André-Jacques Neusy

Measuring social accountability in health professional education: Development and international pilot testing of an evaluation framework

Background: Health professional schools are responsible for producing graduates with competencies and attitudes to address health inequities and respond to priority health needs. Health professional schools striving towards social accountability founded the Training for Health Equity Network (THEnet). Aim: This article describes the development of THEnet evaluation framework for socially accountable health professional education, presents the framework to be used as a tool by other schools and discusses the findings of pilot implementation at five schools. Methods: The framework was designed collaboratively and built on Boelen and Woollards conceptualization, production and usability model. It includes key components, linked to aspirational statements, indicators and suggested measurement tools. Five schools completed pilot implementation, involving workshops, document/data review and focus group discussions with faculty, students and community members. Results: Three sections of the framework consider: How does our school work?; What do we do? and What difference do we make? Pilot testing proved that the evaluation framework was acceptable and feasible across contexts and produced findings useful at school level and to compare schools. The framework is designed as a formative exercise to help schools take a critical look at their performance and progress towards social accountability. Initiatives to implement the framework more widely are underway. The framework effectively aids in identifying strengths, weaknesses and gaps, with a view to schools striving for continuous self-improvement. Conclusion: THEnet evaluation framework is applicable and useful across contexts. It is possible and desirable to assess progress towards social accountability in health professional schools and this is an important step in producing health professionals with knowledge, attitudes, and skills to meet the challenges of priority health needs of underserved populations.

Impact of selection strategies on representation of underserved populations and intention to practise: international findings

Socially accountable medical schools aim to reduce health inequalities by training workforces responsive to the priority health needs of underserved communities. One key strategy involves recruiting students from underserved and unequally represented communities on the basis that they may be more likely to return and address local health priorities. This study describes the impacts of different selection strategies of medical schools that aspire to social accountability on the presence of students from underserved communities in their medical education programmes and on student practice intentions.

The training for health equity network evaluation framework: A pilot study at five health professional schools

Background: The Training for Health Equity Network (THEnet), a group of diverse health professional schools aspiring toward social accountability, developed and pilot tested a comprehensive evaluation framework to assess progress toward socially accountable health professions education. The evaluation framework provides criteria for schools to assess their level of social accountability within their organization and planning; education, research and service delivery; and the direct and indirect impacts of the school and its graduates, on the community and health system. This paper describes the pilot implementation of testing the evaluation framework across five THEnet schools, and examines whether the evaluation framework was practical and feasible across contexts for the purposes of critical reflection and continuous improvement in terms of progress towards social accountability. Methods: In this pilot study, schools utilized the evaluation framework using a mixed method approach of data collection comprising of workshops, qualitative interviews and focus group discussions, document review and collation and analysis of existing quantitative data. Results: The evaluation framework allowed each school to contextually gather evidence on how it was meeting the aspirational goals of social accountability across a range of school activities, and to identify strengths and areas for improvement and development. Discussion: The evaluation framework pilot study demonstrated how social accountability can be assessed through a critically reflective and comprehensive process. As social accountability focuses on the relationship between health professions schools and health system and health population outcomes, each school was able to demonstrate to students, health professionals, governments, accrediting bodies, communities and other stakeholders how current and future health care needs of populations are addressed in terms of education, research, and service learning.

Training for impact: the socio-economic impact of a fit for purpose health workforce on communities

Across the globe, a “fit for purpose” health professional workforce is needed to meet health needs and challenges while capitalizing on existing resources and strengths of communities. However, the socio-economic impact of educating and deploying a fit for purpose health workforce can be challenging to evaluate. In this paper, we provide a brief overview of six promising strategies and interventions that provide context-relevant health professional education within the health system. The strategies focused on in the paper are:1. Distributed community-engaged learning: Education occurs in or near underserved communities using a variety of educational modalities including distance learning. Communities served provide input into and actively participate in the education process.2. Curriculum aligned with health needs: The health and social needs of targeted communities guide education, research and service programmes.3. Fit for purpose workers: Education and career tracks are designed to meet the needs of the communities served. This includes cadres such as community health workers, accelerated medically trained clinicians and extended generalists.4. Gender and social empowerment: Ensuring a diverse workforce that includes women having equal opportunity in education and are supported in their delivery of health services.5. Interprofessional training: Teaching the knowledge, skills and attitudes for working in effective teams across professions.6. South-south and north-south partnerships: Sharing of best practices and resources within and between countries.In sum, the sharing of resources, the development of a diverse and interprofessional workforce, the advancement of primary care and a strong community focus all contribute to a world where transformational education improves community health and maximizes the social and economic return on investment.

