By guest contributor Dhananjaya Sharma
Global health is a multi-billion-dollar sector that receives substantial funding from governments, philanthropic organizations, and international agencies. Yet, paradoxically, the backbone of global health efforts—the indispensable researchers, frontline healthcare workers, and advocates—often work for little or no compensation. This reality exposes an uncomfortable contradiction: while global health is framed as a professional and academic discipline, it remains largely dependent on volunteers, perpetuating inequities and limiting sustainability.
The financial muscle behind Global Health
The financial influx into global health is undeniable. The World Bank, the World Health Organization (WHO), the Bill & Melinda Gates Foundation, and numerous other entities pump billions of dollars annually into global health initiatives. These funds support large-scale disease eradication programs, vaccine distribution, research projects, and capacity-building efforts. Yet, despite these financial resources, a significant portion of the labor force remains voluntary or grossly underpaid. From young researchers conducting fieldwork in resource-limited settings to grassroots healthcare workers managing local interventions, many operate on goodwill rather than fair remuneration.
The unpaid workforce: who are they?
The global health workforce consists of an intricate web of professionals, many of whom contribute voluntarily. Medical professionals, public health experts, researchers, and local healthcare workers dedicate their time and expertise to projects that serve marginalized populations. They continue to volunteer proudly; however, many of these professionals receive little financial support for their efforts.
The academic world of global health mirrors this issue. Universities and global health institutions rely on unpaid or poorly compensated interns, fellows, and junior researchers who conduct significant research, write reports, and coordinate field activities. Despite their contributions to published research and policy recommendations, these youngsters are often compensated only with academic currency—authorship and CV mentions—while struggling to find stable, paid employment. Consultants and department heads volunteer tirelessly, often funding expenses from their own pockets while juggling their clinical and teaching duties and scrambling to secure essential budgets.
At the grassroots level, the situation is even starker. Community health workers (CHWs), who are often the primary link between healthcare systems and underserved populations, operate with minimal stipends. Their work—critical in vaccination drives, maternal health programs, and disease surveillance—is seldom reflected in the financial structures of major global health programs.
Who gets paid in Global Health?
Ironically, while frontline workers and researchers remain unpaid, global health organizations have no shortage of well-funded executives, consultants, and administrative staff. Large global health organizations offer lucrative salaries to directors and senior advisors who often operate from glamorous offices far from the realities of on-the-ground healthcare delivery. Similarly, significant funding is directed toward conferences, networking events, and policy discussions that, while valuable, do not directly translate into financial support for the individuals executing global health programs.
This stark disparity in remuneration is often justified as necessary for attracting ‘top talent’ to manage large-scale global health projects. However, it also raises uncomfortable ethical questions: If global health is a field dedicated to equity, why does its financial model perpetuate inequalities within its own workforce?
The impact of the volunteer model
The reliance on volunteers has profound implications. First, it limits participation to those who can afford to work for free. This disproportionately excludes individuals from low- and middle-income countries (LMICs) and those from less privileged backgrounds in high-income countries. Many talented young professionals, especially from LMICs, simply cannot sustain themselves in an unpaid or poorly paid position, restricting opportunities for diverse perspectives in global health leadership.
Second, the volunteer-driven model contributes to burnout and disillusionment. Many dedicated professionals enter global health with passion but are forced to leave due to financial instability. This leads to high attrition rates and a loss of valuable expertise.
Third, the current system distorts the valuation of labor. If global health continues to function on the assumption that essential work can be done for free, it sets a precedent that undermines fair wages for healthcare workers worldwide. This contradicts global health’s own advocacy for fair pay, particularly in LMICs, where ensuring fair compensation for medical staff is a major policy priority.
Breaking the cycle: A call for change
To resolve this paradox, a shift in the funding and structural model of global health is imperative. Here are some key changes that should be considered:
Fair compensation for all workers: Global health initiatives must integrate fair wages for all contributors, from community health workers to junior researchers. This requires donors and funding agencies to mandate fair pay as a condition for grants and funding.
Transparent budget allocation: Funding structures should prioritize on-the-ground workers and researchers over administrative overhead and high executive salaries. Ensuring a more equitable distribution of financial resources will improve workforce retention and program sustainability.
Sustainable career pathways: Universities, NGOs, and international organizations should create sustainable career paths within global health that do not rely on unpaid internships or voluntary labor. Mentorship, employment pipelines, and financial support for young professionals—especially from LMICs—must be institutionalized.
Accountability in funding practices: Large donors must be held accountable for ensuring that their funds support fair wages at all levels. Transparency in how funds are allocated and used should become a norm in global health.
Conclusion
The paradox of global health—where billion-dollar budgets exist yet the majority of workforce remains unpaid—highlights a systemic flaw that must be addressed. If global health is truly committed to equity, it must begin by practicing what it preaches. Ensuring fair wages for all contributors is not just a matter of justice but also a necessity for the sustainability and effectiveness of global health efforts. Until this issue is rectified, global health will remain a striking paradox where money flows, yet labor remains free.
Disclaimer: Views expressed by contributors are solely those of individual contributors, and not necessarily those of PLOS.