By Dr Mohamed Elhassan Abdalla Elsayed, Assistant Professor of Medical Education/College of Medicine-University of Sharjah and Chairman, Group on Social Accountability, Association of Medical Education (EMRO)
The Eastern Mediterranean Region is the WHO region that contains 22 countries extended over the continents of Africa and Asia, the region represent a wide diversity in the socioeconomic status and health indicators of its countries.
The diversity has been reflected on Medical Education also; in history, there is a wide variation in the time of establishment of medical schools in different countries in the region, and more importantly in the coverage of medical schools to the countries population and geographical distribution, please review (Abdalla & Suliman, 2013)
Medical Education is always among the suggested solutions to improve health status in the region as a whole and the plans of individual countries; continuously the medical education issues are on the agenda of WHO meetings in the region (Committee & Mediterranean, 2015).
With the emergence of the concept of social accountability in medical schools (SA) and specifically after the publication of the global consensus in 2010 (GCSA, 2010), medical schools and medical education authorities in the region start to buy-in and advocate for the concept and its implementation. There may be two reasons for this: first is the need for such innovation in medical education that can have a positive impact on the health status of the society and the health system and the second reason may be related to the long standing history of community based education (CBE) in the region that goes back to 1970s (Elsanousi, Elsanousi, Khalafallah, & Habour, 2016).
In order to promote SA in the region, many activities are implemented. The first attempt to institutionalize SA was the formation of the Group on Social Accountability (GOSA) as one of the working groups within the Association of Medical Education in Eastern Mediterranean Region (AMEEMR) (Please see http://ame-emr.org/ameemr/) . The group was formed with the mission “to promote adoption of the concept of social accountability by medical and health professions schools and accreditation bodies in the EMRO-Region”. This group has representation from almost all the countries in the region. To achieve its mission, the group has implemented the following activities:
- Dissemination of the Global Consensus on Social Accountability of Medical Schools (GCSA) to all schools listed within the WHO-EMRO directory of medical schools.
- Conduction of a survey to assess the compliance of medical schools in the region to the GCSA recommendations. The main responses to this survey came from Egypt, Iran and These responses revealed promising results that respondents are either adopting some of the concepts embedded within social accountability or there are plans in place to move forward towards being socially accountable.
- Capacity building to faculty members in the area of social accountability with an online course on social accountability that was conducted to raise the awareness about social accountability and to discuss with the participants the suitable ways to move towards being socially accountable. The course is a joint activity with the Education Development Center at the Faculty of Medicine- University of Gezira, Sudan. The first course was implemented in April 2016 and has participants from Sudan, Saudi Arabia, UAE and Pakistan. Wider coverage of the other countries and a new version of the course that need less contact with the internet is now prepared to overcome some of the connection difficulties in part of the region or part of the countries in the region.
- Work with the individual countries to promote social accountability. In December 2016 the GOSA collaborated with the Network-TUFH (EMRO chapter) and the Sudan Association of Medical Schools to develop the “Sudan Alliance on Social Accountability” that sets the guidelines to promote social accountability in the Sudan including the adoption of the concept in the accreditation standards that governed by Sudan Medical Council (Abdalla & Nuri, 2017).
- Including social accountability as the main theme in all conferences and meetings held by AMEEMR.
The work on Social Accountability in the region is not limited to the activities of the GOSA only but is present at several levels;
- On the regional level: WHO-EMRO has adopted social accountability as one of the directions of medical education in the region; this happened during the WHO meeting in Kuwait, 2015.
- On the Country Level: The medical schools from Algeria, Morocco and Tunisia are now part of the Francophone medical schools project on social accountability. This collaborative project can set an example for other medical schools in the region to follow.
- On the individual schools level: The College of Medicine at the University of Sharjah in the United Arab Emirates has developed a Social Accountability Unit and included it in the administrative structure of the college. The unit should strive to improve the level of social accountability in the College curriculum, research and service.
As the culture of social accountability has spread within the medical education in the region, many publications and research are now contributing to the literature on social accountability; the literature is coming from different countries including Iran, Sudan, Egypt and Pakistan.
The publications mainly aim to judge on the alignment of the current activities and experiences within the individual medical schools with the concept of social accountability using either GCSA strategic directions as a benchmark or judging the activities against the available frameworks that assess social accountability such as the CPU model of the THEnet framework (Elsanousi, Elsanousi, Khalafallah, & Habour, 2016; Emadzadeh, Bazzaz, Noras, & Karimi, 2016; Hosny, Ghaly, & Boelen, 2015) .
In 2012 a research project was initiated in Sudan to develop standards that can be used in the accreditation system to measure social accountability (Abdalla, 2012). The research was a qualitative research based on the improvements that can be done to the current accreditation standards.
The third kind of publication around social accountability is about the perception of faculty members and students about social accountability in different countries.
Although the research on social accountability is still in its infancy, the existing research can form a sound basis for further research that can address the impact of social accountability on health systems and population health.
Out of the research publication, the work in GOSA and different discussions with the concerned faculty we can summarize that the promotion of social accountability in the region needs to develop a common understanding of the concept and that capacity building, faculty development and sharing experiences and best practices are keys to success.
There is a need to develop effective partnerships between medical schools and the concerned stakeholders that put social accountability as a core activity; the Sudan alliance – that mentioned earlier- can be a model for this.
As referred to in many publications from the region and beyond, accrediting bodies need to re-orient their standards to move them towards social accountability in medical education.
Key challenges and opportunities:
The way towards social accountability is not without challenges; different perceptions of social accountability within the same country and some times within the same medical school are big challenges together with some legislations that put the needed stakeholders in silos and prevent effective collaboration between them.
One of the critical challenges facing social accountability in the region is the lack of research fund that can help in producing good socially accountable practice.
Another fundamental challenge facing medical education in the region is the geographical distribution of medical schools in each country where the majority of medical schools are in the capitals and big cities.
In conclusion, there is a fertile soil for the work on social accountability in the EMRO region to grow but it needs to be irrigated with the proper plans and partnerships.