Overview (continued)
The reasons for the lack of formal engagement by the leaders of health professional schools with politicians and public sector policy-makers and deciders at the national, provincial, and local levels are complex. One reason is that most policy-makers and politicians are unfamiliar with the crucial role that health professional schools play in the success of the health system and tend to look to ministries of health as proxies for health sector interests. In addition, most policy-makers do not have health sciences training or backgrounds and often are unaware of the unique challenges the health sector must address, relative to other sectors. Health professional school leaders are perceived as living in academic “ivory towers” and not being helpful in solving real-world problems.
Some of this reputation as unproductive participants in the policy arena is well deserved; some health school leaders have a worldview in which research takes precedence over care, or in which technical excellence in care is the paramount metric and access to care is less important. Moreover, beyond their three central tasks—education, care, and research—most health academic leaders have been insufficiently entrepreneurial and are either uninterested in or anxious about engaging in the time-consuming and sometimes enervating process of policy dialogue, debate, and compromise. Health professional schools also do not always work sufficiently with professional associations; if they do, it is often more in the interest of protecting professional turf than determining how their profession can deliver and contribute the most value in the health care system. While willing to be courted informally for opinions and advice, many schools consider it almost demeaning to work with government bureaucracies and assess the implications of policy choices both small and large. The attitude of some schools seems to be that it is better to spend time responding to policy decisions than to expend energy shaping them.
The picture of health professional schools is changing, however. Medical and health professional schools in low- and middle-income countries increasingly recognize that early engagement in society’s health sector directions and decisions is a new and essential mission. This evolving viewpoint acknowledges that working together means a “rising tide lifts all boats.” Increasingly, school leaders accept that heightening the awareness of the national leaders and municipal decision-makers who can bring resources to bear in answering the challenges of efficiently and fairly using health care resources is a task that complements their traditional academic focus on education, research, and clinical practice.
This technical brief highlights some—still too rare—examples of how the education and research leadership of health professional schools has engaged, influenced, or obtained resources from national policy-makers and others with significant influence on the health sector, such as the pharmaceutical and health insurance industries, pension programs, parastatals that either directly or indirectly have a say in health policy decisions, and private health service providers. The brief also reviews instances in which different health educational institutions and professional associations have worked to shape national responses to health system needs.