A new profile for non-profit actors? Tracing marketization in Médecins Sans Frontières

Adam Pärleros

Political Science C (Bachelor Thesis)

Department of Government

Uppsala University, Spring 2018

Supervisor: Maria Eriksson Baaz

Words: 10226

Pages: 33

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Abstract This thesis engages in and contributes to the current debate of marketization on the potential

consequences of the seemingly increasing marketization of non-governmental organizations

and the emerge of for-profit actors in humanitarian work, focusing on one of the biggest

actors in humanitarian aid; Médecines Sans Frontières (MSF). By interviewing three highly

positioned representatives from the organization, examining a report on the matter as well as

MSF website several aspects of marketization identified in the literature were searched for,

such as: market language/concepts, commercialization, private sector funding and

professionalization. The study shows that all these aspects of marketization can be traced in

the work of MSF. Moreover, the study reveals that marketization appears to shape how MSF

view and relate to other actors working with humanitarian aid, non-profit as well as for-profit

actors. A fundamental difference that can be seen is that while MSF view for-profit actors in a

very positive way and as partners of collaboration, non-profit actors (similar to themselves)

are portrayed and seen as competition. Hence, the study suggest that the increasing

marketization appears to foster increased competition between non-profit actors – potentially

undermining coordination – while at the same time potentially increasing the potential for

coordination between for-profit and non-profit actors. This study also suggests that more

research should be conducted, analyzing other NGOs in a similar way as well as analyzing to

what extent this competitive view affects a well functioning coordination in humanitarian

actions on the ground.

Key words: marketization; non-governmental organizations; private actor; Médecins Sans

Frontières; coordination; cooperation

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Table of contents 1. INTRODUCTION.............................................................................................................................. 4

1.1 BACKGROUND................................................................................................................................ 4 1.2 PURPOSE AND RESEARCH QUESTIONS ............................................................................................ 6 1.3 LIMITATIONS .................................................................................................................................. 7 1.4 PREVIOUS RESEARCH AND CONTRIBUTION .................................................................................... 7 1.5 OUTLINE......................................................................................................................................... 8

2. THEORETICAL FRAMEWORK ................................................................................................... 9 3. METHOD AND RESEARCH DESIGN ........................................................................................ 13

3.1 MATERIAL .................................................................................................................................... 13 3.2 SELECTION ................................................................................................................................... 14 3.3 INTERVIEWS ................................................................................................................................. 16 3.4 ANALYZING THE MATERIAL......................................................................................................... 18

4.RESULTS .......................................................................................................................................... 19 4.1 MSF AND MARKETIZATION.......................................................................................................... 19 4.2 MSF AND PRIVATE ACTORS ......................................................................................................... 22 4.3 MSF AND NON-PROFIT ACTORS ................................................................................................... 25

5. FINAL ANALYSIS AND CONCLUSION .................................................................................... 27 REFERENCES..................................................................................................................................... 29 OTHER MATERIAL .......................................................................................................................... 31 APPENDIX ........................................................................................................................................... 32

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1. Introduction

1.1 Background

Non-governmental organizations (NGOs) as well as private actors both play a crucial role in a

society’s persistence during a humanitarian crisis and its reconstruction after. Alongside aid

agencies and governments, they support relief operations both during and after major disasters

(Zyck & Kent 2014, 5). While NGOs can be seen to have a clear role in these operations,

private actors may not. Even so, private actors are increasingly engaged in humanitarian

actions in several ways; through traditional philanthropy and financial support, on a solely

commercial basis through fee-based services to humanitarian organizations or by advocating

awareness-raising and promoting action through their channels. The official main motivation

is usually ethical and moral responsibility, without overlooking the good ‘image’ that comes

with it. (OCHA 2017, 15)

The increasing involvement of private actors in humanitarian actions poses new questions

and challenges to one of the main problems identified in humanitarian action, namely

cooperation and coordination between the various actors involved. As new actors enter the

arena a well-functioning coordination is needed to ensure accountability. The crucial

importance of coordination and how it often fails even between non-profit humanitarian

actors themselves have been emphasized in much literature. It was for example highly noted

after the disasters of Haiti 2010 and Japan 2011, where coordination failed. Individual

organizations, both international and domestic, were isolated and thus failed to exchange

information and resources. (Oh & Lee 2017, 43) This is something that is seen as one of the

main issues when coordination collapses, when an information gap occurs on field activities,

which possibly leads to irreversible consequences. (Lucchi 2018, 28) This could also be

observed after the Great Sumatran Earthquake and Tsunami in 2004 where organizations

faced significant complex and uncertain circumstances that refused the practice of usual

emergency management models. Hierarchical system was formed due to a failing

coordination, which lead to additional levels of communication resulting in severe issues

delivering critical information in effective and timely manners. (Oh & Lee 2017, 43)

Likewise, a well-functioning coordination between these actors are of the highest importance

as 218 million people each year are affected by disasters, made by man or nature.

International support by both humanitarian organizations as well as private actors is needed to

manage these crises. (Ehrhart & Kang 2016, 33ff.)

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Even so, the collaboration between NGOs and private actors in humanitarian crisis is not

without barriers. There is often an issue of representation on both sides as who shall be the

driving force of progress, the humanitarian or the business community. The lack of interaction

between the two is often seen as a lacking. Businesses are rarely involved in coordination

mechanisms in humanitarian action. Likewise, aid agencies are seldom represented in

business forums. This makes them unaware of the each other’s work and potential, often

limiting collaboration to financial donations. (Zyck & Kent 2014, 17f.) The emergence of

what on the outset can be seen as a fundamentally different actor (for-profit/business) thus

poses new challenges.

