Woolley, Torres, Halili, Servando D., Siega-Sur, Jusie-Lydia, Cristobal, Fortunato L., Reeve, Carole, Ross, Simone J., and Neusy, André-Jacques (2018) Socially accountable medical education strengthens community health services. Medical Education, 52 (4). pp. 391-403.

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Abstract

Context: Socially accountable health professional education (SAHPE) is committed to achieving health equity through training health professionals to meet local health needs and serve disadvantaged populations. This Philippines study investigates the impact of SAHPE students and graduates on child and maternal health services and outcomes.

Methods: This is a non-randomised, controlled study involving a researcher-administered survey to 827 recent mothers (1 child aged 0-5years). Five communities were serviced by SAHPE medical graduates or final-year medical students (interns) in Eastern Visayas and the Zamboanga Peninsula, and five communities in the same regions were serviced by conventionally trained (non-SAHPE) graduates.

Findings: Mothers in communities serviced by SAHPE-trained medical graduates and interns were more likely than their counterpart mothers in communities serviced by non-SAPHE trained graduates to: have lower gross family income (p<0.001); have laboratory results of blood and urine samples taken during pregnancy discussed (p < 0.001, respectively); have first pre-natal check-up before 4th month of pregnancy (p=0.003); receive their first postnatal check-up <7days of birth (p<0.001); and have a youngest child with normal (>2500g) birthweight (p=0.003). In addition, mothers from SAHPE-serviced communities were more likely to have a youngest child that: was still breastfed at 6months of age (p=0.045); received a vitamin K injection soon after birth (p=0.026); and was fully immunised against polio (p<0.001), hepatitis B (p< 0.001), measles (p=0.008) and diphtheria/pertussis/tetanus (p<0.001). In communities serviced by conventional medical graduates, mothers from lower socio-economic quartiles (<20000Php) were less likely (p<0.05) than higher socio-economic mothers to: report that their youngest child's delivery was assisted by a doctor; have their weight measured during pregnancy; and receive iron syrups or tablets.

Conclusions: The presence of SAHPE medical graduates or interns in Philippine communities significantly strengthens many recommended core elements of child and maternal health services irrespective of existing income constraints, and is associated with positive child health outcomes.

Philippine communities serviced by clinicians from socially-accountable medical schools are shown to have better child health outcomes and maternal health indicators.

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