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SUBMISSION TO WONCA
EXECUTIVE COMMITTEE - JANUARY 2000
WONCA RURAL: A
JEWEL IN THE WONCA CROWN
Table of Contents
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PART
A
INTRODUCTION
Since its inception in 1992, the WONCA Working Party on Rural Practice
has been one of the most active groups within WONCA. Pursuing its vision
of Health for All Rural People around the World, the Working Party has:
- Developed three
documents which have been endorsed as WONCA Policies on different aspects
of Rural Health and Rural Practice, as well as the Durban Declaration
on Health for All Rural People and the Kuching Statement on the Health
of Indigenous Peoples.Developed three documents which have been endorsed
as WONCA Policies on different aspects of Rural Health and Rural Practice,
as well as the Durban Declaration on Health for All Rural People and
the Kuching Statement on the Health of Indigenous Peoples.
- Initiated three
WONCA World Rural Health Conferences which have fostered the development
of world rural health movement.Initiated three WONCA World Rural Health
Conferences which have fostered the development of world rural health
movement.
- Facilitated development
of Pilot Projects for implementation in different countriesFacilitated
development of Pilot Projects for implementation in different countries
- Established the
WONCA Rural Information Technology Exchange (WRITE) as a specific Sub
Group focused on using information technology to improve rural health
care.
From the World Rural
Health Conferences it has become clear that despite the great differences
between developed and developing countries, the major issues of concern
in rural practice and rural health are the same around the world.Even
in developing countries, where most of the population is rural, the resources
are concentrated in the cities.In developed and developing countries,
there are transport and communication difficulties between rural communities
and the urban centres.It seems that in every country, doctors and other
health professionals cluster in the cities and there are major difficulties
in the recruitment and retention of rural practitioners. Another common
theme around the world is the tendency for city-based health service providers
and administrators to assume that second rate health services are sufficient
for rural areas. There is growing evidence that those doctors who are
in rural practice, if well supported, find it provides a challenging,
rewarding and satisfying career and lifestyle.
| This submission
proposes that WONCA Rural become a major component of the WONCA global
plan for the next decade. The submission has five sections including
two specific proposals regarding relations with the World Health Organisation
(WHO). WONCA Rural become a major component of the WONCA global plan
for the next decade. The submission has five sections including two
specific proposals regarding relations with the World Health Organisation
(WHO). |
The key points are
summarised here and outlined in more detail in Part B.
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Part
B
SECTION
1. WONCA Rural
A key feature of the Working Party on Rural Practice is that members are
active rural practitioners or have a close association with rural practice.
In expanding its size to a potential of twenty members, the Working Party
is seeking to ensure representation from each of the world's regions and
gender equity. The Working Party's mission of "Improving Rural Healthcare
Around the World" is to be addressed through achieving its key objectives
as outlined.
With such a large
Working Party, it has been agreed that a smaller Executive Committee of
up to seven members would act on the Working Party's behalf between full
Working Party meetings. WRITE, as a Sub Group of the Working Party functions
as a special interest group in rural information technology and has adopted
a similar structure to the Working Party on Rural Practice.
The Working Party
recommends that its role within WONCA be strengthened by WONCA adopting
"WONCA Rural" as a major thrust of the WONCA global plan. This
would be facilitated by adopting WONCA Rural logo and developing a specific
image for WONCA Rural which would be promoted through WONCA Rural publications,
a redeveloped WONCA Rural Website, the WONCA World Rural Health Conferences
and other activities at the international level.
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SECTION
2. International Conferences on Rural Health
Three WONCA World Rural Health Conferences have been very successful.Each
has drawn participants from up to thirty countries and focusing on major
issues in rural health and rural practice. Each Conference has been more
than an international meeting there has been a strong sense of camaraderie
and commitment to action following from the Conference. In addition, each
Conference has had a strategic impact in the host country.The first Conference
initiated WRITE and its subsequent Policy Statement; the second Conference
adopted the Durban Declaration on Health for all Rural People, as well
as Resolutions which form the basis of the WONCA Policy on Rural Practice
and Rural Health; and the third Conference adopted the Kuching Statement
on Health of Indigenous Peoples and an action framework of Emerging Issues
and Initiatives.
