The international strategies of NGOs : a multiple-case study of NGOs’ international location choices

The International Strategies of NGOs

A Multiple-Case Study of NGOs’ International Location Choices

Master Thesis

MSc. Business Studies – International Management

Supervisor: Dr Johan Lindeque

Second supervisor: Dr Michelle Westermann-Behaylo

Student: Mara Albasio

Student ID: 10731202

Date: January 30 2015

Statement of originality

This document is written by Mara Albasio who declares to take full responsibility for the contents of this document.

I declare that the text and the work presented in this document is original and that no sources other than those mentioned in the text and its references have been used in creating it.

The Faculty of Economics and Business is responsible solely for the supervision of completion of the work, not for the contents.

Abstract

Constructing a theory of NGO internationalization is becoming increasingly important as these organizations progressively undertake activities outside their countries of origin, where they alleviate suffering and promote the interests of the poor, protect the environment, provide basic social services, or engage in community development work. In an attempt to build a comprehensive international strategy for NGOs, location choices made by NGOs are analyzed and an answer to how successful NGOs go about choosing to which countries to expand is developed. Themes from the NGO and international strategy literatures are integrated, a multiple case study is conducted on four international NGOs (INGOs), and finally a conceptual framework for NGO international location choice is built. The study reveals that NGOs pursue need seeking, reputation seeking and strategic-alliance seeking motives in their internationalization.

Acknowledgements

I am using this opportunity to express my gratitude to everyone who supported me throughout the course of my Master Thesis.

I am thankful to my supervisor, Professor Johan Lindeque for his motivating guidance, invaluably constructive criticism and friendy advice, which have been constant during the entirety of the thesis.

I am sincerely grateful to my friends and family who have shared their illuminating and fruitful views on a number of issues related to the project.

I especially thank my parents, for providing me with the facilities, the strength, and the uninterrupted support to pursue not only this project but everything that has led to it.

Thank you, Mara Albasio

Table of Contents

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Index of Tables and Figures

Fig 1. NGO Themes………..10

Fig 2. FDI Motives………12

Fig 3. Factors Influencing NGO Location Choices………...18

Fig 4. Selected Cases……….23

Fig 5. Project Performance………26

Fig 6. Doctors Without Borders Location Choices………...30

Fig 7. Oxfam Location Choices……….33

Fig 8. Greenpeace Location Choices……….36

Fig 9. Amnesty International Location Choices………38

1. Introduction

Despite the significant growth in number of non-governmental organizations (NGOs) and of their geographic scope, research attention has been dedicated primarily to the internationalization of for-profit multinational enterprises (MNEs). NGOs however are important multinational organizations and shedding a light on their dynamics could offer new insights into the internationalization of organizations in general.

Organizations classified as NGOs are considered autonomous, in that they don’t depend substantially on state funds, with the majority of their funds coming from voluntary contribution, and finally, they are characterized by non-profitness (Courier Report, 1987). As is the case with many for-profit organizations, NGOs are often also active in their own country as well as outside the national borders of their home country. Non-governmental organizations that are international in scope and have outposts around the world to deal with specific countries are labeled as “international non-governmental organizations” (INGOs) (World Bank, 2007).

Over the past 20 years there has been a shift in the provision of basic services within developing countries. Services which were once provided by government ministries and other public entities are now being provided by INGOs (Fruttero and Gauri, 2005) with approximately 40.000 active INGOs identified today (UIA, 2010). Well-known INGOs include Oxfam (2014), Doctors Without Borders (2014), Amnesty International (2014), and Greenpeace (2014).

Despite the significant number of INGOs, the vast majority of international strategy literature has focused on for-profit organizations. The United Nations Conference on Trade and Development estimates that the number of multinational enterprises (MNEs) in the world has grown from 7.000 to 80.000 between the 1960s and 2006 (UNCTAD, 2007). The literature on the international strategy of

MNEs has been prolific and reflects this staggering growth in MNEs.Numerous research studies have

been conducted on performance trends of multinational enterprises and a solid theoretical foundation of these has been developend explaining the internationalization and strategic decision-making of MNEs (Rugman et al. 2011). A similar degree of attention has however not been given to the international strategies of the estimated 40.000 active INGOs identified today (UIA, 2010).

The literature on MNE international strategy has consolidated into respected arguments regarding where companies internationalize (Hirsch, 1975; Johanson and Vahlne, 1977; Terpstra and Yu, 1988; Chen and Chen, 1998; Ghemawat, 2001; Delios and Henisz, 2003; Dunning, 1998), when they do (Kerin et al., 1992), how they do (Peng, 2001; Peng, 2002; Dunning, 2000), which international strategy is most appropriate for a specific MNE (Prahalad and Doz, 1987; Ghemawat, 2008), how they should manage their relationship with subsidiaries (Birkinshaw et al., 1998) and the impact of multinationality on firm performance (Vermeulen et al., 2002).

Literature encompassing the world of NGOs extensively focuses on the history, nature and ethical issues regarding these entities (Iriye, 1999; Green, 1977; Fassin, 2009). In the non-profit sector,

research regarding international strategy has been quite scarce (Arts, 2002; Berger et al., 2004; Deri, 2003; Doh and Guay, 2004; Doh and Teegen, 2003; Edwin et al., 2000; Millar et al., 2004; Ramia, 2003; Spar and Le Mure, 2003; Teegen et al. 2004). Nonetheless, the internationalization of NGOs is becoming an increasingly important phenomenon to analyze, as NGOs increase their global presence and face pressing issues in doing so (Robbins, 2002). Recently for instance, NGOs have had to tackle the hurdle of foreign officials restricting foreign funds to NGOs in their own nation in an attempt to form “illiberal” states (The Economist, 2014).

Given the global presence and emerging importance of such organizations and the existing literature on their nature, a valuable contribution to academic literature would be to study internationalization in the area of NGOs and illustrate how major NGOs such as the ones mentioned

(specifically, Oxfam, Doctors Without Borders, Amnesty International, and Greenpeace)

internationalize successfully.

Within international strategy, location choices is the focus of this paper. “Understanding NGO placement is important and can help policymakers and donors understand how NGOs work, who they target, and what their priorities are as organizations.” (Fruttero and Gauri, 2005, p. 761, Liston, 2008) This research thus attempts to integrate two streams of research: The NGO and international strategy literatures, with the objective of extrapolating a successful approach to location choices for NGOs.

Brass’ (2011) dissertation on NGO expansion in Kenya and Fruttero and Gauri’s (2005) research on NGOs in Bangladesh, although from a sub-national perspective, pave the way for research on factors influencing NGO location choices. Brass identifies host country need and the convenience of doing work there as criteria for NGO expansion. Fruttero and Gauri’s research instead concludes that goals of broad geographic coverage drive NGO location choices. Their findings are logically translated and extended into inter-national terms in this study.

