Now being studied in more than 25 US-based undergraduate and graduate medical education programs, Health Systems Science (HSS) began as a collection of concepts. When grouped together, those concepts—the study of health care delivery systems, value, quality improvement, teamwork in health care, etc.—became the third pillar of medical education. A 2016 textbook, Health Systems Science, offered the framework for implementing the ideas across the nation. So what’s next?
How about going global?
A forthcoming collaboration between the AMA and the University of Witwatersrand (Wits), a South African public research university, will be the first examination of the concepts covered in the HSS textbook in the context of international health care.
Local concepts applied globally
Relating HSS topics to a foreign health system is not necessarily an apples-to-apples situation. Unlike the US, South Africa’s health system is largely public in volume. Still, with 16 percent of South Africa’s health care delivery taking place through a private sector that sprung up post-apartheid, the country’s care system is complicated. A further confounder is that the total cost of care for those 16 percent serviced in the private sector the same as for the 84 percent through the public sector, making for great inequity and spiraling costs.
“In many of these countries, their health system is managed through the government by a ministry of health, and in some ways that would be like our public health system,” said Susan E. Skochelak, MD, AMA Group Vice President for Medical Education. “Yet the on-the-ground practitioners, the physicians themselves, need a practical way of understanding systemic issues, and it seems like that is what is in this textbook that spoke to them in a more universal way than what we had anticipated.”
Shabir Moosa, PhD, an associate professor in the Department of Family Medicine, is Wits’ point person on the project. As in the U.S., Moosa and his colleagues identified a need for students to understand health care beyond the basic and clinical sciences. This is especially important, with the development of a national health insurance system, to use the private sector more.
“There are different issues needed to supplement the [basic and clinical sciences],” Moosa said. “Some of it has been taught in South Africa, but it hasn’t been called health systems science. Often it is public health, family medicine, ethics, etc.. It’s very fragmented and there’s an opportunity to use the ideas in the U.S. to be able to pull it together. It would be useful to look at what the U.S. is doing and explore HSS as fundamental third pillar of medical education in South Africa. The same idea could be advocated in Africa as well.”
Customizing the HSS curriculum
Wits has already incorporated HSS into the first year of a bachelor’s of health science degree—akin to a pre-med study in the U.S. educational system, and strengthening it in the second and third year of the degree.
The concept of HSS is still new in South Africa and Africa. Many academics and leaders in South Africa and beyond, have been curious about it. The initial plan is to use hour-long webinars each quarter as a way to engage key stakeholders in South Africa and beyond.
The first 30 minutes of those webinars will offer a broad view of an HSS topic, led by some faculty members from a school within the AMA’s Accelerating Change in Medical Education Consortium. The second portion of the webinars will contextualize the application of a concept within the South African health care system. The initial list of topics that will be covered in the six webinars includes leadership, health care delivery systems and reforms and population health.
After this initial implementation, Moosa is hoping to create additional HSS resources for a variety of students in their training. He’s also hoping to expand the program throughout Africa through his role as African president of WONCA, the World Organization of Family Doctors.
“It’s very useful to have engagement,” he said. “The contexts, and particularly in Africa, differ quite substantially. I hope that in the process we can show that whilst things look very different from the U.S., what we are talking about has strong relevance. We need to be able to think ahead and South Africa offers that opportunity, especially in the light of the national health Insurance system.”