MSF Nordic

Background information and updates
This page is offers a historical overview of the Nordic Process and was last updated November 2019
In the Nordic countries we have had a long history of collaboration, both on the Associative and the Executive side.  The PowWow1, started in the 1990s, and has been a very successful platform for members from three relatively small sections to meet and debate.
In 2010, Dan Sermand (GD MSF-Sweden), Patrice Vastel (GD MSF-Norway), and Michael Gylling Nielsen (GD MSF-Denmark) presented “How to develop in a coherent & optimized manner the 3 Scandinavian sections together in order to strengthen our impact on operations?” at the Office Days2 in Stockholm.  This was followed up by a presentation from Greenpeace on what a joint Nordic MSF might look like.
The same year the MSF Nordic idea was presented at the Governance Reform Meeting in Barcelona.
In 2011 the Boards of MSF Denmark, Norway and Sweden met in Oslo, and for a first official meeting.  At the meeting it was unanimously agreed that MSF Denmark, MSF Norway, and MSF Sweden have a desire to collaborate, to build on their common strengths and knowledge and have an obligation to make better use of their common resources.  The meeting also discussed the reasoning behind a Nordic model. One of the motivating factors was the wish to improve assistance to populations in danger through better collaboration between the Nordic countries. The name MSF Nordic was chosen over MSF Scandinavia as it would then be able to include new initiatives (such as Finland, Iceland, or the Baltic states) and not limit us to just Scandinavia#[3]3. The statement from the meeting declares:
In 2013 the General Assemblies (GA) of MSF Norway4 and MSF Sweden5 passed a motion requesting their respective Boards to explore the option for a potential merging of the Associations.  MSF Sweden went one step further and also asked that the option of merging offices also to be investigated. While the motion proposed this to be a “Nordic process”, there was no motion presented at the Danish GA and thus no mandate from the Danish members to go ahead with the motion.
After the 2013 motions there were several meetings to further discuss the vision of a MSF Nordic, it was discussed by the members at the 2014 PowWow in Oslo in as well.  Each section appointed a Nordic Focal Poin within the Board to act as a link and share information between the Boards as well as facilitate cooperation.  Since March 2013 it was decided that the three Presidents will exchange information on strategic issues in advance of important national and international Board Meetings, share debate evenings via streaming, hold common activities such as a shared newsletter and to consult the other Nordic Presidents prior to opening new positions within any of the Nordic sections6.
Following the 2013 GA votes in Sweden and Norway, KPMG conducted a pro-bono study of three potential models for MSF Nordic, which were presented to the members of all three sections for a vote at the 2014 GAs. The study looked at various factors when evaluating the models, the feeling of belonging of national members, office employees, and expats; participation and active engagement; the interest of donors; efficiency; effectiveness and cost savings, the national impact and practical organization issues and functionality7. The models were:
1. Nordic co-operation:  No major change from how the Boards were functioning at the time, with maintained national governance, influence, and particpation.  The co-operation model maintains the local assocaitoins and preserve the relationship to local donors and expats.
2. Nordic medium: The national associations with strong local offices and engagement would remain, but moving the governance would move to a Nordic level. The reduced national influence on local levels could be viewed as a risk factor, though there would be positive gains in terms of costs and an effective way of collaborating through e.g. a shared service center and benchmarking.
3. Nordic united (also called Nordic Extreme): One joint association and one Board overseeing the activities of all three offices.  There could be negative impacts in terms of engagement, as people do not have a nation association or a strong local office to relate to.  On the other hand it would mean an increase of the Nordic influence and a strong Board.  
Again the outcome varied between the three GAs. While MSF Denmark voted in favor of Nordic Cooperation, the members of MSF Sweden overwhelmingly voted in favor for model three – Nordic United.  In Norway the Board asked the members for a consultative vote, not a binding motion, and the members voted in favor for model three as well but with a smaller margin than in Sweden.
In December 2014 a decision was taken by MSF Norway and MSF Sweden to recruit a Nordic Manager8, preferable someone with experience in change management, to facilitate the merger.  The recruitment was postponed until the end of 2015.  The plan is for the Nordic Manager to report back to the 2016 General Assembly in Oslo.
