COVID-19 fosters social accountability in medical education.

The COVID-19 pandemic has highlighted embedded inequities and fragmentation in our health systems. Traditionally, structural issues with health professional education perpetuate these. COVID-19 has highlighted inequities, but may also be a disruptor, allowing positive responses and system redesign. Examples from health professional schools in high and low- and middle-income countries illustrate pro-equity interventions of current relevance. We recommend that health professional schools and planners consider educational redesign to produce a health workforce well equipped to respond to pandemics and meet future need.

Social accountability and health systems' change, beyond the shock of Covid-19: drawing on histories of technical and activist approaches to rethink a shared code of practice.

BACKGROUND: Recognition of the value of "social accountability" to improve health systems performance and to address health inequities, has increased over the last decades, with different schools of thought engaging in robust dialogue. This article explores the tensions between health policy and systems research and practice on the one hand, and health equity-focussed activism on the other, as distinct yet interacting processes that have both been impacted by the shock effects of the Covid-19 pandemic. This extended commentary brings multidisciplinary voices seeking to look back at health systems history and fundamental social-institutional systems' behaviors in order to contextualize these current debates over how best to push social accountability efforts forward. ANALYSIS: There is a documented history of tension between long and short processes of international health cooperation and intervention. Social accountability approaches, as a more recent strategy to improve health systems performance, intersect with this overarching history of negotiation between differently situated actors both global and local on whether to pursue sustained, slow, often community-driven change or to focus on rapid, measurable, often top-down interventions. Covid-19, as a global public health emergency, resulted in calls for urgent action which have unsurprisingly displaced some of the energy and aspiration for systemic transformation processes. A combination of accountability approaches and mechanisms have their own legitimacy in fostering health systems change, demanding collaboration between those that move both fast and slow, top-down and bottom-up. CONCLUSION: We argue that social accountability, much like all efforts to strengthen health systems, is "everybody's business" and that we must understand better the historical processes that have shaped the field of practice over time to move forward. These differences of perspective, knowledge-base and positioning vis-a-vis interventions or longer-term political commitment should not drive a conflict of legitimacy but instead be named, subsequently enabling the development of a shared code of conduct that applies to the breadth of actors involved in social accountability work. If we are concerned about the state of/status of social accountability within the context of "building back better" we must approach collaboration with a willingness to create dialogue across distinct disciplinary, technical and politically-informed ways of working.

Rendición social de cuentas en España. El papel de las organizaciones de la sociedad civil en la promoción de buena gobernanza durante la pandemia derivada de la COVID-19

El éxito en la construcción de buena gobernanza necesita de la confluencia de, al menos, tres variables: a) una coyuntura crítica;b) reformas iniciales que generen organizaciones de accountability horizontal, y c) una coalición de diversas fuerzas políticas y sociales con suficiente capacidad para superar los obstáculos de la acción colectiva y los puntos de veto del sistema. Este trabajo indaga en la labor de las organizaciones no gubernamentales (ONG) en esa coalición durante la pandemia provocada por la COVID-19. Utilizando una metodología propia del enfoque de la grounded theory, se usaron dos conceptos de sensibilización: el de buena gobernanza y el de social accountability. Con todo ello, se pudieron identificar veinte ONG para narrar la actividad de control sobre la integridad de la gobernanza en España. Se definió como unidad de estudio objetivo las campañas y, tras un análisis teórico y de revisión de literatura, se identificó qué se podía considerar éxito en este tipo de actividades de control social. Finalmente, desde la propia visión de los sujetos de estudio, se analizaron dos campañas desarrolladas durante la pandemia. En ellas se pudo comprobar la importancia que dan las ONG a un enfoque estratégico frente a la mera confrontación, y muy esencialmente, la importancia de trabajar en coalición interna y con los actores públicos dedicados a labores de accountability horizontal.Alternate : Success in building good governance requires the confluence of at least three variables: a) a critical juncture;b) initial reforms to generate horizontal accountability organizations;and c) a coalition of diverse political and social forces with sufficient capacity to overcome the collective action obstacles and the veto points of the system. This article investigates the work developed by NGOs in this coalition during the pandemic caused by COVID-19. Following the grounded theory approach, two sensitization concepts were used, namely, «good governance» and «social accountability». With all this, twenty NGOs were identified to narrate the control on governance integrity in Spain. Campaigns were defined as the target unit of study and, after a theoretical analysis and literature review, the understanding of success in this type of social control activities was established. Finally, two campaigns developed during the pandemic were analyzed from the NGOs’ point of view. These campaigns showed the importance that NGOs in this field give to a strategic approach instead of mere confrontation and, more in particular, the importance of working in an internal coalition and with public actors engaged in horizontal accountability.

