VU University Amsterdam and Royal Tropical Institute. Degree programmes: - Master International Health - Master Public Health

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1 VU University Amsterdam and Royal Tropical Institute Degree programmes: - Master International Health - Master Public Health Netherlands Quality Agency (NQA) Utrecht, April 2010

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3 Management information This is the assessment report of the master programmes International Health and Public Health, offered by the Koninklijk Instituut voor de Tropen under the aegis of the Vrije Universiteit Amsterdam. In this report Netherlands Quality Agency (NQA) gives account of its findings, considerations and conclusions. The assessment was undertaken according to the NQA-Protocol 2010 for professional master s degrees in compliance with Dutch education legislation. This report concerns: Institution Degree programmes Vrije Universiteit Amsterdam and Koninklijk Instituut voor de Trope (KIT) Master of International Health (MIH) Master of Public Health (MPH) Delivery mode(s) MIH: fulltime and part time; MPH: full time Croho-number (ISAT) MIH: MPH: Site(s) KIT, Amsterdam Date(s) of site visit(s) 25 February 2010 Audit team Prof. dr. J. Cohen-Schotanus (chair, representative profession/discipline) Drs. R. Elema (representative profession/discipline) Ms. J.M. Zwiers MSc (student member audit team) Drs. R. van Empel (NQA-auditor) Koninklijk Instituut voor de Tropen (KIT) has submitted files to NQA for the assessment of the existing professional master degree programmes International Health and Public Health. This file was a critical reflection on the degree programme as required by the NQA Protocol-2010 hbo master s degrees. For the assessment of the quality and the level of these existing programmes NQA composed an audit team; this team complies with the NVAO s requirements *. The team studied the critical reflection, had a site visit at the institution and assessed the degree programmes on critical reflection of written and oral information. The assessments in this report concerns both MIH and MPH unless mentioned otherwise. Aims and Objectives, Theme 1 The audit team assessed all three standards as good. KIT/VU has defined suitable aims for both programmes and has a sound structure to update these aims. The difference in objectives and focus of the two programmes can be clearly expressed by all concerned. In defining the aims, the Dublin Descriptors at master level were taken into consideration and KIT/VU can show how the aims and objectives adequately express the master s level. The professional * NVAO Netherlands Flemish Accreditation Organisation charged with execution of Dutch accreditation legislation. NQA - VU/Royal Tropical Institute: audit existing hbo-masters Intern. Health/Public Health 3/61

4 orientation of both programmes is evident, in that KIT/VU manifestly provides for professional organizations in international health and public health. KIT/VU is in constant contact with organizations in which graduates work; this contact may evolve in the programmes of public health and international health. As a result, the audit team assesses Aims and objectives as positive. Curriculum, Theme 2 All standards have at least a positive assessment and as a result the topic Curriculum is positive. The professional orientation of both programmes is up to standard, with both curricula providing modules with a thorough and acceptable content, addressing all matters that the programmes objectives aim at. For both programmes the coherence of the curriculum is in order, as is the study load. Admission criteria and procedures are clear and are well executed. Both programmes meet the requirements of 60 EC for master programmes. Teaching methods and assessments are up to standard. The audit team was pleased to find that formalization of the assessment of the final phase of MPH is being introduced, as already existing in MIH. Therefore, the audit team assesses Curriculum as positive. Staff, Theme 3 The audit team assessed all three standards as good. KIT/VU knows how to recruit suitable teachers, either within KIT or externally. Staff is up to date with training methods for adult learning, a proficiency that is sustained through annual training. KIT has sufficient staff for both programmes. Therefore, the theme Staff is assessed as positive. Services, Theme 4 The audit team assessed both standards as good. KIT/VU has the use of more than adequate facilities and a good information system. Tutoring and coaching are well adapted to the needs of the MIH- and MPH-students; KIT/VU has adequately addressed any negative evaluations by students of former cohorts. Therefore, the audit team assesses the theme Services as positive. System for Internal Quality Assurance, Theme 5 The audit team assessed the standards for Theme 5 as good or satisfactory. KIT/VU closely monitors all aspects in both programmes, through its system of Balanced Score Cards and through additional evaluations. The MIH-programme is also closely monitored through troped, of which KIT/VU is a partner. All findings result in measures for improvement, either directly such as through reviews of course delivery, the results of which are communicated directly to the teaching faculty, or indirectly, through analysis of data, subsequent proposals for change and discussion within the Board of Studies, the External Advisory Committee and the Academic Board. All stakeholders are contacted about evaluation results and intended changes as a result of these evaluations. Therefore, the audit team assesses theme System for Internal Quality Assurance as positive. 4/61 NQA - VU/Royal Tropical Institute: audit existing hbo-masters Intern. Health/Public Health

