The growing popularity of short-term engagements in global health (STEGH) highlights why global health and development efforts must begin to refocus their planning around outcomes rather than interventions.
STEGH typically involve learners and young professionals, often from healthcare disciplines, travelling abroad for short stints to provide a wide gamut of clinical services, research, and community education; related to everything from primary care to surgery. Decisions on what services are provided are often left to the volunteers. Commonly couched as service to the community, there are increasing questions around the effectiveness of such efforts when viewed through a critical lens.
Traditional service oriented STEGH have received much criticism around their unsustainability, the burden they impose on local resources and systems, and evidence that volunteers and sending organizations gain much more from visiting than communities do from hosting them. Yet with interest growing feverishly, one wonders what can be done to foster greater responsibility in their conduct and ensure more meaningful impact.
Some propose that such engagements are irredeemable; that every effort should be made to discontinue such work, or at the least deter participation. This, however, misses the mark given the underlying drivers of such efforts and the potential contexts in which STEGH might be a more effective intervention. There is some consensus that STEGH might be an effective part of a broader development strategy, or an immediate stopgap measure where resources are limited. In both cases, STEGH might serve as a modular process bringing in discrete contributions towards an overall project goal.
Effective deployment of STEGH requires adherence to certain principles, including ensuring that STEGH are not stand-alone, the community leads and directs the work and priorities that such efforts act upon, appropriate processes are in place to seek the right volunteers with the right skills and prepare them in a fulsome manner, and evaluation and monitoring is in place to ensure targets are being met and negative impacts are being mitigated. While these foundational principles might make it more difficult to conduct STEGH, they help towards reducing related harms and increasing potential impact.
Most important, perhaps, is applying outcomes-based thinking to the development effort, working with communities and starting with the question: “What is the problem we are trying to solve?” This simple question highlights a key point: STEGH aren’t the solution to every problem, and in some instances, will fall far short of being a solution. Take, for example, the goal of advancing health equity – giving everyone a fair chance at good health. Service provision to those who are already unwell would be more resource-intensive and less effective than addressing contextual factors that sicken individuals in the first place. Achieving the latter might mean STEGH focus less on providing the service, and more on supporting local organizations and systems or even advocating for policy change at home.
We would propose therefore that STEGH be measured against two lines of questions:
- Does a specific STEGH truly address a community-identified goal, and to what degree?
- If yes, how can that STEGH be deployed effectively and responsibly towards reaching that goal?
This approach is much more complicated than simply “getting up and going”, but the hope is that in the long-run, STEGH might be deployed in a more considered manner as part of overall strategies, and in so doing, achieve more lasting and meaningful impacts around identified community priorities.