Global Citizenship

in the Scottish Health Service

Global Citizenship in the Scottish Health Service is a policy report by the Royal College of Physicians and Surgeons of Glasgow on the mutual benefits of international volunteering by Scotland’s health service workers.

Many Scottish health service workers currently undertake international development work on a predominantly voluntary basis. The aim of this report is to suggest how the Scottish health service can better encourage, support and coordinate this activity. An enhanced focus on coordination and quality will help harness the substantial benefits of volunteering to Scotland’s health sector workers and optimise the benifits to healthcare services in partner countries and back in the Scottish NHS.

The report addresses the common challenges of global health work, provides evidence of the mutual benefits to individuals and the Scottish NHS, and sets out eight recommendations for action. These suggested areas for action take into account the views of all Scotland’s territorial and special Health Boards, alongside many other key organisations and individuals.

This report has been prepared with the support of the Scottish Global Health Collaborative. The Collaborative’s Committee is chaired by the Chief Medical Officer of Scotland, Dr Catherine Calderwood.

Download the full report: Global Citizenship in the Scottish Health Service: the value of international volunteering

Download the executive summary report

The key benefits of international volunteering to individual health workers and to NHSScotland have been summarised in two infographics that are available to download and share below.

As evidence of the benefits and learning opportunities of global health work, the report includes case studies of health workers from across Scotland, who have undertaken international volunteering.

A selection of individual case studies are also available to watch on video.


Scotland’s health sector workers currently invest significant time and energy in global health work, and this is of established mutual benefit. We believe that maximal mutual benefit from global health partnerships can only be realised with a system-wide commitment to global citizenship, based on an agreed strategic approach.

Having taken account of the evidence reviewed, and our stakeholder views, we recommend that action is required in the following areas:

  1. Developing a strategic approach: NHSScotland should consider articulating a strategic approach to global health engagement which embraces global citizenship in the Scottish health service.
  2. Professionalising coordination and support: The Scottish Government should consider professionalising and resourcing coordination and support of global health work at a national level.
  3. Maximising benefit: NHSScotland should consider exploring how the potential personal and professional benefits of global health work could best be maximised in the Scottish health service.
  4. Ensuring effectiveness: NHSScotland should support global health work which is needs-led and follows principles of effective partnership working.
  5. Valuing collaboration: NHSScotland should consider committing to collaborative engagement and advocacy on global health issues.
  6. Expressing local commitment: NHSScotland should consider asking all Health Boards to articulate a focused organisational commitment to global citizenship.
  7. Defining support mechanisms: NHSScotland, in partnership with Health Boards, should consider defining support mechanisms for international volunteering.
  8. Setting expectations: NHSScotland should consider articulating its expectations of Scottish health service workers when engaging in global health work.

Report background

In October 2015 the College became a founding member of the Scottish Global Health Collaborative, an interest group established to work with the Scottish Government to promote effective and coordinated health sector involvement in global health.

The Collaborative, which is chaired by the Chief Medical Officer for Scotland, asked the College to produce a report which would:

  • define and describe current international volunteering by Scottish health workers
  • evaluate the benefits and challenges of international volunteering to the Scottish NHS
  • appraise the current approach by NHSScotland to international volunteering by its staff
  • suggest what actions would deliver improved benefit from global health work to Scottish health workers and the Scottish health system, and improved benefit to partners abroad

The report was led and authored by Mr Stuart Fergusson, Scottish Clinical Leadership Fellow with the Royal College of Physicians and Surgeons of Glasgow, and Mr Mike McKirdy, College Director of Global Health.

Global Citizenship in the Scottish Health Service: the value of international volunteering was published in May 2017.

Dr Adrian Stanley
Consultant Gastroenterologist, Glasgow Royal lnfirmary

Adrian has been involved with an endoscopy training and development project in Malawi since 2012, helping to deliver training to local clinicians at the three major Central Hospitals in the country. More recently this has expanded to include “Train-the-trainer” courses, with the aim of making the service sustainable in the longer term.

“My visits to Malawi give me a different perspective on healthcare provision and the challenges that can arise. My training visits refresh me professionally and provide me with a balanced perspective on the challenges faced when working in Glasgow.”

Dr Linda de Caesteker
Director of Public Health, NHS Greater Glasgow and Clyde

Linda took a year’s leave of absence to take up a post as Director of Projects with the International Federation of Obstetrics and Gynaecology (FIGO). Linda was mainly involved in an initiative to promote the use of post-partum intra-uterine device contraception (a low-cost birth control device inserted immediately following childbirth) in Sri Lanka, Bangladesh, Nepal, India, Tanzania and Kenya.

“On looking back at my year I am aware of what a wonderful opportunity and experience it was. There was personal cost involved financially and socially but the benefits far overwhelmed these. I learnt about different health systems and the challenges of providing high quality care in less well-resourced systems than the NHS. I was impressed by the way many of the obstetricians that I met stayed positive and committed in the face of enormous health challenges and poor facilities. I appreciated afresh the stark global health inequalities in maternal health…
I came back to my role as Director of Public Health, refreshed and re-motivated to improve health and feeling very fortunate to work within our NHS system with its commitment to equality and universal access.”

