From the Wonca President:
Lessons from the Americas
2
3
From the CEO’s Desk
:
Wonca’s Stimulating Regional Conferences
From the Editor
:
A New Resource for Global Family
5
Medicine Development
FEATURE STORIES
5
•Implementing the Family Group Practice Model in Mongolia
•The Past, Present and Future of Family Medicine in Uganda
•Wonca Launches its Global Resource Directory
Wonca REGIONAL NEWS
11
•More than 2,000 Attend the 11th Annual
Wonca European Regional Conference
HEALTH AND HEALTH SYSTEM NEWS
13
•WHO Issues Progress Report on Health and Millennium
Development Goals
•The Role of Physician Assistants in the Health Care System
MEMBER AND ORGANIZATIONAL NEWS
15
•Family Medicine in Russia: Letter to the Editor
•Damilya Nugmanova: Wonca Global Family Doctor for August 2005
•Alan Pugh: Wonca Global Family Doctor for September 2005
RESOURCES FOR THE FAMILY DOCTOR
17
•Fellowships Available to Attend 13th World Conference on
Tobacco or Health
•Improving Health Systems: The Contribution of Family Medicine
WONCA CONFERENCES 2005-2010 AT A GLANCE
19
GLOBAL MEETINGS FOR THE FAMILY DOCTOR
20
VOLUME 31
NUMBER 4
OCTOBER 2005
CONTENTS
Wonca website:
http://www.GlobalFamilyDoctor.com
Wonca President
Prof Bruce Sparks, South Africa
2 Cruden Bay Road
Greenside
Johannesburg 2193
South Africa
Tel: 27 11 646 2140
Fax: 27 11 717 2558
Email: brucespa@global.co.za
Wonca Chief Executive Officer
Dr Alfred W T Loh
Wonca Administrative Manager
Ms Yvonne Chung
World Organization of Family Doctors
College of Medicine Building
16 College Road # 01-02
Singapore 169854
Tel: 65 6224 2886
Fax: 65 6324 2029
Email: admin@wonca.com.sg
Wonca President-Elect
Prof Chris van Weel, Netherlands
Wonca Immediate Past President
Dr Michael Boland, Ireland
Honorary Treasurer
Richard Roberts, MD, USA
Wonca Regional Presidents
Dr Abra T Fransch, Africa
Warren A Heffron, MD, Americas
A/Prof Goh Lee Gan, Asia Pacific
Prof Igor Svab, Europe
Dr Shatendra K Gupta, Middle East
South Asia
Dr Adolfo Rubinstein,
Iberoamericana-CIMF
Wonca Executive Members at Large
Dr Javier Dominguez del Olmo, Mexico
Prof Michael Kidd, Australia
Richard Roberts, MD, USA
Chair, Bylaws and Regulations
Dan Ostergaard, MD, USA
Chair, Publications & Communications
Dr Geoffrey D Martin, Australia
Editor, Wonca News and Editorial Office
Marc L Rivo, MD
4566 Prairie Avenue
Miami Beach, Florida 33140, USA
Tel: 305 671 7327
Fax: 305 674 8839
Email: marcrivo@aol.com
WONCA GLOBAL SPONSORS
FROM THE WONCA PRESIDENT:
LESSONS FROM THE AMERICAS
“The cultivated general practitioner ...... you cannot
reach any better position in a community; the family
doctor is the man behind the gun, who does our
effective work. That his life is hard and exacting; that
he is underpaid and overworked; that he has but little
time for study and less for recreation-these are the
blows that may give finer temper to his steel, and bring
out the nobler elements in his character.”
Sir William Osler (1849-1919)
In my fortunate role within Wonca, I am continually
struck by the remarkable work being done by family
doctors around the world. I have just returned from a
visit to The USA and Chile where the role of family
physicians in health systems and the care of people was
once more emphasised.
In San Francisco, I had the opportunity of again
attending the Congress of Delegates of the American
Academy of Family Physicians, which precedes their
annual Scientific Meeting. The nation was still shaking
its head from the devastation and human suffering
experienced in the wake of hurricanes Katrina and Rita.
I, like many others around the world had been saturated
and even ‘immunised’ by the plethora of news reports
on the disasters, but only when I was able to listen to
the stories of those ‘who had been there’ did I
appreciate the impact of these events.
Repeatedly within the congress of delegates and the
smaller reference committees, I heard impressive stories
and impassioned testimonies of how family doctors
from private practice and academic units across the
nation, were among the first to respond to the disaster.
Under extremely difficult circumstances, they set up
makeshift clinics, emergency medical services, crisis
management and counselling units, immunisation
centres, and hygiene and health counselling services.
There was praise from many quarters for the magnificent
service of these doctors, who as generalists were able
to function in situations where specialist teams were
often impotent to act. Realising the essential role of
family physicians in such situations the Academy
resolved to support the recruitment and involvement of
family physicians in Disaster Medical Assistance Teams
(DMATS) and other disaster related training
programmes, and to ensure the development of cadres
of doctors for what was coined “Family Physicians as
First Responders”.
WONCA
News
FROM THE WONCA PRESIDENT
2
This initiative is something which I believe Wonca
should consider, and I have had exploratory discussions
with some of those in the field regarding possible
training programmes for countries with less
sophisticated services. At times of disaster we are often
contacted by doctors globally who would like to assist
meaningfully, not only during the initial event but also
in post-disaster rehabilitation and management.
Incidentally, a dilemma that was addressed by the
delegates to the meeting is one, which frequently
occupies discussions globally in Colleges and
Academies. There is division on whether to encourage
family doctors to obtain post-residency fellowships or
qualifications (called Certificates of Added Qualification
(CAQs)) in focused areas of practice such as trauma,
endoscopy, allergy, sports medicine, and cardiac or
respiratory care). The proponents argue that such CAQs
would discourage young doctors from pursuing
specialist training and so enrich our discipline and its
scope, while the detractors felt that such multiple
‘diplomatosis’ could fragment the uniqueness of the
generalist discipline. No consensus was reached at this
point!
My experience in Santiago, Chile was equally
illustrative of the fundamental role of family doctors in
health care systems. To set up a meeting with my
Minister of Health could be a major undertaking, but
imagine the gargantuan task of requesting the Ministers
of Health and staff of eighteen Iberoamerican countries
to travel to a foreign country, to attend a meeting to
discuss Family Medicine, and expect them to attend for
the full two days! I was totally overwhelmed by the
attendance and public support by Ministries of Health at
the Second Iberoamerican Summit of Family Medicine
entitled, “Family Medicine: Quality and Equity in Health
Systems in Iberoamericana”. This meeting was
organised by the South American region of Wonca
known as Wonca Iberoamericana-CIMF, together with
Chilean Society of Family Medicine, the Chilean Health
Ministry, and PAHO, (the regional organisation of WHO).
Wow! What a successful get-together in the shadow
of the glazier-clad Andes! What was so encouraging
was the obvious and encouraging support for Wonca
and for the development of Family Medicine within the
region. The goal of the meeting was to improve health
care of the peoples of the Iberoamerican Region by
incorporation of family doctors, as essential elements of
health systems, to deliver personalised, integrated,
comprehensive, equitable, and continuous care to
individuals, families and communities. There was also
an initiative to develop collaboration between
governments, universities, and related institutions to
WONCA
News
FROM THE WONCA PRESIDENT / FROM THE CEO’S DESK
3
FROM THE CEO’S DESK:
WONCA’S STIMULATING REGIONAL CONFERENCES
The growth of Wonca as a global organization from 78 member
organizations in the last triennium ( 2002 - 2004 ) to the current 105 is
most evident in the four exciting and well attended Wonca Regional
Conferences held in different venues around the world during the past five
months.
These were :
1.The Asia-Pacific Regional Conference in May in Kyoto, Japan.
2.The Wonca Europe Regional Conference in September in Kos Island,
Greece.
3.The Iberoamericana-CIMF Regional Conference in early October in
Santiago, Chile.
4.The Middle-East South Asia Regional Conference in mid October in
Colombo, Sri Lanka.
The Asia-Pacific Regional Conference in Kyoto, Japan
This was the largest ever regional conference for the Asia-Pacific Region
with over 2300 registrants. These consisted of a large number of local
registrants from the Japanese Academy of Primary Care Physicians and also
a larger than usual number of overseas delegates from 50 countries as far
as Europe and the Americas.
The Conference was graced by the presence of Their Imperial Highnesses
Prince and Princess Akishino of Japan at the Official Opening of the
Conference, a significant development for Family Medicine in Japan.
