Health ramifications and recovery avenues for Sudan's April 2023 armed conflict: A review

Background: Sudan's history is marred by ongoing sociopolitical challenges, with deep cultural divisions fueling numerous wars. A new conflict erupted on April 15, 2023, pushing the country closer to a full-scale civil war. This war has severely crippled Sudan's already fragile healthcare system, rendering 70% of hospitals in combat zones nonoperational, causing 12,000 deaths, thousands of injuries, and leaving 11 million in dire need of healthcare. More than seven million people are displaced, half of which are children, and are facing severe health challenges, especially vulnerable groups. Heath situation is threatening with unchecked spread of outbreaks of communicable diseases that were previously controlled and marked failure in meeting the health demands of patients with noncommunicable diseases, reproductive and child health issues, and people with serious conditions that require adequate follow-up. Moreover, the projections threaten with more catastrophic consequences including famine, environmental destruction, and further displacement of people. This review article highlights the urgency of the situation and explores potential solutions to enrich global understanding of crisis management. Methods: To comprehensively assess the impact of the crisis and propose a way forward, we drew data by exploring search engines and databases such as Google, Humanitarian Agencies Websites, Google Scholer, and PubMed along with some relevant reports. The search terms included are "Sudan's war", "impact of war on healthcare systems", and "Sudan's armed conflicts". Results: More than 19 publications on the impact of the war on health in addition to periodic reports from international organizations and governmental authorities were reviewed. Conclusion: Although all publications point to the gravity of the situation and the need for prompt response, this crisis offers a unique opportunity to rebuild Sudan's struggling healthcare system with the principles of social accountability. Through domestic and international collaboration, this sector can become a model for similar nations, meeting the needs of its people and promoting sustainable development.

COVID-19 challenge with regard to medical schools social accountability: new professional and human perspectives / El reto de COVID-19 respecto a la responsabilidad social de las escuelas de medicina: nuevas perspectivas profesionales y humanas

Abstract Medical schools play a central role in the compilation and development of professional knowledge, which is why they have privileges and resources that are justified only to the extent that they use them to serve the community, particularly those who are most in need. Medical schools social accountability focuses on the training, healthcare provision and research services they offer. The principles of medical education and the structure proposed by the Flexner Report are in crisis due to the COVID-19 pandemic, and redefinition of the social contract is required. This document offers a proposal for medical schools social accountability that includes anticipation of the needs of the community, patient-centered inter-professional care, training of people in the area of health and collaboration between institutions. It highlights the need for a conscious institution that finds new training spaces other than hospitals, where each patient is cared for in a personalized way, with inter-professional training models that consider the student as a person who takes care of him/herself in open collaboration with organizations. Leaders must act now because it is their social responsibility and because it is the right thing to do.

Resumen Las escuelas de medicina desempeñan un papel central en la acumulación y desarrollo del conocimiento profesional, por lo cual poseen privilegios y recursos que se justifican solo en la medida en que los retribuyan a la comunidad, en particular a los más necesitados. La responsabilidad social de las escuelas de medicina se centra en los servicios formativos, asistenciales y de investigación que ofrecen. Los principios de la educación médica y la estructura propuesta por el Informe Flexner están en crisis debido a la pandemia de COVID-19 y se requiere la redefinición del contrato social. El presente documento ofrece una propuesta de responsabilidad social de las escuelas de medicina que incluye previsión de las necesidades de la comunidad, atención interprofesional centrada en el paciente, formación de profesionales en el área de salud y colaboración entre instituciones. Resalta la necesidad de una institución consciente que encuentre nuevos espacios de entrenamiento diferentes al hospitalario, donde se atienda a cada paciente de forma personalizada, con modelos formativos interprofesionales que consideren al alumno como persona que cuida de sí misma en colaboración abierta con las organizaciones. Los líderes deben actuar ya porque es su responsabilidad social y porque es lo correcto.

