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| The goal: universal health coverage. The means: volunteers? | The goal: universal health coverage. The means: volunteers? |
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| The goal is simple, ambitious and widely endorsed: access to adequate healthcare for all at an affordable price. Yet how can we fill the resource gap to achieve universal health coverage? An estimated one billion of the world's poor without access to basic health services are anxious to find out. | The goal is simple, ambitious and widely endorsed: access to adequate healthcare for all at an affordable price. Yet how can we fill the resource gap to achieve universal health coverage? An estimated one billion of the world's poor without access to basic health services are anxious to find out. |
| Expanding volunteerism is one part of the solution to help improve global health investments and ensure equitable access to health. But there is often vocal criticism of volunteerism, so it is important to be clear not just about the benefits but also about the contexts in which working with volunteers produces the best results. | Expanding volunteerism is one part of the solution to help improve global health investments and ensure equitable access to health. But there is often vocal criticism of volunteerism, so it is important to be clear not just about the benefits but also about the contexts in which working with volunteers produces the best results. |
| Afghanistan has the highest maternal mortality rate in the world and is second for under-five mortality. There is an acute shortage of health facilities and trained staff – particularly female staff. However, the Afghan Red Crescent Society has 22,000 trained volunteers, including more than 2,000 women in 34 provinces. | Afghanistan has the highest maternal mortality rate in the world and is second for under-five mortality. There is an acute shortage of health facilities and trained staff – particularly female staff. However, the Afghan Red Crescent Society has 22,000 trained volunteers, including more than 2,000 women in 34 provinces. |
| Trained female volunteers in the most remote areas of Afghanistan helped vaccinate almost 250,000 children against polio this past year. | Trained female volunteers in the most remote areas of Afghanistan helped vaccinate almost 250,000 children against polio this past year. |
| The benefits of volunteering reach beyond the intended recipient. Volunteering has not only developed the confidence of female volunteers, but increased recognition for them within Afghan communities and encouraged them to seek health support for themselves and their families. | The benefits of volunteering reach beyond the intended recipient. Volunteering has not only developed the confidence of female volunteers, but increased recognition for them within Afghan communities and encouraged them to seek health support for themselves and their families. |
| But the impact of volunteers is greatest when they are integrated within existing health systems – as a complement to, not replacement for, qualified health providers. Ideally as part of the communities they serve, skilled volunteers can develop locally appropriate responses to health issues and in some cases provide direct simple care. | But the impact of volunteers is greatest when they are integrated within existing health systems – as a complement to, not replacement for, qualified health providers. Ideally as part of the communities they serve, skilled volunteers can develop locally appropriate responses to health issues and in some cases provide direct simple care. |
| Volunteers can also reduce the need for hospital and outpatient visits, and extend the reach of health services to remote areas and under-served populations. A recent study published in the Lancet medical journal showed that health education by volunteers contributed to improvements in maternal and child health in Malawi. The financial contribution of volunteers supporting health is also significant. Nearly five million community-based Red Cross and Red Crescent volunteers donated more than US$2.2 bn of health-related services globally in 2010, according to a 2011 survey (pdf). | Volunteers can also reduce the need for hospital and outpatient visits, and extend the reach of health services to remote areas and under-served populations. A recent study published in the Lancet medical journal showed that health education by volunteers contributed to improvements in maternal and child health in Malawi. The financial contribution of volunteers supporting health is also significant. Nearly five million community-based Red Cross and Red Crescent volunteers donated more than US$2.2 bn of health-related services globally in 2010, according to a 2011 survey (pdf). |
| There is little doubt about the financial and social contribution of volunteers. However, the downfall of many volunteer interventions is in oversimplifying and underestimating the necessary investment, support and management required for successful volunteer engagement and retention. Volunteers should be managed as valuable assets and not as a form of cheap labour. | There is little doubt about the financial and social contribution of volunteers. However, the downfall of many volunteer interventions is in oversimplifying and underestimating the necessary investment, support and management required for successful volunteer engagement and retention. Volunteers should be managed as valuable assets and not as a form of cheap labour. |
| When done poorly, volunteer programmes can lead to high and costly turnover rates that reduce the efficiency and effectiveness of the work, and be detrimental to beneficiaries. When done successfully, volunteerism can help a country achieve its development targets. | When done poorly, volunteer programmes can lead to high and costly turnover rates that reduce the efficiency and effectiveness of the work, and be detrimental to beneficiaries. When done successfully, volunteerism can help a country achieve its development targets. |
