UNA SOCIEDAD ATRASADA

A popular imaginary amongst volunteer practitioners, policy makers, and researchers is that voluntarism empowers individuals, encourages civic participation, and enhances social cohesion (Devereux, 2008). This view, however, is widely contested with some observers citing the self–serving motivations of volunteers (e.g. Cannon et al., 2005; Simpson, 2004). In an article, Rachel Mendelson (2008) asks, “is volunteering about saving the world or enhancing a résumé?” This is inherently a difficult question to answer.

There are lots of ‘ifs’ and ‘buts’ when answering this question. It is important to approach this from a whole life perspective, and from the point of view of stakeholders including the volunteers and their hosts.

2.7.1 Benefits for volunteers

The benefits of volunteering to individual volunteers who choose to embark on an international voluntary placement are emerging as a popular research topic as the field continues to grow (e.g. Pastran, 2014; Jones et al., 2013; Baillie Smith et al., 2011). Evidence suggests the practice of voluntarism generates a number of diverse benefits for volunteers including greater participation in the community (Salamon et al., 1999); establishing new social ties (Arai, 2000); learning about diversity and tolerance (Brown, 1999); greater appreciation for civic affairs (Davis Smith, 1999; Arai, 2000); a ‘rite of passage’ generating critical (often essential) mobility/career capital (Ackers et al., 2017); social capital (McBride, Lough and Sherraden, 2012; cultural competency (Thompson, Boore, and Deeny, 2000); and awareness of global inequalities (DeCamp, 2007). Further benefits for volunteers are identified through the concept of ‘frugal innovation’ or ‘reverse innovation’ (Syed et al., 2013). Research suggests that there are multiple opportunities to learn from LMICs and LICs, for example around improved surgical procedures (e.g. Abeygunasekera, 2004), and improved skill mix with scaled use of community health workers (e.g. Kumar et al., 2008). Evidence of frugal innovation is cited in studies that explored the benefits of overseas placements for the NHS. Hague, Sills and Thomson (2015) conducted a study aimed at assessing the benefits NHS volunteers gained from overseas placements.

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Building on Longstaff’s (2012) toolkit for collecting evidence of knowledge and skills gained through global health volunteering, volunteers reported gaining competence in several areas of the NHS’ Knowledge and Skills Framework (KSF). These included KSF competencies in communication, equality, diversity, capacity and capability, supporting findings of previous health partnerships evaluation (e.g. Longstaff, 2012). Furthermore, the volunteers reported gaining a greater confidence to adapt practice and consider resource utilisation in their NHS roles (Hague et al., 2015). Similarly, a systematic review by Jones et al. (2013) of the current research concerning international volunteering and its benefits to individuals highlighted similar outcomes. The authors used the KSF to map the benefits volunteers reported while on international placement to provide a framework indicating key outcomes of the volunteer experience. The review found 40 individual benefits to volunteers; examples of which included “clinical skills, management skills, communication and team work, patient experience, dignity, policy, academic skills and personal satisfaction and interest” (Jones et al., 2013, p.5). The benefits identified by Jones and colleagues (2013) correspond with emerging themes in the SVP evaluation reports (e.g. Ackers et al., 2014), which highlight diverse skills volunteers gained following their placements in Uganda. In addition to clinical skills – complex cases, exposure to diseases that are less common but present in the UK; hands–on exposure to cases that emerge in LICs due to extensive delays which NHS staff often have theoretical or limited practical exposure to are cited as key benefits of volunteering for NHS staff. Further, the All Party Parliamentary Group (APPG) on Global Health ‘Improving Health at Home and Abroad’ (Crisp and Hillier, 2013, p.11- 13) identified three key benefits NHS staff can gain from volunteering abroad:

1. Leadership development. Working in LMICs and LICs presents an opportunity to develop leadership and management skills of NHS staff – central tenets of the Health and Social Care Act 2012.

2. Sharing innovation: It is widely acknowledged that international volunteering brings NHS staff into first–hand contact with professionals and settings across the world with novel approaches to healthcare delivery.

The report saw innovation as “the only way” to meet the current challenges of exponentially rising demand and constrained resources. This was echoed at

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the King’s Fund by the originator of the term ‘reverse innovation’, Professor Chris Trimble14_.

3. International relationships:

“Many individual organisations running overseas schemes noted the contribution it made to their reputation. Developing an international presence was something of a growing trend within the UK health sector, as this opened up new opportunities domestically and overseas.” (p.13).

Similar impacts on hosts is hard to come by. However, there are a few studies that examined host impacts of voluntarism which are outlined next.

2.7.2 Benefits for Hosts

Literature on the benefits of voluntarism from the perspectives of hosts is very limited (e.g. Lasker, 2016). However, there are a handful of field studies that purposefully explored the benefits of volunteering for hosts in LMICs and LICs. These studies indicate that international volunteering has the potential for positive impacts for all stakeholders (Graham et al., 2011). For example, Comhlámh’s 2006 study showed host organisations in India and Tanzania associated volunteers with skill sharing and improved cultural awareness. Similar findings emerged from Tanzania and Mozambique. Graham and colleagues found that host organisations in both countries stated that international volunteers were able to view their programmes and settings with ‘fresh’ eyes and were able to produce technical and cultural innovation. One Mozambican host organisation cited in Graham et al.’s study stated:

“An international volunteer brings innovation/innovative thinking and different experiences of dealing with problems. They can contribute to the improvement of certain activities that the organisation is implementing. If there is a doubt, quickly there is an exchange of ideas and things move forward.” (2011, p. 13). Furthermore, Laleman and colleagues (2007) conducted a study among ‘African health managers’ in several Sub–Saharan African countries including Uganda, the context of this study. The study explored the contributions of international volunteers placed in health systems in sub–Saharan Africa. Positive outcomes reported by African health managers included innovation and management, knowledge exchange (particularly via highly–skilled volunteers), and improved health system learning.

14 _{http://www.kingsfund.org.uk/time-to-think-differently/audio-video/chris-trimble-reverse-innovation-}

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The African managers also suggested that foreign health volunteers facilitated international exposure, solidarity and networking. However, the authors cautioned that such benefits were limited to highly–skilled volunteers and, those with longer– term service commitments who were perceived as “fitting well within and strengthening existing structures and having more appropriate qualifications.” (p.8). More recently, research showed benefits to host communities manifest through advocacy and international networking. A survey of around 1,750 international volunteers undertaken by VOSESA showed that returned volunteers reported maintaining close contact with their placement hosts and international development more generally. The returned volunteers also reported linking their placement hosts with international partners, and providing resources to them directly to support their work (Perold et al., 2011).