Numerous authors in the field of international strategy have treated location choices of for-profit MNEs. Regarding the process of location choices, Benito and Grisprud (1992) distinguish the rational approach to internationalization from one that is based on previous international experience (Johanson and Vahlne, 1992). Authors such as Terpstra and Yu, (1988), Chen and Chen (1998), Ghemawhat (2001), Delios and Henisz (2003) and Dunning (1998) instead identify location specific factors such as country distance, strategic linkages, political instability which determine MNE location choices. Finally, Mariotti, Piscitello and Elia (2010) find that the presence of other firms in host countries influences location choices.

This research integrates the main themes wich emerge from both bodies of literature and formulates propositions which lead the way through the case study and toward the development of a solid conceptual framework. A conceptualization of INGOs is provided, identifying key themes to be considered in relation to location choices. Subsequently, a framework based on Dunning’s (1998) four investment motives for MNEs compares and integrates arguments for MNEs’ and NGOs’ location choices and allows for an identification of factors influencing location choices in NGOs. Finally, a

multiple-case study is conducted on the location choices of four INGOs (Oxfam, Doctors Without Borders, Amnesty International, and Greenpeace) to confirm the theory.

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2. Literature review

Academic research on international strategy has focused primarily on for-profit organizations, leaving an open door for research on non-governmental organizations (Lambell et al., 2008; Borini, 2007). The internationalization of NGOs thus remain significantly less well understood than their for-profit counterparts. However, NGOs are now strategically mature organizations which interact with governments, inter-governmental organizations such as the UN and the World Bank, and MNEs (Fruttero and Gauri, 2005). The increasing role of NGOs in the global context suggests that they may be an important focus for academic research (Buckley, 2002).

Investigating location choices of successful NGOs above all other international strategy topics is important for a number of reasons. Firstly, analysing location choices in successful NGOs can provide a conceptual framework for NGOs wishing to expand their area of impact in the most efficacious way. Secondly, a clear understanding of NGO location choices is relevant for policy effectiveness. Donors and developing country policy makers need to know whether NGOs target the most needy communities, thus constituting valuable partners (Fruttero and Gauri, 2005). Finally, an understanding of NGO location choices can help develop an account of NGO incentives, helping governments and donors specify better contracts (Fruttero and Gauri, 2005).

INGO Conceptualization

“Any non-profit, voluntary citizens’ group that is organised on a local, national and international level. Task oriented and driven by people with a common interest, NGOs perform a variety of service and humanitarian functions, bring citizen concerns to governments, advocate and monitor policies and encourage political participation through provision of information. Some are organised around specific issues, such as human rights, environment and health.”

United Nations Rule of Law (2011) NGOs are non-profit organizations, meaning that they are precluded from distributing financial surplus to those who control the use of organizational assets (Hansmann, 1980). As private organizations, independent of government control, NGOs focus on alleviating suffering and promoting the interests of the poor, protecting the environment, providing basic social services, or engaging in community development (Wei, Liang, and Husheng, 2013).

NGOs today are involved in the fields of health, education, rural and urban development, environment, social welfare, employment creation, skills training, economic development, environmental concerns, gender awareness and action, peace and human rights, and the informal sector (Commonwealth Foundation, 1994 pp. 23-29). They can be classified as operational, meaning that their main purpose is fostering community-based organizations within each country, or

advocacy-based, meaning that their main purpose is influencing policy-making by different national governments regarding certain issues or promoting awareness of certain issues (The World Bank, 1995). Many larger NGOs have both operational and advocacy-based activities.

NGOs, being non-profit organizations, rely heavily on external funds (Frandsen, 2002). The availability of external funds therefore tends to determine the timing, type, place, duration, and scale of NGO responses to emergencies. External donors such as individuals, foundations and corporations tend to make gifts of property, money, or services to NGOs (Frandsen, 2002). Governments will generally use specific contracts whereby in exchange for substantial funding, NGOs must conduct activities for the public good (Frandsen, 2002). The dependence on external funding is likely to restrict NGO location choices in terms of budget and results, which must be accounted for.

“NGOs represent communities, social and political movements, and special interests of all ideological persuasions and at all geographical levels from the local to the global” (Lambell et al., 2008). The United Nations Economic and Social Council (ECOSOC) recognizes, as of September 1 2013, 147 NGOs with general consultative status (concerned with most of the Council’s activities), 2.774 with special consultative status (concerned with a few of the Council’s activities), and 979 on the Roster (occasionally useful to the Council’s activities). NGOs quite often have outposts around the world, making them international NGOs (INGOs). Well-known NGOs defined as international today include Oxfam (2014), Doctors Without Borders (2014), Amnesty International (2014), and Greenpeace (2014).

The core function of an NGO is to provide assistance regardless of any other socio-economic or political motivation (ACBAR, 2010). NGOs thus conduct their activities of alleviation of urgent issues without any consideration regarding political, religious, cultural or geographical preferences. In fact, NATO state members officially commit to three principles:

• “Humanity: Human suffering must be addressed wherever it is found, with particular attention to the most vulnerable in the population, such as children, women and the elderly. The dignity and rights of all victims must be respected and protected.”

• “Impartiality: Assistance is provided in an equitable and impartial manner without political conditions; it must be provided without discrimination as to ethnic origin, gender, nationality, political opinions, social status, race or religion and solely on the basis of needs.”

• “Neutrality: All humanitarian assistance must be provided without engaging in hostilities or taking sides in controversies of a political, religious or ideological nature.”

Agency Co-ordinating Body for Afghan Relief (2012) Finally, NGOs respond to social and political challenges through inter-firm cooperation, making great use of collaborations with governments, inter-governmental institutions such as the United Nations and the World Bank and MNEs (Lambell et al., 2008). NGO alliances vary in terms of their purpose, membership and intensity of co-operation. They may be operational or advocacy

alliances as a specific organizational strategy through which to acquire control over needed resources, and to achieve political influence (Yanacopulos, 2005).

This conceptualization of NGOs identifies themes that provide an initial pathway to identifying factors of NGO location choices, see fig. 1. The first theme involves the objective of NGO activity, which distinguishes an NGO from an MNE in that the former is not profit-driven. NGOs fulfill non-profit goals which exclude profit-maximization considerations that come into play instead in MNE location choices. NGOs work with the sole purpose of fighting poverty, health, education, environment and welfare related issues. The second theme concerns NGO funding. NGOs rely exclusively on external funds (charitable contributions, public funding and foundation grants), which has a huge impact on shaping NGO activity. The third theme concerns the area of interest delimitating NGO activity. NGOs can be defined as “impartial”. They are indifferent to ideology and geography, which excludes these considerations from their location choice rationale. Finally, the theme of strategic alliances indicates NGOs’ relationships with governments, inter-governmental organizations and MNEs, which influence the preprequisites of NGO geographical expansion.

