Bernarda, Karla and Yan's slides on Economic analysis of the value of international volunteering and placements to the healthcare sector in the UK presented at the NHS Volunteering Group, 2017.

1. Economic analysis of the value of
international volunteering and placements to
the healthcare sector in the UK
Bernarda Zamora, Karla Hernandez-Villafuerte, and Yan Feng
NHS International Volunteering Group
London, Monday 4th September 2017

2. 04/09/2017 2
Outline
• Stage 1:
 Literature review on outcomes of international
volunteering in the health sector
 Outcomes framework
 Monetary valuation model
• Stage 2:
 Example of the valuation model with the Health
Partnership Scheme

3. Literature review -
Outcomes of international
volunteering in the health sector

4. 04/09/2017 4
Literature selection and outcomes
• Previous literature reviews, systematic reviews,
scoping reviews on international volunteering in
the health sector
• Data extracted:
 Outcomes for individuals, healthcare organisations,
society
 Outcomes themes: education and skills; labour
market; organisational; health

5. 04/09/2017 5
Papers selected:
International volunteering (IntV)
Country Study Interventions
Evaluation
method
UK and international
studies
Machin, J., 2008. The Impact of Returned International Volunteers on the UK:
A Scoping Review. London: VSO.
VSO International
volunteers
Scoping review
International
volunteering:
Managed by VSO in
UK
Barzegar, B., 2015. Contradictions in international volunteering outcomes:
Bridging the gap between theory and practice through a host-country
perspective. Voluntary Sector and Volunteering Research Conference. 8 - 9
September 2015, Leeds, the UK.
Role of International
Volunteer Sending
Agencies
Literature review
International
volunteering:
Tanzania and
Mozambique
Graham, L.A., Mavungu, E.M., and Perold, H., 2011. International Volunteers
and the Development of Host Organisations in Africa: Lessons from Tanzania
and Mozambique. Southern African Conference on Volunteer Action for
Development. 17-19 October 2011, Johannesburg, South Africa
2010 VOSESA survey of 201
volunteer placement
organisations. 30%
response rate (61
organisations).
Survey analysis
International
volunteering
Lewis , D., 2005. Globalisation and international service: a development
perspective. Voluntary Action, 7(2), 13-26.
None
Discussion on
globalisation
International
cooperation through
health partnerships
Syed, S.B., Dadwal, V., Rutter, P., Storr, J., Hightower, J.D., Gooden, R., Carlet,
J., Nejad, S.B., Kelley, E.T., Donaldson, L., and Pittet, D., 2012. Developed-
developing country partnerships: Benefits to developed countries?.
Globalization and Health, 8(17), 1-10.
Information on health
system benefits accrued by
developed countries from
partnering with developing
countries
Literature review

6. 04/09/2017 6
IntV - Outcomes:
Education, skills and attributes
• Inter-culturalism: Social/cultural capital/social entrepreneurship
• Communication: Better information sharing
• Improved employee morale
• Problem solving
• Influencing and persuading
• UK employers’ perception of innovative ways: Innovation in
mobile phone use, monitoring/evaluation, client tracking
systems, Education in communicable disease control
• Training in public health policy, health financing, and
administration
• Low technology simulation training
• Greater commitment to civic engagement

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IntV - Outcomes:
Labour market institutions
• Impact on choice of career for youth volunteers
 International development, social care
• Capacity building in human resources
 For the receiver country
• Bridge between the professionalised world of development
experts and organisations and the ‘non-specialised public’ who
engage with the ideas and practices of development
• UK workforce planners benefit from utilising developing country
models for worker substitution, mobilisation, recruitment, and
retention
• Knowledge base on community workforce policy, training, and
education
• Raise the profile of community-based interventions

8. 04/09/2017 8
IntV - Outcomes:
Healthcare Organisations
• Donors were more likely to trust the views of the
international volunteers
• Rural health service delivery
• Decentralisation of management
• Improved patient-provider relationships

9. 04/09/2017 9
IntV - Outcomes:
Negative outcomes and barriers
• Out-of-date skills (“lost ground”), networks and
knowledge
 Concern among employers as well as returning volunteers
• Communication failures
 Partly as a result of the indirect relationship between the placing
organisation and the host organisation
• What are the causes behind large numbers of early
return?
 For example, VSO reported 43% early return rate in Papua New
Guinea (van Eekelen, 2015)

10. Outcomes framework

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Our proposed framework
• Objectives
 To acknowledge that social capital and health are both ultimate
outcomes from the perspective of the society
 To keep the chain in several stages of outcomes production as per
the theory of change used in the logic framework of the Health
Partnership Scheme (Edwards, 2016)
 To adopt the NHS perspective with “barrier of accountability” one
stage before valuing social capital and health as ultimate outcomes
 To acknowledge that international volunteering shares key aspects
of the economic, political, and institutional context with informal and
youth employment
Adoption of MILES framework

