Symposium #4 - Learn About Change Within Local and Global Ecosystems

Planning an Advocacy Strategy for Socially Accountable Accreditation


Larisa Carrera is Vice rector at Universidad Nacional del Littoral UNL), former Dean of the Faculty of Medical Science (FCM-UNL), in the same university, Santa Fe, Argentina. She holds a Ph.D. in Medicine from Universidad Nacional de Buenos Aires and a master's degree in Higher Education. She has been President of the FAFEMP (Argentine Forum of Publics Schools of Medicine) between 2016 and 2018. From 2009 to 2014, she led the Teacher Training Program of the Faculty of Medical Sciences of the UNL, participating as an expert in numerous teacher training courses for physicians and other health professionals, where she was responsible for the accreditation process of medical career.

Jacques E. Girard is a visiting professor at Université Laval, as a special advisor in Global and Planetary Health at the School of Medicine. During his career, he was actively involved in the fields of Social Medicine, Primary Health Care (PHC), Health System Analysis and Global Health Research. In October 2005, he joined the Pan American Health Organization (PAHO) to work as an international advisor for the development of health systems and services first in Chile and then Mexico for more than 6 years. Back to Quebec, during his mandate as the Global Health Director until 2022, he was aligned with the Faculty’s vision of social accountability. He acts now also as a Public Health Consultant in the Americas.

Charles Boelen is an international consultant in health systems and workforce. Former coordinator of WHO headquarters program of human resources for health. President of RIFRESS - International francophone network for social accountability in health

Robert Woollard is a Professor of Medicine at the University of British Columbia. He has chaired Canada’s accreditation systems for UGE and continuing professional development. Has been working on the issue of social accountability for more than 3 decades.


The ISAATT has four assigned actions to the advocacy group, the ISAASC initiative, focused on creating a global momentum to ensure that accreditation systems of medical schools are designed to address societal health needs.

  1. Creating a list of arguments/seeling points for social accountability, being values-driven, based on partnership and in search of impact
  2. Designing advocacy packages for specific targets: national authority, university leadership, school leadership, health professions, accreditation agencies, civil society, students, and citizens
  3. Organizing special events and participating in national/international meetings to promote SA accreditation as a tool to achieve excellence
  4. Obtaining support from international organizations such as WHO, UNESCO, World Bank, OECD, WFME, etc 

A socially accountable medical school is one which:

  • Responds to current and future health needs and challenges in society
  • Reorients education, research and service priorities accordingly
  • Strengthens governance and partnerships with stakeholders
  • Uses evaluation and accreditation to assess performance and impact

Context and Rationale in Advocating for Change

Social accountability as a component of excellence recognized in the accreditation process

It is important to emphasize that social accountability is a component of excellence in accreditation. The definition of excellence, as per Charles Boelen et al. (2019), is “the capacity to make the highest possible contribution to human welfare”.

Social accountability involves a committed effort to address the pressing health needs and challenges of individuals and society. This commitment is demonstrated through implementing essential changes and adaptations guided by three fundamental principles: a system approach, a core of values and a partnership with health actors.

This can be conceptualized using a “3-4-5” social accountability framework in health:

  • 3 feet of a stool represent the 3 tiers of a system approach
  • 4 corners of a frame represent the 4 reference values,
  • 5 points of a pentagram represent partnership with 5 key actors

The 3-tiers of a system approach are

  1. Identifying health needs and determinants in society
  2. Adapting and transforming for a better response
  3. Following up to ensure greater impact on society

The 4 reference values are

  1. Quality
  2. Equity
  3. Relevance to local, regional and national context
  4. Cost-effectiveness

The 5 partnerships with key actors are

  1. Public authorities
  2. Health organizations
  3. Academic institutions and schools
  4. Health professionals and associates
  5. Civil society

The document highlights the need for change in accreditation processes and introduces the idea of a planned journey involving top-down and bottom-up approaches. It stresses the importance of incorporating social accountability into accreditation processes and identifies potential change agents, such as ministries of health, ministries of education, and medical schools.

Global Panorama for Accreditation of Schools of Medicine

A focus on WFME recognition and FAIMER’s role in listing accrediting agencies worldwide.

The document provides a case study of Argentina’s accreditation system through CONEAU and discusses the mandatory and voluntary nature of accreditation in different countries.

Stakeholder analysis methodology for the SA Pentagram partners: the need for a mapping tool?

Stakeholder analysis methodology is introduced, emphasizing the importance of a mapping tool for understanding support, opposition, and power dynamics. An advocacy strategy template is presented, covering issues, potential allies and opponents, status and timeline, critical path, resources, risks, exit strategy, and evaluation.

Group Discussion

The discussion groups section provides insights from stakeholders on power vs. interest, challenges, and potential partners. Challenges identified include finding indicators for societal impact, defining standards for social accountability within existing accreditation systems, and operationalizing social accountability values. The importance of involving powerful bodies, communication, and students as stakeholders is highlighted.


The conclusions emphasize the need for engagement with accreditation systems, thinking beyond individual connections, and the importance of policymakers, healthcare leaders, and the public in moving the work forward. The document underscores the political nature of this exercise, urging responsibility, learning, listening, and collaboration to bring people together for meaningful change.


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