Theme Description

Non profitness Objective: alleviating poverty, health, education,

environment and welfare related issues

External funding Relying only on primarily on charitable

contributions, public funding and foundation grants

Impartiality Indifferent to ideology and geography

Use of strategic alliances Collaboration with governments,

inter-governmental organizations and MNEs

Fig 1. NGO Themes

MNE Strategy Perspective on Location Choice: FDI Motives

The academic literature on international strategy of for-profit firms extensively covers the most crucial questions regarding the theoretical foundations of multinational enterprises (MNEs), including where MNEs decide to invest (Hirsch, 1967; Johanson and Vahlne, 1977; Terpstra and Yu, 1988; Chen and Chen, 1998; Ghemawat, 2001; Delios and Henisz, 2003; Dunning, 1998; Mariotti et at., 2010). Location choices in for-profit MNEs are higly dependent on the specific investment motive of the internationalization. FDI by MNEs is broadly accepted to fall into one of four types, which are not

exclusive (Dunning, 1998): Resource seeking, market seeking, efficiency seeking, and strategic-asset seeking. Each motive leads MNEs to value different aspects of convenience in target host countries (Dunning, 1998).

Resource seeking motives refer to MNEs investing abroad to obtain natural resources. MNEs conducting this type of FDI value availability, price and quality of natural resources in the host country. Furthermore an infrastructure which allows resources to be exploited and products arising from them to be exported results attractive to these MNEs. Another important factor for MNEs seeking natural resources abroad is the government restrictions on FDI and/or capital and dividend remissions. Finally, investment incentives as well as the availability of local partners to jointly promote knowledge and/or capital-intensive resource exploitation constitute an important factor for MNEs conducting resource-driven FDI (Dunning, 1998). For some MNEs ecological motives are strongly considered: Lower demands, in relation to other countries, for environmental protection which are stricter for developed countries could be an incentive to shift production abroad (Cywinski & Harasym, 2013).

Most MNEs investing abroad expect to achieve greater profits in the future. They are driven by the same motive as local enterprises, with the difference that the focus is on the environments of different countries (Cywinski & Harasym, 2013). Firms investing in order to access new markets for their products or services are said to pursue a market-seeking motive. These MNEs are likely to base their location choices on the following factors characterizing the host country: market size, availability and price of skilled and professional labor, quality of infrastructure and institutional competence, agglomerative spatial economies and local service-support facilities, macroeconomic and macro-organizational policies, and promotional activities by development agencies (Dunning, 1998).

FDI can also be driven by efficiency seeking motives. MNEs whose FDI is driven by efficiency give great importance to production costs, the freedom to engage in trade of intermediate and final products, the presence of agglomerative economies, investment incentives, the role of the government in removing obstacles to restructuring economic activity and facilitating the upgrading of human resources, and the availability of special spatial clusters (Dunning, 1998). Since many services are non tradable and non storable but must be produced where they are consumed, FDI in the service sector is primarily affected by market seeking motives. Manufacturing FDI instead is likely to be driven by efficiency seeking motives as well, as the manufacturing sector is also driven by international price competitiveness measured by real unit labour costs (Riedl, 2010).

Finally, firms may be driven in their foreign investment choices by the possibility of acquiring strategic assets, intangible resources dealing with the technology and core competence of the company. In these cases factors influencing location choices in MNEs include the availability of knowledge-related assets and markets necessary to protect or enhance ownership advantages and at the right price, institutional and other variables influencing ease or difficulty at which such assets can be

exchange of localized tacit knowledge, ideas and interactive learning, and finally, access to different cultures, institutions and systems and different consumer demands and preferences (Dunning, 1998). Technology-based competitive advantages and a high level of industry research and development (R&D) intensity tend to motivate strategic asset seeking FDI, whereas an MNE’s export experience and higher level of domestic industry competition tend to induce market seeking FDI (Lu et al., 2010). Given these four investment motives of MNEs, a parallel can be drawn between these and the expansion motives that lead NGO internationalization. In the previous paragraphs, the main themes concerning NGO international activity are identified and divided in the categories of non profitness, external funding, impartiality and use of strategic alliances. Each of these categories, in turn, contains specific characteristics of NGO activity. Following the framework of Dunning’s (1998) four investment motives for MNEs, expansion motives of NGOs can be extracted from the aforementioned NGO characteristics and can serve as a new classification of these very characteristics, one which eventually leads to the identification of factors influencing location choices.

In the following table, see fig. 2, FDI motives, for clarity, are classified as concerning inputs, transformation processes and outputs. Each of the main themes of NGO activity are translated into motives of NGO FDI. The NGO objective of alleviating poverty, health, education and welfare related issues can be translated into a need seeking motive of NGO internationalization and finds its parallel in MNE market seeking as it is related to organizational outputs. The NGO themes regarding external funding instead can be translated into fund seeking and reputation seeking motives and compared to resource seeking in for-profit MNEs. Finally, in regards to transformational processes, the NGO practice of collaborating with governments, inter-governmental organizations and MNEs can be defined as strategic-alliance seeking and assimilated to strategic-asset seeking and efficiency seeking in MNEs. As is the case with MNE location choice motives, NGO motives are not mutually exclusive and may simultaneously drive the choice for one location over another or operate more independently.

Inputs Transformation Outputs

MNEs Resource seeking • Strategic-asset seeking • Efficiency seeking

Market seeking

NGOs • Fund seeking • Reputation seeking

Strategic-alliance seeking Need seeking

INGOs and Location Choice

NGOs need to carefully choose the locations in which they are active in order to survive as organizations and fulfill the objectives declared in their mission statement (Fruttero and Gauri, 2005). The logic applied by NGOs in making location choices can be extracted from the afore-discussed framework which identifies NGO themes and investment motives. Working propositions are used to express the factors determining NGO location choice.

Within the FDI motive framework, the theory-building process of this paper is strengthened by research on location choices of NGOs conducted by Brass (2011) and Fruttero and Gauri (2005), which identify key factors influencing the decision making process in NGOs’ location choices. Although both researches are conducted on a sub-national level, analyzing NGO location choices within Kenya and Bangladesh respectively, their findings can be extended to NGOs operating internationally, as they are related to characteristics of NGOs themselves. The authors ask themselves what the reasons are for NGOs selecting particular locations to implement their programs.

