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STRATEGIC

ORIENTATIONS 2026 » 2031 MSF OCP

MSF OCP STRATEGIC ORIENTATIONS 2026 » 2031

TABLE OF CONTENT FOREWORD: SUMMARY OF OUR KEY CHOICES �� 4 WHAT WE WANT TO PRIORITIZE �� 10 Protecting our emergency response capacity ��11 Remaining faithful to the “Telling it as it is” vision in our public advocacy ��12 Mobilizing in support of marginalized migrant populations ��13 Advancing our practices and medical care in support of women ��13 Offering care models adapted to patients with chronic diseases in our contexts ��14 Advancing care for people affected by cancer, a neglected catastrophe in low-resource settings ��16 Strengthening our responsibility in the global fight against antimicrobial resistance ��18 Clarifying and improving our interventions in the field of mental health ��19 Exploring the field of environmental health ��21

WHICH APPROACHES DO WE WANT TO PROMOTE? �� 22 Providing assistance without perishing ��23 Delivering on our safeguarding commitments ��24 Sharing power with our patients ��24 Reducing treatment inequalities between staff categories ��26 Compensation and benefits ��26 Healthy teams ��27 Reducing our carbon and environmental footprint ��29

WHICH TEAMS DO WE NEED? �� 30 Diversity serving emergency operations ��31 The right skills in the right environments ��31 Strengthening the role of women in our field teams ��31 Transforming the HR function: From reactive management to strategic leadership ��32

WHAT STRUCTURE DO WE NEED TO CARRY OUR AMBITIONS FORWARD? �� 34 Strengthening risk governance and reducing structural vulnerabilities ��35 Effectively supporting teams and facilitating their work ��36 MSF OCP STRATEGIC ORIENTATIONS 2026 » 2031

FOREWORD: SUMMARY OF OUR KEY CHOICES

MSF OCP STRATEGIC ORIENTATIONS 2026 » 2031

The result of several months of collaborative work between the associative and executive bodies of the OCP group, enriched by consultations with our field teams and incorporating the perspectives of our key partners (donors, ministries of health, and patients1), this document formalizes the strategic orientations that the OCP group sets for the upcoming 2026–2031 cycle. These orientations take into account key developments in our operating environment and in our organizational trajectory.

CONTEXTUAL ELEMENTS At the time of finalizing this document, our environment is undergoing profound upheaval. The multilateral system for responding to global health crises has been jeopardized by decisions taken by the U.S. administration in power since early 2025. Funding for international aid and global health by major donor countries (starting with the United States) has fallen sharply. The vast majority of the world’s population now lives under authoritarian regimes, while nationalist and xenophobic movements are gaining ground. In Libya, Afghanistan, Haiti, the Sahel, and Sudan, populations subjected to massive human rights violations are left face to face with the perpetrators of violence. For more than two years, we have also been witnessing, from the front lines, Israel’s campaign to eradicate the Palestinian population in Gaza and the West Bank, carried out with impunity and with the acquiescence or active support of Western democracies. The fragile progress achieved in recent years in combating discrimination and advancing ecological commitments, secured under pressure from progressive social movements, is being brutally rolled back by reactionary forces. Actions guided by the principle of humanity at the core of our commitment are increasingly being criminalized by a growing number of states. These include supporting migrant populations who are marginalized and subjected to violence on 1 The methodological elements and summaries of these consultations and discussions are available on the dedicated Sharek page: SiteDG/Sharek-Strategic-Plan-20262031

all sides; contributing to the protection of women’s sexual and reproductive rights by providing access to safe abortions or contraceptive pills; and assisting populations living in disputed territories or under the control of groups designated as terrorist. This threatening context, which encourages inward retreat, raises the question of the risks we are willing to take in order to fully fulfill our social mission. MSF OCP’s trajectory has been marked by continuous growth across nearly all of our activities2, reflected both in the number of patients treated and in financial volume. This growth accelerated significantly in the post-COVID years and has since struggled to be sustainably supported by fundraising, despite its strong dynamism. Today, we are mobilized in acute crisis contexts, often dangerous, where we sometimes deploy particularly large-scale operations (250,000 malnourished children treated in our out–patient programs in 2025; 45,000 surgical interventions). We are also engaged in long-standing projects (nearly 40 percent of our hospital projects are more than 10 years old), where we collaborate with ministries of health and where the number of patients treated in hospitals continues to increase. We carry out particularly innovative projects, such as Antibiogo or TACTiC (Test, Avoid and Cure Tuberculosis in Children), which require medium-term investments if they are to yield results. At the same time, we continue to expand our medical scope of activities, including physiotherapy, chronic disease management, and mental health care. Alongside this continuous increase in activity volume, we have also developed, in recent years, ambitions related to our ways of working, some of which directly echo broader societal aspirations. Driven by the Black Lives Matter movement, we have strengthened our critical examination of the discrimination and inequalities that we reproduce in the way we treat our staff and patients, and we have committed to reducing them, notably through the overhaul of our compensation and benefits system under the “Rewards Review” project. The #MeToo movement has prompted renewed attention 2 With the exception of our routine vaccination activities and epidemic response, which have declined somewhat in recent years, and those in the field of HIV. MSF OCP STRATEGIC ORIENTATIONS 2026 » 2031

to the place of women within our teams, to how we care for them in our projects, and to the abuses to which they may be exposed, leading us in particular to strengthen our prevention and abuse-management mechanisms. Social and political mobilization around accelerating climate disruption has led us to formalize our own commitments to reducing our carbon footprint. Inspired by the rise of collective patient movements, we committed as early as our 2017–2019 strategic plan to develop approaches that are more centered on patients’ needs, constraints, and preferences; to give them a more active role in decisions affecting them; and to rely more heavily on them to improve care.

OUR CHOICES

In the face of all these ambitions, our teams report feeling under constant pressure to do more and to do better, but with limited resources and absorption capacity. Moreover, some of these ambitions are perceived as being disconnected from operations, particularly those related to reducing inequalities and combating discrimination within our workforce.

We will protect our capacity to respond to acute crises requiring rapid action to assist populations whose health or lives are threatened by the consequences of conflict, epidemics, nutritional crises, natural and climate-related disasters, and by situations of mass violence in which our witnessing role takes on particular importance. This commitment will require that we permanently maintain the human, financial, medical expertise, and logistical resources necessary to respond to the unexpected and to deploy large-scale relief operations when access and security conditions allow. In unstable countries where we have been present for a long time, we will seek to strengthen our operational agility in order to respond to epidemics and sudden contextual shifts that require a reorientation of priorities. In situations that are particularly dangerous for our teams (especially national staff) we will ensure a concerted assessment of risks and of their specific exposure, and we will strengthen the measures enabling them to exercise their right to withdraw.

Building on these internal and external contextual elements, we organized a series of discussions and consultations between October 2024 and June 2025 to clarify our major action priorities and to examine the tensions associated with each of our stated ambitions. The orientations set out in this document do not reflect the full range of essential medical and logistical activities that our teams will continue to carry out in the coming years. Rather, they are intended to articulate our key choices and to clarify the strategic priorities that require the concentration of specific efforts and resources, and that entail particular transformations.

Confronted with the abrupt weakening of the international solidarity system and crisisresponse mechanisms, as well as with signi ficant uncertainties, our primary intention will not be to increase the volume of our operations in an attempt to compensate for the withdrawal of aid actors or to expand coverage to populations with limited access to care. We will focus on explicit operational and medical priorities. During the next cycle, we will maintain a strong operational footprint in emergency situations and contexts of extreme violence.

We also choose to mobilize in support of migrant populations, a population that is marginalized and criminalized by xenophobic policies, by strengthening our protection activities, seeking to shield them from the violence they endure, and explicitly opposing violations of their fundamental rights throughout their entire journey. Alongside this commitment to emergencies and situations of extreme violence, we seek to continue advancing humanitarian

MSF OCP STRATEGIC ORIENTATIONS 2026 » 2031

medicine for the benefit of populations affected by health problems that are particularly prevalent or neglected in our fields of intervention and beyond. In these areas, in close collaboration with the Foundation, Epicentre, and MSF Access, we will place particular emphasis on establishing and demonstrating the relevance of care models informed by patients’ experiences, leveraging medical innovations adapted to our operational contexts and designed to be replicable. In a context in which women’s rights are being broadly challenged, including their sexual and reproductive rights, with US budget cuts explicitly targeting this area, we choose to move against this trend by committing to deliver specific medical efforts in support of women. This commitment must be reflected both in improvements to our gynecological and obstetric care offerings and in the adaptation of our care delivery mechanisms and approaches, which must give women greater control over their own bodies and greater decision-making power.

public positioning and advocacy efforts. Our choice of orientations must also inform and clarify our decisions to open, readjust, or close projects, and help us critically question, in particular, the continuation of projects in stable contexts and in contexts where our operational space— meaning our autonomy of action and freedom of expression—is heavily constrained by those in power, thereby drastically limiting our ability to be useful to the populations we seek to assist. In light of the upheavals underway in international aid and the global health landscape—which could trigger major health crises in the years to come, including a massive resurgence of tuberculosis (TB) or HIV, forgotten diseases, and new threats—we will strengthen dialogue with global health actors.