The Conference was also the venue for Wonca to announce to its
members the release of the International Primary Airways Group (IPAG)
Handbook with members of the international press attending the press
release and during which all conference delegates at the event were given
free copies of the Handbook. A lunchtime satellite symposium on COPD was
held in conjunction with the launch of the IPAG Handbook. The symposium
organised by Wonca World in conjunction with the HOC was very well
attended by over 450 delegates.
The Regional Council Meeting of the Asia-Pacific Region as well as a
meeting of the Wonca International Classification Committee took place a
day before the Conference to take advantage of the presence of
representatives from the various Wonca Member Organizations in the
Region. A full Wonca Executive Meeting was also held three days prior to the
Conference date and some Members of Executive were able to stay on after
the meeting to represent Wonca at the various official functions of the
Conference. An invitational post conference workshop was also held for
delegates from the Asia-Pacific Region.
train, integrate and support family
doctors in these health systems. The
Ministers and their staff attended all
sessions and workshops!
Dr Barbara Starfield presented
excellent international data on the
effectiveness of family doctors and
primary health care in health care
systems, all of which fell on very
receptive ears. Most speakers also
stressed the need for documented
research in the region to assist the
process. A major catalyst for the
initiative was the tangible and
overwhelming support of PAHO, but
the success of the meeting is largely
due to the remarkable facilitative
roles played by the Regional Wonca
President, Dr Adolfo Rubinstein and
Dr Oscar Fernandes Fuentealba, the
Congress Chairman. Of course, the
two days would not have been the
major networking opportunity that it
was, without the hospitable Chilean
festivities, entertainment, ‘Pisco-
sour’ cocktails and music!
It was a privilege to observe
family doctors making real
differences to the health of nations!
Bruce Sparks, M.D.
President
World Organization of Family
Doctors
WONCA
News
FROM THE CEO’S DESK
The Wonca Europe
Regional Conference in
Kos Island, Greece
This regional conference was the
largest in terms of registration for a
Wonca Europe Regional Conference
as over 2400 registrations were
received. But difficulties in obtaining
air connections between Athens and
Kos Island led to over 200
registrants having to cancel their
participation. The climax of the
Conference was the pageant and
Hippocratic Oath taking during the
closing ceremony held at the
Asclepion, the site where
Hippocrates practiced and taught his
pupils in ancient Greece.
The Regional Council for Wonca
Europe was held a day earlier and
the meeting was also attended by
the President-Elect of Wonca and
the CEO. Extensive discussions took
place during this meeting on
sponsorships by pharmaceutical and
non-pharmaceutical companies in
support of the global mission of
Wonca.
Two evening satellite symposia,
organized by Wonca World in
conjunction with the HOC were held
on the subject of Asthma and COPD
on different days. At the end of the
symposia, the two Wonca Global
Sponsors (ALTANA Pharma and
Boehringer Ingelheim) which were
also sponsors for the satellite
symposia, were each given a
certificate and a crystal momento for
their support for Wonca’s global
mission.
The Iberoamericana-CIMF
Regional Conference in
Santiago, Chile
This was the Second Regional
Conference for this new and
dynamic Region of Wonca. Held in
the beautiful city of Santiago, Chile
4
over three days, the Conference was
special in the very visible support
given to Family Medicine by the
various governments of the Region.
The Ministers of Health of Ecuador,
Paraguay and Chile were present at
various times during the conference.
The Conference had over 400
registrants with delegates coming
from all countries of the
Iberoamericana-CIMF Region,
including Cuba. Discussions were
held between the delegates from
Cuba, the Regional President and
the Wonca CEO on the possibility of
Cuba joining Wonca.
The support shown by Wonca
World was equally significant. The
Wonca World President, the
President Elect, the Regional
President and Wonca CEO were all
present throughout the Conference.
The World President and President-
Elect also took active part in the
conference programme as plenary
speakers and session chairs.
Simultaneous translation from
Spanish to English and vice versa
for certain parts of the programme
were offered as a courtesy to the
small group of English speaking
delegates, mainly from Wonca
World. This was highly appreciated.
Following this Regional
Conference, the Scientific Society of
Family and General Medicine of
Chile held their Annual Scientific
Congress which had over 650
registrants. The opening ceremony
for this national congress was
attended by the Wonca President-
Elect and CEO.
The Middle-East South
Asia Regional Conference
in Colombo, Sri Lanka
This was the second MESA
Regional Conference to be hosted
by the Sri Lanka College of General
Practitioners. About 300 registrants
attended from the various member
countries of MESA and as far as
England, Australia and New Zealand.
The scientific papers presented
included some from medical school
undergraduates, which were of a
very high standard. In addition,
teaching staff from the various
medical colleges in the country
attended.
World Wonca was represented by
the Regional President and the CEO.
At the Opening Ceremony, the CEO
presented a cheque of US $24,000
(equivalent to 2.4 million Sri Lanka
Rupees ) to the Sri Lanka College on
behalf of the University of
Nehmegen and the Dutch College in
aid of the Tsunami Relief Fund. This
fund was set up by the Sri Lanka
College to help rebuild the lives of
those affected by the disaster.
A large contingent from India
attended the Conference.
Discussions were held between the
Regional President, the CEO and
these delegates on how best to
have India’s family doctors and its
organizations more involved in
Wonca.
I must add that it is important
that Wonca Regions hold regional
conferences annually if possible
except in the year of a Wonca World
Conference. These events allow for
better networking between member
organizations in the region and
globally. The Wonca Regional
Conferences are also very useful in
identifying common agendas that
member organizations may work
towards for their mutual benefit.
Dr Alfred Loh
Chief Executive Officer
World Organization of Family
Doctors
WONCA
News
FROM THE EDITOR / FEATURE STORIES
5
FROM THE EDITOR:
A NEW RESOURCE FOR
GLOBAL FAMILY MEDICINE
DEVELOPMENT
Since the World Organization of
Family Doctors was established in
1972, Wonca has promoted family
medicine development as a key
health system strategy to meet
people’s health needs. Over the past
three decades, dedicated family
doctors from established Wonca
member organizations have
contributed their knowledge,
expertise and time to spread
general practice/family medicine
globally.
Wonca has served as an
invaluable resource for family
doctors to share their experiences
and help one another. The growth
and development of Wonca’s
Regions, member organizations,
working groups and their products -
- - reports, conferences, networking
opportunities - - - have improved
our ability to make a meaningful
impact on people’s health
throughout the world.
This issue of Wonca News
reports on the successful 11
th
Wonca
Europe Regional Conference held on
the Island of Kos, Greece. Wonca
Region Europe has been a model for
how member organizations and their
leaders can come together and help
each other promote family medicine
development throughout their
region and around the world.
This issue of Wonca News
features important and interesting
news on family medicine
development in Mongolia, Uganda
and Russia, very different countries
politically, economically and socially,
yet all seeking to reform their health
systems to improve access, quality,
equity and affordability for their
citizens.
In addition, this issue of Wonca
News reports on our new Global
Resource Directory (GRD) for family
medicine development that has
been established on Global Family
Doctor – Wonca Online at
www.GlobalFamilyDoctor.com. The
Global Resource Directory contains
additional reports and information
on family medicine in Mongolia,
Uganda and Russia that may be of
interest to our Wonca members.
Our new Wonca Global Resource
Directory will help us archive and
share in an organized, accessible
and user friendly manner valuable
information on family medicine
development around the world. As
importantly, it was enable family
doctors to identify and network with
others around family medicine
development in a particular country.
Please check this out!
Please send me your articles,
photos and additional background
information on family medicine
development around the globe that
you would like to publish in Wonca
News. All the information you wish
to share with your fellow family
doctors will be saved and made
available through our online Global
Resource Directory.
Marc L. Rivo, M.D, M.P.H.
Editor, Wonca News
marcrivo@aol.com
4566 Prairie Avenue
Miami Beach, FL 33140 USA
1-305-674-8839 (fax)
FEATURE STORIES
IMPLEMENTING THE
FAMILY GROUP PRACTICE
MODEL IN MONGOLIA
Like other countries influenced
by the Soviet model of health care,
the pre 1990 Mongolian health
system was centrally planned,
dominated by hospitals with no
tradition of general practice, and
exclusive of community involvement
or participation. Since the 1990-93
transition to a market economy,
health reform is now firmly on the
Mongolia agenda through the Health
Sector Development Program
(HSDP), an initiative funded from
Asian Development Bank loans. The
major reform element in Mongolia is
the Family Group Practice (FGP)
model aimed at developing General
Practice.
Under the old Mongolian system,
General Practice was unknown.
Public health doctors focusing on
prevention worked alongside
specialists in polyclinics attached to
hospitals. The reform program
provided the opportunity and
resources to develop a General
Practice focus. The program had
several key elements.