Furthermore, findings from literature on for-profit MNEs and their internationalization (Ghemawat, 2001; Grisprud, 1992; Mariotti et al., 2010; Johanson and Vahlne, 1977; Chen and Chen, 1998; Delios and Henisz, 2003). are used to compare and corroborate the conclusions on factors determining NGO location choices.

As previously stated, NGOs pursue a need seeking FDI motive with the objective of alleviating major issues disturbing humanity today, and do so without any profit goals (The Commonwealth Foundation, 1994). Thus it can be stated that NGOs locate their projects where recipient need is the greatest and means of provision are either insufficient or non-existent (Brass, 2011). Under this expansion motive, NGOs are regarded as “saintly” charitable organizations. If indeed NGOs choose their locations according to recipient need and resources, NGO activity is expected to be correlated to high poverty, low human development, and poor health, education, sanitation, and economic indicators (Brass, 2011). So one would expect indicators of poverty and other measures of community wellbeing to be among the main determinants of NGO location choices (Fruttero and Gauri, 2005).

P1. Need seeking internationalization will be driven by the perceived degree of greater need in one

location relative to another.

The need seeking investment motive also results in NGO indifference to the dominant political and cultural ideologies of a country affected by issues it battles. NGOs in fact are impartial to political ideologies and geography (Fruttero and Gauri, 2005). Their location choices therefore often exclude considerations regarding cultural, administrative, geographic, or economic proximity. This

research argues however that managers must always be conscious of all of these dimensions of distance.

Ghemawat (2001) points out that in pursuing global expansion, companies routinely overestimate the attractiveness of foreign markets. “They become so dazzled by the sheer size of untapped markets that they lose sight of the vast difficulties of pioneering new, often very different territories.” (Ghemawat, 2001). The analytic tools that managers rely on when making judgements on international investments are said to consistently underestimate the costs of doing business internationally. By focusing on national GDP, levels of consumer wealth, and people’s propensity to consume, these tools place all the emphasis on potential sales, while ignoring the costs and risks of doing business in a new market. These costs and risks are identified by Ghemawat as deriving from cultural, administrative, geographical and economic distance. Finally, he states that an accurate measure of these distance factors, collectively called CAGE, would lead to a more successful international expansion of MNEs.

When considering international expansion, MNEs must take distance into account and consider distance in its four dimensions (Ghemawat, 2001). Distance can manifest itself along the following dimensions: Cultural, administrative, geographic and economic. Cultural distance results from differences in religious beliefs, race, social norms and language. Administrative distance refers to the administrative and political ties between two countries. Geographic distance results from how far away the two countries are to each other, each country’s actual size, access to waterways, topography, and transportation and communication infrastructures. Finally, economic distance is mainly created by the difference in wealth between two countries. When taking a particular country into consideration for foreign expansion, companies must assess each and every one of these four dimensions in a balanced manner (Ghemawat, 2001).

A similar conclusion is argued for NGOs. MNE neglection of CAGE distance leads to a misinterpretation of the company’s growth potential in a specific market (Ghemawat, 2001). In a similar way, location choices by NGOs which fail to measure CAGE distance adequately are likely to lead to an incorrect judgement of the degree to which the NGO is able to address the country’s need. The total need of a country is measured, as previously stated, by poverty, human development, health, education, sanitation, and economic indicators (Brass, 2011). The sole factor of a country being in need is insufficient for an NGO to determine its ability to tackle this need. When evaluating whether it is possible to successfully address the country’s issues, an NGO must measure the cultural, administrative, geographic and economic distance factors which could potentially keep it from reaching its objectives. Measuring CAGE distance thus modifies the strength of the relationship between factors influencing location choices and the success of the same location choices.

P2(a). When CAGE distance is neglected in the location choice NGOs are expected to face more

P2(b). When CAGE distance is reflected in the location choice NGOs are expected to face less

difficulty after entering a host location.

The second investment motive identified in NGOs is fund seeking. NGOs rely exclusively on external funds (Courier Report, 1987). Their resources depend on how potential donors, looking for demonstratable results, react to their perceived success or failure (Fruttero and Gauri, 2005). Without the need for external funding, NGOs may be more charitable than pragamatic (Fruttero and Gauri, 2005).

FDI decisions made by for-profit MNEs are driven by cost-minimization in regards to resource obtainment, given that MNEs are profit-driven organizations (Grisprud, 1992). Higher labor costs, transportation costs, tariff barriers, non-tariff barriers, and unfavorable government policy are likely to push a firm away from a country (Grisprud, 1992).

In an effort to successfully respond to incentives to reduce poverty and/or support socio-economic developments under the organisational imperative to secure funding, NGOs choose locations also according to the ease of obtaining funds, which refers to the ease of access to donor resources (Brass, 2011). Under this view NGOs locate themselves in countries characterized by the presence of wealth and a high sensitivity to philanthropic initiatives, which makes funding easily accessible.

P3. NGOs locate themselves in countries where wealth and the propensity to give (philanthropy) are

higher.

The third investment motive characterizing NGO internationalization is reputation seeking. NGOs need to single themselves out. If they have already established successful programs in one country, NGOs are likely to put great importance on geographical expansion in order for a brand to be constructed (Fruttero and Gauri, 2005). In this case NGOs go to areas in which they can show their ability to new potential donors. Therefore, NGOs establish new programs where they themselves have not yet established programs (Fruttero and Gauri, 2005).

This finding is in line with the internationalization process theory developed for MNEs by Johanson and Vahlne (1977). The theoretical framework elaborated by Johanson and Vahlne views FDI as a learning process. Initially, a firm wanting to invest abroad only takes “culturally proximate” countries into consideration. However, as the company acquires more and more international experience, it considers increasingly distant markets as potential FDI locations. Countries which initially seemed too distant end up being judged as more familiar once the firm has already had experience in similar countries. Internationalization therefore takes the shape of an incremental

Attracting donor attention is obtained through geographical expansion and brand building (Fruttero and Gauri, 2005). This means that when an NGOs projects in a certain country have not yet reached success, reputation is built through brand building within that country.

P4(a). When NGOs have already established programs in one country and these are successful, they

are likely to build reputation through geographical expansion.

P4(b). When NGOs have already established programs in one country and these are not successful,

they are likely to build reputation through brand building within that country.

Corollary to the argument on NGO dependence on external funding is the decision of NGOs to locate themselves where other NGOs are already present. This decision may make it difficult for donors to identify who to blame or compliment for development outcomes (Fruttero and Gauri, 2005). If this leads to failure not being linked to a curtailment of funding from the donor, NGO programs are likely to concentrate themselves in the same location (Fruttero and Gauri, 2005). External funding can thus result in the agglomeration of NGOs in one area.

