From the Wonca President
:
On our way to 2010: Working for
2
Every Family to have a Family Doctor
From the CEO’s Desk
:
Highlights from the Wonca World
3
Council Meeting
From the Editor
:
Setting Sail in the New Triennium
5
FEATURE STORIES
5
•Wonca Council Elects Leadership and Sets Goals for New Triennium
•Wonca Celebrates at the 18th World Conference in Singapore
•Wonca Endorses Hamilton Gender Equity Recommendations
Wonca REGIONAL NEWS
9
•International Conference in Buenos Aires Focuses on Primary Care
•Preethi Wijegoonewardene - Middle East South Asia Regional
President
•EURACT Patient Empowerment Course Held in Bled
HEALTH AND HEALTH SYSTEM NEWS
13
•Wonca Council Hears WHO Commission on Social Determinants of
Health
•WHO DG Margaret Chan Addresses Primary Health Care Conference
•Behavioral Changes Key to Health Care Reform in Hong Kong
MEMBER AND ORGANIZATIONAL NEWS
17
•Rich Roberts - Wonca President Elect
•Ian Couper - New Chair of Wonca Working Party on Rural Practice
RESOURCES FOR THE FAMILY DOCTOR
18
•8th Wonca World Rural Health Conference Set for Calabar, Nigeria
•Save Your Life: A Six-Step Plan for Staying Healthy Longer
WONCA CONFERENCES 2007-2013 AT A GLANCE
20
GLOBAL MEETINGS FOR THE FAMILY DOCTOR
21
VOLUME 33
NUMBER 5
OCTOBER 2007
CONTENTS
World Organization of Family Doctors
www.GlobalFamilyDoctor.com
Wonca President
Professor Chris van Weel
Department of Family Medicine,
117 HAG
University Medical Centre Nijmegen
PO Box 9101
6500 HB Nijmegen
The Netherlands
Tel 31 24 361 6332
Fax 31 24 354 1862
Email C.vanWeel@hag.umcn.nl
Wonca Chief Executive Officer
Dr Alfred W T Loh
Wonca World Secretariat
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
Richard G Roberts, MD, JD, USA
Immediate Past President
Professor Bruce L W Sparks, South Africa
Honorary Treasurer
Professor Michael Kidd, Australia
Executive Members at Large
Dr Javier Dominguez del Olmo, Mexico
Dr Iona Heath, United Kingdom
Professor Michael Kidd, Australia
Regional Presidents
Wonca Africa
Profesor Khaya Mfenyana, South Africa
Wonca Asia Pacific
Dr Donald K T Li, Hong Kong
Wonca Europe
Professor Igor Svab, Slovenia
Wonca Iberoamericana - CIMF
Professor Adolfo Rubinstein, Argentina
Wonca Middle East South Asia
Dr Preethi Wijegoonewardene, Sri Lanka
Wonca North America
Dr Alain Montegut, USA
Chair, Bylaws & Regulations Committee
Dan Ostergaard MD, USA
Chair, Wonca Publications and
Communications Committee
Dr Geoffrey D Martin, Australia
Editor, Wonca News & Editorial Office
Marc L Rivo, MD, MPH
4566 Prairie Avenue
Miami Beach, FL 33140, USA
Tel 1 305-671-7327
Fax 1 305-674-8839
Email marcrivo@aol.com
WONCA GLOBAL SPONSORS
FROM THE WONCA
PRESIDENT :
ON OUR WAY TO 2010 - -
- WORKING FOR EVERY
FAMILY TO HAVE A FAMILY
DOCTOR
The life cycle of Wonca runs in a
triennial rhythm and with the
successful conclusion of the World
Council and Conference in Singapore
the focus in now ‘2010’ and the
meeting in Cancun. In directing our
attention in that direction, it is
important to pay tribute to Bruce
Sparks our immediate past
president, and in him all who have
contributed so much in the past
years to Wonca and family medicine.
But I would like to refer you for this
to other articles in this issue and
use this column for a view of our
future.
In Singapore, the conference
touched on an important aspect of
future family medicine: genomics
and the (technical) implications for
heath care in the decades to come.
This theme could easily have
become technology dominated, but
it is a great tribute to the
conference organizers that this did
not happen. To the contrary, the
prospect of genomics emphasized
the need of a patent-centered
medicine, generalistic in its
approach to the greatest needs in
societies.
Professor Chris Van Weel, Wonca President
2007-10
WONCA
News
FROM THE WONCA PRESIDENT
2
Social factors determine to a
large extent the health status of
people and communities, and
genomics is not going to change
this. The WHO is preparing an
important report on this - the Social
Determinants of Health - and the
Wonca Council had an opportunity
to discuss this issue with the
committee’s deputy chair professor
David Satcher, in the days before
the conference. The role of primary
care, and the family doctor are
crucial, in establishing a coherent
link between individual patient care
and societal actions to promote
health: an agent for patients and
communities, in addition to the
provision of healthcare.
