who ebook on integrating a social determinants of health ...6.1.3. alignment with who technical...

First Meeting of the Steering Group1st - 2nd December 2014WHO, Geneva

WHO eBook on integrating a Social Determinants of HealthApproach into Health Workforce Education and Training

Social determinants of health are the con-ditions in which people are born, grow, live, learn, work, worship and age.

© World Health Organization 2014All rights reserved. Publications of the World Health Organization are available on the WHO website (www.who.int) or can be purchased from WHO Press, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland (tel.: +41 22 791 3264; fax: +41 22 791 4857; e-mail: [email protected]).

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Design & layout by Julian Fisher & Hannover Medical SchoolPrinted by the WHO Document Production Services, Geneva, Switzerland

These circumstances are shaped by the distribution of money, power and resources at global, national and local levels which are themselves influenced by policy choices.

WHO eBook on the social determinants of health approach to health workforce education and training

Table of Contents

1. The objectives of the meeting 11.1. Specific objectives 11.2. Preparatory work 11.3. Agile development process of eBook 1

2. Summary of Steering Committee opening statements and points of discussion 2 2.i.United Nations Educational, Scientific and Cultural Organization (UNESCO) 2 2.ii.WHO Department of Public Health, Environmental and Social Determinants of Health 32.iii. WHO Department of Knowledge, Ethics and Research (KER) 32.iv. University College London (UCL) Institute of Health Equity 42.v. WHO Collaborating Centre Dalhousie 42.vi. International Alliance of Patient Organizations (IAPO) 42.vii. World Medical Association (WMA) 42.viii. World Federation of Medical Education (WFME) 42.ix. International Federation of Medical Students Associations (IFMSA) 42.x. International Federation of Medical Students Associations Alumni Network / Young Professionals 42.xi. Hannover Medical School 52.2. Issues considered and discussed by the steering committee 5

3. Context of development 73.1. New challenges, new environments, new players; the need for a social determinants of health approach 83.2. Designing capacity building for the social determinants of health approach; re-framing, re-orienting and re-calibrating the health workforce education 83.2.1. By re-framing 83.2.2. By reorienting both health and education sectors 83.2.3. By re-calibrating 9

4. The use of technology and eBook publishing formats 104.1. eBook publishing formats 10

5. Key areas of consensus arising from discussions during the meeting 115.1. Scope of eBook 115.1.1. Introduction 125.2. Review of draft table of contents 145.2.1. Reframing 145.2.2. Reorienting 145.2.2.1. Improving the daily living conditions of individuals, communities and populations through actions on the social determinants of health 145.2.2.2. Looking beyond health, broadening perspectives 145.2.2.3. The future we want for our planet and for present and future generations 155.3. Recalibrating 155.4. Research agenda 16

6. Conclusions of the meeting and next steps 166.1. Conclusions of the meeting 166.1.1. Smart connected health workforce education tools and system networking 16 6.1.2. Synergy with WHO transformative education website and WHO SDH-Net partnership website 176.1.3. Alignment with WHO technical working group (TWG) for recommendations on eLearning 176.1.4. Agile development process 176.1.5. eBook narrative and chapter template 176.1.6. Sustainability of eBook 17


6.1.7. Working with partners 176.1.8. Meetings and Publications 176.1.9. eBook audience 176.2. Next steps 176.2.1. Next steps post meeting 176.2.2. Milestones 186.2.3. Publications 18

Annex 1 Steering Committee / List of participants of 1st steering committee meeting 18Annex 2 Steering Committee terms of reference 19Annex 3 Agenda of 1st steering committee meeting 19

Health and Environment

1. The objectives of the meeting

The first meeting of the steering group for the eBook on a social determinants of health approach to trans-forming health workforce education was chaired by Dr Erica Wheeler of the Department of Health Workforce and held at WHO headquarters Geneva from 1st - 2nd December 2014.

The broad objective of the meeting was to:

- Create synergies between the different programmes in WHO that support ICT for Health / eLearning, health workforce education and social and environmental de-terminants of health;- Provide multi-sectoral representation;- Ensure representation from different areas of techni-cal expertise;- Recognize that the compilation of the eBook should be a living document designed to allow updates as neces-sary.

The eBook will provide a framework that articulates and demonstrates the relevance of the social determinants of health approach to transformative health workforce education and training. It aims to draw together the best global resources on social determinants of health and ask international subject matters experts to cap-ture and present essential themes in a concise and suc-cinct manner, using new learning media in a way that engages and inspires the reader.

The process of developing the eBook must be subjected to review and analysis by appropriate peers and stake-holders. To this end, the WHO Secretariat (the Depart-ment of Health Workforce Department together with the Department of Knowledge, Ethics and Research and the Department of Public Health the Environment and Social Determinants) has established a steering com-mittee comprised of a body of experts who can guide and inform the eBook development process and through their networks help to provide content.

The eBook is not intended to be; a comprehensive textbook for the social determinants of health, a stand alone technical publication that lies outside key stake-holder networks and dynamic input of country level experiences; a static, non-modular resource without opportunity for a country level adaptation; a high-end information and communications technology product designed for and only applicable in high income coun-tries.

The eBook is laid out in order to provide: a narrative and educational resource for social determinants of

health approach; a vehicle to reframe, reorient and recalibrate health workforce education and train-ing to deliver a sustainable and resilient health work-force that is fit for purpose to meet the challenges and opportunities of the 21st century.

1.1. Specific objectives

The specific objectives of the first meeting of the refer-ence group on Steering Committee for the development of an eBook on a social determinants of health approach to transformative health workforce education were to:

1. Agree on the terms of reference, 2. Identify the scope of eBook,3. Draft table of contents and potential contributing authors, 4. Develop a plan of action for the eBook, 5. List actions that need to be taken by WHO Secretariat

The following sections address: the preparatory work done prior to the meeting with steering group members; incorporates the material circulated in the concept note prior to the meeting and describes the rationale for the development of the eBook in the context of WHO lead-ership priorities which includes the need for re-framing, re-orienting and re-calibrating for a social determinants of health approach; and finally, the conclusions and next steps.

1.2. Preparatory work

A concept note for the eBook was produced that pro-vided an initial offering for the steering committee to review and comment on. A number of consultations with the members of the steering committee were made in the lead up to the meeting to identify the key issues and to build consensus around the approach, design and formats.

This feedback informed the meeting agenda and its desired outputs.

1.3. Agile development process of eBook

The steering committee agreed to adopt an agile devel-opment approach underpinned by participatory action research methodology. This approach would enable the steering committee to improve quality and responsive-ness as part of an iterative, incremental and evolution-ary process.

An agile development approach minimizes overall risk and allows the project to adapt to changes quickly, where requirements and solutions evolve through collab-

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oration between self-organizing, cross functioning teams. A participatory action research methodology to be developed by Hannover Medical School will underpin this approach.

Establish eBook Steering Committee (SC)

Pre-work and 1stSC meeting(December 2014) ;Terms of reference,draft of table of contents presented

Learning session1 (LS 1): SC meeting report including reviewand feedback on eBook table of contents.

Action period 1(AP 1):SC to review;the eBooknarrative 2. the chapter template

Learningsession 2(LS 2)

Actionperiod 2(AP 2)

Plan Do Study Act

SUMMATIVE REPORTS for2016 WHO EBand WHA 2016(66.23)

Questions to guide and inform the development and productionof the WHO eBook on the social determinants of health apporach:

What are we tryingto accomplish?

How will we know that achange is improvement?