12. 04/09/2017 12
Our Outcomes framework (1):
Adapted from MILES
Social Capital & Health
Supply of skills and
attributes (E)
• Individual attributes
• Skills
Volunteering programmes and partnerships
• Perceptions of
employers
• Perceptions of staff
• Retention/Promotion
• Gap formal labour
market/ community
• Role of partnerships
• Role of volunteering
organisations
Labour market
characteristics (L)
Demand for
volunteers by
organisations
Partnerships (I)
Management/
Information/
Service delivery (I)
• Innovation
• Gap professional/
informal service
delivery

13. 04/09/2017 13
Our Outcomes framework (2):
Adapted from MILES
• NHS perspective: What are the outcomes adding value
to the NHS?
 Skills and attributes of the labour force
– Learned directly in international volunteering or transmitted by
international volunteers
 Labour market (recruitment, retention, and promotion)
– Readiness to hire international volunteers and to receive staff
returning from international volunteering
 Readiness to start new partnerships with volunteering and
host country organisations
– Improvement in roles and communication
 Change in organisational behaviour by incorporating
international volunteer experiences (e.g. management, service
delivery, information systems)

14. Monetary valuation methods

15. 04/09/2017 15
Valuation method - Wider impact
• Haldane (2014)
 “In giving, how much do we receive? The social value of
volunteering” Speech by Bank of England Chief Economist
Labour
input
Number of volunteers
Economic
Value
Replacement theory: the value of the labour
input
- VIVA: The Volunteer Investment and Value
Audit
- International Labour Organisation, (2011),
Manual on the measurement of volunteer work
Private
value
Well-being theory: the value of increased life
satisfaction, including learning, achievement
and personal health
- Fujiwara, D et al. (2013)
Social value
Social capital theory: benefits derived from
formal opportunity structures or activities
where individual actors develop social ties and
social networks

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Valuation of relevant outcomes for
the NHS
• We will estimate the value to the NHS in terms of the value
of the three outcome dimension framework: E,L,I (from the
MILES framework)
 In the terms of “volunteering onion” by Haldane (2014)
 The outcomes in the dimensions E and L are part of “private value”
 The outcomes in the I dimension should be reflected in the quality of
health care and service delivery
 Then, the I outcomes are part of the “economic value” of health
services
 Part of economic value if captured by the host organisation during the
volunteering period
 Part of economic and private value is captured by the NHS from
returned volunteers. Stage 2 estimates this dimension in the form of
increased labour productivity.
• Ultimate outcomes social capital and health have spillovers
on the NHS

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References
• Edwards, S., 2016. Evaluation of an Established International Health Partnership Using
Theory of Change. London: Tropical Health & Education Trust (THET)
• Fujiwara, D., Oroyemi, P., and McKinnon, E., 2013. Wellbeing and civil society.
Estimating the value of volunteering using subjective wellbeing data. Department for
Work and Pensions Working Paper 112.
• Gaskin, K., 2011. VIVA – The Volunteer Investment and Value Audit. A self-help guide.
Second Edition. London Institute for Volunteering Research (IVR).
• Haldane, 2014, In giving, how much do we receive? The social value of volunteering.
Speech 9 September 2014, Lecture to the Society of Business Economists. London:
Bank of England
• Holzmann, R, 2007. MILES Workshop: Identifying binding constraints to job creation
and productivity growth - An introduction. Washington, D.C.: World Bank
• Independent Evaluation Group and The World Bank Group, 2013. Youth Employment
Programs. An Evaluation of World Bank and IFC Support.
• Teasdale, S. 2008. In good health. Assessing the impact of volunteering in the NHS. IVR
• van Eekelen, W., 2015. The second independent progress review of VSO’s strategic
grant agreement with DFID Final report. London: Voluntary Service Overseas (VSO).

18. Stage 2: Estimation of value of international
volunteering

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OBJECTIVE
• Based on NHS publicly available
information
 To estimate the benefit for the NHS of the
increase in productivity as a result of new
skills learned by NHS staff during
international volunteering
 NHS perspective

20. 04/09/2017 20
International Volunteers from the Health
Partnership Scheme
• Number of UK health professional days spent
volunteering overseas and in the UK:
 67,363 days in period July 2011 to April 2016
– Female: 41,956; Male: 19,124; Unknown: 6,283
 17,878 in the period May 2015–April 2016 (12,364
overseas, 5,514 UK)
– 1,700 volunteers
– 56% women and 44% men

21. 04/09/2017 21
Assumptions (1)
• Salary per year (p.a.) level reflects productivity
 Before being an international volunteer, a person is at a
salary level that reflects his/her productivity
• NHS international volunteers acquire new skills
 This increases the productivity of a number of volunteers to
a level comparable to the next salary level
 Volunteers return to the same salary level that they had
before
– Increase in productivity is fully captured by the NHS
o Higher skilled people for the same salary