Future Conferences
are planned for Calgary in August 2000 and Melbourne in May 2002. An Expression
of Interest to hold the 2003 Conference in Santiago de Compostela, Spain
has been accepted by the Working Party and discussions have begun towards
holding the 2005 Conference in South America, possibly Argentina. It is
intended that the World Rural Health Conferences continue to encourage
participation by all those concerned with Rural Health and that they focus
on major issues of concern around the world.
In addition to the
stand-alone World Rural Health Conferences, the Working Party recommends
that there be a major WONCA Rural focus at each triennial WONCA World
Conference. This may take the form of a Rural Day as occurred at the Dublin
Conference. In addition, the Working Party recommends that WONCA Rural
be a featured of all WONCA Regional Conferences.
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SECTION
3. WONCA Rural Policy Documents and Statements
The Rural Policy documents endorsed by WONCA have had a substantial impact.
The Policy on Training for Rural Practice has been used for new initiatives
in rural practice training in a range of different countries and the Rural
Telehealth Policy has provided a framework for developing and implementing
telehealth in rural areas at the national and international levels. The
Durban Declaration has been supported by the World Health Organisation.
It is intended that the package of WONCA Rural Policy Documents and Statements
be widely circulated and disseminated in early 2000. This will be not
only through distribution of hard copies to international and national
organisations, but also through the World Wide Web and presentations to
relevant bodies by individual rural practitioners and rural doctor organisations.
Future Policy Statements
may address:
- Rural Health Research
- Quality in Rural
Healthcare
- Healthy Villages
- Sustainable Health
Services in Small Rural Communities
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SECTION
4. Pilot Projects
There have been developed
several pilot projects focussed on rural health services and rural practice
training. A key to implementing these pilot projects is suitable funding.
This issue was pursued through a visit to the World Bank in July 1999.
There is potential for a relationship between the World Bank and WONCA
focussed on issues of common interest. Attraction of World Bank funding
for rural pilot projects will require strong liaison between WONCA and
the national government of the country where the pilot project is to take
place.It is recommended that WONCA seeks to establish a strong relationship
with the World Bank, so as to facilitate WONCA Rural Pilot Projects in
different countries.
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SECTION
5. World Health Organisation
The Rural Health Initiative is a key component of the Memorandum of Understanding
(MoU) between WONCA and WHO signed in October 1998. This commits WONCA
and WHO to include the special needs of rural health in future plans and
to pursue development of distance education.
The World Health Organisation
has initiated the Towards Unity for Health (TUFH) Project which intends
to study and promote sustainable integration of medicine and public health.
Integration of health care occurs frequently in rural practice. As well
as knowing the health care needs of individual patients, rural doctors
must understand the needs of the community and its resources for health.
Through its MoU with
the WHO, WONCA has the opportunity to promote two specific proposals to
the World Health Organisation.These are outlined in Section 5 and summarised
below:
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5.1
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The first is
a proposal for the Monash University Centre for Rural Health in
Australia to become a WHO Collaborating Centre in Rural Health as
the focal point of an international network of centres and institutes
with special focus on and expertise in rural health and rural practice.
Constituent members of the network might include the Institute of
Rural Health (UK), the National Centre for Rural Health (New Zealand),
Southwestern Ontario Rural Medicine Education, Research and Development
Unit (SWORM - Canada), the WWAMI Rural Health Research Centre (USA)
and others in various stages of development around the world.
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| 5.2 |
The
second proposal in Section 5 is that WONCA and WHO convene and co-sponsor
an Invitational International Conference "Health for all Rural
People" to focus on the implementation of the WONCA-WHO Policies
and Initiatives for Rural Healthcare. Such an Invitational Conference
would bring together government representatives together with WONCA
and WHO representatives plus other rural associations and organisations.
The intention would be for the Invitational Conference to establish
a consensus for a global initiative in rural health with particular
emphasis on the contribution of rural general practitioners in collaboration
with others.There is the potential to link the WHO Collaborating Centre
in Rural Health proposal with the proposal to hold the WONCA-WHO Invitational
Conference on Rural Health Care possibly prior to the 5th World Rural
Health Conference in Australia. |
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RECOMMENDATIONS
As WONCA adopts a Global Plan for the first decade of the 21st Century,
there is a unique opportunity for WONCA to establish a lead role in Rural
Health on the world stage.