This is where the notion of
equity becomes the guiding
principle of health care.
Equity towards gender, race,
social-economic, cultural and other
factors is fundamental to family
medicine. On the initiative of the
Working Party of Women and Family
Medicine Wonca committed itself to
work with ever more efforts, within
the organization and in its external
activities, from these principles.
The logical implication of the
contribution of primary care to
health of people and communities is
the need of a family doctor in every
community in the world: in the
words of Council ‘every family in the
world a family doctor’. Wonca is an
academic organization and the
ambition of global penetration in all
communities of the world should be
seen in that light. The ambition is to
support all family doctors through
networking them in an academic
outreach of teaching, training,
research and development to
provide care of the highest quality.
The Working Party of Education
formulated this in terms of the need
of every medical student to be
exposed to primary care.
At the Wonca Council Meeting
(21-23 July 2007) and Wonca World
Conference (24-27 July 2007) in
Singapore, the strategic mission of
Wonca to care for people of the
world was reviewed. Safe and
effective primary care, with family/
general practice of the highest
quality is essential, for better health
and health care. To pursue this, and
to support its Member
Organizations, Wonca adopted three
resolutions:
1. On Access to High Quality Health
Care: “Every family should have
a family doctor.”
To improve health of people and
populations, access to high
quality primary care is essential,
and every community in the
world should be served by family
practice of the highest quality.
Wonca strives, together with its
Member Organizations to engage
all family physicians in every
community in an academic
network to support and improve
their work.
2. On Gender Equity: The Health
Equity Recommendations (HER)
Statement, prepared in the
Hamilton, Ontario Conference by
the Working Party of Women and
Family Medicine:
The full text of the HER
Statement is published in this
issue of Wonca News. Adoption
of this statement was taken in
the spirit that equity is a generic
ethical notion in the governance
of health care and in the
functioning of Wonca and
gender, ethnicity, social-
economical development should
be taken into account.
3. On Medical Education: The
Singapore Statement prepared by
the Working Party on Education:
* Every medical school in the
WONCA
News
FROM THE WONCA PRESIDENT / FROM THE CEO’S DESK
3
FROM THE CEO’S DESK:
HIGHLIGHTS FROM THE
WONCA WORLD COUNCIL
MEETING
The Wonca World Council was
held at the Marina Mandarin Hotel
in Singapore from 21
st
- 23
rd
July
2007 just prior to the 18th Wonca
World Conference held at the Suntec
Convention Centre.
Present were 53 Full Member
Organisations from 51 countries, 6
Associate Member Organisations
and 6 Organisations in Collaborative
Relations (OCR) present for the
Council Meeting. In addition, 14
proxies from 28 Member
Organisations unable to sent
representatives to the meeting were
received at the start of the Council.
The names of the 13 organisations
admitted since the last Wonca World
Council in Orlando in 2004 as Full or
Associate Members and
Organizations in Collaborative
Relations were read out and noted
by Council.
Some of the key issues and
decisions discussed and adopted by
Council during the three days of
deliberations were as follows.
The Wonca Council voted
unanimously in favour of ratifying
the Wonca Bylaws & Regulations
approved at the last Wonca World
Council held in Orlando in October
2004. These new Bylaws and
Regulations were effective
immediately
The CEO reported on the state of
Wonca’s finances. The Council
accepted the report of the CEO on
the 2004 - 2006 Triennium Account.
They acknowledged the positive
financial outcome for the Triennium
world should have an
academic department of
family medicine, or an
equivalent academic focus.
* Every medical student in the
world should experience
family practice as early as
possible and as often as
possible in his or her training.
Medical education is a powerful
tool in health care reform and the
improvement of quality of care.
Hands-on experience of family
medicine is often decisive for future
career choice, and family medicine
involvement in the undergraduate
curriculum substantially promotes
the recruitment of the best students
in family practice. For students who
will find a career in secondary care,
their undergraduate experience in
family practice will substantially
shape their ability to collaborate
later with primary care.
The three motions - on equity,
on education and on every family a
family doctor - presents valuable
support in our pursuit of primary
care around the world. Times look
favorable, in that - at last - money
is being made available for primary
care. But this development is not
without its challenges. A substantial
number of initiatives are (vertical)
disease-specific programs, rather
than promoting integrated,
horizontal primary care. The
evidence is with the latter, but the
money seems to be with the first.
The major issue will be to re-define
vertical programs in that they work
through horizontal primary care. And
that a small part of their finances -
say 15% - will be invested in the
development of integrated
horizontal primary care: “fifteen by
2015”.
Professor Chris van Weel
Wonca World President
due to the dual approach of prudent
budgeting of expenditures and a
willingness to engage industry in an
ethical manner in new revenue
generating ventures through the
Wonca Global Sponsorships, the
Wonca Website, satellite symposia
at conferences and educational
projects involving the website.
