Enhancing the value of short term volunteer missions in health from host country perspectives: the Case of Uganda

Short-term medical missions (STMMs), estimated to involve 1.6 million volunteers and US$2-3 billion annually, can be very valuable, but there is a growing critique of practices. Serious concerns have arisen around possible harms to host countries and patients, including medical errors, non-alignment with local systems and priorities, cultural insensitivity, and the high cost compared to benefits. Scholars and practitioners across diverse sectors involved-faith-based, corporate, NGO, and educational-have questioned the value of STMMs and proposed strategies for improving them. Missing from this assessment are voices of host communities and research on host country efforts to control the quality of visiting programs. In this study, we investigated host perspectives on STMMs. The study was driven by the need to examine the regulatory and policy environment as well as to establish the perspectives of all country stakeholders on STMMs with the view of enhancing their value. This research is a collaborative effort between researchers at Uganda Christian University in Mukono, Uganda and Lehigh University, PA, United States of America. A qualitative methodology was adopted, with in-depth interviews as the main tool. A total of 46 interviews with policy makers, Non-Governmental Organisations and those who have engaged with volunteers in the communities were conducted in Uganda. The analysis was computer-assisted and thematic. The study revealed that the health needs of the country are many, and STMMs contribute to closing some of the gaps, although this may be limited given the scope of needs. Some of these health needs include limited infrastructure and budget support for health, low levels of staffing and inadequate resources such as equipment in the facilities. It was further revealed that the contributions made are bi-directional, with host communities claiming that they contribute towards pre-visit preparations, accommodation, local expertise on tropical diseases, and social support while volunteers contribute skills, treatment, equipment, awareness and research. Nevertheless, from the perspective of stakeholders interviewed, STMM volunteers face challenges such as cultural shock, inadequate resources to work with, manpower to support them, high expectations from the communities and delay in clearance for practice. Despite their contributions, the study established that host communities expressed concerns about the nature of STMMs involving lack of experience, hidden interests, misalignment with community needs, security risks, code of conduct and sustainability of support. A review of Ugandan laws reveals many that are related to the regulation of health services, but none that specifically mentions short-term mission trips. Most stakeholders interviewed were unaware of any regulatory oversight of visiting health teams, although some were aware of the need for clearance of visitors’ credentials. It is therefore recommended that in order to enhance the value of STMMs in Uganda, concrete actions be taken involving improving and making known the conditions for licensing and oversight, improving communication, enhancing collaboration and supporting capacity building for local experts.Uganda Christian University, Uganda and Lehigh University, US