Modest outputs of graduates by relatively few medical schools and chronic emigration contribute to low physician presence in Sub-Saharan Africa (SSA).The Sub-Saharan African Medical School Study (SAMSS) examined the challenges, innovations, and emerging trends in medical education in SSA.SAMSS identified 168 medical schools and achieved a 72% survey response rate of the 146 schools surveyed. The Study found that countries are prioritizing medical education scale up as part of health system strengthening, and identified many innovations in pre-medical preparation, the use of expatriate faculty, and creative use of scarce research support. SAMSS also noted ubiquitous faculty shortages, weak scholastic infrastructure, and limited accreditation. Trends observed include the growth of private medical schools, community-based education, and international partnerships, and the benefit of research for faculty development.Ten recommendations provide guidance for efforts to strengthen medical education in SSA. BACKGROUND

Context  An association with excellence should be reserved for educational institutions which verify that their actions make a difference to people’s well‐being. The graduates they produce should not only possess all of the competencies desirable to improve the health of citizens and society, but should also use them in their professional practice. Four principles enunciated by the World Health Organization refer to the type of health care to which people have a right, from both an individual and a collective standpoint: quality, equity, relevance and effectiveness. Therefore, social, economic, cultural and environmental determinants of health must guide the strategic development of an educational institution. Discussion  Social responsibility implies accountability to society for actions intended to serve it. In the health field, social accountability involves a commitment to respond as best as possible to the priority health needs of citizens and society. An educational institution should verify its impact on society by following basic principles of quality, equity, relevance and effectiveness, and by active participation in health system development. Its social accountability should be measured in three interdependent domains concerning health personnel: conceptualisation, production and utilisability. An educational institution that fully assumes the position of a responsible partner in the health care system and is dedicated to the public interest deserves a label of excellence. Conclusions  As globalisation is reassessed for its social impact, societies will seek to justify their investments with more solid evidence of their impact on the public good. Medical schools should be prepared to be judged accordingly. There is an urgent need to foster the adaptation of accreditation standards and norms that reflect social accountability. Only then can educational institutions be measured and rewarded for their real capacity to meet the pressing health care needs of society.

The clarification of concepts of social responsibility, responsiveness and accountability and the examples provided in designing indicators may help medical schools and other health professional schools in crafting their own benchmarks to assess progress towards social accountability within the context of their particular environment.

More than ever are we facing the challenge of providing evidence that what we do responds to priority health needs and challenges of the ones we intend to serve: patients, citizens, families, communities and the nation at large. Which are those health needs and challenges? Who defines them? How do medical schools organize themselves to address them through their education, research and service delivery functions? Principles of social accountability call for an explicit three-tier engagement: identification of current and prospective social needs and challenges, adaptation of school's programmes to meet them and verification that anticipated effects have benefited society. Measurement tools need to be designed and tested to steer development in this direction, particularly to establish a meaningful relationship between inputs, processes, outputs and impact on health. The Global Consensus on Social Accountability of Medical Schools provides a unique opportunity to foster collaborative research and development in an area of great significance for the future of medical education.

Health systems worldwide are confronted with challenges due to increased demand from their citizens, an aging population, a variety of health risks and limited resources. Key health stakeholders, including academic institutions and medical schools, are urged to develop a common vision for a more efficient and equitable health sector. It is in this environment that Boelen and Heck defined the concept of the "Social Accountability of Medical Schools" - a concept that encourages schools to produce not just highly competent professionals, but professionals who are equipped to respond to the changing challenges of healthcare through re-orientation of their education, research and service commitments, and be capable of demonstrating a positive effect upon the communities they serve. Social Accountability calls on the academic institution to demonstrate an impact on the communities served and thus make a contribution for a just and efficient health service, through mutually beneficial partnerships with other healthcare stakeholders. The purpose of this Guide is to explore the concept of Social Accountability, to explain it in more detail through examples and to identify ways to overcome obstacles to its development. Although in the Guide reference is frequently made to medical schools, the concept is equally applicable to all forms of education allied to healthcare.