What changes can wemake that will resultin improvement?

Stakeholder identifcation mapping andrecruitment+ Selection and prioritzationof thematic areas

Development of concept notefor WHO eBook on the social determinants of health

Collaborate with partnersand key stakeholders toidentify, de�ne and further develop the table of contents

WHO PMAC report with outputsindicating opportunities to strengthen thetransformative health workforce education policy dialogue with partners and keystakeholder groups.

Plan Do Study Act

January 2014 August 2014 January 2015 February 2015

Process to improve quality and enhance project agility where by requirements and solutions evolve through collaborationbetween self-organizing, cross-functional teams. It promotes adaptive planning, evolutionary development, early delivery, continuous improvement, and encourages rapid and �exible response to change.

Agile eBook development underpinned by participatory action reseach methodology

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2. Summary of Steering Committee opening statements and points of discussion

2.i.United Nations Educational, Scientific and Cultural Organization (UNESCO)

UNESCO covers all areas of education. There is a recognition that education means different things to different people. It is a human right, and at the same time integral to sustainable development, health and well being. Health in turn is essential for education and learning, with evidence showing that educating girls reduces mortality by 66%.

UNESCO’s work on education has evolved over time. Looking towards the post-2015 agenda, there is an increasing emphasis on poverty. There is a re-framing of education and learning, in which education, health and well-being are seen as inter-related. UNESCO is focusing on: education for health including HIV/AIDS, childhood obesity and more latterly Ebola. UNESCO has been supporting education through use of the radio in those countries affected by Ebola.

A continuing focus of UNESCO is how it can contribute to overcoming health inequalities. In the discussions of the 2015 development agenda, they have promoted Goal 4 (provide equitable and inclusive quality education and life-long education for all) and also recognize the importance of Goal 3 (Attain healthy life for all at all ages).

UNESCO regards the work on transformative health workforce education and training as highly relevant and collab-orated with WHO to present its work on the transition from secondary to tertiary education at the Prince Mahidol Award Conference (PMAC) in January 2014. UNESCO also takes a lifelong learning perspective, where continuing professional development (CPD) of health workers has a crucial role to play.

This eBook project is both an opportunity for dialogue and an example of intersectoral collaboration. Transform-ing health workforce (HWF) education is both a health and an education priority, so we are all stakeholders.


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Re-orienting, re-framing, and re-calibrating with the emphasis on ‘‘re’ implies a continuum of change. One of the challenges is that ministries of health and ministries of education have tended to work separately. This is a historical problem but is reflected in the gap between faculty members educating health workers and health ser-vice managers managing health services. This fact was noted in the WHO World Health resolution 66.23 (paragraph 1.1) and forms part of transformative health workforce agenda.

2.ii.WHO Department of Public Health, Environmental and Social Determinants of Health

For the past 15 years WHO has been looking at the effects of societal and environmental factors on health out-comes. WHO has revised its definition of health to stress that health is “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” In 2005 the WHO Director General created a commission that was tasked to look more broadly at health, encompassing societal issues and how economic devel-opment contributes to health and vice versa. In 2011 WHO held a summative conference on social determinants of health in Rio de Janeiro, Brazil which looked at:

- the need to re-consider social participation, since policies should be inclusive;- articulate what additional work should be done within the health sector;- examine the relationship between health and society, particularly in terms of measuring and monitoring policies.

There is a need for capacity building and we would like to thank the department of health workforce for taking this initiative in developing the eBook. We are very interested and committed to working on this project.

2.iii. WHO Department of Knowledge, Ethics and Research (KER)

It is a pleasure and honour to be involved in this project. WHO department of knowledge, ethics and research has been collaborating with the department of health workforce for a number of years, for example on standards of registration of social health and in eHealth and eLearning.

Health must adopt an integrated approach as reflected in WHO’s 12th General Programme of Work. There has been a huge expansion in the use of information, communication technologies (ICT) and social media in health. Access-ing health information is a fundamental part of health service delivery and quality of care, and health workforce education so it is important to include a smart integrated systems approach in the design and development of this eBook.

The department of of knowledge, ethics and research is committed to working together with the department of health workforce demonstrating action on the social determinants of health and expanding its range of publication to include electronic and new media formats. The innovative approach and the eBook’s electronic format will ena-ble Member States to adapt the resource to their own context and needs.

The eBook should be used as an educational tool and should be open access (a WHO policy for research and journal material), thus supporting knowledge sharing and exchange as well as education of the global health workforce.

2.iv. University College London (UCL) Institute of Health Equity

The UCL Institute of Health Equity seeks to increase health equity through actions in four specific areas, including capacity building of the health workforce, community organizations, policy makers and practitioners. It is important to empower health professionals to take action on the social determinants of health, not only as clinicians but as advocates, managers and employers.

As the newly elected President of the World Medical Association (WMA), Professor Sir Michael Marmot is keen to ad-vance the work on social determinants in WHO’s transformative health workforce education initiatives. In his role as WMA President Prof Marmot wants to advocate for the key role that health workforce can play in reducing health inequalities and ensuring that health systems support the necessary actions.


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2.v. WHO Collaborating Centre Dalhousie

Taking a historical perspective, it can be seen that the USA invested in professional education on the 1980’s, but the emphasis was on sickness and not health. Ministries of Education (post secondary) and Health were not speaking to each other. There was no understanding of the policy implications of collaboration between health and educa-tion. The only place for different health professionals to learn together was in the clinic/hospital setting.

The development of the eBook offers an opportunity to highlight the economic aspect to this work, namely the inability to increase spending / GDP on health, so it is important to capitalize on the social determinants of health approach.

We should be thinking creatively about the word ‘book’. We should consider options for wikis and Massive Open Online Courses (MOOCs). With these in mind we need to think ahead to think about how we measure the impact of this eBook.

2.vi. International Alliance of Patient Organizations (IAPO)

IAPO has 250 members globally who’s work and interests encompass a broad and diverse range of diseases and con-ditions. IAPOs focus is on people centred care with the key message is that the universal voice of patients should be heard at all levels and domains i.e. policy, education and practice. Many of IAPO’s key policy documents focus on health literacy and listening to what communities want.

2.vii. World Medical Association (WMA)

WMA is an international organization representing physicians and represents medical associations in 111 countries.

While health care will attempt to pick up the pieces and repair the damage caused by premature ill health, it is these social, cultural, environmental, economic and other factors that are the major causes of rates of illness and, in particular, the magnitude of health inequalities.

It is difficult to separate social determinants of health and universal health coverage since one cannot put aside the social, economic and environmental aspects of patients lives and circumstances. The environment needs to allow physicians time to assess the patient as a whole and not just the illness/problem they are presenting with.Hence WMA has made the social determinants of health a key organizational priority.

The importance of a social determinants of health approach is also consistent across other health professions. The World Health Professions Alliance (WHPA) brings together the global organizations representing the world’s dentists, nurses, pharmacists, physical therapists and physicians and speaks for more than 26 million health care profession-als in more than 130 countries. WHPA works to improve global health and the quality of patient care and facilitates collaboration among the health professions and major stakeholders.

2.viii. World Federation of Medical Education (WFME)

WFME welcomes the opportunity to participate in the conceptual design and development of the WHO eBook on the social determinants of health.

This project speaks to core mission of WFME which aims to provide leadership for the future of medicine and medi-cal education.

2.ix. International Federation of Medical Students Associations (IFMSA)

IFMSA is the world’s oldest and largest independent organization representing associations of medical students internationally. It currently maintains 123 National Member Organizations from more than 100 countries across six continents with over 1,2 million students represented worldwide.


