[Volunteerism and the reorientation of health services]

Volunteers are increasingly viewed as health agents. This seems to be linked to the reorientation towards primary health care and the current reforms in the health services. Seen as a way of breaking down social and cultural barriers between the formal health care system and the client community it also claims to cut the cost of services.

To know the roles of volunteers in promoting health and the practical aspects of implementation and evaluation.

This paper is based on a review of published and sentinel papers from the bibliographic databases, MEDLINE (1991-1995), ERIC (1982-1995) and ERIC INTERNATIONAL (1965-1995). We have also reviewed the IME (until 1997) and the Spanish journals in MEDLINE to know the Spanish context (from 1995-98).

The practical experiences from developing countries, the USA and the UK were reviewed within the framework of health promotion. A wide variety of experiences exist. There is a striking difference between activities in these countries, depending of the health service provision. In developing countries the aim is to bring primary health care services to areas with few professional resources. In developed countries, however, experiences have developed in response to failings in the formal health care system, to facilitate illness prevention and health promotion. The settings are different but the process is the same, factors fundamental to performance have therefore been identified in: recruitment, training, monitoring, continuing support and evaluation. The impact on health improvements and the quality of services in both systems, developed and developing countries, seems to be positive. We haven't found too much details from the Spanish experience, then, it emphasizes the need to know abroad experiences.

Finally, the benefits and constraints derived from this type of voluntary action in the health field have been raised. Some specific social changes and health care system reforms contribute to establish volunteering in the health system, but we have to remark organization, coordination and community participation.