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Assumptions (2)
• Volunteers are from all NHS staff categories, excluding
administrative staff
• Volunteers are distributed among staff categories and
levels are similar to that observed in the NHS
 Total of 1700 volunteers
• Only a proportion of volunteers increase their productivity
to a point similar to the people in the next salary level
Staff Categories
Number of productivity levels
(i.e. salary levels) per category
HCHS doctors 5
Nurses 15
Scientifics 16
Technicians 4
Ambulance 2
Tutors 2
Other 9
Total of levels included 58
Administrative Staff 5

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Example HCHS Doctors
Other doctors in training:
Productivity = £25,885 p.a.
Registrars:
Productivity = £37,483 p.a.
BEFORE
International
Volunteering
Other doctors in training:
Productivity = £25,885 p.a.
Other medical and dental staff
Productivity = £64,892 p.a.
AFTER International Volunteering:
Assuming 50% of volunteers increase their skills to the next level
Registrars:
Productivity = £37,483 p.a.

24. 04/09/2017 24
Average
annual salary
level =
Productivity
p.a.
Percentage of the
total NHS staff
(excluding
administrative staff)
Number of
volunteers by
productivity
category
(unadjusted)
After the International Volunteering*:
Assuming 50% of volunteers increase their skills
to the next level
A) Number of
volunteers that stay
in the same
productivity level
B) Number of
volunteers that have
moved up a
productivity level
Number of
volunteers by
productivity category
(adjusted)
= A + B
Staff Group: Nurses £28,199 44.2% 752 752
1) Nursing Assistant / Auxiliary £15,786 5.9% 101 50 50
2) Pre-Registration Nurse Learner £16,321 0.2% 3 1 50 52
3) Nursery Nurse £17,369 0.5% 9 4 1 6
4) Nursing Assistant Practitioner £18,678 0.5% 8 4 4 9
5) Post 1st Level Registration Nurse £22,491 0.2% 3 2 4 6
6) Other 2nd Level Nurse £26,109 0.2% 4 2 2 3
7) District Nurse £26,768 0.6% 9 5 2 7
8) Qualified School Nurse £26,899 2.7% 46 23 5 28
9) Other 1st Level Nurse £27,245 29.9% 508 254 23 277
10) Qualified Midwives £27,401 0.1% 2 1 254 255
11) Children's Nurse £28,325 1.6% 27 14 1 15
12) Community Matron £36,639 0.1% 2 1 14 15
13) Nurse Manager £42,270 1.1% 19 9 1 10
14) Modern Matron £43,073 0.5% 8 4 9 13
15) Nurse Consultant £47,617 0.1% 2 2 4 6
Numerical Example: Nurses
254 volunteers
(50%) moved up
from level 9 to a
level of productivity
equal to 10
254 volunteers
(50%) do not
increase their
productivity:
stay in level 9
*Rounded values

25. 04/09/2017 25
Quality (skills) adjusted: Fisher Index
• Commonly used to estimate output, input and
productivity indexes
• Weights the number of staff of each type by their
respective wages before aggregating
 By holding wages constant, the index measures “real‟
changes in the (weighted) volume of staff, not changes in
how much they are paid
– Allows capture of new skills effect on the growth in total
labour hours
 Can be calculated even when some quantities are zero
Fisher Index = 𝑠 𝐿 𝑠1 𝑤 𝑠1
𝑠 𝐿 𝑠0 𝑤 𝑠1
∗ 𝑠 𝐿 𝑠1 𝑤 𝑠0
𝑠 𝐿 𝑠0 𝑤 𝑠0
𝑃𝑟𝑜𝑑𝑢𝑐𝑡𝑖𝑣𝑖𝑡𝑦 𝐺𝑟𝑜𝑤𝑡ℎ = 𝐹𝑖𝑠ℎ𝑒𝑟 𝐼𝑛𝑑𝑒𝑥 − 1

