Overview
In the transition from the Millennium Development Goals (MDG) era to the post-MDG era, many low and middle-income countries will be making significant shifts in their national health policies. Many will focus on universal health coverage and the epidemiologic shift from infectious to chronic diseases as causes of death. An important contributor to the process should be health professional schools.
Health policy reforms flow from the political leadership, which makes decisions to transition to new policy goals in response to demographic changes (such as a growing, more urbanized population) as well as greater public awareness and higher expectations regarding the centrality of health. Leaders may also adjust to existing or potential funding strengths and constraints. Many health systems move to expanded community-level health services, with community participation in planning and delivering primary care, and more effective systems of referral to secondary and tertiary care.
The leadership that is drawn upon to make policy changes tends to be in ministries of health, flagship hospitals, physicians and nurses associations, and social protection entities. Health professional schools are an additional and valuable—yet often overlooked—source of leadership in health reform and health policy-making. Leaders of health professional schools include deans of schools of medicine, nursing, midwifery, public health, pharmacy, and other health sciences, as well as chairpersons of clinical and nonclinical departments and centers (such as maternal health, obstetrics/gynecology, cardiology and cardiac surgery, oncology, biotechnology, health economics, health informatics, and health policy) and, increasingly, presidents and vice-chancellors of universities who are health professionals.
Health professional schools are important in that they produce health workers, the major input in the health system. Not only are labor costs a central part of the health budget, but the majority of all health system costs are determined by health worker variables. The practice behaviors and personal preferences of health workers will determine the communities in which they work and whether they practice primary or specialty care. In some countries, the amount of study and the magnitude of educational debt with which health workers graduate also significantly affect their practice behavior. Moreover, because health workers are employed in both public and private health systems, their education has a significant impact on all health systems in a country (Frenk et al. 2010).
In most countries, health professional schools such as medical schools, nursing schools, and health sciences schools are typically seen as academic and viewed as responders to national health policies and programs, rather than as originators or formal participants in the formulation of health policy. They are not typically institutionally oriented, nor do they have discrete funds to undertake in-depth studies of health services or health economics (including health labor market economics), nor is there usually any assessment of their capacity to respond to health objectives. In this way, leading thinkers are cut out of the policy design process. Insufficient inclusion of health professional schools in health policy-making often results in a disconnect between what a given health policy calls for and what the health education, training, and research system can produce. This disconnect places increasing strain on teaching faculties and facilities, creates political and citizen disappointment that health workers are not readily available or are not responsive to competency needs of positions in the health labor market, and contributes to health system inefficiencies.