Training for impact: the socio-economic impact of a fit for purpose healthworkforce on communities

Training for impact: the socio-economic impact of a fit for purpose health workforce on communities

Björg Pálsdóttir1*, Jean Barry2, Andreia Bruno3, Hugh Barr4, Amy Clithero5, Nadia Cobb6, Jan De Maeseneer7,8, Elsie Kiguli-Malwadde9, André-Jacques Neusy10, Scott Reeves11, Roger Strasser12 and Paul Worley13

Abstract Across the globe, a “fit for purpose” health professional workforce is needed to meet health needs and challenges while capitalizing on existing resources and strengths of communities. However, the socio-economic impact of educating and deploying a fit for purpose health workforce can be challenging to evaluate. In this paper, we provide a brief overview of six promising strategies and interventions that provide context-relevant health professional education within the health system. The strategies focused on in the paper are: 1. Distributed community-engaged learning: Education occurs in or near underserved communities using a variety of educational modalities including distance learning. Communities served provide input into and actively participate in the education process. 2. Curriculum aligned with health needs: The health and social needs of targeted communities guide education, research and service programmes. 3. Fit for purpose workers: Education and career tracks are designed to meet the needs of the communities served. This includes cadres such as community health workers, accelerated medically trained clinicians and extended generalists. 4. Gender and social empowerment: Ensuring a diverse workforce that includes women having equal opportunity in education and are supported in their delivery of health services. 5. Interprofessional training: Teaching the knowledge, skills and attitudes for working in effective teams across professions. 6. South-south and north-south partnerships: Sharing of best practices and resources within and between countries. In sum, the sharing of resources, the development of a diverse and interprofessional workforce, the advancement of primary care and a strong community focus all contribute to a world where transformational education improves community health and maximizes the social and economic return on investment. Keywords: Health workforce education, Economic impact, Social impact, Social accountability, Social determinants of health, Distributed learning, Community engagement, Interprofessional education, Primary care Excerpt: There is increasing awareness that to maximize positive impact on health, education systems need to be embedded in health systems. The recent Ebola epidemic in West Africa is a grim reminder that not investing in a fit for purpose workforce deployed at all levels of a health system can devastate health, cripple development and have global repercussions [1, 2]. The challenge is urgent. The 2013 WHO report estimates that the shortage of healthcare workers is likely to increase from 7.2 million to 12.9 million by 2035 [3]. Producing and maintaining an adequate supply is not the only existing challenge. There is a misalignment between health system needs and the education and training of the health workforce [4]. Chisholm and Evans estimate that inefficiencies such as inappropriate skill mix, attrition, retention issues and maldistribution of health workers; unnecessary or too long hospital admissions and inappropriate training could be costing the global health economy more than US$500 billion [5]. These challenges are major impediments to universal health coverage and health equity in high-, middle- and low-income countries. Producing a context-relevant workforce that is fit for purpose re- quires education to be designed accordingly. The answer to how can the impact of educational in- vestments be maximized may be socially accountable education. It is increasingly seen as a mechanism to maximize impact and is included in several major policy guidelines and documents such as the World Health Organization’s Guidelines on Transforming and Scaling up Health Professional Education. Socially accountable (SA) health professional education is broadly defined as “the obligation to direct their education, research and service of activities towards addressing the priority health concerns of the community, region and/or nation that they have a mandate to serve. The priority health concerns are to be identified jointly by governments, healthcare organizations, health professionals and public”. It means ensuring learners understand the culture, the needs and the assets of the communities in which they learn and then develop relevant competencies for practicing in these communities, becoming a more “fit for purpose” worker. Strategies to create a fit-for purpose workforce include giving community members a voice in both the selection and training of students, training diverse students early on and throughout their curriculum in primary care and underserved settings, training a cadre of health workers including community health workers, using competency-based assessment of theoretical learning, integrating and reinforcing learning on the effect of social determinants of health and equity on both individuals and populations, and learning to practise in interprofessional teams. Collaboration and sharing of best practices to evaluate the impact of such complex dynamic educational interventions is challenging, but methodologies are evolving to better capture the impact of SA and other trans- formative education efforts [6–9]. Illustrative examples, some of which are presented below, from across the globe suggest that a combination of strategies can con- tribute to improved workforce and health outcomes which may persuade key decision makers that investment in education generates a sound return on investment (see Fig. 1). In this paper, we provide a brief overview of six promising strategies and interventions, which are potentially important links in a chain of evidence For full article access, sign up. New members are welcome! Open Access