Yet, despite this subdivision, between private and non-private actors, research on NGOs

since the 1980s show that these actors become more alike private actors and for-profit

enterprises, a transformation often referred to as ‘marketization’. (Maier et al. 2016, 64)

Studies have shown that NGOs has developed a more business-like rhetoric and organization,

as well as business-like goals. Methods and values of the market has been adopted to guide

management and activities within non-profit organizations. Thus, the clear line that before

could be drawn between NGOs and private actors appear increasingly blurred, seemingly

because of outside forces pushing non-profit organizations to a market-based behavior. (Maier

et al 2016, 69; Eikenberry et al 2004, 132) This could mean that the gap between NGOs and

business actors decreases which might lead to better cooperation and coordination, as the

actors find common ground and shared interest. Yet, another potential effect is that these

processes make NGOs cling to a nonprofit branding in an effort to distinguish themselves, as

private actors possibly can be seen as a threat and factor of competition. This current study

will not be able to provide any definite answers on these questions. Yet, by providing insights

based on interviews with representatives of one of the biggest humanitarian actors, Médecins

Sans Frontières (MSF), text analysis and by observing MSF Sweden’s website, it will shed

light on the potential implications of the increasingly blurred lines between non-profit and

profit actors in humanitarian interventions, focusing on the potential for coordination.

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1.2 Purpose and research questions

This study takes its starting point in the current debates on the potential consequences of

increased marketization of NGOs, and the increasing importance of private actors in

humanitarian action, focusing on the potential impact on coordination between the actors

involved. This study will proceed with the overarching research question:

What traces of marketization can be identified in the work of MSF and what potential effects

does marketization appear to have in terms of how they view and relate to other (non-profit

and for-profit) actors in humanitarian work?

This overarching question will be addressed through the following more specific research

questions:

- What traces of marketization can be identified in the work of MSF?

- How do ‘MSF’ portray private actors in humanitarian action and what role do

divisions between non/for-profit and marketization play in the accounts of the

relationship and the potential of cooperation?

- How do ‘MSF’ portray their relationship with other non-profit humanitarian

actors and what might such accounts tell us about the potential consequences of

the increasing marketization of non-profit humanitarian actors?

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1.3 Limitations This study is limited in scope given the time constraints and focuses only on one organization.

Yet, since MSF is one of the biggest and most influential humanitarian actors operating at an

international level and that the Swedish section is well intertwined with MSF at the global

level, MSF is a particular pertinent choice of organization. While it can be assumed that

similar patterns are observable also in other organizations (also given the literature on the

general marketization of NGOs) I have no aim to generalize further beyond the MSF case.

However, it is worth mentioning that MSF differ from many other NGOs, as they do not

receive any governmental funds, as will be explained more further down. Moreover, while the

main rationale for the study is the potential consequences for the increasing marketization of

non-governmental organizations and the emerge of for-profit actors in humanitarian work in

term of cooperation and coordination in humanitarian action, the study is limited in views of

other actors and the potential consequences are inferred from that. Hence, I do not analyze/the

study does not say anything on factual cooperation- and coordination-processes between MSF

and other actors in practice.

1.4 Previous research and contribution

Previous research has tried to map out strengths and weaknesses of cooperation between

NGOs and private actors in humanitarian crisis, but always pointing to the fact that more

research has to be done in the field. Research has also mapped out the concept of

marketization, its mechanisms and how NGOs has begun to assimilate these notions as a part

of their daily activities. A common trait among previous research is to point out that relatively

little is understood regarding entrepreneurial behavior within NGOs and the literature on this

topic is fragmented and the demand for further studies is high. (Maier et al. 2016, 65;

Coombes et al. 2011, 829; Eikenberry et al 2004, 132)

Previous more policy and oriented studies have looked into a number of factors arising

from the increasing presence for profit actors in humanitarian action. For instance, United

Nations Office of Coordination of Humanitarian Affairs (OCHA) together with the Overseas

Development Institute in London has done research regarding private actor’s role in

humanitarian crisis, with case studies from Jordan (Zyck & Armstrong 2014), Kenya

(Drummond & Crawford 2014), Indonesia (Burke & Fan 2014), Yemen and southern Somalia

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(Taraboulsi-McCarthy et al 2017) The Overseas Development Institute has also done similar

studies by their own observing the role of business and the private sector in humanitarian

crisis, conducting their qualitative research in Kenya, Jordan, Indonesia and Haiti. (Zyck &

Kent 2014)

Marketization as a concept and its role within the public sector has been addressed by

several scholars, including by Hansen and Lindholst (2016) who developed the concept and in

a review of seven papers analyzed marketization in six countries. (Hansen & Lindholst 2016)

The conception of marketization has been examined long and in 2004 studies highlighted that

business-like behavior was becoming a part of the non-profit sector by examining current

trends within nonprofit organizations. (Eikenberry et al. 2004)

The pattern that nonprofit organizations become more market-oriented has been stressed in

an immense literature review of 599 relevant sources where key concepts of marketization

was clarified and later applied on nonprofit organizations. (Maier et al. 2016) An additional

study based on 200 interviews with senior managers of nonprofit organizations showed

similar results that social entrepreneurship is seen within NGOs. (Zhang & Swanson 2013)

Further literature reviews on smaller non-profit organizations confirms these results. (Beck et

al. 2008)

This study aims to build on this research on how NGOs relate to and reflect private actors.

Is it possible to trace the mechanisms of marketization as a part of NGOs activities as the

literature claims, and if that is the case, how might that shape views on other humanitarian

actors (non- and for-profit) and the potential of coordination? This is something that previous

research has not looked into.

1.5 Outline

This study will proceed as follows. First I will lay out the theoretical framework of the study,

further clarifying the central concepts. This is followed by a discussion on methodology

where I present the material and analytical framework. After this, I will present the analysis,

with an outline that largely follows the research questions presented above.

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2. Theoretical framework

This section outlines the theoretical framework guiding the study. First, I will present how

NGOs and private actors are defined within this thesis. Second, this is followed by an

elaboration of marketization as a concept, including critic and possibilities with

marketization.

NGOs and Private actors

What constitute the most appropriate definition of a non-governmental organization is highly

debated. (Gray et al. 2006, 324) Teegen et al. (2004, 466) emphasizes that NGOs are:

“any non-profit voluntary citizen group which is organized on a local, national or

international level. […] NGOs perform a variety of services and humanitarian functions,

bringing citizens’ concerns to government.”