The WONCA Working
Party on Rural Practice recommends to WONCA Executive Committee that:
| 1. |
WONCA
Rural become a major component of the WONCA Global Plan. |
| 2.1 |
WONCA
Rural to be a key theme in triennial WONCA World Conferences and WONCA
Regional Conferences. |
| 2.2 |
WONCA
Rural WONCA Rural Health Conferences continue each year between WONCA
World Conferences with emphasis on participation by all those concerned
with rural health particularly from developing countries. |
| 3 |
WONCA
Rural Policy Documents and Statements continue to be developed by
the Working Party on Rural Practice for world wide dissemination and
implementation. |
| 4. |
WONCA
Rural WONCA Rural Pilot Projects be facilitated through WONCA developing
a strong working relationship with the World Bank |
| 5.1 |
WONCA
endorse the proposal that the Monash University Centre for Rural Health
become a WHO Collaborating Centre in Rural Health as the focal point
of an international network of centres and institutes with special
focus on and expertise in rural health and rural practice. WONCA endorse
the proposal that the Monash University Centre for Rural Health become
a WHO Collaborating Centre in Rural Health as the focal point of an
international network of centres and institutes with special focus
on and expertise in rural health and rural practice. |
| 5.2 |
WONCA
and WHO Convene and co-sponsor an Invitational Conference "Health
for All Rural People" to focus on developing a WONCA WHO global
initiative in rural health with particular emphasis on the contribution
of rural general practitioners. WONCA and WHO Convene and co-sponsor
an Invitational Conference "Health for All Rural People"
to focus on developing a WONCA WHO global initiative in rural health
with particular emphasis on the contribution of rural general practitioners. |
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Part
C
WONCA World Executive
Committee response to the Rural Health Working Group Submission
ISSUE
Are we doing enough in rural health?
Are there other forums
to address rural health?
RESOURCES FOR DISCUSSION
Submission by the Working Party on Rural Practice
DISCUSSION
The recommendations of the Working Party were used as a basis for discussion.
Modifications were made to the recommendations. As rural areas in many
countries are generally areas of greatest need, Executive considered that
the proposal from the Working Party fitted into WONCA's goal 1: ‘Develop
family practice training and services in areas of greatest need, in the
spirit of equity.’ and objective 1.1: ‘In the context of family
medicine, to establish a system whereby developed countries can assist
underdeveloped countries with specific projects.’
CONCLUSION
The recommendations of the Working Party were accepted with modification.
In the submission
of the Working Party on Rural Practice, ‘WONCA Rural’ was interpreted
as meaning Rural Practice.
Resolution E.2000.7
WONCA Executive Committee resolved that:
1. Rural Practice
become a component of the WONCA Goal 1.
2.1 Rural Practice
be a significant component in triennial WONCA World Conferences and WONCA
Regional Conferences.
2. 2 WONCA Rural Health
Conferences continue each year between WONCA World Conferences with emphasis
on participation by all those concerned with rural health, particularly
from developing countries.
3. WONCA Rural Policy
Documents and Statements continue to be developed by the Working Party
on Rural Practice for endorsement by Executive for worldwide dissemination,
implementation and evaluation.
4. WONCA Rural Practice
Pilot Projects be facilitated through WONCA developing a strong working
relationship with the World Bank and other granting bodies.
5.1 WONCA endorse
the proposal that the Monash University Centre for Rural Health become
a WHO Collaborating Centre in Rural Health as the focal point of an international
network of centres and institutes with special focus on, and expertise
in rural health and rural practice.
5.2 Subject to a specific
proposal for Executive to consider, WONCA and WHO convene and co-sponsor
an Invitational Conference "Health for All Rural People" to
focus on developing a WONCA WHO global initiative in rural health with
particular emphasis on the contribution of rural general practitioners.
ACTION
Implement the above proposals – Working Party on Rural Practice.
Concern was voiced
about the potential for a clash between the dates of WONCA World and Regional
Conferences and World Rural Health Conferences.
Executive requests
the Working Party on Rural Practice to consult with Executive and the
relevant Regional Vice President about the proposed dates of World Rural
Health Conferences.
Executive felt that
it would like to have a report on the implementation of recommendations
of existing documents prepared by the Working Party before it produced
further documents.
Action:
CEO
Professor
Wes Fabb
Chief Executive Officer
World Organization of Family Doctors - WONCA
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