Socially accountable medical education strengthens community health services.

CONTEXT: 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. METHODS: This is a non-randomised, controlled study involving a researcher-administered survey to 827 recent mothers (≥1 child aged 0-5 years). Five communities were serviced by SAHPE medical graduates or final-year medical students (interns) in Eastern Visayas and the Zamboanga Peninsula, and five communities in the same regions were serviced by conventionally trained (non-SAHPE) graduates. FINDINGS: Mothers in communities serviced by SAHPE-trained medical graduates and interns were more likely than their counterpart mothers in communities serviced by non-SAPHE trained graduates to: have lower gross family income (p < 0.001); have laboratory results of blood and urine samples taken during pregnancy discussed (p < 0.001, respectively); have first pre-natal check-up before 4th month of pregnancy (p = 0.003); receive their first postnatal check-up <7 days of birth (p < 0.001); and have a youngest child with normal (>2500 g) birthweight (p = 0.003). In addition, mothers from SAHPE-serviced communities were more likely to have a youngest child that: was still breastfed at 6 months of age (p = 0.045); received a vitamin K injection soon after birth (p = 0.026); and was fully immunised against polio (p < 0.001), hepatitis B (p < 0.001), measles (p = 0.008) and diphtheria/pertussis/tetanus (p < 0.001). In communities serviced by conventional medical graduates, mothers from lower socio-economic quartiles (<20 000 Php) were less likely (p < 0.05) than higher socio-economic mothers to: report that their youngest child's delivery was assisted by a doctor; have their weight measured during pregnancy; and receive iron syrups or tablets. CONCLUSIONS: The presence of SAHPE medical graduates or interns in Philippine communities significantly strengthens many recommended core elements of child and maternal health services irrespective of existing income constraints, and is associated with positive child health outcomes.

Addressing health workforce inequities in the Mindanao regions of the Philippines: Tracer study of graduates from a socially-accountable, community-engaged medical school and graduates from a conventional medical school.

Developing and retaining a high-quality medical workforce in low-resource countries is a worldwide challenge. The Filipino Ateneo de Zamboanga University-School of Medicine (ADZU-SOM) has adopted a strong focus on socially accountable health professional education (SAHPE) in order to address the shortage of physicians across rural and urban communities in the Western Mindanao region. A cross-sectional survey of graduates from two Philippines medical schools: ADZU-SOM in the Mindanao region and a medical school with a more conventional curriculum, found ADZU-SOM graduates were more likely to have joined the medical profession due to a desire to help others (p = 0.002), came from lower socioeconomic strata (p = 0.001) and had significantly (p < 0.05) more positive attitudes to community service. ADZU graduates were also more likely to currently work in Government Rural Health Units (p < 0.001) or be generalist Medical Officers (p < 0.001) or Rural/Municipal Health Officers (p = 0.003). ADZU graduates were also less likely to work in private or specialist Government hospitals (p = 0.033 and p = 0.040, respectively) and be surgical or medical specialists (p = 0.010 and p < 0.001, respectively). The findings suggest ADZU-SOM's SAHPE philosophy manifests in the practice choices of its graduates and that the ADZU-SOM can meet the rural and urban health workforce needs of the Western Mindanao region.

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

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.

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.

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 Woollard's 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.

Processes and outcomes for a successful engagement between a medical school and a remote Indigenous community in North Queensland, Australia.

INTRODUCTION: Medical students should be equipped with the necessary knowledge, skills and attitudes to engage with local communities on placement, and later act as agents of change in addressing health system priorities and inequities. Determining what are the necessary knowledge, skills and attitudes requires the medical school to collect input from the local communities they serve. This study describes the steps taken by the James Cook University (JCU) School of Medicine & Dentistry (SMD) to develop a systematic process for collecting input from a local Indigenous community. METHODS: This 2011 study utilised a participatory action research design. An Indigenous Reference Group (IRG) consisting of 13 local Indigenous people including health professionals, Elders and community members was established by the JCU SMD in the North Queensland town of Mount Isa. 'Yarning Circle' discussions between SMD representatives and the IRG developed a Terms of Reference (ToR) to guide the engagement process, and negotiated reciprocal benefits to compensate participants for time involved in consultations and to promote sustainability. RESULTS: A framework for engaging with the Mount Isa Indigenous community was developed. Benefits for the SMD included a list of the good and bad engagement strategies with the local Indigenous community. Benefits for the IRG members included assistance with grant applications, media skills and organizing a community-wide health event. CONCLUSIONS: Successful and sustainable community partnerships between a medical school and an Indigenous community can be achieved, with Indigenous researchers and community members guiding the engagement process, and for stakeholders to follow through in providing the negotiated reciprocal benefits. Having an established IRG should increase Indigenous input and participation into the medical curriculum, and into future research and community activities to improve the health of the Indigenous people.