Transformative Education
for Health Professionals

Social accountability, Could it be used to underpin the health-education system model to empower society in addressing health inequities, by holding health and education systems accountable ?

Social Accountability will feature in several sessions during the Prince Mahidol Award Conference to be held in Bangkok, Thailand, Jan 2014;

Plenary 2  poses the question "The vision for transforming education includes the promotion of social accountability in health workforce education and in close collaboration with communities. Could the principle of social accountability be used to underpin the health-education system model to empower society in addressing health inequities, by holding health and education systems accountable? 

Session 3.7 in the main programme is entitled  'Social accountability; Frictions and Cohesion between health professional Councils, Associations and Civic Organizations.

In this blog Julian Fisher interviews Dr Charles Boelen, International Consultant in health systems and personnel, former coordinator of the WHO programme (Geneva) of Human Resources for Health to explore and discuss the background to social accountability and current activities.

1. What are the origins of social accountability ?

There has always been an interest expressed either by governments or educational institutions
to train health professionals responding to people's health needs.  The most common term used to characterize this commitment was  "community-orientation".  With the advent of the WHO and UNICEF declaration of Alma Ata for primary health care in 1978 and the subsequent strategy of Health for All , countries were urged to ensure a better match between people's health needs and health workforce relevance and availability. In 1995, a WHO monograph authored by Boelen and Heck proposed a definition of social accountability for medical schools, focusing on a reorientation of education, research and service missions towards meeting values of quality, equity, relevance and cost-effectiveness in health care. ( ref :  Boelen C, Heck J. Defining and Measuring the Social Accountability of Medical Schools. Geneva: World Health Organization 1995. )

2.    Why has it gained prominence in the discussions around transformative education ?


Any purposeful and sustainable transformation of education requires an depth introspection on how education can make a difference on people's health status taking into account the values mentioned in the earlier question. The transformation implies not just improving the content of education but assuming responsibility for outcomes and eventual impact of the educational institution on the overall performance of the health system. A socially accountable school is one that makes its best in ensuring that its products, be graduates, research findings or health service models, are being used to have the greatest impact on health professional practice, and ultimately on people's health status. It is now largely recognized that only principles of social accountability can lead to effective transformation. (ref :Boelen C, Woollard R, Social accountability: The extra Teap to excellence for educational institutions, Medical Teacher 2011; 33: 614–619 )


3.    Why is it needed ?


It is needed because educators, health service organizers, policy makers realize that the huge investments in education must demonstrate their usefulness in responding to society's priority health needs and challenges.  For a long time, educational institutions and initiatives were not confronted with the task to follow-up where their graduates would settle, how they would practice and whether they had an influence on social determinants of health, which the concept of social accountability encourages them now to do. Worldwide today there is an increasing concern to make the best use of the limited health resources and ensure educational institutions adopt transparent approaches highlighting their contribution.   

4.    What does it aim to do ?


Social accountability aims to endorses policies and methods for educational institutions and initiatives to optimally contribute to attain values of quality, equity, relevance and cost-effectiveness in the health care system. Evaluation and accreditation indicators and processes should take social accountability into account if transformative educational initiatives are to be materialized sustainably.

5.    Who is involved and what is currently being done?


The Global Consensus for Social Accountability of Medical Schools ( www.healthsocialaccountability.org ) in 2010 was a landmark event as it resulted from a large consultation of a global sample of experts in medical education and regulation using a Delphi study. It is hoped that similar initiatives will be taken by educational institutions of other health professions. The Global Consensus document suggests ten strategic directions to transform medical schools into socially accountable ones. These strategic directions would be equally valid for any educational programs in the health sector .  A critical activity is to define indicators to assess the social accountability of medical schools. An example of such effort is the CPU model which explores the commitment of medical schools to several stages of "Conceptualization", "Production" and  "Usability" of their graduates ( ref : Boelen C, Woollard R. Social accountability and accreditation: a new frontier for educational institutions. Med Educ 2009;43:887–94.)

6.    Who should be involved ?


Any educational institution in the health sector should be involved. Any faculty member, be an educator, a researcher or a practitioner , can play a role in facilitating the transformation of a health professional school or an academic institution to readjust their programs in the light of the highest priorities in health. The social accountability movement that emerged in educational institutions should also affect other key stakeholders in the health system, namely, health professions, health care organizations, health insurances schemes, as current and prospective needs and challenges will only be effectively addressed if a strong partnership is established and supported to improve quality, equity, relevance and cost-effectiveness in health care. Spearheaders in education must soon be shouldered by the entire spectrum of health partners to ensure impact on health status.

7.    How I can support / participate in the social accountability ?


As an educator, a researcher or a practitioner, you can assess whether your institution meets the criteria of social accountability. Does it influence graduates in opting for a career that is most in tune with society's health priorities ? Does it help graduates to settle in areas where people are in greatest need ? Does it entertain a strong relationship with potential employers of their graduates ? Is it openly committed to collaborate in adapting the health system for greater social justice and efficiency ?
You can become an advocate for social accountability by improving your knowledge about the concept and being aware of the several experiences to implement social accountability approaches. You can form or participate in a working group within your institution to exchange ideas on best ways to involve your institution, and obtain support from the leadership to recognize social accountability as a strategic dimension for development.

8.    Where can I get more information ?



Social accountability of educational institutions is an issue increasingly published about. Most journals in health professional education have rubriques and research articles on social accountability.   Among the organizations publishing on social accountability issues, you can find : WHO, the Global Consensus for Social Accountability of Medical Schools (GCSA: www.healthsocialaccountability.org), the Network Towards Unity for Health, the Association of Medical Education in Europe (AMEE) through its ASPIRE project, the project THEnet, the action-research project of Francophone Medical Schools

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