Host Country Regulation of Short-Term Medical Missions: Evidence from Three Countries

Background: Globally there is a grown concern about the ethics and effectiveness of short-term global health activities, also known as short-term medical missions (STMMs). Guidelines for better practices have been developed exclusively by organizations in the Global North, with no mechanisms to enforce and monitor any of these. Objective: The goal of this study is to analyze regulations in three host countries where such STMMs take place. Methods: Researchers from Ghana, Uganda, and Guatemala were recruited to investigate regulations affecting STMMs. Interviews were performed with 129 participants, including policymakers, health services staff and administrators, patients, and community leaders. Data was analyzed using NVIVO and R Package for Qualitative Analysis, having as the foundation grounded theory and sentiment analysis for identification of patterns in responses. Findings: In all three countries, there are regulations regarding the practice of health care generally, as well as governing the importation of medications, but these are rarely enforced when it comes to STMMs, and many participants were unaware of them. In Ghana and Uganda, there is no specific regulation for STMMs. In Guatemala, specific and detailed regulations do exist governing the practice of STMMs, but participants did not report awareness of these regulations. Conclusions: The lack of explicit regulation of STMMs in some countries and the lack of enforcement of existing professional regulations and rules on importation of medications can easily be exploited by those volunteers who prefer not to follow them. All three countries studied do have procedures to be followed by any person who intends to perform STMMs.