Oral Presentation at the 2016 Conference of the South African Association of Health Educationists (SAAHE) in Port Elizabeth, South Africa. By Esoh Godfrey Nji

1. Community perceptions of the Social
Accountability of health professionals in
Bamenda-Cameroon.
Esoh Godfrey Nji
School of Medical and Biomedical Sciences,
National Polytechnic University Institute, Bamenda
Bamenda, Cameroon
Heike Geduld
Faculty of Health Sciences
University of Cape Town
Cape Town, South Africa

2. Introduction
• Socially accountable health professionals (HP) are:
• Appropriately trained and function as required by society;
• Able to predict the needs of the community and respond
appropriately,
• Able to render services and conduct teaching and research
consistent with identified needs;
• Able to impact on the improvement of the health system both
locally and internationally.
Boelen C, Wollard R. “Social Accountability: The leap to excellence for educational institutions:, Medical Teacher
2011:33(8);614-619.

3. Introduction
• Practice of the health professions is not yet regulated in Cameroon
• A professional degree or diploma in the respective discipline
automatically qualifies the graduate for practice
• A framework for ensuring safe practice and continuing professional
development is still at its rudimentary stage
• In this context embedding social accountability in the health
professions education curricula has the potential to create a
practitioner-led platform for safe and community responsive practice.

4. Introduction
• The literature on social accountability in the domain of health is still
dominated and animated by the concept of “social accountability of
medical schools”. (GCSA, 2010)*
• For the health professions community to be socially accountable, the
socially accountable school should logically produce a socially
accountable graduate.
*Global Consensus for Social Accountability of Medical Schools, December 2010. Available from
www.healthsocialaccountability.org (Accessed 18th January 2016).

5. Aim of the study
• This study was conducted with the aim of assessing the perception of
adult community members on the social accountability of health
professionals in the Mbachongwa health area, a rural community in
Bamenda, North West Region of Cameroon.

6. Significance of the Study
Perception of the
community
Perception of
health professions
educators
Perception of
students
Content of health
professions
curricula
Develop and pilot a
module to inform
curriculum reform
Hopefully, make
ensure socially
accountable
health care
practice
SOCIAL ACCOUNTABILITY OF HEALTH SCIENCE EDUCATION IN
CAMEROON

7. Methodology
• The CPU Model of Boelen and Wollard*(conceptualization, production,
usability) was used to assess the perception of adult members of the
Mbachongwa health area about the social accountability of the HPs
serving them.
• Focus Group Discussions in three villages (Mbatu, Nsongwa, and
Chomba) elicited feedback on the questions
• “who are HPs?”
• “How are HPs trained?”
• “What do HPs do?”
• Data was collected and analyzed between the months of July and
October 2015.
*Boelen C, Wollard R. “Social Accountability: The leap to excellence for educational institutions:, Medical Teacher
2011:33(8);614-619.

8. Results
CPU DOMAIN RESEARCH QUESTION
CONCEPTUALIZATION Who is a health professional?
Community members perceived health professionals to be people who:
• are trained in a specialized educational environment regulated by the state,
• who possess specialized knowledge, skills and attitudes that make them capable of pro-
actively responding to the health needs of the community (both preventive and
curative), and
• are socially recognizable by their dressing and behavior.

9. Results
• “A health personnel is a person that is trained by the government to
provide health services to members of the community…They provide
both curative care and counselling to members of the community. We
know that health problems come in great variety. The health
professionals have knowledge about health and can apply this
knowledge practically to solve our health problems. In the work
environment you can easily tell who a health professional is. They are
often dressed in white. You can tell a doctor from his long jacket and a
nurse from her short sleeve gown and cap.” (FG1P04)

10. Results
CPU DOMAIN RESEARCH QUESTION
PRODUCTION How do people become health
professionals?
Regarding the training of health professionals, community members said that;
• Health professionals undergo specialized training in health professions education
institutions
• The training of health professionals is regulated by the state
• The community has confidence in the quality of training given to health professionals
• The only problem is whether the health professionals translate their knowledge and skill
into socially accountable practice.

11. Results
• “…Their training is well regulated so we are confident that they are given
the right knowledge and skills they need to cater for the health of the
community. We are not really involved in this aspect.” (FG2P01)
• “I don’t know if health professionals are trained to reflect on the
significance of that “white” that they put on. Health is not just a job but a
vocation.” (FG2P03)
• “We have confidence that our health workers are well trained. The
government takes care of that. The problem is whether or not they practice
what they learn in school.” (FG2P07)

12. Results
CPU DOMAIN RESEARCH QUESTION
UTILIZATION How do health professionals behave in the
community; do they live up to your
expectations?
Community members perceived that health professionals are generally not socially
accountable. Some issues raised were:
• Deplorable state of roads and living conditions deter health professionals from coming to
live and work in the rural community
• Rural health facilities are so under-equipped that even when they are available the
healthcare staff do not have the resources to render optimal care
• Lack of proximity of health facilities to the rural population
• Poor pay leading to unethical money-motivated practices

13. Results
“What I don’t like is the idea of doctors in public hospitals referring a patient
to special pharmacies to obtain drugs. Is it that those drugs are found only in
those particular pharmacies or that they have other interests?
Nurses should also be patient with patients. I have no business visiting a
nurse when I am not sick, so when they see a patient they should remember
that this is a suffering person and extend some kindness.
Bad news flies, and there is a scandal in the recent past that has damaged
the reputation of our health center. A woman went into labor at night and
the husband rushed her to the health center only to be told that the health
center is not open at night. As he was struggling to get a cab to rush her to
town, the baby came out and fell on the ground. That is how bad things are
here.” (FG2P06)

14. Discussion
• Community members do not feel involved in the training of HPs
• There is dissonance in that although HPs are considered well trained,
they do not render quality care to the community (not socially
accountable)
• This is attributed mostly to systems factors but also poorly motivated
staff
• These findings corroborates those of Leinster (2011) who reported
that factors such as the available resources and the structure of the
health services have a very large effect on doctors’ attitudes and
behaviour.
Sam Leinster (2011) Evaluation and assessment of social accountability in medical schools,
Medical Teacher, 33:8, 673-676,

15. Recommendation
• Focusing on the social accountability of health professions education
may be a means of improving quality of care and the relationships
between communities and health professionals.
• Further research should assess the perception of health professions
educators, the perception of HP students, the content of social
accountability in the HP curricula, and the impact of a ‘social
accountability course’ on the practice of HPs.

16. Way forward
Perception of the
community
Perception of
health professions
educators
Perception of
students
Content of health
professions
curricula
Develop and pilot a
module to inform
curriculum reform
Hopefully, make
ensure socially
accountable
health care
practice
SOCIAL ACCOUNTABILITY OF HEALTH SCIENCE EDUCATION IN
CAMEROON

17. Please engage with us
Godfrey Esoh
goddynji@yahoo.com
Heike Geduld
heikegeduld@yahoo.com

18. THANK YOU