First, doctors from hospitals were
moved to practices in the
community, particularly poorer areas
(often with no water or electricity
supplies). Second, the population
was encouraged to register with a
Family Doctor of their choice – thus
strengthening the patient role. Third,
the payment status of the new
Family Doctors was changed from
state employees to private
practitioners paid under capitation
arrangements for patients in their
care.
The FGP program started in mid
1999 and currently, 234 FGPs have
WONCA
News
FEATURE STORIES
6
been established throughout
Mongolia: 118 in the capital,
Ulaanbaatar, and 116 in the
population centres in the aimags
(provinces). Over 56% of the
population is covered by the 234
FGPs (1.3 million people), which
include 940 Family Doctors and
almost the same number of staff
(mainly family nurses, assistants,
caretakers, etc). On average, one
doctor serves 1350 individuals
(similar to Australia and Europe).
Mongolian Family Doctors
A Mongolian FGP clinic
Mongolian doctors and nurses undergoing
training
Certain factors were critical in
establishing the FGPs. First, public
health doctors and interested
specialists were recruited to
comprise the pool of new Family
Doctors forming themselves into
FGPs (ranging from 3-5 doctors in
each practice). Potential FGP bases
were mapped out according to
target populations and doctors
selected their particular area.
Next, through an information and
education campaign, the population
registered with FGPs. To assist in
selection, individual doctor details
were circulated widely. Under a
capitation arrangement, doctors
were paid for each patient
registered. Capitation payments
were initially weighted according to
needs categories and risk adjusted
by age-sex and poverty ratings.
Subsequently, this was simplified
to Poor:Non-Poor (with significantly
higher rates for Non-Poor), and
applied selectively to urban and
rural areas and to poor areas within
cities to reflect the higher need for
services.
The next factor was a program of
training and retraining. Training took
the form of an introduction to
primary care principles; UK and
Australian type general practice;
practice management; and finance
and accounting. Re-training was
intended to refocus on General
Practice based on a series of clinical
modules emphasizing patient
centered approaches; management
of common conditions; holistic care;
and communication. Each FGP was
given an extensive package of
equipment, purchased under the
program, comprising basic items
such as stethoscopes,
ophthalmoscopes, suture sets,
sterilizers, folding table,
gynaecological chairs, lamps etc.
Each package contained over 100
items of
equipment. New
equipment was seen as an
important factor in demonstrating to
the public that the new FGPs were
professional and competent.
The final factor was establishing
a contract between FGPs and local
government for the provision of
services and as the basis of
payment. The Contract specified
targets and performance including
extended working hours; regular
home visits; health education and
prevention activities; ongoing
education; and targets for
immunization and vaccination. The
Contract sets out the payment rate
(based on aggregrated capitated
amounts for patients registered) and
frequency of payment (quarterly).
The lump sum payment covers all
FGP costs – salaries; rent; heating,
electricity etc.
For Mongolia, capitation is the
most appropriate payment system
to support overall reforms. Risk
adjustment means higher payments
for poorer areas and encourages
doctors to work there, thus
increasing access and equity. No
direct patient payment and universal
coverage encourages use of FGPs as
alternatives to hospitals and assists
in transferring resources from
hospitals to primary care. As more
people use FGPs, there will be a
corresponding reduction in hospital
use and resources can be redirected
to reinforcing General Practice.
Capitation also encourages
quality improvement and client
focus. In Mongolia, money follows
the patient. If patients register with
a doctor in another FGP, capitation
payments go from one practice to
the other. Thus, by voting with their
feet, patients drive improvements in
standards. Patients under this
market approach tend towards the
“better” doctors (as understood by
clients) – those who explain
treatments; provide comfortable
premises; emphasise courtesy; carry
out home visits etc. Capitation is
therefore an incentive for doctors to
focus on patients and quality
improvement.
7
WONCA
News
FEATURE STORIES
From 2000, FGPs extended from pilot areas to cover
all urban districts and population centres. Recent
survey evaluations indicate strong consumer
satisfaction with FGPs.
Family Doctors surveyed responded positively to the
new system. Family Doctors valued the autonomy and
increased clinical scope. Previously, their focus had
been narrowly preventive; now treatment and holistic
care are central aspects. The model has also increased
Family Doctors’ status, reinforced by ongoing
information campaigns.
FGP workload has also changed since the start
of the model with increases in clinic and home
visits, pointing to greater utilization of services.
Comparing a 2003 survey with a 1999 pre-model
baseline shows how practices and workloads have
changed.
•Excessive administrative work with numerous
government forms and statistics. This takes time
away from patient centered work. The aim is to
reduce paperwork by eliminating most forms and
developing a Minimum Data Set.
Mongolia’s relative success to date in establishing a
General Practice system provides valuable lessons for
former Soviet influenced systems in Central Asia
attempting to develop primary care. First, by putting
General Practice at the centre of the reforms, Mongolia
has been able to advance health sector change overall
by coalescing all the necessary elements into an
integrated package.
Second, earmarked funding was used to cover
training, equipment, acquisition of premises and
comprehensive implementation of the FGP program,
Table 1: Changes in FGP activities 1999 - 2003
FGP variables
1999 survey
2003 survey
Patients registered per doctor
790
1580
Clinic visits per day
18.8 (10.1 Poor: 8.7 Non-Poor)41.5 (23.4 Poor: 18.1 Non-Poor)
Home visits per day
9 (5 Poor: 4 Non-Poor)
21.5 (12.5 Poor: 9 Non-Poor)
Referrals per week
9
12
Patient education activities
50% of surveyed practices
100% of surveyed practices
Quality improvement activities
45% of surveyed practices
100% of surveyed practices
Continuing Medical Education activities
< 10% of surveyed practices
100% of surveyed practices
Source: FGP Surveys 1999 and 2003.
Generally positive results notwithstanding, problems
still exist in implementing the FGP model. Major current
concerns include:
•Delays in training. Mongolian logistics make
decentralized training difficult and the Training
Program has slowed in some areas. One solution is
to establish new groups of trainers to fast track
training
•Lack of clarity around the FGP legal and tax status
sometimes leading to problems with tax agencies.
Many now recognize the need to strengthen the FGP
legal basis and various regulatory amendments are
underway.
•Local authorities using the Contract to “control”
FGPs. To redress this, an information package for
local officials has been developed to help to change
attitude towards FGPs.
from pilot phase to nationwide extension.
Finally, health restructuring and development of
primary care has received continued and broad ranging
bipartisan support across the political spectrum for the
reform process.
The Government remains committed to primary
health care, but ongoing financial support will be an
ongoing strategic issue for Mongolia. The future
emphasis also needs to be on quality and continuous
improvement. Continuing education for Family Doctors is
now a condition of licensing and all doctors must show
commitment to ongoing development. Another
important objective for Mongolian Family Doctors is to
enhance their position as the community’s first point of
contact with the health care system.
Important organizations for advancing General
Practice are the Mongolian Association of Family
Doctors, aimed at supporting FGP education and the
WONCA
News
FEATURE STORIES
8
Mongolian Family Clinics Trust,
aimed at advocating for government
support. Another important element
in developing Mongolian FGPs is
contact with organisations like
WONCA, and Mongolia is actively
seeking international linkages to
increase capacity and quality in
Family Medicine.
Michael O’Rourke, MPH
Adjunct Senior Lecturer at the
School of Public Health,
University of Sydney, Australia
morourke@tpg.com
Dr Sodov Sonin
Executive Director, Health Sector
Development Program,
Ministry of Health, Mongolia
ssonin@magicnet.mn
Dr Bunijav Orgil
President of the Mongolian
Association of Family Doctors
bolort@yahoo.com
Takako Yasukawa
Social Sectors Specialist with Asian
Development Bank (ADB), Manila,
Philippines
tyasukawa@adb.org
Dr Jacques Jeugmans
Asian Development Bank Consultant
to the Health Sector Development
Program
jjeugmans@adb.org
Professor Galsan Dashzeveg
Health Sector Development Program
Consultant and Board Member of
the Mongolian Association of Family
Doctors
hsdp2@magicnet.mn
(Editor’s note: Additional
information on Family Medicine in
Mongolia is available in Wonca’s
Global Resource Directory at
www.GlobalFamilyDoctor.com via the
Global Family Doctor homepage:
Left Menu Quick Links > Global
Directory, or Top Menu > Education >
Global Resource Directory. See the
Global Resource Directory article in
this issue for further details)
The Past, Present and
Future of Family Medicine
in Uganda
The Government of Uganda aims
“to ensure that all the people of
Uganda attain a good standard of
health.” While Uganda has made
tremendous progress in reducing the
prevalence of HIV/AIDS and
improving immunization rates,
thousands continue to suffer from
preventable diseases and premature
mortality.
