With globalization, there has been significant growth in short-term medical service trips (MSTs) from high-income countries (HICs) to low- and middle-income countries (LMICs). Although MSTs deliver significant amounts of care, relatively little attention is given in the medical and public health literature to the impact of these interventions on the populations being served. The following review offers a step forward by addressing this gap with a systematic analysis of the existing empirical work and suggestions for further study.

According to the World Health Organization, the highest proportions of the global burden of disease fall on the regions that also suffer significantly from physician shortages. A growing group from HICs aims to address both medical and surgical unmet needs in LMICs through MSTs, sometimes referred to as medical missions.

For purposes of this review, MSTs are defined as trips in which volunteer medical providers from HICs travel to LMICs to provide health care over periods ranging from 1 day to 8 weeks. Both faith-based organizations and non–faith-based organizations facilitate these trips, a feature that will be discussed in more detail later. Team composition can range from members of academic departments from a single institution to collections of individuals affiliated only by friendship, geography, or the organization facilitating the trip.

Authors of several published articles have noted that MSTs as a form of aid do not address the primary sources of the health care problems in the developing world: poverty and overstretched health care infrastructure. There are, however, significant resources, financial and human, dedicated to MSTs annually. Although there is no central monitoring group or agency for MSTs, conservative estimates that do not take into account opportunity costs for the volunteers place the annual expenditures at $250 million.With expenditures of this magnitude, questions naturally arise about the return on investment. If noteworthy returns exist and organizations are simply not measuring or reporting them, then this can be remedied. If the returns do not exist and the missions continue, an ethical dilemma may be emerging.

Over the past 20 years, publications describing MSTs have largely aimed to promote models of health care delivery in these settings. The pressure to develop practice guidelines has created some standardization in care, but the lack of critically reviewed empirical data continues to be a concern. Assumptions that the safety and acceptable risk or rates of complications from HICs are automatically transferable to MSTs are unwarranted and could be dangerous.

The lack of evidence is particularly concerning when one considers the vulnerable nature of patients living in LMICs. Under the best circumstances, MSTs address an unmet medical need with high-quality care. Under the worst circumstances, they serve, as one author states, as an opportunity for physicians to practice techniques for the treatment of conditions that are less common in the developed world. This example is extreme and is unlikely to play a role in the justification for most contemporary MSTs, but the possibility is concerning. One report in the faith-based literature (of an evangelical short-term mission trip in this case) suggested that some trips may benefit the volunteer as much as or more than the recipient of aid as well as potentially costing the hosts valuable time and resources.

Martiniuk et al. recently