Studies on location choices of MNEs assert the influence of the presence of other firms in a target market in the case of for-profit organizations as well (Mariotti et al., 2010). Such a conclusion is based on the effect of information externalities and knowledge spillovers. More specifically, it has been empirically demonstrated that firms are likely to agglomerate with other MNEs when the foreign investment is marked by high uncertainty and high information costs, because they can adopt mimetic behavior. Secondly, MNEs are found to agglomerate with domestic firms when these hold comparative advantage and with other MNEs on the basis of potential knowledge inflows. When instead the presence of domestic firms could potentially result in knowledge outflows, due to the fact that such firms do not hold any comparative advantage, firms are less likely to agglomerate with said domestic firms.

Given their charity-driven nature, NGOs are not in competition with each other and for this reason the potential of knowledge outflows is not an issue in NGO location choices. The prospect of adopting mimetic behavior and receiving knowledge inflows instead is applicable to NGOs as their location choices often involve extremely distant and unfamiliar countries.

P5(a). When there are numerous NGOs in a country and attributing failure to a single NGO is

difficult, NGOs locate themselves there.

P5(b). When there are numerous NGOs in a country and receiving knowledge inflows is possible,

The decision of NGOs to locate themselves where other NGOs are already present brings up the fourth investment motive extracted from NGO literature, which relates to strategic alliances. NGOs rely heavily on collaborations with governments, inter-governmental institutions and MNEs to reach their objectives (Lambell et al., 2008). The prospect of forging these types of alliances is likely to play a big role in NGO location choices. Political hazard is likely to impede the creation of strategic linkages with players of interest to NGOs (governments, inter-governmental organizations and MNEs). Given the dependence of alliances on the political stability of the host country, strategic alliances between NGOs and the aforementioned actors are likely to influence the importance of political hazard in NGO location choices.

As is the case in MNE activity, relational linkages refer to the creation of strategic links by a firm in order to acquire advantages from resources that are lacked, by creating a link to a foreign country in which these are available. The availability and ease of establishing such linkages are likely to significantly determine FDI location choices as well (Chen and Chen, 1998).

Consequently, firms generally avoid investing in countries where policy credibility is low, meaning that public policy makers can act unilaterally or know that allies will support their actions. Countries with a similar public policy environment are considered politically hazardous (Delios and Henisz, 2003).

P6. When a country is politically hazardous, NGOs do not locate themselves there.

The identification of NGO expansion motives on the basis of Dunning’s (1998) model on FDI motives in for-profit MNEs has made it possible for six propositions to be formulated on the rationale of NGO location choices, thus enriching the knowledge on factors determining NGO location choices. In turn, the six working propositions identify six specific factors influencing NGO decisions on where to expand on an international level.

Factors influencing NGO Location Choices

MNE FDI

motive

NGO FDI motive Propositions Factors

Market seeking Need seeking P1. Need seeking internationalization will be driven by the perceived degree of greater need in one

location relative to another.

Country need

Resource seeking Fund seeking P3. NGOs locate themselves in countries where wealth and the propensity to give (philanthropy) are

higher.

• Wealth

• Philanthropy Reputation seeking P4(a). When NGOs have already established programs in one country and these are successful, they

are likely to build reputation through geographical expansion.

P4(b). When NGOs have already established programs in one country and these are not successful,

they are likely to build reputation through brand building within that country.

Other NGOs

Efficiency seeking Strategic-alliance seeking

P5(a). When there are numerous NGOs in a country and attributing failure to a single NGO is

difficult, NGOs locate themselves there.

P5(b). When there are numerous NGOs in a country and receiving knowledge inflows is possible,

NGOs locate themselves there.

Previous experience

Strategic-asset

seeking

P6. When a country is politically hazardous, NGOs do not locate themselves there. Political hazard

Moderator P2(a). When CAGE distance is neglected in the location choice NGOs are expected to face more

difficulty after entering a host location.

P2(b). When CAGE distance is reflected in the location choice NGOs are expected to face less

difficulty after entering a host location.

CAGE distance

3. Methodology

###The goal of this study is to explain how INGOs choose which countries to expand to by identifying factors shaping NGO location choices in the process of internationalization. The research seeks to bridge an existing gap in academic literature between international strategy and NGOs, where the former fails to address the latter. In the literature review a synthesis of significant themes regarding location choices of both for-profit MNEs and NGOs leads to five propositions being formulated on NGO location choice. The following section focuses on the design and implementation of a multiple-case study conducted to draw conclusions on the validity of said propositions. First, an overview of the research philosophy is provided in which conceptual issues regarding research methods are addressed. Secondly, the most appropriate research model for the purpose of this specific research is identified. The research design and implementation are then addressed. Finally, a focus on on how the data collection and analysis are conducted conclude the section.#

Research philosophy

The way in which research is conducted is highly dependent on the research philosophy adopted by

the researcher, which consists in the assumptions the researcher holds on the way he or she views the world (Saunders and Lewis, 2012). The research philosophy adopted in this study is an objective post-positivist one.

A research’s ontology refers to the nature of the reality and can be divided into objectivism and subjectivism. It is a concept that represents the researcher’s philosophy about the reality and the world. An objective ontology argues that an independent researcher examines the reality as it is, without altering it. A subjective ontology on the other hand argues that reality is a product of the human mind and consequently each individual has its own projection of reality (Brannick & Coghlan, 2007). The epistemology instead refers to the knowledge necessary for the study and in regards to it post-positivism focuses on the creation of new knowledge and the extension of established theories (Ryan, 2006). While objectivism is used in the following research, post-positivism regarding the epistemology reinforces the idea that reality cannot be known in its totality but only probabilistically (Gephart, 2004). While positivism assumes thaits findings are to be accepted as facts or laws, post-positivism assumes its findings as non-falsified and therefore may be regarded as probable facts or laws (Guba & Lincoln, 1994).

Research method

A research study aims at building a theory, an explanation of the relationship between two variables (Saunders and Lewis, 2012). How that theory is built is important for the construction of the research

design. Two research approaches can be identified (Saunders and Lewis, 2012): Deduction and induction.

The construction of a theoretical framework on NGO location choices involves a deductive process. Induction involves the collection and analysis of data, followed by the development of a theory. A “bottom up” approach is adopted, whereby specific observations of NGO FDI choices lead to the identification of patterns and regularities, which are elaborated into theoretical generalizations. The deductive approach on the other hand consists in testing a theory through a specific strategy. A research question is defined and operationalised, data is collected and analysed to answer the question, and the initial theory is confirmed or modified (Saunders and Lewis, 2012).

