There is global recognition that the institutions training health workers need to better align their programs and strategies to meet the changing needs of all population groups. The impactful strategies of THEnet’s partner institutions played an important role in convincing global policy leaders that social accountability principles and mechanisms are essential in this effort. THEnet partners and other socially accountable schools form effective partnerships with the health sector, policy makers and communities. They are vital contributors to health system development and agents of innovation and reform.

In 2011, THEnet, building on common and successful strategies of its founding partners and an existing social accountability model, developed a powerful, practical and comprehensive tool to help schools align the training of health workers with community needs. The goal is to support evidence based, socially accountable health workforce education that is people-centered and focuses on improving quality of services and reducing inequities including social determinants of health and access to needed services.  The Framework identifies key factors that affect a school’s ability to educate a health workforce that will positively influence health outcomes and health systems performance and develops ways to measure and improve the outcomes across institutions and contexts.

Instead of merely counting how many graduates they produce, socially accountable health workforce education institutions assess whether the competencies of their graduates are aligned with community needs. Instead of only tallying how many articles their researchers have published, these schools consider the impact these articles have had on policy. And instead of basing their student recruitment policies on high test scores alone, they recruit students who are most likely to stay in communities where health professionals are scarce – and urgently needed. The Framework and its accompanying Toolkit helps schools design, modify, and evaluate these areas and guide institutions to become more socially accountable.

Theory of Change

The model guiding the development of THEnet’s schools programs and its Framework, assumes that to meet the needs of the populations it serves, a school or program must be designed based on a thorough needs assessment and understanding of the environment it operates in. This includes the social systems it seeks to impact and how various systemic and other factors may influence its operations and outcomes. The assessment is conducted in collaboration with key stakeholders including health system actors and underserved communities.

Guided by the values it espouses the school then sets outcome objectives and selects strategies likely to achieve them. Desired competencies of the health workers and research priorities are defined based on the need assessment. Schools then design and delivers programs to meet their defined outcomes. The school then evaluates its processes, strategies, outcomes and the impact the school is having on the systems, communities, and individuals it serves to ensure its activities are meeting needs. This is an ongoing process and the school must continue to examine their underlying assumptions, be proactive and responsive to changing needs and demands. THEnet logic model illustrates the key underlying assumptions and philosophy of THEnet and its member schools.

Acknowledgements

Many individuals were involved in the development and review of the Framework for Socially Accountable Health Workforce Education. They include:

• Original developers of the Framework (version 1.0 published February, 2012)
• Sarah Larkins, Iris Lindemann, Marie Matte, Jose Alvin P Mojica, André-Jacques Neusy, Björg Pálsdóttir, Robyn Preston, Rex Samson, Simone Ross, David Buso, Filedito Tandinco, and Afdal Kunting
• Other contributors to the development of the Framework (version 1.0)
• Charles Boelen, Kate Brennan, Juan Carrizo, Pasqualito Concepcion, Fortunato L. Cristobal, Aaron Goldstein, Jenenne Greenhill, Dan Hunt, Jehu Iputo, Joel Lanphear, David Marsh, Khaya Mfenyana, Ileana del Rosario Morales Suárez, Richard Murray, David Prideaux, Jusie Lydia Siega-Sur, Roger Strasser, Paul Worley, Sarah Strasser, and Zorayda Leopando
• Developers of version 2 of the Framework online (Version 2.0 published June, 2014)
• Simone Ross, Sarah Larkins, Iris Lindemann, Björg Pálsdóttir, Robyn Preston, Kristien Michielsen, Torres Woolley, and André-Jacques Neusy
• Further acknowledgements: The Framework and this resource was funded by the generous support of the Atlantic Charitable Trust. THEnet would also like to thank the Arcadia Foundation for their generous support. We are indebted to Charles Boelen and Robert Woollard who developed the Conceptualisation– Production–Usability Model that THEnet used as a basis for the development of the Framework.