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Its aim include empowering and training medical students to become advocates in leading social change.

2.x. International Federation of Medical Students Associations Alumni Network / Young Professionals

Many young people are hungry for new knowledge, particularly how they can innovate to address the significant social, economic and environmental challenges of the 21st century. WHO is in a good position to provide this knowl-edge.

From the point-of-view of young health professionals there is the need for a universal document on education and training for a social determinants of health approach which builds capacity particularly of teachers as mentors.

The eBook therefore must be ‘real’ and not an artificial book. This generation needs to see young people who are passionate about taking action on the social determinants of health. A ‘movement’ is needed, which will change the approach of health professionals.

2.xi. Hannover Medical School

The eBook provides a unique opportunity to look beyond a traditional education resource to create a smart con-nected health workforce education system that both empowers and enables WHO’s vision and recommendations on transformative health workforce education.

Hannover Medical School is one of the leading university medical centres in Europe and is pleased to act as the coordinating editor and technical implementing institution for the project.

2.2. Issues considered and discussed by the steering committee

Based on the above, the following issues were considered during the discussions and have been interwoven into subsequent sections of the meeting report:

Communication

- Using stories as a way of capturing the interest of the intended audiences. The WHO transformative education website was seen as a means of achieving this.- Case-based learning to facilitate and support inter professional education and community oriented advocacy.- Communication between the nurses and the patients which is largely ignored in the medical profession should be recognized as an important element in conveying messages in the eBook regarding health service delivery.

Target audience

- The eBook must appeal to a broad range of health disciplines and sectors outside health that impact health.- There should be a section for the non-health sector. However we cannot use the same material for different sec-tors.

Values and principles

- Health as a human right and the ethical principles in health care delivery must be addressed.- Principles of people-centred care should be reflected in the eBooks design and content.There should be a statement on values, which should include: human rights, people-centred care, gender, equality, equity and social justice.

Measurements

What are the interventions and processes that we will measure post-2015? We may wish to come up with new ideas to influence those measurements and should seek to review appropriate health workforce education indicators, particularly in terms of the social determinant of health.

The eBook is a continuously evolving project and must use data including the dialogue around policy implementa-tion to guide and inform it continued development.

Paedagogy

Social determinants of health, how to teach and exactly what to really teach?The importance to start teaching social determinants of health early in childhood to bring about long term change;Teaching using this material should be an interprofessional exercise and community based;The target audiences of the eBook must be clear: only health professionals? all health workers? health sectors work-ers? Non-health sector? Educators? With these audiences in mind the following become important:- What do social inequalities look like?- What actions are needed?- What should health systems look like?- How do we change educational systems?- How to we empower health workers and patients?

The pedagogy behind the eBook should seek to promote critical thinking’ and needs to be really’ big’;

Case studies

Obtaining case studies on social determinants of health from around the world is important and was a common out-put of the various WHO co-hosted sessions at the 2014 Prince Mahidol Award Conference. - case studies can be ‘dynamic’ e.g. a video that shows how a particular situation evolves dynamic and can be up-dated;- case studies can be identified with topics members of the group are interested in, in a particular country/region;- case studies can be looked at from the point-of-view of what is the biggest challenge that is being faced and then document how those involved overcame that problem.

Featured stories to allow people to tell their stories is an important feature to be included and highlights that there is no perfect answer / solution to all of the questions and challenges.

Subjects to be addressed

- gender and poverty are important and must be included;- add income and social protection (link this to poverty), with a new chapter on social isolation;- global issues which include migration and trade.

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3. Context of development

The development and production of the eBook is part of ongoing work to implement the WHO guidelines on ‘Transforming and scaling up of health professionals’ education and training’ launched in Recife in 2013 and also in support of the World Health Assembly Resolution WHA 66.23 “Transforming health workforce education in support of universal health coverageThis work on transformative health workforce education also is in itself part of broader efforts across WHO looking towards the post 2015 development agenda and the World Health Organization’s role in moving towards universal health coverage and sustainable development.

WHO is in the process of updating the global Human Resources of Health (HRH) strategy entitled ‘Global Strategy on Human Resources for Health: health workforce 2030’ with partners, which includes transformative health workforce education. This refocussed strategy goes beyond but articulates the Recife Declaration which calls for “HRH development priorities and universal health coverage” to be “given due consideration in discussions of the post 2015 development agenda”.

In re-examining heath workforce education and training within the post 2015 development agenda and the Global HRH Strategy, it is right that universal health coverage be a key outcome of health workforce strengthening, but equally important that it is contextualized within action on the social determinants of health and health equity.

Leadership priorities

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unicable diseases

Our leadership priorities give focus and direction to our work. They are areas where it is vital for WHO to lead — the key issues which stand out from the body of our work.

The big ideaThe world must sustain the gains

that have been made towards the 2015 Millennium Development Goals

and help create more equal levels of achievement.

What will we do?The Goals will integrate many

aspects of our work, particularly building robust health systems and effective health institutions for sustainable and equitable health outcomes.

The big ideaThe rise of noncommunicable diseases has devastating health consequences for individuals, families and communities, and threatens to overwhelm health systems.

What will we do?It is a priority to coordinate a coherent, multisectoral response at global, regional and local levels.

The big ideaUniversal health coverage combines

access to the services needed to achieve good health with financial

protection to prevent ill health leading to poverty.

WHOleadershippriorities The big idea

Equity in public health depends on access to essential, high-quality and affordable medical technologies.

Improving access to medical products is central to the

achievement of universal health coverage.

What will we do?We will continue to improve

access to safe, quality, affordable and effective medicines. We will

support innovation for affordable health technology, local production,

and national regulatory authorities.

The big ideaTo improve people’s health

outcomes and increase healthy life expectancy requires action across the

range of contextual factors associated with ill health as well as inequitable

health outcomes.

The big ideaWHO has a leadership role in

establishing the systems that make up the global defence against shocks

coming from the microbial world.

What will we do?Support countries to put in

place the capacities required by the International Health Regulations (2005) and report on progress. We will strengthen our own systems and networks to ensure a rapid and well-coordinated response to public health emergencies.

What will we do?Respond to demand from countries seeking practical advice on how to take universal health coverage forward.

What will we do?We will work with other sectors to act on what causes disease and ill health. Our work will address health determinants and promote equity.

WHO valuesWHO has been at the forefront of improving health around the world since 1948.

Health: is a state of complete physical, mental and social well-being, not just the absence of disease or infirmity

is the fundamental right of every human being, everywhere

is crucial to peace and security

depends on the cooperation of all individuals and States

should be shared: extending knowledge to all peoples is essential

WHO directs and coordinates international health by:providing leadership on matters critical to health

shaping the health research agenda

defining norms and standards for health

articulating policy options for health

providing technical support and building capacity to monitor health trends

Leadership priorities, WHO Twelfth General Programme of Work 2014-2019


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3.1. New challenges, new environments, new players; the need for a social determinants of health approach

The social determinants of health approach finds its rationale in the WHO Twelfth General Programme of Work1 2014-2019 under the heading of ‘Addressing the social, economic and environmental determinants of health as a means of reducing health inequities with-in and between countries’. It states that the work on social determinants has been given renewed emphasis and momentum because of the High-Level Meeting of the General Assembly on the Prevention and Control of Non-communicable Diseases.