Insulados e não democráticos: a (im)possibilidade do exercício da social accountability nos Tribunais de Contas brasileiros / Aislados y antidemocráticos: la (im)posibilidad de ejercer la social accountability en los tribunales de cuentas brasileños / Insulated and undemocratic: the (im)possibility of social accountability in Brazilian courts of accounts

Resumo Este artigo tem por objetivo analisar a permeabilidade dos Tribunais de Contas (TCs) brasileiros à sociedade, por meio de 3 perspectivas: a) transparência dos portais; b) transparência da atividade de fiscalização; e c) participação cidadã. Para tanto, foi estruturado um roteiro de observações, a partir de recomendações de organismos internacionais, e foram coletadas informações dos 32 TCss existentes no Brasil. Em seguida, foram elaborados mapas perceptuais para cada uma das perspectivas analisadas, por meio da técnica de escalonamento multidimensional. As evidências sugerem que os TCs não são transparentes, o que limita a social accountability, e são muito resistentes à participação social, limitando-se a disponibilizar os mecanismos de ouvidoria, portal da transparência e serviço de atendimento ao cidadão. Essas práticas evidenciam que os TCs são, ainda, muito insulados, burocratizados e, apesar de terem um relevante papel no contexto republicano, pouco democráticos. Identificou-se, entretanto, forte influência da Lei de Responsabilidade Fiscal (LRF) e da Lei de Acesso à Informação (LAI) sobre os TCs. Isso pode significar futuras mudanças, ainda que incrementais, na direção da atuação dos TCs como fortes aliados para o aprimoramento da accountability vertical.

Resumen Este artículo examina la permeabilidad de los tribunales decCuentas (TC) brasileños a la sociedad, y si dichos tribunales han actuado de forma que facilite el ejercicio del control social sobre la administración pública. La técnica de escalonamiento multidimensional se utilizó para la construcción de mapas perceptuales en tres dimensiones, elaborados a partir de informaciones recolectadas de los 32 TC existentes en Brasil. Las evidencias sugieren que los TC son todavía poco permeables a la sociedad y poseen pocos mecanismos para auxiliar o facilitar el control ciudadano. Se constató, además, una limitación de medios para la participación social, que se reducen, básicamente, a la oidoría, al portal de transparencia y al servicio de atención al ciudadano. Se identificó, sin embargo, una fuerte influencia de la Ley de Responsabilidad Fiscal y de la Ley de Acceso a la Información sobre los TC. Esto puede significar cambios futuros, aunque incrementales, en la dirección de la actuación de los TC como fuertes aliados para el perfeccionamiento de la accountability vertical.

Abstract This article examines the transparency of the Brazilian Courts of Accounts to citizens, andwhether these Courts have acted in a way that facilitates social accountability over public administration. The multidimensional scaling technique was used to determine the integrity of the 32 Courts of Accounts in Brazil. Evidence suggests that Brazilian Courts of Accounts are still not transparent to society and count on few mechanisms to help and facilitate citizen control. Evidence also shows that the means of social participation is limited, and represented by the Ombudsman, the Transparency Web Portal, and the Citizen Assistance Service. However, this study identified that the Fiscal Responsibility Law (LRF) and the Access to Information Law (LAI) had a strong influence on the Courts of Accounts. Although gradual, these elements can lead to future changes in terms of an increasingly prominent role of the Courts of Accounts as strong allies in the process of enhancing vertical accountability.

Teaching the Fundamentals of Medical Professionalism / 医学教育

It is said that there is no universal and comprehensive definition of professionalism. This is because there are various factors to consider depending on age, social situation, and medical context. Another reason is that academics differ in how they think about professionalism. This situation has made it difficult to introduce professionalism education. However, it is thought that a certain educational effect can be obtained by promoting education while working with the learner to consider the concept and definition of professionalism based on the social contract that forms the basis of the concept of professionalism and the trust of society. We present examples of teaching the concept of professionalism through the use of concrete examples.

Social accountability – The missing link in dental education.

In this century, dental colleges will be gauged by their capacity to anticipate the kind of doctors required by evolving health systems. They will need to consider the challenges these systems face as they grapple with critical health concerns in society. The roots of ill health lie in poverty, discrimination, lack of education, misdistribution and misuse of often scarce resources; and in any given country, those who identify health issues, act on health determinants, decide on the use of resources, deliver health services, or train health manpower are usually different groups that may not share the same value system and priorities. Thus, fragmentation is a serious threat to the efficiency and effectiveness of health systems everywhere. Meeting requirements of socia accountability is a real challenge for dental colleges as it is for the dental health professions, health service organizations, health insurance schemes, and health policy leaders. So this article tries to evaluate the need for social accountability in the dental education system.