Quality of care

Outline of the debate and panel
Outcome of the debate - by Karin Nordstrand
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Outline of the debate

Quality of care: Capacities, complexity & choices

In 2017, MSF provided more than 10 million outpatient consultations, and 750 000 patients were admitted to our clinics. These are vast figures, but what do we really know about the quality of care that we provide in each of these patient and practitioner encounters?

According to the La Mancha agreement, we as an organization strive to provide quality medical care in order to contribute to the survival and relief of as many people as possible. We are also committed to pursue essential innovation and to continue to undertake initiatives in the constant search for relevant and effective action. In other words, our main objective is to provide relevant quality medical care for the populations we serve.

This debate aims to investigate whether the current capacity of our medical staff, our HR system (from recruitment strategy to development) and the complexity of our operational portfolio enables us to do so in the best possible way:

  • What do we mean by quality of care?
  • How can we ensure our staff has the right capacities and clinical skills?
  • Are we too ambitious in our program objectives and operational choices?
  • Do we have too many projects, or are they too complex?



A common misperception is that quality care equals advanced care, whereas the level of specialized services in just one aspect that may contribute to the over-all quality of care provided. Quality care entails many elements, such as qualification, capacity and motivation of staff, availability and correct use of diagnostic tools, adherence to protocols, availability and correct use of drugs and medical technical equipment, adequate hygiene and infection prevention and control measures to mention a few.

The environment in which MSF operates has changed significantly over the past decades. The epidemiological transition has shifted the pattern of mortality and disease from infectious diseases towards chronic and non-communicable diseases, often requiring more complex and long-term care. At the same time, an increasing proportion of our projects are in middle income countries where more advanced health care systems and services have set the standard for what is expected in terms of the level of care provided. Proximity and accountability to the communities we serve are key values for MSF. We need to acknowledge and adapt to the needs of the population in any given context – and provide care that is considered relevant.

New technology and innovation provide us an opportunity to deliver more advanced quality care to our patients. As an organization, we contribute to this innovation by testing and implementing new methods and models of care. Today, the care we provide in many of our projects is far more specialized and than only a few years back, including patients on mechanical ventilation or dialysis, and orthopaedic interventions including internal fixations. This tendency towards increased specialization and more complex projects seems to continue – and reflects choices we have made and continue to make.

At the same time, we are struggling to build a sustainable HR pyramid, and we have been unable to solve the chronic HR gaps in the field, particularly in coordinating positions. More complex and specialised projects require more specialists, also from the non-medical side to sustain a large support system. Finding candidates with the capacity to fill specialist positions may be more challenging than finding generalist profiles, and hence lead to increased risk of gaps. Frequent HR gaps may in turn influence the overall quality of care negatively. We also know from the 2017 Retention study that it is the generalist, and not the specialists, who want to stay on in MSF with the aim of taking on leadership positions in the field.

We must navigate through this complex landscape in a way that allows us to remain medically relevant and at the same time stay true to our identity and core values (as described in La Mancha). These elements should guide our operational choices and HR strategy.



Javid Abdelmoneim, president of MSF UK, will lead us through the debate. First, we will give the word to dr. Pierre Malchair, who will share some critical reflections on the quality of care we provide in our projects, based on his experience from eight missions as Medical doctor with MSF since 2007. He will also highlight some of the main challenges, and propose potential ways of improving.

We will then hear the perspective of the Medical department, HR department, and Operations department in OCB, as well as their reaction Pierre’s introduction.

Finally, Cristian Casademont, Deputy medical director of OCBA will join the panel and share OCBA's experience and lessons learned in operationalizing quality of care improvement.

And, of course, we will open the debate to the floor, to ensure you can contribute with your experience, knowledge and critical thinking, so that together we can pave the way for the future. Hippocrates pledge to “first, do no harm” still stands. It’s time to act - here, now and together.



  • Pierre Malchair, MD, experienced field worker, OCB
  • Sebastian Spencer, Medical director, OCB
  • Valeria Orlandi, Recruitment and Development Advise referent, OCB
  • Marc Biot, Operational director, OCB
  • Cristian Casademont, Deputy medical director, OCBA

The outcome of the debate
Read the excellent summary Karin did !

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By: Sophie Guillaumie