In summary, volunteers seem to function best when peer support, opportunities for positive interaction with locals and expatriates, and resources for personal, professional, and bureaucratic problem solving are in place.
These responses support observations drawn from discussions of attrition and organizational partnering that point to the successes of well-established partnerships with well defined roles and good supervision as the best contexts for effective volunteer performance. They also suggest that volunteer performance and achievement of objectives are enhanced when health networks have solid and mutually reinforcing relationships at all levels: local, in-country, regional, and international. In this way, local health cultures can be respected and their resources employed to full advantage (for example in organizing traditional birth attendants to support voluntary counseling, testing, and prevention of mother-to-child transmission and in combining HIV work with broader health and development goals). At the same time, volunteers, other expatriate health professionals, and their local counterparts and colleagues can fully utilize resources such as distance learning, international, consulting and sources of information, capacity building, and supply that can be made available through international partnering.