Abstract

BackgroundA high burden of HIV in many sub-Saharan African countries has triggered renewed interest in volunteer-based community health programmes as a way to support treatment roll-out and to deliver services to children orphaned due to HIV. This study was undertaken as an evaluation of a USAID project implemented by a consortium of 7 NGOs operating in 52 Zambian districts. We aimed to examine motivations for becoming volunteer caregivers, experiences in service and commitment to continue volunteering in the future.MethodsA mixed-method survey approach was adopted incorporating close- and open-ended questions. District selection (3 of 52) was purposive, based on representation of urban, peri-urban and rural volunteers from a mix of the consortium’s NGO affiliates. Individual volunteer recruitment was achieved via group information sessions and opportunistic sampling was used to reach a quota (~300) per study district. All participants provided written informed consent.ResultsA total of 758 eligible caregivers were surveyed. Through parallel analyses of different data types and cross-over mixed analyses, we found shifting patterns in motivations across question type, question topic and question timing. In relation to motivations for entering service, responses to both open- and close-ended questions highlighted the importance of value-oriented functions and higher order social aspirations such as “helping society” or “humanity”. However, 70% of participants also agreed to at least one close-ended economic motivation statement and nearly a quarter (23%) agreed to all four. Illustrating economic need, as well as economic motivation, over half (53%) the study respondents agreed that they had become a volunteer because they needed help from the project. Volunteers with lower and mid-level standard-of-living scores were significantly more likely to agree with economic motivation statements.ConclusionsReliance by national and international health programmes on volunteer workforces is rooted in the assumption that volunteers are less costly and thus more sustainable than maintaining a professional cadre of community health workers. Understanding individuals’ motivations for entering and remaining in volunteer service is therefore critical for programme planners and policy makers. This study demonstrated that volunteers had complex motivations for entering and continuing service, including “helping” and other pro-social values, but also manifest expectations of and need for material support. These findings contribute to evidence in support of various reforms needed to strengthen the viability and sustainability of volunteer-dependent services including the need to acknowledge and plan for the economic vulnerability of so-called volunteer recruits.

Highlights

  • Since Alma Ata and before, community health worker programmes reliant on volunteer labour have been seen as a way to address issues of health care access and equity in low-income settings [1,2]

  • Study aims and conceptual framework This study aimed to advance understanding of why individuals in Zambia enter into and remain in volunteer service by identifying (a) motivations for volunteering (b) the extent to which these motivations are fulfilled in service and (c) factors related to discontinuation or prolongation of service

  • Motivations to continue In response to the final question of the interview – “List three things that would make you willing and able to perform more volunteer care giving in the future” – we found familiar themes, but with the exception of work-related issues, these themes were patterned differently

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Summary

Introduction

Over the past 15 years, the rapid scale-up of prevention and treatment programmes around the region [3,4,5,6] has resulted in a burgeoning of volunteer service-delivery programmes [7,8,9,10,11,12,13] These programmes have focused on a range of clinical, palliative and social support services, such as medication dispensing, homebased counselling and testing and support for orphans and vulnerable children [9,14,15,16,17]. A high burden of HIV in many sub-Saharan African countries has triggered renewed interest in volunteer-based community health programmes as a way to support treatment roll-out and to deliver services to children orphaned due to HIV. We aimed to examine motivations for becoming volunteer caregivers, experiences in service and commitment to continue volunteering in the future

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