Faced with the rapid rise of chronic diseases in all the countries where we operate, we will set for ourselves the ambition of strengthening access to treatment and developing care pathways adapted to patients’ constraints, particularly for patients with diabetes.

We will also ensure that our efforts are aligned with those of other MSF operational centers to guarantee that, at the MSF-wide level, we maintain essential medical expertise that may need to be redeployed at a later stage.

We will also strengthen our engagement in the field of cancer, an area that has been neglected in the countries where we work and a medical catastrophe obscured by the lack of screening, by building on our unique positioning across the entire continuum of care.

Faced with a repressive global climate accompanied by threats to civil society organizations and individuals engaged in the defense of human rights and freedom of expression, we choose to resist by reaffirming the operational value of our witnessing role, as developed in the 2019 framework document “Telling it as it is,” and by actively bringing it to life in practice.

The concentration of our efforts on acute crisis contexts and emergency situations, as well as on these medical and operational ambitions, must be reflected in the overall balance and dynamics of our portfolio, as well as in our

Confronted with international coordination mechanisms that reflect divergences in analysis and risk assessment within the movement, and that tend to level-down our communications, we will assume a degree of autonomy in order to preserve our own sensitivity. We will remain open to collaborations and ad hoc coalitions with MSF OCP STRATEGIC ORIENTATIONS 2026 » 2031

human rights organizations, civic movements, and investigative media to help bring to light the realities experienced by populations subjected to mass violence and to clearly identify specific responsibilities. We will not abandon progressive practices despite a reactionary climate that seeks to suppress them. On the contrary, we will demonstrate determination in advancing the following initiatives: •

•

Active prevention of abuse and mistreatment in our care and work environments. We will provide ourselves with the means to fully implement our safeguarding policy adopted in January 2024. This will require sustained engagement across the entire chain of prevention, detection, and response to abuse, as well as targeted efforts to protect those most vulnerable to abuses of power among our patients and colleagues, namely women, LGBTQI individuals, and persons with disabilities. Particular attention to the place of women in our projects and teams. Beyond the determination we will show in protecting them from abuse and sexual violence, of which they are the primary victims, we will take concrete steps to improve the dangerously low male-tofemale ratio in our field staff, both national and international, and to strengthen women’s presence in decision-making positions. Aware that sexist biases permeate MSF just as they permeate the societies from which our teams originate, we will work to counter biases that hinder women’s integration into our teams, the medical advances we seek to make in their favor, and the genuine consideration of their specific vulnerabilities, expectations, and experiences across all projects. The transformation of our practices through engagement with the experiences of the people we assist, with the aim of humanizing care, strengthening their involvement in decisions that affect them in order to improve our care delivery systems, and with a commitment to sharing power with them. Improvements in our medical interactions with patients, and in our MSF OCP STRATEGIC ORIENTATIONS 2026 » 2031

capacity to progressively make their rights effective, will be fundamental markers of the medical quality of our interventions. •

The reduction of inequalities in treatment within our workforce. We will deepen this effort, initiated in 2018 through the Rewards Review project, by addressing particular inequalities in access to health care between locally recruited staff and internationally recruited staff.

These progressive ambitions should not be viewed as parallel to the development of our operations, but as initiatives that directly contribute to their quality and to the ongoing professionalization of humanitarian action as we conceive it. They impose an obligation of means, including human and financial resources, and in this sense, we will accept that our operations, at an equivalent level of activity, may cost more, as well as sustained change management and continuity in implementation efforts. They will also require a gradual adaptation of team profiles and skills, which must be reflected in how we recruit, set objectives, and define the criteria for assessing a wellmanaged project. We will seek to take our fair share in the fight against climate disruption and environmental degradation. Alongside efforts to adapt our operations to this reality, our commitment will involve continuing to reduce our carbon and environmental footprint while working to redefine a motivating horizon 10 years after the Paris Agreement that shaped our initial ambitions in this area. In the field of environmental health, we will explore our potential role in health crises caused by different forms of direct pollution, in coordination with existing mobilizations.

ARTICULATION WITH THE MOVEMENT OCP’s strategic orientations are part of the SPARC (Strategic Planning, Accountability, and Resource Cycle) dynamic and take our interdependencies into account. Some of our

ambitions directly echo shared priorities. In areas such as safeguarding or security, the progress we achieve will inform progress at the MSF movement-wide level, and we will actively collaborate in the implementation of actions decided jointly. In close collaboration with the movement’s central purchasing entities, in particular MSF Logistique, and in line with commitments made at the

international level, we aim to play an active role in transforming our international supply chain, seeking to preserve its quality and responsiveness while optimizing its overall performance. Finally, all of our ambitions are underpinned by the capacity for evolution of our global talent pool and by the transformation of our HR architecture, a body

of work entrusted to the entire movement under SPARC and in which we are fully engaged.

Isabelle Defourny on behalf of OCP Group Committee and Claire Magone OCP General Director

MSF OCP STRATEGIC ORIENTATIONS 2026 » 2031

WHAT WE WANT TO PRIORITIZE

MSF OCP STRATEGIC ORIENTATIONS 2026 » 2031

PROTECTING OUR EMERGENCY RESPONSE CAPACITY Between 2020 and 2024, MSF OCP strengthened its emergency response, particularly in armed conflicts (e.g., Sudan, Ukraine, North Kivu in Democratic Republic of Congo (DRC), Chad, and Gaza, Palestine). We conducted large-scale operations, notably in war surgery, as well as in nutritional crises, with nearly 200,000 malnourished children treated in Nigeria between 2021 and 2023. We also demonstrated innovation in epidemic response and water supply and leveraged the diversity of our medical activities to be as useful as possible in emergency settings. This included integrating mental health care or physiotherapy in conflict contexts such as Ukraine, or the management of patients with chronic diseases in Syria. However, our increased presence at the epicenter of highly violent conflicts is testing our ability to manage team security, particularly for national colleagues exposed to extremely dangerous daily conditions (e.g., Palestine, DRC, Sudan, Haiti, and Burkina Faso). Moreover, sometimes largescale deployments in highly disrupted environments increase the risk of abuse against our patients, as illustrated by our experience in Chad during the emergency response for Sudanese refugees in 2023, where we recently had to investigate numerous cases of abuse. Progress on safeguarding in such contexts has remained insufficient to prevent situations of exploitation. In the coming years, we aim to protect our response capacity and responsiveness in emergency situations, including conflicts, population displacement, epidemics, nutritional crises, and natural and climaterelated disasters. This priority commitment will guide the allocation of our resources. Within the budget dedicated to emergencies, which will represent at least 20 percent of our operational budget each year, a significant envelope will be ring-fenced without prior allocation. This will enable all field projects to cope

with contextual changes requiring rapid reorientation of activities to address acute needs; to swiftly launch exploratory missions in response to alerts (whether or not they lead to operations); to respond to epidemic outbreaks and nutritional or food crises; to mobilize in situations of mass violence; and to provide shelter and safe water to displaced populations. In contexts of mass violence, our usefulness lies not only in the medical and psychological care of victims, but also in our capacity to expose the nature and scale of the violence, through the joint efforts of communications and Epicentre. We will seek to maintain a substantial level of engagement in contexts linked to the consequences of conflicts. Maintaining our emergency response capacity will also require: •

Continuing the work undertaken in recent years on national E-prep plans, meaning anticipated emergency response strategies that include surveillance and the maintenance of national pools, and developing an international pool of experienced personnel trained in the professional culture of emergencies to conduct exploratory missions and initiate operations.

•

Strengthening core competencies for large-scale activities such as vaccination, treatment, and food assistance, including supply and procurement; the organization of distributions, particularly cash and alternative modalities that we aim to use more proactively; as well as monitoring and evaluation to measure distribution effectiveness and actively prevent abuse. Further developing our strategic partnerships to access key inputs, notably with the World Food Program (WFP), the International Coordination Group, and the World Health Organization (WHO).

•

Maintaining our engagement in epidemic response, including less frequent outbreaks such as hemorrhagic fevers or respiratory diseases (for example COVID-19), which will require preserving the skills of a dedicated group of experts. It will be essential to retain a significant role in key countries and within the international response MSF OCP STRATEGIC ORIENTATIONS 2026 » 2031

system, to strengthen our partnership with WHO, and to develop close analytical and collaborative work with emergency medical teams (EMTs). We will also work to secure access to vaccines subject to supply constraints, such as the cholera vaccine. •

•

Revitalizing temporary hospital structures. Our logistical mastery of field hospitals—now maintained through inter-sectional collaboration—is a major asset for rapid deployment in emergency situations. During the next cycle, we will work with the various sections to update their medical content, which is now no longer suited to our needs. We will also work—with due attention to interoperability with other sections— to strengthen the modularity and complementarity of our emergency deployment solutions, in order to better respond to the evolution of our medical interventions and operational contexts. Integrating proactive measures to pre vent and detect abuse against our patients, the most vulnerable segments of our workforce, and the most exposed material resources.

