Definition of the term
There were ten educators and two student leaders interviewed. The term social accountability was not a familiar term to the key informants. Half of them had not previously encountered the term and it was vague to the rest of the respondents as exemplified by this respondent:
"“Yes I have but not very frequently”."
The term was clarified to interviewees after collecting their views.
The concept of social accountability within medical practice and education was thought to be a duty of individuals towards a community by providing service and training medical students to be more sensitive to the community needs that they serve as expressed in this quote:
"“It borders with social responsibility….one has to be responsible for health materials in order that that they should not be embezzled or wasted. Consumers should be able to question how I use the resources that are meant for them.”"
This statement could be taken for ensuring equity of service provision. Emphasis is laid on the point that corruption impedes access to quality services.
Expression of social accountability in the college
The training of health workers was looked at as a major contribution to social accountability
]. The PBL method
] of teaching and learning was viewed as a means through which social accountability is realized as students learnt through real life problems and hopefully mastered the skills of problem solving thereby becoming lifelong learners. It would then translate into solving community priority problems. The COBES program places students of each class once a year in a rural health care facility. The activities carried out involve providing a service to those that need it. This is now known to improve quality of service delivery in the communities where the students go. It is also known to increase the chances of students once they graduate, to work in underserved areas
]. Exposure to real life rural situations endears many students to these communities as shown in the statements made by the students’ respondents below:
"“COBES helps future health workers to be exposed to the community they are meant to serve upon graduation. Stakeholders are invited to participate in curriculum development in order to improve relevance of training to community needs…”"
Whereas training was believed to be an act of social accountability, it is an assumption that is usually wrong
]. The trained workers have to be seen getting involved in solving community priority health needs.
Deployment of the students to the community sites for COBES curriculum activities and by the school staff offering services at the national referral and teaching hospital was seen as evidence of social accountability and here are quotes in that regard;
"“There is training of health care providers by the College. Research in carried out in the community….COBES offers service to the community……”"
"“….Students give back to the community through the projects done in the community…. they volunteer at Internally Displaced Peoples’ camps and, do research around Mulago hospital….”"
These assumptions may only be right if there is evidence that priority health needs are met. However it was also felt that sometimes the service was both direct and indirect as stated by one of the respondents:
"“Service to the community is done directly and indirectly by staff helping out in provision of health care, teaching at the hospital…….”"
Furthermore, the current expression of social accountability was articulated by the Head of the College as shown in Table
The current expression of social accountability at the CHS#
Accountability to whom?
Respondents believed that the university structure was the platform through which one appraises faculty on social accountability activities however this appraisal is not mandatory and neither is it tracked as noted in the quote below:
"“The dean (representing the university) as well as Mulago hospital management …. do not necessarily check performance with regard to social accountability closely…am my own boss”."
Another respondent was quoted saying:
"“…achieving social accountability is more of a feeling but nothing measurable…….through the execution of my duties.”"
There were no performance indicators for social accountability; if they were, then they are not known to everyone. Indeed reporting activities of social accountability is not formally done; the indicators and the roles of individuals have not been thought through with clarity, as said by the respondent below:
"“Yes we should inform the community about our social accountability activities for their guidance, feedback and facilitation. But I think the institution on the whole does not inform the public much”."
The respondents clearly thought that personal accountability in the institution is part of social accountability. However, proper governance and compliance with administrative procedures were identified as a means to ensure quality training of graduates.
Institutional activities supportive of social accountability
There were varied responses to the question of the strengths of the College in respect to support for social accountability. The role of teaching and research that takes place at the institution was felt to be as strength. The use of PBL and COBES as teaching methods with students who are eager to learn was thought to be a strength in teaching and learning social accountability since the students are placed in rural community sites. There is no concrete proof yet that the priority health needs of the population are being met, though it is clear that COBES has acted as an enhancing platform for the College to partner with public health facilities in health service delivery. Traditionally, integration of health service activities between the Ministry of Education and Ministry of Health has largely been nonexistent.
Impediments to realizing social accountability
The weakness of the institution in as far as ensuring social accountability was mainly the lack of infrastructure that can sustain students in the community. There was also lack of a clear flow of information on what the community needs and how these needs would be met even though the students are capable of collecting this information while they are out in the field. Indeed the lack of a reward or punishment for institutions that are not socially accountable deters the drive forward for this important societal call.
There were gaps identified in the system that hinder implementation of social accountability in the three pillars of teaching, research and service. These challenges include lack of resources in the community to support continued students and faculty stay, resources to conduct translational research activities from a pre determined research agenda.
"“…. the gaps are big, in the implementation of the three aspects.”"
"“Most of the research being done is funder driven. But if we had money we would address priority areas.”"
It was therefore felt that there was a need to strengthen social accountability as it would produce better doctors for the community as said by a respondent:
"“…should set up objectives, sensitize staff and students…….medical issues are influenced by social issues so they should be integrated in learning and teaching activities, as a leading institution we should strengthen our position in the direction of social accountability…”"
The involvement of all hospitals in carrying out social accountability was raised and was further emphasized in the need for research conducted by postgraduate students to be oriented to community needs:
"“Social accountability should not stop at the main teaching hospital, it should be broadened…. Post graduate students may have to rotate in all hospitals surrounding the institutions”."