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The CommunityFirst Framework is intended to be implemented by field teams at MSF. The theoretical aspects and evidence presented on the importance of community engagement are intended for all MSF staff seeking to learn more about why and how to shift the way we work with communities as humanitarians. We believe this guideline, and other tools like it (including OCA’s Person-Centred Approach Guidance07, and MSF Vienna Evaluation Unit’s Guidance for Involving Communities08), to be an important contribution to the growing movement of communities and humanitarian actors who are pushing for changes in the humanitarian system that translate to dignity, health, justice, equity and self-determination for communities around the world. Specifically, the CommunityFirst Framework is intended to guide MSF teams to co-design health strategies with communities, throughout all stages of the project cycle, for exploratory missions, projects that are just opening, projects that have been running for some time, or those that are closing. At the time of publication, the CommunityFirst Framework has been tested in pilot projects in: (1) Madre de Dios, Peru (MSF OCP, August 2022), (2) Tonkolili, Sierra Leone (MSF OCA, November 2022) and (3) Anzoátegui, Venezuela (MSF OCB, February 2023) The experiences from these pilots (feedback from teams, implementation results, adaptations to each context, etc.) have informed the adaptation of the Framework. CommunityFirst builds on existing community engagement work inside MSF and contributes a practical framework for co-designing health initiatives with communities. To avoid duplicating efforts and resources around community engagement inside MSF, the appendices in this guideline largely refer to already existing MSF resources.09 This guideline is meant to be a living document that can evolve and be adapted given the experience of MSF staff and community members and diverse community contexts. This guide can be used by anyone in MSF who is interested in partnering with communities to improve the responsiveness and impact of their humanitarian programs. This is the first iteration of the document. Subsequent iterations will be published based on additional testing during future phases of the CommunityFirst TIC project.