5 Results, Theme 6 The audit team assessed both standards as good. KIT/VU has shown that its graduates reach the intended learning outcomes and that the success rates of both programmes comply with the set targets. The success rates are closely monitored: KIT/VU is aware of the impediments in study progress and takes adequate measures to address any impediments, be they personal or collective. Therefore, the audit team assesses theme Results as positive. The NQA audit team concludes that the quality and the level of the existing professional master s degree programme complies with the required quality. A substantiation of this conclusion can be found in Chapter 2. NQA - VU/Royal Tropical Institute: audit existing hbo-masters Intern. Health/Public Health 5/61

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7 1 Basic data 9 2 Assessments and Conclusion Aims and objectives Curriculum Staff Services Internal quality assurance system Results 42 3 Annexes 45 Annex 1: Expertise of the Members of the Audit Team 47 Annex 2: Statement of Independence by the Members of the Audit Team 53 Annex 3 Programme for the Site Visit 57 Annex 4: Documents made available 59 Annex 5: Documents regarding the professional profile and domain objectives of the programme 61 NQA - VU/Royal Tropical Institute: audit existing hbo-masters Intern. Health/Public Health 7/61

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9 1 Basic data The basic data of the two existing professional master s degree programmes: Master International Health (MIH) and Public Health (MPH): 1. Name institution Vrije Universiteit van Amsterdam (VU) and Koninklijk Instituut voor de Tropen (KIT) 2. Status institution Both programmes are not funded by the Dutch government 3. Name institution in BRIN VU brin = 21pl 4. Registration number in CROHO and Orientation and level Professional master 6. Amount of European Credits 60 EC 7. Specializations MPH: general and HIV/AIDS 8. Site(s) Lineausstr 35F, Amsterdam 9. Code of conduct for support of non-eu students Yes 10. Delivery mode(s) MPH: full time MIH: fulltime and part time 11. Profile degree programmes Quoting KIT/VU MPH: A typical public health manager is a person working in the health system in a low or middle-income country, who will be responsible, at any level (national, regional, district and community) for all or some of the following: policy-making and regulation, strategic planning, resource mobilisation and the management of routine and emergency activities in the field of public health. This includes the management of human, financial and logistical resources, applied research, information management and knowledge transfer, advocacy, managing multi-stakeholder processes and intersectoral collaboration. Their work environment will be in either a public or private sector organization that is responsible for public health and addresses the wider determinants of health and health inequities. MIH: As an international health expert for low and middleincome countries, you will be involved in analysing, interpreting and addressing the impact of international developments on national health and national public health problems on international health. You will understand international influences on national health systems i.e. international funding. You will draw on the experiences of many countries and apply these to other contexts in order to improve equity in health. You will interpret and apply relevant theories and concepts, formulate effective and appropriate responses to complex practice and policy issues in international health, make use of evidence-based practice, engage in clinical or non-clinical applied research, and work confidently across disciplines, sectors, national boundaries NQA - VU/Royal Tropical Institute: audit existing hbo-masters Intern. Health/Public Health 9/61

10 12. Intended professional environment 13. Position degree programme in organisation structure and in-country levels i.e. national, regional, district, community. You may choose to focus on a given area such as reproductive health. Your work environment will be at the interface between international organizations and networks and country health systems. MPH: Examples of career perspectives of typical MPH graduates are: - programme manager or policy adviser for the implementation of public health or specific disease control programmes and projects at national, regional or decentralized district level in low and middle-income countries; - health policy adviser or programme manager of public health programmes and projects or sector-wide support programmes in the context of multi-lateral, bi-lateral and non-governmental aid cooperation in low and middleincome countries; - senior policy adviser or regional/national director to national governments in relation to the planning, management, organization and evaluation of national and decentralized health systems and the effective implementation of health reforms. MIH: Examples of careers of typical MIH graduates are: - Country representatives for non-governmental organizations (NGOs) working in the field of international health; - Program officers working in international organizations dealing with international health, such as Doctors without Borders, World Vision; - Policy advisers, working in national organizations or governmental institutes dealing with international health issues such as Pharmaccess. Belongs to Department KIT Development Policy and Practice, in Area Education 14. Date previous assessment and accreditation decision NVAO Site visit on July 30, 2005; NVAO-decision August Relevant changes in degree programme since previous assessment - In 2008, the formal aims of both programmes were reassessed. In the case of MIH, this was done in close collaboration within troped. On the basis of a round table discussion the professional profile of the ICHD as well as the MIH were sharpened, and the general competencies revised, based on the profiles - Use of Balanced Score Card as a Quality Assurance System, and revision of the BSC to capture the NVAO facets - Introduction of use of Virtual Learning Community: on-site e-learning - Improving assessments: balancing between a variety of assessment tools 10/61 NQA - VU/Royal Tropical Institute: audit existing hbo-masters Intern. Health/Public Health

