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Measurement and accountability for results in health. Does what gets measured, get done?

Measurement and accountability for results in health. Does what gets measured, get done?

Dr Chan the former Director of WHO reflected that ‘what gets measured, gets done’.

Yellow measure tape By karandaev Adobe Stock

The idea of reorienting towards population and community needs is a central principle and organizational drive of United Nations Transforming our world: the 2030 Agenda for Sustainable Development. This call to reorient towards people-centredness and ‘population / community needs’ is now being taken up by UN agencies, including WHO, for example WHO 12th Programme of Work, 2014-2019.

And specific to the health workforce, as we discussed in the first blog in the accreditation series, the UN High-level Commission on Health Employment and Economic Growth (ComHEEG) and WHO Global Strategy on Human Resources for Health (GSHRH): Workforce 2030, both of which highlight the growing mismatch between health workforce demand and supply and population health needs.

So what gets measured?

Social accountability is embedded in the ComHEEG report and accompanying action plan, as well as GSHRH. Both reflect the main arguments and recommendations of THEnet policy brief that noted ‘while the challenges are complex, evidence is emerging that socially accountable health workforce education, which aims to ensure that education programmes are relevant to the local context and that needs are identified in collaboration with key stakeholders, can strengthen health systems and positively influence the availability, distribution and performance of health workers’.

So how might we achieve comparable global measurement in health workforce, and within this social accountability? 

WHO has developed the National Health Workforce Accounts (NHWA), which will act as the instrument for both ComHEEG and GRHRH (see NHWA policy brief) and define core indicators in support of strategic workforce planning and global monitoring. The initial NWHA draft includes indicators on ‘existence of national education plans for health workers, aligned with the national health plan (see indicator 10_06), and the ‘existence of social accountability as an element of the accreditation standards used at the national level (see indicator 03_04)’.

So social accountability will be measured, both in terms of an enabling policy environment and institutional action / reforms.

So what gets measured, get done?

Key strategies associated with social accountability in health workforce education include the alignment of curricula with local needs, targeted student selection, training taking place in the primary care contexts in which graduates are expected to serve, regional postgraduate training and career pathways in underserved regions, interprofessional education and practice, and meaningful partnerships with communities and other stakeholders.  

This raises the question, which we have posed on THEnet accreditation discussion forum “is it sufficient to have one overarching standard for social accountability, or should social accountability be distributed and reflected within standards in accreditation mechanisms as per World Federation of Medical Education Global Standards for Quality Improvement: Basic Medical Education, or it is necessary to have both?”

This touches on the definition of social accountability.  As a community perhaps we need to reflect on the term social accountability, as it often takes time to explain, and means different things in different contexts and cultures. Another aspect is that social accountability is singular, whereas its call to action –  reorienting towards population and community health needs - is pluralistic. This is not unique to social accountability, but as momentum gathers for social accountability at a global level we must ensure the pluralistic approach within a robust and clear definition of social accountability informs and guides, instructional and institutional reforms and the monitoring and evaluation process.

That just leaves the missing element, what gets measured, gets done but must be paid for. The ComHEEG action plan recognizes that there has to be adequate budgetary resources for investments in transformative education and skills (ComHEEG action plan deliverable 7.1

Join THEnet Community of Practice to engage in the debate, and most importantly shape the result 

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