The social, economic and environmental determinants of health are grouped as one of the leadership priorities of WHO in the Twelfth Global Programme of Work 2014-2019 which ,“ gives focus and direction to our work“. It spells out what the WHO Secretariat will do as, “We will work with other sectors to act on what causes disease and ill health. Our work will address health de-terminants and promote equity”. It speaks directly to the need to work with different sectors influencing the determinants of health.

The social determinants of health are intrinsically linked with equity, social cohesion and poverty reduc-tion. They have a central role in global health, devel-opment and foreign policy. They are a key part of the overall global development agenda and are aligned or linked with other major global development priorities and initiatives, including sustainable development, uni-versal health coverage and social protection.

The Commission on Social Determinants of Health and the subsequent Conference in Rio de Janeiro, Brazil in October 2011 expanded the concept of social deter-minants of health calling for a way of thinking about health that ‘requires explicit recognition of the wide range of social, economic and other determinants associated with ill health, as well as inequitable health outcomes’.

Rapidly emerging challenges in the form of violent con-flict, an outbreak of infectious diseases or unexpected catastrophic events are cited as one of the five chal-lenges for human resources for health.

Articles from PLOS (Bausch D.G. and Schwarz L., 20142) and The Lancet (Abramowitz S.A. et al 2015) point to “complex and interwoven ecology and socioeconomics” of epidemica and restate previously published evi-

dence that “sociocultural, economic, and political dimensions play a defining part in epidemics and pandemics3’. Abramowitz et al further state that “The Ebola response shows the need for new global mech-anisms to be established that can rapidly mobilise all experts who can bring relevant local contextual, medi-cal, epidemiological, and political information on global health emergencies. Now is the time to consider how to bring social science into the centre of future pandemic surveillance, response, community preparedness, and health system strengthening.”

3.2. Designing capacity building for the social determi-nants of health approach; re-framing, re-orienting and re-calibrating the health workforce education for the 21st Century

3.2.1. By re-framing

Capacity building is not effective when implemented in a vacuum and must be framed within a broader devel-opment goal and context. While health workers have a central role to play in “reducing health inequalities through action on the social determinants of health”, capacity building on social determinants should go beyond independent interventions to encompass the strengthening and re-shaping of the institutions and sys-tems. The work on transformative health workforce ed-ucation is embedded within ‘Global Strategy on Human Resources for Health: health workforce 2030’ in order to provide the appropriate framework and mechanisms for change.

3.2.2. By reorienting both health and education sectors

Reorienting and transforming health workforce educa-tion and training towards reducing health inequalities is an imperative for each country’s human resources for health strategy. The health and education sectors have a key role to play in advocating a social determinants of health approach and explaining how this approach is beneficial, both for society as a whole and for the goals and priorities of different sectors.

Critical shortages of health workers will hamper achievement of internationally agreed health devel-opment goals, including those contained in the MDGs and the proposed sustainable development goals. But it is not just an issue of quantity. Issues of quality, rele-vance and sustainability of health workforce education must be considered if we are to effectively support transforming health workforce education in support of

1. http://apps.who.int/gb/ebwha/pdf_files/WHA66/A66_6-en.pdf2. Outbreak of Ebola Virus Disease in Guinea: Where Ecology Meets Economy, July 2013.3. Social science intelligence in the global Ebola response, Volume 385, No. 9965, p330, 24 January 2015

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universal health coverage (WHO WHA 66.23).

The health and education sectors have particular expertise in and responsibility for monitoring health inequities and the impact of policies on health and well-being through the social determinants. The health sector can (and should) play an important role in bringing sectors together to plan and implement work on the social determinants and should also develop its own capacities for such work. A key aspect of reorienting the health sector to reduce health inequities is moving towards universal health coverage; accessible, affordable, with good quality heath for all and that addresses the continuum of prevention, promotion, curative, rehabilitation and palliative care.

Ministries of Education can work with their counterparts in health to review secondary schools and their curricula so as to promote the recruitment of students with the appropri-ate range of competencies from the ‘pool of eligibles’ to apply for admission to professional, technical and vocational educa-tion and training.

Transforming health workforce education for health equity will also require the development of ‘bridging programmes’ that em-power and expand the ‘pool of eligibles’ (adapted 2013 health workforce model) through action in primary and second-ary education curricula. Such programmes would facilitate the recruitment of students with the appropriate range of competencies for admission into professional, technical and vo-cational education and training.

3.2.3. By re-calibrating

Capacity building must also go hand in hand with the tools to enable the desired transforma-tion in health workforce educa-tion. Those tools must ensure equitable participation so as to underpin sustainability as well as resilience.

WHO’s Global Toolkit for evaluating health workforce education4 will provide health workforce planners, education institutions and key stakeholder groups with the metrics and protocols to properly assess, commit to and evaluate the transformational process in a collaborative and consistent manner.

Reframing (Sections 2.3 / 3.1 / 3.2)Working together for health (WHO 2006 World Health Report); re-framing the conceptual framework togenerate and recruit health workforce within the post 2015 development agenda

Social Determinants of Health Approach

Post 2015 Development Agenda

Accreditation

Education & Training Institutions

- Primary

- Secondary

- Tertiary

- Professional

- Technical

- Vocational

Licensing / Certi�cation

Potential Health Workers

Recruitment

Attrition

Migration: Work in other sectors

UniversalHealthCoverage

Pool of Eligibles

Sustainable DevelopmentGoals (SDGs)

Global HRH Strategy

- Lower secondary

- Upper secondary

- Non-tertiary / pre-medical

Health Sectorworking with & acrossother sectors

GraduatesSelection

- Professionals

- Associate Professionals / Mid Level Providers

- Educators

- Technicians

- Auxillaries

- Community Workers

Health Workforce

- Continuing Professional Development

Reframing to contribute to sustainable development goals, including universal health coverage, health equity and life long learning will require re-orientation for desired outcomes

RELEVANCE SUSTAINABILITYQUANTITY QUALITY

IN SUPPORT OF UNIVERSALHEALTH COVERAGE

GOVERNANCE, POLICY &

FINANCING

NATIONAL STANDARDS

REGULATION & ACCREDITATION

CURRICULA, FACULTY &

EDUCATION

STUDENTSELECTION

CAREER &RETENTION

HEALTHWORKFORCE

PLANNING

BUILDING BLOCKS FOR TRANSFORMATIVE EDUCATON

IN SUPPORT OF LIFELONGLEARNING

Transforming Health Workforce Education

COUNTRY LEVELINDICATORS

ANALYSIS TOWARDSTRANSFORMATION at InstitutionalLevel

A. LOGICAL FRAMEWORK MODELS FOR EACH DOMAIN B. POOL OF QUESTIONS AND INDICATORS (that provides �exibility, taking into account and recognising the special needs of some Member States

EDUCATION

RESEARCHHEALTH SERVICEDELIVERY and QUALITY OF CARE

Measure and catalyse the degree of overlap between

the three domains

Re-calibration (Section 5) using WHO Global Evaluation Toolkit for healthworkforce education and training provides a framework and mechanismto coordinate policy, strategy and interventions at an international, nationaland institutional level.

Committment by stakeholdersre. SDH education and trainingfor HWF worldwide

Re-calibrate and transform health workforce SDH education and training

WHO WHA 66.23Use of good / best practiceand country level experiencesto guide and inform policy,strategy and programmes(* see eBook research agenda)

Re-orientation(Sections 4.1 / 4.2 )Reorientating and transforming health workforce education and training towards reducing healthinequalities is an imperative for each countries human resources for health strategy. The health andeducation sectors have a key role to play in advocating a social determinants of health approach andexplaining how this approach is bene�cial, both for society as a whole and for the goals and priorities of di�erent sectors. .