Others, such as Gray et al. (2006, 324) propose a slightly different definition to NGOs;

“[Organizations] Whose stated purpose is the promotion of environmental and/or social goals

rather than the achievement or protection of economic power […]”.

Alongside this definition four forms and functions in which NGOs engage is also pointed out:

1) New public management: They work as sub-contractors to policy makers. 2)

Corporatization: NGOs are partnering up with companies to fulfill their objectives. 3) Social

capital or self-organization: Civil society building trust through networking. 4) Activism:

NGOs are monitoring, challenging and/or influencing power-holders. The two latter activities

go hand in hand with the traditional view on NGOS while the first two are growing within

established NGOs. These four functions in total are according to Gray et al (2006, 325)

necessary to separate NGOs from each other and relevant because it highlights the blurring of

boundaries that can be seen.

‘Private actors’ as a notion is widely used in different ways depending on the agenda, and

can include transnational corporations, private security companies or even NGOs. It can refer

to actors with a profit-making ambition or the complete opposite and is therefore used in a

very wide spectrum and scholars tend to use the term differently depending on the context.

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However, one trait that is usually seen within organizations designated as ‘private actors’ is

that they are profit seekers and accountable to stakeholders. (Krahmann 2016, 54).

I will in my research go by one small but essential distinction between NGOs and private

actors, namely that NGOs is seen, as stated above, as actors whose stated purpose is the

promotion of environmental and/or social goals rather than achievement of economic profit.

They are in that sense defined and used in this study as non-profit actors/organizations. The

private actors in focus here on the other hand, as recalled, seek economic profit are thereby

equivalent to for profit- or profit actors.

Marketization and businesslike

As indicated earlier, this study takes its theoretical takeoff in the term ‘marketization’.

Marketization as an analysis tool is most easily described as a ‘non-profit organization (NPO)

increasing its market-type relationship with stakeholders’ and involves the concepts of

consumerism and commodification. Consumerism refers to a change in attitudes of funders or

volunteers brought about by marketization, encouraging acquisition of goods.

Commodification indicates the altered character of a NPOs actions and outputs, turning

goods, services and/or ideas into commodities. Marketization can thereby be used from a

macro-perspective in the sense that market-type relationships gradually penetrating a

country’s welfare system. (Maier et al. 2016, 70) However, this is not the use in this research.

An effect of marketization that can be seen is the blurring that occurs between for-profit

and non-profit actors, as mentioned earlier. We see NGOs that use for-profit models to

accomplish their missions just like private actors. For example, NGOs can use for-profit retail

models to fund projects on their own and that are not dependent on state funding. (Haigh &

Hoffman 2012, 126) Another important aspect of marketization is the increasing importance

put on branding and creating a brand. (Meier et al. 2016, 71) NGOs tend to operate in

ambiguous environments with different types of actors, which forces them to balance between

competing interests, goals and values. (Kreutzer & Jager 2011, 639) As demonstrated by, for

instance Meier et al (2006, 71), a sense of branding becomes more central and new ways of

communications with clear narratives and a changing rhetoric that otherwise is seen among

private actors has emerged. Eikenberry et al (2004, 133) argues, with the help of resource-

dependency theory and institutional-theory that NGOs are in need of these market-based

models, as they require resources to survive. The only way to require these resources is to

interact with other actors. They are dependent on their environment and have to use market

strategies to deal with resource constraints. These constraints combined with increasing

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pressure from government and donor demands, NGOs has taken on the values and methods of

the market. Additional entrepreneurial behavior that can be distinguished includes an

implementation of fees for services, an expansion of networks, revenue-generating programs

and commercialization related to this and a more market-based funding; unique type of

sponsorships, advertising, rental of assets and resource sharing. (Coombes et al. 2011, 834)

So what is really that we are looking for when examining marketization within a non-profit

organization? Building on Mailer et al (2016, 71ff.), Bednall et all (2000, 172) and Coombes

et al (2001, 834), and for the purpose of this study I suggest that it can be narrowed down to

four central concepts of marketization:

1. A use of market concepts/language:

The use of market concepts such as competition, trademark, profit, branding and PR is a key

feature of marketization. This can be observed in how non-profit representatives speak about

their organization, in media statements and how advertisement is used.

2. A use of commercialization:

Commercialization captures NGOs increasing reliance on revenue from sales of services and

goods. A shift from a traditional collecting of funds to a more commerce-based collection

whereby NGOs, instead of just asking for donations, sell fictitious goods such as a goat or

food packages which is the main example of this.

3. A collaboration with private actors in terms of funding:

Non-profit organizations marked by marketization tend to address private actors to a high

extent. Manifested in direct financial contribution and/or sponsoring. It is usually a win-win

collaboration where for-profit actors are able to improve their brand by supporting non-profit

actors.

4. A use of professionalization:

Professionalization refers to how NGOs selects new personnel from a market-oriented

background. It describes the phenomenon where experts are hired and in charge of

departments in non-profit organizations, or if the same organizations decide to outsource their

work to similar actors. To adopt more business-like goals are also a part of

professionalization.

Nevertheless, marketization is not a concept without criticism. Ponte and Richey (2014,

66) are two scholars who highlight how NGOs and for-private actors are engaging and

collaborating in so called ‘brand aid’, where private actors sell a product to consumers which

triggers a business donation to that specific NGO. Ponte and Richey stress (2014, 82f) that

partnerships like this between non-profit humanitarian actors and for-profit actors makes

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‘development’ a commodity-transfer, depoliticizing and simplifying development. Brand aid

and similar collaborations provides an easy solution to existing crisis by linking the global

economy and trade to international development. This market-solution in humanitarian aid

leads, according to the scholars, to private actors branding themselves as ‘caring’ without

changing their business practice and consumers engaging in NGOs without meaningfully

increasing their awareness of the problem and people they are supposed to be helping. In

other words, NGOs turning to for-profit actors has a risk of reducing ‘development’ and

humanitarian action to a depoliticized process of identifying a lack, locating a supplier,

provide a commodity and then manage the distribution, which in the end mostly favors the

for-profit actors, and hide the complexity of poverty and the ways in which business actors

and market-based solutions often reproduce inequalities and poverty. (ibid, 82f.)