The target of health for all
remains distant in the context of
extensive poverty, illiteracy, a high
burden of infectious diseases, and
scarce health resources. Ugandan
health outcomes stagnated and
even worsened for some conditions
during the 1990s. Recent data from
the Ministry of Health (MoH) reflect
an infant mortality rate of 88/1,000,
an under 5 mortality rate of 152/
1,000, maternal morality rate of 505/
100,000, population growth rate of
3.4%, and average life expectancy
of 43 years. Over 38% of children
suffer from chronic malnutrition.
More than 60% of life years lost due
to premature deaths are attributable
to ten preventable diseases:
perinatal and maternal conditions
(20.4%); malaria (15.4%); acute
lower respiratory tract conditions
(10.5%); HIV/AIDS (9.1%); and
diarrhea (8.4%). Uganda is also
experiencing the epidemiologic
transition as chronic diseases,
cancers, alcohol abuse, mental
disorders and trauma rates are
increasing.
.
.
The Uganda National Health
Sector Strategic Plan (HSSP)
provides a strong framework from
which to improve health care
services. The HSSP seeks to provide
primary health care (PHC) services
to all through the Uganda National
Minimum Health Care Package
(UNMHCP). The minimum package
includes maternal and child health
services, control of communicable
and non-communicable diseases,
health promotion, disease
prevention and community health
initiatives.
Ugandan health services have
been decentralized to promote local
autonomy and accountability. The
country is divided into more than 50
districts; each district is divided into
subdistricts (counties) and villages.
Each district is served by at least
one general hospital that serves a
population of roughly 500,000
people; each subdistrict contains a
Health Centre Level IV that serves a
population of about 100,000 people.
Unfortunately financial and
human resources are seriously
inadequate for providing the
UNMHCP. The cost of providing the
UNMHCP is estimated at $28 per
person per year, yet the Government
of Uganda has only $12 to invest.
Limited financial resources result in
shortages of most facilities, basic
supplies, drugs and equipment.
Additionally many families spend a
large proportion of their limited
financial resources on out of pocket
expenses for health care.
Drs. Sam Luboga (Associate Dean), Anne Atai
Omoruto (Acting Head), Cindy Haq (Honorary
Lecturer), Ralph Kolbe (Honorary Lecturer),
and Nelson Sewankambo (Dean-Makerere
College of Health Sciences)
Family and Community Medicine Senior
House Officers and Students, Makerere
Drs. Ralph Kolbe, Andrew Mwanika and
George Welishe, national meeting on the
Future of Family Medicine in Uganda,
Kampala, June, 2005
Though financial resources are
necessary, they are not sufficient to
ensure access to high quality health
services. People are the most critical
elements of health systems; they
deliver health services and are
essential for strategic management
of scarce health resources. A short-
age of skilled health workers is the
most critical limiting factor in
providing health services in Uganda.
Uganda has a very low density of
skilled health professionals, the
majority of whom are employed in
the public health sector. In 2003
the Ministry of Health (MoH)
employed 2,074 doctors and 9,510
nurses and midwives for a
population of more than 25 million.
The doctor to population ratio is
1:12,500 at best and as low as
1:50,000 in some parts of the
country. Additionally most health
professionals are concentrated in
urban centers while 88% of
Uganda’s population is rural.
Family physicians’ broad scope of
practice makes them ideally suited
to deliver the UNMHCP. They are
prepared to provide maternal and
child health services, manage
infectious and chronic diseases, and
provide preventive health services
for adults and children. They are
trained to work at the community
level, to serve as the first point of
contact, manage emergencies,
ensure adequate referral to
specialists, and to provide
comprehensive follow-up after
hospital care. Well-trained family
physicians can also teach other
health workers and may thus greatly
enhance the quality and scope of
PHC services.
The MoH is working with
districts, universities and training
centres to increase the numbers and
deployment of competently trained,
broad-based health professionals.
Comprehensive health nurses are
being trained to provide general and
surgical nursing care, midwifery
skills, mental health counseling,
teaching and management. Yet
training and deployment of
sufficient numbers of
comprehensively trained family
physicians has been very slow.
Most physicians in East Africa are
general doctors who have not
completed postgraduate specialty
training. While many of these
physicians provide excellent health
services, most have not mastered
the wide scope of practice needed
to ensure comprehensive, high
quality health care to communities
in East Africa.
Postgraduate training of family
physicians began at Makerere
University in 1989 (the specialty was
formerly called community practice);
a similar programme began at
Mbarara University in 1997. Training
began at the Aga Khan University in
Tanzania in 2004 and at Moi
University in Kenya in 2005. The
Ugandan training programmes have
produced only 24 graduates to date;
the Kenyan and Tanzanian
programmes have yet to produce
graduates.
Given the great needs for family
physicians in Uganda and East Africa
why have so few been trained and
employed? A national dialogue on
‘The Future of Family Medicine in
Uganda’ was held in Kampala in
June, 2005 to address this question,
assess the status and identify
bottlenecks and future plans.
University and MoH officials,
practicing physicians, nurses and
representatives of NGOs attended.
Representatives of the MoH
identified the recruitment, training
and deployment of family physicians
(also known as community practice
physicians) as a top priority for
improving health services in
Uganda. They recommend posting
at least three family physicians at
each of the 85 general hospitals, at
least one family physician at each of
the 151 Health Centre Level IVs, and
to equip each of the centres with
functional operating theatres
(currently only 18 are functional).
The MoH has asked universities to
scale up current training to prepare
at least 400 new family physicians
to meet these expectations.
At the National Dialogue more
than 50 health leaders discussed
current bottlenecks or challenges.
Participants identified the following
themes:
Insufficient resources:
•Human resources: Departments
of family medicine are severely
understaffed with few teachers,
limited support from short-term
expatriate consultants, and few
support staff.
•Physical resources: Office space,
equipment, computers and
library resources are inadequate.
There is little to no support for
transport and housing for rural
training sites.
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Invisibility:
•Limited space and promotional materials:
Prospective trainees and faculty often do not know
about the specialty, department or its purpose.
•No family medicine association: The few practicing
family physicians in Uganda do not yet have a forum
for collaboration or communication.
•Undergradute curriculum gap: Since departments are
not yet actively involved in teaching undergraduates,
medical school graduates may not have heard of
family medicine before they pursue postgraduate
training.
Uncertainties:
•Curriculum content: People are not yet sure of the
expectations for family doctors. This leads to
questions such as, “What will I be?” Will I be a
medical officer, a specialist, or a surgeon?
•Career path: There are questions and doubts about
career pathways. Prospective trainees wonder if they
will be able to be promoted to the levels of
consultants and senior consultants like in other
specialties.
•Employment opportunities: Trainees wonder what
their job descriptions will be! Can he/she be
employed by the government, by non-governmental
organizations, or begin private practice; will he/she
serve as a clinician, a district health director, or as
an administrator?
Practice Difficulties:
•Limited facilities: Insufficient resources make it
difficult or even impossible to conduct necessary
investigations, procedures or refer patients
appropriately.
•Overload: Limited numbers of health professionals
and facilities in the district health centers results in
very high patient loads at the General Hospitals.
•Limited outreach: Lack of transport and fuel limit
capacity to conduct community health prevention
efforts or home visits.
These bottlenecks are similar to the challenges faced
by family medicine in many other countries. Ugandan
family medicine will be strengthened through sustained
strategic efforts. National leaders identified the following
key priorities:
•Promote greater understanding of the identity,
competencies and career paths of family physicians;
•Strengthen university departments and curricula;
•Market and expand the training programmes;
•Develop high quality educational resources;
•Employ distance learning methods;
•Provide appropriate supervision, support and
evaluation of family physicians in training;
•Mobilize resources to expand training programmes.
MoH staff will expand scholarships and inform
officials in the Ministries of Finance, Planning and
Education, and District Health Officials, to ensure that
career pathways for family physicians are clearly
defined, promoted and supported.
Makerere and Mbarara University faculty and staff are
synchronizing efforts to develop a common core
curriculum, and to expand and develop a network of
decentralized training programmes using distance
education methods. Ugandan faculty are collaborating
with East African, South African and other international
colleagues to review best practices and to gather
relevant materials for adaptation to the Ugandan
setting. The evolving East African Community with its
emphasis on regional cooperation may provide
additional incentives for Ugandan, Kenyan and
Tanzanian universities and governments to harmonize
efforts and share resources to educate, monitor and
support family physicians.
Training family physicians is only one part of the
equation. If recruitment, support and maintenance of
family physicians are not addressed, Uganda’s well-
trained family physicians may run away to ‘greener
pastures.’ The role of the MoH, NGOs, and the private
sector will be critical for recruitment, posting and long
term maintenance. External donor support could help
Uganda move more quickly to meet these challenges.