11 - Reducing in advanced modules contact hours, to give more time for self-learning, and unsupervised group work and to reduce study load - Introduction of self-reflection by students - Introduction of possibility for primary data collection for thesis, after approval by the (newly installed) Research Ethics Committee For MPH: - Development of HIV/AIDS specialization within MPH, 3 new modules developed and implemented - Rearranging of modules for improved coherence i.e. merging of the modules epidemiology and statistics and dividing them into Epistat 1 and Epistat 2, adding selfassessment exercises and increasing tutorials For MIH: - More emphasis on writing skills in the core course 16. Structure degree programmes MIH consists of three elements: a number of core modules, a number of advanced modules; a thesis. The advanced MIHmodules can be followed in other troped-countries. MPH consists of a fixed number of sequential modules, of which the last 3 differ between MPH-general and the MPH- HIV/AIDS specialisation NQA - VU/Royal Tropical Institute: audit existing hbo-masters Intern. Health/Public Health 11/61

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13 2 Assessments and Conclusion The audit team comes to the following assessments and conclusion with regard to the degree programme: Themes Conclusion Standards Assessment 1 Aims and objectives POSITIVE 1.1 Domain specific requirements 1.2 Level 1.3 Professional orientation (hbo) 2 Curriculum POSITIVE 2.1 Requirements for professional orientation (hbo) 2.2 Correspondence between the aims and objectives and the curriculum 2.3 Consistency of the curriculum 2.4 Study load 2.5 Admission requirements 2.6 Credits 2.7 Coherence of structure and contents 2.8 Learning Assessment 3 Staff POSITIVE 3.1 Requirements for professional orientation (hbo) 3.2 Quantity of staff 3.3 Quality of staff 4 Services POSITIVE 4.1 Facilities 4.2 Tutoring 5 Internal quality assurance system POSITIVE 5.1 Periodical evaluations 5.2 Measures for improvement 5.3 Involvement 6 Results POSITIVE 6.1 Achieved learning outcomes 6.2 Study progress good good good good good MPH: good MIH: satisfactory satisfactory good complied good satisfactory good good good good good good satisfactory good good good The audit team concluded that the quality and the level of the existing professional master s programmes International Health and Public Health meet the required quality. Therefore the audit team recommends the NVAO to award accreditation. In the following sections the audit team describes its findings, considerations and conclusions concerning the themes and standards. Each section concludes with a summary. NQA - VU/Royal Tropical Institute: audit existing hbo-masters Intern. Health/Public Health 13/61

14 2.1 Aims and objectives Domain specific requirements (standard 1.1) The intended learning outcomes of the programme correspond with the requirements set by professional colleagues, both nationally and internationally and the relevant domain concerned (subject/discipline and/or professional practice). The programme originates from The most recent revision of the intended learning outcomes was in November 2009 when the Academic Board of MPH, in which both the Royal Tropical Institute (KIT) and the VU University of Amsterdam (VU) are represented, approved the revision of the revised sets of competencies. This revision was the result of a one-year-process, with elements such as a round table conference of experts from the field, experts from similar institutions, WHO and alumni (2008) and a subsequent proposal by the course management. This proposal was also based on input such as the developments within the programme in recent years and a quick scan by NQA. This revision is a thorough update of the former set of programme s aims rather than a fundamental change. After the revision, the programme has eight distinctive aims, c.f. Annex 5. These eight programme outcomes are concretized in the specific objectives for the modules (c.f. standard 2.2). MPH is the only such programme in the Netherlands, with the VU-master specialization in International Public Health being comparable in content, but different in orientation being academic rather than professional. This VU-programme however is a set of modules that together serve as a specialization for a number of initial master s programmes for which no work experience is expected. VU offers this specialization as a separate 60-credit programme within the initial master programmes in Health Sciences (60 credits), in Biomedical Sciences (120 credits), or in Management, Policy Analysis and Entrepreneurship in the Health and Life Sciences (120 credits). Students are trained to cooperate and communicate with professionals from various scientific and medical disciplines and with representatives of public health and related health organizations. Master s in International Health (MIH): International Health is a relatively new discipline, with its first cohort dating from MIH focuses on analyzing international health issues, problems and situations. This includes applied research and development of adequate and appropriate responses in a global context. Most of the theses that the audit team examined (c.f. standard 6.1l) were literature studies. MIH encompasses elements of both tropical medicine and public health in low and middle-income countries: - Tropical medicine focuses on the evidence-based treatment and organization of individual treatment for diseases of major importance in low and middle-income countries and important pathology in a tropical ecology. - Public health is geared towards planning and organization of the health sector and policy and management of the health system to improve the health of populations within countries. 14/61 NQA - VU/Royal Tropical Institute: audit existing hbo-masters Intern. Health/Public Health

