In determining the design and structure of a socially accountable medical school, in terms of ethics, quality of health care delivery, and universal access to healthcare, we reviewed the bases of medical ethics, and what additions or refinements are needed to equitably deliver universal healthcare in the 21st century.Medical schools should meet three criteria, i.e. educating medical students in sufficient numbers to quality international standards to meet national requirements for health professionals, conducting research and being a community advocate for national and regional health and medical problems and ensuring curriculum meets these, and thirdly, providing via suitably educated graduates, health and medical care to all members of society based on ethical guidelines. Moreover, medical schools should not only consider the needs of the communities which they serve but also deliver their services based on socially and culturallyacceptable criteria.The main criteria to be achieved globally by the socially accountable medical school, is universal access to quality healthcare within nations and across nations. Evidence suggests that nowadays medical schools are finding it increasingly difficult to meet the changing needs of their communities due to a variety of factors, with health economics the main barrier. Therefore, a fundamental revision is required in schema of medical schools to make them more socially accountable. This also requires a similar commitment from the government, health stakeholders and the society generally, as there will be no socially accountable medical schools until there is a commitment to parity and equity of healthcare for all, from society and governments. In turn, a socially accountable medical school must seek to contain the costs of education and educate students on cost effective treatment and processes of care. A socially accountable medical school therefore provides its services based on cost-effectiveness, relevance, equity and high quality criteria.