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Background Growing concerns about the value and effectiveness of short-term volunteer trips intending to improve health in underserved Global South communities has driven the development of guidelines by multiple organizations and individuals. These are intended to mitigate potential harms and maximize benefits associated with such efforts. Method This paper analyzes 27 guidelines derived from a scoping review of the literature available in early 2017, describing their authorship, intended audiences, the aspects of short term medical missions (STMMs) they address, and their attention to guideline implementation. It further considers how these guidelines relate to the desires of host communities, as seen in studies of host country staff who work with volunteers. Results Existing guidelines are almost entirely written by and addressed to educators and practitioners in the Global North. There is broad consensus on key principles for responsible, effective, and ethical programs--need for host partners, proper preparation and supervision of visitors, needs assessment and evaluation, sustainability, and adherence to pertinent legal and ethical standards. Host country staff studies suggest agreement with the main elements of this guideline consensus, but they add the importance of mutual learning and respect for hosts. Conclusions Guidelines must be informed by research and policy directives from host countries that is now mostly absent. Also, a comprehensive strategy to support adherence to best practice guidelines is needed, given limited regulation and enforcement capacity in host country contexts and strong incentives for involved stakeholders to undertake or host STMMs that do not respect key principles.

Growing attention to the proliferation of short-term medical missions (STMMs) in the Global South has increasingly taken the form of critiques of inadequately prepared volunteers, lack of community control and continuity. In response, scholars and practitioners in high-income countries have created guidelines for best practices. These have rarely incorporated the views of host community members and leaders. While research has begun to address what host countries want from STMMs, these projects have also been carried out almost exclusively by scholars from the Global North. The aims were to provide additional insights into host views in three countries that are frequent destinations for STMMs and to explore the possibility that design and direction by host country researchers would yield new perspectives. Scholars from Ghana, Uganda, and Guatemala designed and directed studies of medical staff, public officials, and patients from multiple locations around each country. Interviews and focus groups were carried out with a total of 129 people. All three studies found widespread appreciation of STMMs for providing needed medical services. In Ghana and Guatemala, language differences were cited as a major barrier, while Ugandan participants criticized volunteers' lack of skills and mismatch between their expertise and community needs. Ghanaian and Ugandan participants voiced resentment of patients' preference for white volunteers and the arrogance of some visitors. The amount of time and effort required to host was a common theme. The findings confirm the importance for STMMs of understanding the local health context and language and working collaboratively and respectfully with hosts. Direction by host country researchers enhanced the value in several ways, including access to officials and establishment of trust with interviewees.

Background The demand for international volunteer experiences to promote global health and nutrition is increasing and numerous studies have documented the experiences of the international volunteers who travel abroad; however, little is known about effective practices from the perspective of partner organizations. This study aims to understand how variables such as the skill-level of volunteers, the duration of service, cultural and language training, and other key variables affect partner organizations’ perceptions of volunteer effectiveness at promoting healthcare and nutrition. Method This study used a cross-sectional design to survey a convenience sample of 288 volunteer partner organizations located in 68 countries. Principle components analyses and manual coding of cases resulted in a categorization of five generalized types of international volunteering. Differences among these types were compared by the duration of service, skill-level of volunteers, and the volunteers’ perceived fit with organizational needs. In addition, a multivariate ordinary least square regression tested associations between nine different characteristics/activities and the volunteers’ perceived effectiveness at promoting healthcare and nutrition. Results Partner organizations viewed highly-skilled volunteers serving for a short-term abroad as the most effective at promoting healthcare and nutrition in their organizations, followed by slightly less-skilled long-term volunteers. The greatest amount of variance in perceived effectiveness was volunteers’ ability to speak the local language, followed by their skill level and the duration of service abroad. In addition, volunteer training in community development principles and practices was significantly related to perceived effectiveness. Conclusion The perceptions of effective healthcare promotion identified by partner organizations suggest that program and volunteer characteristics need to be carefully considered when deciding on methods of volunteer preparation and engagement. By better integrating evidence-based practices into their program models, international volunteer cooperation organizations can greatly strengthen their efforts to promote more effective and valuable healthcare and nutrition interventions in partner communities.