While the challenges are tremendous, we believe the
future is bright for family physicians to contribute to
improving health services in Uganda.
Cynthia Haq, MD
Director, University of Wisconsin Global Health Program
clhaq@facstaff.wisc.edu
George Welishe, MD
Lecturer in Family Medicine, Makerere University
georgewelishe@yahoo.com
(Editor’s note: Additional information on Family
Medicine in Uganda is available in Wonca’s Global
Resource Directory at www.GlobalFamilyDoctor.com via
the Global Family Doctor homepage: Left Menu Quick
Links > Global Directory, or Top Menu > Education >
Global Resource Directory. See the Global Resource
Directory article in this issue for further details)
Wonca launches its
Global Resource Directory
The concept of creating a
directory of developments in family
medicine around the world was first
discussed during the preparation of
Improving Health Systems: The
Contribution of Family Medicine A
Guidebook, published by Wonca in
2002. The idea was to provide a
place for those involved in
supporting projects in other
countries to record the essential
details of the project for the
information of others interested in
similar projects, or projects in the
same country or similar situations.
With Wonca’s website now well
established, an opportunity arose
to build an online directory that
could be added to, and updated,
remotely.
Wonca has now launched its
Global Resource Directory (GRD) on
Global Family Doctor – Wonca
Online. Access it via the Global
Family Doctor homepage: Left Menu
Quick Links > Global Directory, or
Top Menu > Education > Global
Resource Directory. You’ll see that
the first entries are from Mongolia,
Russia, Uganda and India.
If you’re involved in an overseas
development project in family
medicine, and particularly in
countries where development is still
in its infancy, you’re now able to
submit details from your computer.
You will see on the Global Resource
Directory page: To apply for space
in the GRD Projects database click
here. This will take you to a ‘form’
where details can be entered. When
you ‘submit’ your form it will be
emailed to the Webmaster and
Medical Editor for selection and
entry into the GRD Projects
database. This database will enable
those interested in international
collaboration to ascertain ‘who’s
doing what and where’, thereby
increasing cooperation and
minimizing duplication.
Papers and reports about
developments in family medicine
may also be submitted to the
Medical Editor
(wonca@bigpond.com) and will be
posted in the Directory as they
arrive.
It is anticipated that this
database will soon build into a
valuable resource for those already
involved in, or wishing to participate
in, international collaborative
endeavours.
Suggestions about how we can
make this Global Resource Directory
more useful will be welcome. Please
email the Webmaster at
webmaster@globalfamilydoctor.com.
Professor Wes Fabb
Medical Editor,
Global Family Doctor - Wonca Online
wonca@bigpond.com
http://www.globalfamilydoctor.com
WONCA REGIONAL NEWS
MORE THAN 2,000
ATTEND THE 11
TH
ANNUAL
WONCA EUROPEAN
REGIONAL CONFERENCE –
KOS
The most important annual
meeting for General Practitioners /
Family Doctors in Europe, the 11th
Conference of the European Society
of General Practice/Family Medicine -
Wonca Region Europe was held with
great success in Greece from the 3rd
to the 7th of September. The
Conference was organized on the
island of Kos, the homeland of
Hippocrates, who was the founder
of rational medicine. As such, the
island of Kos could not have been a
better place for hosting this
conference in Greece, both
symbolically and in practical terms.
The overall theme of the
Conference, was “From Hippocrates
to the Human Genome: The Past,
Present and Future of General
Practice/Family Medicine.” This
theme started the Conference during
the Opening Ceremony as it was
addressed by the Chairman of the
International Scientific Board, Prof.
Theodore Mountokalakis.
The main themes of the
Conference were:
•Measuring effectiveness in
General Practice / Family
Medicine
•Cultural determinants of illness
and the role of General Practice /
Family Medicine
•Needs assessment in General
Practice / Family Medicine
Each day of the Conference was
dedicated to one of the above
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FEATURE STORIES / REGIONAL NEWS
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themes, in terms of workshops, parallel sessions, round
tables, lectures, etc. In addition, there were exhibitions
as well as satellite round tables sponsored by
pharmaceutical companies.
Opening Session at the 11
th
Wonca Europe Regional Conference in Kos
Wonca Europe President, Igor Svab, gives presentation to the
conference participants
Wonca Europe Region Family Doctors Celebrate Greek Style in Kos
One of the strong points was the fact that EURACT,
EGPRN and EQUIP – Wonca Europe main Network
Organisations – played a leading role at the conference,
and this was a crucial goal which was totally achieved.
In more detail, there was a thematic workshop every
morning which included representatives of each of the
three networks commenting on the results of the
previous day’s workshops and parallel sessions.
The scientific program was an innovation and met
the needs of GPs/ FDs not only in Europe but
worldwide. Officially, 2011 registrations were counted, 54
countries were represented, and approximately, and 250
students attended the conference.
Hundreds of
abstracts were submitted, covering all the scientific
range of the discipline, of which 839 were officially
admitted, both, as oral and poster presentations.
Another important event of the conference was the
official presentation in a plenary session of the “Vasco
Da Gama Movement”, the WONCA Europe Working Group
for Young and Future General Practitioners. It was driven
from the efforts of Amsterdam “Junior Doctor Project”
delegates’ committee and EURACT. The movement’s
ideas were originated in Lisbon, the home port of Vasco
Da Gama. The movement’s aspiration is to create a
network for GP/FM young trainees/junior doctors’
representation.
In addition to the main conference,
50 participants
from 18 countries across Europe, nominated by their
colleges attended a pre-conference invitational meeting.
This meeting was held in the same conference centre
from the 2nd to the 3rd of September 2005, supported
by the Greek Association of General Practitioners
(ELEGEIA) and the Host Organizing Committee of Wonca
Europe 2005. The main themes of the preconference
were: the Educational Agenda that comes from the new
definition of the General Practitioner and the
Recruitment issues in GP/FM career. Motivated young
GPs exchanged their thoughts and the conclusions were
presented and discussed in two plenary sessions during
the main conference.
The success of the Wonca Europe Regional
Conference – Kos
2005 was crowned after the closing
ceremony, by a memorable moment. The participants
visited the Asclepion – the school of medicine in ancient
Greece and also temple of Asclepios who was the god
of medicine and healing – where an unforgettable
ceremony took place: the enactment and recitation of
Hippocratic Oath in ancient Greek.
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HEALTH AND HEALTH SYSTEM NEWS
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HEALTH AND HEALTH SYSTEM NEWS
WHO ISSUES PROGRESS REPORT ON
HEALTH AND MILLENNIUM
DEVELOPMENT GOALS
The report, Health and the Millennium Development
Goals, presents data on progress on the health goals
and targets and looks beyond the numbers to analyse
why improvements in health have been slow and to
suggest what must be done to change this. The report
points to weak and inequitable health systems as a key
obstacle, including particularly a crisis in health
personnel and the urgent need for sustainable health
financing.
Building up and strengthening health systems is vital
if more progress is to be made towards the Millennium
Development Goals (MDGs), the World Health
Organization (WHO) said in this new report. Unless
urgent investments are made in health systems, current
rates of progress will not be sufficient to meet most of
the Goals.
The key health related MDGs are to:
1.To strengthen health systems and ensure they are
equitable.
2.To ensure that health is prioritized within overall
development and economic policies.
3.To develop health strategies that respond to the
diverse and evolving needs of countries.
4.To mobilize needed resources for health in poor
countries.
5.To improve the quality of health data.
All in all, the 11
th
Wonca Regional Conference in Kos,
Greece generated a spectacular amount of relevant
information, networking opportunities and fond
memories for the more than 2,000 participants.
Bodossakis P. Merkouris
merkouris@the.forthnet.gr
Host Organizing Committee Chairman
(Editor’s Note: Additional information and photos
from the 11
th
Wonca Regional Conference – Kos 2005 can
be found on the Wonca Europe Region website at
www.woncaeurope.org)
Three out of eight goals, eight of the 18 targets, and
18 of the 48 indicators are directly related to health. Of
the 18 quantitative indicators for monitoring progress
towards the eight MDGs, 17 are monitored by the World
Health Organization in collaboration with UNICEF,
UNAIDS and UNFPA.
The MDGs have focused attention on the importance
of sound data as a basis for public policy decision-
making. They have also brought attention to measurable
indicators of progress and the institutionalized system
of reporting. Working with partners, including the Health
Metrics Network — a global collaborative effort to
generate and streamline support to country health-
information systems — WHO promotes the application
of sound principles and practices for data generation,
analysis, dissemination and use.
