Introduction To
The Framework

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.

Member School’s Social
Accountability Operational

health system community
and student needs
research, competencies
and attitudes for meet
education, research and
needs, process, outcomes
and impact
governance, education,
research and services
Through The
Lens Of


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.

THEnet Logic Model

Theory of change for how socially accountable health professional edu-
cation (SAHPE) institutions collaborating under THEnet contribute to
health equity.

Faculty has a process for critical reflection on
the curriculum based on periodic assessment of, and accountability towards, the needs of its
students and reference population (local communities and health systems)

SAHPE Philosophy
of THEnet
Long Term

SAHPE Philosophy
of THEnet

School’s mission, values, governance and strategies are needs-based: centered on addressing health issues and social determinants of health among target populations, strengthening local health systems, and reducing health inequities

School has a participatory approach: governance and strategies are planned with meaningful input from all relevant stakeholders, particularly local government and communities, with a primary focus on the priority health and social needs of local communities.

SAHPE Activities

ui accordion buttonui accordion buttonui accordion buttonui accordion buttonFaculty

  • Includes representatives from the geographic/cultural profile of the reference population
  • Community-based practitioners are recruited and trained as student preceptors
  • Staff development programs responsive to community needs

ui accordion buttonui accordion buttonui accordion buttonui accordion buttonLearners

  • Taught the principles of socially accountable medical practice
  • Targeted recruitment policy to actively encourage & support culturally, socially or geographically disadvantaged students

ui accordion buttonui accordion buttonui accordion buttonui accordion buttonCurriculum

  • Curriculum tailored to priority local community needs
  • Local government has input into the School’s curriculum content and teaching activities
  • Integrates basic & clinical sciences with principles of population health and social sciences

ui accordion buttonui accordion buttonui accordion buttonui accordion buttonPedagogy

  • Student-centered and problem-based pedagogic methods
  • Service-based learning occurs as a shared responsibility between the medical school, community and the local health system
  • Students trained to recognize and take action on health disparities

ui accordion buttonui accordion buttonui accordion buttonui accordion buttonResearch

  • Reflects priority community health issues and the health of underserved groups
  • Has a focus on participatory methodologies & research partnerships with local communities

ui accordion buttonui accordion buttonui accordion buttonui accordion buttonCommunity Service

  • The School engages and supports community and community health service providers in a manner which strengthens local health services and promotes the aspirations of community members
  • The School plays a role in advocacy and policy reform
  • The School gives community a voice on health service reform

SAHPE Outcomes

ui accordion buttonui accordion buttonui accordion buttonui accordion buttonTransformed Graduates

  • New SAHPE graduates have positive intentions for community-based service, and to address local health inequities
  • Registered Graduates engage in client advocacy & broader health reform
  • New SAHPE graduates have the appropriate clinical, social and cultural competencies to address priority health needs
  • Registered SAHPE graduates adopt professional behaviors and choose their career and geographic practice location to address local health workforce needs

ui accordion buttonui accordion buttonui accordion buttonui accordion buttonHealth Service Support

  • SAHPE Faculty staff and students contribute to health service delivery in reference area

ui accordion buttonui accordion buttonui accordion buttonui accordion buttonHealth Policy & Practice

  • Faculty staff have meaningful input into the development of regional health policies and health services

Regional Impact

ui accordion buttonui accordion buttonui accordion buttonui accordion button‘Fit-for-purpose’ medical workforce

  • Little or no geographic areas of health workforce shortage
  • Culturally competent health service delivery that is cognizant of the social determinants of health
  • All cultural and social groups in reference area have access to health services
  • Responsive in addressing health inequities in the reference population

ui accordion buttonui accordion buttonui accordion buttonui accordion buttonTransformed communities

  • Engagement by SAHPE students, graduates and staff strengthens the social fabric of local communities
  • Community is an active partner in research and interventions to improve the health & well-being of its citizens

Long Term Goals

ui accordion buttonui accordion buttonui accordion buttonui accordion buttonHealth equity and improved health outcomes*

  • Priority health needs are addressed in reference area
  • Continuous reduction in systemic, socially produced or preventable differences in the health of reference populations


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.

Measured Through
The Lens Of

  • Quality
    Health services must be delivered in a way that optimally satisfies both professional standards and community expectations.
  • Equity
    Opportunities for health gains are available to everyone. Health equity and social determinants of health should be considered in all aspects of education, research and service activities.
  • Relevance
    The most important and locally relevant problems are tackled first. Decisions on health resources are responsive to community needs and the principles of cultural sensitivity and competency.
  • Partnership
    Partnerships are key in developing, implementing and evaluating efforts between all stakeholders- faculty and students, communities, health and education systems, and schools.
  • Efficiency
    The greatest impact on health is achieved through cost-effectiveness and with available resources targeted to address priority health needs.