These will include the systematic implementation of basic standards, as well as the development of prevention plans integrated at every stage, from recruitment to project design, under the responsibility of operational coordinators, supported by adequately sized teams and by the expertise of technical and safeguarding coordinators.

REMAINING FAITHFUL TO THE “TELLING IT AS IT IS” VISION IN OUR PUBLIC ADVOCACY The communication vision expressed in the document “Telling it as it is” remains the cornerstone of our strategic ambitions in public communication. We will continue to uphold it in practice, in a context where growing repression of media and civil society organizations worldwide makes our witnessing role particularly valuable.

MSF OCP STRATEGIC ORIENTATIONS 2026 » 2031

During the previous strategic cycle, OCP demonstrated its commitment to this function. This included documenting the influx of wounded individuals and refugees in Chad fleeing ethnic violence in Sudan (summer 2023); producing an unprecedented volume of field testimonies, patient stories, reports, and documents on the genocidal war waged by Israel in Gaza, including the destruction of Palestinians’ living conditions, the massacres of humanitarian workers and health personnel, and attacks on Gaza’s hospitals; publishing a damning report on violence perpetrated by the RSF and the SAF against civilians in North Darfur (June 2025); and continuing efforts to document violence and precarity in contexts such as Ukraine, Haiti, the DRC, and Bangladesh, to name just a few. However, the development of these public positions has also revealed persistent divergences within the MSF movement, as well as within the OCP group, regarding how the principles of “Telling it as it is” are applied in practice. These divergences come at a cost. They complicate and slow down processes and weigh heavily on the working capacity and well-being of communication teams. This assessment makes it necessary to reaffirm certain guiding principles on which MSF OCP intends to continue building its public advocacy: •

Our witnessing role goes beyond the mere medical description of a situation or the relay of first-hand information. Although MSF is not a human rights advocacy organization, this does not prevent us from entering the arena of public debate on war crimes and extreme violence committed against the populations alongside whom we work.

•

Our public statements may at times be driven by the desire to influence a situation we deem unacceptable, and at other times by the intention to make our voice heard “officially” on a given issue in order to inform the work of media, researchers, other organizations, or judicial bodies.

•

Our public advocacy must not be paralyzed or flattened by fear of being

challenged or of generating controversy, nor by the illusory aim of having, for example, “perfect evidence” when denouncing perpetrators of attacks against civilians. We accept that analyses rooted in our local understanding of a context and informed by the testimonies of the populations alongside whom we work are sufficient to legitimize our public positions. •

The pursuit of MSF’s “neutrality” in public communications in conflict situations is neither realistic nor desirable, any more than the pursuit of acceptance by those in power. While MSF refrains from political or partisan affiliation, we allow ourselves to side with populations and victims.

•

Our influence strategies must fully integrate the operational power of our public communication, without opposing or subordinating it to the imperatives of so-called “humanitarian diplomacy” conducted behind closed doors.

Faced with internal divergences on these critical points, we will accept the possibility that several MSF positions may coexist on the same issue, in the spirit of the "minority voice" affirmed in La Mancha.

MOBILIZING IN SUPPORT OF MARGINALIZED MIGRANT POPULATIONS MSF OCP re-entered the field of migration toward Europe in 2015 by opening projects providing medical and psychological support and shelter in Greece and France. From 2017 onward, in France we prioritized services for unaccompanied minors, and in Libya we focused on medical activities for migrants in detention. For the latter, we also worked, with mixed success, to facilitate their evacuation. In a context marked by the multiplication of conflicts in Africa and the Middle East, increasingly perilous migration routes, erosion of reception standards, tightening European migration policies, and a period of growing criminalization of aid actors,

we reaffirm our determination to remain present alongside these people who are rendered invisible and sacrificed by public policies. In particular, we will continue to provide medical, social, and legal support, and will further develop protection activities, including access to safe shelter, while continuing to alert and document their situation. Working on migration constitutes in itself a strong stance in the face of the rise of illiberal trends and also represents a strategic space for developing cross-cutting skills. Medical activities cannot function without social, legal, or psychological support components, skills that can be reinvested across the rest of our operational portfolio, particularly in high-violence contexts. Moreover, these projects have historically made it possible to test ways of working that foreshadow broader institutional developments, such as strengthening partnerships with other aid actors and paying particular attention to the voices and expressed needs of the people we assist.

ADVANCING OUR PRACTICES AND MEDICAL CARE IN SUPPORT OF WOMEN In a global context marked by a worrying rollback of human rights, MSF reaffirms its responsibility toward an entire category of patients, namely women. This responsibility goes beyond the strict medical dimension to take into account the social, economic, and structural conditions that shape women’s health. It will require specific attention to the constraints and needs unique to women, and a critical examination of our practices when they reproduce sexist biases and generate discrimination in care delivery. In the services we provide and in our interactions with women, we will seek to help give them greater control over their own bodies and greater decisionmaking power, by involving them not only in their care but also in the definition of projects and strategies. MSF OCP STRATEGIC ORIENTATIONS 2026 » 2031

Historically focused on complicated deliveries and childbirth-related mortality, our women-specific care activities have expanded over time to include the management of sexually transmitted infections, sexual violence, contraception, abortion, and, more recently in some projects, the introduction of specialized surgery for vesicovaginal fistulas and the management of cervical and breast cancers. This broad range of activities masks insufficient results. Preventive and curative services specific to women remain too rarely available in our projects, despite strong demand and the existence of internal expertise. Some of our maternity wards do not meet the minimum quality criteria set by WHO and by our own teams. They are often understaffed and sometimes insufficiently trained. Prevention, screening, and individualized care for women with high-risk pregnancies, including hypertension, preeclampsia, gestational diabetes, anemia, and malaria must be improved, as must postnatal followup for conditions such as postpartum depression and psychosis, cardiomyopathies, diabetes, and other chronic conditions. The management of infectious diseases during pregnancy must no longer be limited solely to preventing transmission to the child. For example, maternal hepatitis B can now be treated. The efforts already undertaken to strengthen respectful maternal care, through a multidisciplinary offer centered on women’s choices and needs, must more decisively include effective options for pain management during childbirth, a true oversight in our practices, and must prevent obstetric violence. Aware of their key role, we will value and strengthen the role and place of midwives so that they can fully support these efforts. Since 2023, the Operations Department and the Medical Department have reaffirmed that safe abortion must be available in all MSF projects, with or without a dedicated component. Between 2021 and 2024, the number of abortions provided increased fivefold, but across a limited number of projects. Too often, implementation is hindered by reluctance and resistance within our teams. We will promote access to contraception services and safe abortion in all our projects, as well as for all MSF employees

MSF OCP STRATEGIC ORIENTATIONS 2026 » 2031

and their dependents, as already provided in our health policy. Similarly, we will continue to develop and offer comprehensive and integrated care for survivors of sexual violence in our fields of intervention. We will establish dedicated, welcoming care spaces, such as “women’s houses,” where women can learn how to avoid unwanted pregnancies and protect themselves from sexually transmitted infections. We will also seize opportunities when women come to us, for example by organizing joint mother and child appointments or by offering consultations when they accompany a hospitalized child. Finally, for chronic conditions, we will strive to develop differentiated care models that take into account women’s specific constraints and facilitate their sustained participation in care over time. Our commitment to women’s health must also inform our research and medical innovation efforts. Producing women-specific data by documenting physiopathological differences between sexes; working on risk factors for mortality and morbidity among pregnant women; ensuring the inclusion of pregnant women in research such as therapeutic and vaccine trials; analyzing the health consequences of gender-based violence; and developing and testing, together with women themselves, integrated and or differentiated care models to improve access to health services are essential levers for advancing medicine for women and with women.