Academic literature also makes a distinction between exploratory, descriptive and explanatory studies (Saunders and Lewis, 2012). The data collection and analysis in the present paper aims at answering “how” NGOs choose which countries to operate in, identifying itself as an explanatory study. Explanatory studies seek to explain a certain circumstance by discovering causal relationships. The investigator needs to examine FDI activity conducted by NGOs over time and elucidate operational links between situational factors and location choices.

When a topic is not understood well by the researcher, he or she conducts exploratory research to discover information about the topic. Exploratory research usually involves searching for academic literature, interviewing experts in the subject and conducting interviews. Descriptive research instead makes use of questionnaire surveys, sampling, interviews and a reanalysis of secondary data in order to give an accurate description of persons, events or situations.

Within the exploratory, descriptive and explanatory categories of research, there are different methods that should be chosen according to specific conditions of the research (Yin, 2014). When choosing the appropriate research method researchers should first answer three questions: What type of research question is being asked (“who”, “what”, “where”, “why” and “how”), how much control the investigator has over behavioral events and if the research focuses on contemporary or historical events. On the basis of this framework, researchers choose between experiments, surveys, archival analyses, histories and case studies (Yin, 2014).

Methods most commonly used in explanatory studies include case studies, observation, historical analysis, attitude surveys and statistical surveys (Saunders and Lewis, 2012). The identification of factors determining NGO location choices necessitates the implementation of the case study method. Case studies as a research method are explanatory and answer “how” and “why” questions. Furthermore, they examine contemporary events and cannot manipulate the relevant behaviors. Techniques preferred by researchers conducting case studies are documents, artifacts, interviews and observations (Yin, 2014). As previously stated, the research aims to answer a “how” question dealing with the explanation of NGOs’ international evolution. Furthermore, the investigators look at past NGO decisions regarding FDI and thus have no control over the events studied.

Case studies bring along with them four main difficulties that researchers try to overcome. The first is that bias can enter into experiments (Rosenthal, 1966). Bias relates to many research methods but has been encountered more frequently in case studies. Investigators must report everything fairly (Yin, 2014). The second is that case studies risk providing an insufficient basis for scientific generalization (Kennedy, 1978). Since case studies are only generalizable to theoretical propositions and not to populations, multiple-case studies can provide a basis for scientific facts (Yin, 2014). Case studies are also said to take too long and to result in large, complicated documents (Feagin et al., 1991). For this reason, one can avoid lengthy narrative as well as use rapid methods of data collection such as the Internet (Yin, 2014). Finally, case studies have been criticised for not establishing causal relationships (Jadad, 1998). Case studies can therefore complement experiments by explaining “how” and “why” the treatment in them worked (Cook and Pane, 2002).

The aforementioned risks in conducting the case studies are taken into consideration in this research and the appropriate measures, which have been mentioned, are applied.

Research design

In order to link collected data to an initial research question, one must elaborate a research design

(Yin, 2014). There are five crucial components of research design in case studies (Yin, 2014).

The first element is the research question, which is most likely a “how” or “what” question. The research question of this study is formulated in the following way: How do NGOs choose which countries to expand to?

Secondly, study propositions indicate the object of examination. Six working propositions extrapolated from existing academic literature are constructed:

P1. Need seeking internationalization will be driven by the perceived degree of greater need in one

location relative to another.

P2(a). When CAGE distance is neglected in the location choice NGOs are expected to face more

difficulty after entering a host location.

P2(b). When CAGE distance is reflected in the location choice NGOs are expected to face less

difficulty after entering a host location.

P3. NGOs locate themselves in countries where wealth and the propensity to give (philanthropy) are

higher.

P4(a). When NGOs have already established programs in one country and these are successful, they

are likely to build reputation through geographical expansion.

P4(b). When NGOs have already established programs in one country and these are not successful,

they are likely to build reputation through brand building within that country.

P5(a). When there are numerous NGOs in a country and attributing failure to a single NGO is

P5(b). When there are numerous NGOs in a country and receiving knowledge inflows is possible,

NGOs locate themselves there.

P6. When a country is politically hazardous, NGOs do not locate themselves there.

Thirdly, the unit of analysis defines what the actual case is. The selected unit of analysis for this case study is the NGO. Four NGOs are put under the lense. The research considers FDI conducted in each NGO. In particular, FDI is tested as being characterized or not by factors related to working propositions:

Country need: Access to water and healthcare, life expectancy and illiteracy

CAGE distance: Cultural, administrative, geographic and economic distance between home and host

country

Wealth/Philanthropy: Wealth and the propensity to give (philanthropy) Previous experience: Whether FDI in the same country precedes this one Other NGOs: Whether other NGOs are already present in that country Political hazard: Political risk indicator

Fourthly, the way in which data is linked to propositions is an important ingredient of the research design and can include pattern matching, explanation building, time-series analysis, logic models, and cross-case synthesis.

Finally, a research design needs to include criteria for interpreting the study’s findings. One can identify rival explanations and take them into consideration.

To ensure a high quality research design, the researchers strive to satisfy four commonly used tests in the world of research (Yin, 2014). Construct validity is the extent to which a study investigates what it claims to investigate. To ensure construct validity, one can take three steps: Use multiple sources of evidence, establish a chain of evidence and have the draft case study report reviewed by key informants (Yin, 2014). Internal validity occurs when a causal relationship is explained and no external factor influencing the relationship has been neglected. The risk of invalidity in this case can be overcome through pattern matching, explanation building, addressing rival explanations, and using logic models (Yin, 2014). External validity is the extent to which a study’s findings are generalizable beyond the study itself. The issue can be addressed by using theory in single case studies and replication logic in multiple-case studies (Yin, 2014). Finally, reliability is the extent to which other researchers conducting the study along the same steps would reach the same insights. One must firstly document the procedures followed for other investigators to be able to repeat the case study. In order to ensure that procedures are well documented, two tactics are provided: The use of a case study protocol and the development of a case study database (Yin, 2014).

Multiple-Case Study Design

The research method used to identify NGO location choice determinants is the multiple-case study. A multiple-case study, as the name suggests, is an alternative to single-case studies containing

more than one case. Multiple-case studies are considered to be more robust than single ones (Herriott and Firestone, 1983). Replication logic has been suggested as ideal for multiple-case studies (Hersen and Barlow, 1976). This means that each case should be selected so that it either predicts similar results (literal replication) or predicts contrasting results but for anticipatable reasons (theoretical replication) (Yin, 2014). Moreover, a theoretical framework needs to state the conditions under which literal replication or theoretical replications are likely to occur. When cases do not work as predicted, theory must be modified (Yin, 2014).