15 In , the programme s objectives were revised through the same procedures as described above concerning MPH, at the same time and in the same meetings. Just as for MPH, the revision of the former MIH-aims is rather a thorough update than a complete change. C.f. Annex 5 for the programme s aims. MIH and the troped-network The objectives of MIH comply with the working definition of international health adopted by the troped-network. In this network some 26 institutes for higher education in- and outside Europe in international health collaborate in joint postgraduate education and training aimed at health professionals in tropical and low and middle income countries (LMI). KIT is a member of the troped network as one of seven partner institutes that offer this master s programme in International Health. troped monitors all education at the troped-institutes (c.f. standards 5.1, 5.2 and 5.3). All member institutes adhere to troped s definition of International Health, which was redefined by the networkin 2007: International Health is a discipline that systematically compares factors that affect the health of all human populations with a special focus on poverty-related health problems in low and middleincome countries. International Health includes the promotion of health, prevention and treatment of diseases and rehabilitation. Knowledge, skills and the ability to critically analyse and draw implications for practice related to the major endemic diseases, health systems research, health economics, health policy and management of health services are essential. MPH, which is described above, is partly comparable to MIH though MIH focuses specifically on international interface and management in health policy. Other master programmes similar to MIH are e.g. the other troped-master programmes in Europe. These troped master programmes are accredited in their respective countries. - Institut fur Tropenmedizin, Freie Universität und Humboldt Universität, Berlin, Germany. - Centre René Labusquiere, Université Victor Segalen, Bordeaux, France. - The Department of International Health, Institute of Public Health, Copenhagen University, Denmark. - The Centre of International Health studies, Queen Margaret College, Edinburgh, Scotland. - Schweizerisches Tropeninstitut, Basel, Switzerland. - The Centre for International Health, University of Bergen, Norway. - The Department of Tropical Hygiene and Public Health, Ruprecht-Karls-Universität, Heidelberg, Germany. - The Centre for International Health and Development (formerly known as the Centre for International Child Health), University College London, United Kingdom. Each troped-institute has specific characteristics: - KIT/VU MIH, through its extensive network of partners in the field of international and public health and its network of staff operating at an international level, specifically identifies and illustrates contemporary international developments in health matters. KIT s expertise focuses on health systems, human resource development, sexual and reproductive health, human resources for health, health economics, HIV/AIDS and major communicable diseases. - In Berlin and Bordeaux, the advanced modules concentrate on tropical medicine. NQA - VU/Royal Tropical Institute: audit existing hbo-masters Intern. Health/Public Health 15/61

16 - In Copenhagen, the emphasis is on health care systems. Edinburgh concentrates on social development and health. - Basel focuses more on management, and Bergen on applied clinical research. - Heidelberg has a strong focus on health financing and quality management. The International Child Health Institute in London focuses on child health. Both programmes KIT/VU had installed an external advisory committee for each of the programmes. In 2009 it was decided for these two committees to merge, as the matters that were put to them generally coincide and as the MIH-committee had not found sufficient opportunities to convene. At the time of the site visit, February 2010, the newly established joint Committee had not yet convened. The representative of this joint Committee that the audit team interviewed was a member of the original Committee for MPH. The audit team found that this member of the Committee feels that attention will be needed so that discussions about subject matter of the programmes continue to be of sufficient depth, as from now on the Committee consists of more members than before, representing a wider spread of disciplines. Comparison of the KIT/VU and VU Master s programmes Domain Level Entry Orientation requirement: work experience KIT/VU Public health Master, postgraduate (mid-career professional) KIT/VU KIT/VU VU International Health International health International Public Health Master, postgraduate At least two but Professional/ preferably four HBO years of relevant professional experience in low and middleincome countries At least two years of relevant work experience European Master At least two years of relevant work experience Professional/ HBO Professional/ HBO Fulltime/ Part-time Full-time Fulltime/ Part-time Full-time Duration 1 year 1-5 years 1 year Initial Master None Academic Full-time 1 or 2 years Considerations The audit team considers that KIT/VU scrupulously monitors that the programmes aims are up to date and fit the changing issues in Public Health and International Health. The audit team supports the care KIT/VU shows to adequately involve the professional field in discussion the programmes, in reorganizing the external advisory committees. The audit team agrees with the representative of the Committee that the modus operandi of this new Committee should be monitored to ensure that discussions can have sufficient depth. 16/61 NQA - VU/Royal Tropical Institute: audit existing hbo-masters Intern. Health/Public Health