OFFERING CARE MODELS ADAPTED TO PATIENTS WITH CHRONIC DISEASES IN OUR CONTEXTS In many countries where MSF operates, the epidemiological transition does not follow the expected pattern: infectious diseases persist while noncommunicable diseases increase sharply. In low-resource countries, noncommunicable diseases have been and continue to be neglected and sidelined by international funding mechanisms. Yet in 2021, 18 million people

died from noncommunicable diseases before the age of 70, and 82 percent of these premature deaths occurred in low- or middle-income countries3. In crisis or conflict settings, these diseases represent a major cause of morbidity and mortality, notably due to interruptions in treatment. Historically, we have focused on infectious diseases, malnutrition, and war or reconstructive surgery, and we invested little in these areas, with the gradual exception of cancer since 2017. We are beginning to develop expertise in these fields and are working on decentralized care models adapted to our contexts, with a view to scaling them up under the responsibility of other actors, including ministries of health. The surge in consultations related to hypertension, epilepsy, and diabetes in our pediatric and adult projects, whether for outpatient treatment renewals or for hospitalizations due to disease decompensation, has sounded the alarm. This increase in cases, partly linked to rising prevalence but above all to much broader screening outside MSF, is not accompanied 3 h ttps://www.who.int/news-room/fact-sheets/detail/ noncommunicable-diseases

by access to treatment through ministries of health. In general, national recommendations and protocols exist, but essential health products are not available in the public sector, even less so in a decentralized manner at health center level. The noncommunicable diseases we plan to address in the coming years include diabetes, hypertension, epilepsy, chronic mental disorders, and hemoglobinopathies such as sickle cell disease. Among noncommunicable chronic diseases, insulin-dependent diabetes, due to the complexity of its management, is undoubtedly the condition that poses the greatest challenge and requires the most extensive work, both in terms of access to medicines and the development of new care models. In the coming years, we aim to develop a package of care that can be replicated by ministries of health, structured around work on several pillars. The first pillar consists of improving access to a range of products available in high-income countries but out of reach in many contexts where MSF operates: insulin pens, insulin analogues, blood glucose monitoring tools such as glucometers and patches, and new therapies

MSF OCP STRATEGIC ORIENTATIONS 2026 » 2031

for type 2 diabetes. The insulin market, for this synthetic protein that is central to diabetes treatment, is currently controlled by three major pharmaceutical companies that have capitalized on the non-patented and initially low-cost synthetic production of insulin. These companies now hold intellectual property rights, preventing largescale generic production, and set prices far above manufacturing costs. We will mobilize to remove these barriers to access, together with MSF Access and alongside other civil society organizations. At the same time, the complexity of treating type 1 or insulin-dependent type 2 diabetes makes management difficult without specialists. However, in many countries where MSF works, particularly in sub-Saharan Africa, care is mainly provided by nurses, clinical officers, or general practitioners. Task shifting is therefore essential and requires the development of skills among both health personnel and patients. We will engage in this effort through partnerships with organizations that train practitioners and patient associations, and by co-developing tools that facilitate care delivery.

MSF OCP STRATEGIC ORIENTATIONS 2026 » 2031

Faced with conditions that require longterm follow-up and treatment, we will develop differentiated and decentralized care models that promote patient empowerment by enabling selfmonitoring of disease, treatment adherence, and recognition of signs requiring consultation. More broadly, we aim to manage these diseases in an integrated manner within existing projects or as part of emergency responses, particularly to ensure continuity of care, rather than through vertical projects.

ADVANCING CARE FOR PEOPLE AFFECTED BY CANCER, A NEGLECTED CATASTROPHE IN LOW-RESOURCE SETTINGS Cancer incidence is increasing significantly worldwide, and growing numbers of patients are presenting to our services.

The WHO and International Agency for Research on Cancer project an increase of 142 percent in the number of cases between 2022 and 2050 in countries with a low Human Development Index, and 99 percent in countries with an intermediate Human Development Index. These projected increases are linked to several factors such as population growth, increased life expectancy, the emergence of certain risk factors, and improved access to diagnosis. This disease, which affects all population groups, starkly illustrates inequalities in access to health care. Prevention and treatment solutions exist but remain largely inaccessible in the contexts where MSF operates, leading to profound disparities in survival chances. Cancer care in low-resource countries has received relatively little attention from global health actors. Based on these observations, we began working on this issue in 2017 in two countries in particular, Malawi and Mali, focusing on highly prevalent cancers, namely cervical cancer and breast cancer. As a third project is currently being launched in Papua New Guinea, our ambition is to develop care models adapted to low-resource countries, including prevention strategies, early diagnosis, and treatment, and to engage in initiatives to improve access to quality health products in order to advance cancer care beyond our own activities. These projects also challenge us to rethink certain standard internal processes that hinder medical innovation initiatives. For example, systems must be created to enable us to recruit and retain specialized profiles and to stabilize autonomous senior management teams over longer periods than is currently our practice. We accept that these projects remain vertical, given their complexity, the breadth of issues to be addressed, and the ambition at this stage. The objective is not to mainstream cancer care across all our operations, but rather to learn; to push the boundaries of our medical practice and of global health through advocacy based in particular on the demonstration of effective models. In terms of prevention, we aim to develop more effective models for ministries of health in low-resource countries, such as

the use of sensitive and specific tests within realistic protocols, or the development of HPV vaccines covering oncogenic subtypes prevalent in sub-Saharan Africa and absent in high-income countries. The MSF Foundation, which has been engaged for several years in research and development of cervical cancer screening tools using artificial intelligence, will remain a key operational partner in cancer prevention. With regard to treatment, in the context of constantly evolving research driven by the high prevalence of cancer in highincome countries, scientific monitoring and innovation will be critical. It is essential to remain attentive to any opportunity enabling simplified modes of administration, for example shorter radiotherapy courses, reduced chemotherapy doses, or the use of new therapeutic agents. Ensuring access to quality health products, including vaccines, diagnostic tests, chemotherapies, and targeted therapies, as well as to surgery and radiotherapy beyond our own projects, remains a major challenge in the countries where we operate. This work will need to be carried out together with MSF Access, for which cancer is one of the priorities. We have a responsibility to ensure the most rigorous possible collection and analysis of data in order to meet the objectives of evaluating our care and care models, as well as supporting research and advocacy. Given the complexity of this field, Epicentre must become a leading ally, as illustrated by the recent cohort analysis of patients in Bamako treated for breast or cervical cancer. Finally, these projects embody several of our broader ambitions. Historically, they have focused on the health of women affected by breast and gynecological cancers. Their holistic dimension, addressing patients’ quality of life at all stages of disease, lies at the heart of our commitment to delivering patient-centered care. The implementation of a broad range of supportive care services, including psychological support, physiotherapy, nutrition, palliative care, and social support, is a concrete expression of this approach. They also reflect our determination to work more effectively with others, as this field requires close collaboration with MSF OCP STRATEGIC ORIENTATIONS 2026 » 2031

medical networks, research and innovation bodies, global health actors, health authorities, and civil society.

STRENGTHENING OUR RESPONSIBILITY IN THE GLOBAL FIGHT AGAINST ANTIMICROBIAL RESISTANCE Bacterial infectious diseases remain among the most frequent pathologies in MSF intervention settings and affect all patient groups, including pediatrics, malnutrition, surgery, and women’s health. With the growing emergence of multidrugresistant bacteria, their management is becoming increasingly complex and can lead to therapeutic dead ends in the absence of precise diagnosis and appropriate antibiotics. Antimicrobial resistance is estimated to be associated with 4.7 million deaths per year, the majority occurring in low- and middleresource countries. One of the main drivers

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of antimicrobial resistance is the prescription of unnecessary and or inappropriate antibiotics, or prescriptions given for unsuitable durations, compounded by the circulation of substandard or counterfeit medicines. Any health organization therefore bears responsibility in the fight against antimicrobial resistance, both to prevent the emergence of such infections and to limit their spread within health care facilities. For more than 10 years, MSF has invested in a multidisciplinary approach within our projects, encompassing infection prevention and control, including hygiene measures in care settings, reinforced precautions for certain patients when necessary, prevention of contamination of hospital water networks, wastewater treatment, highquality microbiological diagnostics, and appropriate use of antimicrobials. Regarding antimicrobial use, while progress has been made in our hospitals, particularly through dedicated clinician positions focused on antibiotic stewardship, much remains to be done, especially in primary health care consultations where antibiotic prescription is widespread. Access to microbiological diagnostics must be expanded across all projects at high risk of resistance,

coupled with the Antibiogo application, which enables more reliable diagnosis of antimicrobial resistance and appropriate prescribing, while also making this still too often silent pandemic more visible. Our main ambitions are structured around several key axes. Operationally, this involves implementing infection prevention and control measures, dedicating antibiotic stewardship positions within our hospitals, and ensuring access to microbiology, whether MSF-run or external laboratories, as a priority in hospitals at high risk of infection, with the aim of ultimately achieving a comprehensive antimicrobial resistance package, the only effective way to address these complex bacterial infections. As MSF has become one of the pioneering actors in this field in our countries of intervention, ministries of health are increasingly calling on us to share our experience and tools, in particular Antibiogo, whose large-scale deployment we will actively promote. In terms of access, challenges are significant both for conventional diagnostics such as microbiological cultures and for new rapid

tests adapted to our constraints, as well as for the availability of new antibiotics at affordable prices. Finally, MSF has a key role to play in epidemiological surveillance, which will contribute to global advocacy on antimicrobial resistance.