Roundtable: revisiting innovative leaders in medical education

In the fall of 2008, MEDICC Review published a roundtable discussion with six of eight deans representing schools of health sciences with a strong social accountability mandate, who had just founded a new collaborative: the Training for Health Equity Network (THEnet). The topic was the changing paradigm of medical education. MEDICC Review returns to hear their perspectives on how their schools contribute to universal coverage, the theme of this issue. An appropriate health workforce is a critical component of universal health coverage. Discussions until now have focused mostly on managing supply and demand. Yet, it has become increasingly clear that what is needed is a fundamental shift in approach: different types of health workers employed in different ways in different health systems to meet the needs of all. Because the traditional “ivory tower” model of medical education is failing to meet the health and social needs of the underserved, THEnet schools are pioneering innovative models to improve access to and quality of health services in disadvantaged communities. Through THEnet, voices of the underserved are being heard—challenging the policies, institutions, and orthodoxies that have systematically failed these populations. THEnet schools measure their success, not by how many graduates they produce or how many of their articles have been published, but by whether their graduates have the right competencies to meet the needs of their reference populations and whether a large proportion of them stay and work in regions where they are most needed. They also measure whether their research and services positively affect health policies and practice and improve health in vulnerable communities. Community engagement is hardwired into the schools’ activities, a cornerstone of their mission to impact health service provision and health workforce retention in disadvantaged areas. THEnet schools view the public as a vital component of the health system, and of any effort to expand health coverage. In their experience, communities can be mobilized and supported to take responsibility for their own health and promote health-seeking behavior, becoming partners in developing solutions to their health challenges. THEnet is scaling up its research and capacity development activities to examine the return on investment in communityengaged socially accountable education, and to better support schools through evidence-based strategies, peer learning environments, and practical tools. The aim is to demonstrate that health equity is a realistic and actionable goal for sustainable health workforce development.

Global Health: Networking Innovative Academic Institutions

Medically underserved communities suffer a high burden of morbidity and mortality, increasing with remoteness where access to health services is limited. Major challenges are the overall shortage and maldistribution of the health workforce. There is a lack of understanding of how academic institutions can best contribute to addressing these health inequities. A new international collaborative of health professions schools, Training for Health Equity Network, is developing and disseminating evidence, challenging assumptions, and developing tools that support health profession institutions striving to meet the health and health workforce needs of underserved communities.

The impact of socially-accountable health professional education: A systematic review of the literature

Abstract This literature review describes the impact of health professional schools with a social accountability mandate by identifying characteristics of medical education found to impact positively on medical students, health workforce, and health outcomes of disadvantaged communities. A critical appraisal tool was used to identify the strengths and weaknesses of the published articles. Data are presented as a narrative synthesis due to the variety of methodologies in the studies, and characterized using a logic model. Health professional schools aiming to improve health outcomes for their disadvantaged local communities described collaborative partnerships with communities, equitable selection criteria, and community-engaged placements in underserved areas as positively impacting the learning and attitudes of students. Students of socially accountable schools were more likely to stay in rural areas and serve disadvantaged communities, and were often more skilled than students from more traditional schools to meet the needs of underserved communities. However, published literature on the impact of socially accountable health professional education on communities and health outcomes is limited, with only one study investigating health outcomes. The findings of this literature review guide schools on the inputs likely to maximize their socially accountability outputs and increase their impact on students, local health workforce and local communities.

Socially accountable medical education strengthens community health services

Socially accountable health professional education (SAHPE) is committed to achieving health equity through training health professionals to meet local health needs and serve disadvantaged populations. This Philippines study investigates the impact of SAHPE students and graduates on child and maternal health services and outcomes.

Improving Community Health Using an Outcome-Oriented CQI Approach to Community-Engaged Health Professions Education

Health professionals providing health-care services must have the relevant competencies and clinical experiences needed to improve population health outcomes in different contexts. Current models of health profession education often fail to produce a fit-for-purpose workforce ready and willing to provide relevant, quality care to underserved communities. Evidence is emerging that community-engaged and socially accountable health workforce education, i.e., aligned with priority health needs, produces a workforce ready and willing to work in partnership with underserved regions. This model of education fosters greater affiliation between education and service delivery systems and requires institutions to measure graduate outcomes and institutional impact. The Training for Health Equity Network (THEnet), a partnership of socially accountable health workforce education institutions, has developed and tested a Social Accountability Framework for Health Workforce Education (the Framework) and toolkit to improve alignment of health workforce education with outcomes to assess how well education institutions meet the needs of the communities they serve. The Framework links education and service delivery creating a continuous quality improvement feedback loop to ensure that education addresses needs and maximizes impact on the quality of service delivery. The Framework also provides a unifying set of guidelines for health workforce policy and planning, accreditation, education, research, and service delivery. A key element to ensuring consistent high quality service delivery is an appropriately trained and equitably distributed workforce. An effective and comprehensive mechanism for evaluation is the method of CQI which links the design, implementation, accreditation, and evaluation of health workforce education with health service delivery and health outcomes measurement.

International organizational response to infectious disease epidemics

Publisher Summary The roots of global public health are found in the economics and interface of war, trade, and health. One of the earliest examples of public health policy in action was the routine short-term use of quarantine and isolation of trade ships in order to combat plague, beginning in the fourteenth century. Efforts at long-term prevention leading to institutionalizing response began much later. The social ecology of infectious diseases links the fates of peoples and ecosystems around the globe. Because the world has not dealt with a pandemic caused by a highly contagious, rapidly spreading infectious disease since the 1918 influenza epidemic, assessment of todays true organizational response capacity is speculative at best. Effective organizational response to the threat of infectious disease involves the integration of two basic models: emergency response and primary health care and prevention. The emergency response model is a direct response to a specific disease threat. Its main goal is to control, contain, or eliminate an imminent threat. The primary care and prevention model is concerned with prevention and control of a myriad of disease threats through the ongoing supply of basic public health infrastructure and primary health care.