17 Conclusion These considerations lead to the audit team s assessment of good for Standard 1.1. Master Level (standard 1.2) The intended learning outcomes of the programme correspond with the general, internationally accepted descriptions of a master s qualification. Findings The audit team was presented in the self evaluation report with an overview in which the five Dublin descriptors were linked to the qualifications of both programmes, followed by an elaboration of how these links were to be interpreted. For a number of the Dublin descriptors and the competencies of each of the programmes this is shown below. MPH: - Citing from the self evaluation report (SER): the students will demonstrate knowledge and understanding that provides a basis or opportunity for originality in developing and/or applying new ideas. This is reflected in competencies one, two three and four. Knowledge and understanding of key factors that shape health, challenges to health, appropriate responses and research needs will give students this basis. - The students will have the ability to integrate knowledge and handle complexity and formulate judgments with incomplete or limited information, which includes reflections on social and ethical responsibilities linked to the application of their knowledge and judgment. This is reflected in competencies one, three and four. In the first competency students have to take into account international changes in health, objective three focuses on responses to complex international practice and policy issues and competency five states that students should be able to critically analyses and use research results. - The requirement that students are able to communicate their conclusions, and the knowledge and rationale underpinning these to specialist and non-specialist audiences, clearly and unambiguously, is contained in the second, fourth and sixth competency. - Students must also have the learning skills to allow them to continue to study in the manner that may be largely self-directed or autonomous. This requirement is reflected in the third and fifth competencies. The ability to identify research needs, to commission research and to critically analyze and use research results is essential to this ability. MIH: - Citing from the SER: the students will demonstrate knowledge and understanding that provides a basis or opportunity for originality in developing and/ or applying new ideas. This is reflected in the first competency: Critically analyses the health status of a population and identifies health needs, as well as by aims two, three, five and eight. In order to fulfill these objectives, students will need to have knowledge and understanding of the causes and consequences of health problems and approaches to solving them, which will provide a basis for originality in analysis, in drawing conclusions and finding feasible solutions. NQA - VU/Royal Tropical Institute: audit existing hbo-masters Intern. Health/Public Health 17/61

18 - The students will be able to.. apply their knowledge and understanding and problemsolving abilities in new or unfamiliar environments within broader contexts related to their field of study. This is reflected in the programme s aims one to seven (c.f. Annex 5), as all these competencies require the application of problem-solving skills in new or unfamiliar situations within a broader interdisciplinary context and in an evolving political and scientific context related to public health. - The requirement that students are able to... communicate their conclusions, and the knowledge and rationale underpinning these to specialist and non-specialist audiences clearly and unambiguously, is contained in competencies three, four, five and six, as clear communication to a range of audiences is required when communicating in a team and in reports. - Students must also have the learning skills to allow them to continue to study in a manner that may be largely self-directed or autonomous. This requirement is reflected in competency five and in the last competency. Considerations The audit team finds that KIT/VU has demonstrated clearly that the learning outcomes of the programme are at the required level as described by the Dublin descriptors. Conclusion These considerations lead to the audit team s assessment of good for Standard 1.2. Professional orientation (standard 1.3) The intended learning outcomes are also based on the professional profiles and/or professional competencies drawn up by (or in collaboration with) the relevant professional field. A professional master (hbo-master) has the qualifications at the level of an independent and/or managerial professional in a profession or professional field, or the level required to function adequately in a multidisciplinary environment for which professional higher education is required or useful. Findings MPH: From the description of the MPH s programme s aims which are described in the course handbook:... a public health manager is an independent professional, who is able to work in a multidisciplinary environment within public health. There is no professional body for MPH in the Netherlands nor internationally. VU/KIT could not define the professional field where graduates will work, although the type of work is clearly defined: graduates of a Master of Public Health are at work as public health managers or senior policy advisers in a wide variety of institutions and organizations at various levels (e.g. national, provincial, or decentralized district level), or with international and national non-governmental organizations (NGOs) or multilateral and bilateral organizations such as WHO, UNAIDS, UNICEF, MSF, NLR, KNCV, Cordaid. 18/61 NQA - VU/Royal Tropical Institute: audit existing hbo-masters Intern. Health/Public Health

19 This broad field of development organizations influences the programme s aims, through information gathered in various ways, e.g: - KIT and VU staff regularly travel abroad to carry out activities such as formulation, backstopping or evaluations of national public health programmes. They then meet ministers and other key decision-makers, including donor organizations, in the respective countries. - KIT and VU staff are regularly requested by the Netherlands Directorate-General for Development Cooperation (DGIS) to give policy advice or carry out research and are also invited to speak at international conferences. - KIT regularly organizes international conferences, e.g. the upcoming conference on Human Resources for Health in KIT and VU staff are members of a number of international and national networks, (e.g. troped, Tropmed, the Nederlandse Vereniging voor Tropische Geneeskunde (NVTG) and Sharenet). - KIT and VU staff members are invited to act as examiners or reviewers at other Master's programmes. - KIT and VU staff meet structurally with managers of Dutch organizations who fund or implement public health programmes abroad; KIT and the VU are generally involved in projects with these organizations (i.e. KNCV, NLR, MSF, Cordaid). These organizations also regularly send their staff or sponsor staff from low income countries to participate in the programme. - Since the start of the programme in 1964, a large number of MPH-graduates have been at work in Public Health all over the world, therefore in virtually all international contacts in the area of public health, KIT and VU staff work with MPH-graduates. MIH: The qualifications of an expert in international health are those of an independent professional, who is able to work in the multidisciplinary environment required within international health. As shown under standards 1.1. and 1.2, the MIH-learning objectives are derived from the troped-definition of an international health expert. This definition was developed at KIT/VU and accepted by troped in 2008 (cf. standard 1.1). Therefore the MIH-learning objectives concur with the objectives at other MIH troped-programmes and reflect a common, recently updated, understanding of what constitutes an international health expert. Some examples of careers of typical MIH graduates are: - Country representatives for non-governmental organizations (NGOs) working in the field of international health. - Program officers working in international organizations dealing with international health, such as Doctors without Borders, World Vision. - Policy advisers, working in national organizations or governmental institutes dealing with international health issues such as Pharmaccess. - Graduates are generally also involved in international health training activities. NQA - VU/Royal Tropical Institute: audit existing hbo-masters Intern. Health/Public Health 19/61

