Written By: Björg Pálsdóttir
The concept of social accountability in health professional education has been around for nearly three decades. It took years, a workforce crisis and persistent advocacy to gain traction. While the term is becoming more popular, I have noticed that, even in academic publications, people often only reference one of its key elements, namely, the “obligation to direct education, research and service activities towards addressing the priority health concerns of the community, region and/or nation they have a mandate to serve”. [1] The second element, namely, that “priority health concerns are to be identified jointly by governments, health care organisations, health professionals and the public”,1 which is just as important, is often skipped.
Social accountability is a broad concept that leaves a lot of room for interpretation. In my mind, what is most important is that it calls on us to think differently about how academic institutions work and how they measure success. The Training for Health Equity Network (THEnet) is a community of practice of health professional institutions committed to social accountability and reducing health inequities. These institutions, located in Asia, Africa, North America, Europe and Australia, are clear about what they want to hold themselves accountable for. They define their success not by the number or titles of their graduates or how many articles they publish, but by whether their graduates have the right competencies to meet the needs of the populations they serve and whether a high portion of them stay and work in regions where they are most needed. They track where their graduates go, the careers they choose and whether their competencies match community needs. They also assess whether the research and services their institutions conduct positively affect health policies and practice, and improve health in marginalised and underserved communities.
Schools striving towards social accountability partner with communities, practitioners, learners and others to identify priority needs and design education, research and service activities that address those needs. Since such schools start with the needs in mind, they reflect on whom they should educate to maximise the likelihood that graduates will choose careers in underserved communities. Their admission criteria and selection processes support the recruitment of learners from underserved and under-represented groups. Community members participate in governance, engage in identifying desired competencies and participate in teaching. A significant part of learning takes place in communities with the greatest needs. Learners acquire important competencies, including those related to social determinants of health, by living, learning, and providing services in communities that suffer the most negative effects of those determinants. Such competencies are focused around people-centred approaches to health, being able to communicate and collaborate effectively with others, screening for non-health determinants, and advocating for patients and policy change. Deep-rooted bias based on race, gender, caste, ethnicity, sexual orientation or other causes of marginalisation and providers’ professional status can affect the quality and equity of care. Therefore, health professionals need to be self-reflective and committed to personal growth.
Most educational institutions are not adequately committed to addressing inequities. However, there is progress. Social accountability standards are included in the World Health Organization’s National Health Workforce Accounts. The Australia Pharmacy Council worked with education providers, professional associations, associations of Aboriginal and Torres Strait Islanders and Māoris, pharmacy students and consumers to develop and incorporate the principles of social accountability into the latest set of accreditation standards for pharmacy programmes in Australia and New Zealand.
Academic institutions shape the values, behaviours and world views of key groups in the health system, with wide-ranging effects. By working across sectors and partnering with, working in, and building trust in underserved communities, educational institutions will be instrumental in reducing health inequities and ensuring that we are better prepared to face future health challenges and pandemics.
[1] Boelen C, Heck JE. Defining and Measuring the Social Accountability of Medical Schools. Geneva, Switzerland: World Health Organization; 1995