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This study by the Population Council and the Zambia-Led Prevention Initiative was designed to examine the motivations of individuals volunteering as STEPS-OVC caregivers; to explore their experiences in service, including perceived barriers to carrying out their volunteer work and if, and how, their expectations for volunteering had been met or not; to assess individuals’ intent to continue caregiving; and to ascertain factors associated with volunteer productivity. Two main findings stand out from this study: that communitarian and religious helping values were virtually universal in the study population, and that a majority of the volunteers indicated economic and material interests and needs. We can thus assume that exercise of choice and, hence, voluntary action is compromised for individuals who are faced with severe material needs and limited or absent livelihood options. From this perspective, we must examine the ethics of continued reliance on poor volunteer workforces to deliver basic public health services in the name of sustainability. Our hope is that these findings trigger reflection, advance understanding of the issues, and provoke critical deliberations about the future of volunteer health programs in low-income populations.