This vertical and horizontal perspectiveis essential if we are to improve daily living conditions of individuals, communities and populations, tacklethe inequitable distribution of power, money and resources as well as measureand understand the problem andassess the impact of action. Adapted 2013 health workforce model

Education

Research

Health service deliveryand quality of care

Baseline assessment of SDH educationand training globally (* results of the mapping exercise conducted by WHO)

9

4. Developed in response to the WHA resolution 66.23 ‘Transforming Health Workforce Education in support of universal health coverage’.


Download the reporthttp://whoeducationguidelines.org/content/elearning-report

e le arn ingfor undergraduate

health professional education

A systematic review informing a radical transformation of health workforce

development

Edited by: Najeeb Al-Shorbaji, Rifat Atun,

Josip Car, Azeem Majeed, Erica Wheeler

4. The use of technology and eBook publishing formats

WHO recognises that the use of technology and social media is transforming how the world works and communi-cations. The eBook should reflect these changes, particu-larly in terms of eLearning. ELearning, the use of electronic media and devices in edu-cation, is already used by some universities to support tra-ditional campus-based teaching or enable distance learn-ing. Wider use of eLearning might help to address the need to train more health workers across the globe. According to a recent WHO report, No Health without a Workforce5

notes that the world is short of 7.2 million healthcare pro-fessionals, and the figure is growing.

The World Health Organization (WHO) Department of Health Workforce in collaboration with the Department of Knowledge, Ethics and Research commissioned the Global eHealth Unit (GeHU) at Imperial College London to conduct a systematic review of the scientific literature to evaluate the effectiveness of eLearning for undergraduate health professional education. The publication ‘eLearning for Un-dergraduate Health Professional Education’ responds to a need at the country level for evidence to inform and guide health professional education as an important vehicle in preparing health professionals to be ‘fit-for-purpose’.

At a global level, it will assist in the implementation of the WHO’s global human resources for health strategy by pro-viding the best evidence of how and where eLearning can best be used in country settings. The report also provides a foundation for the development of future WHO guide-lines for pre-service training and the direction for future research.

WHO publications on eLearning and the work of the WHO technical working group on recommendations for eLearn-ing in health professionals’ undergraduate education will provide the evidence base to inform and guide the eBook’s development.

The interactive format of the Book and ability to link to a range of resources will make it easy to update as it evolves through the addition of referenc-es, case studies and new research.

4.1. eBook publishing formats

The eBook format has five important attributes:

1. Use of the full spectrum of learning strategies and new media to compresses content into an ‘executive summary’ so that it is compact in terms of length but effective in knowledge delivery, yet not compro-mise on restricting access to knowledge as its digital (interactive) format will ensure that readers can go onto explore their line of interest and quest for knowledge.

2. Has its focus on problem and team-based learning. ‘Best practice, best buy’ case studies and country ex-periences of transformative health workforce educa-tion will provide the entry point and the hub aroundwhich knowledge is built.

105. http://www.who.int/workforcealliance/knowledge/resources/GHWA-a_universal_truth_report.pdf?ua=1


Start of global economic and financial crisis.

2009 2010 2011 2012 20132007 2008Eleventh General Programme of Work, prepared during a period of global economic growth and optimism.

2006

Globaleconomicdownturn

Globaleconomy

Setting the scene

New political, economic, social and environmental realities…

Environment under pressure: health risks comefrom climate change. Progress in creatingmechanisms for a coherent approach tosustainable development has been slow.

Rapid, unplanned urbanization, particularly in low- and middle-income countries, brings opportunities and risks.

Technology and social media have transformed how the world works and communicates.

Changing demographics and ageing populations.

Risk of outrage and uprising where youth unemployment continues to rise with lack

of economic and political rights.

Migration offers benefits, but migrants can be exposed to,

and bring, health risks.

GlobalizationLiving standards have improved for some but there is wider inequality and lack of balance between economic, social and environmental policies.

75%of the world’s

poorest people livein middle-income

countries

Poverty and inequityInequality deepens poverty and increases gaps in health outcomes. This calls for new ways of working among multiple sectors.

PowerRelative powers of States, markets, civil society and social networks of individuals have changed: progress requires significant collaboration among all stakeholders.

A changing world — where are we going? 2014Economic fluctuation may lead to decreased public spending,

which affects public goods and services.

Rising healthcare spendingHealthcare spending is rising faster than GDP in developed countries, adding pressure to increase efficiency.

Changing burden of disease63% of all deaths are now caused by noncommunicable diseases...

but progress is still lagging in reducing maternal and child deaths, and turning back the epidemics of HIV, TB, malaria and other diseases.

Greater complexity in response to health needsA complex landscape, with new players…

Need to work with different sectors influencing the determinants of health. Need for holistic approach to emergency risk management, removing artificial distinctions between relief and development.

More complex health challenges

$2.93trillion

$6.45trillion

2000 2010

“In a context of growing inequity, competition for scarce natural resources and a financial crisis threatening basic entitlements to health care, it would be hard to find a better expression of health as a fundamental right, as a prerequisite for peace and security, equity, social justice, popular participation and global solidarity...”WHO Twelfth General Programme of Work (GPW12)

3. Embeds an implementation ‘arm’ by including WHO’s Global Toolkit for evaluating health workforce education and training, which will enable readers to translate knowledge into action in a consistent and comparable manner with fellow researchers, educators and practitioners around the world.

4. Embraces learning as a social activity. Social media will allow easy access to the views of experts in the field of SDH and for sharing of experiences from the country level through blogs, video reportage and case studies which will enable and empower cross- pollination of ideas, feedback loops and the development networks and partner-ships

5. Allows the use web-based analytical tools to monitor and assess outputs as a part of a quality improvement con-tinuum, which is real-time, data driven and evidence based.

It is envisaged that the eBook would be published in the following formats;

i. print version as pdfii. interactive pdfiii. ePub 3 formativ. web based App tors and practitioners around the world.

The results chain

ImpactImproved health outcomes achieved

The overall impact of the Organization sits at the highest level of the results chain, with eight impact goals. Outcomes can combine in different ways to contribute towards one or more impacts.

The results chain is the main way WHO assesses performance. We ask two questions:

• Did the resources allocated deliver the defined outputs?

• Has there been measureable progress in the agreed outcomes and impacts?

OutcomesIncreased access to health services or reduction of risk factors

Outcomes are demonstrable changes in the countries where we work. We measure progress towards each outcome by looking at policy changes, institutional capacities, reduction of risk factors or levels of service coverage and access.

AUDIT

EVALUATION

PERFORMANCE SELF-ASSESSMENT

Reduce under‐fivemortality

Reduce the number ofpeople dying from AIDS,tuberculosis and malaria

Reduce premature mortalityfrom noncommunicable

diseases

Eradicatepolio

Prevent death, illnessand disability arisingfrom emergencies

Reduce rural‐urban differences in

under‐five mortality

Eradicateguinea worm

Reduce maternalmortality

Impact goals

Demonstrating how our work contributes to, or influences, outcomes and impact is crucial. To do this we will report on outcomes, explaining the links between what we did and what was achieved. We have set indicators, baselines and targets for each outcome, covering the full six-year programme of work.

OutputsDefined outputs for each programme,

which clearly state what WHO will

deliver.