However, according to some scholars, there is no issue combining a non-profit

organization with a market-based behavior, it can actually go hand in hand. Zhang &

Swanson (2013, 108f.) are two scholars that emphasize that non-profit actors can be defined

and have two objectives, a social-based and a market-based, and in that process become so

called social entrepreneurs. These two objectives do not have to collide but can instead be

pursued simultaneously and foster each other.

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3. Method and research design I will in this section present the method used to complete my studies in four steps. First, I will

present the methods used to complete my studies, and why I have chosen this method.

Second, I will go through the selection of my material. Third, give an account of how the

interviews conducted for this study was made, as this constitute the most important material

for this study. Four, I will operationalize the central concepts and present the analytical

framework guiding the actual analysis.

3.1 Material This study uses qualitative interviews, text analysis and an examining of MSF website as its

methods. The interviews with representatives of MSF constitute the most important part of the

material and are necessary in order to capture both the central aspects of marketization

(particularly the aspects of market concepts, collaboration with private actors and a use of

professionalization) and how MSF views other for- and non-profit actors, as this is difficult to

extract from the text available. The interviews are therefore essential for a study like this, as

text by itself cannot provide enough information. One could argue that by examining all

material and communication provided by MSF (annual reports, publications, newsletters,

advertisements, digital communication, social media etc.) that this would give an overall view

on the given research questions. However, an initial consultation of available texts showed

that many of the aspects of marketization in focus here cannot be analyzed through available

texts and these texts furthermore says little about how MSF view other actors. Yet, as I will

develop on further below, in addition to the interviews, I have also relied on analysis of one

text and MSF Sweden’s website. For instance, analysis of the website was useful in order to

search for sponsorships with private actors (logos) and the selling of fictitious goods, as this is

something that cannot be read from text analysis nor interviews.

Qualitative semi-structured interviews, as within this study, are a good supplement

together with text analysis. When analyzing texts there is always a question of how to

approach the texts. What questions is it that we are trying to answer? It can either be to

systematize the content of the texts if the goal is to clear out or classify to answer the research

question, or it can be critically review the text to see to which extent the text lives up to

predetermined conditions. (Esaiasson et al. 2012, 210-212) In this study a critical view will be

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taken towards the text presented in the next section, as it is needed to study the issues of this

research. This study will thereby focus on finding and extracting certain components and

analyze them critically when examining the written sources.

3.2 Selection

In all processes of selection, the optimal would be to study all relevant material. Nonetheless,

there are practical limitations that need to be taken into account, and delimitations are

necessary to reach distinct and trustworthy results. (Esaiasson et al. 2012, 220)

As noted in the introduction I have chosen Médecins sans Frontiéres as it is considered one

of the leading international NGOs in medical humanitarian actions. Their work consists of

direct medical aid for populations affected by natural disasters and crisis made by man, as

well as victims of armed conflicts. In 2016 they were present in 71 countries and their daily

activities are highly affected by both governments, other NGOs and private actors. (Doctors

without borders 2016) This makes them a noteworthy and important actor to look at.

I have conducted three interviews with representatives of MSF. The criteria for selection

was to interview high level representatives that all have had long experience working with

MSF, both in office and out on the field, have different responsibilities and experiences, and

are all involved in different departments at MSF, which makes them a good complement to

each other. Something that has to be kept in mind is the respondent’s potential incentive to

uphold a certain picture of MSF. This has however tried to be circumvented by interviewing

one representative that no longer is an employee at MSF. All informants have been given an

alternative name to maintain anonymity. While anonymity did not appear to be important to

them I have nevertheless, as anonymity is emphasized as an important factors of research

ethics (Esaiasson et al. 2012, 258) provided them with fictitious names, refraining to use their

real names.

The first interview was held with Carl, 2018-03-29, today university lecturer at a Medical

University, and specialized in international disaster medicine. He began his service at MSF

when the Swedish section was founded in 1993 and held a leading role in the organization. He

has over 25 years of experience as a doctor in humanitarian crisis, deployed by MSF as well

as other organizations like World Health Organization. As he today is an employee at a

Medical University, he is no longer active at MSF. This makes him valuable for this study, as

he does not have the same incentives to uphold a certain image of the organization.

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The second interview was held with William, 2018-04-11, who is a ‘humanitarian advisor’

at the Swedish section of MSF. His main work circles around the organizations lobbying and

influence on the Swedish government. He is also a part of the organizations evaluation unit

and its innovation unit, working closely with MFS’s private partners.

The third interview was held with Emilia, 2018-04-24, who is highly positioned within the

Swedish section of MSF and has been a part of the organization since 2005. She has over ten

years of field experiences with a total of 23 field assignments, working with medicine and

coordination. As for today her work includes daily insights in all of MSF’s working areas.

As a complement to these interviews, the study is based on one article published by MSF

that contained data that was useful for my study as it addressed for-profit actors. I was

searching through all of MSF publications looking for texts that treated for-profit actors. Yet,

such texts appeared to be largely unavailable. However, I was able to locate one such text: in

February 2018 MSF published a report called “Introducing ‘for profit’ initiatives and actors

in humanitarian response – Preliminary analysis of facts, trends and concerns” by Elena

Lucchi, who is and independent consultant writing this report for MSF. The report’s results

are largely shared with MSF and it intends to map practices and identify current and future

scenarios regarding the privatization of humanitarian actions, both within MSF and also

within the humanitarian field as a whole. While written by an independent consultant, the fact

that the report was commissioned, published and approved by MSF makes it possible to read

it as (at least partly) reflecting of MSF views. The report is based on a comprehensive

literature review and twenty-one in depth interviews with key stakeholders from the

humanitarian and private sector. It pinpoints both the risks and the advantages by combining

non-profit and for-profit activities. The report constituted a valuable complement to the

interviews and provided an opportunity of triangulation (Esaiasson et al. 2012, 125) as it

partly covered the same themes as the interviews, in particular regarding views on private

actors.

