[CIMSIGHT #3] Social Accountability in Medical School: Create a Better Healthcare in the Society

Medicine is a profession that upholds trust and accountability to society. This responsibility extends to all medical education institutions. Medical education should aim to produce doctors who are ready to provide care and who understand their role in the context of community and society. To achieve the goal of ‘health for all’ advocated by the World Health Organisation (WHO), both health systems and medical schools must undergo major reforms.

Get to Know the Concept of Social Accountability

Social accountability in medical education refers to the commitment of medical schools to engage, partner, and respond to the needs of communities, regions, and nations. This involves directing education, research, and service activities to address the priority health issues of the communities, regions, and nations they serve, as jointly identified by governments, healthcare organizations, health professionals, and the public. Social accountability is a framework that guides medical schools in their mission to improve the health of the communities they serve, particularly vulnerable and underserved communities.

Aspects of Social Accountability in Medical Education

Medical accreditation standards that include social accountability aspects will help improve the quality of medical education and produce doctors who are competent and oriented towards public health needs. The social accountability aspect of medical education includes three stages: Social Responsibility, Social Responsiveness, and Social Accountability.

1. Social Responsibility: Medical education that provides educational programs that take into account the health needs of the community and have specifically defined objectives.
2. Social Responsiveness: Medical education that has an educational program that integrates community-based activities in its program.
3. Social Accountability: Medical education that anticipates the identification of public health needs through its contributions, leading to the function and stage of education, research, and service programs.

4 Pillars of Social Accountability

Although many medical schools recognize their obligation to fully serve society, there are some conceptual issues regarding definitions and evaluation, which, if resolved, could facilitate the wider application of the social accountability paradigm. The concept of social accountability proposes a framework designed to help medical schools evaluate their continued progress in achieving this goal based on the four pillars of relevance, quality, cost-effectiveness, and equity in health care, which are defined as follows.

1. Relevance: Relevance in health care can be defined as the extent to which the most important problems are addressed first. Although priorities may be set in different ways in different communities, primary attention should be given to those who suffer most, to more common diseases, and to conditions that can be addressed by locally available means.
2. Quality: High-quality healthcare uses evidence-based data and precise technology to deliver comprehensive healthcare services to individuals and communities, taking into account their social, cultural and consumer expectations. The WHO definition of health as ‘a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity’ should be a reference for healthcare reformers and communities.
3. Cost-effectiveness: A cost-effective healthcare system is one that has the greatest impact on public health and makes the best use of available resources. Whatever the level of resources available, cost-effective care can be provided.
4. Equity: Equity, which is at the core of a socially accountable healthcare system, means the endeavour to provide high quality healthcare to all people in all countries. The ultimate goal of the WHO Global Strategy for Health for All is for all people to receive at least such a level of health that they are able to work productively and participate actively in the social life of the communities in which they live. To achieve this level of health, every individual must have access to primary health care services and through these services, access to all levels of a comprehensive health system.

Implementation of Social Accountability in Medical Education in Indonesia

The implementation of social accountability in medical education in Indonesia is seen through the institution’s efforts to adhere to the principles of social responsibility, social responsiveness, and social accountability. These principles are designed to ensure that medical schools address relevant community health issues, with a focus on the clinical and preventive aspects of care. To be socially accountable, medical education in Indonesia must:

1. Direct their education, research, and service activities to address the priority health problems of the community, region, and/or country they are mandated to serve.
2. Identify priority health issues together with government, healthcare organisations, health professionals, and communities.
3. Guide the entire scope of their activities towards the principle of social accountability.
4. Medical education in Indonesia is encouraged to integrate social accountability into its mission, planning, and day-to-day management. This includes reflecting the health needs and diversity of the school community, region, curriculum, learning experiences, research activities, healthcare partnerships, and graduates. 

In conclusion, the implementation of social accountability in medical faculties in Indonesia is essential to ensure that the institution addresses the health concerns of its community and contributes to the overall improvement of healthcare.

Writer: Hans Agabe Mangatur Sagala – Medical Education Trainer