Burck Smith wrote in 2012 what remains one of the clearest summaries of how accreditation is based primarily on a higher education institution’s inputs rather than its outcomes, and serves to create an “iron triangle” to maintain high prices, keep out new entrants, and resist change.
It is worth quoting Smith at length (see this link) as we think through the proposal that the transformation of global health education for impact should rely on accredited institutions. Global health efforts are focused on outcomes and aim to achieve impact. Of necessity, this requires rethinking a broad swath of fairly fundamental issues, from how to construct education to what philosophy should underpin what we design and develop. And the focus on results makes the prevailing input-based accreditation criteria unlikely to be the most useful ones to help achieve global health goals.
The call for a “revolution” in education for public health is unlikely to be answered by institutions that form a protected monopoly. The most exciting and promising innovations in education are happening on the fringes of the education landscape, in bootcamps, edtech startups, and other non-traditional organizations that are catalyzing change. Such change remains primarily seen as a threat by established institutions that, in a protected market buttressed by accreditation, are seeking to preserve gross margins that hover at around sixty percent in some countries.
Of course, there is a very real problem with the proliferation of degree mills and other shady profit-first organizations that sell the promise of career development and opportunities but cannot deliver them. Unfortunately, many such outfits are, it turns out, accredited ones. This explains why, alongside accreditation, a parallel industry of quality labels and certifications is supposed to help potential “customers” make better purchasing decision.
Instead, we should rethink what determines the value of a credential. Moving toward competency-based degrees is one necessary but insufficient step that has already been explored. But could we invent a “lifelong credential” that would increase in value over time, as its holder applies what was learned in order to progress and ultimately achieve measurable impact? The tools (blockchain, AI, etc.) to support this already exist. A reductive obsession with legitimacy based on accreditation and the prestige and rankings it supposedly confers will only serve to hinder those of us who are working toward new forms of credentialing, grounded in the needs of people working in countries and guided by what will actually save lives and improve health.
Image: Walled garden, New College (Oxford). Photo by Elaine Heathcote on Flickr.