Globally there is a grown concern about the ethics and effectiveness of short-term global health activities, also known as short-term medical missions (STMMs). Guidelines for better practices have been developed exclusively by organizations in the Global North, with no mechanisms to enforce and monitor any of these. The goal of this study is to analyze regulations in three host countries where such STMMs take place. Researchers from Ghana, Uganda, and Guatemala were recruited to investigate regulations affecting STMMs. Interviews were performed with 129 participants, including policymakers, health services staff and administrators, patients, and community leaders. Data was analyzed using NVIVO and R Package for Qualitative Analysis, having as the foundation grounded theory and sentiment analysis for identification of patterns in responses. In all three countries, there are regulations regarding the practice of health care generally, as well as governing the importation of medications, but these are rarely enforced when it comes to STMMs, and many participants were unaware of them. In Ghana and Uganda, there is no specific regulation for STMMs. In Guatemala, specific and detailed regulations do exist governing the practice of STMMs, but participants did not report awareness of these regulations. The lack of explicit regulation of STMMs in some countries and the lack of enforcement of existing professional regulations and rules on importation of medications can easily be exploited by those volunteers who prefer not to follow them. All three countries studied do have procedures to be followed by any person who intends to perform STMMs.

Background Various governments in Ghana have tried to improve healthcare in the country. Despite these efforts, meeting health care needs is a growing concern to government and their citizens. Short term medical missions from other countries are one of the responses to meet the challenges of healthcare delivery in Ghana. This research aimed to understand Ghanaian perceptions of short-term missions from the narratives of host country staff involved. The study from which this paper is developed used a qualitative design, which combined a case study approach and political economy analysis involving in-depth interviews with 28 participants. Result Findings show short term medical mission programs in Ghana were largely undertaken in rural communities to address shortfalls in healthcare provision to these areas. The programs were often delivered free and were highly appreciated by communities and host institutions. While the contributions of STMM to health service provision have been noted, there were challenges associated with how they operated. The study found concerns over language and how volunteers effectively interacted with communities. Other identified challenges were the extent to which volunteers undermined local expertise, using fraudulent qualifications by some volunteers, and poor skills and lack of experience leading to wrong diagnoses sometimes. The study found a lack of awareness of rules requiring the registration of practitioners with national professional regulatory bodies, suggesting non enforcement of volunteers’ need for local certification. Conclusion Short Term Medical Missions appear to contribute to addressing some of the critical gaps in healthcare delivery. However, there is an urgent need to address the challenges of ineffective utilisation and lack of oversight of these programs to maximise their benefits.

Background: Short-term medical missions (STMMs) are quite common and largely understood to be a response to health needs in low-income countries. Yet most information about STMM practices is anecdotal. Even less is known about the preferences of in-country host communities regarding STMMs. Objective: We aimed to gather enough quantitative and qualitative information from both STMM organizers and host community staff to compare dominant practices of organizers as well as preferences of host community staff. We use these data to discover differences between practices and preferences and suggest ways in which STMMs can be more responsive to the communities they serve. Methods: Researchers gathered online survey responses from 334 STMM organizers and conducted interviews to determine existing practices. Similar methods were used to collect 49 online survey responses from, and conduct 75 interviews with, host community staff. Results: Organizer practices and host community staff preferences are different in several areas. Organizers admit to minimal screening and preparation of volunteers whereas host staff have clear ideas of topics that should be covered in preparation, including culture and basic language skills. Organizers prioritize provision of clinical care during trips whereas host staff prioritize capacity building. Practices and preferences also differ in relation to the length of STMMs, the nature of the partnership itself, and the type of assessment and evaluation that is needed. Conclusions: The large amount of data gathered for this study allows us to confidently say that organizer practices are often not aligned with host community staff preferences. Several concrete changes can be made to STMMs to bring practices more in line with the desires of the communities they serve.