As noted above, in addition to the material mentioned above, MSF Sweden’s website has

been studied in order to get a picture regarding how the organization works with

advertisement, a market-oriented rhetoric and if commodification with the selling of fictitious

goods can be seen. This source was also crucial in terms of triangulation and as a complement

to the interviews (which risk a distorted view) by having the questions as a part of the

interviews.

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3.3 Interviews The interviews were carried out in a semi-structured way with prepared questions (see

appendix) but allowed supplementary questions depending on the respondent’s answers. The

order of which the questions were asked did also shift depending on the directions of the

discussion. This kind of interview is a good method to get a deeper understanding of the

subject, in relation to surveys or structured interviews. It is also an efficient way to record

unexpected answers. (Esaiasson et al. 2012, 251f.)

When performing qualitative interviews, the person interviewed can either be seen as a

respondent, where the person’s own perceptions are studied, or as informants, when they are

used as witnesses on how the world is constituted. (Esaiasson et al. 2012, 227) In my studies

the representatives are mainly seen as informants of MSF, however it cannot be overlooked

that they are individuals with their own perspectives.

The interviews were held either on Skype or by phone. The main reason for not meeting

eye to eye has been to facilitate for the respondents with their busy schedule or because of

pure geographical impediments. The discussions varied between 40-45 minutes and

everything was recorded with the consent of the respondent. No questions were revealed for

the respondent beforehand and due to the scope of the interviews and limitations of this study

they will not be presented as a whole but relevant content will be extracted instead. The

interviews were held in Swedish and then translated for this study.

As the questions are not designed in a difficult manner and as my appearance show that I

am not an advanced scholar, the respondents might have answered the questions in a

simplified way. However, that should not have affected the interview too much in a negative

way, especially as several respondents referred to me as a researcher during the interviews,

and therefore took the interviews and me seriously. One important potential bias of the

interview material is that the people interviews most certainly had a wish to present the

organization in a positive light. This made the very prominent use and acceptance of the

marketized logic and language particularly interesting. The respondents were always given

their time and were not interrupted.

The core topic; “Contribute to get a deeper understanding of how NGOs view their own

work as well as their cooperation with other actors in humanitarian actions” was presented

to the respondents when making contact and in the beginning of the interview. After a short

introduction to the purpose of the interview the respondents were asked to present his/her

organization and position to determine the relevance for this study. That was followed by

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several questions regarding MSF work internally, to get a sense of how they work and their

own view on MSF. In this segment the questions were formulated to connect to the theories

demonstrated earlier in this study. The interview started off broad with questions such as:

- How does MSF work with humanitarian actions?

Then narrowed down to more specific subjects related to marketization and social

entrepreneurship as depicted earlier, asking specific questions about their work, such as:

- How does your organization work with collection and founding?

And:

- How does MSF work with branding and PR?

This was followed by questions related to their view on coordination and cooperation with

other actors, both for-profit as well as non-profit, to get an understanding of the opportunities

and challenges that NGOs and MSF in particular are facing, such as:

- To what extent does MSF work together with NGOs/for profit actors today in

humanitarian actions? How does that work look like?

And:

- Which barriers/impediments/challenges do you experience when working with

NGOs/for profit actors? What is required to overcome these challenges?

Hence, in order to get a sense of how MSF reflected upon their work with other actors,

questions were then asked if the organization collaborate with other NGOs and if so, their

opinions and attitudes towards it. Subsequently, the same questions were asked in relation to

private actors. Finally, some questions were asked concerning coordination in a broader sense

to catch up answers that otherwise could have been overlooked.

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3.4 Analyzing the material Since the aim of the research is to understand if marketization can be seen within MSF and

how this might shape images of the coordination with other humanitarian actors, it is

important that the research questions are operationalized in a clear way - both for the

understanding of this study but also for future research. The following analytical framework

was in relation both to the interview-texts as well as the other material.

The analytical framework (the more specific questions posed to the material) builds on the

conceptualization of the various aspects above and follows the research questions. Hence, for

research question 1 I searched for the following aspects:

1. A use of market concepts/language: to what extent, and what kind of market concepts,

(e.g. competition, trademark, profit) do MSF representatives use when talking about

their work? (based on the interview material)

2. A use of commercialization: to what extent is it possible to find examples of

alternative commerce-based (e.g. fictitious goods) funding methods? (based on

interviews and MSF website)

3. A collaboration with private actors in terms of funding: to what extent and in what

way are MSF turning to for-profit actors for financial contribution and/or sponsoring?

(based on interviews and MSF website)

4. A use of professionalization: to what extent can personnel with a market-oriented

background be found working with MSF and what function do they have? (based on

interviews)

Research question 2 was analyzed through the following (more concrete) questions: How

are private actors presented – e.g. as a threat/problem, competitor or an opportunity, and how

is it motivated? How are they described as similar or different to MSF? Are they described as

offering perspectives that are useful to MSF? How is cooperation with them described (good

and/or problematic) and why? (based on interviews and MSF report)

Research question 3 was analyzed in a similar way through the following (more concrete)

questions: How are non-profit actors presented – e.g. as a threat/problem, competitor or an

opportunity, and how is it motivated? Are they described as offering perspectives that are

useful to MSF? How do the potential consequences of the increasing marketization shape the

relationship between MSF and other non-profit actors? (based on interviews)

19

4. Results I will in this section with the help of the collected material, conducted interviews, texts

analysis and MSF Sweden’s website, present the analysis and results. The outline of the

analysis largely follows the specific research questions posed. This is followed by a final

analysis and summarizing discussion.

4.1 MSF and marketization As seen when looking at previous research on marketization, it claims that NGOs has become

more and more business-like, closing up on for-profit organizations. What is interesting to see

is if that that can be seen within one of the biggest and most influential NGOs, Médecins Sans

Frontières, and if so, how it features within the organization.

