A Curriculum for Achieving Universal Health Care: A Case Study of Ateneo de Zamboanga University School of Medicine

Abstract

Introduction: Universal Health Care requires equal distribution of a health workforce equipped with competencies appropriate for local population needs. While health inequities persist in the Philippines, the Ateneo de Zamboanga University School of Medicine (ADZU-SOM) in Zamboanga Peninsula – an impoverished and underserved region – has demonstrated significant success retaining graduates and improving local health statistics. This study describes the qualitative evidence of ADZU-SOM students and graduates having positive impacts on local health services and communities, and the contextual factors associated with the school's socially-accountable mission and curriculum that contribute to these impacts.Methods: This qualitative study involved 41 one-on-one or group interviews conducted across seven participant groups (faculty, graduates, final-year students, health professionals, health workers, community members, community leaders). Gale et al's method for analyzing qualitative data in multi-disciplinary health research, WHO's “6 Building Blocks for quality health systems” framework and THEnet's social-accountability framework were used to organize and interpret data.Results: Local community members, community leaders, and health staff consistently reported examples of ADZU-SOM students and graduate doctors developing health infrastructure and providing health education, health promotion, and disease prevention activities accessible to all population groups. Students and graduates suggested these impacts were due to a number of factors, including how ADZU-SOM's sandwich model of longitudinal community-engagement culminating in 10-months continuous community placement in the final year helped them develop a strong motivation for community service, the teachings and curriculum activities that focused on public health and the social determinants of health, and faculty's commitment and ability to operationalize ADZU-SOM's mission and values. Staff also reported impacts were driven by integration of regional and national health priorities as core curriculum, and involving local stakeholders in curriculum development.Conclusions: This study provides qualitative evidence that ADZU-SOM's curriculum content and immersive community placements are training a medical workforce that is strengthening local health systems and health infrastructure across all 6 WHO “Building Blocks for quality health systems.” These findings suggest ADZU-SOM has managed to evolve a consciousness toward community service among final year students and graduates, adding evidence to the assertion it is a fully socially-accountable health professions institution.

The Integration of Primary Care and Public Health in Medical Students’ Training Based on Social Accountability and Community-Engaged Medical Education

“…Government support for the initiative and alignment of institutional goals within the Zamboanga Peninsula context are systemic factors for enabling integration. For example, the priorities of the Department of Health served as core curricular content [ 18 ], which led to a shared agenda between ADZU-SOM and its partner communities and government agencies. Organizational factors include committed and competent faculty members for integrating primary care and public health, as well as allocating sufficient time for integration in order for outcomes to materialize [ 18 ].…”

“…For example, the priorities of the Department of Health served as core curricular content [ 18 ], which led to a shared agenda between ADZU-SOM and its partner communities and government agencies. Organizational factors include committed and competent faculty members for integrating primary care and public health, as well as allocating sufficient time for integration in order for outcomes to materialize [ 18 ]. Other facilitating factors include faculty members who were also graduates of the same program and working in the same communities where medical students engaged in, and thus served as role models for the students’ future career choices.…”

“…When compared with graduates of the conventional medical curriculum, a study has shown that ADZU-SOM graduates were more likely to work as government physicians than in private health facilities and as generalists than specialists [20]. Although lessons from the ADZU-SOM experience were previously described in the literature [15][16][17][18][19][20][21][22][23][24][25][26][27][28], none has explored how primary care and public health could be integrated during medical students' training based on social accountability and CEME. Since there are calls to integrate primary care and public health for optimal health systems [29], more evidence is needed about how the functions could come together in practice to achieve potential synergies for enhancing individual-and population-level health [30].…”

“…In addition to CHP, medical students also conduct individual research projects on solutions to specific community health problems. Graduates earn a complementary Master of Public Health (MPH) degree after an additional fifth year when they complete a thesis project that draws on the public health coursework integrated throughout the 4 years of the MD program [ 18 ].…”

Transition to Post-Pandemic Education in the Philippines: Unfolding Insights

“…Tria (2020) highlighted in his study that higher education should utilize its research and development to find ways to improve school processes and generate knowledge about the pandemic. This idea of health integration and retrofitting in education and the utilization of the academe in research was discussed by Guingona et al, (2021) in their study on the curriculum formulation, development, and implementation which augment requirements for effectively achieving Universal Health Care. The report addresses two critical issues regarding the integration of health into Philippine education: the adaptation of health curriculum content to local situations and the critical role of research and development in developing improved healthcare.…”