Medecins sans Frontieres (MSF, Doctors without Borders) is an organization that responds to humanitarian crises throughout the world with medical staff and supplies. The organization also acts as an advocate for those it serves, providing "testimony" (temoignage) about the plight of those caught up in humanitarian crises. In the late 1990s MSF began caring for people with HIV/AIDS and in 2000 began the first efforts to provide anti-retroviral (ARV) drugs to HIV-infected people in developing countries. The case describes these efforts, and, in particular, an initiative in Ethiopia by MSF Holland. The discussion of the situation in Holland focuses on the reasons why MSF began an ARV program in Ethiopia and what its future was likely to be. The case highlights the problems facing a highly decentralized organization oriented towards emergency response, which is, nevertheless, engaged in a long-term intervention. As such, it raises questions about the alignment between the organization's mission, structure, and the requirements of a particular program. It also highlights questions about organizational decision making both in terms of entry into a new initiative and exit from it. Finally, it provides an example of organizational effectiveness as advocacy - how proving the impossible is possible moves policy makers to act. The case is appropriate for classes on strategic management and operations management. HKS Case Number 1851.0

American businessman, Greg Casagrande, founder and president of the South Pacific Business Development Foundation (SPBD) in Samoa has a decision to make: who should he hire to be the next general manager of SPBD, when the contract of his current general manager ends in January 2005. Should he hire a local Samoan or a palegi, a foreigner? Casagrande founded the SPBD, a microfinance institution (MFI) providing financial services to poor people, in January 2000. He hired a Samoan with an MBA from the US to be his general manager. Nine months later Casagrande discovered that the general manager was engaging in a variety of fraudulent activities, as were some of his staff. Casagrande was forced to leave his home in New Zealand to fly to Samoa to step in directly. He instituted a number of reforms, including the decision to lend to women only. Casagrande's reforms put the SPBD back on track and, in 2002, he hired Minh Lai, a Vietnamese-Canadian investment banker, to become the general manager. Lai built on Casagrande's reforms, expanded the client base, and introduced new products, including a savings product. But questions still remained. Was SPBD having its intended impact on the lives of its women clients? Would SPBD reach its goal of financial self-sufficiency by 2006? HKS Case Number 1804.0

In 2003, Minh Lai, manager of the South Pacific Business Development Foundation (SPBD), a nonprofit microfinance institution providing financial services to women in Samoa, made a decision to lend to fa'afafines after several asked whether SPBD would lend to them. Fa'afafines are biologically men, but dress and behave like women. How boys become fa'afafines varies. It may be a matter of choice by a boy to take on a female role or it may be a role that they are raised to play by a family that has no or few daughters and needs someone to carry out female tasks within the household: cooking, cleaning, and washing. HKS Case Number 1805.0