CLARIFYING AND IMPROVING OUR INTERVENTIONS IN THE FIELD OF MENTAL HEALTH In recent years, mental health activities have increased significantly, driven primarily by field teams’ desire to integrate this component when confronted with people experiencing psychological distress in diverse contexts, including refugee or displaced populations, survivors of violence, natural disasters, and severe medical events. However, there remains a limited understanding of this specialty within MSF teams at all levels. In the field, due to the absence of a clearly defined strategy and an insufficient number of psychologists and MSF OCP STRATEGIC ORIENTATIONS 2026 » 2031

psychiatrists, some programs do not meet expected quality standards. Social support or therapeutic education may sometimes be delivered or supervised by psychologists, while mental health care is entrusted to teams with little or no training and without adequate supervision. Recognizing the full importance of mental health activities and wishing to continue investing in this field, we must clarify our ambitions, raise our standards for the quality of psychological and psychiatric care when it is provided, and rationalize these activities by ensuring that they are always grounded in a strategy understood by operational and medical teams and that they benefit from appropriate supervision. Since 2010, the priority for a medical NGO in the broad field of mental health has been the care of the most severe patients, previously largely excluded. We have embraced a strategy of integration and deployment of the WHO Mental Health Gap approach. Field doctors and clinical officers receive robust training in psychiatric disorders and epilepsy, combined with online clinical supervision or the use of telemedicine. In the

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same task shifting logic, national teams of psychosocial counselors must be trained by qualified psychologists. This care framework must guide our progress in two areas requiring particular attention: The first concerns psychological care for people who have experienced different forms of violence, whether related to conflict or displacement, such as rape, torture, or witnessing massacres, or stemming from gender-based and sexual violence leading to discrimination against survivors. Not all of these individuals will develop psychotrauma, but we must have the means to prevent, identify, and treat those who do develop severe psychological distress or disorders as a result of these experiences. These programs rely on national teams, who alone can ensure continuity of care and sociocultural adaptation, but these teams must be supported and supervised by qualified professionals. Severe depressive disorders are often associated with severe psychotrauma, and combined pharmacological treatment may be required, underscoring the need for multidisciplinary teams.

The second area concerns patients with psychiatric disorders: Experience has shown that we can stabilize individuals with severe depression, including certain forms of psychotrauma, as well as those with acute or chronic psychoses, through trained and supervised national physicians, provided there is continuous access to appropriate treatments. Such follow-up within MSF chronic disease clinics can be considered. The development of these orientations goes hand in hand with the transformation and support of the mental health professional pathway in terms of human resources, enabling recognition of the work carried out by clinicians in the field, whether in frontline care roles or in support, management, or coordination positions.

EXPLORING THE FIELD OF ENVIRONMENTAL HEALTH Climate change, pollution, biodiversity loss, resource depletion, and the collapse of ecosystems that have enabled human societies to thrive: Long considered external to our scope of action and to the time horizons of our interventions, the environmental crisis is now understood as an existential threat to humanity, one from which MSF cannot turn away. Beyond our commitment to reducing our own environmental footprint, since 2019 we have affirmed an ambition to assist the victims of the environmental crisis. All health emergencies, including epidemics, conflicts, so-called “natural” disasters, and population displacement, have causes that are simultaneously social, political, and environmental. In this respect, all of our operations already address populations affected by the climate and environmental crisis. This is particularly true of preventive and curative activities related to waterborne and vector-borne diseases, such as malaria, cholera, and dengue, zoonotic diseases, and noncommunicable diseases whose incidence may also be shaped by environmental factors.

As for the future health impacts of climate change, they are extremely difficult to predict and to measure. This is due to the possibility of non-linear tipping effects and, above all, the complexity of the causal chains linking atmospheric composition to the health of people living in society, combined with cumulative exposure to other environmental factors. For this reason, our main challenge is not to anticipate the (unpredictable) mediumterm consequences of climate change, but to detect and respond to the unforeseen crises whose occurrence it already favors. For the 2026–2031 period, we propose to give favorable consideration to operational proposals in two types of situations in which the environment plays a predominant role: 1. Health crises associated with extreme climatic events, in particular floods and heatwaves, areas in which we must improve our risk analysis, infrastructure, and medical and operational practices. 2. Health crises caused by contamination of air, water, food, or soil by toxic physicochemical substances. Aware of the difficulty, in these contexts, of proposing effective preventive and curative solutions, as well as of the political challenges involved in negotiating an operational space, we will prioritize projects anchored in existing social and political mobilizations and supported by independent medical and epidemiological expertise. As these impacts are disproportionately borne by certain groups, including older people, children, pregnant women, people with underlying conditions, and migrant or displaced populations, we will take these criteria into account in our future environmental health interventions. Finally, with more than 50 percent of humanity now living in urban settings, poor urban populations, particularly those living in informal settlements, are exposed to a concentration of health problems directly linked to environmental conditions. These populations will require particular attention.

MSF OCP STRATEGIC ORIENTATIONS 2026 » 2031

WHICH APPROACHES DO WE WANT TO PROMOTE?

MSF OCP STRATEGIC ORIENTATIONS 2026 » 2031

PROVIDING ASSISTANCE WITHOUT PERISHING At the time of drafting this document, states around the world, including liberal democracies, are showing increasing tolerance toward the killing of humanitarian workers and medical personnel. In Gaza, Sudan, Haiti, and many other countries, our teams are more than ever threatened by the practices of terror employed by governments and armed groups that attack hospitals, ambulances, displacement camps, and relief personnel with impunity, often accusing them of serving as “human shields” for their enemies.

cells handling critical incidents are designed in accordance with these principles. •

Recent experience (Gaza, Ethiopia, Sudan, Afghanistan, etc.) reminds us that risk reduction does not rely on adherence to abstract humanitarian principles, but rather on negotiation efforts involving the construction of a balance of power and shared interests with armed actors, in which the threat of withdrawal and public denunciation constitutes our ultimate “deterrent tool.” “In this regard, our security depends closely on the quality of our contextual analysis,” as stated in our policy. We will continue efforts to improve this analysis, including changes to the scope of action of the TAC, strengthening links with journalists, academics, and activists, and improving the training and support of our senior staff. We will mobilize in support of initiatives aimed at countering the normalization of attacks against health facilities and humanitarian workers, particularly in situations where bombardments of hospitals are justified by states through loopholes in international humanitarian law.

•

Finally, we will strengthen Duty of Care measures in dangerous situations where our locally recruited teams are particularly exposed. This commitment will involve continuous and joint assessment of the risks incurred, in order to enable them to exercise their right of withdrawal, even in extreme situations where shelter options are limited (Gaza, Khartoum). We also commit to specifically monitoring and protecting individuals whom we recruit to establish contacts with actors considered by others to be criminals, and who are particularly exposed as a result.

In the face of violence threatening our teams, the “risk-taking and security management policy” adopted in February 2015 by the OCP Group Boards remains a relevant reference framework. It inspired the commitments made under the MSF We Want To Be process and informed SPARC priorities on team security carried by the Operations Directors platform. In line with these commitments, during the coming cycle we will place particular emphasis on three aspects: •

Knowledge of security accidents and incidents affecting our colleagues is essential both to improving our practices and to ensuring the expression of informed consent. We will continue efforts to document and analyze security events through inter-operational center collaboration. This commitment will translate into support for the development of interoperable tools and processes that have a concrete effect on the inter-operational director security agreement signed in 2017, in line with SPARC ambitions in this area. However, working on tools alone will not be sufficient to significantly improve the quality of exchanges between operational centers, which is essential to progress on duty of care, informed consent, and accountability. For its part, OCP will widely disseminate knowledge of security incidents to its teams, ensure that deliberative management practices are strictly respected with regard to team security, and ensure that the operating procedures of crisis

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DELIVERING ON OUR SAFEGUARDING COMMITMENTS In 2022, we launched a reflection process on the management of abuse, based on the observation that our system did not allow for effective protection of those most exposed to abusive or discriminatory behavior, including among staff, patients, and their companions. In particular, reports from patients and non-managerial staff, who are among the most vulnerable, were largely absent from the channels in place at the time This reflection led, in 2024, to the adoption of a safeguarding framework carried by general management, conceived as a core operational system embedded in everyday practices and shared responsibilities across functions, rather than as a standalone or purely compliance-driven policy. Its ambition goes beyond responding to abuse alone and aims at a profound transformation of our professional practices. The objective is to guarantee safer, more protective, more respectful, and more inclusive working and care environments, for both patients and teams, with particular attention to those most exposed, notably women and people with limited access to decisionmaking spaces. Since then, we have been working on the practical implementation of this policy. In the next cycle, this implementation will be driven through the steering of associated workstreams, including the generalization of awareness-raising actions on individual and institutional MSF commitments, the implementation of safe recruitment principles, and the improvement of patient feedback mechanisms. The operationalization of patients’ rights, a strategic pillar of our safeguarding policy, will be articulated around a unit more broadly dedicated to improving our interactions with patients and transforming our care practices (see below). The major challenge is to move from a reactive approach focused on the handling of reported cases to a dynamic of active detection and prevention of abusive behaviors. This is a substantial undertaking,

