funders or specialists recruiters for MSF projects, there is an active and meaningful role we can play in the humanitarian venture. We can bring our experience in emergency response, triage, etc. to support MSF’s response to increasingly complex medical and humanitarian crises.

Addressing the need to have autonomy (outside of Europe) to respond to emergencies. It is also imperative that we have the autonomous capacity to respond to emergencies – including the COVID-19 pandemic – that are happening in our communities and local contexts. We have the capacity to respond efficiently and effectively.

    What is your solution? What motivates you to work on addressing this problem?
    With WaCA, we wanted to propose a more modern and efficient way of working for MSF. It’s about evolution and change. It’s about harnessing new technologies that are not currently reflected in the way we work. Today, there are 5 MSF Operational Centres working in many of our countries – with 5 different Heads of Mission that are managing people, logistics, etc. In total, we are currently investing approximately one hundred million euros in our projects in West Africa and Central Africa. It makes much more sense to have one body managing the coordination of people, handling the transportation of supplies, negotiating the access, and signing the Memorandums of Understanding with governments in the African countries where MSF delivers humanitarian aid. This would allow us to use our resources more effectively and efficiently.

    There is also an associative component to WaCA. In the current configuration of MSF associations, there isn’t really an opportunity for association members outside of Europe to respond to the issues surrounding them in their communities and contexts. Creating this dynamic for active participation is important to us. MSF associations are not mobilized in the humanitarian response – this remains the responsibility of operations and the executive, but as members of a medical association, we know that we can also play a role to respond to needs of our populations. This concept is known as associative operationality.

    We are all part of this life and everyone is doing their part. For many West and Central African colleagues who have worked for MSF consistently for many years –in very precarious situations in war zones and natural disasters – this experience has shaped how we see the world and our own future. With current and emerging global challenges like climate change, security, forced migration, displaced populations, and pandemics like COVID-19, the need is increasing. This was an underlying motivation to create WaCA.

      What have you done so far and what results have you achieved? How has your project pivoted to support MSF’s response to the COVID-19 pandemic?
      We are quite new. We submitted our application to become an MSF association, which was validated at MSF’s International General Assembly in 2019. This is one key success. We also just had our very first General Assembly in February, 2020 with over 800 association members that are motivated to offer their skills to the movement. We have elected a formal board of directors, set up a small office and started three projects – all during a global pandemic. And just before the COVID-19 outbreak started, we launched an assessment for MSF to deliver psychiatric care. As MSF, it’s important to provide pediatric care, obstetric care and also care for mental health as these are the patients that are often left behind in a crisis.

      We want to bring diversity and change how we understand humanitarianism and how we define emergencies. We need to consider the social aspect of our roles and not just the medical aspect. We need to give some comfort to our patients and let them be the decisions-makers in how they receive health care. For example, do we need to ask people to line up for food distribution? Can we instead use technology and find ways to bring our medical and humanitarian assistance closer to the communities we serve?

      In the Ivory Coast, we are responding to the COVID-19 pandemic in several ways. We are providing support to COVID-19 patients hospitalized in 72-bed health facility in capital of Abidjan. We are also doing health promotion and supporting health centres to keep them running during the pandemic. Finally, we initiated a mask project where we worked with a textile manufacturer to produce 1 million masks for home use.

      Similar to our work in Ivory Coast, we are supporting health centres on COVID-related infection prevention and control. In Nigeria, we have started a COVID-19 project with two primary health care centres in Kanu. We are also working in the communities to help identify vulnerable patients – people with diabetes and hypertension – to support with testing and treatment. With these initiatives, we are working closely with MSF’s Operational Centres (OC) on the coordination side. We have been working with OC Paris in the Ivory Coast and OC Geneva in Nigeria and Niger.

        What challenges have you faced? What lessons have you learned? What’s next?
        We are quite deliberate about wanting to adopt new ways of thinking and doing things in MSF, but change is difficult and old habits die hard. But with the COVID-19 pandemic, everyone has been forced to adapt to new realities and this has helped to catalyze our efforts. One challenge we’ve faced is in recruiting managers for our new projects – ones that are confident and ready to build something from the ground up. Because of this challenge, our projects are not overly ambitious but are aligned well within our means as a start-up.

        The key lesson learned so far is innovation – we need to be innovative in everything we do including how we communicate about MSF. Facebook and WhatsApp may seem trivial, but these platforms are having a major impact on how the narrative of the world is being shape. With WaCA, we want to be more fluid and to embrace these tools to break down barriers to communication and impact.

        In terms of what is next for WaCA, we are in the early stages of developing a Telemedicine project in the Ivory Coast with a national NGO known as Africa Saves Africa. Through this initiative, we will be able to offer digitalized medicine, where a physician can work in an office and conduct virtual medical consultations with patients.

          What have staff said about the project?

          “…I am working as an emergency coordinator for Doctors Without Borders’ COVID-19 response in Ivory Coast. I am proud of what I do. The biggest challenge here is to get all the necessary supplies, such as drugs, personal protection equipment and other materials. We usually get supplies from international providers, but with all the restrictions to travel and closure of borders, it’s getting more and more difficult. We risk facing shortages when it’s crucial for frontline health workers to be protected in order to avoid any new contamination chains.This situation makes us think out of the box. For instance, here in Abidjan, we are now producing one million tissue masks in the local factories, in order to distribute them to the general population.” – Colette Badjo, Doctor

          Are there any interesting partners that you are collaborating with?
          We have some interesting partnerships and will continue to grow our network. Within the MSF ecosystem, WaCA is part of the MSF’s OC Geneva Congress and we have an agreement with MSF Japan to support with financial infrastructure, technical expertise, recruitment, etc.
          We also want to create links with the broader humanitarian sector. So far, we are an official member of the United Nation’s Access to Global Online Research in Agriculture (AGORA). As mentioned earlier, we are also partnering with Africa Saves Africa for our emerging work in Telemedicine, and we’ve collaborated with the WHO-Africa on training for COVID-19 and with the World Food Programme in coordinating humanitarian flights during the pandemic.

            What is the expected long-term impact of the project? How will this project improve MSF’s lifesaving work?
            The COVID-19 pandemic is forcing MSF to re-think our operational approach and limitsin this model. With global travel restrictions, our field workers around the world are being blocked and many of our projects are facing workforce fatigue. If we can build the capacity outside of Europe to facilitate human resources for our missions, then we can overcome the current challenges.

            We don’t yet know what our long-term impact will be, but we want to ensure that Africans can see themselves working with MSF longer and making a long-term impact in the humanitarian sector. On the scientific side, we want to define research questions and collaborate on research initiatives. When we talk about clinical trials, WaCA’s point of view is relevant in terms of fighting for access to affordable medicines. We also want to bring MSF’s decision-making closer to our patients. We want to change how we work with populations so that they can help shape MSF’s humanitarian response in a way that is more people-centered and context-specific.

            This is the kind of impact we want to have.