Dr Andrew Pearson
Specialty Registrar in Obstetrics and Gynaecology

After qualifying as a doctor and completing his first two years of medical training (the ‘Foundation Programme’), Andrew volunteered in a rural South African hospital. During his year abroad he gained experience across different departments and specialties, and developed his technical, clinical and management skills. From his volunteering experience, Andrew has developed an interest in management and leadership and is currently completing a year as a Scottish Clinical Leadership Fellow.

Professor Charlotte Wright
Consultant Paediatrician

Charlotte has been volunteering with a children’s hospital in Lahore, Pakistan, for several years via an official twinning link with Glasgow’s Children’s Hospital. During her visits she has supported the development of audit and basic research skills within the hospital, and more recently she has been working with staff to address the high rates of patient malnutrition.

“I have found every visit stimulating illuminating and inspiring. Seeing health care delivered under such pressure encourages me to think about what aspects of care are really critical and which can be done without, if need be.”

Mr Chris Faldon
Nurse Consultant, Public Health

Chris volunteers as part of an official twinning relationship between NHS Borders and St. Francis hospital in Zambia. Since 2012, Chris has made several visits to St. Francis to support the work carried out there, and has found that learning opportunities from international volunteering are very much two way.

“It’s very easy to get institutionalised and very easy to accept that this is way things are done [in the NHS], but to find yourself in an low-income country where the resource challenges are immense and yet still they have a quality to their healthcare which is admirable, it makes me think when I come back to the UK – ‘perhaps I can do things differently’.”

Miss Emily Broadis
Scottish Clinical Leadership Fellow and Paediatric Surgeon

Emily‘s first experience of international volunteering was a year out of Scottish paediatric surgical training in 2008-2009 to visit Malawi as a Clinical Lecturer in Surgery. Since then Emily has developed a strong connection with Malawi, and secured funding from the Department for International Development (DFID) to establish the paediatric burn prevention project, ‘Reduction of Burns and Scald’ (ReBaS), in the Malawian city of Blantyre. The project is an ongoing partnership between clinicians in the UK and the Queen Elizabeth Central Hospital in Blantyre.

“The experience was almost indescribable in terms of benefits gained. I saw clinical cases I would never see in an entire lifetime of work within the UK. I learnt how to rely on my clinical skills and trust my gut instinct. I learnt how to be resourceful, how to deal with frustrations and how to work with people from a different culture and background.”

Mr Gary Mortimer and Mr Graham Davidson
Director of Acute Services and Technical Supervisor for NHS Grampian

Gary and Graham spent a week at the Felege Hiwot Referral Hospital in Ethiopia providing essential facilities maintenance support. They visited the hospital following reports that efforts there to improve standards were being hampered by the daily loss of power, water and the general poor state of infrastructure.

“Since returning, we have reflected on how much we all take the quality of our healthcare environment and healthcare standards for granted, but importantly the significance of infrastructure and engineering to the delivery of safe uninterrupted healthcare.
We simply do not notice or recognise this in the UK as infrastructure systems rarely fail, and even when they do, resilience and backup systems automatically kick-in, usually un-noticed by clinicians or patients.
Our experience has strengthened our connection between what we do, and how it impacts. No classroom based learning, or even real-time UK exercise or experience could deliver the learning that was achieved by visiting and doing and seeing and feeling.”

Ms Gillian Calder

Gillian became involved in the Reduction of Burns and Scald (ReBaS) project, a partnership between clinicians in the UK and clinicians at the Queen Elizabeth Central Hospital in Blantyre, Malawi, in early 2015. It was identified that more physiotherapy input was needed to reduce the morbidity of patients surviving burn injury, and so Gillian visited the hospital to deliver training to clinical officers, nurses and physiotherapy staff. Gillian has helped host a Malawian physiotherapist in Glasgow for further training, and has also been involved in fundraising for much needed equipment for the hospital.

“It has been a wonderful experience and I have learnt so much about the Malawian culture… It has definitely made me realise how wasteful we can be in the NHS (and in general) and appreciate the equipment that we have at our disposal.”

Dr Roger Alcock
Consultant in Emergency Medicine

Roger volunteered as part of the UK’s response to the Ebola crisis in West Africa, firstly in assisting with the recruitment of the volunteer teams, and then on the ground in Sierra Leone. As part of a multi-disciplinary team, Roger helped to set up and run Ebola treatment centres in several parts of Sierra Leone. He has also gained experience of delivering healthcare in a wide variety of other international settings.

Professor Tracy Humphrey
Consultant Midwife and Dean of Health and Social Care, Edinburgh University

Tracy has been leading a project in Malawi since 2010, working to improve outcomes for mothers and babies during birth and pregnancy. The maternal death rate in Malawi is one of the highest in the world, and Tracy’s initial focus was to improve maternal mortality rates by giving women better access to maternity care. Working with the Malawian Government, local villages, Colleges and Universities, her team developed the first ever accelerated midwifery programme of study in Malawi. The results have been positive with more women attending health facilities to give birth and better overall outcomes. Her current focus is on facilitating ‘respectful care’ to expectant mothers, based on a human rights approach.

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