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as safeguarding is a cross-cutting issue that affects all ways of working. Its success will depend on progress in other equally critical areas, such as people-centered approaches, social dialogue, internal control, and gender balance within teams. It is important to recall that our safeguarding commitment must be understood as an obligation of means rather than of results, on the one hand because no progress in this area will be achieved without significant investment, and on the other because these efforts will initially contribute to making these realities more visible. We will actively contribute to the actions discussed within the SPARC framework on safeguarding, in order to promote the development of shared approaches and tools. In practical terms, this obligation of means must in some cases translate into reflection on team composition and the strengthening of certain functions in the field, as well as on the evolution of the role of HR within operational cells, which is particularly critical. While remaining the primary responsibility of operations coordinators, safeguarding coordinators have thus been deployed in several projects, including during emergency responses, contexts that are particularly exposed due to intense activity rhythms and the rapid mobilization of a large number of people. Finally, a preventive approach to abusive or discriminatory behavior must be accompanied by transparent communication on cases that occur and, on the sanctions, imposed, an area in which we still need to make further progress.

SHARING POWER WITH OUR PATIENTS A few years ago, we acknowledged the need to improve the way we treat patients by deepening our understanding of their needs, involving them more closely in decisions concerning their care, and including them in our prevention and abuse management policy, which until then had largely focused on our staff. With the establishment of a “people-centered approach” (PCA) team in 2021, we clarified our intentions and

formalized commitments, notably through the articulation of seven pillars of this peoplecentered approach (listening to patients, fostering their autonomy, preventing and managing abuse, engaging in dialogue with the community, better coordinating different forms of care around patients, offering supportive care beyond medical activities, and improving the working environment of our staff), as well as, and above all, through the patient rights charter. Since then, we have observed progress. Our safeguarding policy explicitly includes patient protection and respectful care. Some projects are piloting approaches involving peer or partner patients, while others integrate this topic transversally into multi-year plans.

caregivers and insufficiently take into account patients’ expectations, constraints, and experiences.

However, these advances remain fragile. Basic elements, such as access to information or adequate pain management, are far from being systematically in place. Many of our patients barely know why they are in our health facilities, and even less what decisions have been made on their behalf. Our care practices remain largely defined by

staff and patients exist at project level to enable these exchanges.

The power imbalance between a humanitarian and medical institution such as ours and people who are displaced or chronically marginalized by failing health systems remains immense. This is why efforts to promote patient rights, particularly in hospital settings, and to translate them into practice must be strengthened. Progress in this area requires clarifying the role that each actor along the medical and operational chain must play and drawing on patient experience to improve or even transform our medical practices, while ensuring that dedicated spaces for dialogue between MSF

The trust placed in the people to whom we provide care is often too limited. We must value their capacity to develop expertise in their own conditions and to fully engage in their care pathways. This will be indispensable to achieving results in the MSF OCP STRATEGIC ORIENTATIONS 2026 » 2031

management of chronic diseases and cancer. Moreover, this is one of the levers for largescale responses, as demonstrated by certain nutrition projects through the distribution of mid-upper arm circumference bracelets to families, or HIV projects by delegating antiretroviral drug dispensing to patient groups when they live far from health centers. In the coming years, we will also rely more decisively on patient associations, which can play a key role in information provision, support, patient education, and accompaniment. This support may take the form of assistance with structuring, formal partnerships, or financial support. We will also explore modalities for including patients in our governance in order to share power by involving them in certain strategic or programmatic decision-making processes, at project level, at headquarters, or at board level. This commitment to sharing power must also inform how voice, participation, and responsibility are organized within our teams and collectives. A dedicated cross‑cutting unit will operationalise the Patient Rights Charter, elevate patient‑experience‑driven improvement, and support field initiatives. This unit will reinforce the central role of nursing in respectful care and ensure alignment with hospital management roadmaps, people‑centred approaches, adverse event management, and health promotion. OCP is committed to delivering safe, high‑quality, patient‑centred care, and recognises that achieving this requires a strong organisational commitment—and a cultural shift—in understanding how nursing and midwifery leadership directly drives improved quality of care. We will ensure the meaningful inclusion of nurses and midwives in leadership and governance; equip them with the skills and competencies needed to meet patient needs; and advance a progressive interdisciplinary approach aligned with international best practice. We will broaden operational research to strengthen nursing and midwifery practice and increase investment in our largely locally hired workforce to enhance patient care.

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OCP will strengthen nurses as key coordinators of care pathways by ensuring appropriate staffing, competencies, and working conditions, integrating this into the OCP Nursing Action Plan for the next three years. This commitment, supported by the full spectrum of management including both medical and operations, aligns with the spirit of the IGA Nursing and Midwifery in MSF 2021 motion.

REDUCING TREATMENT INEQUALITIES BETWEEN STAFF CATEGORIES Compensation and benefits Our compensation and benefits policies have historically evolved in step with the organization’s structural developments. Headquarters entities (operational centers, sections, recruitment offices, etc.), embedded in legal and social environments that are generally more regulated, stable, and protective, have enabled the establishment of more comprehensive, more specific, and more structured schemes than those gradually developed in countries of intervention. This difference, combined with the existence of distinct and parallel frameworks depending on staff categories (headquarters, internationally mobile staff, locally recruited staff), has resulted in treatment disparities sometimes perceived as discriminatory, particularly between colleagues working side by side within the same project. Initially, international, local, and headquarters staff evolved in largely separate spheres. Positions were generally not the same across employment statuses, and headquarters remained largely distant from intervention contexts. Today, these boundaries have considerably blurred. A considerable proportion of internationally mobile staff now come from our countries of intervention. Headquarters-type entities increasingly coexist with intervention contexts (Nairobi, Amman, Dakar, etc.). These contexts themselves are becoming more stable, more structured, and more demanding,

both legally and socially. This growing interconnection makes the limitations of historical schemes more apparent and reinforces the need for coherence and equity across all teams. Aware of these challenges, the MSF movement, with strong involvement from OCP, initiated a fundamental shift as early as 2018 through the Rewards Review project. This wide-ranging reform effort aims to thoroughly rethink compensation and benefits policies in order to build a system that is more transparent, more equitable, and better aligned with current realities, both in the field and at headquarters. By 2031, our ambition is to firmly embed the reduction of treatment inequalities between staff categories as a central issue that is intrinsic to how we operate. Beyond the concrete deliverables of the Rewards Review, this will involve strengthening shared foundations and minimum standards applicable to all employees, adopting a more cross-cutting and integrated approach to managing compensation and benefits policies, and exercising increased vigilance in

identifying and justifying any remaining differences in treatment.

Healthy teams Delivering on these ambitions requires sustained attention to the people who make them possible and to the conditions in which they work and live. This calls for greater attention to staff health and well-being, encompassing physical and mental health, workload, working and living conditions, and the broader environments in which teams operate over time, with particular attention to reducing disparities in access to health care within our teams. This issue particularly affects locally hired colleagues, whose access to health services remains far below our expectations, despite the fact that they are permanently immersed in fragile and demanding contexts. For many, medical expenses represent a major burden for already vulnerable families. These stark disparities are deeply misaligned with our ambitions regarding collective wellbeing and contradict the medical priorities we defend in our programs, such as access to safe abortion, contraception, prevention and MSF OCP STRATEGIC ORIENTATIONS 2026 » 2031

management of chronic diseases, and mental health care.

further increases vulnerability to these challenges.

Admittedly, it is not always easy to make the health of our locally hired colleagues a constant priority in the face of the many lifethreatening emergencies our teams confront. The size and diversity of our workforce imply highly varied health needs, and a truly appropriate response would require structures comparable, if not in scale then in complexity, to those established for our patients.

In the coming years, we commit to implementing care strategies informed by the framework resulting from the Rewards Review and grounded in the realities of each context. This will involve country-by-country mapping of risk factors, specific needs, available services, and local administrative frameworks. It will also require identifying the appropriate human resources and mechanisms to respond to these needs. These mechanisms may vary depending on the context, including MSF-managed staff clinics, referral to reference facilities, insurance schemes, or local social security systems. The objective will always be to offer a coherent approach, implemented in collaboration with other sections. Despite the seriousness of current shortcomings and the persistence of disparities in access to care between countries, this process will be gradual. Its purpose is ultimately to build a concrete, robust, and sustainable framework for the health of our staff.