We follow an independent, systematic, disciplined approach to examine the adequacy of our control measures and compliance with them

We adopt a risk-based approach to determine the extent to which we have delivered on our expected results

We systematically and independently assess policies, activities and programmes, to ensure accountability for results and reinforce organizational learning

Accountability for resources and results

ActivitiesEvery task and

action WHO carries out in the course of the programme

of work.

InputsAll resources within each programme, including budget,

skill, time and materials.

5. Key areas of consensus arising from discussions during the meeting

5.1. Scope of eBook

The Steering Committee was very clear that the eBook should be designed from a ‘how to’ perspective and use

questions to both engage the reader / learner in critical thinking and to ensure applicability with regard to setting.The steering committee reviewed eBook concept note and its table of contents.

11

cess.

Objective

Support the reorienting of education and health system that will support and equip the health workforce with the knowledge base, cadre-specific and generic com-petencies and attributes, which support and nourish interprofessional education and collaborative practice so as to actively contribute to:

- Improve the daily living conditions of individuals, communities and populations;- Tackle the inequitable distribution of power, money - and resources;- Measure and understand the problem;- Monitor and evaluate, and assess the impact of ac-tion.

Target audiences

Primary target audience (relates to stakeholders of transformative health workforce education6): - Policy makers;Health professional educators, which would include full time institutional faculty, community-based clinicians and health workers (aligns with recommendation 3 in WHO guidelines7)- Community leaders and patient groups and advocates- Health workforce students

Social determinants overview and definition

Social determinants of health are the conditions in which people are born, grow, live, {learn}, work, {wor-ship} and age. These circumstances are shaped by the distribution of money, power and resources at global, national and local levels which are themselves influ-enced by policy choices.

The eBook would have 4 sections, which are detailed below.

5.1.1. Introduction

Principle and values

- Primary health care - Person-centred care - Gender equality and the empowerment of women- Human rights based approach - Ethics, equity and social justice- Universal health coverage- Sustainable development

Short descriptors would be draw from WHO sources to accompany the above

Case for action

- Moral imperative- Empowerment- Economic case- Demographic change- Epidemiological transition- Environment / climate change

These represent 6 top level aspects of the case for action. SC suggested developing an infographic to avoid the use of a list which implies hierarchy. An infographic would seek to emphasize the interconnected, interdependent nature of these issues.

Value proposition

This short statement which will make clear action on SDH requires a choice (we must choose, not just can choose) and clearly communicate the benefit that is provided over an alternative, including that of inaction and at what ‘cost’.

Goal, aim and objective

GoalTo enable the global health workforce to reduce health inequalities through actions on the social determinants of health.

AimTo re-frame, re-orient and re-calibrate health workforce education and training in order to build and strength-en global health workforce capacity as a part of the transformative health workforce education reform pro-

12


6. Transformative scaling up of health professional education and training is defined as the sustainable expansion and reform of health professional education and training to increase the quan-tity, quality and relevance of health professionals, and in so doing strengthen the country health systems and improve population health outcomes.7. Health professionals’ education and training institutions should consider innovative expansion of faculty, through the recruitment of community-based clinicians and health workers as educators.

Conceptual framework of ebook to SDH education and training

In re-examining heath workforce education and training within the post 2015 development agenda, it is right that universal health coverage be a key outcome of health workforce strengthening, but equally important that it is contextualized within action on the social determinants of health and health equity.

The 2013 model to generate and recruit the health workforce builds on the WHO World Health Report (2006) provid-ing a framework that seeks to ensure consistency and coherence between the process of educating and training the various cadres of the health workforce, and multi-sectoral health workforce policy, strategic planning and imple-mentation (figure 1).

The model positions health workforce education in support of universal health coverage within the post 2015 development agenda, as called for by Recife Declaration (2013) and WHO World Health Assembly resolution on health in the post-2015 UN development agenda, 2013.

Innovations to transform education are required along the full length of the health workforce learning and career pathway taking a lifelong learning approach, from primary and secondary education through undergraduate education and training to continuing professional development and life long learning.

Social Determinants of Health Approach

Post 2015 Development Agenda

Accred

itation

Education & Training Institutions

- Primary

- Secondary

- Tertiary

- Professional

- Technical

- Vocational

Licensin

g / C

erti�catio

n

Recruitment

Attrition Migration: Work in other sectors

UniversalHealthCoverage

Pool of Eligibles

Sustainable DevelopmentGoals (SDGs)

Global HRH Strategy

Primary &Secondary Education

-Lower secondary

- Upper secondary

- Non-tertiary / pre-medical

Health sectorworking with & acrossother sectors

GraduatesSelection

- Professionals

- Associate Professionals / Mid Level Providers

- Educators

- Technicians

- Auxillaries

- Community Workers

Health Workforce

- Continuing Professional Development

Equitable and inclusive quality education and life-long learning opportunities for all

Transforming HWF education in support of Universal Health Coverage

This requires that the assessment, evaluation and implementation process for transformative health workforce education be undertaken in a coordinated and structured manner. The process should guide and inform institutional and instructional reform at the national level in relation to healthcare service and system developments.

The adapted 2013 model to generate and recruit health workers seeks to provide a conceptual frameworkto ensure consistency and coherence between policy and implementation, as well as guiding and informing institu-tional and instructional reform at the national level.

13


Figure 1 The adapted 2013 model to generate and recruit health workforce 2030

5.2 Review of draft table of contents 5.2.1. Reframing

The world will not change after 2015, what will change will be what we are measuring. New ideas must contrib-ute to these measurements so that this drives process and we can understand and influence how process and context impacts outcomes.

Knowledge base will include: - ‘The Future we want’; the post 2015 development agenda and the proposed sustainable development goals (health’s priorities for the post 2015 development frame-work);- Health and education; critical pathways to human rights and equality;- Human resources for health, critical to achieving universal health coverage and central to the post-2015 agenda;- Transformative learning strategies and ICT for health; integrating lifelong learning, health and care services

A set of questions based on the issues above and linked to reference case studies (on WHO transformative edu-cation website interactive map) would be used to engage and promote critical thinking.

5.2.2. Reorienting

Short general introduction to the section covering:

Evidence, action and actorsDaily living conditionsPower, money and resourcesKnowledge, monitoring and skills; the backbone of action

This introduction would draw upon resources from WHO and University College London Institute for Health Equity (eg Working for Health Equity; the Role of the Health Professionals)

The Steering Committee agreed that it will be important to engage and excite the reader by starting with mate-rial that they are most familiar with, then broaden to perspectives beyond health at a neighbourhood / local community level and introduce policy choices of the dif-ferent sectors that impact health including national and global dimensions.

This section would have three sub-sections;5.2.2.1. improving the daily living conditions of individu-als, communities and populations through actions on the social determinants of health5.2.2.2. Looking beyond health, broadening perspective5.2.2.3. The future we want for our planet and for

present and future generations.

5.2.2.1. Improving the daily living conditions of individu-als, communities and populations through actions on the social determinants of health

Knowledge base: This section uses the WHO document ‘Equity, social determinants and public health pro-grammes’ as the basis to explore the impact of social determinants on specific health conditions.

Each chapter would pose specific health condition questions to encourage critical thinking in terms of the overall structure of society, the differential exposure to risks and disparate vulnerability within populations, individual differences in health care outcomes and their social and economic consequences.