20 Considerations The audit team found that KIT/VU has a clear view of the working environment in the international health and public health areas that have a need for the graduates of the programmes and, simultaneously, how these needs develop and what adjustments are needed in the programmes aims to successfully cater for these professional needs. The External Advisory Committees, in future only one Committee for both programmes, is closely involved in supplying information on how the professional field for both programmes evolves. Graduates that the audit team interviewed supported that the knowledge and skills that they acquired are what their work environment needs: hands on managing and advice on public health and international health. Conclusion These considerations lead to the audit team s assessment of good for Standard 1.3. Summarized assessment Aims and objectives The audit team assessed all three standards as good. KIT/VU has defined suitable aims for both programmes and has a sound structure to update these aims. The difference in objectives and focus of the two programmes can be clearly expressed by all concerned. In defining the aims, the Dublin Descriptors at master level were taken into consideration and KIT/VU can show how the aims and objectives adequately express the master s level. The professional orientation of both programmes is evident, in that KIT/VU manifestly provides for professional organizations in international health and public health. KIT/VU is in constant contact with organizations in which graduates work; this contact may evolve in the programmes of public health and international health. As a result, the audit team assesses Aims and objectives as positive. 2.2 Curriculum Requirements for professional orientation (standard 2.1) Students develop their knowledge through the study of professional literature, by the study of materials derived from the professional practice and by interaction with the professional field and/or (applied) research. The curriculum has verifiable links with current developments in the professional field /the discipline. The curriculum ensures the development of professional competencies and has verifiable links with current professional practice. Findings For both programmes, the reading list is made by the lecturers in close contact with the programme management. The reading list is reviewed yearly. The audit team found that the reading lists for both programmes are up to standard, consisting of relevant and recent literature of sufficient depth. 20/61 NQA - VU/Royal Tropical Institute: audit existing hbo-masters Intern. Health/Public Health

21 Teaching is partly done through case studies. As all students have at least two years of relevant work experience (c.f. standard 2.5), students may be considered to be able to add their own case study material to that which KIT/VU provides. Examples of recent developments that found their way in the curricula are the organization to address the influenza pandemic, discussions around aid-effectiveness, the role of the global funds and discussions concerning human resources for health. Professional skills, such as organizing, fact finding, research skills and communication skills are enhanced in specific assignments in all modules. Module evaluations indicate that the students feel that the skills they have acquired are up to standard. Research skills are specifically addressed in the core modules and further enhanced in the advanced modules of both programmes. The audit team found that research is rather applied research and literature study than fundamental research, with a focus on understanding and applying research. The audit team found this focus on application is evident in both skills training and in actual assignments. The audit team finds this focus is in compliance with the aims for both programmes. The External Advisory Committee annually discusses recent developments in the related scientific disciplines and in the professional field with the programme management; in previous years the curricula were adapted accordingly. An example is the specialisation in HIV/Aids with the three new HIV/AIDS modules which were developed based on the changing working environment in many of the countries. As MIH and MPH-staff are in close contact with each other and as they share their programme director, both programmes benefit from information about the professional and scientific developments in either of them. The connection of MIH with other scientific educational institutions through troped provides MIH with additional opportunities to discuss new developments in either science or practice that may be implemented in the curriculum. The essays and assignments that students of both programmes work on are related to specific health problems or current health policy dilemmas. MPH-students relate the current literature to the context of health policy in their own country; MIH-students relate current literature to international health in LMI-countries. Course lecturers are selected on basis of their ongoing work in public and international health. The audit team found that the teaching staff currently at MPH and MIH is indeed well informed about issues in public health and international health (c.f. standard 3.1). Considerations The audit team closely considered how the requirements for a professional orientation were evident in both programmes. The audit team is convinced that the connection that is shown in the content of the modules in the application of theories in e.g. management, communication, problem identification, problem solving, to address practical issues in public health and international health and the focus on applied research, results in a thorough professional orientation, with both programmes offering sufficient openings for students to pursue theories and research skills to greater depth. Conclusion These considerations lead to the audit team s assessment of good for Standard 2.1. NQA - VU/Royal Tropical Institute: audit existing hbo-masters Intern. Health/Public Health 21/61