Under our current operating model, this burden often falls on medical teams such as COMED and Deputy COMED, who lack sufficient time and whose turnover prevents continuity of follow-up. Specific care pathways are not always clearly defined, particularly in projects where external health care structures are themselves weak. In the absence of a strategy that systematically links these pathways to local medical realities, we too often remain confined to the application of standardized policies. This imbalance illustrates a conflict of priorities that we can no longer ignore. In light of our ambitions, we must establish appropriate structures and mechanisms that are organically integrated at the core of our operations. Over the past few years, Staff Health Units (SHUs) have been created within each operational center to rethink our approach to staff health. Their role is not limited to defining reimbursed care packages, but rather to providing genuine health support tailored to the real needs of teams. Their work has shown in particular that while acute care is generally covered, preventive aspects remain largely underestimated. In the future, prevention must be strengthened, whether through information, monitoring of psychosocial risks, screening, or early management of chronic diseases. Several deaths among locally hired colleagues, linked to complications of chronic diseases, whether infectious or noncommunicable such as cardiovascular diseases, could likely have been avoided through earlier diagnosis and appropriate follow-up. The COVID-19 pandemic also highlighted the widespread exposure of our teams, whose natural aging

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More broadly, the health of our staff is not solely a matter of medical arrangements or access to care. It is part of a broader vision of support and well-being, without which our teams, as a whole, would not be able to sustainably carry out the missions entrusted to them. By affirming this requirement, we recognize that caring for those who provide care is an essential condition for the quality of our action.

REDUCING OUR CARBON AND ENVIRONMENTAL FOOTPRINT Four years after publicly committing to halve our carbon emissions by 2030, thereby aligning ourselves with a broader societal movement following the 2015 Paris Agreement, we reiterate our determination to contribute to these global efforts and to reduce our carbon and environmental footprint. Since then, we have adopted a roadmap in 2023 and made considerable progress in areas such as energy efficiency; air freight, thanks to improved procurement processes; and waste management. However, we also acknowledge the tensions between our commitment to achieving a 50-percent reduction by 2030 and our imperative to deliver lifesaving care, as our carbon footprint is intrinsically linked to our intervention model and to elements that are indispensable to our action, such as air freight in emergency contexts, international staff air travel, and the carbon impact of our medical procurement.

For the next cycle, we must maintain a motivating horizon that allows us to continue implementing proactive measures. To this end, we wish to refresh our approach and our assessment of the levers and responsibilities of an international humanitarian medical actor by integrating equity considerations developed, among other contexts, within the framework of the Paris Agreement, through the principle of common but differentiated responsibilities and respective capabilities. This perspective encourages us to intensify our efforts in waste reduction and management, while fully recognizing our primary responsibility toward the health of populations who are more directly exposed to our waste and hospital effluents. We will increase our investments in solutions that offer financial and or qualitative co-benefits, including in energy, supply chains, and rational medical use. We will also deepen our research into environmentally responsible sourcing and seek to influence the specifications of products that we co-develop. Finally, we will demonstrate greater determination in rationalizing air travel, a goal that has been slow to materialize, starting with headquarters. MSF OCP STRATEGIC ORIENTATIONS 2026 » 2031

WHICH TEAMS DO WE NEED?

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DIVERSITY SERVING EMERGENCY OPERATIONS

THE RIGHT SKILLS IN THE RIGHT ENVIRONMENTS

International mobility is an essential pillar of MSF’s operating model. By bringing together people from diverse geographic, cultural, and socioeconomic backgrounds, it enables the formation of teams whose diversity, commitment, and dynamism are an invaluable asset. It also contributes, through the involvement of some staff in fundraising initiatives, to securing the resources necessary to fulfill our social mission.

Skills, however strong they may be, only make sense if they are exercised within an enabling environment. It is not enough to know how to act; one must also have the power to act. When living conditions are precarious, trust erodes, or team voices are not taken into account, and engagement weakens, to the detriment of the quality and continuity of our action.

Initially focused on residents of countries where an MSF section was established, international mobility has gradually expanded to include people from countries of intervention. International mobility is perceived as an opportunity to access coordination positions, obtain better conditions, or secure a professional pathway within MSF. The institutional commitment to integrating staff from regions that had previously been underrepresented, particularly Africa and the Middle East, into international pools has led to significant flows. Today, nearly half of the international pool is made up of former locally hired colleagues, compared to barely 25 percent in 2010. This shift has profoundly transformed the configuration of international pools and has also brought to light several concerning imbalances. The most notable is a decline in the representation of women, which has fallen from 42 percent to 37 percent in just five years. In addition, an increasing number of positions that were previously open to international mobility, such as clinicians, supervisors, and activity managers, are now being filled by locally hired staff, mechanically reducing opportunities for international mobility. In this context, without disregarding the legitimate aspirations of locally hired staff to access mobile positions, we will need to make the necessary trade-offs and adjustments to find the right balance in team composition, in line with our operational needs and organizational priorities.

Creating the conditions for a sustainable working environment requires ensuring appropriate living conditions, fostering a climate of trust and recognition, and making social dialogue a pillar of cohesion and equity. Such an environment also rests on a non-punitive, just culture approach that recognizes the right to make mistakes as part of learning and continuous improvement. This culture also values deliberation in decision-making, and provides teams with both the support and the autonomy they need. It is from this articulation between the ability to act and the power to act that a collective strength emerges, one that is indispensable to the effective conduct of our operations.

STRENGTHENING THE ROLE OF WOMEN IN OUR FIELD TEAMS The proportion of women within our teams in the countries where we operate, particularly in positions of responsibility, has deteriorated in a worrying manner in recent years. This trend jeopardizes team diversity, our safeguarding commitments, and our ambition to invest more strongly in the field of women’s health, which requires the integration of perspectives attuned to women’s specific conditions. We are considering positive discrimination measures to reverse this trend. This will include, in particular, a temporary reduction in recruitment opportunities for men within MSF OCP STRATEGIC ORIENTATIONS 2026 » 2031

the international pool, for the duration of a rebalancing process that is expected to take several years.

TRANSFORMING THE HR FUNCTION: FROM REACTIVE MANAGEMENT TO STRATEGIC LEADERSHIP

In the coming years, the HR function will need to undergo a profound transformation to fully support the ambitions set out in these strategic orientations. Beyond its essential role in administration, compliance, and individual support, HR must become a core operational system, contributing directly to the organization’s preparedness, resilience, and ability to act in increasingly volatile environments. Fully assuming this strategic role means that HR takes on a proactive and clearly defined

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role, alongside operations and medical departments, in anticipating workforce needs, identifying human and organizational risks, and supporting inclusive leadership and collective dynamics across the organization. This transformation is essential to ensure that the scale, complexity, and pace of our ambitions do not outstrip our capacity to staff, support, and sustain teams over time. This repositioning anchors HR as a strategic partner in operational decision-making, with a clear mandate to inform feasibility

assessments, risk analysis, and strategic trade-offs. It strengthens HR’s contribution to workforce planning, the identification of critical skills and functions, and the anticipation of tensions related to scale, workload, security, and team sustainability in high-pressure contexts. It also requires stronger HR governance and analytical capacity to develop a shared and reliable understanding of our workforce. Improved visibility on staff composition, availability, mobility, critical roles, and exposure to risks supports informed decision-making and closer alignment between operational

priorities and human capacities, in coordination with operations and medical leadership. The effectiveness of this transformation depends on clearer ownership and accountability across the HR–operations– management chain. Responsibilities related to team management, safeguarding, staff health, workload regulation, and people development must be explicitly clarified. HR will equip and support managers to assume these responsibilities, while also exercising oversight and an early alert role when risks to teams or organizational sustainability emerge. Sustaining our operations requires more than individual expertise; it depends on the quality of leadership, management practices, and collective functioning. HR will therefore support managerial pathways, strengthen leadership capacities, and foster inclusive environments that enable dialogue, shared responsibility, and sound decision-making, particularly in high-risk or high-pressure contexts. Reducing structural inequalities in treatment, representation, and access to responsibility within our workforce remains a strategic priority. HR will support more equitable

access to opportunities, strengthen the representation of underrepresented groups, particularly women, in decision-making spaces, and foster inclusive environments for participation and dialogue. The principle of “sharing power,” which guides our relationship with patients and communities, must also inform how power, voice, and responsibility are organized within our teams. Finally, issues such as safeguarding, staff health, and broader working and living conditions must be addressed as core operational systems rather than treated as parallel or compliance-driven functions. They are integral to the quality, credibility, and sustainability of our action. HR will integrate prevention, early risk detection, and appropriate response mechanisms into everyday practices, from recruitment and onboarding to mobility, team management, and leadership support, with particular attention to the health and psychosocial wellbeing of nationally recruited colleagues. This transformation will require sustained investment, reinforced capacities in the field and at headquarters, and strong alignment with operational and medical leadership. We consider this investment a necessary condition for maintaining the integrity, effectiveness, and humanity of our action.

