The World Health Organization (WHO) estimates that an additional 2.4 million doctors, nurses, and midwives are needed globally but nowhere near enough are being trained, particularly in the areas where they are needed the most; but increased numbers of health professionals is insufficient (1). They need to be equitably distributed, competent to meet the needs of their communities, and be motivated and empowered to deliver quality care that is appropriate and acceptable to the sociocultural needs of the population (2). It is well documented that poverty and social inequity are the most important determinants of ill health worldwide (3, 4). Many, if not all, intractable health problems have as their root cause social determinants, including health inequities between economic and ethnic groups and poor access to health care. Health professionals have a responsibility to address social inequity and its deleterious effects on individual and population health. An appropriately trained and evenly distributed health workforce is essential to reduce the health equity gap within and across borders and to achieve universal health coverage (UHC) and meet the Sustainable Development Goals (SDG 3) (http://www.who.int/topics/sustainable-development-goals/targets/en/).

The Independent Global Commission on Education of Health Professionals for the twenty first century identified that “glaring gaps and inequities in health persist both within and between countries … and … professional education has not kept pace with these challenges” (4). They acknowledge that the problems are systemic and require a new era of health professional education. Specifically, they classified three successive levels of learning for students to build their knowledge, skills, attributes, and values for how to become a health system change agent. These are:

Informing: acquiring skills

The Global Strategy on Human Resources for Health: Workforce 2030 recommends education strategies include social accountability (SA) approaches to ensure a better distribution of health workers where they are most needed, emphasizing the underserved and most vulnerable populations (2). This is echoed by the recently released report of the High Level Commission on Health and Economic Growth stressing that socially accountable education should be institutionalized emphasizing the role of training institutions in addressing population and health system needs (5).

Further, there is a growing global consensus recognizing the importance of holding health professional schools accountable to society for achieving these goals. The WHO defines SA as “the obligation to orient education, research, and service activities towards priority health concerns of the local communities, the region and/or nation (schools) one has a mandate to serve. These priorities are jointly defined by government, health service organizations, and the public” (6). The WHO is not alone in recognizing SA as a critical mandate. The 2010 global consensus on SA document, reflecting the agreement of 130 organizations and individuals from around the world involved in health education, professional regulation, and policy-making, called for schools “to reorient their education, research, and service priorities” (7) to improve their response to current and future health-related needs and challenges in society. This requires health professional schools to shift their traditional education model toward a socially accountable approach. Despite this, there are limited practical tools to guide health professional schools to transform their curriculum and measure their impact on health outcomes.

The Framework identifies key factors for schools to educate a health workforce to positively influence health outcomes and health systems performance and provides the training and tools to measure and improve the outcomes across institutions and context. The Framework was developed using a logical framework matrix (NORAD 1999), a well-tested project planning and evaluation tool (18). The Framework helps schools evaluate how well they are doing in terms of meeting priority needs and assists to establish educational improvement and areas for research via the four sections of the Framework. Each section addresses an element of the CQI cycle by asking practical questions linked to stages of the quality improvement process. The four sections are (1) what needs are we addressing? (2) how do we work? (3) what do we do? and (4) what difference do we make? These four sections of the Framework inform each of the other sections and provide strategies for transformational learning to generate future cycles leading to continuous improvements over time.

THEnet recognizes that SA is a fundamental principle that requires a flexible approach in how it is operationalized. The Framework is a generic tool and can be used in phases and allows for creativity and adaptability to different contexts and different resource availability. Over the past 4 years, THEnet schools realized the benefit of the Framework, not only for curriculum transformation but also as a mechanism for CQI for the production of a fit-for-purpose workforce to improve local health outcomes.

A significant investment is required by health professional education institutions and society to develop health professionals who have both technical expertise and professional values that include a service orientation and ethical commitment to not only their individual patients but the communities in which they practice. SA is a principle that translates into educational strategies resulting in value-based competencies that are best demonstrated by health professionals who act as change agents in partnership with their communities. THEnet iterative CQI model links the educational and service delivery systems. As a practical CQI tool, THEnet Framework on SA has filled an important gap and is currently being used by a growing number of health professional education institutions around the world. We propose integrating the Institute of Medicine’s definition of CQI with health professional education by including education as a strategy for improving health-care services and by describing targeted patient groups as communities: “Quality improvement consists of systematic and continuous actions that lead to measurable improvement in education, health care services and the health status of targeted patient groups [communities]” (21).

A CQI approach is useful for understanding and monitoring socially accountable educational mechanisms that lead to fit-for-purpose graduates and improved quality of care and health outcomes at a population level. SA in health professional education is gaining traction internationally as a mechanism for combatting health inequities and advancing UHC (1).

Including SA indicators in health professional education accreditation standards would acknowledge the importance of holding health professional schools accountable to society for addressing population and health system needs (5). We call for key indicators around an appropriately trained and evenly distributed health workforce to be included in all health professional higher education accreditation processes. This is essential to reduce the health equity gap within and across borders and to achieve UHC and meet the Sustainable Development Goals (SDG 3) (http://www.who.int/topics/sustainable-development-goals/targets/en/).

THEnet’s Framework for Socially Accountable Health Workforce Education links education and service delivery creating a CQI feedback loop to ensure that education addresses needs and maximizes impact on quality service delivery. Evidence is emerging that community-engaged and socially accountable health workforce education produce a workforce ready and willing to work in partnership with underserved regions (22–27).

All authors contributed to the writing and editing of the article. AC wrote the first draft and managed subsequent drafts with revisions from all other authors. SR wrote the second draft. CR and LM reviewed subsequent drafts and provided revisions. A-JN did the final review. All authors gave final approval of the publication of this version of the paper.

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.