26. 04/09/2017 26
Average
annual salary
level =
Productivity
p.a.
Percentage of the
total NHS staff
(excluding
administrative staff)
Number of
volunteers by
productivity
category
(unadjusted)
After International Volunteering*:
Assuming 50% of volunteers increase their skills
to the next level
A) Number of
volunteers that stay
in the same
productivity level
B) Number of
volunteers that have
moved up a
productivity level
Number of
volunteers by
productivity category
(adjusted)
= A + B
Staff Group: Nurses £28,199 44.2% 752 752
1) Nursing Assistant / Auxiliary £15,786 5.9% 101 50 50
2) Pre-Registration Nurse Learner £16,321 0.2% 3 1 50 52
3) Nursery Nurse £17,369 0.5% 9 4 1 6
4) Nursing Assistant Practitioner £18,678 0.5% 8 4 4 9
5) Post 1st Level Registration Nurse £22,491 0.2% 3 2 4 6
6) Other 2nd Level Nurse £26,109 0.2% 4 2 2 3
7) District Nurse £26,768 0.6% 9 5 2 7
8) Qualified School Nurse £26,899 2.7% 46 23 5 28
9) Other 1st Level Nurse £27,245 29.9% 508 254 23 277
10) Qualified Midwives £27,401 0.1% 2 1 254 255
11) Children's Nurse £28,325 1.6% 27 14 1 15
12) Community Matron £36,639 0.1% 2 1 14 15
13) Nurse Manager £42,270 1.1% 19 9 1 10
14) Modern Matron £43,073 0.5% 8 4 9 13
15) Nurse Consultant £47,617 0.1% 2 2 4 6
Remembering the example
*Rounded values
Ls0
Ls1
Ws0=Ws1

27. 04/09/2017 27
Data
• NHS Staff Earnings:
 Data of HCHS doctors (salaries, staff categories and number
of doctors in each category)
– NHS Staff Earnings Estimates to September 2016 -
Provisional statistics (December 20, 2016)
http://www.content.digital.nhs.uk/catalogue/PUB22697
• NHS Workforce Statistics
 Data of Non-HCHS doctors (salaries, staff categories and
number of people in each category)
– NHS Hospital & Community Health Service (HCHS)
monthly workforce statistics - Provisional Statistics
http://www.content.digital.nhs.uk/catalogue/PUB22088

28. 04/09/2017 28
Methodology
• 1700 volunteers are shared across the different
categories and levels according to two scenarios
1. Assuming that administrative staff are not volunteers
2. Assuming that only HCHS doctors and nurses are volunteers
• Sensitivity analysis:
 Assuming different values for the percentage of volunteers
who acquired new skills that increased their productivity to a
level similar to the people in the next salary category
– 25% ; 50%; 75%

29. 04/09/2017 29
Number of volunteers per staff
category
Scenario 1 Scenario 2
Non-HCHS doctors
1,458 1,286
Nurses
752 1,286
Scientifics
115 -
Technician
55 -
Ambulance
39 -
Tutors
3 -
Other
494 -
HCHS doctors
242 414
Total 1,700 1,700

30. 04/09/2017 30
Results: Fisher Index
Productivity growth
Scenario 1
No AD staff*
Scenario 2
Only HCHS doctors and nurses
Proportion of volunteers whose
productivity increase to the next
category
0.25 0.5 0.75 0.25 0.5 0.75
Non-HCHS doctors
Nurses 0.6% 1.3% 1.9% 0.6% 1.3% 1.9%
Scientifics 2.3% 4.6% 6.9%
Technician 4.1% 8.2% 12.3%
Ambulance 3.3% 6.5% 9.8%
Tutors 7.5% 14.9% 22.4%
Other 1.5% 3.0% 4.5%
HCHS doctors 5.0% 10.1% 15.1% 5.0% 10.1% 15.1%

31. 04/09/2017 31
Total productivity growth p.a. (£)
• Fisher index - 1 = % productivity growth of volunteers
 Total productivity growth (£) = Level of productivity in initial period
* (Fisher Index-1)
– Level of productivity in initial period = 𝑠 𝐿 𝑠0 𝑤𝑠0
Total productivity growth p.a.
Scenario 1 Scenario 2
Proportion of volunteers whose
productivity increase
0.25 0.5 0.75 0.25 0.5 0.75
Non-HCHS doctors
Nurses £126,194 £252,388 £378,582 £215,956 £431,911 £647,867
Scientifics £76,283 £152,565 £228,848
Technician £50,336 £100,672 £151,008
Ambulance £29,895 £59,790 £89,686
Tutors £4,857 £9,713 £14,570
Other £140,765 £281,529 £422,294
HCHS doctors £1,457,296 £2,914,592 £4,371,888 £2,493,867 £4,987,735 £7,481,602
Total £1,885,625 £3,771,250 £5,656,874 £2,709,823 £5,419,646 £8,129,469

32. 04/09/2017 32
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33. 04/09/2017 33
Annex: HCHS doctors Scenario 1
Average annual
salary level (£)
% of the total
NHS staff
(excluding
administrative
staff)
Number of
volunteers
Number of
volunteers
according with
their increase in
productivity
HCHS doctors 14.22% 242 242
1) Other doctors in training £25,885.55 5.68% 31 15
2) Registrars £37,483.24 5.17% 88 59
3) Other medical and dental staff £64,892.76 1.81% 25 56
4) Hospital practitioners & clinical
assistants
£69,462.28 0.10% 2 13
5) Consultants (including Directors of
public health)
£89,529.82 1.46% 97 97
Assuming 50% workers with new skills