February 11, 2018
In November 2017, Charity Intelligence posted its Top 10 Impact charities that included, for the first time, an international aid charity, Doctors Without Borders. For once, a household name Canadian donors are familiar with. Some donors have asked us to share our analysis of Doctors Without Borders. We have. Our spreadsheets are huge. If you would like more detail on the analysis, please contact Angela Wang or Greg Thomson at Charity Intelligence.
From our analysis, 3 programs are the key drivers for the high impact found at Doctors Without Borders.
Doctors Without Borders (MSF International)
Many people in the world do not have access to doctors and health care professionals during the time of their greatest need. Doctors Without Borders (MSF) is an international humanitarian aid organization delivering life saving medical assistance in countries torn apart by war, disease, and natural disasters.
MSF believes that people who need aid come first in humanitarian aid situations. This means that MSF is largely funded by donors rather than governments to avoid interference of politics and religion. MSF has also established its own supply chain of personnel and materials to remain independent and to respond quickly.
In 2016, MSF spent $2B helping over 9 million people through life saving surgeries, vaccinations, treatments, and more. On average, MSF’s outcomes cost only $227 per person.
In Ci’s assessment, MSF’s high impact comes from these three drivers:
1. 44% from vaccinations. MSF reached more than 4 million people with life saving vaccinations in 2016. These include both routine vaccinations for children and major vaccination campaigns to control disease outbreaks.
2. 28% from medical interventions. MSF set up field hospitals, conducted surgeries and assisted with local hospital operations. MSF doctors perform surgeries, neonatal consultations, and assist with child births.
3. 24% from medical treatments. MSF provides treatment for cancers, communicable diseases, and malnutrition in locations where people do not have adequate medical services.
In measuring impact, there is typically a lack of data reported by charities. MSF's annual reports provide donors, and analysts, with detailed outcomes achieved in the previous year. It is, by far, the best reporting we have seen within the international charity sector.
Vaccines are relatively cheap and easy way to save lives in developing countries. Vaccines are preventative, which means people are protected against the economic cost and suffering of becoming ill. Children who receive vaccination against common diseases will avoid costs and risk of death every year that the vaccinate is effective. For most vaccinations, this means people are protected against diseases for the rest of their lives. 71% of MSF vaccinations are good for life, meaning that people are protected for up to 50 years. 29% of MSF vaccines lasts only a few years, like cholera and tetanus, it offers protection for the immediate future. For children, it often means that they are protected during their most vulnerable years.
During disease outbreaks, those who are not vaccinated are at higher risk than usual. If outbreaks are not controlled, it means a whole region are at greater risk. In 2016, MSF responded to 10 cases of disease outbreaks with large vaccination campaigns, reaching over 2 million people. The largest campaign vaccinated over a million people in the Democratic Republic of Congo against a yellow fever outbreak. Yellow fever is spread by mosquitos and can pass from person to person quickly in dense areas. The World Health Organization (WHO) reports that a small percentage of people with yellow fever will enter a toxic phase, where 50% die within 7-10 days. For 99% of people vaccinated, they become immune to yellow fever within 30 days and will remain immune for the rest of their lives.
MSF reached almost 1 million people with routine vaccinations. Routine vaccinations target common diseases and prevent some rare diseases from becoming common again. MSF often combine routine vaccinations with other interventions in an area.
The rest of the people who received MSF vaccinations, over a million individuals, lives in disease endemic countries. Disease endemic countries are countries where disease levels are relatively high and stable. Increasing the number of people vaccinated in these areas is a major way of decreasing disease levels.
The second driver of MSF’s value is the life saving interventions for people who would have otherwise suffered more or died from their injuries. These activities have high social value because without timely medical intervention, their situation could get much worse. The first major type of intervention is surgery or supported surgery. In 2016, MSF performed surgeries on 92,000 patients and supported surgeries for another 225,000 patients.
For neonatal consultation and assisted births, MSF help to save both the mother and the babies. Having a healthcare professional present during birth can drastically decrease the mortality rate of both mother and child. MSF provided neonatal consultation to 170,000 mothers, assisted in 180,000 births, and assisted hospitals with further 43,000 births.
MSF treat injuries and provide medication and vaccination for women who have recently experience sexual violence. In addition to the trauma, women who have been raped are also exposed to risk of HIV/AIDS, tetanus, and HPV. MSF provides post-exposure HIV/AIDS treatment medication to prevent women becoming infected. Tetanus and HPV vaccine are also given to decrease risk of tetanus and HPV.
The final major driver of MSF’s value comes from medical treatment for people who are already ill. MSF covers treatment of a range of health problems including post Ebola complications, HPV, measles, meningitis, HIV, tuberculosis, cholera, yellow fever, and child malnutrition. In 2016, MSF treated 2.8M people for transferrable disease. The largest value comes from tuberculosis treatment because of the high mortality rates, and malaria treatments due to large number of people treated.
MSF admitted over 290,000 children to hospitals and feeding centres for treatment of severe acute malnutrition. While it does not address the underlying causes of malnutrition, MSF targets children who need immediate help to survive.
In light of Oxfam events of Feb 2018, we have greater awareness of safeguarding in international aid organizations. Safeguarding is the protection of vulnerable adults and children from harm done by the charity itself. This is currently inadequately monitored and reported. This introduces downside risk that may be material and significant to donors. MSF has shown leadership in releasing its serious incident report on 21 staff dismissed for sexual exploitation and abuse.