Academic journal article Bulletin of the World Health Organization

Examining Health-Care Volunteerism in a Food- and Financially-Insecure World

Academic journal article Bulletin of the World Health Organization

Examining Health-Care Volunteerism in a Food- and Financially-Insecure World

Article excerpt


The problem of severe shortages in global health workforces is addressed in many places by using community volunteers. Whether it is unjust and/or unsustainable to rely on volunteerism in low-income settings, particularly in sub-Saharan Africa, has become a major concern for a widening group of researchers and community health practitioners, particularly in the wake of the 2008 food and financial crises.

The World Health Organization (WHO) recommends that "essential health services cannot be provided by people working on a voluntary basis if they are to be sustainable. While volunteers can make a valuable contribution on a short-term or part-time basis, trained health workers ... should receive adequate wages and/or other appropriate and commensurate incentives". (1) In other words, volunteerism is not a sustainable practice in low-income settings, in particular because the lack of regular, predictable remuneration leads to high turnover rates in volunteer workforces, and thus wastes substantial resources on recruitment and training. But will various" players in HIV/AIDS treatment and care attempt to adhere to WHO's recommendation?

For the recommendation to be effective, policy-makers and practitioners will need to do (at least) three things: first, examine the myth of the humble, sacrificing volunteer spirit; second, determine how --and whether it is even possible--to hold volunteers accountable for the quality of the work that they do; and third, come to some consensus on what is meant by sustainable.

The myth of the selfless volunteer

Volunteer HIV/AIDS-care projects in low-income settings rest on the assumption that local communities are full of "untapped" moral and social energy, producing an abundance of individuals ready to donate their labour to make their communities healthier. Armed with this convenient assumption, the question of why one does not have to pay for labour is easily answered--because locals are simply willing to do it for free. This myth is apparent in discourses of major international nongovernmental organizations: in its 2007 Ethiopia report, Family Health International boasted that it had trained more than 11000 volunteers for home-based care and antiretroviral treatment support, and wrote, "The level of interest and commitment of volunteers to the program has been overwhelming.... The program has shown the untapped spirit of volunteerism that exists within Ethiopian communities despite such pervasive poverty". (2)

How should we interpret this "spirit" that international organizations, public health and donor communities are so keen to tap ? Underlying this question is the issue of whether a loaded term like "volunteer spirit" is a veneer for labour exploitation. Choosing a stance on this issue depends on one's perspective.

On the one hand, lay persons who have been affected by HIV/AIDS are often uniquely capable of providing culturally-congruent and compassionate chronic disease care. (3,4) Further, many volunteers involved in the struggle to roll out antiretroviral therapies say that they derive spiritual satisfaction and meaningful relationships by helping others. (5) Thus from this perspective, community health programmes have the potential to generate psychosocial and health "capital" derived from volunteers' pro-social motivations. This is a far cry from straightforward labour exploitation.

On the other hand, recognizing the production of such psychosocial benefits suggests that the pro-social "spirit" of volunteers--not just their physical labour--is usurped by the programmes that they serve.

From this perspective, the organizers of volunteer workforces attempt to generate and maintain Durkheimian solidarity or "shared emotional energies" (6,7) among volunteers and the communities they serve. The ritual reinforcement of religious and pro-social values among volunteers occurs in training programmes, "appreciation" ceremonies and every-day interactions between supervisors, patients and volunteers. …

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