atencion-primaria-mujeresAround the world, health systems, and the populations they serve are facing growing common challenges associated with population aging, lack of access to comprehensive, appropriate, timely, quality health services (1).  In the Region of the Americas, many countries encounter shortages, migration and a marked unequal distribution of their health care workers.
Health professions education has increased rapidly in the Region. At the same time, primary health care is declining in interest for health professionals worldwide, affecting the provision and retention of a fit-for-purpose health workforce, particularly in remote and underserved areas.

In this context, a new paradigm around the idea of social accountability in health professions education is emerging, and promotes the need for change in health care systems, in the roles of health professionals and in the design of health professional education. In this sense, medical schools should be able to train students to be prepared to work with and within the communities, and in multi-professional healthcare settings, to fulfill their social mission to achieve Universal Health (2).

What is social accountability?

Social accountability in health profession education is "the obligation of medical schools to direct their education research and service activities towards addressing the priority health needs of the community, region, and/or nation they have the mandate to serve. The priority health needs are to be identified jointly by governments, healthcare organizations, health professionals and the public" (3).

According to Boelen et al. (2), "the concept encourages academic centers and health services to produce not just highly competent professionals, but professionals who are equipped to respond to the changing challenges of healthcare through re-orientation of their education, research and service". To be socially accountable, educational institutions should be able to develop a positive impact in the communities they serve, train competent health professionals who can address populations' needs, and define the health priorities needs jointly with their community, regional, and national health care stakeholders (2).

Over the years, a number of institutions, including the Pan American Health Organization/ World Health Organization (PAHO/WHO), have promoted social accountability principles to guide health professions education and training to support health systems moving towards Universal Health.

In 2010, the Global Consensus for the Social Accountability of Medical Schools, sponsored by WHO, established ten strategic directions to guide medical schools to become socially accountable (4). The directions promoted schools to:

  • Respond to current and future health needs and challenges in society
  • Reorient their education, research, and service priorities accordingly
  • Strengthen governance and partnerships with other stakeholders
  • Use evaluation and accreditation to assess performance and impact

Transformative education seeks to ensure the sustainable expansion and reform of health professions education and training to increase the quantity, quality and relevance of health professionals and, in doing so, strengthen national health systems, expand access to quality healthcare, and improve health outcomes, particularly among populations in the most vulnerable situations. This means training health professionals with a comprehensive vision, committed to the health of the most vulnerable communities, and with a strong insertion in the practice of first level of care (5).

Moving forward

Effective health-care systems require an adequate supply of trained staff and distribution of physicians to underserved areas in order to deliver high-quality care. At the same time, investment in health and health professions' education not only improves and extends lives but also yields substantial economic gains and contributes to nations' development.

A better alignment is needed between medical school programs, and the health systems responsible for delivering health services to the population. In most countries in the Region, there is a need for greater links and coherence between human resources for health policies, the model of care and the organization of health services. These issues are core to the WHO Global Strategy Health Workforce 2030, the United Nations High-Level Commission on Health Employment and Economic Growth Recommendations 2016, and the technical cooperation for PAHO Regional Strategy on Human Resources for Universal Health in consultation process.

Socially accountable health and education systems can help to promote health professions education that possess the necessary humanistic, technical, inter-cultural and collaborative inter-professional competencies to accelerate the progress towards Universal Health.

References

(1) World Health Organization. Transforming and scaling up health professionals' education and training. Guidelines 2013. Geneva: WHO; 2013. Available from: http://apps.who.int/iris/bitstream/10665/93635/1/9789241506502_eng.pdf

(2) Boelen C, Pearson D, Kaufman A, Rourke J, Woollard R, Marsh D, and Gibbs T. Producing a socially accountable medical school: AMEE Guide No 109; Medical Teacher 2016.

(3) Defining and Measuring the Social Accountability of Medical Schools. World Health Organization, Geneva, 1995. Available from: http://apps.who.int/iris/handle/10665/59441

(4) Global Consensus for Social Accountability of Medical Schools. Available from: http://healthsocialaccountability.org/

(5) Organización Panamericana de la Salud. pdf La misión social de la educación médica para alcanzar la equidad en salud. Informe de reunión, Manaus, Brasil 2014 . Available from: http://www.observatoriorh.org/?q=memoria-de-la-reunion-la-mision-social-de-la-educacion-medica-para-alcanzar-la-equidad-en-salud