This paper examines the goals of organizations that sponsor short-term volunteer trips in global health, whether they be NGO's, faith-based, educational, or corporate organizations. Results from a U.S.-based national survey of 177 such organizations and 27 interviews with trip organizers suggest that organizations often sponsor volunteer trips to achieve goals that are quite different from the improvement of health outcomes in poor countries. While providing health services is often cited as the most important goal, volunteer activity is also considered important in enhancing the organizations' reputation, recruitment and retention, and financial well-being. The prominence of other goals has the potential for diverting resources and focus from what is presumably the primary purpose of serving host communities in the most effective manner possible. Cet article examine les objectifs des organisations qui sponsorisent les voyages de bénévolat de courte durée dans le domaine de la santé mondiale, qu'elles soient des ONG, des organisations confessionnelles, éducatives ou d'entreprises. Les résultats issus d'une enquête nationale américaine de 177 de ces organisations et de 27 entretiens auprès d'organisateurs de voyages donnent à penser que les organisations commanditent souvent des voyages de bénévolat pour atteindre des objectifs qui sont très différents de l'amélioration des résultats en matière de santé dans les pays pauvres. Alors que la prestation de services de santé est souvent citée comme l'objectif le plus important, l'activité bénévole est également considérée comme importante pour renforcer la réputation, le recrutement et la fidélisation et le bien-être financier des organisations. L'importance d'autres objectifs est susceptible de détourner des ressources et l'attention de ce qui est sans doute l'objectif principal pour servir les communautés d'accueil le plus efficacement possible. Dieser Beitrag untersucht die Ziele von Organisationen, die kurzfristige Reisen für Ehrenamtliche innerhalb des globalen Gesundheitsbereichs organisieren, wobei es sich hierbei um nicht-staatliche, glaubensbasierte, Bildungsoder Unternehmensorganisationen handeln kann. Ergebnisse aus einer USA-basierten nationalen Befragung von 177 solcher Organisationen sowie aus 27 Interviews mit Reiseorganisatoren weisen darauf hin, dass die Organisationen, die Reisen für Ehrenamtliche sponsern, häufig ganz andere Ziele verfolgen als die Verbesserung der Gesundheitsversorgung in armen Ländern. Während die Erbringung von Gesundheitsdienstleistungen oft als das vorrangige Ziel angegeben wird, erachtet man auch die ehrenamtliche Tätigkeit als wichtig, um den Ruf einer Organisation, die Anwerbung und Bindung von Mitarbeitern sowie die finanzielle Lage zu fördern. Die Wichtigkeit anderer Ziele kann die Ressourcen und Konzentration von dem mutmaßlichen Hauptzweck, die Gastgemeinden zu unterstützen, auf effektivste Weise ablenken. El presente documento examina las metas de organizaciones que patrocinan viajes de voluntarios de corto plazo en salud mundial, ya sean ONG, u organizaciones religiosas, educativas o corporativas. Los resultados de una encuesta nacional en EE.UU. de 177 de dichas organizaciones y 27 entrevistas con organizadores de viajes sugieren que las organizaciones a menudo patrocinan viajes de voluntarios para lograr metas que son totalmente diferentes de la mejora de los resultados sanitarios en países pobres. Aunque la provisión de servicios sanitarios se cita a menudo como la meta más importante, la actividad de los voluntarios también se considera importante para aumentar la reputación, el reclutamiento y retención, y el bienestar financiero de las organizaciones. La prominencia de otras metas tiene el potencial de desviar los recursos y el foco de atención de lo que presumiblemente es el propósito fundamental de servir a las comunidades anfitrionas de la manera más efectiva posible.

This study focuses on the role of an Internet-based group for people who have an autoimmune liver disease, primary biliary cirrhosis. Primary biliary cirrhosis is a relatively rare disease, affects primarily women in their 40's and older, and is not well understood. The PBCers Organization (PBC stands for primary biliary cirrhosis) provides electronic mailinglists (listservs) and informational resources for those with primary biliary cirrhosis. (1) to identify the issues of greatest importance to those posting to the listserv, specifically the relative importance of biomedical, socioemotional, and organizational/systems messages; (2) to compare frequency and content of posts by people at different stages of disease; (3) to identify how people with primary biliary cirrhosis represent the psychosocial challenges and dilemmas (role and identity change, uncertainty, and stigma) identified in the social-scientific literature as key elements of the experience of chronic disease. The paper is based on content analysis of messages posted during two months to the Daily Digest listserv for people who have primary biliary cirrhosis. To analyze the posts, we developed a coding system with three major categories--biomedical, socioemotional, and systems/organizations--and 12 codes in each category. A total of 275 people posted 710 messages. Of the 250 people for whom information on gender was available, 239 (95.6%) were women and 11 (4.4%) were men. Analysis of 710 messages posted to the listserv revealed a predominance of requests for and reports of biomedical information, such as health care providers (32.7%), medications (30.9%), tests and procedures (25.8%), and symptoms (25.7%), combined with very frequent expressions of emotional support. The most frequent single topics were peer support (included in 40.6% of all posts) and positive emotions (25.3%). Posters who reported fewer years since diagnosis were more likely to be seeking biomedical information than those who were further in time from their diagnosis (r= -.241, P<.001, n=313). Those in later stages posted an average of 3.87 messages, compared to an average of 2.64 for people in earlier stages (t= 1.786, P=.08, n=90), which is different from what we expected. No relation between years since diagnosis or age and number of messages was found. Contrary to our expectations, the topics reflecting issues of role change/identity (2.9%), stigma (0.7%), and thoughts about the future (3.9%), all identified in social-scientific literature as key concerns for people with chronic illness, appeared infrequently in this set of messages. Messages exchanged on this particular mailing list have a biomedical, rather than socioemotional or organizational, emphasis. The Internet offers a highly valued opportunity for those with rare diseases to connect with, learn from, and provide support to others having similar experiences. Research that compares those with primary biliary cirrhosis, who are involved in an Internet support group and those who are not, would be an important next step to better understanding the role of the Internet among patients with chronic liver disease and the implications of it in the course of their illness.