AEDES

In 1984, MSF Belgium created AEDES (Association Européenne pour le Développement et la Santé/ European Association for Development and Health) in order to tackle two issues. The first was to create an organisation to support long-term projects that MSF wanted to hand over. The other was to offer more stable jobs for certain MSF employees.

document

Overview of AEDES, 1984 (in French).

Extract:

AEDES: transition to independence and relationship with ‘Médecins Sans Frontières’

Médecins Sans Frontières came up with the idea of creating an organisation like ‘AEDES’ after noticing that, for structural reasons, it could not handle certain activities when the opportunity arose.

The initial reaction was to consider modifying structures by broadening the scope of our activities. But it quickly became apparent that this process could potentially cause numerous problems and sow confusion in an organisation that was operating smoothly in its field. Upon further thought, it seemed better to create a separate organisation with resources not being used by MSF; this organisation’s activities would be distinct from those of MSF.

The aim of ‘Médecins Sans Frontières’ is to support the launch of AEDES, help it quickly achieve autonomy, and maintain a number of links between the two organisations for mutual benefit and a synergy of goals. By being an independent organisation, AEDES could bring in people who were not part of MSF. This has two advantages: first, AEDES would bring new blood into the discussion and develop new forms of cooperation and second, it would provide an opportunity to disseminate new ideas more broadly to the outside world.

A. Launch phase

MSF will help AEDES get off the ground in the following ways. It is estimated that this phase will take one year.

1. Funding

MSF will provide financial support to AEDES until it becomes financially independent. The MSF board of directors will determine the amount, which will total approximately BEF 500,000 [€11,300]. This loan will be repaid according to the agreed terms (to be determined).

2. Administrative offices

MSF will provide AEDES with two rooms on the third floor of its headquarters building in Brussels. AEDES will also have access to certain facilities, such as a switchboard, secretarial services and the use of meeting offices. AEDES will have its own headquarters and administrative offices as soon as possible.

3. Administrators

The first people working for AEDES will not be working full-time at the start. MSF will gradually reduce its responsibility for the relevant activities, giving the AEDES staff time to adapt to the growth of the new organisation. Here again, the long-term goal is to create a legal separation between the two organisations.

4. Contacts

MSF will introduce AEDES to people and organisations that might prove helpful.

5. Staff

People who have been working at MSF for several years could serve as an initial candidate pool.

6. Responsibilities and projects

AEDES will gradually take on responsibility for carrying out its own activities. MSF may advise AEDES on project requests, but that will not be one of its priorities. In addition, MSF may initially subcontract projects with AEDES that fall more under the purview of the new association.

B. Independence phase

AEDES’s major internal objective is to quickly gain operational independence. This mainly involves financial autonomy and independently providing expertise both outside AEDES (project management and implementation) and inside the association (administration).

1. Financial independence

Method

Various bodies will provide AEDES with funding to conduct projects. The estimates submitted will take the projects’ actual estimated costs into account, with a certain percentage added to cover the central office’s operating costs, the risk of underestimating costs, and the funding of its own projects based on the association’s objectives.

This additional charge will also take account of the need to build a cash reserve that will have the resources necessary for keeping the association running smoothly. Because AEDES is a non-profit association, any surplus revenues must be used for investments or its own activities.

Viability

The estimates submitted by AEDES will be highly competitive: first, because costs will be much lower than those charged by private-sector organisations and bilateral and multilateral partnerships, and second, because the services provided will be a good value for the cost. Because there will inevitably be a large number of proposals, a lack of financial resources will not be a limiting factor. Instead, any such limits will be imposed through the process of developing organisational structures.

2. Technological independence

Staff

AEDES will benefit from the support of qualified staff with project and administrative expertise. There are many such employees, who come from a wide variety of backgrounds and have strong technical skills (as indicated above, it is the structures themselves that have deficiencies).

Moreover, because AEDES is based on a concept whose aim is to foster new ways of cooperating in the area of development, the association is likely to attract idealistic people who, in return, will create a working environment and organisational culture in their own image.

The middle way was also chosen in terms of staff motivation, i.e. a combination of personal commitment based on ideas (personal fulfilment) and pragmatism that solidly supports this commitment (material motivation). It seems possible that AEDES, as defined, could have a sufficient candidate pool for finding qualified and motivated employees willing to work for mid-range salaries, which would enable the association to submit highly competitive estimates.

Technology

Staff will quickly provide AEDES with basic technology. The association’s main goal is to use trial and error to advance this technology by comparing new theoretical concepts with their practical results on a daily basis. At the beginning, the external focus areas will be health and construction, while other areas such as agriculture and education might be included depending on the skills of new employees.

The major factor posing an obstacle to viability and, therefore, AEDES’s productivity will be the creation of an organisational structure. It will not be enough to bring together the various components; instead, it will be necessary to breathe life into the structure, which can only happen by combining a determination to succeed with good organisational knowledge (such as administration, internal policies, group relations and institutional organisation).

document

Report on AEDES founding General Assembly, 13 November 1984 (in French).