The full report may be downloaded from the WHO at:
http://www.who.int/mdg/measuring_progress/en/
The Role of Physician Assistants in the
Health Care System
Neil Erickson is a U.S. physician assistant (PAs) hired
by a practice in England. He and other PAs are part of
an effort to help meet a medical staffing shortage within
the country’s National Health Service. Cameron R.
Macauley, PA-C, has opened and supervised outpatient
community clinics in Guinea-Bissau, Brazil, and on the
Thai-Cambodian border, and provided immunization
services in southern Angola. Winnie Barron, PA-C,
divides her career between serving as a physician
assistant in Oregon and her role as director of the
Makindu Children’s Center, which serves children in
Kenya orphaned as a result of the AIDS pandemic.
Michael Wawrzewski III, PA-C, founded Hospitals of
Hope, an international mission composed of health care
professionals who bring medical care, much needed
supplies, and health care educational programs to
Bolivia, Haiti, and Guatemala.
These are just some of the examples how U.S.
physician assistants are providing medical care in other
countries. As their numbers grow, more and more
countries are investigating ways to incorporate the
physician assistant concept into their health care
systems.
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HEALTH AND HEALTH SYSTEM NEWS
Delegates from the United Kingdom (foreground) attended an
international symposium held in May 2005 and hosted by the
American Academy of Physician Assistants to learn more about the
U.S. physician assistant profession.
A recent international symposium on the U.S. physician assistant
profession included a presentation by delegates from the United
Kingdom on the development of the PA profession in that country.
The symposium was hosted in May 2005 by the American Academy of
Physician Assistants.
The American Academy of Physician Assistants
(AAPA) has worked closely with representatives of
various countries to inform them about the history of
the PA profession in the United States, the role that
physician assistants play in expanding patient access to
quality medical care, and the possible establishment of
a PA-like profession in other countries.
In 2005, there are more than 55,000 clinically
practicing PAs in the United States. They are found in
virtually all medical and surgical specialties and all
practice settings. Educated in the medical model,
physician assistants provide a board, comprehensive
range of services that include taking medical histories,
conducting physicals, ordering and interpreting tests,
developing and implementing treatment plans, writing
prescriptions, assisting in surgery, making rounds at
hospitals and nursing homes, and handling
administrative duties.
One goal of the AAPA has been to expand the
concept of the physician assistant profession worldwide.
The Academy recognizes that while this kind of health
care professional could be a means to enhancing health
care in different countries, the concept should be
adapted to fit the needs of the host country, reflecting
its educational system, the patient population to be
served, and the funding structure for health care
professionals in that respective country.
For this reason, AAPA has conducted special
seminars and hosted on-site visits for visiting dignitaries
so they can better understand the physician assistant
profession in the United States. At its annual conference
each year, the Academy has brought together
representatives from various countries to discuss the
educational, professional practice, and regulatory issues
of the U.S. physician assistant profession. Attendees at
the 2005 conference included representatives from the
Netherlands, Taiwan, Canada, Scotland, and England.
One constant in the PA profession, wherever it has
taken root, is the fact that physician assistants work as
members of the medical team and are supervised by
physicians. This close philosophical and legal
relationship between PAs and physicians is formed in
their respective educational programs and continues to
the work setting. What a PA is authorized to do is
determined by his or her education, experience, the law,
and the supervising physician. The team concept is
embraced by the physician assistant profession in the
United States because it provides for continuity of care.
It also frees up the physician to handle the more
difficult case, while the PA tends to the more common
cases presented in a practice. In the United States, the
medical care services provided by physician assistants
are generally reimbursed by federal, state, and private
health insurance programs.
Staff members from the Academy are available to
meet with representatives from other countries to
provide historical and regulatory information about
physician assistants in the United States. To schedule a
meeting or for more information, contact Marie-Michele
Leger, AAPA director, clinical affairs, at mleger@aapa.org;
703/836-2272, ext. 3104. Or visit the AAPA Website at
www.aapa.org.
WONCA
News
MEMBER AND ORGANIZATIONAL NEWS
15
MEMBER AND
ORGANIZATIONAL NEWS
FAMILY MEDICINE IN
RUSSIA: LETTER TO THE
EDITOR
I was so pleased to read the
comments by Dr. Bruce Sparks, the
President of WONCA, “Improving
Russia’s Health System – The
contribution of Family Medicine” in
the August 2005 issue of Wonca
News. It is gratifying to see that the
work initiated in the 1980’s by many
different individuals and Family
Medicine organizations has brought
fruit to the palate of the Russian
medical consumer.
In 1989, the Maine Academy of
Family Physicians, a chapter of the
AAFP began conversations with the
Ministry of Health, USSR about the
Family Medicine model and its
attributes to enhance primary care
in the Soviet Union. This effort was
quickly joined by the Brown
University Department of Family
Medicine and its Chair, Vince Hunt,
MD to develop a post graduate
Family Medicine training program at
the Moscow Medical Academy under
the direction of the former USSR
Minister of Health and then Chair of
this Department, Dr. Igor Denisov.
On August 26, 1992 the Ministry of
Health issued Order 237 declaring
that the specialty of Family Medicine
was created and that all primary
health care services in the Russian
Federation must develop along the
lines of Family Medicine.
I wish to add that
simultaneously to these efforts; our
colleagues from the College of
Family Physicians of Canada, Donald
Rice, MD, Carl Moore, MD and Reg
Perkins, MD had been quite active
as well in the advocacy needed for
this new specialty. In addition, the
Royal College of General
Practitioners, under the leadership
of Douglas Garvie, MD and Robin
Fraser, MD worked very hard
towards this same goal.
However, I must note that the
tenacity in this work was truly
related to that of the Russians
themselves. From the MOH, initially
Dr Yevcheny Chasov, Minister in the
late 1980s, Dr Denisov, and Dr.
Vladimir Shabalin were ever active
in this pursuit. The leadership from
Soyuzmedinform’s (later called
Medtelecominform) Drs Alexander A.
Kiselev and Vyacheslav Platonenko
were the guiding presence and the
leaders in the Family Medicine
development movement. Finally, the
physicians of the Sabourova District
in Moscow, Drs Andrei Lissin and
Nadia Masslanikova, were the
pioneers of the practice of Family
Medicine, having established the
first Family Medicine office in a
Russian polyclinic in 1992.
The development of Family
Medicine around the world is
gratifying to see. The history of our
specialty is now long and storied.
Many thanks to all who contribute
to this work around the world
through Wonca. You make all of our
work as family physicians just a
little easier.
Alain J. Montegut, MD
montea@mmc.org
(Editor’s note: Additional
information on Family Medicine in
Russia is available in Wonca’s Global
Resource Directory at
www.GlobalFamilyDoctor.com via the
Global Family Doctor homepage:
Left Menu Quick Links > Global
Directory, or Top Menu > Education >
Global Resource Directory. See the
Global Resource Directory article in
this issue for further details)
Damilya Nugmanova:
Wonca Global Family
Doctor for August 2005
Professor Damilya Nugmanova is
a well-recognised leader within
Kazakhstan of efforts to improve the
primary health care system through
organization, training, and
implementation of Family Medicine.
She has been head of the Family
Medicine Faculty of the Almaty
Postgraduate Institute for Physicians
for nine years.
She has been instrumental in the
retraining of hundreds of primary
care pediatricians, internists, and
others, and in developing health
reform strategies and action plans
at both oblast and national levels.
She is currently the President of the
Kazakhstan Association of Family
Physicians which works to promote
the interest of primary care
physicians, holds training and
continuing medical education,
organizes population education
efforts, and develops and provides
materials for primary care physicians
to use in the education of patients.
Professor Damilya
Nugmanova: Wonca
Global Family Doctor
for August 2005
She has organized and taught
courses on clinical topics for
practicing physicians, evidence
based medicine (EBM) for clinicians,
academics, and administrators, and
on health reform topics. She is head
of the Association of Family
Physicians Trainers which has
organized and provided training for
the teachers from all the medical
schools of Kazakhstan, developed
curriculum for family medicine
continuous education and
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MEMBER AND ORGANIZATIONAL NEWS
developed family medicine residency
standards.
Through her work as the Clinical
Director of USAID Funded Central
Asia ZdravPlus Project, Professor
Nugmanova has also been
instrumental in the development of
Family Medicine in other countries in
the Central Asia Region, such as in
Uzbekistan and Tajikistan, by
assisting their Family Medicine
Faculties to organize Family
Medicine Training Centres.
Professor Nugmanova has
participated and spoken at
numerous regional and international
conferences on the topics of family
medicine development, health care
reform, and evidence based
medicine. She has published
numerous articles in professional
and lay publications, and on
television and radio.