| In the Philippines, attracting and retaining staff in under-served areas is a key challenge. The country is a major exporter of health workers, yet some rural and poor areas still face critical shortages. Public health workers, including volunteers, administer health services in communities. | In the Philippines, attracting and retaining staff in under-served areas is a key challenge. The country is a major exporter of health workers, yet some rural and poor areas still face critical shortages. Public health workers, including volunteers, administer health services in communities. |
| The Philippine Red Cross systematically manages the recruitment, mobilisation, retention and training of 900,000 volunteers. They annually evaluate and plan for what type of volunteers, how many are needed, and what kind of training is required. In addition, volunteer management is supported with strong human resource policies, codes of conduct and insurance coverage. As a result, the PRC is halfway to achieving its goal of having 1.8 million volunteers in 42,000 villages across the country's 7,000 islands. Skilled local volunteer teams support disaster management, community-based health and blood services. | The Philippine Red Cross systematically manages the recruitment, mobilisation, retention and training of 900,000 volunteers. They annually evaluate and plan for what type of volunteers, how many are needed, and what kind of training is required. In addition, volunteer management is supported with strong human resource policies, codes of conduct and insurance coverage. As a result, the PRC is halfway to achieving its goal of having 1.8 million volunteers in 42,000 villages across the country's 7,000 islands. Skilled local volunteer teams support disaster management, community-based health and blood services. |
| It is a significant undertaking but a worthwhile investment. For every peso spent on volunteers, the Philippine Red Cross receives eight pesos worth of service and improved service delivery. Since volunteers are embedded in communities, the resources to respond to disasters and health crises are also greatly reduced. | It is a significant undertaking but a worthwhile investment. For every peso spent on volunteers, the Philippine Red Cross receives eight pesos worth of service and improved service delivery. Since volunteers are embedded in communities, the resources to respond to disasters and health crises are also greatly reduced. |
| On the issue of remuneration, there can sometimes be a temptation to provide financial incentives to attract volunteers. However, other than covering nominal expenses, such as travel and meal costs, any significant monetary rewards can damage the sustainability and spirit of voluntary work. It becomes difficult in the long run to recruit volunteers who are not motivated by financial gains. | On the issue of remuneration, there can sometimes be a temptation to provide financial incentives to attract volunteers. However, other than covering nominal expenses, such as travel and meal costs, any significant monetary rewards can damage the sustainability and spirit of voluntary work. It becomes difficult in the long run to recruit volunteers who are not motivated by financial gains. |
| Volunteers are best motivated when they see that their contribution improves the health of their family and community, which can be an incentive more powerful than money. They can benefit by learning new skills and developing useful contacts for future employment. | Volunteers are best motivated when they see that their contribution improves the health of their family and community, which can be an incentive more powerful than money. They can benefit by learning new skills and developing useful contacts for future employment. |
| Governments can also promote volunteerism for universal health coverage in non-monetary ways. By adopting legislation, policies and other strategies that reduce barriers to the participation of volunteers, the impact and motivation of volunteers can be enhanced in national health systems. Practices currently exist around the world that penalise or tax volunteerism, such as losing unemployment benefits when volunteering and charging for police background checks. Repealing these barriers, providing corporate tax incentives for volunteerism, as well as liability protection and insurance to volunteers would further unlock the potential of volunteerism to support Universal Health Coverage. | Governments can also promote volunteerism for universal health coverage in non-monetary ways. By adopting legislation, policies and other strategies that reduce barriers to the participation of volunteers, the impact and motivation of volunteers can be enhanced in national health systems. Practices currently exist around the world that penalise or tax volunteerism, such as losing unemployment benefits when volunteering and charging for police background checks. Repealing these barriers, providing corporate tax incentives for volunteerism, as well as liability protection and insurance to volunteers would further unlock the potential of volunteerism to support Universal Health Coverage. |
| According to the World Health Report 2006, 57 countries fell below the critical threshold of 2.3 physicians, nurses and midwives per 1,000 people. With this gap, the world cannot afford to ignore the role of volunteers in extending the reach of health services. | According to the World Health Report 2006, 57 countries fell below the critical threshold of 2.3 physicians, nurses and midwives per 1,000 people. With this gap, the world cannot afford to ignore the role of volunteers in extending the reach of health services. |
| The government, private sector and civil society partners must work together to fund and promote volunteerism as an integral part of universal health coverage. Together, we can help ensure access to quality health services and reduce the unnecessary financial burden of health costs around the world. | The government, private sector and civil society partners must work together to fund and promote volunteerism as an integral part of universal health coverage. Together, we can help ensure access to quality health services and reduce the unnecessary financial burden of health costs around the world. |
| Matthias Schmale is under-secretary general at the International Federation of Red Cross and Red Crescent Societies. He tweets as @matzschmale | |
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