MSF OCP STRATEGIC ORIENTATIONS 2026 » 2031

WHAT STRUCTURE DO WE NEED TO CARRY OUR AMBITIONS FORWARD?

MSF OCP STRATEGIC ORIENTATIONS 2026 » 2031

a documentation and archiving policy (paper and digital) for headquarters and the field, linked to a clarified project cycle and to the identification of key information common to all countries of intervention. To be fully effective, this framework will be accompanied by investment in team skills and practices, so that documentation becomes a collective reflex, guaranteeing memory, compliance, and accountability.

STRENGTHENING RISK GOVERNANCE AND REDUCING STRUCTURAL VULNERABILITIES To ensure the fulfillment of our social mission and the achievement of our ambitions, we will work to better identify and assess our exposure to risks and to reduce our vulnerabilities, whether inherited from underinvestment in certain areas, resulting from structural fragilities, or stemming from new or heightened risks. We will identify the major risks from which we explicitly seek to protect ourselves, working with each MSF department and in a coordinated manner within the OCP group, and, for the most systemic risks, at movement level. We will put in place appropriate safeguards, whether in the form of necessary investments, or the strengthening or adaptation of business processes and control tools. This risk governance will articulate the imperatives of our social mission with the compliance requirements to which we are subject, the quality standards set by the various departments, and external risks that could compromise our action.

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Clarify the strategy, governance, and architecture of our data, particularly medical data, in order to make them reliable, comparable, and accessible, which are essential conditions for steering our activities. These data suffer from fragmented governance spanning field to international levels, non-integrated tools, a lack of standardization, often poorly justified data collection, and highly uneven use. This results in inconsistencies, duplication, and loss of reliability, as well as overload and loss of meaning for teams. This overhaul will need to be carried out in coherence with the other Operational Directorates in order to ensure the required level of interoperability.

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Strengthen our cybersecurity capabilities to improve prevention, detection, and response to constantly evolving threats. This effort responds to increased exposure to risks linked to the growing use of IT resources (hardware, software, and artificial intelligence solutions) in our contexts of intervention and at headquarters. A risk analysisbased approach, conducted in close collaboration with the other sections of the movement and with SITS, will make it possible to define priorities and implement the necessary actions while respecting MSF’s specificities.

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Improve our project governance capacity in order to prioritize those projects that directly contribute to the ambitions set out in our strategic orientations or to the reduction of identified vulnerabilities. This will also involve better anticipating the evolution, scale, and security of our application assets, as well as our portfolio of transformative medical

In order to reduce already identified vulnerabilities, we will: •

Intensify our efforts to prevent, investigate, and manage situations of fraud. This approach builds on the gradual establishment of risk prevention committees in our countries of intervention since 2022. Particular attention will be paid to the most exposed environments, notably emergency contexts involving large-scale deployments.

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Strengthen our operational documentation framework, from production to archiving. This chain is essential for building and preserving institutional memory of operations, ensuring traceability of key decisions, meeting our regulatory obligations, and fulfilling our accountability requirements. This strengthening will be based on the definition and implementation of

MSF OCP STRATEGIC ORIENTATIONS 2026 » 2031

and operational projects that include innovation, advocacy, and research components. For these latter projects, we will ensure that the expected contributions of medical and operational departments are articulated as clearly and as early as possible with those of the Foundation, Epicentre, and MSF Access.

EFFECTIVELY SUPPORTING TEAMS AND FACILITATING THEIR WORK Our operations are growing in both volume and complexity. Field teams are faced with an accumulation of medical and operational objectives, quality standards, and innovative approaches to integrate, without always having the time or resources to absorb them. This intensification of work generates increasing pressure and fuels a sense of overload and conflicting demands. Our teams regularly express a feeling of isolation. Managers, in particular, too often have to handle complex situations without

MSF OCP STRATEGIC ORIENTATIONS 2026 » 2031

sufficient support, with decision-making margins that are difficult to define. These difficulties weaken team cohesion and directly affect the continuity of our operations. The quality of our support must become a strategic priority and aim to clarify responsibilities, make processes more readable, develop facilitation skills, and maintain constant attention to the health and well-being of teams. In the coming cycle, we will strengthen our support to teamwork through several commitments:

» Clarifying and driving the management of our operations, including our project cycle In 2016, work was undertaken to formalize roles and interactions across the entire operational chain and support departments, leading to the creation of cells. While this work helped define broad responsibilities, it did not, in practice, significantly improve the coherent coordination of functions and support along our project cycle.

To strengthen this, we will focus on formalizing a common project cycle for all cells, which they will be responsible for facilitating. With the exception of one-off interventions, associated objectives and intervention strategies will be defined on an annual and/or multiannual basis. The structured facilitation of our project cycle, through the formalization of jointly developed and shared documents, will strengthen traceability and continuity of decisions, improve coordination and planning of support mobilization based on clear and shared objectives, and make trade-offs explicit. These efforts should also help improve dialogue, collaboration, and the co-construction of our projects with ministries of health and other partners involved in MSF OCP action, whether internal or external to the movement.

» Strengthening our deliberative spaces The multidisciplinary nature of our activities and the complexity of the environments in which we operate require bringing together a wide range of perspectives, analyses, and expertise at the decision-making

table. This includes transforming routine meetings, too often limited to information sharing, into deliberative spaces focused on the challenges to be addressed. It is in this spirit that we developed the “Ways of Working” training in 2020, designed to promote collaborative work, autonomous learning, reflective practices, and active participation. In the coming years, we will deploy this training more proactively and ensure that its content is aligned with our actual practices. In particular, we will ensure that the competencies expected of our operational managers are aligned with WoW requirements and that collegial deliberation is valued in our daily practices, from headquarters to the field.

» Coherent and readable support functions In recent years, field support functions have undergone a process of regionalization, including in Dakar, Nairobi, and Dubai, along with the development of roles such as focal points, specialists, technicians, MIOs, and mobile support staff. In practice, MSF OCP STRATEGIC ORIENTATIONS 2026 » 2031

these functions play distinct roles along the operational chain, including direct support to the implementation of transformations, quality control, and advisory and followup roles. We will seek to improve their articulation by clarifying the management of operations and our project cycle, as well as their specific role at each stage of that cycle.

» Strengthening field teams where necessary We will strive to provide field teams with the direct means to implement certain key transformations that cannot be driven from headquarters. For example, delivering on part of our safeguarding commitments and improving our working environment will require strengthening HR teams in the field. The need to control our IT environment will also lead us to deploy dedicated teams. To enable our teams to directly access technical or professional expertise essential to implementing their actions, we will make the best possible use of ongoing or SPARC legacy initiatives aimed at improving interoperability and pooling certain functions in the field. In particular, we will support the implementation of international roadmaps intended to transform our entire supply chain, through the Supply Transformation Roadmap, and our HR organization, through the Global Workforce Strategy, while ensuring that support for these transformations is adapted to the imperatives of our operations and the constraints faced by our teams. In the next cycle, we will continue our efforts to harmonize basic standards and technical policies at the international level across all logistical technical domains, a process initiated by OCP in 2024. Adopted by all operational departments, these essential minimum standards to ensure patient and staff safety will facilitate staff mobility between intervention sites and provide a common operational foundation.

» Improving our capacity as a learning organization With the majority of our so-called regular projects now being more than five years old, the need for continuity in the implementation and follow-up of key decisions for long-term projects clashes with the turnover of international staff, who remain overrepresented in management roles, and with the growing inadequacy of our onboarding system. Our intention to strengthen access for national staff to coordination roles and to better clarify, formalize, and share operational documentation on projects will contribute to this continuity. We will also strengthen our onboarding system so that it benefits all work communities on the same site, starting with national staff, who make up the majority of our teams. Finally, we will liberalize access to tools and resources that directly enable field teams to make decisions adapted to their specific situations. This commitment will shape how we seek to leverage, among other things, digital health tools and artificial intelligence, for example by moving from tele-expertise to telemedicine, or by developing platforms where essential multidisciplinary guidelines, tools, and knowledge are centralized, prioritized, and continuously updated, in order to facilitate access to resources that can be directly activated by our field teams.

Photo credits: Cover Zoe Bennell/MSF, p1 Marx Stanley Léveillé/MSF, p4 MSF, p9 Léa Gillabert/MSF, p10 Sam Bradpiece/MSF, p15 & p16 Diego Menjibar, p18 Ismael Diallo, p19 Azad Mourad/MSF, p20 Maryam Srour/MSF, p22 Aurélie Lécrivain/MSF, p25 Daniel Buuma, p27 Peter Caton, p29 Mohammed Sanabani/MSF, p30 Skye McKee/MSF, p32 Julien Dewarichet/MSF, p34 Manon Massiat/MSF, p36 MSF, p37 & p39 Ante Bussmann/MSF.

MSF OCP STRATEGIC ORIENTATIONS 2026 » 2031