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Sustainable Professional Volunteerism

Summary

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.

Objectives

Our Professional Volunteer Programme initially has its origins in an action research project, initially funded by the Tropical Health Education Trust. Through the Liverpool-Mulago Partnership, £495,000 was allocated to the project under the timeframe of two years from April 2012 to April 2015, with the objectives outlined as being 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.

Activities

This initial 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.

Conclusions of original research project

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, informing our decision-making and identification of in which services, the sustained support of professional volunteers is most suitable. We have since placed over 400 additional professional volunteers in our in-partner locations in both Uganda and Tanzania, and continue to utilise our sustainable model in the evaluation of all K4C professional volunteering activities.

Since then, the programme has transformed...

Since the completion of the Tropical Health Education Trust- Liverpool-Mulago Partnership project, K4C has placed more than four hundred additional NHS professional volunteers in our in-partner locations in Fort Portal, Kampala, Moshi and Zanzibar. With the ongoing input of volunteers themselves, we continue to utilise our sustainable model in the evaluation of all K4C professional volunteering activities.

Supported by the K4C team, many of our professional volunteers spend their first weeks at work gathering preliminary data and evidence of a local need within a healthcare facility, whether it be an inefficiency in resource-usage, a lack of a physical medical device, or a gap in knowledge practice. Once identified, volunteers communicate with the management team on how they would like to proceed designing and implementing an intervention to make a positive incremental change to this local need. Many choose to conduct training workshops or sessions, collaborating with Ugandan and Tanzanian nurses, doctors, midwives, to engage them in trying improved methods of practice. This model has facilitated mutual exchange of knowledge between healthcare workers, contributing to the organisation's objectives and led to greater outcomes for healthcare service delivery on the ground.

Recent Professional Volunteer Activities

 

Expansion of Respectful Care Project, Research & Knowledge to Zanzibar

K4C is always encouraging our staff, volunteers, and students to share their learning and ideas on Respectful Care across K4C location sites, from Fort Portal and Kampala in Uganda, to Zanzibar and Moshi in Tanzania, as well as with local healthcare staff working in the facilities.

Recently in Zanzibar, K4C had UK Midwife, Chanelle Beaumont, stationed in Jitimai District Hospital, Stone Town, for a period of 6 months. In the Maternity Department, between March - October 2025, Chanelle assisted in hands on practice, particularly supporting difficult and complicated labour and deliveries, provided post and antenatal care to mothers, and led on the exchange of knowledge and training with local hospital staff. Her own qualifications as an NMC-registered midwife, and having engaged with principals illuminated in the Respectful Care project, positioned her well to be able to showcase to others, what safe and respectful midwifery care can, and should, look like, in lower-income and lower-resource settings.

Before carrying out any teaching, Chanelle (and the other volunteers) would work to collect data on identifying needs, and gaps of knowledge. The aim was to highlight to where expertise would be best targeted. Having done this, Chanelle recognised that there was an ongoing need for greater understanding of emergency care amongst post-qualified nurses and midwives. She pulled together preliminary data, quoted a budget according to K4C funds and student donations (kindly donated by a group of student Adult Nurses who had been on placement in the weeks before), and organised five "stations" focused on different aspects of emergency maternity care, to which she allocated different K4C nurse-midwives to each station according to their area of expertise, alongside student midwives on placement at the time. The team then invited staff from both Jitimai, and Mnazi Mmoja hopsitals, to attend an in-person training day on Sunday 17th August 2025, in Jitimai District Hospital.

The exciting training and study day was named and advertised around the hospital as "lJitimai District Hospital Maternity Study Day", and was facilitated by ZED Co. Limited, a healthcare provider on contract under the Zanzibar Ministry of Health. The image below shows the poster circulated by the team!

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

The training day involved North-South and South-South teaching on the following topics:

  • Breech births
  • Neonatal resuscitation
  • Foetal monitoring
  • Episiotomy
  • Wound care
  • Meconium aspiration
  • Abruptio placentae
  • Post-partum haemorrhage

Twenty-five nurse-midwives attended the day, and completed pre- and post-teaching surveys. The team collected the feedback to assess learning outcomes on each of the topics, for every station. Chanelle then summarised and analysed the data, and wrote up the findings in a coherent report. You can open the final draft of the report below, and read about the training outcomes!

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Overall, the training and study day was a great success. You can look through photos below of the team in action. Congratulations Chanelle and the K4C team!

 

 

 

Related Publications

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:

Tyler et. al. (2020) "A questionnaire study of the negative outcomes for UK health professional volunteers in low- and middle-income countries" BMJ Open 2020;10:e037647. doi:10.1136/bmjopen-2020-037647

Ackers, H.L. & Ackers-Johnson, J. (2017) “Mobile Professional Voluntarism and International Development: Killing Me Softly?” Palgrave Macmillan. DOI: 10.1057/978-1-137-55833-6

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

Horder, C. & Ackers, H.L., (2024) "Global Engagement and Cultural Competence in the NHS Workforce: An Evidence Review" University of Salford; NHS England

 

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