Alim A-H Yacoub. Basrah Medical College And Social Accountability: What Has Been Achieved? The Medical Journal of Tikrit University 1997;3:3-4

1. 3
Basrah Medical College and social accountability: What has
been achieved?
From: “Changing Medical Education and Medical Practice”, World Health Organization,
Issue no. 10, December 1996.
The Medical Journal of Tikrit
University (1997);3:3-4
The setting
The University of Basrah College
of Medicine, established in 1967, is one
of nine medical colleges in Iraq that
serve to supply the nation with
its medical workforce at both general
and specialist levels. Basrah
Medical College is the sole medical
school in the southern region of Iraq.
For the last three years it has made
an attempt to establish a new pattern
of alliance with the health authorities
in Basrah, which belong to the Ministry
of Health, in order to pursue and
express its social accountability.
Initiatives in education at the
interface with health authorities
Following the Declaration of
Alma-Ata, in 1978, Basrah Medical
College initiated a project to incorporate
primary health care programmes in
undergraduate medical education. The
project involved selecting a field practice
demonstration area in Abu-Al-Khassib
district in southern Basrah. Last year
medical students were posted in the
health centres distributed within the
district for one month per group.
The involvement of health
authorities in planning, management
and assessment of the project
was, however, only marginal and was
limited to giving instructions to
doctors in charge of the selected
health centres to facilitate the training
programme. The supervision and
assessment of students were carried out
mainly by the faculty of the medical
college. The project had to be
terminated in 1984 because of the
Iraqi-Iranian war.
A new programme for training
fourth-year students in field surveys was
initiated in 1993. This time the health
authorities in Basrah were involved from
the beginning in the planning and
administration of the training
programme. Surveys were carried out to
assess the health needs of the
population covered, the use of existing
health services, especially preventive
and promotive services, and to
determine aspects of health-related
behaviour among the population
studied.
The results of the four surveys
completed so far have been useful in
identifying gaps in the delivery of health
services and in highlighting priority
areas to be addressed. In one region,
for example, it was found that the target
for DPT and polio vaccination of infants
had not been achieved. A “booster”
campaign was soon started to improve
coverage. The surveys have also been
very useful in improving the
communication skills of medical
students and in developing broader
understanding of health and disease
than would probably have been possible
by just training in hospitals.
Other studies were carried out on
the effect of economic sanctions on the
health status of different sectors of the
population as reflected in infant and
under-five mortality, nutritional status,
incidence of cardiovascular diseases
and cancer and related mortality, etc.
The health needs of certain population
groups at risk, such as the elderly and
the physically and mentally
handicapped, were studied as well.

2. 4
Basrah Medical College and quality
assurance of services provided
The college has developed a
mission statement that includes its
commitment to collaborating with health
authorities in promoting the delivery of
high-quality relevant and cost-effective
services. The College contributes to
quality assurance of services provided
through the participation of its teaching
staff at primary, secondary and tertiary
levels.
In one initiative, a supervisory
committee on primary health care
chaired by both the dean and the chief
medical officer for health services was
established to monitor the
implementation of various primary
health care programmes according to
WHO guidelines. Such programmes
include promotion of breast-feeding,
control of acute respiratory infections,
control of diarrheal diseases and
prevention of vitamin A deficiency.
A mechanism for medical audit
has been proposed by the College in
collaboration with the chief medical
officer through an advisory committee to
monitor adherence to standards of
medical practice in hospital settings.
The committee encouraged consultants
to carry out death conferences, clinical
grand rounds, records reviews,
complaints investigations and
formulation of practice guidelines. More
effort is required in this direction,
however, because medical staff resist
being involved in quality assurance
programmes in the belief that their
competence is being questioned or their
authority threatened.
The challenges and the way forward
The collaboration between the
Basrah Medical College and health
authorities in Basrah is now recognized
by both the Ministry of Health and the
Ministry of Higher Education and
Research as a model for partnership in
Iraq. Motivation to serve community is of
paramount importance to achieve such
alliance. However, a sustainable
commitment to change and action in line
with recommendations made by the
concerned international organizations
(such as WHO and the World
Federation for Medical Education) is
required from all parties concerned. The
sanctions imposed on Iraq have made it
even more imperative to work hard to
demonstrate the social accountability of
the College.
From : Prof. Dr. Alim A-H Yacoub, Dean,
University of Basrah, College of Medicine,
Basrah, Iraq.