In the MSF commissioned report, Lucchi (2018, 10f.) states that a trend that can be seen is

that NGOs increasingly move away from traditional donations from private for-profit actors

to a more strategic level, not only in a way to collect funds but also for their expertise in either

problem solving or as advisors. For many organizations, including MSF, it is easier to

outsource or buy services from private actors than to proceed with own investments in heavy

equipment, internal capabilities or technical skills. These trends that Lucchi is pointing to

overlaps and supports two of the marketization theories used and searched for in this research;

first a market-oriented way of funding with for-profit collaborations and second a hiring of

personnel with private sector experiences and expertise.

When examining MSF Sweden’s website, it is easy to see that similar patterns can be seen

there, when looking at fictitious goods. Even though MSF do not sell any fictitious goods in

terms of food- or medicine-packages, they are very straight forward with how much a

donation will contribute. Different examples are presented as how much meal-replacements,

delivery kits, malaria and cholera medicine as well as field hospitals cost as a way to increase

donations and specially to connect donations to a specific product. This commodification

process is a clear example of how MSF uses market-oriented means of funding. Another

noticeable thing connected to their funding is the close connection to private actors. A

company logo are seen at the bottom of all pages throughout the website which indicates that

the private actor is a sponsor to MSF. In this way MSF receives funds while the company, in

20

this case ‘Svenska postkodlotteriet’, get promotion, which is also a trait of marketization.

(Läkare utan gränser, 2018)

How about the representatives from MSF, can marketization also be traced in the way that

they speak about the organization and its communication strategies?

It is interesting to note how the representatives in a very openly and direct way use a

language of the market when talking out their organization. When asking William,

humanitarian advisor at MSF Sweden, how MSF are working with their labeling and

communication, he says:

“We are trying to get the field perspective out there, which serves a branding purpose, we

really care about our trademark, to be a highly present field-oriented organization that works

with distinct medical operations. […] We have experts on branding and PR, experts working

with digital advertisement. [...] ”

As reflected in the citation, there is no questioning that William freely speaks in a market-

oriented way, using terms as trademark, branding, PR and digital advertisement. The

conscious choice to get the field perspective out there (as an aspect of branding) and show off

MSF as an operational organization can also be seen at the website (Läkare utan gränser,

2018). All advertisement and marketing for MSF has a focus on present crisis and events out

on the field. William also mentions that MSF has a global framework of communication,

telling the local offices around the world what should be in focus the upcoming weeks, and

they shape their advertising strategies by that. That the Swedish section of MSF by itself has

over 60 people working with communication, as William tells me, clearly shows that PR

plays a crucial role in the organization. In other words, how to portrait MSF outward

constitute a crucial part in the internal workings of the organization. This is also mentioned

during my interview with Carl, university lecturer at a Medical University and former

longtime employee at MSF:

“When you look at an organization, how they market themselves and then what they actually

do, I believe that one will find huge differences. MSF says that they are an emergency

organization who are at quickly on site, but I think that 60% of their projects are long-time

projects with HIV- and tuberculosis treatment, but that is not sexy and not sellable, so you sell

another picture instead, and uses that resources for other things.”

21

In this, rather frank, account of how certain aspects of the work is prioritized in

communication Carl clearly states that MSF has active communication strategies that only

partly correspond with their actual work. During my interview with Carl, he also made it clear

that a professionalizing has occurred among NGOs working with humanitarian actions and

especially at MSF, stating that:

“It is obvious that MSF has an advanced organization, working with key figures and

indicators, return of invest and so on, there are trained specialist working on that. One can

have different opinions regarding it, but MSF is dependent on private funds […] And the

donor looks different from before. They want to buy products and services, to save the life of a

child costs this and this much. That has nothing to do with the reality, but one adopts the

rhetoric and advertisement to society.”

In this quote, Carl really touches upon all criteria of marketization. Like William, he appears

to have/see no problem with speaking about MSF as market-oriented as he talks about key

figures and return of invest. He also talks about how MSF are hiring personnel with a market

background, ending with saying that MSF are commercialized in their funding and that they

are dependent on private funds.

That the private fund is of private nature is highly connected to marketization theories and

this is not on a small scale for MSF. Emilia, highly positioned employee at MSF, explains that

MSF Sweden is funded 100% by private funds, while the figures of MSF globally are about

98%. However, she points to the facts that the reason of this is mainly that MSF wants to

uphold an unbiased, independent and neutral organization and thereby does not want to

receive governmental funding.

As alluded to in the citation above from Carl, MFS also searches for personnel with

market-oriented backgrounds. William highlights during the interview, that MSF more and

more are hiring people with a background from the private sector, instead of the increasing

amount of ‘global studies students’ as he puts it. Emilia too, like William and Carl, states that

MSF hires staff that does not have background in humanitarian work:

“To really receive funds, we have to go get the message out there on what we are doing. We

have huge communication departments with people who are experts and knows this.”

22

Thus, theories of marketization that is put forward by a number of scholars can in a clear way

be seen within MSF in a number of ways; 1) through their communication and market-based

rhetoric, both when speaking about MSF as an organization and in their marketing, and 2)

through their use of commercialization by selling fictitious goods, and 3) through their

collaborations with private actors and private funding, and finally 4) through their way of

hiring personnel with a private sector background which offers expertise that does not exist

in-house.

Let me now turn to the question of how MSF portrays for-profit actors: How do they portray

private actors and what role do divisions between non/for-profit and marketization play in the

accounts of the relationships and the potential of coordination?