Extract:

Members of the non-profit association AEDES gathered for a General Assembly in Brussels on 13 November 1984 and appointed members of the board of directors:

Jean Burke, doctor, Belgian

Marius Foucart, civil servant, Belgian

Helmut Jousten, engineer-architect, Belgian

Jean-Marie Kindermans, doctor, French

Philippe Laurent, doctor, Belgian

document

Annex to MSF Belgium Activity Programme 1984 -1985 (in French)

Extract:

I. The process:

AEDES was founded after a lengthy process of review and analysis within Médecins Sans Frontières. This was not an academic undertaking or a theoretical plan developed in lockstep with a rigid intellectual approach but, rather, a growing awareness that emerged from daily work in the field.

Our primary observation was that development aid generally does not offer the returns hoped for, given the scale of the investments. This aid is provided by various kinds of organizations, so it is appropriate to examine the gaps.

International organizations – primarily UN entities and bilateral cooperation agencies – draw the lion’s share of available budgets. While this may be understood politically, these huge aid machines produce a certain inertia that is inherent to them: their operations absorb a significant amount of energy to the detriment of activities in the field.

Conversely, non-governmental entities have few resources. They are numerous and varied and combine flexibility with low operating costs. However, they are highly unstable and their members remain for very short periods, leading to loss of skills. Those that can be preserved are restricted enough to limit their impact.

Last, private for-profit entities primarily use professionals, but the cost cuts sharply into the amounts allocated to technical aid. In addition, their commercial nature sometimes leads them to make certain compromises that have a negative effect on their freedom and independence.

This somewhat harsh review reveals existing problems as a stimulus for improvement. The above-mentioned deficiencies relate to both financial and human resources. At the same time, officials in developing countries have become justifiably more demanding about dialogue, the development partner’s qualifications, and the local takeover of projects. Donor countries are also concerned about the efficient use of funds for philosophical, political and economic reasons. For these reasons, we created an organisation that will attempt to avoid these stumbling blocks because we continue to firmly believe in the virtues of cooperation, believing that it is both useful and necessary. To that end, we are focusing our efforts on certain basic principles, which we will briefly explain before going into greater detail.

II. Basic Principles

AEDES is a private, non-profit association, currently under Belgian law and with a European orientation. It is composed of professionals and seeks to provide technical cooperation, working with developing countries, in the interest of the greatest possible efficiency and effectiveness. It is multi-disciplinary and its priority is to remain an operational entity.

1. Objectives

Three types of organisations are involved in development cooperation: national and international institutions, non-governmental organisations, and private-sector companies. The association’s goal is to operate at the meeting point of these three sectors by trying to bring together each organisation’s contributions.

This ambitious approach is guided by an ongoing concern for improving the quality of the cooperative partnership. Enthusiasm and an innovative spirit are key factors in this search for a middle way. Internal discussions will be characterised by an attitude of open-mindedness toward any constructive idea; the discussions will avoid a dogmatic approach while remaining faithful to the key concepts of independence, competence and realism.

In other words, AEDES, which is operational by nature, must remain a forum for deliberation about its activities as well as development in general. Lastly, meeting developing countries’ needs clearly requires contact and collaboration with local stakeholders and counterparts; as a result, it would be best if they could be included in the organisation’s operations and structures.

2. Legal aspects

As a non-profit association, AEDES’s very nature clearly indicates that it does not operate for profit. Headquartered in Brussels, it is temporarily operating under Belgian law. Employing a multinational staff, AEDES intends to become European in scope, as demonstrated by its name. For that reason, it will register as an organisation under European law as soon as the latter takes effect. It may eventually decide to set up its headquarters in another country.

This international identity, in addition to its private nature, should ensure its independence. This will also depend on the diversity of its funding sources, which will come from any international, national or private organisation that chooses AEDES as an operating partner while meeting the objectives set by the association.[…]

4. Operations

The organisation’s founders all share a practical knowledge of the realities at both the local and central government levels. They bring to the organisation their wide-ranging backgrounds, diverse skills and adherence to the above-mentioned general principles, enabling them to meet the expectations of developing country officials.

he General Assembly consists of the founding members and members who were later recommended. The GA appoints a board of directors, which delegates its responsibilities to administrators who run the organisation on a daily basis. Field staff are full members and share the same ideas. They work under contract and receive priority during contract renewal. Headquarters manages project acceptance, implementation, and coordination.

document

Annual Report, MSF Belgium, 1985 (in French).

Extract:

Yes, we handle emergencies and of course we try to be effective, but what does ‘emergency’ really mean? Is it a selfless act, an isolated act, a spectacular act? No, as we’ve already shown, it’s whatever the country needs, as we’ve seen in the Philippines, where local doctors take over; in Chad, where our activities are part of Ministry of Health operations; and in Mali, where ‘emergency’ refers to health policy tailored to the country’s needs. And this issue is always in the back of our minds as we start every project, but we’re also concerned about not getting involved in anything long term, including development.

Based on this perspective, we created the European Association for Development and Health or AEDES, a non-profit association independent of MSF that strongly focuses on long-term projects. In last year’s annual report, we demonstrated the need to find a way for doctors and nurses who had worked with our organisation for several years to acquire an employment status other than that of volunteer. We’re aware that it’s not possible to make a career with MSF and that some people’s family situation requires greater stability.

