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Africa: international volunteer impact small but significant

International health volunteers make a small yet significant contribution in sub-Saharan Africa, according to research published in the online open access journal Human Resources for Health. Medical volunteer numbers remain low, and resources are shifting to local capacity building initiatives.

Geert Laleman and colleagues from the Institute of Tropical Medicine in Antwerp, Belgium quizzed human resource managers from 13 organisations sending volunteers to sub-Saharan Africa, and eight African medical officers with not-for-profit sector experience. In 2005 international health volunteers working in the region did not exceed 5000 full-time equivalent posts. Up to 1500 of these were doctors staying from a couple of weeks to two years. The annual cost to send a volunteer was typically $36 000 - $50 000.

Secular medical humanitarian NGOs, development NGOs and volunteer organisations, such as Voluntary Service Overseas (VSO) or the United Nations Volunteers (UNV) have distinct agendas. Young, secular medical organisations (such as Médecins sans Frontières) send the most volunteers – and adding more annually. Junior and inexperienced NGO volunteers were often ill prepared to work in low-income countries, country experts said. Volunteers didn’t always value local knowledge, and increased tension by creating parallel systems or procedures. However, longer-term volunteers to mission hospitals or those seconded by volunteer agencies to government facilities, often with specialist training such as tropical medicine, had a significant local impact on capacity building and resource allocation.

Health managers organise and develop health services for the general population, whereas volunteer organisations do not always fit into such a comprehensive and long-term approach. "Country health service managers in sub-Saharan Africa consider international volunteers as a last resort measure, judging that it is not very cost effective, as compared with investment in local capacity," says Laleman. "In countries in Southern and Eastern Africa hardest hit by HIV/AIDS, the reliance on international health volunteers, especially doctors, is likely to increase."

The World Health Organisation (WHO) identifies 36 countries with critical human resource shortages in sub-Saharan Africa. Development work has shifted focus towards long-term partnerships and local recruitment, and many western countries have cut budgets for sending development workers overseas.

Charlotte Webber | alfa
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