Le secteur bénévole dans le monde de la santé publique

The research in this paper is based on document review, as well as 20 semi-structured interviews with government officials and with representatives of VSOs involved in public health. To protect anonymity, these interviews, when cited, will be identified by a number and the date on which the interview in question was conducted.

The voluntary sector: terminology and context

A number of different terms can be found in the literature related to this sector, with overlapping but not identical meanings which can lead to a certain amount of terminological confusion. Civil society, non-governmental organizations, non-profit organizations, the “third” sector, philanthropic organizations and interest groups are all fairly common terms, but do not always carry the same meaning. Civil society is often understood to mean “the broad range of social institutions that occupy the social space between the market and the state” (Salamon et al. 1999: 3), but this can sometimes be understood to include both for-profit and not-for-profit organizations. In the same way, non-governmental organizations can also include both types of organizations. In this chapter, we will use the term “voluntary sector” which we take to mean all organizations led by boards, the members of which serve on a voluntary basis. This does not mean that these organizations are composed entirely of volunteers, as in many cases they have salaried personnel to carry out their activities. Moreover, these are organizations which operate on a not-for-profit basis for the purpose of achieving a public good. Finally, they are understood to be formally independent from government, even though, as will be discussed, they may work quite closely with government, or may indeed receive a significant portion (if not all) of their funding from government.¹ Using “voluntary sector” rather than non-profit or not-for-profit has the added advantage, as has been pointed out, of avoiding describing the sector in the negative, that is, as not being something else (Phillips 2001: 259 fn. 3.).

The importance of the voluntary sector is not new in liberal democracies. Indeed, de Tocqueville attached a great deal of importance to this sector as a “necessary guarantee against the tyranny of the majority” (de Tocqueville, 1945: 201-02). Freedom of association also features prominently in the First Amendment of the US Constitution, which is sometimes referred to as the Magna Carta of the voluntary sector in that country. More recently, it has been quite common in US literature to cite the importance of the “Iron Triangle” in public decision-making: the three points of the triangle being congressional committees, the bureaucracy and “interest groups” (Pross 1986: 97).

Since the 1960s, the role of the voluntary sector, consistent with the notion of modern governance, has undergone a fairly significant transformation. A. Paul Pross observed that the diffusion of power in modern society “has transformed participating interest groups from useful adjuncts of agencies into vitally important allies” (Ibid.: 243). Indeed, VSOs are now often the delivery agents for government programs and services, and are increasingly finding a place in the development of research and public policy (Brock 2001: 263; Juillet et al. 2001: 25). The increasing importance of the voluntary sector is evidenced in the fact that in the late 1990s, both the UK and Canada produced major reports on the role of the voluntary sector, followed by “compacts” (in the case of England and Scotland) and an accord (in the case of Canada) to guide relations between government and the voluntary sector (The Compact 1998; Accord Between the Government of Canada and the Voluntary Sector 2001).

¹  This definition is consistent with that used in Building on Strength: Improving Governance and Accountability in Canada’s Voluntary Sector, (Broadbent Report), 1999: 7; see also Morison, 2000: 98.