AEDES meets this need and also aims to transfer all experience gained in the field and thus avoid losing it because experienced personnel are the most useful assets for the Third World. While AEDES may be independent of MSF, it must still maintain close relations so that it can take over some of our projects; I’m thinking in particular of Guinea, Mali, and maybe someday Chad.

INTERVIEW

The idea was to focus MSF’s work on emergencies and post-emergencies, and to create another organisation that would handle the more sustained activities. That allowed us to offer longer commitments and career prospects for people after they’d left MSF. MSF had just been set up. People referred only to emergencies while the word “development” was banished from the organisation’s vocabulary. We talked of short and long term because emergency and development didn’t mean anything to us. There were many slogans and people didn’t understand what “long term” meant. At the time, Rony, with Liberté Sans Frontières and others from the outside, had theorised that development needs were linked to democracy, and many other elements that have nothing to do with international aid; he also believed that international aid had nothing to do with development, which must be endogenous. That was one of the main reasons for not having “development” or “long-term” activities within MSF. Europe was our “new frontier”: everything was European at the time. We even tried to create AEDES outside the national framework. We looked for a European law, but there wasn’t one. We believed in the European dimension of aid, but not in the utopian idea that this would help countries develop. But we thought it would allow for ongoing relationships between our societies and poorer countries, and that there was a role for a new, private initiative. We chose people for the board of directors based on the following representation: one-third from NGOs, people from the institutional cooperation world, particularly Belgian, from the public, then people from the European Union, and a large number of MSFers or former MSFers, who would serve on their own behalf. There was no institutional link between MSF and AEDES, which could act as it chose, based on its members’ decisions. And there was no financial link either. MSF put some money in at the start, but not a lot. Then, AEDES managed its contracts, like any other NGO, totally subsidised by contracts.

Dr Jean-Marie Kindermans, AEDES - Director, 1984-1995 (in French)

In 1987, MSF Belgium’s Operations Department considered restarting the implementation of mid- and long-term projects. Their objective was to strengthen MSF Belgium’s growth since funding for these types of projects was easy to obtain from the European Union.

AEDES then began focusing on offering consulting services in the area of health economics. MSF Belgium used these services until it decided to provide them on its own by employing health economists. In the end, the two entities no longer had any opportunities for collaboration.

document

Annual report, MSF Belgium, 1987 (in French).

Extract:

We are also submitting a document for the General Assembly’s approval concerning MSF B[elgium]’s takeover of long-term activities. Emergency medical care gave rise to these activities, which include early warning systems and health product stores in sub-Saharan countries. They had been under the direction of the European Association for Development and Health (AEDES) until the present time, but will now become full-fledged MSF projects. The reintegration proposal recommends changes to the way missions are managed in Brussels, clarifies the project’s medical and logistical needs in each country, and regularises the fact that 70% of our activities are already mid- and long-term. It also enables MSF members with extensive field experience to stay involved with our organisation for a longer period of time.

document

Minutes from MSF Belgium Board of Directors Meeting, 6 May 1992 (in French).

Extract:

6. AEDES (Anne Krings)

Anne Krings suggested adding this item to the agenda because there seems to be a lack of awareness of AEDES’s role. She would like to provide general information about AEDES, explain the relationship between MSF and AEDES and recommend discussion topics:

- Long-term projects: limits of MSF and AEDES’s efforts

• What are the methods being used and what impact will each method have on the relevant local organisation?

• Funding methods

• How much decision-making autonomy will MSF have when running typical programmes?

- Branch office and partner:

• Background, method of creation, independence, openness to the outside world, development process, its own rationale.

• Benefits for MSF.

INTERVIEW

For a long time MSF Belgium’s obsession was to be the biggest. After Philippe Laurent’s departure [Founder and CEO], I made an agreement with Jean-Pierre Luxen [CEO] and George Dallemagne [Director of Operations]. They had a theory of development which was to give the largest association a monopoly. Then, around 1988, the operations department of MSF Belgium has decided to take over the responsibility for operations on the medium and long term. They considered that in the end, it was worthwhile to continue to carry out, after the emergency, projects that would have normally been taken over by AEDES. I think it’s because they wanted keep these activities, which were heavily funded. In the 1990s, MSF worked in many countries including ones we didn’t even know if they were stable or not, like in Liberia. There were a lot of projects around malnutrition in stable areas, supported by MSF Belgium, which considered that there was still a notion of urgency in this care. AEDES has therefore been increasingly pushed back towards a role of technical assistant referrer. In the meantime, we had begun to diversify our resources. We’ve got developed a lot of consulting activities, responding to requests for European Union tenders. We even had to change status and become a cooperative limited liability company so that we can continue to respond to these calls for tenders. AEDES has thus become more and more a design office with expertise in the organization of healthcare services and the economy of health, which was sometimes put at MSF’s service here and there. But MSF had also recruited health economists, doubling the number of and didn’t need AEDES. So we developed our own and we moved away from MSF so far that today, MSF people don’t know AEDES.

Dr Jean-Marie Kindermans, AEDES - Director, 1984-1995 (in French)

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