Following on the 2014 votes, the Board of MSF Norway and MSF Sweden decided to hold a first joint General Assembly in Göteborg in 2015.  Significant work was also done to begin harmonizing the statutes and General Assembly Guidelines to facilitate for a joint event.  At the GA the member proposed motion where they asked the Boards of MSF Norway and MSF Sweden to “present a shared set of legal statutes, fully harmonized between both associations in order to give clear direction to the MSF Nordic vision process, the associations of MSF Norway and MSF Sweden mandates the Boards of MSF Norway and MSF Sweden to present a shared set of legal statutes, fully harmonized between both associations and also towards the statutes of MSF International and applicable for the general governance of both associations.  The proposed set of common statutes changes should be presented for approval by the associative at the joint General Assembly in 2016”9.
In September 2015 the Swedish Board unanimously approved a statement for the Nordic where they wrote: “We, the Board of MSF-Sweden, stand unanimously behind the creation of ‘MSF-Nordic’ and the MSF-Sweden General Assembly motions passed in 2013, 2014 and 2015. We do so for the benefit of our patients and the people we speak out for” 10 and “Acting on the motions put forth, and approved by our members, our short to medium term goal (to be completed latest by 2018 given the legal complexities of the process) is to fully merge the MSF-Sweden and MSF-Norway Associations and Boards in order to create the MSF-Nordic Association. The implications of this merger are being thoroughly considered in order to deliver the best results for our Associations and the movement. MSF-Nordic will be a joint voice at the international level while maintaining our diversity and strength
In December 2015 Katrin Kisswani, President of MSF Sweden, and Björn Nissen, President of MSF Norway wrote a "Why Nordic?" statement which was sent to the associations and the movement where they outlined the process and new terminology: 
  • MSF Nordic = Norway, Sweden 
  • MSF Nordic Network = Denmark, Norway and Sweden 
  • NAP - Nordic Action Plans =  Common Executive Framwork 
But Why MSF Nordic? Well, this is the answer:  The purpose of MSF Nordic is first and foremost to support the MSF Governance Reform that will internationalise the movement by increasing diversity and inclusiveness, while keeping agility and responsiveness. One way of doing this is to merge current MSF Sections and make room for new non-European Associations. 
The statement was well received by the Swedish members, and the movement in general.  Following the statement the national subpages on the membership intranet were merged and renamed Nordic.
At the 2016 PowWow in Uppsala a discussion about the future of the associative structure was held.  Should we combine the PowWow with the Nordic GA, should we keep the events separate but move the PowWow to the fall, or should everything remain as is. Following the PowWow a survey was distributed to the full membership of MSF-Denmark, Norway, and Sweden to allow those who did not attend the meeting to give feedback on their wishes on the future of the PowWow and on other priorities in general.
Respondents were asked if they were more likely to attend the PowWow if it took place in the fall.  While 50% replied “don’t know”, 25% replied that they were in favor of moving it, with a minority (16%) replying that the PowWow should remain as is. As for whether we should combine the Annual General Assembly and the PowWow a majority (44%) were in favor of keeping the events separate (27% voted for combining them, and 29% had no opinion).  Subsequently it was decided in April 2016 to keep the PowWow and the General Assembly separated, but to move the PowWow to the fall as of 2017.
Ulf Hertin was hired as the Nordic Manager in February 2016 for a 6-month contract and was tasked to create a workplan for an Associative merger.  His terms of reference were developed jointly by the Boards of MSF Norway and MSF Sweden with an overall objective to “move towards a finalized merger of the Norwegian and Swedish Associations while defining the consequences of such a merger for the executive. The ToR made it clear that a merger would take time and could not be implemented over night, and that the final decision was to be taken by the respective GAs. Ulf produced a proposal for how to move ahead after extensive consultative meetings and workshops with both board members and members of the executive in Norway and in Sweden, as well as legal advice from Deloitte. His full proposal “Status report to the Associative of MSF Norway and MSF Sweden“ summarizes the key findings and proposed a way forward which would bring closure to the motion on the associative merger by 2018 in a transparent, timely and relevant way.
The report recommended that the merger be managed as an investment where enough resources were to be allocated to ensure success, and to not lose focus of delivering high quality results to benefits the social mission of MSF. This would entail the creation of a Nordic Teaching and Transformative Board (Nordic TT Board) which would consist of selected members from the two national Boards. The Nordic TT Board would work on strategy for the future positioning of MSF Nordic, and leave the oversight of the executives to the national Boards. The Nordic TT Board would also be a platform for learning and adapting before the full merger were to take place.
