Archive: GA 2018 (Oslo)

Final Agenda

Medical Debate: Quality of Care at MSF

Harassment & Abuse Motion Feedback; Sexual Misconduct Discussion

OCB Management Values

Tuberculosis Presentation

MSF Sweden Motions and Recommendations

Joint MSF Norway and MSF Sweden Motions

The following were elected to the MSF Sweden Board of Directors: 

Andreas Häggström, Regular Member (2018-2021)

Behzad Arta, Regular Member (2018-2021)

Peter Moberger, Regular Member (2018-2021)

Jenny Gustafsson, Regular Member (replacing Anna Bergström) (2018-2020)

Jon Gunnarsson Ruthman, Alternate Board Member (2018-2020)

The following was elected IGA Representative for MSF Sweden:

Jon Gunnarsson Ruthman was elected IGA Representative 2018-2021

Here you have all the reading material for the GA regarding only MSF Sweden:

Recording of the joint sessoins

Joint GA Minutes


DEBATES:

Hunting high or low? Quality of care in MSF

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Facilitator: Håkon Bolkan, surgeon, field worker MSF Norway. Founder of CapaCare, a non-profit humanitarian organization dedicated to medical education and training in developing countries.

Panelists: 

  • Bart Janssens, MD, outgoing operational director OCB, incoming director of the MSF medical academy.
  • Luis Encinas, paediatric nurse, board member MSF Sweden. Former quality of care referent in OCBA (until March 2018).
  • Evy Dvergsdal, nurse, field worker and board member MSF Norway.
  • Hani Khalifa, MD, field worker MSF Sweden.

Background:

There is not a universal definition of quality of care: In different times and places different kinds of practices are valued as high quality. This is true also within MSF, as we operate in very different contexts ranging from serving highly underserved populations in extremely poor and remote areas, to implementing high-tech hospital care in middle-income countries where expectations of what we can provide are far greater.

Over the last years we have seen several initiatives where implementation of new technology and innovation provide us an opportunity to deliver increased quality of care to our patients. At the same time, hospital infections and outbreaks continue to contribute to preventable morbidity and mortality in our projects. Many of these situations could have been prevented if basic hygiene measures and infection control protocols were implemented more strictly. More patients could have been cured with more appropriate use of diagnostic tools and stricter adherence to medical guidelines.

In order to ensure provision of high quality care to our patients, we need to have a clear understanding of what quality care means to us. In order to do so, we need to start by identifying the determinants, some of which include:

  • Qualification and motivation of staff
  • Availability and correct use of diagnostic tools
  • Adherence to locally adapted protocols of good quality
  • Availability and correct use of drugs
  • Availability and correct use of medical technical equipment
  • Hygiene and IPC measures
  • Knowledge of and adaption of services to the local context (patient-centered approach)
  • Possibility to ensure adequate follow-up
  • Equitable provision of services
  • Staff’s attitudes related to determinants of quality care

What does quality of care mean to MSF in the diverse environment we operate? What are the most important determinants for the quality of care we provide in the field? What are we good at, and what are we less good at, from a field and headquarter perspective? What does quality HR mean? Do we manage to be innovative and at the same time keep focus on the basic elements necessary to provide high quality patient care? How can we improve?

Background documents:

One way to look at quality of care in MSF – 15 mins video lecture by Maya Fehling, MD, Medical Quality Advisor in MSF Germany

Médecins Sans Frontières and medical quality – publication from Crash by Rony Brauman and Michèle Beck (2017)


UPDATES:

Harassment/Abuse motion + Discuss the Sexual misconduct issue

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Reporting back on progress made following last year’s motion on Prevention and management of harassment and abuse of power in MSF and discussion on the way forward in light of the recent months' attention on misconduct in the humanitarian sector and current initiatives in the movement.

Here are several background documents and updates so that our members are informed and prepared ahead of the topic discussion:

We are lucky to welcome at our GA Jay Achar who will speak to us about Tuberculosis and how we can be innovating to solve an old problem. 

