Wonca has launched a historic, new publication, Improving Health Systems: The Contribution Of Family Medicine - A Guidebook. The guidebook was produced in collaboration with WHO and represents many months of compilation and editing. The principal authors and contributors are listed below. You may obtain a copy or copies of the Guidebook from the Wonca Secretariat at the address below.

At the 1998 World Council meeting in Killarney, Ireland, Wonca identified as its top priority 'the development of family practice training and services in areas of greatest need, in the spirit of equity'. More specifically in the context of family medicine it aimed ' to establish a system whereby developed countries can assist underdeveloped countries with specific projects'.

The guidebook is an important foundation on which to build a Wonca programme of expert assistance. The ultimate goal is to maintain and improve the health and well being of individuals by helping to develop more productive, high quality, well coordinated and cost-effective approaches to health care.

Guidebook Project Team

Charles Boelen
Cindy Haq
Vincent Hunt
Marc Rivo
Ed Shahady

Many of the challenges facing health care are universal. To that extent it is possible to generalize about how healthcare systems should be structured to make them responsive to peoples needs. Based on that analysis, a vision of optimal services can be described. Not surprisingly our vision, as set out in the guidebook, is based on primary health care.

However the critical importance of balancing complementary viewpoints and conflicting priorities is recognized. This can be achieved by appealing to shared values and goals. The guidebook identifies some of these such as improving the health status of every individual, the health of the population, and the equitable distribution of services. United by these common values, partnerships of different stakeholders, and multi-professional, multidisciplinary teams can be formed to achieve change.

The guidebook recognizes the limitations of a 'one solution fits all' approach. It advocates flexible approaches that take account of the specific needs of individual countries, their particular cultural context and the resources available to them. It also recognizes that positive health outcomes are associated with accessible, comprehensive, coordinated, person-centred care. Scarce resources are often wasted on expensive technology and overuse of specialists. Balance between primary and secondary care workforce is crucial.

Having described the general framework of healthcare, the second half of the Guidebook is devoted to family medicine. This is not a narrow self-serving or partisan approach. It is a carefully documented description of the contribution that well trained and professionally supported family doctors can make - not just to primary health care, but to health services generally. As clinicians, health care coordinators, leaders, managers and supervisors they can respond flexibly and quickly to the needs of individuals and communities.

Wonca recognizes that many other disciplines and professions make important contributions to healthcare. The Guidebook focus is on family medicine not because we believe it to be the only solution to healthcare problems (although its value has been greatly undervalued in the past) but because that is our area of expertise.

Our contribution to healthcare can only realize its full potential if family doctors are appropriately educated and trained, and if the conditions under which they practice make it possible. This is not just a matter of resources. In many countries institutional barriers prevent the development of effective family medicine. In many cases their removal would involve no financial cost whatever.

The Guidebook sets out in detail the characteristics of good education and training for family doctors throughout their professional careers. It outlines strategies for teaching the teachers and retraining doctors wishing to become family doctors later in their careers. It describes how to establish a professional association, a certification program, family medicine departments and vocational (residency) programs, and how family doctors work most effectively in health systems.

Optimal family practice requires more than education. It needs services supported by research and quality improvement. It needs positive team relationships with colleagues and, where they exist, with nurses, pharmacists, and managers. It needs adequate reliable funding which provides reasonable patient access without distorting the normal pattern of practice.

The Guidebook includes a resource directory, an extensive bibliography, a limited number of key documents in full text and text boxes containing numerous actual examples of some of the issues raised drawn from all over the world.

To Obtain a Copy of the Guidebook

The Guidebook is available through the Wonca Secretariat at a cost of $10 (US) for Wonca members and $15 for nonmembers. Payment may be made by Visa or Mastercard. 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 INTERTNATIONAL 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, Administrative Manager, Wonca, College of Medicine Building, 16 College Road #01-02, Singapore 169854.

The publication of the Guidebook is only a beginning. The focus of our activity must now shift to the strategy for implementation. Member organizations, individually or in small consortia, will be encouraged to undertake specific projects in countries of greatest need. Some already have active programmes in place. These might be enhanced by collaboration with others. Other members have never engaged in international projects for lack of funds, expertise, or knowing where to start. The challenge for Wonca is to facilitate their involvement, to coordinate existing and new activity, to identify resources, and to make it happen.

Congratulations to the project team. The Guidebook is an important milestone. Now lets get on with implementation!

Dr. Michael Boland
President
Wonca