Professor Damilya Nugmanova is
a most deserved winner of the
Wonca Global Family Doctor of the
Month Award for August 2005.
Alan Pugh: Wonca Global
Family Doctor for
September 2005
Doctor Alan Pugh graduated from
The University of Cape Town in 1954
keen to work in a rural African
setting where doctors are needed
the most. He moved to Harare,
Zimbabwe (then Salisbury,
Rhodesia), where he met and
married Jill, an English nurse and his
constant companion.
After
obtaining a public health doctorate,
Dr Pugh joined the Government
Provincial Health Department and
became Minister of Health with
responsibility for all aspects of
health care in the Matabeleland
Province.
While visiting health workers, as
well as farmers, chiefs and
headmen, Dr Pugh realised that
members had very little contact with
or knowledge of what other health
staff did. Meetings were arranged
regularly so that people met each
other, common problems were
discussed and plans agreed upon.
This helped the PMOH department
to maintain control of endemic
diseases such as TB, leprosy,
malaria and waterborne infections
even in very difficult and dangerous
times when some hospitals and
clinics had to close and WHO pulled
out for political reasons. These
interventions are now firmly
established, but 40 years ago were
considered quite radical!
Two further examples
demonstrate how Dr Pugh and his
public health team helped empower
rural communities to take
responsibility for solving their health
problems. Over 35 years ago a
severe drought led to crop failures
in many areas of Matabeleland
South. Food aid was made available
by NGO’s and Government sources
in the form of maize, beans, cooking
oil and ground nuts, but how to
distribute them effectively? The
nurses at Thelenyemba Mission
Hospital set an example. They went
into the communities and explained
that food would be available, but
had to be cooked and shared
equitably. The community women
responded, forming cooking groups
in various convenient places. The
food was delivered and before long
the benefit to the children was
obvious to all.
Dr Alan Pugh:
Wonca Global
Family Doctor for
September 2005
Then there was an outbreak of
diarrhoeal diseases in the Filabusi
area. The cause was a polluted
dam, surrounded by reeds which
served as toilets, from which water
was drawn for cooking and washing,
laundry and bathing. How to get the
community to understand and take
action? The local Headman was
invited to meet Dr Pugh. They
walked along the bank talking
about the causes of diarrhoea, and
noted how the reeds were the only
places private enough for use as
toilet facilities. The Headman saw
they needed proper toilet facilities
and organized the community to
solve the problem.
More recently Dr Pugh has been
a key figure in the setting up of the
Thembelihle Halfway Home for
patients with AIDS. Thembelihle is a
nursing home which cares for these
patients until they are fit for
discharge to home. While Dr Pugh is
a most deserving Global Family
Doctor of the Month, he would give
credit to all the health workers and
community leaders who these
accomplishments possible.
(Editor’s Note; The “Global
Family Doctor of the Month” Award
is an award to encourage
philanthropy among primary care
practitioners and to honour doctors
giving their time and expertise to
their global colleagues and their
patients. The award is given to
doctors who are recognised by their
colleagues as having contributed
significantly to the community in
which they work by way of their
practice, community involvement,
charity work or other humanitarian
acts.
Each Award winner is given a
letter of congratulations from the
Wonca CEO, an award certificate and
a complete office diagnostic set
from Welch Allyn worth
approximately $400.
17
WONCA
News
MEMBER AND ORGANIZATIONAL NEWS / RESOURCES FOR THE FAMILY DOCTOR
RESOURCES FOR THE
FAMILY DOCTOR
FELLOWSHIPS AVAILABLE
TO ATTEND 13TH WORLD
CONFERENCE ON
TOBACCO OR HEALTH
Wonca members from low and
middle income countries with an
interest in Tobacco control may be
eligible for a followship to attend
the 13th World Conference on
Tobacco OR Health (WCTOH) which
will be held July 9-15, 2006 in
Washington, DC. The deadline to
submit applications is November 21,
2005.
The goal of the Fellows program
is to enhance capacity and
strengthen networks for tobacco
control among rising practitioners
and emerging leaders in low-and
middle-income countries.
A key element of the Fellows
program is the structured
Submission Requirements
include:
1.Title and Full Name of nominee.
2.Photo of nominee. The winner
and his/her photo would be
featured on Wonca’s website
www.GlobalFamilyDoctor.com
3.Postal address of nominee.
4.Reasons for nomination for the
Award.
5.Brief resume or CV of the
nominee
6.Any other relevant information
that would assist Wonca in the
selection process.
Please submit nominations for
this monthly Award to Dr Alfred Loh,
CEO of Wonca at the Wonca
Secretariat via email to
admin@wonca.com.sg)
opportunity for Fellows to learn about effective tobacco control strategies
from each others experiences. This program has been successfully offered at
the previous two World Conferences. Approximately 70 Fellowships will be
awarded to applicants from low and middle income countries.
The objectives of the 13
th
WCTOH Global Tobacco Fellows program are to:
•strengthen global leadership and increase the number of organizations
and individuals engaged in the fight against tobacco
•exchange successful ideas and strategies to create social, political, and
economic change to reduce tobacco use and exposure world-wide
•expand and strengthen the understanding and application of tobacco
control policy changes
•create on-going networks and establish new networks for global tobacco
control
The 13
th
WCTOH Global Fellows Program consists of:
•2.5 day pre-conference training (July 9 – 11, 2006)
•Participation in the WCTOH (July 12 – 15, 2006)
•Economy round trip air travel from country of residence to Washington,
DC, accommodation and meals in Washington, DC during the pre-
conference training and WCTOH, WCTOH registration fee, ground
transportation and a small per diem.
•Opportunity to apply for seed grants following the WCTOH
Individuals who meet the following criteria may apply to participate in
the Fellows program:
•Work or study is in tobacco control
•Live/work in low-or middle-income country
•Educational and/or professional background qualifies her/him to benefit
from short intensive program
•Employment or study is of practical importance in his/her country
•Have no connections to the tobacco industry
•Command of English is adequate to actively participate in discussions
•Able to make practical use of skills and knowledge to mobilize others
Additional information on the program, and the application form, can be
found on the following URL: http://www.13thwctoh.org/t-scholarships.php
Applications will be accepted until November 21, 2005. Applicants will be
notified the week of February 1, 2006 if they are accepted.
If an on-line application is not feasible, please contact:
Celeste D. McNair;
Talley Management Group, Inc.;
19 Mantua Road; Mt. Royal,
New Jersey 08061 U.S.A.
Phone: +856-423-7222 extension 254
Fax: +856-423-3420 Email: cmcnair@talley.com
Rick Botelho
Covenor, Wonca Special Interest Group on Health Behavior Change
Rick_Botelho@URMC.Rochester.edu
WONCA
News
RESOURCES FOR THE FAMILY DOCTOR
18
Improving Health
Systems: The
Contribution of Family
Medicine
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, coordinated 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,
published by Wonca in 2002, 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
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
Royal New Zealand Collage of
General Practitioners
(Editor’s Note: Reprinted from the
July 2002 issue of Wonca News)
WONCA
News
CONFERENCES 2005 – 2010
19
Information correct as of October 2005.
May be subject to change.