4.2 MSF and private actors

In the MSF commissioned report (Lucchi’s 2018, 11) it is stressed that non-profit actors have

different key drives to approach private actors and to enter partnership. The reason closest at

hand is that of improving efficiency in their field of work. It is stated that collaboration and a

well functioning coordination has the potential to enhance and improve work processes and

operations, increasing coverage and ensuring sustainability. It is further concluded that the

private sector often offers means and services that a non-profit humanitarian actor cannot

manage on their own. Hence, several positive aspects can be seen for non-profit actors

approaching for-profit actors. Nevertheless the report (Lucchi 2018, 32) highlights that there

are some risks for an NGO like MSF to work together with private actors. The most apparent

is that there might be a collision between the two when private actors might have their own

for-profit agenda that goes against the non-profit humanitarian organization’s ethical

principles. Even so, for-profit actors are presented to be more flexible in their work and more

coupled with technology, and can therefore, according to the report, help push innovations

and adapt products for specific needs or contexts. MSF and Veolia, a company working in the

field of energy, waste and sanitation is presented an example of a long-term partnership that

focuses on technical innovations. (ibid, 13) Hence, it can be summarized that even while

problems are highlighted that alludes to the non/for-profit distinction private actors are mostly

seen as something positive and not as a competitor.

23

This positive image was even more predominant in the interview material: almost no

negative opinions were uttered from the representatives. Nevertheless, William as well as

Emilia points to the fact that MSF as an organization wants to work alone. They emphasize

that all their projects and activities have an overall thought that MSF shall be unbiased,

independent and neutral and that it cannot be guaranteed if they by themselves are not

accountable for their work. Even so, MSF has some collaborations and projects together with

private for-profit actors. Williams mentions IKEA-foundation and their project “better

shelter” that provides innovative housing solutions, which MSF is a part of in three

humanitarian crises so far. He speaks fondly of it and sees it as role model of cooperation.

Additional to this, both William and Emilia highlight the so-called ‘innovation hubs’ scattered

over the world. Project-based technical collaborations, often with small startups that offer

expertise that MSF do not have in-house. William explains:

“We have several innovation hubs scattered across the globe, they are usually project-based,

so it can be everything from digitech, VR-solutions, 3D-printers, technical specific

companies. […] It’s fairly new, we started these collaborations in Sweden for about 5 years

ago.”

William is very enthusiastic about these projects, stating that it is always a ‘win-win’ situation

and emphasizing that:

“The innovation is highly interesting for both parties, if the can offer technical expertise that

we don’t have, then it becomes really interesting. […] There is a huge interest generally

towards the private sector […] it is a trend that is here to stay.”

This is also backed by Carl, pointing to the fact that the humanitarian sector had sales for

about 27 billions of US dollars in 2017, emphasizing that we will see more and more

collaborations with for-profit actors as they enter the arena. He adds that NGOs either can

choose to turn their back on new actors and say that this is their field of work or adapt to the

changing environment. This potential adaptation is an essential part of marketization.

When asking William about the impediments of cooperation with for-profit actors he

mentions two. The first is that MSF are very sector specific, only working with medical aid,

and that all collaborations must be relevant for that specific cause. The second impediment

mentioned is that there might be an internal resistance:

24

“You can sometimes see an internal resistance, not a repulsion, but a fear from the past.

Before you either worked to save the world or you were working in the private sector and

then you were cold hearted. This is not the reality of today, but there are remains of this

among the staff.”

This citation can be interpreted as reflecting almost totally positive image of for-profit actors

and the possibilities to cooperate with them. The people in the organization that are somehow

opposed to this are described as stuck in the past. This fear cannot be seen when interviewing

William or any of the other representatives interviewed.

To summarize, what we can see are different ways in which marketization has an effect on

the relationship between MSF and private actors. MSF are turning to for-profit actors as a

way to both collect funds but also for their expertise, often technical which is something that

is missing in-house. This is an essential part of marketization and fosters a market thinking

within MSF. Finally, the most fundamental thought that can be seen when examining the

Lucchis report (2018) and discussing the matter with representatives of MSF is that private

actors do not emerge as competition, they emerge as collaboration partners.

Let me now turn to the question of how MSF portrays non-profit actors: How do they portray

non-profit actors and what role does marketization play in the accounts of the relationship and

potential of coordination?

25

4.3 MSF and non-profit actors

In Lucchi’s report (2018, 31f.) it is stated that NGOs are developing more and more

partnerships with private actors, moving away from the traditional arena in the humanitarian

field. Within the humanitarian system there exists shortcomings that is bypassed by partnering

up with for-profit actors. However, Lucchi argues that instead of partnering up with private

actors, NGOs should improve the humanitarian sector altogether. That humanitarian aid is a

specialized discipline with its own operational standards and ethical principles.

As mentioned before, MSF organizational structure is independent. All representatives

emphasize that and even though exceptions can be seen with collaboration with the private

sector, there is basically no collaboration with other NGOs. Emilia mentions that MSF

sometimes supports local aid organizations with material, money and expertise when security

is too much at stake, as of today’s Syria, but they never see it as their own projects. This does

not mean however that coordination is not an important factor out on the field on a daily

basis, as Emilia states:

“Cooperation is also central for us. We are not doing ‘double-work’. So, it is important that

we discuss, share and receive information, both where the needs are but also what other

NGOs are doing so that complement each other or do something completely different.”

Hence, the importance of coordination with other NGOs is emphasized in the interview. Yet,

while all representatives express a very positive attitude towards for-profit actors the opposite

is communicated towards non-profit actors. The relationship with other NGOs is stated as

more problematic and MSF tend to view other non-profit actors as competition. This begins at

an early stage in the humanitarian process. As William states:

“All NGOs tries to be the best collector and get the most attention. A lot of NGOs says the

same things: We are in Jemen, give us money. […] We are all competing for the same

donors.”

Emilia puts it in a similar manner, interestingly also using (again) the term market:

“We are all in the same market and we are all fighting for the same funds, people

[companies] cannot give the same amount to everyone asking for it.”

26

Hence, these accounts suggest that marketization shape the view that MSF have on other

NGOs, and in extension coordination. As MSF turns too private funding, as other NGOs, they

begin to compete for the same means and funds. How can this be seen in practice? The most

comprehensible way would be through another concept within marketization;

professionalization. When discussing competition with other NGOs with William he also

states:

“If you look at the number of job ads that is out for digital communication specialists every

month, everyone is trying to the same thing and all have become very good at it. It is no

longer an old lady out on the street with a collection box asking for coins […] In that sense I

think that competition has increased, because all NGOs are so good at communication, PR,

branding and digital marketing. All NGOs are fighting for the same space the public sphere.”