You can read his report here
After speaking to 46 members of the Associations and the executives, and conducting several workshops, Ulf came up with a set of key issues to take into account while moving ahead with the plans:
  • The MSF Movement forecast continued growth and need to constantly position itself to adapt to global trends like the global economy, increased digitalization, etc.
  • The MSF Governance Reform which aimed to internationalize the movement by increasing diversity and inclusiveness, while keeping agility and responsiveness.
  • The difficulties to find suitable Board Members (particularly medical board members for the Norwegians).
  • The objective and rationale of the Nordic Association.
  • To allow the Boards to work on focusing more on long term direction and strategy positioning.
  • To find ways for the MSF Nordic Association be a tool for a better MSF, where the MSF Nordic Association would give guidance and input without the constraints of national interest.
  • Finding the balance between a transnational association, and at the same time being more proactive in local engagements.
The transfer of powers from the national boards to the Nordic TT Board was to be gradual and with the expressed intent that it would be less focused on national executive matters, and rather lift the focus towards a strategic level, while actively working to influence the MSF movement.
The proposed organizational chart would look at follows:
The proposal was based on foreseeing a move towards a more network oriented and centralized structure, where strong teams with interdisciplinary skills adds value where required.  The proposal also pointed out the importance of any move towards a full associative merger be built on mutual trust, collaboration, and to the Charter of MSF front and center.
The following deliverables were suggested (to be approved by the Norwegian and Swedish associations):
  • Create a common Nordic Vision for the executive and the associative.
  • Harmonized executive long-term plans; the annual action plan, monthly and yearly reporting, and the budget of the two offices should be comparable and compatible (for the Nordic TT Board to be able to compare "apples with apples" and not "apples and oranges".
  • Continue the development of the Nordic Action Plan (NAP) by the two executives.
  • Ensure that the Nordic TT Board and the empowered association are made key investments (in terms of resources).
  • Select three Board members from each Board (including the Presidents) to create the Nordic TT Board.
  • Focus the planned September/October Nordic Board Retreat on what mandates to move to the Nordic TT Board.
  • Strengthen the local associative presence outside of Stockholm and Oslo, and define relevant activities.
  • Define the continued process, possibly hiring a Nordic Implementation Officer to oversee the Nordic TT Board.
  • Strengthen the Nordic TT Board to support the Presidents and Association Coordinators.
  • Plan to have one common auditor for both national sections post the 2017 GA.
  • Set up a joint election committee to plan for the 2017 GA.
  • Engage the international in discussion on how to determine agreements such as the London ratio and the RSAIII.
  • Create a professional communications plan prior to June 2016 in order to keep the respective associations abreast.
At the second Nordic GA in Oslo 2016 fully harmonized statutes were presented and approved by the members of both Norway and Sweden. The new joint GA structure was further defined and a lot of space was given to joint motions and debates.
However, a group of Norwegian members put forth a motion during their national part of the meeting called: “Motion to adjust the Nordic Process” which asked that “the General Assembly mandates the MSF-Norway Board to stop the merger of the Associative and rather focus on increased informal co-operation between all three Nordic Sections.” The motion was heavily debated on the Nordic Facebook group leading up to the General Assembly and it was clear that the Association in Norway was very torn.
The motion argued that since the original 2013 motion calling for a full merger of “… the association, board, and office with the associations, boards and offices of the other Scandinavian MSF-Sections in order to make MSF-Nordic a single entity, a de facto MSF-Section” failed with 61% of the Norwegian members voting against it – the notion of a full merger isn’t vested in the Norwegian membership. The motion did pass (with 51% of the members present voting in favor) the following day, in a slightly altered version, instead asking for “… the creation of one single Nordic association, by unifying the Norwegian, Swedish and Danish current associations and boards, giving it one single voice within MSF. The General Assembly mandates the board to work towards this objective and to report back to future General Assemblies on the progress made.”
They pointed out the discrepancies in buy-in from the different association: while MSF Denmark outright rejected the notion of a merger of the three partner sections, MSF Sweden voted for a complete merger, and MSF Norway for a partial merger. In addition, they stressed what they perceived as a “lack of clear rationale, reason, and vision” from the Board.  They also cited what they saw as a lack of a clear success criteria of a merger and that in their opinions, any merger of the Boards would undoubtedly lead to an executive merger. Lastly the motion claimed that with the harmonized statutes on the table, 2016 would be the last time the MSF Norwegian associative would be allowed to independently decide the future of its own association.
