Coming from 62 countries, about 1,400 people—all concerned about global health—convened at the 2011 Global Health Conference: Advancing Health Equity in the 21st Century in Montreal, Canada on 13-15 November 2011. The program included a plenary panel and breakout session on the Lancet Commission Report, which stimulated robust and dynamic discussions. The conference was presented by the Canadian Society for International Health, the Consortium of Universities for Global Health, and the Global Health Education Consortium.
(Note: click on speakers’ names for a pdf of their powerpoint presentations)
Dr. Julio Frenk, Dean of Harvard School of Public Health and Co-chair of the Lancet Commission, opened with the findings, recommendations and follow-up to the Lancet Commission Report. He reviewed the Flexner, Winslow and Welch-Rose reports, which 100 years ago led to a transformation in medical, nursing and public health education. He discussed the rationale for revisiting healthcare worker training now, and the process by which the Lancet Commission was chosen, the methods for reviewing available information, and its recommendations. A crucial difference from earlier reports was the emphasis on training that is global rather than country or location specific, and that it be integrated rather than discipline specific.
Dean Frenk discussed some of the major demographic trends of the last 100 years, including the dramatic increase in life expectancy and advances in knowledge and technology, as well as the stresses these changes place on the healthcare system. These changes demand a systems approach to rethinking healthcare education that includes understanding the relationship between the population, the healthcare labor force, and the educational and healthcare delivery systems. He pointed out that there is a very low investment in healthcare worker training relative to healthcare spending, at only 1.8% for the world and 0.5% in the US.
Among the recommended reforms and associated enabling actions is the focus on competency-based curriculum derived from health needs. Learning occurs at multiple levels, and to facilitate teamwork, needs to be integrated across disciplines. Dean Frenk closed with a brief review of dissemination activities undertaken since the publication of the report, and Louis Menand’s challenge to “keep our feet on the ground but our heads in the clouds.”
Dr. David Serwadda, professor and former Dean, Makerere University School of Public Health in Uganda and Lancet Commission member, spoke about the implications of the Lancet Commission report for sub-Saharan African schools. He started with challenges, including the vast size of the African continent, its rapid population growth and recent urbanization. He reviewed representative statistics for Uganda, highlighting the health issues facing many countries in this region. He also discussed the low numbers of healthcare workers per population, the reliance of private schools on fees, as well as the problem of “brain drain, citing the statistic that 25% of physicians in Canada come from Africa.
Dr. Serwadda reviewed Lancet report dissemination efforts undertaken so far, and mentioned its importance in supporting local efforts for change. He talked about efforts at Makerere University, describing how his institution has already moved to integrate inter-professional training. Dr. Serwadda described new opportunities afforded by the Medical Education Partnership Initiative, the $130 million collaboration between US and sub-Saharan African medical schools. Finally, he presented possible next steps to continuing to build on these changes.
Dr. Zulfiqar Bhutta, founding Chair of the Division of Women & Child Health of the Aga Khan University in Pakistan (and also a Lancet Commission member), started with an overview of health and health care in Pakistan, highlighting the marked differences in poverty, infant mortality and healthcare worker availability across the country. He discussed the challenges facing health care and healthcare workers, including the concentration of healthcare workers in urban academic centers, the heavy teaching and service demands on faculty, the necessity of having a private practice for income, and the lack of public health infrastructure. He described the use of paraprofessional healthcare workers to address some of these needs.
Dr. Bhutta talked about the efforts to disseminate the Lancet Commission report to Pakistan medical schools, including a questionnaire survey of 8 schools across the country. The need for globally applicable training was recognized, as was the need for more “community-oriented” education. Challenges were also recognized, including the identification of resources for teaching and the concern about taking on service commitments in a dysfunctional healthcare system. One unique problem raised was the possibility of creating hierarchies of healthcare professionals, where some have globally recognized degrees while others do not. Actions steps were identified: curriculum review, stakeholder consultation and feedback, and the securing of core funding.
These presentations were followed by a lively interactive discussion with the plenary audience. Among the issues raised by the audience was the high burden of debt held by US medical graduates limiting career choices, the opportunities and obstacles of training across disciplines and countries, and examples of institutions that have begun to implement some of the Commission recommendations.
During a break-out symposium, there were the following additional presentations (click on titles to get pdfs of powerpoints):
"Education for health professionals in the 21st Century: A Proposal for a Reform in Thailand"—Pisake Lumbiganon, MD, Dean, Khon Kaen University, Thailand
"The University of Nairobi Partnership in Innovative Medical Education for Kenya (PRIME-K) Project"—James Kiarie, MBChB, MPH
“Alignment with Canadian Recommendations for Change”—Dr. Nick Busing, President and CEO of the Association of Faculties of Medicine of Canada
“All Health Professions Training: Communicating Across Silos”—Brenda Zierler, PhD, RN, University of Washington, Seattle, WA
Link here to Consortium of Universities for Global Health blog about the sessions.