Governance of health professions education in Sudan: implications for appropriateness of graduates to population health needs

Quantity, quality, and relevance challenges of the health workforce are widely recognised and represent a global concern. Educational governance as a strategy to tackle these challenges is under researched despite its obvious importance. The aim of this study was to explore governance for health professions education in Sudan in the context of graduate appropriateness to population health needs. I developed a conceptual framework to guide the study and employed a qualitative case study approach to investigate national governance using documentary review, observation, and interviews as data collection methods; and adopting reflexivity to enhance the study. The study analysed the structures, relationships, and processes for health professions education governance in the light of applying good governance principles and examined their influence on the quantity, quality, and relevance (appropriateness) of graduates in context of health system realities and population health needs. Complex and multidimensional effects of governance are verified in the milieu of a state-controlled model of higher education. Structural, relational, and process related dynamics of governance in the context of Sudan resulted into both gains and limitations for the quantity, quality, and relevance of graduates of health professions education. Despite substantial quantitative gains, the quality and relevance aspects of graduate health workers are challenged by considerable imbalances and capacity issues. Gaps in conceptualisation, governance dichotomies, policy inconsistencies, sociocultural realities, and weak monitoring and evaluation explain the imbalances observed. These factors are either governance related or amenable to governance interventions. The study provided for conceptual clarity around governance, established the significance of governance to graduate appropriateness, offered lessons for policy and practice, and delineated areas for future research. Methodological contributions of the study include a revised conceptual framework for analysing and strengthening educational governance for health, a conceptualisation around good governance principles, and considerations for using reflexivity in qualitative studies when researching own-field.