The motion did not pass, the board argued that the process should be allowed to continue given the fact that the GA already gave the Board the mandate to move ahead and present the final set-up in 2017 at which time the association would have their say – no plan would move ahead past 2017 without an affirmative vote by the members.  Further the Norwegian Board invited the members to ask questions, and to attend Board meetings where the future of the Nordic is discussed.
MSF Norway did not elect a President at the General Assembly and Henrik Glette agreed to be interim President until new elections at an extraordinary GA could be held.  With a new Board, and an interim President, MSF Norway decided to pull the breaks on the Nordic process.  Henrik prepared a memo where he outlined an alternative merger process called “MSF Nordic: non-legal merger proposal” which was passed by the Norwegian Board on August 23,2016.  In the paper, he proposes that a lighter model with less organizational effort and lower costs would be preferred.
The new merger proposal stipulates that the national associations continue as a base for governance for the national executive and as a base within the respective communities. The Nordic dimension would be added as an extra layer on top of that, similarly to how OCB is governed.  Each national Board would elect two representatives, one of them the President, to serve on a Nordic Board. In addition, all members of the national associations would also be members of a Nordic Association. As such, they would elect two-three members for the Nordic Board.
The Nordic GA would have no governing functions, and no executive branch to oversee. The Nordic Board would be tasked to focus on association development, field related issues, and ensuring a medical focus.
As for the International governance, two alternatives were proposed:
  • To keep things as is, with each country sending two representatives to the OCB Board and to the IGA (preferred model MSF Norway), or;
  • A voluntary reduction of representatives, to be reversed at any time as each association would keep their representation rights.  This could be reduced to equal the representation of a single association, i.e. two IGA reps, one OCB Board member, or any solution between this and full representation from each national entity. Being voluntary, this could be reversed at any time, as each association keeps its representation rights.
  • A meeting was held in Oslo in the fall of 2016 with the newly elected President Katrine Norstrand where representatives of the MSF Norway Board and the MSF Sweden Board met and discussed the non-legal merger proposal, put forward by MSF Norway. The Norwegian Board made it clear that they were not prepared to go beyond the “non-legal merger” as outlined by Henrik. MSF Norway were not prepared to transfer the decision power to another platform i.e. Nordic TT Board while they were legally responsible.
During subsequent discussions within the MSF Sweden Board it was equally clear that they did not feel that the Norwegian proposal matched the mandate given by the members, neither in terms of ambition or having any clear benefits to the Swedish Association Members or to the MSF movement as a whole. The non-legal merger would create an additional platform that need time and efforts without any clear benefit. The Swedish Board discussed the Norwegian proposal during an extra Board telephone on November 10, 2016 where they discussed the meeting held in Oslo. The new President of MSF Norway fully supported the “non-legal” merger, and as such is taking a different stand compared to the previous Presidents of MSF Norway. The only options on the table for the Swedish Board would be to either agree with the proposal at hand, or to end the formal Nordic merger.  In general, though it was pointed out that this could be the first step towards a future legal merger, the Swedish Board felt that the proposed set-up would create layers without real responsibilities and failed to see the added value for the members. There was a general feeling that “we’ve tried, and this is as far we got.”  It was decided that the issue would be further discussed at the November in-person meeting of the Board.
At the November 25-26, 2016 meeting the Board continued the discussion in closed session. The discussion centered on:
  • To accept the “non-legal” merger proposal as presented by MSF Norway, or;
  • To reject the “non-legal” merger which would de facto mean that there is no merger process on the table anymore.
In the end the Swedish board decided against the Norwegian proposal, and subsequently the following statement was sent out to the members of MSF Sweden, on December 9:
This mail is intended to report back on the Nordic merger process.
In 2013 the General Assembly of MSF Sweden passed a motion requesting the Board to explore the option for a possible merger of the Associations, Boards and Offices of MSF Denmark, MSF Norway, and MSF Sweden, stating:
The will and vision of the General Assembly is that MSF Sweden, as far as possible, should merge its association, board and office with the associations, boards and offices of the other Scandinavian MSF Sections in order to make “MSF Nordic” a single entity, a de facto MSF Section.
