Health systems throughout the world are undergoing change, in many cases driven by new understanding of the importance of primary health care. In the UK, Primary Care Trusts have taken on purchasing of secondary care services, and in the USA health maintenance organisations purchase similarly. In New Zealand, Primary Health Organisations will use an integrated capitation model partially with purchasing of laboratory and pharmaceutical services as well as personal care.
But many countries in the developing world have poorly developed primary health care systems, resulting in poor access to care, and higher costs of service delivery. Frequently the contribution of family medicine is under-recognised, leading to under utilization and higher costs of medical care.
So it comes as no surprise that the World Organisation of Family Doctors (WONCA) and the World Health Organisation (WHO) have collaborated to publish a guidebook "Improving health systems: The contribution of family medicine". This guidebook shows how family medicine/general practice can help countries throughout the world maintain and improve their citizens health and well-being by developing more productive, co-ordinated and cost effective approaches to health care.
In broad terms the book considers the rationale for health care systems to be more responsive to the needs of people; the role that family medicine can play in such reformed systems, the challenges and barriers for family medicine; and the responses, and ways and means to strengthen family medicine.
The strength of this book is the fact that this is a collaborative effort between WONCA/WHO, drawing together the evidence for the contribution of family medicine towards the health communities and countries. The values of family medicine are seen as central to effective delivery of health care.
The complementarity of clinical and community health skills is noted, along with strategies to educate family doctors in community health, epidemiology, community organisation and health development strategies. Medical Schools are encouraged to express social accountability by directing their education, research, and service activities toward the priority health concerns of community, region or nation that they serve. Comprehensive patient care, communication skills, working with families, medical ethics, preventive medicine, management of prevalent conditions, community and population health, and leadership and management skills are all covered.
The role of postgraduate organisations in vocational training, alongside observations of the content of the family medicine curriculum is discussed. Sections also cover financing of primary care services, improving access to primary care, supporting primary care research, and enhancing quality of care and outcomes.
| The
WHO-Wonca Guidebook, Improving Health Systems: The Contribution of Family
Medicine, is available through the Wonca Secretariat by surface mail*
at a cost of $10 (US) for Wonca members and $15 for nonmembers and by air
mail* at a cost of $15 (US) for Wonca members and $20 for nonmembers. Payment
by Visa or Mastercard is preferred and quicker to process. Please forward
your credit card number, card expiration date and name on the credit card
by email to admin@wonca.com.sg or
by fax: +65 6324 2029 .
Alternatively, you may pay by bank draft or check drawn on a US bank made payable to "Wonca International Inc." for the appropriate US dollar amount. Please state the number of copies of the Guidebook you wish to purchase. Send your order and check payment to: Ms. Yvonne Chung, Wonca Administrative Manager, College of Medicine Building, 16 College Road #01-02, Singapore 169854. *Please note: depending on the destination, surface mail can take up to 2 months; air mail takes 7-10 days |
The one weakness of this book is that while it unashamedly advocates the role of family practice in international health systems, it fails to acknowledge the role of the practice nurse. I understand that this is not an oversight, but a felt lack of mandate to address the subject. Having said that, this book is an outstanding contribution towards drawing attention to the highly significant role that family practice can and will play in the development of health systems in the future. For those interested in the essential contribution that family practice can make in health reforms internationally, to provide better health care for patients and populations, this book is required reading. WONCA and WHO should be complimented for this outstanding publication.
Prof Gregor Coster
July 2002