Social Accountability in Spain. The role of civil society organizations in promoting good governance during the COVID-19 pandemic

Success in building good governance requires the confluence of at least three variables: a) a critical juncture;b) initial reforms to generate horizontal accountability organizations;and c) a coalition of diverse political and social forces with sufficient capacity to overcome the collective action obstacles and the veto points of the system. This article investigates the work developed by NGOs in this coalition during the pandemic caused by COVID-19. Following the grounded theory approach, two sensitization concepts were used, namely, "good governance" and "social accountability". With all this, twenty NGOs were identified to narrate the control on governance integrity in Spain. Campaigns were defined as the target unit of study and, after a theoretical analysis and literature review, the understanding of success in this type of social control activities was established. Finally, two campaigns developed during the pandemic were analyzed from the NGOs' point of view. These campaigns showed the importance that NGOs in this field give to a strategic approach instead of mere confrontation and, more in particular, the importance of working in an internal coalition and with public actors engaged in horizontal accountability.

The social accountability of nursing training institutes in Morocco: The knowledge, perceptions and realization of its aspects.

INTRODUCTION: The social accountability (SA) challenges health professional training institutes to reorient their missions to train the graduates aligned with the society's priority needs and produce quality, population centered care. The objective was to assess the knowledge, perceptions, and implementation of SA by nursing education institutions. METHOD: The cross-sectional observational survey was conducted at the Higher Institute of Health Professions and Techniques of Marrakech (ISPITS-M) and its annexes between May 17 and June 4, 2020, using a mixed methodology. The data were collected through an online questionnaire, which was tested with 11 students and teachers. It was completed by 50 teachers and 213 students, recruited on a voluntary basis and was developed based on the literature review, aspects and principles of social accountability. In addition, eight semi-structured interviews were performed with administrative staff recruited by purposive sampling. RESULTS: Out of a total of 924 students and 75 teachers, 213 students and 50 teachers participated in the survey, with a response rate of 23% and 67% simultaneously. The average age was 40.2±8.9 years for the teachers and 19.7±1.3 years for the students. 36% of the students had no knowledge of SA; teachers and leaders had different perceptions and the concreteness of the aspects of SA was low. The students felt they were less prepared in social determinants of health (85%), community lifestyles to be served (85%), outreach care, and frontline work (83%). CONCLUSION: The knowledge of SA is average; there is a need to raise awareness of SA in addition to strengthening training programs and the concretization of actions in this direction.

Reimagining medical education for primary care in the time of COVID-19: a world view.

This article sets out to highlight the challenges and opportunities for medical education in primary care realised during the COVID-19 pandemic and now being enacted globally. The themes were originally presented during a webinar involving educationalists from around the world and are subsequently discussed by members of the WONCA working party for education. The article recognises the importance of utilising diversity, addressing inequity and responding to the priority health needs of the community through socially accountable practice. The well-being of educators and learners is identified as priority in response to the ongoing global pandemic. Finally, we imagine a new era for medical education drawing on global connection and shared resources to create a strong community of practice.

COVID-19 challenge with regard to medical schools social responsibility: new professional and human perspectives.

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 accountability and because it is the right thing to do.

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.