The General Assembly mandates the Board of Directors to work towards this objective and to report back to future General Assemblies on the progress made.
The motion was passed with clear majority and subsequent motions in 2014 and 2015 were put forward to push the process forward.
However, after several years of discussion and intense work, the Swedish Board is disappointed that MSF Norway and MSF Sweden have not been able to reach an agreement on a merger and the creation of “MSF Nordic” as a new legal entity. The final proposal put forward by MSF Norway do not match the mandate given by our members, neither in terms of the overall ambition to reach one legal entity nor of having clear benefits for our Association and for MSF Sweden in the movement.
We did reach far in our collaboration already and we need to acknowledge our achievements.  There is a Nordic voice in the movement, there is the Nordic GA which is successful forum to enrich the debate between the association members from both sections and the motions. We do have a close collaboration between Boards and Executives.  The MSF Sweden Board intend to keep this close collaboration and to explore how we, together with MSF Norway, can develop it further.
We will make sure there are the forums to answer your questions according to needs and requests.
There has been several follow up meeting between the President of MSF Norway and MSF Sweden where both sides assured the will to continue the close collaboration and consider how to develop it further.
At the February 10-11, 2017 MSF Sweden Board Meeting amended statutes were discussed where all mentions of the Nordic are to be removed.  The amended statutes were approved at the 2017 General Assembly in Stockholm.
A Nordic meeting were held on the March 5, 2017 between Presidents and Nordic Focal Points of MSF Denmark, Norway and Sweden to discuss the future collaboration. The MSF Sweden representatives made it clear that though we are disappointed that the collaboration around the legal merger has stopped, we want to collaborate as much as possible. With the legal merger officially ended, going forward it will be a loose collaboration of three equally committed members. “Nordic” and “MSF Nordic” will be removed from all official/external communication such as the Nordic GA and Nordic Motions.
The following main points were agreed upon, and will be presented at the Joint MSF Norway and MSF Sweden General Assembly in Stockholm and at the MSF Denmark General Assembly in Copenhagen in 2017:
  • The collaboration will officially be referred to as “the Nordic Network.”
  • All references to “Nordic” will be removed from the statutes of MSF Norway and MSF Sweden.
  • The Nordic GA will be called the “Joint GA of MSF Norway and MSF Sweden.”
  • The Joint GA of MSF Norway and MSF Sweden will be evaluated in 2018 to see if it is worth continuing.
  • The PowWow will continue as planned in the fall (rather than the spring as before).
  • Each section will decide whether or not they want to have a Nordic Focal Point. There will be no common ToR for the focal points, rather it’s up to each section.
  • The Nordic Focal Points will be in touch before the GA to share information, motions, etc.
  • The Nordic Motions will officially be called Nordic Network Motions, or will be sent to the movement signed as MSF Sweden and MSF Norway motions.
  • The IGA Representatives will meet prior to the IGA.
  • MSF Denmark will promote the joint Facebook page to their members.
  • The Nordic space on InsideOCB will be divided in a dedicated MSF Norway space and a dedicated MSF Sweden space.
  • The Association Coordinators will continue to share information ad hoc.
  • There will not be any formal collaborations between the Executives beyond the Nordic Action Plan.
  • The Nordic Newsletter will revert to an MSF Swedish Newsletter.
In September 2018 the Board decided to continue with a joint General Assembly together with MSF Norway – to be reviewed again after the 2020 GA. 
In November 2018 the PowWow changed name to the TEFKAP (the Event Formally Known as the PowWow), and it was decided to post-pone the 2019 TEFKAP due to movement wide financial troubles. 

More Reading

Review of Regional Associative Initiatives (February 2018): 

Nordic Board Meeting Minutes:

Towards a Legal Merger: 

Proposals, reports and ToRs:

Other Background Documents (shared with our members):

[1] The PowWow is a Scandinavian associative gathering that takes place once a year, and where the three Scandinavian sections take turns in hosting the event. The PowWow started in the late 1990's when the Scandinavian sections were young and small and the executives and expats needed a platform to meet, debate and network. The PowWow is not a decisional body like the national GA's, it is purely a forum to discuss how to best adapt the organization for the future and become better at what we do.  In 2018 the PowWow changed name to the TEFKAP (the Event Formally Known as the PowWow)
By: MSF Norway Association