Voluntarism in Health Care: a Model for Community Participation (Sri Lanka).

Abstract

The initial focus of this study was on the informal processes of care provided within communities by lay persons on a voluntary basis in rural Sri Lanka. The provision of care by primary groups within the lay referral system was examined, and the process involved in its organization into a system of health volunteers was analyzed. An assessment was made as to whether an indigenous lay voluntary system of care is viable when organized into a system of health volunteers; and to what extent organizational environments affect volunteer role performance. The processes in the retention of volunteers were found to be related to (1) selection and modes of entry, (2) acceptance of volunteers by the community and providers of care and (3) processes in training. Volunteer role performance was conceptualized as the extent to which identified tasks are actually performed. A quasi experimental design was utilized to compare the performance of two categories of health volunteers--linked and non linked--functioning within the health, school and community development systems. A baseline survey of twenty villages with a population of 8980 to determine health needs was followed by educational and service intervention for six months. Terminal survey showed early referral and more complete utilization of available resources. It was seen that linked volunteers performed significantly better than non linked volunteers, and that overall performance was similar within the three systems. In the model developed for community participation, volunteers serve an integrative function and are a vital link between community structures in self care and organizations that provide direct or indirect health care. This study demonstrates the capacity among younger persons to voluntarily care for others and emphasizes the need to develop this potential within communities through health professionals and institutions. The exp and ed roles for voluntarism in care, and the range of rewards for participation are seen as likely mechanisms to stabilize volunteer efforts in the future.