When relying on private funds, NGOs and especially MSF are in need of market-oriented

experts for branding, PR and marketing. So here competition takes two forms between MSF

and other non-profit actors. First, there is a more direct competition of competent and relevant

personnel for this cause. Second, a more abstract rivalry exists, as William mentions, for

space in the public sphere, or market as Emilia put it, as a result of increasing focus on

branding and marketing. But this constant struggle is not only isolated to funding and

advertising, it can also be seen within MSF daily work out on the field. When asking Emilia

about her experiences out on the field she says:

“There is a scarce of medical personnel and so many organizations are in need of medical

personnel, so we are competing on the same market there, all need doctors, nurses, midwifes

and surgeons. So, there is definitely a competition of workforce.”

This scarcity of relevant personnel is difficult to connect to marketization, as humanitarian

crisis always has limited means, material as well as human resources are in short supply. In

spite of this, it is important to highlight that competition, according to the respondents, occurs

throughout the whole chain of humanitarian aid. This is something that affects how MSF view

other NGOs, as a rivalry, which might risk affecting the coordination process.

To summarize, coordination with other NGOs is something that MSF emphasize as being

very important. Yet, in all of the their work, through all the humanitarian chain, they stress

27

that there is constant competition between MSF and other non-profit actors and they largely

describe other NGOs as competitors. This can first be seen when looking at funding, where all

non-profit actors are fighting for the same means of private actors. It can be seen when

looking at how MSF has undergone a professionalization which has lead to competition of

personnel and a common struggle for the public sphere. Finally, it can also be seen out in the

field where a scarce of workforce exists.

5. Final analysis and conclusion As previous research highlights (Maier et al. 2016, 65; Coombes et al. 2011, 829; Eikenberry

et al 2004, 132), NGOs are becoming more and more like for-profit actors. This study clearly

demonstrates that this is also the case when it comes to MSF. It can be seen in their way of

funding; relying on private means, through sponsoring and by commercialization through

selling of fictitious goods. It can be seen in their rhetoric, by using a market-oriented language

speaking and focusing on marketing, branding and PR. It can also be observed through their

selection of personnel with experiences and knowledge from the private sector. That this

marketization process shapes MSF relationship towards other actors, for-profit and non-profit,

is apparent when discussing with representatives and complementing with a report and MSF

website. What can be seen when comparing how MSF portray for-profit actors versus non-

profit actors is that while for-profit actors are largely viewed as something positive, as a

collaboration partner where common interests exists, non-profit actors are largely portrayed as

competition. This can be observed throughout the whole humanitarian process, from funding

to direct field operations. Thus, and reflecting the logics of marketization we can see that

MSF describes how it is easier to cooperate with private actors than other NGOs. These

findings contradicts with current research which says that: “These [a market-oriented

behavior and a focus on social needs] does not have to collide but can instead be pursued

simultaneously” (Zhang & Swanson 2013, 108f.). This study does not provide support for

such a view as we can see that marketization leads to an impaired relationship between MSF

and other NGOs, in turn risking affecting the important coordination process in a negative

manner. When coordination fails so does the fundamental thought with humanitarian aid.

Thus, a market-oriented behavior and a striving for humanitarian aid cannot be pursued

simultaneously without severe negative affects in coordination.

28

By reason of the existing debate regarding marketization within NGOs this thesis has

shown that one of the biggest actors within humanitarian aid, MSF, are a part of this

development in humanitarian actions. It has also shown that it shapes how MSF portray and

relate to other actors, for-profit in a positive way and non-profit in a negative manner because

of competition. This is likely to harm the coordination process that is needed for well

functioning humanitarian actions. Future research should conduct similar studies but with

other NGOs, as MSF might be an example of an NGO highly connected to marketization as

they do not accept any governmental funds. Focus should also lay on to what extent this

competitive view among non-profit actors affect coordination in humanitarian actions on the

ground and out in the field. This would be necessary to get a more complete insight in the

field of humanitarian aid, how crisis are managed, and the actors working within.

29

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Appendix

Interview guide

Purpose of the interview:

• Contribute to get a deeper understanding of how NGOs view their own work as well as their cooperation with other actors in humanitarian actions

• The interview will consist of five parts. After some short opening questions, we will

discuss MSF’s work internally, followed by some questions of MSF’s cooperation with NGOs/private actors, ending with some final questions.

Interviewee and relevance

• Please describe MSF and your role Work internally

• In what regions does MSF operate in humanitarian actions?

• How does MSF work with humanitarian actions?

• What are MSF’s biggest impediments regarding humanitarian action?

• How does MSF work with collection and founding?

• What are MSF general goals?

• Do MSF outsource any field of work?

• What is MSF’s view on profit vs. non-profit? Do you have any stakeholders to consider?

• What is MSF’s opinion on risk taking?

• How does MSF work with branding and PR?

- How do you view your trademark? - How do you work to improve your brand? - Has competition increased in recent years?

• How does MSF measure success?

Cooperation with non-governmental organizations

33

• To what extent does MSF work together with NGOs today in humanitarian actions? How does that work look like?

• What is the role of other NGOs, what purpose does they fill, that your organization

cannot manage on your own?

• What do you think work well when coordinating with NGOs?

• Which barriers/impediments/challenges do you experience when working with NGOs? - What is required to overcome these challenges?

Cooperation with private actors

• To what extent does MSF work together with private actors today in humanitarian actions? How does that work look like?

• What is the role of private actors, what purpose does they fill, that your organization

cannot manage on your own?

• What do you think work well when coordinating with private actors?

• Which barriers/impediments/challenges do you experience when working with NGOs? - What is required to overcome these challenges?

Final questions

• Do you experience any competition with other actors, private and non-private, in terms of humanitarian work?

• How does your company/organization view the differences regarding coordination and

competition with private and non-private actors?