Selected case studies (case based learning in an inter-professional education setting) would allow readers to review possible entry points and interventions within ex-isting health programmes, for interventions that address the upstream causes of ill-health. This would act as a bridge to the following section 3.2

Chapters around specific health conditions:

AlcoholCardiovascular diseaseDiabetesRespiratory diseaseTobacco useHealth and nutrition of mothers, newborns, children and adolescentsMental health and mental disordersNeglected topical diseasesOral health and oral diseasesUnintended pregnancy and pregnancy outcomesTuberculosis and MalariaHIV / AIDSViolence and unintentional injuryEmergency and essential surgical care

5.2.2.2. Looking beyond health, broadening perspectives

This section is looking ‘from inside health sector out’ i.e. health professional perspective of the social deter-minants of health and the „distribution of money, power and resources at a global, national and local levels which are themselves influenced by policy choices“.

It is not possible to teach interprofessional education and the social determinants of health in a classroom. It needs to be done in an appropriate community setting or ‘Place’ where students can sense and appreciate the

14


conditions in which people are born, grow, live,{learn}, work, {worship} and age.

Selected case studies would illustrate the key messages and allow readers to review possible entry-points and interventions.

The approach would be to take each issue e.g. housing stability and then review how it is influenced by certain factors a,b,c which will have impacts on h,i,j through a series of well designed questions (critical thinking).

Chapters:

Economic stability PovertyEmployment / world of workFood safety and securityHousing stabilityInfrastructure and transport

EducationEarly childhood education and developmentLanguage and literacyYouth / adolescent educationVocational and technical trainingEnrollment in higher educationAdult learningNon-formal education

Social and community contextSocial cohesion / inclusionSocial protectionCommunity resilience & solidarityCivic participationPerceptions of discrimination and equityIncarceration and institutionalization Freedom of expression, freedom of worship

Health and health careAccess to health careAccess to primary careHealth financingHealth literacyMaternal, neonatal, child and adolescent healthHealthy ageingTraditional medicineHealth care and services managementNeighborhood and built environmentAccess to healthy foodsQuality of housingCrime and violenceEnvironmental conditionsSafe clean waterOutdoor air quality

5.2.2.3. The future we want for our planet and for present and future generations (outside look-ing in)

This section builds on the idea of ‘Place’ - conditions in which people are born, grow, live, learn, work, worship and age - and continues with the second component of SDH definition … distribution of money, power and resources at a global, national and local levels which are themselves influenced by policy choices but from the perspective of other sectors.

This section is looking ‘from outside the health sector in’ i.e. health and social determinants from the per-spective of other sectors.

GovernanceConflict and fragility / security and justice / disastersAgriculture and foodWater and sanitationEnergyGrowth and employmentEducation / lifelong learningPopulationInfrastructure, planning and transportEnvironment and sustainabilityClimate changeHousing and community servicesLand and cultureInformation, communication technologies for health

5.3. Recalibrating

WHO’s Global Evaluation Toolkit for health workforce education provides a both framework and mechanism to coordinate policy, strategy and interventions at an international, national and institutional level.

The transformative scale-up of health professionals’ education and training is defined as the expansion and reform of health professionals’ education and train-ing to increase the quantity, quality and relevance of health professionals so as to best meet population health needs and expectations in an equitable and efficient manner and, in so doing, strengthen coun-tries’ health systems and improve population health outcomes.

Addressing the degree to which the quantity, quality, skills mix and distribution of the health workforce (HWF) is appropriate and aligned to a country’s health context, burden of disease and health system is a global imperative. It is essential that the HWF is equipped with the knowledge base, technical skills, cadre- specific and generic competencies and at-

15


tributes to ensure the centrality of patients and the population in the pursuit of equitable access to quality universal health coverage (UHC).

There is a need to go beyond simply assessing health workforce education and training if we are truly aiming to transform HWF education not just to support UHC, but also to make an active and significant contribution to reducing health inequities and sustainable develop-ment. WHO has developed an evaluation tool with a protocol in order to fulfill the mandate of transforming health workforce education in support of universal health coverage and the broader agenda.

The steering committee identified five key questions that would help inform and guide the development of this section:

- How do we strengthen and develop faculty- How do we create or modify the SDH curriculum- How do we go about teaching- Where should we be teaching SDH- How to put it into practice / apply to the field, daily practice

5.4. Research agenda

The eBook provides a unique opportunity to establish a global collaboratory of organizations and institutions for a social determinants of health approach to trans-forming health workforce education.

The steering committee agreed that research is a necessary component of the eBook implementation to routinely explore, gauge, and adjust strategies and approaches in a timely manner.

Incorporating research questions in the project design adds value to the analytical framework and scientific rigor of implementation strategies and the project qual-ity improvement process.

The more targeted, well structured and focused the research questions are, the more relevant the outcomes and impact are likely to be.

WHO Global Evaluation Toolkit for health workforce ed-ucation provides a set of core indicators at national and institution level which could be used to establish base line data to contribute to a health workforce educa-tion account as part of the Global Human Resources ofr Health Strategy.

The Steering Committee suggested areas of research are:

Transforming social determinants of health (SDH) ed-ucation and training - application / implementation of WHO Global Toolkit for evaluating health workforce education (GET) to establish baseline and map change in social determinants of health education and training;

Interprofessional education and collaborative practice research agenda through WHO Collaborating Centres network and also exploring the International Classifica-tion for Functioning, Health and Disability as a tool for implementing a social determinants of health approach into people centre care;

Faculty leadership and development programme for SDH based on WHO guidelines for transforming and scaling up of health professionals’ education and training and WHO Global Toolkit for evaluating health workforce educa-tion.

6. Conclusions of the meeting and next steps

6.1. Conclusions of the meeting

6.1.1. Smart connected health workforce education tools and system networking

The steerinf committee recommended that eBook devel-opment should explore the opportunity to build a smart connected health workforce education system that inte-grates and links WHO tools, resource and networks on a social determinants of health approach.

Smart educational resources are those that intelligently combine physical elements (devices e.g. computer, lap-top, mobile phone), with a smart component (eg country level and institutional level dashboard of WHO Global Toolkit for evaluating health workforce education) and connectivity (web-based eLearning, ICT for Health tech-nologies and social media).

The option to produce a web-based App enables the eBook to used on smart phones which significantly expands its functionality and capabilities particularly in terms of harnessing the use of social media in health workforce education.

The WHO Global Toolkit for evaluating health workforce education (GET) has a number of core indicators that are relevant to the eBook development and implementa-tion. GET ‘big data ‘ collection should be used to create a smart connected ebook which can contribute both the transformative health workforce education and the WHO global human resources for health strategy; health workforce 2030.

16


6.1.2. Synergy with WHO transformative education web-site and WHO SDH-Net partnership website

The SC agreed that the use of case studies should be an integral part of the eBook. It recommended the use of the interactive map of the WHO transformative education website http://whoeducationguidelines.org/case-studies.

6.1.3. Alignment with WHO technical working group (TWG) for recommendations on eLearning

WHO is currently developing recommendations for the use of eLearning in undergraduate health professionals’ edu-cation and training. The steering committee recommend-ed that the development of the eBook should be aligned with the relevant recommendations.

WHO secretariat and Hannover Medical School should liaise with WHO partners to make use of any tools that would facilitate the development of the eBook, such as tools which could assist in identifying blended learning options (idea of the flipped classroom). 6.1.4. Agile development process

The steering committee agreed that adopting an agile de-velopment approach underpinned by participatory action research methodology will enable the steering committee to the improve quality and enhance project agility as part of an iterative, incremental and evolutionary process.

A participatory action research methodology to be de-veloped by Hannover Medical School will underpin this approach taking into account the work of WHO on health policy and systems research.

