Application

Step 1 of 13

1. What is the name of your institution?

The name of the institution whose leaders are leading and engaging in the ISAT self-assessment process.

2. Where is the location of the institution?

City/State/Country

3. What is the name and contact of the institution's leadership (e.g., rector, vice-chancellor, dean, director, CEO, etc.)

Full name and email address

4. What is the name and contact of the person-in-charge in leading the ISAT assessment and implementation in the institution? This person will be the primary resource person for TUFH when contacting the institution related to ISAT.

First name, Last name, Email address, WhatsApp Number

5. List a minimum of 5 faculty delegates and their respective roles included in the application process that aligns the process with Social Accountability principles, including their email, included in the application process. The delegates should be samples of various seniority, department/division, gender, etc.

Please list a minimum of 5 faculty delegates included in the application process who are aligned with Social Accountability principles, including their email addresses. The delegates should represent a diverse range of seniority, departments and divisions, gender and sexual orientation, and racialized and classed identities. Institutional leaders are encouraged to consider a cross-section of faculty beyond medical faculty within the university. A diverse and representative group of leaders can ensure institutional buy-in. Depending on national and regional contexts, terms like “school” and “faculties” may be defined differently. Regardless, institutional leaders should define their stakeholders and their criteria for selecting them.

6. List a minimum of 5 student delegates and their role, included in the application process that aligns the process with Social Accountability principles including their email, included in the application process. The delegates should be samples of various seniority (year/batch of study), study program, gender, etc.

Please provide the names and email addresses of 5-7 student delegates, included in the application process who are sympathetic with Social Accountability principles, and who will be included in the application process. The delegates should represent various levels of seniority (year/batch of study), study program, gender and sexual orientation, racialization and socioeconomic class, etc.

7. Please provide a list of prospective and confirmed stakeholders and constituents who reflect the societies and communities to which the institution is accountable, as it undertakes the ISAT process. Please emphasize concrete representatives and groups such as health administrators, government officials, legislators, and community delegates, in ways that align with the Partnership Pentagram Plus (environment, infrastructure, economy, society, people, and the health system).

Emphasis should be placed on concrete partners who would benefit from an institution becoming socially accountable. Institutional leaders should also consider the contextual development of each group’s involvement overs time, for example by narrowing or broadening number of dedicated sub-groups, Examples: Medical Doctors (public and private), Local Government Officials, Local and International NGOs, Hospital CEOs, Students, Medical Education Experts, Department Heads, Health Care Providers, Frontline Workers, Paramedicine Groups, Community Representatives, Primary Patient Populations and their representatives, vulnerable populations, groups that geographically span rural and urban areas, Local Executives, Community Health Care Workers, and Program Alumni.

8. This question aims to understand to what extent your institution engages stakeholders in planning for advancements, policy and decisions overall. Using the most appropriate/realistic developmental descriptions provided in the criteria below, please indicate your institutional phase.

(Phase 1) Involvement of internal stakeholders (i.e., faculty members and students) in the completion of self-assessment and action plan to advance to the next stage.

(Phase 2) Involvement of internal stakeholders and health professionals and community representatives in the completion of self-assessment and action plans to advance to the next stage.

(Phase 3) Involvement of internal stakeholders, health professionals, community representatives and health care organizations in the completion of self-assessment and action plans to advance to the next stage.

(Phase 4) Involvement of internal stakeholders, health professionals, community representatives, health care organizations, and government in the completion of self-assessment and action plans to advance to the next stage.

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