Tuberculosis Presentation

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Tuberculosis continues to be the leading killer infectious disease globally. A recent resurgence and alarming rise in cases of drug-resistant tuberculosis make it very much an issue of the present day and age. We’ll demonstrate how MSF is on the forefront in a battle against a global health crisis that shows few signs of slowing down.

Jay will make sure that his presentation can also interest and be accessible to non medical staff, and has prepared the below documents as background information for you to get informed on the topic prior to the GA.

The first document is a fact sheet on the Access campaign’s annual TB policy report (Out of Step), the second one is the report itself.

We hope you will find the topic as interesting as we do!


MSF SWEDEN MOTIONS AND RECOMMENDATIONS

 

Recommendation: Post-mission medical check-ups

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Sponsors of this recommendation: Peter Moberger, Gunnar Hagström, Annelie Eriksson, Stefan Liljegren, Elin Folkesson, Helena Nordenstedt and Fredrik Rücker

Recommendation background: Previously, fieldworkers were offered medical examination before and after a mission, often at UD/SIDA läkarmottagning. This practice has changed. There is now no post mission medical examination routinely.

We believe that there is good thing to have a medical checkup after a mission. There might be conditions that might not be sought for immediately but that are needed to be detected, as for example intestinal parasites, other infections, anemia etc. Many employers also request MRSA screening after medical work abroad. To organize this within the primary care is of course an option, or if you are a doctor, you can manage testings yourself, but to facilitate the return from the field as much as possible, we think a post mission medical checkup is best practice and should be offered to field workers.

Recommendation text: MSF Sweden should offer routine medical checkup after missions for field workers.

Motion: Debriefing consultations for fieldworkers - MOTION PASSED

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Motion sponsors: Peter  Moberger, Helena Nordenstedt, Elin Folkesson, Gunnar Hagström, Stefan Liljegren, Annelie Eriksson and Fredrik Rücker

Destination: To the Board of MSF Sweden

Motion background: MSF fieldworkers often face stressful events and work in stressful environments during their mission. Once back the memories can still cause distress and might need to be dealt with. After returning from the mission, the fieldworker is offered a debriefing appointment by the psychologist at the Swedish office. If the fieldworker then wants to continue debriefing talks there is an insurance that needs to be activated. This means some administration and a certificate from a doctor that the person needs to have debriefing consultations. The fieldworker can then have up to 20 consultations during the first 3 months after the end of the mission. The fieldworker pays for the consultations and is then reimbursed by the insurance.

Before this practice, the fieldworker did not activate any insurance and there was no need to have a doctors certificate in order to receive further debriefing consultations. The number of consultations was initially limited to three (3) but could be extended, if needed, after discussion with the office.

We find the current practice to be unfortunate. As the insurance demands a doctor’s certificate for debriefings, MSF is sending the signal that there is something wrong with you needing further debriefing consultations. The administration surrounding the procedure is an obstacle for the one needing/ wanting debriefings. Others sections within MSF might have this practice but many Swedish organizations offer debriefings without having to activate insurances and we should strive for best practice.

Debriefings consultations are a normal thing to have after a stressful mission and should be made as easy as possible for the field worker to receive. 

Motion text: Debriefings should be made possible, by MSF Sweden, for returning fieldworkers without the fieldworker having to apply for it or having to get a doctors certificate.

Voting: in favour (57); against (4); Abstentions (2)

Motion: Associative Life in the Field - MOTION PASSED

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Motion sponsors: Göran Svedin, Ana Chaurio, Jessica Svefors, Jon Gunnarsson Ruthman

Motion text: The General Assembly requests that the Board of MSF Sweden develops a sustainable partnership with one of more associations/associative committees, preferable but not exclusively in countries/areas where MSF carries humanitarian projects, and that the necessary means are allocated to make it a meaningful cooperation. An assessment exploring what way of cooperation can be developed vis-á-vis other associations/associative committees in the field should be carried out. These partnerships shouldn’t duplicated efforts or overlap with similar initiatives from other Partner Sections of OCs.

