Promoting ‘No Harm’ and Frugal Innovation Approaches to Global Health Placements for Professional Volunteers and Students in Low- and Middle-Income Countries

Placements in public health systems in low- and middle-income settings have become an increasingly essential component of many early career pathways in health professions, despite the lack of research on the impacts for the individuals and organisations involved. Our research has provided a unique evidence base, raising significant ethical and pedagogical concerns about the quality of learning and the impacts on the National Health Service (NHS) and the health systems of low- and middle-income countries (LMICs).

In response to concerns about aid dependency and the potential damages associated with overseas ‘volunteering’, our action-research approach assessed the role that volunteer deployment played in knowledge mobilisation processes and health systems outcomes.

The findings provided evidence on the contribution that international volunteering makes to the transferable skills that lie at the heart of the NHS 15-year Strategic Plan (2014), with a particular emphasis on multi-disciplinary team-working; communication; attention to cultural diversity and resource management. This provided the evidence base to support a shift in policy in favour of releasing staff to volunteer during a climate of financial crisis.

In 2016, Health Education England funded research focussed on the development of a model of ethical (‘No Harm’) undergraduate placements – the Ethical Educational Placement (EEP) Model – to support skills development in the NHS without burdening LMIC health systems. Benchmarking work found evidence of international students effectively placed without support in facilities, substituting for absent local staff with no supervision, putting themselves and patients at risk and creating limited opportunities for skills enhancement. The action-research intervention (known as the Ethical Undergraduate Placement Project) involved detailed evaluation of over 80 placements.

Funders

Health Education England

Higher Education Funding Council

Tropical Health and Education Trust

Publications

Ackers, H.L. and Ackers-Johnson, J. Mobile Professional Voluntarism and International Development: Killing Me Softly?, Palgrave (2017). Book available at: https://doi.org/10.1057/978-1-137-55833-6

Ackers, H.L., Ackers-Johnson, J., Tyler, N. and Chatwin, J., Healthcare, Frugal Innovation, and Professional Voluntarism: A Cost-Benefit Analysis, Palgrave (2017).

Chatwin, J. and Ackers, H.L. (2016) Volunteering and overseas placements in the NHS: a survey of current activity, BMJ Open (6)10 http://dx.doi.org/10.1136/bmjopen-2016-012160

Tyler, N., Ackers, H.L., Ahmed, A., Byrne, G. and Byrne-Davis, L. (2020) A questionnaire study of the negative outcomes for UK health professional volunteers in low- and middle-income countries, BMJ Open 10(6). https://doi.org/10.1136/bmjopen-2020-037647

Ahmed, A., Ackers-Johnson, J. and Ackers, H.L. The Ethics of Educational Healthcare Placements in Low and Middle Income Countries: First Do No Harm?, Palgrave (2017). Book available at: https://doi.org/10.1007/978-3-319-48363-4

Ackers, H.L., Ackers-Johnson, J., Ahmed, A. and Tate, N. (2019) Optimising student learning on international placements in low-income settings: the contribution of cultural brokerage, Open Journal of Social Sciences 7(3). https://doi.org/10.4236/jss.2019.73026

Team

Professor Louise Ackers

Dr James Ackers-Johnson

Claire Horder

Juliette Bowman

Allan Ndawula, Knowledge For Change, Uganda.