6.1.5. eBook narrative and chapter template

The steering committee requested that the WHO secre-tariat produce a short document that succinctly sets out the narrative of the eBook. Such an ‘at a glance’ summary would assist effective communication to wider audiences, particularly in non-health sectors.

6.1.6. Sustainability of eBook

The steering committee stressed the need that WHO ensure that the eBook project has a robust plan to ensure it is sustainable. In this respect consideration should be given to the opportunities to develop a native App for the eBook.

Hannover Medical School offered to take the lead in developing a sustainability plan and to liaise with oth-er steering committee members to explore options and

synergies. A plan would be presented for review before the second steering committee meeting.

6.1.7. Working with partners

The steering committee highlighted the importance of collaborating with other UN agencies and partners to ensure the eBook s based on current evidence and thinking.

In this respect the steering committee requested that the WHO secretariat reach out to World Economic Forum and agencies / partners working on issues of labour market reforms.

6.1.8. Meetings and Publications

The evidence base for the eBook and where appropri-ate individual chapters should be published. It is envis-aged that the steering committee members and their networks would be involved in publishing the evidence and also promoting the eBook through their respective networks.

6.1.9. eBook audience

There was considerable debate and discussion in the steering committee meeting on the target audience. This report details the current target audience of the eBook. However the steering committee requested that further consideration and discussion was needed and should support the Global Strategy on Human Re-sources for Health: health workforce 2030.

6.2. Next steps 6.2.1. Next steps post meeting

1. The steering committee meeting report distribution to SC (1st March);2. Review the eBook narrative to ensure that there is a clear rationale for, and logical sequencing of the main sections of the ebook (6th March);3. Selfie campaign; plan of action (13th March);4. Based on revised narrative to review and compress the table of contents (30th March);5. Produce template powerpoint presentation for eBook project (24th March);6. Complete grid of contributing authors against re-vised table of contents (20th April);7. Produce demonstration chapter on USB card (WHO WHA 2015);8. Develop design, layout for each of eBook formats (prior to 2nd eBook SC meeting);9. Organize and hold 2nd steering committee meeting (TBC but within May - June) to review sections, design

17


and layout of each of agreed formats, eBook agile devel-opment plan, eBook research agenda, eBook sustainabili-ty plan.

6.2.2. Milestones

WHO secretariat to produce GANATT chart detailing milestones, deliverables and timelines of eBook project. Currently the projected deliverables are:

1. completion of report on eBook to be included as annex on WHO WHA 66.23 reporting to Executive Board 2016 / WHA 20162. eBook delivered in agreed formats (May 2016)

6.2.3. Publications

The evidence base for the eBook and where appropriate individual chapters should be published. It is envisaged that the steering committee members and their networks would be involved in publishing the evidence and also promoting the eBook through their respective networks.

Hannover Medical School will prepare i. a template powerpoint presentation for use by steering committee members and their networks and ii. a schedule of events where the eBook project would be presented.

Annex 1

Steering Committee

The steering committee will have 13 members serving in an independent and personal capacity for the period of November 2014 to October 2015 with expertise in the following areas: global health policy; global education policy; health workforce education and training; social determinants of health as it applies to curriculum de-velopment; ICT for Health including eLearning and its applications in health care; people-centred care.

World Health Organization

WHO Department of Public Health, Environment and Social Determinants - Dr Marie Neira, Director - Dr Eugenio Montesinos Villar, Technical Officer WHO Department of Knowledge Management, Research and Ethics- Dr Najeeb Al-Shorbaji, Director WHO Department of Health Workforce- Dr James Campbell, Director- Dr Erica Wheeler, Technical Officer

UNESCO- Dr Keith Holmes

Academia and Nongovernmental organizations

UCL Institute of Health Equity- Prof. Sir Michael Marmot - Dr Matilda AllenGraduate Institute GenevaDr Ilona KickbuschWHO Collaborating Centre DalhousieProf John GilbertWorld Medical Association- Dr Otmar Kloiber- Dr. Julia Tainijoki-SeyerWorld Federation of Public Health Associations- Dr Mengistu Asnake - Professor Bettina BorischWorld Federation of Medical Education- Dr David Gordon- Dr Claire de BurbureInternational Alliance of Patients’ Organizations- Ms Alison Lightbourne International Federation of Medical Students Associ-ations Allumni Network / Young Professionals- Dr Renzo GuintoInternational Federation of Medical Students Associ-ations - Mr Agostinho Sousa, Hannover Medical School- Dr Julian Fisher

List of participants of 1st steering committee meeting

- Matilda Allen, University College London- Claire de Burbure, Université catholique de Louvain- Julian Fisher, Hannover Medical School- John Gilbert, University of British Columbia- Ramon Guinto, Health Care Without Harm- Keith Holmes, UNESCO- Alison Lightbourne, International Alliance of Patient Organizations- Julia Tainijoki-Seyer, World Medical Association- Agostinho Sousa, International Federation of Medical Students’ Associations - Najeeb Al-Shorbaji, WHO- Eugenio Montesinos Villar, WHO- Erica Wheeler, WHO - Chairperson- Sandra Pandi, WHO Consultant

18


Annex 2Steering Committee terms of reference

In November 2013, WHO published guidelines on ‘Transforming and Scaling up Health Professional Education and Training ’. The vision for the guidelines was that they ‘set out a vision of such a transformation of education for the health professions, and offer recommendations on how best to achieve the goal of producing graduates responsive to the health needs of the populations they serve’.

The three pillars on which the transformative education recommendations are built, comprise quantity, quality and relevance. It is therefore with the latter two outcomes that the eBook on a social determinants of health approach to transformative health workforce education is concerned with in its application.

The eBook planned as an interactive publication with guidance and supportive reference material, laid out in order to provide; a narrative and educational resource for social determinants of health approach; and, a utility to reframe, reorient and recalibrate health workforce education and training to deliver a sustainable and resilient health workforce that is fit for purpose to meet the challenges and opportunities of the 21st century.

Members of the Steering Committee were invited to participate for their variety of experiences, technical exper-tise, competencies and skills to assist in the development of an eBook on a Social Determinants of Health Approach to health workforce education. Particular consideration was given to the following criteria:

• Creating synergies between the different programmes in WHO that support eLearning, health workforce education and the social and environmental determinants of health; • Multi-sectoral representation; • Having representation from different areas of technical expertise; • Recognizing that the eBook should be a living document designed to allows updates as necessary.

Key objectives and responsibilities of the Steering Committee

The Committee does not have a regulatory or an executive function. Its roles and responsibilities include, but are not limited to:

• Identifying the need / demand for the Ebook and provide oversight, along with the WHO Secretariat, of the design and development of the eBook; • Agreeing on the scope of the eBook and table of contents; • Contributing references, written or audio-visual material as appropriate to chapters related to specific areas of expertise; • Taking on a monitoring role, where feasible, regarding sections of the book that correspond to areas of expertise to ensure viability of the content over time; • Recommending content experts on particular areas to contribute to/review the relevant chapter(s), making intro-ductions and providing contact details where possible; • Ensuring that the process of developing the eBook is tailored to provide the most up-to-date material in relation to the competencies required for undergraduate and postgraduate education and training; • Being available for participation in monthly teleconferences over the period of development of the eBook; • Reviewing and commenting on draft versions of the eBook; • Proofreading of the technical content that correspond to areas of expertise; • Assisting in the dissemination and use of the eBook.

Annex 3

Final Agenda, 1st meeting of the Steering Committee for the development of an eBook on a social determinants of health approach to health workforce education and training

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