"We need all of us": Promoting diversity, equity, and inclusion at MSF-USA

Over the past few years, we have made some important progress toward promoting DEI principles, including:

• Highlighting our values
  In 2018, MSF-USA issued a statement pledging to uphold diversity, equity, and inclusion as core principles inextricably linked to our success so that we may carry out our social mission and serve our patients. We publicly reaffirmed this commitment as new leaders of the organization in 2019. We have incorporated this statement into our recruitment and hiring practices to ensure that all staff members fully support these principles. In June 2020, MSF-USA published a personal statement by me, Africa, speaking out against racism and health inequities as a medical doctor, as the board president, and as a black woman. Both Avril and I have expressed our shared commitment to listening, learning, and taking action against racism.
   
• Institutionalizing DEI
  In 2018, MSF-USA established the DEI Council, a voluntary body of staff and association members with a mandate to challenge existing norms, reshape our culture, and help empower our staff to work together toward the ultimate goal of improving the quality of patient-centered care. MSF-USA identified upholding DEI as a priority in its last Strategic Plan (2017-2021), and is committed to building on these initiatives in the next Strategic Plan (2022-2025). DEI is an integral part of each of the departmental initiatives, understanding that making real change requires all of us pulling together. The communications and development departments are committed to applying a DEI lens to the depictions of our medical humanitarian work. Our new director of DEI strategy will partner across departments to ensure that initiatives are on track and that MSF-USA is making progress toward our goals. Priority areas of focus include public and internal engagement, compensation, recruitment, retention, and advancement. We embrace diversity across various dimensions, including race and ethnicity, sexual orientation, gender identity, age, and ability.  
    
• Diversifying leadership
  In recent years we have made intentional moves toward expanding the diversity of our senior management team and board. MSF-USA's management team is currently 70 percent women and 50 percent people of color. MSF-USA's board of directors is 54 percent women and 38 percent people of color. We are actively improving outreach and recruitment efforts to attract a broad slate of candidates for senior roles and build a pipeline for new leadership. The percentage of people of color recruited into the MSF-USA field pool grew from 22 percent to 32 percent from 2017 to 2020. The number of recruits identifying as black or African American in the US grew from 6 percent in 2020 to 20 percent as of June 2021. These shifts are the result of concerted action, including expanded recruitment efforts through historically black colleges and universities (HBCUs) and diverse professional networks and associations.
   
• Improving research and analytics
  MSF-USA is starting to gather data on hiring, promotions, and retention, and working to create pathways to leadership for people from diverse backgrounds. We are investing in data-based analysis of DEI outcomes, using this evidence to drive decision-making, and ensuring transparency and accountability. We will share our successes and challenges with the staff, association, and the MSF movement, including through reporting on key indicators over time. 
   
• Strengthening complaints mechanisms
  In 2018, MSF-USA and MSF Canada launched a reporting hotline to enable more people to submit complaints about violations of MSF policies, including discrimination, harassment, and abuse of power. The hotline is an independent service that can be used instead of, or in addition to, the regular reporting through operational management lines or at New York headquarters. Reports to the hotline can be made anonymously, and communication can continue with anonymity on the hotline platform. We know that underreporting remains a serious issue, and the hotline platform is a reporting mechanism and not an investigative mechanism. Movement-wide, MSF received a total of 41 complaints alleging discrimination in 2020. MSF-USA is also collaborating with MSF Canada on a pilot project to understand the barriers to reporting abuse or misconduct. We hope to better understand these trends so that we can make changes that will help people feel confident in coming forward.

We pledge to continue using MSF-USA’s voice and leverage to advocate for DEI across the MSF movement, on everything from resourcing to governance to improving the quality of care. We advocate for a fair and equitable rewards framework, one global workforce, common policies on duty of care for all staff, and improved access to learning and development opportunities for all staff. We strive for the inclusion of patients and their communities in establishing priorities and encourage regional proximity in operational decision-making. We look forward to continuing to support important regional initiatives such as the new operational directorate led by MSF West and Central Africa (WaCA) and the Central America and Mexico Integrated Office (CAMINO).

Tackling interpersonal, institutional, and systemic racism is hard work. But we are absolutely committed to rolling up our sleeves and doing it. We are getting more comfortable having uncomfortable conversations and questioning our biases. Ultimately, we are trying to shift the culture. 

We are grateful to have you with us in this effort—with special thanks to the members of the DEI Council and to the activists pushing us to do better. We need all of us to ensure that MSF lives up to its ideals.

Sincerely,

Africa Stewart, MD, MSF-USA Board President

Avril Benoît, MSF-USA Executive Director