Doctors without Borders (Médecins Sans Frontières, MSF) is an international medical and humanitarian organisation which “provides assistance to populations in distress, to victims of natural or man-made disasters and to victims of armed conflict.” (Activity Report 2013)

Introduction

Last month I considered switching my regular pledge donation to MSF. The ebola outbreak in West Africa has put medical volunteers in the spotlight and MSF seemed to be at the forefront of the response[1]. Reading accounts written by medical volunteers,[2] I was struck by just how awesome they are. MSF’s own cautionary notes about working overseas[3] demonstrate the high level of sacrifice involved, and incidents in the Central African Republic[4] and Somalia[5] remind us that the risk is very real.

MSF seems a bit like a global emergency response team. An ambulance service on a massive scale. If I was President of the World and choosing how to spend my budget I’d definitely have an ambulance service. So MSF is a good thing. But is it the best thing I could do with my donation? I felt compelled to donate, but first I did some research.

This article is meant to outline some of the factors I considered and hopefully provide some helpful information for others making a similar decision. It should not be taken as either a positive or negative rating of MSF.

How does it work?[6]

Size:

MSF is a large organisation, currently operating in around 60 countries worldwide

is a large organisation, currently operating in around 60 countries worldwide In 2013, the three largest country programmes were in Democratic Republic of Congo, South Sudan, and Haiti

What they do:

MSF runs short term health programmes in response to armed conflicts, epidemics, famines and natural disasters

runs short term health programmes in response to armed conflicts, epidemics, famines and natural disasters It also runs longer term health programmes, targeted at ongoing health crises

crises MSF doctors treat a diverse range of problems, including malaria, HIV , mental health and cholera

Effectiveness of intervention type:

Disaster relief Much of MSF’s work is in response to natural or man-made disasters. A 2006 report by the Disease Control Priorities Project concluded that “the highly emotional and sensationalized climate of disaster response has long prevented the adoption of a cost-effectiveness approach in decision making.”[11] The effectiveness of disaster relief efforts is difficult to evaluate but it seems likely that it is less effective on objective measures than other modes of intervention. You can read an excellent blog post on disaster relief here.[12]

Working in effective areas MSF works in a number of areas which have been identified as particularly cost-effective and scalable. This includes mass vaccination programmes[7] and bednet distribution.[8] They were also instrumental in founding the Drugs for Neglected Tropical Diseases Initiative (DNDI) which has a very high potential upside[9].

Working in less effective areas MSF also works across a broader range of equally worthy but less well understood or less cost-effective interventions, including HIV treatment and mental health. For this reason, Givewell decided to deprioritise them as a ‘top charity’.[10]

Effectiveness of MSF :

Good at what they do As MSF undertakes such a variety of programmes it is difficult to evaluate the effectiveness of the charity as a whole. However, it seems safe to say that MSF enjoy a good reputation in their field. The British Medical Journal praised MSF for “leading the world’s response to Ebola” and chose MSF for their winter charity appeal in 2014.[13] Their global presence means they are often in a good position to respond to disasters quickly.[14] Both Givewell[15] and Giving What We Can[16] have recommended MSF as a top charity for disaster relief.

Independence 90% of MSF funding comes from private individuals[17]. Non-affiliation with governments allows MSF to work in politically sensitive conflict zones such as Afghanistan and DRC. It also insures independence from political goals, meaning programmes are prioritised based on need alone.

Transparency MSF undertakes regular critical evaluations of their programmes and have published a number of negative conclusions of their own programmes. These reports are freely available here[20]. Givewell concludes that while MSF is “more transparent than the vast majority of charities we have considered, it is not as transparent as the most transparent charities we have found.”[21]

Funding considerations:

Room for funding In 2013, MSF held slightly over €600m in cash and equivalents[18]. This should not necessarily be interpreted as no room for more funding as the nature of MSF’s work means the flexibility to start programmes without delay is crucial. MSF has a good track record of making sure funds are used in the most efficient way, closing their 2004 tsunami appeal after just 6 days as it was sufficiently funded.[19]

Conclusion

In the end, I concluded that the reason I found MSF particularly compelling was as much because of my admiration for the doctors and nurses, as the effectiveness of their work. While MSF didn’t seem to be as effective as the Giving What We Can recommended charities, they are doing good work in a way which I find personally inspiring and a donation seemed appropriate.

I therefore decided not to switch my regular pledge donation from the Schistosomiasis Control Initiative (SCI) but to make a small regular donation to MSF in addition to my pledge.

You can donate here.

References

Image taken from the MSF page on ebola.