Moving away from volunteerism in community health? Motivations and wellbeing among urban and rural Ethiopian volunteers.

Questions about the fairness, efficacy, and sustainability of volunteerism in community health have led some states and programs to attempt to scale back their reliance on "volunteer" labor. Such attempts demand theory-driven, comparative ethnographic research that makes sense of how such moves unfold and impact the lives of CHWs and the programs surrounding them. Guided by theory of the interaction of political and moral economies, this article comparatively analyzes two predominantly female community health workforces in Ethiopia, who worked as unpaid volunteers when their federal government was supposedly "moving away from volunteerism" in community health: (1) HIV/AIDS-focused, home-based caregivers in Addis Ababa (2007-9) organized by NGOs; and (2) primary health care-focused members of the Women's Development Army in rural Amhara (2012-16) organized by the state. Ethnographic and mixed methods, including surveys of volunteers' wellbeing (n = 110 in Addis Ababa; n = 73 in rural Amhara), were used to assemble each dataset. These data show 1) how exploitation of "volunteer" community health labor by states, NGOs, and partnerships between them is maintained through discourses of sacrifice and related notions; 2) what the deprivation, distress, and desires of community health workers reveal about the "voluntariness" of their labor; 3) how CHWs organize themselves into collectives seeking better working conditions; and 4) how these experiences and processes are gendered. In this post-COVID-19 era of persistent inequalities in health globally, comparative ethnographic research of efforts to move away from volunteerism can provide useful lessons for CHWs, policymakers, and advocates.