Table 1 Barriers and enablers to implementing social accountability

External factors

Economic instability

Government/funders expectation of accountability

Potential instability in partner organisations

Effective partnerships especially with voluntary organisations

Economic contribution to regional development and local health improvement

Institutional systems & staff

Emphasis on maintaining academic prestige

Good communication between the institution and partners

Success defined in terms of degree results rankings and graduates becoming tertiary specialists

Emphasis on advocacy and enabling communities to advocate for themselves

Staff personal time pressures, political views, level of interest, conceptual understanding and commitment

Research priorities, design, delivery

Emphasis on laboratory research

Patient and public participation with grassroots developed projects

Need to ensure financial viability of research departments

Explicit requirement to identify patient benefit in research proposals

Social accountability viewed as a distraction

Source of funding

Emphasis on translational research

Support from regional health authorities

Student selection & values

Widening participation seen as detrimental to prestige

Targeted support to students from underrepresented backgrounds

Difficulty of selecting students on their values

Change in student values over time in education

Recruiting internationally

Graduate retention

Curriculum design & delivery

Narrow focus of curriculum on clinical skills and procedures

Teaching on wider heath determinants and communities

Involvement of students in community projects or, voluntary work

Uncertainty of geographical location for which students should be trained

Empowering students to challenge other health professionals

Relative newness of the concept

Auditing of outcomes of such placements and providing

Adequate support to students in external placements

Implementation & evaluation

Difficulty of developing metrics to gauge progress

Presence of fully supported champions

Assessment fatigue

Demonstrating the impact of the institution via assessment

Availability of guidance

Assessment as a driver of change