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Accreditation, A Critical Lever for the Massive Scale Up of Social Accountability Globally

October 5, 2017

By Julian Fisher, Director Advocacy and Networks, THEnet

These are very exciting times for social accountability, now mainstreamed in health workforce policy at a global level (1).  This establishes the policy environment for interconnected and aligned action to deliver the massive scale up and implementation social accountability at institutional, national, regional and global levels (2).

THEnet’s Community of Practice is launching a series of blogs in the run up to the 4th Global Forum on HRH in Dublin, 13-17th November. The aim is to keep you updated on developments in the lead up to and during the conference, and enable you to participate policy implementation dialogue.

So who’s writing?

We have contributions from world leaders in socially accountable health workforce education, with Roger Strasser (Professor of Rural Health, Dean and CEO Northern Ontario School of Medicine), and Mohamed Elhassan Abdalla Mohamed Elhassan Elsayed (Chairman Group on Social Accountability, Association of Medical Education in Eastern Mediterranean Region (AMEEMR) providing blogs over the next few weeks.

So why act now?

Social accountability (SA) grew out of work by WHO / Charles Boelen and others in the early 1990’s with an early definition for social accountability of medical schools  (1995) emerging from this work.

THEnet defines socially accountability as “institutions that train health workers design their education, research and service activities to meet health needs of the communities they serve—with priorities jointly defined by government, services providers and others including the populations in greatest need“.

There is now political buy-in and a drive for implementing social accountability across UN agencies and within WHO. The report of UN High-level Commission on Health Employment and Economic Growth (2016) (ComHEEG) has a set of 10 recommendations, with SA a central element of educating and training a fit for purpose health workforce in the Commission’s report. The accompanying action plan  has immediate actions to be initiated by March 2018, including the “massive scale-up of socially accountable and transformative professional, technical and vocational education and training supported with technical assistance, institutional capacity building and financing”.

Focussed attention on social accountability is also embedded in WHO Strategy on Human Resources for Health (GSHRH).

The implementation of both ComHEEG and GSHRH will need to be supported by concise information on the health workforce situation and trends of a country.

WHO has developed National Health Workforce Accounts (NHWA) to enable countries to me progress on sharing data on human resources for health, and collect data on a set of core health workforce indicators to measure and assess the impact of action. The NHWA contains indicators of relevance to country, regional and global reporting across the spectrum of health workforce priorities.

WHO National Health Workforce Accounts (NHWA) is clearly promoted in the ComHEEG report and action plan, and specifically the GSHRH (2020 Milestone), as an important means to support countries in their national health workforce policy and planning. WHO NHWA will allow countries to measure and understand the problem, and assessing the impact of action.

The NHWA indicators include two dedicated to accreditation standards for social accountability, as well as systems level indicators supporting an enabling environment for the implementation of SA at institutional, national, regional levels.

The ball is in play, and we need to run with it

So how can we massively scale up of SA globally?

The GSHRH sets out Milestones 2020, which includes “all countries have established accreditation mechanisms for health training institutions”?

This opens a window of opportunity to develop national and/or sub-national standards for social accountability in accreditation mechanisms.

This raises questions,

  • How should we go about this?
  • Can we draw upon the work of World Federation of Medical Education to ensure common and consistent standards across all health workforce education?
  • As we discuss accreditation standards for SA, how can we ensure that it is framed within lifelong learning so its not just confined to pre-service / undergraduate education?

These are some of the issues we shall be exploring over the next few weeks and we will post an updated blog schedule each week.

Look forward to seeing you in our CoP …



  1. Enabling universal coverage and empowering communities through socially accountable health workforce education Lead author: Björg Pálsdóttir. Contributing authors: Nadia Cobb, Julian Fisher, John H.V. Gilbert, Lyn Middleton, Carole Reeve, Mariela Licha Salomon, Roger Strasser
  2. UN High-level Commission on Health Employment: A Five-Year Action Plan (2017–21) http://www.who.int/hrh/com-heeg/com-heeg_actionplan2016.pdf?ua=1

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