Healthcare professionals such as doctors, nurses and midwives have been travelling to Low- and Middle-Income Countries (LMICs) for decades as missionaries, volunteers and researchers. However, there has been very little research into the potential benefits, costs and risks associated with such activities. Some researchers argue that, despite huge amounts of goodwill, voluntarism may not be effective and in some cases may actually be damaging for LMIC health systems. This research project examined the ethics and potential risks of such activities to volunteers, local staff, patients and LMIC health systems.
This action research project was initially funded by the Tropical Health Education Trust (£495,000) and ran from April 2012 to April 2015 through the Liverpool-Mulago Partnership. Its objectives were to assess the learning outcomes and risks associated with professional volunteering placements in LMICs and to develop an ethical and sustainable model that could maximise the positive impacts, sustainability and cost effectiveness of interventions, mitigate the risks for volunteers, local staff and patients and better address ethical considerations.
This action research project followed a mixed methods approach. Over 100 professional volunteers from Medical (Obstetric, Paediatric and Anaesthetic), Nursing, Midwifery and Biomedical Engineering backgrounds were placed in nine health facilities across Uganda, each for a minimum of 6 months. Their experiences and learning were assessed using various surveys, focus groups and interviews. Interviews were conducted with local staff, health officials and policy makers in both countries, as well as Royal Colleges and other development organisations. Quantitative data was also collected in the form of pre- and post-training questionnaires and surveys, health facility data and patient records in order to analyse the impact of volunteer interventions. The placement structures were continuously updated and refined over the course of the project in line with findings.
The project concluded that professional voluntarism can be ethical and the positive impacts of interventions be sustained, providing all risks are properly considered and that they are organised for the mutual benefit of all stakeholders. Without such considerations, professional voluntarism can be ineffective, or worse detrimental, to LMIC health systems, and can jeopardise the health and safety of both volunteers and patients. The importance of coordinating activities between individuals and organisations was highlighted, as well as the critically important role that current and previous professional volunteers can play in supervising new volunteers. It was found that long-term (or ongoing) on-the-job co-working between volunteers and local staff, as opposed to short-term ‘fly-in, fly-out’ training, greatly increased the learning outcomes for volunteers and local staff alike, and was also far more likely to lead to behaviour change and sustainability.
A successful model was designed and this now forms the basis of K4C’s ongoing professional volunteering activities. We have since placed over 250 additional professional volunteers in Uganda. The evaluation of all K4C professional volunteering activity is ongoing.
Our research findings have led to various important policy changes at government and organisation level. We have shared the findings at numerous conferences and workshops, as well as writing five publications which can be accessed (for free) using the links below:
Ackers, H.L.; Ackers-Johnson, J.; Chatwin, J. & Tyler, N. (2017) “Healthcare, Frugal Innovation, and Professional Voluntarism: A Cost-Benefit Analysis”, Palgrave Macmillan, DOI: 10.1007/978-3-319-48366-5
Ackers, H.L.; Ioannou, E. & Ackers-Johnson, J. (2016) “The Impact of Delays on Maternal and Neonatal Outcomes in Ugandan Public Health Facilities: the Role of Absenteeism”, Oxford University Press: Health Policy and Planning, 31 (1152–1161) DOI: 10.1093/h
Ackers, H.L.; Lewis, E. & Ackers-Johnson, J. (2014) “Identifying and Mitigating Risks in Medical Voluntarism: Promoting Sustainable Volunteering to support Maternal & Infant Well-Being in Uganda”, IARMM JMS
Ackers, H. L.; Ackers-Johnson, J. & Ssekitoleko, R (2018) “Maternal Mortality in Low Resource Settings: Are Doctors Part of the Solution or the Problem?” The BMJ Opinion (https://blogs.bmj.com/bmj/2018/06/28/maternal-mortality-in-low-resource-settings-are