Short-term global health engagements can be an incredibly rewarding experience for the volunteer. It provides a learning and enrichment opportunity, can help recovery from burnout at home, and provide a way for health professionals to realize their philanthropic goals. And while volunteers can help meet some of the challenges of healthcare delivery in lower income countries, unfortunately too many volunteer projects are designed in ways that do not plan for sustained change or leave communities open to unintended harmful effects of their work.
While there is no universal best practice guideline for global health volunteers, through a grant from the Brocher Foundation in Geneva, a coalition of stakeholders, including global health leaders representing thirty-six agencies, published a statement of ethical principles to maximize the value and minimize the harm of short-term engagements in global health.
The ethical principles laid out in the Brocher Declaration challenge existing practices and ask us to commit to better in order to reduce harm, increase benefits to host communities and reduce inequities.
1) Mutual partnership with bidirectional input and learning
- Emphasize mutual partnership and bidirectionality–both parties have input and learn from one another.
- Recognize expertise and experience of host country health professionals.
- Establish equality, trust and partnership as the foundations of all activities
2) Empowered host country and community define needs and activities
- Create programs based on the host country and community’s priorities
- Define activities such that external actors do not divert funds and efforts from real needs of the community
- Align with national planning frameworks and WHO/SDG priorities
3) Sustainable programs and capacity building
- Commit to long-term healthcare development and sustainability
- Aim to strengthen health systems rather than providing unsustainable alternatives
- Emphasize and utilize existing health systems
4) Compliance with applicable laws, ethical standards, and code of conduct
- Comply with existing legal and regulatory frameworks in the host and originating countries and with local regulations for professional practice and drug distribution
- Consider ethical principles including social justice, social contract, and utilitarian principles
- Abide by common quality principles
5) Humility, cultural sensitivity, and respect for all involved
- Respect the culture, history, strengths, expertise, and knowledge of host communities
- Recognize the limitations of visitors’ cursory understanding as non-members of the community and that they are subject to the constraints and biases of their own cultural backgrounds
- Transform the current narrative of privileged volunteers gaining social capital with lower regard for the perspectives of the host communities to one of solidarity and respect
6) Accountability for actions
- Evaluate programs appropriately so that negative outcomes and unintended consequences are reduced
- Place special emphasis on the concerns of environmental impact due to the travel and activities involved.
- Ensure accountability to local authorities
