Expertise in Transnational Healthcare Delivery: Professional versus Amateur Aid
Nongovernmental organizations (NGOs) are key organizational actors in transnational healthcare delivery, but the kinds of personnel who lead, work, and volunteer within these organizations is heterogeneous and constantly shifting. The rationalization of the nonprofit sector in the twentieth century resulted in NGOs hiring professionals with management- and development-related credentials (e.g., MPAs, PhDs). In recent decades, however, ordinary lay citizens without such credentials are increasingly establishing their own NGOs to deliver healthcare abroad. The types of health services and the roles of volunteers vary greatly between “professional” and “amateur” NGOs, with each producing its own organizational interaction order that creates distinctive forms of knowledge about health and development. The central questions that guide my research, then, are: (1) What kinds of expertise do NGO leaders, staff, and volunteers define as relevant to their work in professional and amateur organizations?; (2) How does expertise get put to use when planning and implementing transnational healthcare delivery?; and, more practically, (3) What implications do different articulations of expertise have for communities being served?
My dissertation research project, supported by multiple prestigious external fellowships including a Fulbright award and Boren fellowship (declined), explores these questions through a comparative ethnography of three NGOs in Cambodia that each provide different kinds of healthcare services (e.g., surgical care, primary care, neonatal care) but all rely on foreign volunteer healthcare professionals to treat patients. Drawing upon 980 hours of ethnographic observations and 156 interviews with NGO leaders, local staff, and foreign volunteers across the three NGO cases, I seek to answer, “How do transnational healthcare professionals, and the organizations in which they work, manage the application of medical expertise in new settings?”
I find that a key constraint on how healthcare professionals, be they foreign volunteers or local staff, deploy medical expertise when treating patients is ambiguity surrounding what kinds of expert knowledge and skills are reflected in different types of professional healthcare credentials. Much of this ambiguity stems from the transnational character of the organizational context: since NGOs host foreign volunteers who come from disparate countries, each with their own traditions for training and credentialing healthcare professionals, foreign volunteers and local staff struggle to make sense of what each other’s professional credentials signify. This creates disorder when delegating tasks and coordinating patient care. To arrive at shared understandings of each other’s credentials and competence, foreign volunteers and local NGO staff adopt specific sense-making strategies during interactions “on the shop floor”: competence checks and observing role performances. I further find that once order is restored, both foreign volunteers and local staff experience opportunities to engage in work not typically associated with their respective professional credentials (e.g., a credentialed urologist providing ophthalmological care). By assuming flexible roles, they transcend rigid hierarchies that typify work in the medical profession.
These findings contribute to understandings of how organizations and professionals coordinate work in transnational contexts. First, it illuminates the conditions under which professional credentials lose their standardized meanings of expertise. Second, it explains how professionals coordinate work when formal structures provide an insufficient basis for action. Finally, professionals’ flexible role-taking challenges Weberian depictions of organizations as rigidly defining roles and role relationships. I am preparing a subset of these findings as article manuscripts to submit to academic journals in fall 2025 and spring 2026. I will subsequently reformat my broader arguments as a book-length manuscript for submission to an academic press.
These credential-related issues do not appear, however, in my research on amateur NGOs. Prior to beginning dissertation fieldwork, I co-authored a research report on small-scale international aid initiatives and interviewed 20 leaders of such organizations that deliver healthcare services abroad. The interview project seeks to understand not just what kinds of expertise amateur aid altruists bring to their organizations, but also how they develop partnerships in their intervention sites to provide health care in the absence of institutionalized knowledge and connections to the broader aid industry.
I find that amateur NGO leaders and volunteers develop a practical toolkit of skills and schema from their diverse work backgrounds – for instance, as healthcare professionals, teachers, lawyers – and combine it with resources that local “aid brokers” possess in their intervention sites (e.g., language and cultural knowledge, connections to local government leaders and healthcare facilities). The mishmash of ideas, perspectives, and skills that inform the aid delivery process reflects different institutional logics, which appear in how amateur NGO leaders describe their motivations and modes of action.
My research on amateur NGOs helps explain the ongoing democratization of aid delivery, as the emergence and growth of small-scale, citizen-led aid initiatives represents a departure from established, professionalized norms in the mainstream aid industry. The creative combination and rearticulation of disparate institutional logics explain how these organizations are able to achieve a complex mission – treating patients abroad – without, on one hand, the material resources that big-budget, professionalized NGOs wield and, on the other hand, adopting the “best practices” that professionalized NGOs promulgate. I am preparing an article manuscript outlining these findings for submission to academic journals in 2026.