22 Correspondence between the aims and objectives and the curriculum (standard 2.2) The curriculum is an adequate realisation of the intended learning outcomes of the programme and this regards the level, the orientation and the subject-/discipline-specific requirements. The intended learning outcomes are adequately transferred into the educational goals of the curriculum or parts thereof. The contents of the curriculum ensure the students achievement of the intended learning outcomes. Findings In the self-evaluation report, KIT/VU presented the audit team with overviews of both curricula in which the programmes objectives/aims were presented in relation to the various modules of the curricula and to the Dublin descriptors. The audit team found that in both curricula students work at achieving the aims of the programmes in at least two modules. During the Round Table meeting of experts in 2008, all module objectives were revised to comply with the revised competencies. All elements of the Dublin descriptors and the programmes competencies are fully addressed in the curricula. The two programmes differ in content and structure, but are related: - MIH is made up of three equal parts: 20 EC of core modules, 20 EC of advanced modules and 20 EC of finalizing the programme in a thesis. - MPH consists of a set of sequential fixed modules of which the last three modules can be chosen, i.e. 3 HIV/AIDS modules for the HIV/AIDS specialisation and three general modules for the MPH general, concluding with a thesis. - Some of the core modules for MIH and MPH have similar elements and students of both programmes may meet in the lectures and assignments for those elements. - MPH has a fixed curriculum (c.f. standard 2.3) whereas MIH-students may choose a number of advanced modules. In these advanced modules, MIH-students can choose some of MPH s modules (subject to troped s accreditation of these modules. - Examples of advanced MPH-modules that MIH-students can choose are: HIV/Aids modules such as Dynamics of HIV and AIDS Epidemics and Analyzing effective responses, Health sector reform and financing, Human Resources Development. Students evaluations over the years show that students found the modules to be of a high level and that module content was relevant and up to date. In these evaluations, students indicated that they achieved the learning objectives. Specifically for MIH: The MIH-curriculum starts with a set of modules in basic knowledge and skills in international health. Students make their choice of advanced modules together with their study adviser at KIT/VU. The advanced modules can be taken at KIT and at other troped institutions that offer advanced modules which were accredited by the troped General Assembly. MIH-students that receive Erasmus Mundus scholarships can study at three troped-institutions for equal proportions of time; they will receive a degree from each institute after finishing their thesis. Students may also choose suitable advanced modules at another NVAO-accredited master programme, not necessarily accredited by troped. In such a case, this student will be awarded an MIH-diploma by KIT/VU only, not with a diploma of another troped as well. 22/61 NQA - VU/Royal Tropical Institute: audit existing hbo-masters Intern. Health/Public Health

23 MIH is offered as a full time and as a part time programme. The modules for part time delivery mode do not differ from the full time modules, as part time refers mainly to the fact that students may spread their study of the three parts of the curriculum over a number of years. Because MIH-students may work in international projects during their studies and as those projects generally take some three years, module-certificates are valid for five years. Thus, MIH-students must complete their programme within five years of initial enrolment. Typically, MIH-students will either finish their programme within one or two years, of will take time out after completing the set of core modules (20 EC) before going abroad for a three year period in international health, after which they will complete the programme (advanced modules and thesis). The set of core modules at MIH also serves as the final component of postgraduate education in tropical medicine and international health for medical doctors and paramedical personnel in the Netherlands (NTC). The training for medical doctors includes qualityassured residencies in surgery and obstetrics/gynaecology of 12 months duration. Their training aims at future responsibilities in resource-poor circumstances. Twenty training days are organized for Capita Selecta, mainly aimed at enhancing clinical skills such as surgery, ophthalmology, dermatology and forensic medicine. The Netherlands Society of Tropical Medicine and International Health (NVTG), through its Education Council for Tropical Medicine (Concilium Opleiding Tropische Geneeskunde), is responsible for the content and quality of the preparatory education of these physicians. The NVTG awards a Diploma in Tropical Health to candidates who have successfully completed all the required elements: residencies in surgery and obstetrics/gynaecology, the training days and the core course. This diploma is considered an asset when applying for jobs with several NGOs. The NVTG endorses the MIH. Considerations The audit team considered both programmes to be a solid operationalisation of the aims and objectives as described in standard 1.1. All relevant aspects of the programmes aims are adequately addressed in the curricula. Conclusion These considerations lead to the audit team s assessment of good for Standard 2.2. Consistency of the curriculum (standard 2.3) The contents of the curriculum are internally consistent. Findings MPH Almost all MPH modules are compulsory (with the HIV/AIDS specialisation that is not anymore true). The set of modules in the first term (some 14 weeks, 20,5 EC) enhance basic skills in writing, communicating, research, describing and analyzing health situations of a population and its multidimensional determinants, health systems, organization and planning processes. In classes, students discuss e.g. basic health issues such as economics and finance in health system. The core modules are each a relevant mix of NQA - VU/Royal Tropical Institute: audit existing hbo-masters Intern. Health/Public Health 23/61