Multiple-case studies can be holistic or embedded just as single case studies (Yin, 2014). In this research the validity of each working proposition is established on the basis of data collection for each NGO and a subsequent integration of this data, which treats the multiple cases as one unit of analysis (holistic multiple-case study). A holistic design in multiple-case studies is when multiple cases are treated as one unit of analysis (Yin, 2014). An embedded design is used when research is conducted seperately and appropriately for each case.

Case Selection

Case selection in multiple-case study designs is somewhat complicated (Eisenhardt and Graebner, 2007). Each case in this research is selected so that it either predicts similar results (literal replication) or predicts contrasting results but for anticipatable reasons (theoretical replication) (Yin, 2014). The four NGOs selected for the multiple-case study are Oxfam, Doctors Without Borders, Amnesty International, and Greenpeace. Each of these deals with different developmental issues and has outposts in multiple countries. Moreover, they are all characterized by international fame and transparency, which facilitates accessibility to data via Internet.

Operational Advocacy

Doctors Without Borders (Health) Greenpeace (Environment) Oxfam (Poverty) Amnesty International (Human Rights)

Data Collection

Constructs and hypotheses are strengthened by the practice of triangulation, the use of multpile data collection methods (Eisenhardt, 1989). Investigators should make use of both quantitative and qualitative data if this strengthens their research. The techniques used in the case study are observation and the use of documents. Data concerning NGO FDI is collected from each NGO’s annual reports and NGO newpapers (observation).

Data Analysis

An overlap of data collection and data analysis is often advised and is applied in the conduction of this case study (Glaser and Strauss, 1967). In fact, not only does this overlap give researchers a head start on the process of data analysis, it allows researchers to take advantage of flexible data collection Eisenhardt, 1989). This overlap can and is achieved through good field notes. Useful field notes result from writing down all impressions and questioning how informative the notes are (Eisenhardt, 1989).

Within-case analysis, which involves detailed case study write-ups for each NGO, facilitates the study of enormous volumes of data (Eisenhardt, 1989). When an investigtor is intimately familiar with each NGO, unique patterns of each emerge before the researcher bushes generalization. Moreover, when an investigator acquires rich familiarity with each NGO, this accelerates cross-case comparison (Eisenhardt, 1989).

Once within-case analysis and cross-case comparison have been concluded, researchers compare the emergent framework with each NGO and assess the fit (Eisenhardt, 1989). Completing this practice includes sharpening the definition of the construct, building evidence that measures the construct in each NGO and verifying that the emergent relationships between constructs fit with the evidence in each NGO (Eisenhardt, 1989).

Analytical Strategy

The case study in process explores six working propositions that have been constructed from existing academic literature.

The selected unit of analysis for this case study is the NGO. Four NGOs are studied: Oxfam, Doctors Without Borders, Amnesty International, and Greenpeace. Each deals with a different developmental issue. It makes sense to choose extreme and polar cases in which the process of interest is transparently observable (Eisenhardt, 2013). The authors have chosen to identify NGOs according to area of interest: health (Doctors Without Borders), poverty (Oxfam), environment (Greenpeace) and human rights (Amnesty International).

The research considers FDI conducted by each NGO. In particular, FDI is tested as being characterized or not by the following factors related to the working propositions: country need, CAGE distance, wealth/philanthropy, previous experience, other NGOs present and political hazard.

A timeline of international projects between 2005 and 2010 is built for each NGO based on annual reports provided on each NGOs’ website. For each project, location, motives, decision factors, CAGE distance, its assessment and project effectiveness are identified and supported with illustrative material. Such an arrangement of data provides a clear illustration of each NGO’s location choices and data to support the previously formulated working propositions.

Factors influencing the location choice of each project are determined by NGO annual reports provided by each NGOs’ website as well as international databases which provide country data found on The World Bank (World Bank, 2015) and assessment tools such as the United States Department of Commerce’s ACE tool for measuring political risk (Assess Costs Everywhere, 2015). Country need is determined by the emergency characterizing the particular country, stated in the NGO’s very annual report. Wealth is determined by the host country’s GDP per capita, reported on the GDP per capita map for the 2010-1014 time frame, found on the World Bank. Philanthropy is defined as the national attitude towards philanthropy in the country and found on the Global Giving Resource report, which outlines the philanthropic history of each country. Previous experience is determined by the documentation of projects in that country in the NGO’s previous annual reports. The presence of other NGOs in the host country is revealed by a quick research on the Worldwide NGO Directory provided by the Worldwinde Association of Non-Governmental Organizations (WANGO, 2015). Political hazard is revealed by research conducted on government stability in the country and reported on the ACE tool of the United States Department of Commerce. CAGE distance is based on Ghemawat’s (2001) CAGE comparator, using the number of English speakers in each countries as an indicator of cultural distance, the relations between the two countries found on the government website of the home country as administrative distance, the physical distance between the two countries and the presence of bodies of water as geographic distance, and country GDP per capita as economic distance. CAGE distance assessment on behalf of the NGO is determined by the NGO’s annual report. Finally project effectiveness is drawn from NGO newspapers reporting on the success or failure of the project. NGO news reports assessing the quality of each project are read and analyzed through a coding scheme. Coding schemes are a critical data reduction tool (Miles & Huberman, 2013). Coding is an established method of “meaning condensation” (Lee, 1999) in which the most relevant themes (“codes”) are abstracted from the data, arranged in a hierarchy to record relationships, and noted in a dictionary that builds during data analysis to document the precise meanings (Kreiner et al., 2006). A code is assigned to a section of text when researchers recognize a theme in it.

News reports from each NGO project are collected and text search is conducted on the basis of specific codes and search terms to assess the success or failure of the project. Sections of the project report were coded into success or failure according to the following search terms:

Explanation News reports from each NGO project are collected and text search is conducted on the basis of specific codes and search terms to assess the success or failure of the project. Sections of the project report were coded into success or

failure according to the following search terms

for each INGO.

Success Failure

Doctors Without Borders supported, provided,

prevented, supplied

unable, suspended

Oxfam helped, increased,

positive

unable, suspended

Greenpeace protected, prevented,

endorsed, stopped

unable, continue to use

Amnesty International succeded, improved no action, still

operating, no imrpovement

Fig 5. Project performance

Nvivo 10 is used in the following research to create codes, perform text searches and facilitate causal links. News reports from each NGO project are collected and text search is conducted on the basis of the specific codes and search terms for each NGO.