WONCA CONFERENCES 2005 – 2010 AT A GLANCE
See Wonca Website www.GlobalFamilyDoctor.com for upates
2005
Region
Venue
Theme
8 – 11 Dec
Americas
Vancouver
Canada
Preparing For Tomorrow
Regional Conference
The Way Forward
2006
27 – 30 Aug
European
Florence
ITALY
Towards Medical Renaissance:
Regional Conference
Bridging the Gap Between Biology
and the Humanities
8 – 15 Sept
7th Rural
Seattle
Transforming Rural Practice
Health
Washington
Through Education
Conference
USA
11 – 14 Oct
Iberoamericana -
Buenos Aires
Pursuing Equity and Efficiency in
CIMF Regional
ARGENTINA
Healthcare: the Role of the Family Doctor
Conference
5 – 9 Nov
Asia Pacific
Bangkok
THAILAND
Happy and Healthy Family
Regional Conference
2007
24 – 27 July
18th WONCA
SINGAPORE
Human Genomics and its Impact on
World Conference
Family Physicians
17 – 21 Oct
European
Paris
Re-Thinking Primary Care in the European
Regional
FRANCE
Context: A New Challenge for General
Conference
Practice
2008
1 – 5 Oct
Asia Pacific
Melbourne
Theme to be confirmed
Regional
AUSTRALIA
Conference
2009
5 – 8 June
Asia Pacific
Hong Kong
Building Bridges
Regional
Conference
2010
26 – 30 May
19
th
WONCA
Cancun
Millennium Development Goals:
World Conference
MEXICO
The Contribution of Family Medicine
20
WONCA
News
GLOBAL MEETINGS FOR THE FAMILY DOCTOR
GLOBAL MEETINGS FOR THE FAMILY DOCTOR
WONCA WORLD AND REGIONAL
CONFERENCE CALENDAR
Family Medicine Forum 2005/Wonca Americas Regional
Conference, Vancouver
Host:College of Family Physicians of Canada (CFPC)
Theme:Preparing for Tomorrow
Date:8-11 December, 2005
Venue:Vancouver Exhibition and Convention Centre
Vancouver, British Columbia, Canada
Contact:Joanne Langevin; Meetings Manager
Cheryl Selig, Registration Coordinator
2630 Avenue Skymark
Mississauga, Ontario, Canada L4W 5A4
Tel:905 629 0900 /1-800-387-6197
Fax:905 629 0893
Email:fmf_registration@cfc.ca
info@cfpc.ca
Web:www.cfpc.ca
Wonca Europe Regional Conference, Florence 2006
Host:CSERMEG
Theme:Towards Medical Renaissance
Date:27-30 August, 2006
Venue:Florence, Italy
Contact:OICsrl
Viale Matteotti 7
50121 Florence, Italy
Tel:+39 0555 0351
Fax:+39 0555 001912
Email:wonca2006@oic.it
Web:http://www.woncaeurope2006.org
Wonca 7th Rural Health Conference, Seattle-Anchorage
2006
Host:Wonca Rural Health Working Party
Theme:Transforming Rural Practice Through Education
Date:8-15 September, 2006
Venue:8 -10 September – Wonca Rural Conference
University of Washington campus
11-13 September, 34th Annual Advances in
Family Practice
University of Washington campus
13-15 September, Post Conference
Talkeetna Alaskan Lodge
Anchorage, Alaska
Contact:Tom E Norris, MD
Chair, Host Organizing Committee
Department of Family Medicine
University of Washington School of Medicine
Box 356390
Seattle, WA 98195-6390, USA
Fax:206-543-3101
Email:tnorris@u.washington.edu
Web:http://www.ruralwonca2006.org/
Wonca Iberoamericana-CIMF Region, Buenos Aires, 2006
Host:Federacion Argentina De Medicina Familiar y
General
Theme:Pursing Equity and Efficiency in Healthcare:
The Role of the Family Doctor
Date:11-15 October, 2006
Venue:Sheraton Hotel, Buenos Aires
Contact:Federacion Argentina De Medicina Familiar y
General
Tel:54 11 4958 5071
Email:aamf@lvd.com.ar
Web:www.aamf.org.ar
15th Wonca Asia Pacific Regional Conference, Bangkok
2006
Host:General Practitioners/Family Physicians
Association of Thailand
College of Family Physicians of Thailand
Theme:Happy and Healthy Family
Date:5-9 November, 2006
Venue:Miracle Grand Convention, Hotel Bangkok
Contact:Dr Kachit Choopanya, Chairman, Host
Organizing Committee
10th Floor, Royal Golden Jubilee Building
2 Soi Soonvijai, New Petchaburi Road
Bangkok, Thailand 10320
Tel:66(0) 2716 6651
Fax:66(0) 2716 6653
Web:www.thaifammed.org
21
WONCA
News
GLOBAL MEETINGS FOR THE FAMILY DOCTOR
18th Wonca World Conference, Singapore 2007
Host:College of Family Physicians, Singapore
Theme:Human Genomics and its Impact on Family
Physicians
Date:24-27 July, 2007
Venue:Singapore International Convention and
Exhibition Centre
Contact:Dr Tan See Leng, Chairman,
Host Organizing Committee
College of Family Physicians, Singapore
College of Medicine Building
16 College Road #01-02
Singapore 169854
Tel:65 6223 0606
Fax:65 6222 0204
Email:contact@cfps.org.sg
Web:www.wonca2007.com
Wonca Europe Regional Conference, Paris, 2007
Host:French National College of Teachers in General
Practice
Theme:Rethinking Primary Care in the European
Context
Date:17-21 October, 2007
Venue:Palais des Congres
Paris, France
Contact:French National College of Teachers in General
Practice
6 rue des Deux Communes
94300 Vincennes, France
Tel:33-153 669 180
Emailcnge@cnge.fr
Web:www.cnge.fr
19th Wonca World Conference, Cancun 2010
Host:Mexican College of Family Medicine
Theme:Millennium Develop Goals:
The Contribution of Family Medicine
Date:26-30 May, 2010
Venue:Cancun Conventions and Exhibition Center,
Cancun Mexico
Contact:Mexican College of Family Medicine
Anahuac #60
Colonia Roma Sur
06760 Mexico, D.F.
Tel:52-55 5574
Fax:52-55 5387
Email:javier.dominguez@unfpa.org.mx
MEMBER ORGANIZATION AND RELATED MEETINGS
International Society for Quality in Health Care
22nd International Conference, Vancouver 2005
Date:25-28 October, 2005
Venue:Vancouver, British Columbia, Canada
Contact:ISQua Secretariat
212 Clarendon Street
East Melbourne 3002 Australia
Tel:+61 3 9417 6971
Fax:+61 3 9417 6851
Email: isqua@isqua.org
Web: http://www.isqua.org
Network: Toward Unity for Health International
Conference, Ho Chi Minh City, Vietnam 2005
Date:12 - 17 November, 2005
Theme:On Making Primary Health Care Work:
Challenges for the
Education and Practice of the Health Workforce
Venue:Ho Chi Minh City, Vietnam
Contact:Ms. Yoka J.H. Cerfontaine
P.O. Box 616
6200 MD Maastricht
The Netherlands
Tel:31-43-3885638/3881524
Fax:31-43-3885639
Email:secretariat@network.unimaas.nl
Web:http://www.the-networktufh.org/conference/
5th Austrian Winter Conference on General Practice and
Family Medicine, Austria
2006
Date:January 14-21, 2006
Venue:Hotel Rote Wand in Lech am Arlberg, Austria
Contact:Vienna Medical Academy
Attn. Hedwig Schulz
Alser Strasse 4,
1090 Vienna, Austria
Tel:+43 1 405 13 83-10
Fax:+43 1 405 13 83-23
E-mail:h.schulz@medacad.org
Web:www.oegam.at
13th World Conference on Smoking or Health,
Washington, DC 2006
Theme:Building Capacity for a Tobacco-Free World
Date:12-15 July, 2006
Venue:Renaissance DC Hotel
Washington, D.C., USA
Contact:John Seffrin, PhD
Chief Executive Officer
American Cancer Society
Email:secretariat2006@cancer.org
Web:http://www.2006conferences.org/
Preparing for Tomorrow
Préparer l’avenir
Please join us in Vancouver! • Soyez des nôtres à Vancouver!
December 8-11,2005 • Du 8 au 11 décembre 2005
Vancouver Convention and Exhibition Centre
Vancouver • British Columbia • Colombie-Britannique • Canada
The College of Family Physicians of Canada
(CFPC), the British Columbia College of Family
Physicians (BCCFP), the CFPC’sSections of
Teachers and Researchersand the Americas
Region of Wonca(The World Organization of
Family Doctors) invite you to Family Medicine
Forum 2005.
Join family physicians from Canada, the USA
and the Caribbean for the combined Scientific
Assembly of the CFPC and the Americas Region
of Wonca!
•Over 20 hours of accredited CME/CPD
(Mainpro M-1 and C)
•Outstanding Keynotes, plenary sessions,
small group workshops
•Wide range of clinical, teaching and research
presentations, and hands on sessions
•Interact with medical students and residents
– our family doctors of the future
Le Collège des médecins de famille du Canada
(CMFC), le Collège des médecins de famille de la
Colombie-Britannique(CMFCB), la Section des
enseignants et la Section des chercheursdu CMFC,
ainsi que la Région des Amériques de Wonca
(l’Organisation mondiale des médecins de famille)
vous invitent au Forum 2005 en médecine familiale.
Joignez-vous aux médecins de famille du Canada,
des États-Unis et des Caraïbes pour l’assemblée
scientifique conjointe du CMFC et de la Région des
Amériques de Wonca!
•Plus de 20 heures de FMC/DPC approuvé
(crédits Mainpro M-1 et C)
•Conférences d’ouverture, séances plénières, ateliers
en petits groupes exceptionnels
•Large éventail de présentations cliniques,
d’enseignement et de recherche, et de sessions
pratiques
•Venez interagir avec les étudiants en médecine et
les résidents – nos médecins de famille de demain
Visit the CFPC Website for more information • Visitez le site Web du CMFC pour plus d’information
www.cfpc.ca