24 theory linked to practice; skills training is part of most modules. The set of advanced modules of the second term build on the basis modules in the first term. Students begin preparing for their thesis during the first term, with decisions on the topic, research methods and the necessary data. In the third term, students write their theses. In their theses, students must integrate the knowledge and skills they acquired earlier in the curriculum. The students who choose the HIV/AIDS specialisation have to do assessed assignments in the first and second semester modules on HIV/AIDS after the Human Resources Development module they follow three different modules than those who follow the general MPH-programme. Over the years, MPH participants evaluated the order and build-up of the curriculum most positively. The programme management made adjustments in case of suggestions and comments by students. An example is the MPH HIV specialisation that started in in reaction to evaluations by the students of the previous cohort. MIH Student can complete the full set of modules as a coherent programme in one year, but may also take the three sets of modules (core modules, advanced modules, thesis) over a period of five years. Their specific focus on any area within international may shift during these five years, but all modules deal with elements in international health. All core modules in the first term (some 14 weeks, 20 EC), are compulsory. As in the MPHprogramme, this set of core modules consists of a relevant mix of theory linked to practice and skills training is part of most modules. All core modules must be completed successfully before students may begin with advanced modules, although the audit team found that exemption of this rule is possible. Students are guided by the course coordinator in selecting their advanced modules according to their personal profile for MIH. The course coordinator oversees their choices to ensure that the complete set of modules is complementary and forms a logical entity, in line with the planned thesis subject, the specific future working environment of this particular student and his previous experience. Students can choose accredited modules from the troped network or appropriate modules from NVAO accredited Master s programmes. Students and graduates that the audit team interviewed were positive about the period of five years that the programme allows them in completing the programme (c.f. standard 2.4). Such a stretch of time offers them opportunities to combine work and study. But the audit team found that this may also lead to less contact between them and their fellow students, especially as these fellow students, or they themselves, may expect to do one or two advanced modules in another institute. With MPH-groups and their close contact and their mutual stimulus in full view, MIH-students, though mid career mature students, can at times feel rather, or even too much, on their own in deciding about their personalized curriculum. MIH, troped and multiple or joint degrees MIH students who receive an Erasmus Mundus scholarship as they follow an equal amount of study time at different troped-institutions, receive a degree from each of these institutes. Currently, the European master can only lead to multiple degrees. KIT/VU aims at awarding a joint degree in future, when Dutch legislation has been adapted (as is to be 24/61 NQA - VU/Royal Tropical Institute: audit existing hbo-masters Intern. Health/Public Health

25 expected in 2010). One of the conditions for KIT/VU awarding joint degrees in the new legislation will be that the institute which in this case will be VU, and thus the Academic Board and KIT are in control of the quality of the study components at the other institutes. The audit team found that through their involvement in all troped-matters KIT/VU is indeed closely involved in establishing whether the modules submitted for troped-accreditation comply with troped-standards. These standards are derived from quality assurance standards which originated at KIT. Both programmes In meetings of the Academic Board and of the two separate Boards of Studies (opleidingscommissies), specific attention is given to the order of the modules and any possible overlap. A number of changes have been made in the programme based on the conclusions of these meetings and based on information from evaluations, meeting of the External Advisory Committee and of the Examination Committee. E.g. since , presentations by the students are preceded by a session with a professional debater, which increases the quality of the presentations and debates. Considerations The audit team found that both programmes are consistent in their build up of knowledge and skills and of theory and practice. The structure that requires MPH-students to decide early in their studies on the topic of their thesis and of the approach to their thesis, may direct their choices in their assignments in their core modules and their advanced modules. For MIHstudents such a time frame is also possible, but not compulsory. Most of them work for their living and their choice for advanced modules and topics for their theses may be a few years in the future. For these students, completing the set of core modules is an end in itself and the combination of theory, practice and skills is a preparation for their immediate work in international health. The audit team discussed how the personalized curriculum in MIH may draw greatly on students study motivation. Although the audit team accepts that the MIHcurriculum is adequately equipped for both full time and part time completion of the programme, most students in the past five cohorts have taken more than the one-year period. The audit team considers that five years is indeed the maximum period over which the MIHmodules may be considered to lead to a coherent programme. The team finds that the long term for decisions about when, what, where and how to complete the advanced modules, the decisions about the subject of the thesis and how to work on the thesis, can negatively influence coherence in the programme, be it that these students make these decisions in contact with their study advisers. The audit team sees a connection here to a possible extra study load (c.f. standard 2.4), but feels that this element is more obviously connected to the questions of this standard 2.3. Conclusion These considerations lead to the audit team s assessment of good for MPH and satisfactory for MIH in standard 2.3. NQA - VU/Royal Tropical Institute: audit existing hbo-masters Intern. Health/Public Health 25/61