4. Results

The results of the case study are obtained through a multiple-step approach. First, a table is built for each INGO breaking down the international projects it carried out between 2005 and 2010. Within this table, each project is described according to the presence or not of country need, wealth/prosperity, other NGOs present, previous experience, political hazard, CAGE distance, CAGE distance assessment and project performance. Patterns are identified from each table, giving results which are then tied to the previous theoretical framework. Secondly, a cross-case analysis is completed, in which results and patterns from each INGO analysis are integrated and compared to build a conceptual framework on factors influencing INGO location choices

4.1 Within-case analysis

Doctors Without Borders

Doctors Without Borders, or Médecins Sans Frontières, is a Switzerland-based INGO dedicated to delivering medical aid to those affected by conflict, epidemics, natural disasters, and exclusion from healthcare. Founded in 1971, MSF started as an organization sending doctors to crisis zones and later developed into a more structured organization. Today MSF employees more than 30,000 people across the world and has offices in 28 countries (MSF, 2014).

An evaluation of Doctors Without Borders’ location choices is illustrated in fig.4. International activity in the Kashmir region of Pakistan and India (2005), Jordan (2006), Chad (2007), Ethiopia (2008) and Pakistan (2009) are analyzed in terms of factors influencing the location choice. The identification of patterns along columns and rows allows conclusions to be drawn in terms of motives feeding the projects.

Results reveal that Doctors Without Borders is always lead by a need seeking motive in its decisions to initiate campaigns and concrete operations abroad. Examples include the devastating earthquake in India and Pakistan as well as the nutritional crisis in Ethiopia. Furthermore, the organization states in its own charter that “MSF rejects the idea that poor people deserve third-rate medical care and strives to provide high-quality care to patients” (Médecins sans Frontières, 2014), emphasizing the importance of responding to country need.

Reputation seeking as well as strategic-alliance seeking also seem to be constant motives for Doctors Withour Borders’ activities abroad, as the presence of previous experience and other NGOs create a pattern across rows. The reputation seeking motive is demonstrated by previous experience, which is constant in all of Doctors Without Borders’ observed activities. Strategic-alliance seeking instead is revealed as a significant motive as the presence of other NGOs characterizes the NGO’s foreign operations. These results support the important role played by donors and partners in an INGO’s activity. As the attempt to build a reputation is linked to the necessity of funding, the

reputation seeking motive is supported by the organization’s statement that “around 5 million individual donors around the world provide some 89 per cent of our funding. This helps to ensure operational independence and flexibility. The remaining funds come from governments and international organisations” (Médecins sans Frontières, 2014). As far as strategic-alliance creations are concerned instead, Doctors Without Borders gives great importance to it in its international activity as it has formed strategic alliances with the international organizations The Lindesmith Center (TLC), Open Society Institute-Russia (OSI-R) and Médecins du Monde.

Political hazard instead does not result as a factor supporting the INGO’s quest for strategic-alliances. As Doctors Without Borders is an INGO which delivers emergency aid to people affected by armed conflict, epidemics, natural disasters and exclusion from healthcare (Médecins Sans Frontières, 2014), it has mostly to do with unstable environments and thus cannot exclude politically hazardous countries from its horizon.

Fund seeking instead is found to be completely absent from the NGO’s initiating motives, confirming that the wealth and philanthropy in a country are not determining factors in Doctors Without Borders’ decision to go overseas. As the organizations targets countries in severe need and politically unstable conditions, it logically excludes the possibility of collecting funds.

Regarding the relationship between an NGO’s correct assessment of CAGE distance and the project’s success or failure, results reveal a pattern in which in three out of five cases, an adequate consideration of CAGE distance results in a successful project, while in the two remaining ones, a mismeasured CAGE distance results in unsuccessful project. Thus, the relationship is confirmed. As Doctors Without Borders stresses the fact that it offers assistance to people based on need, irrespective of race, religion, gender or political affiliation (Médecins Sans Frontières, 2014), it is evident that neither cultural, administrative, geographic, nor economic distance will keep it from conducting activities in a country. Results reveal however that the greater the CAGE distance between home and host country, the more an adequate assessment of it is linked to positive results.

Doctors Without Borders Location Choices Ye ar Co u n tr y Mo ti ve (s ) Co u n tr y n ee d We al t/ P h il an th ro p y Pr ev io u s ex p er ie n ce Ot h er N GOs Po li ti ca l h az ar d CAG E CAG E a ss es sm en t Pr oj ec t ef fe ct iv en es s Il lu st ra ti ve m at er ia l 2005 Kashmir region Need seeking Reputation seeking Strategic-alliance seeking

Yes No Yes Yes Yes Cultural, administrative, geographic, economic

Yes Positive Devastating earthquake hits Southeast Asia. (country need)

MSF teams are already present in the region, and are able to respond quickly. (CAGE assessment) Supply of tents, generators, and waterpump, bladder-tank & sanitations products for the victims of the earthquake (project effectiveness) 2006 Jordan Need seeking Reputation seeking Strategic-alliance seeking

Yes No No Yes Yes Cultural, administrative, geographic, economic

Yes Positive Severely war-wounded patients referred by medical colleagues in Iraq (country need)

Unable to work safely in Iraq, MSF sets up a surgical program in Jordan. (CAGE assessment)

The MSF surgical project has provided medical emergency services to over

the region. (project effectiveness) 2007 Chad Need seeking Reputation seeking Strategic-alliance seeking

Yes No Yes Yes Yes Cultural, administrative, geographic, economic

Yes Positive More than 150,000 displaced people attempt to survive in makeshift camps in eastern Chad as fighting escalates between

government and rebel groups. (country need) Operating from local hospitals since 1986. (CAGE assessment) MSF is supporting three hospitals and several more outlying health posts across eastern Chad, providing access to emergency medical and nutrition support to an estimated two million people. (Project effectiveness) 2008 Ethiopia Need seeking Reputation seeking Strategic-alliance seeking

Yes No Yes Yes Yes Cultural, administrative, geographic, economic

No Negative Massive nutritional crisis sweeps the south of the country as a result of drought, poor harvests, and soaring food prices. (country need)

Administrative hurdles and intimidations towards MSF staff have prevented the organization from bringing urgently needed medical care. (CAGE assessment) Unable to respond to the

medical needs of populations affected by internal conflict in Ethiopia’s Somali Region, MSF has decided to stop its activities and withdraw. (project effectiveness) 2009 Pakistan Need seeking Reputation seeking Strategic-alliance seeking

Yes No Yes Yes Yes Cultural, administrative, geographic, economic

No Negative Violence and widespread displacement in Pakistan (country need)

May have been able to operate if had agreed to work through national NGOs or only with members of team from Pakistan. (CAGE assessment)

Work is suspended after two staff members are killed. (Project assessment)