Call for proposal: Monitoring report on Field Recentralisation At Médecins Sans Frontières

Background

Médecins Sans Frontiers is one of the world’s largest medical humanitarian organizations. Operational Centre Brussels (OCB), is one of five operational centres through which MSF manages operations, runs over 100 projects on an annual basis across the world. Field based project management is currently run through a national coordination team, including a head of mission (HoM), medical coordinator (MedCo), but also specific functions coordinating the contribution of the support departments (supply, logistics, finance, human resources, etc.). On specific project level, a set of coordinators – including the project coordinator (PC) and project medical referent (PMR) – manage the project. In Brussels, cells (units) within the Operations Department are structured based on a division of geographic areas (countries) to follow the missions. Other OCB based departments[1] provide direct support to the cells and missions.

Since 2019, OCB is implementing a change management program to bring decision making capacities closer to the patients, called Field Recentralization (FrC). Reflected upon in the OCB Strategic Orientation 2020-2023, FrC aims to: “…put decision-making as close as possible to the medical-humanitarian act and patients. This will be achieved by increasing the autonomy of the field teams and ensuring accessible knowledge and adapted support.”. Leading the FrC, is a catalyst team composed of three staff members. At the time of writing this ToR, a steering committee with representation from OCB management guides the process, though this is currently being adapted. Ultimately, as the program is part of the strategic direction, OCB’s committee of directors (CoDir) is responsible for strategic choices, including those under this project.

The FrC was further elaborated in a program document, where the main goal is stated as follows: “In order to increase the impact of our medical-humanitarian operations, the F(r)C programme aims to put the project at the centre of the organisation. This will be achieved by increasing the autonomy of the field team and ensuring accessible knowledge and adapted support.”.

Embedded in the program document, is a theory of change. The ToC’s overarching goal is stated as: “Decision making as close to medical-humanitarian act & beneficiary as possible” with aims for change with the following sub-objectives:

• Stimulated and empowered medical humanitarian operations,
• Speed & Reactivity enabled,
• Get out of “one-size-fits all” mentality,
• Knowledge & Support is adapted to the project’s needs,
• De-standardised models and systems,
• Project Teams are given Autonomy to fulfil objectives, and
• Project Positions are filled by capable & competent people.

To reach these objectives, changes are mapped out along pathways that address the organization’s culture, approach, structure, and systems. These can include applying a test and try culture and daring to be more experimental, but also to shift from control to a more mentoring and coaching approach, as well as adapting systems (i.e., Finance systems are adapted where necessary).

As a first step, FrC program was launched in southern Africa, targeting South Africa, Mozambique[2], Zimbabwe[3]. Over the past two years (2019-2020), facing some specific challenges due to the global pandemic, a process to reorient the staff structure and decision-making processes has been implemented. The traditional cell structure begins to detach (to be finalized summer 2021) and a regional support team has been established in southern Africa (since end of 2020). As of 2021, the FrC team has begun working to support another region of Africa, that includes DRC, CAR, and Burundi. Considering the FrC stated approach to find adapted ways of working depending on the context, the specific ways in which southern Africa was reoriented is likely not to be the blueprint for the central African region or any other. In 2020, the catalyst team prepared an internal review, with the support of an external volunteer, in 2020 to identify lessons learned and areas for continued improvement. These lessons learned are still being addressed.

Purpose and Intended use

The FrC team, together with its sponsors, are now requesting a monitoring exercise that will assess progress made along the change pathways to date, going beyond a report of completed activities and outputs.. The exercise should also contribute to reviewing and updating the Theory of Change (ToC) and consider how it can be measured as the program continues to be implemented.

The specific scope of the exercise will focus only on the work done to date in southern Africa, recognizing that this process is still in development and a final status has yet been reached. The report will contribute towards a more comprehensive evaluation planned for 2022.

Questions

1. Upon what and whose assumptions has the Theory of Change been built and are any adjustments needed to revise these?
2. What are the outcomes that have been initially planned? What results can be observed, both intended and unintended, positive and negative?
3. What other drivers and barriers have affected the outcomes, and in what ways?
4. Are there plausible, evidence-based explanations for the observed results?
5. What lessons can be taken from above and what recommendations can be made for the future of the program

Methodology

The program has been framed around a Theory of Change and the proposed monitoring methodology needs to take this into account, looking beyond activities in order to identify elements of change within a complex program.

The consultancy will include, although is not limited to, a document review (internal and external literature), a limited number of interviews and a participatory workshop.

Expected deliverables

1. An inception report developing the methodology and timeline (August),
2. Plan and lead a virtual workshops with approximately 20 participants (early September),
3. A draft and final report in English (end-September),
4. Internal presentation of the report (including a PowerPoint presentation) (early October).

Recommended documentation

Policy level documents including OCB’s strategic plans 2020-2023, Strategic Orientation Prospects, Department Strategies, etc.
Project related documents for Field Recentralization (FrC) including planning and strategy documents, theory of change, updates and dashboard reporting, previous assessments (internal), initial benchmark study etc.

External documents or grey literature about change, change management, decentralization, etc.

Profile requirements

• Proven capacity (5+ years) to plan and conduct exercises that monitor a Theory of Change, preferably based on a participatory approach.
• Excellent communication and diplomacy skills and ability to negotiate sensitive information with a range of stakeholders.
• Good knowledge of organizational development and strategic planning, as well as change management processes.
• Fluency in English, spoken and written. French (primarily reading) is an asset.
• The consultant needs to develop a good understanding of the nuances of the changes being proposed, where experience with MSF (not necessarily field work) can be an asset.

Timeframe

The following is a proposal but there is flexibility as to how activities are planned and carried out. The evaluator will eventually have to consider the fact that staff are taking summer holidays. The final delivery of the report has to be by end of September/early October.

• Document review – July
• Interviews – July/August
• Workshop – September
• Finalization of final report and presentation – End-September/Early October

[1] Medical Department, Human Resources, Supply, Logistics, Finance, Analysis, Communications.

[2] It should be noted that the Mozambique transition will be adapted due to the evolving context.

[3] While Malawi is also included in the MSF southern Africa region, projects there have recently closed.