Ethical Challenges in Global Short-term Health Volunteering in Low- and Middle-Income Countries: A Narrative Review

Abstract

Short-term medical missions have become a common response to global health needs in resource-limited countries, yet concerns persist about their ethical implications and sustainability. This study aimed to explore the ethical challenges of short-term medical missions and volunteer health initiatives in low- and middle-income countries, with a particular focus on their impact on local health professionals and systems, using Ethiopia as a contextual example. The study adopted a narrative review of literature published between 2010 and 2024. A comprehensive search of MEDLINE, CINAHL Complete, Dentistry & Oral Sciences Source, and Scopus, supplemented by Google Scholar, was undertaken. After screening titles, abstracts, and full texts, along with reference lists of included sources, 61 sources were included. Findings were narratively synthesised to identify major ethical themes and structural contributors. Three recurring themes emerged: violations of clinical scope of practice and inconsistent regulatory oversight; structural power imbalances between foreign volunteers and local professionals; and psychological strain and moral distress among local health professionals. Weak credential verification, dependency on external funding, and limited institutional accountability were identified as contributing factors. Ethical reform in global health volunteering requires a shift from episodic charity to partnership-centred practice that prioritises local leadership, accountability, and sustainability. Key strategies include transparent credential verification, pre-departure ethics and cultural competency training, equitable supervision frameworks, and alignment with international guidelines. By implementing these measures, global health volunteering can strengthen local health services and professionals, build more resilient systems and ensure the benefits endure beyond the mission period.