Voting: in favor (27), against (26), abstain (16)


JOINT MOTIONS

MOTION 1: Growth and Evolution of MSF - MOTION PASSED

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Motion sponsors: Katrin Kisswani, Adam Thomas, Andreas Häggström 

Statement proposed to the vote: 

In 2019 all Operational Centres will align the timing of their Strategic Plans. We call on all OCs to include a written commitment within each Strategic Plan to state the principle behind any intended growth, to analyse the potential risks of this growth and to outline the mitigations that will be put in place to avert these risks. We would also expect all OCs to incorporate their principled decisions on growth into their annual reporting processes.

Background and explanation:

In recent years MSF has grown and evolved in an unplanned and uncontrolled way. This growth has been fuelled by our drive to meet the humanitarian imperative that is at the core of our identity. We must continue to meet this imperative in the future. However, the growth has put enormous strain on our resources, in many ways compromising our ability to effectively discharge our duty to our beneficiaries. For example, we have entered cycles of “boom and bust” whereby some years we have more money than we 

can spend whilst in others we have to restrict our spending; we have had chronic and disruptive shortages of HR to support our missions, thereby compromising our quantity and, more importantly, quality of our services. In order to counteract these issues, we have increased our associative footprint, which in turn drives increased pressure to grow. This attitude of uncontrolled and unplanned growth has to be better managed, with both the executive and associative taking responsibility to lead MSF into a more stable future.

Background Documents: 

Vote:

In Favor (118); against (4); abstentions (8) - MOTION PASSED

MOTION 2: Redefine the motion committee’s mandate and structure - MOTION FAILED

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Motion sponsors: Jon Gunnarsson Ruthman

Statement proposed to the vote:

Introduce motion committee’s with elected members in all associations. Redefine the motion committee’s mandate and structure, to be more democratic and also include motion follow up.

Background and explanation:

Motions are members’ formal tools to influence or create change. It is a powerful tool if used correctly. After a master thesis that has looked at internal democracy and motions as a tool of change, the current structure of the different motion committees has been identified as an internal weakness but it could be transformed into an opportunity. Some associations have committee’s that “filter” motions and that supports the motion writers up until the day of the GA. The members of the committee are not elected by the general assembly but by the board. The day after the GA their job ends but that is where the job actually begins. Making a motion and the voice of the members, reality. The current mandate and structure should be more democratic and supportive as well as extend to include motion follow up. Suggested changes to the mandate:

  • Support motions writers in the process and provide a historical perspective
  • Support in how to present a motion at the GA
  • Link motion writers to appropriate board and executive counterpart within the movement after approval
  • Follow up on implementation progress of approved motions
  • Follow up on status of previously approved motions

The formal responsibility remains with the board and a suggestion is that the committee includes 2 board members, 2 members elected by the GA and the motions writers.

Vote: 

In favor (33); against (84); abstentions (14) - MOTION FAILED 

MOTION 3: Online platform for global and local associational discussion - MOTION PASSED

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Motion sponsor: Karl Green / Jon Gunnarsson Ruthman

Statement proposed to the vote:

The internet is one of mankind's greatest achievements. It has the possibility of connecting everyone to everyone. What we would like to see is MSF taking advantage of this by connecting the associations globally, giving each their own space within an online social platform for the possibility for members to have discussions with the rest of the movement.

What we propose is that the IGA takes a decision on this motion to implement this global solution so that members don't have to rely on third part services as Facebook to have our discussion on for ownership of content and privacy's sake.

Background:

During a discussion after Jon's presentation of his thesis where he mentions MSF's social capital we sat down during lunch discussing issues, and one of those where that the online discussions in the Nordic associations are done on Facebook, and the problem with this is that we don't own the content or discussions and people who, for whatever reason, don't use Facebook has no way of participating in these and there are no other forums.

Voting:

In favor (65), against (32), abstained (8) - MOTION PASSED

By: Rebecca Cederholm