The Wonca Council also accepted
the Honorary Treasurer’s Report and
his recommendations for Wonca’s
future financial health: 1) Wonca
should have a reserve account of
one year’s operating expense to
help it weather unexpected financial
situations; 2) The Wonca
membership dues should be
regularly scrutinized to ensure
equity, integrity and value to
members, and 3) Wonca should
develop revenue sources which are
consistent with its ethical standards,
congruent and not competitive with
its member organizations and reflect
an appropriate risk taking into
account Wonca’s limited capacity to
handle financial missteps.
The Wonca Council approved the
revised 2007 - 2009 Triennium
Budget recommended by Wonca
Executive at its recent meeting prior
to the World Council. Council also
approved that for the budget years
of 2008 - 2010, the membership
dues assessed to each members
organization be kept at the 2007
level.
The World Council, in accepting
the report of the Chair of the Wonca
Membership Committee, approved
the application for membership at
the Council meeting :
* The Caribbean College of Family
Physicians (Full Member)
* The Russian Association of
General practitioners/Family
Physicians - All Russian Fund
(Full Member)
* The Oman Family Medicine
Society (Full Member)
WONCA
News
FROM THE CEO’S DESK
4
* The Armenian Association of Family Physicians (Full
Member)
* The Egyptian Society for Improving Family Health
(Full Member)
* The Lesotho Medical Association (Full Member)
* The Society of Family Physicians of Nigeria, SOFPON
(Associate Member)
* The International Primary Care Respiratory Group,
IPCRG (Organisation in Collaborative Relations)
The World Council received and noted the reports of
the Wonca Webmaster, Mr Alex Wescott and the Medical
Editor, Prof Wes Fabb. Council thanked Prof Wes Fabb
for his contributions to the development of the website
and bid him a fond farewell as he retires as the Medical
Editor. Wonca Council also expressed continued support
for the development and promotion of Journal Alerts
and website resources as a service to members of
Member Organisations.
Two breakout sessions — Guiding Wonca’s Future
and The Commission on the Social Determinants of
Health (see article on Commission) were also held
during the three day Council Meeting. The objectives of
these breakout sessions were to allow for greater
interactions between the various Members of Council
from the different Member Organisations. More
importantly, the breakout sessions gave Council
Members of the Council a direct say in the direction that
Wonca is to take on key issues affecting Primary Health
Care globally.
The Council commended the work of the Working
Party on Women and Family Medicine in advocating and
promoting equity via the Hamilton Equity
Recommendations Statement and the Ten Steps to
Gender Equity. The Wonca Council then endorsed the
HER Statement (see article on Gender Issues) and the
Ten Steps.
The Regional President for the Middle East South
Asia Region informed the Wonca World Council that his
Regional Council discussed the formation of a new and
separate Middle East region comprising eight member
organizations. At that meeting it was agreed that a new
region be called Wonca EMRO (Eastern Mediterranean)
as is the same region within WHO. They also decided
that the South Asia Region may be more appropriately
named Wonca SEARO (Southeast Asia) as it works
closely with WHO regional counterpart. This issue would
be discussed by the new Triennium’s Regional Council
and any request for a name change would require
approval from the World Council. The new Wonca EMRO
Region would only be formalised and approved by the
next Wonca Council in 2010, once the due process of
establishing a regional structure and Regional Bylaws
and Regulations were completed.
The World Council also ratified the following
Regional Presidents elected by their respective Regional
Councils at their meetings held before the start of the
World Council
* Regional President of Wonca Africa:
Prof Khaya Mfenyana (South Africa and re-elected for
a 2nd term).
* Regional President of Wonca North America:
Dr Alain Montegut (USA)
* Regional President of Wonca Asia Pacific:
Dr Donald Li (Hong Kong)
* Regional President of Wonca Europe: Professor Igor
Svab (Slovenia and re-elected for a 2nd term).
* Regional President of Wonca Iberoamericana-CIMF:
Professor Adolfo Rubinstein (Argentina and re-elected
for a 2nd term).
* Regional President of Wonca Middle East South Asia:
Dr Preethi Wijegoonewardene (Sri Lanka).
At the election held on the third and final day of the
Council Meeting, the following candidates were elected
into the various offices of Wonca:
* President Elect: Dr Richard Roberts (USA)
* Executive Members at Large: Prof Michael Kidd
(Australia), Dr Iona Heath (United Kingdom), Javier
Dominguez (Mexico)
Prof van Weel, on behalf of the Nominating and
Awards Committee recommended and the World Council
approved the candidates for Wonca Fellowship,
Honorary Life Direct Membership (see article on Wonca
Council for details). The Wonca International Award for
Excellence in Health Care- the 5 Star Doctor was given
to Dr Arthur Kaufman from the USA.
All in all, the Wonca Council accomplished much,
while renewing old friendships and meeting new friends
and colleagues from around the world.
Dr Alfred Loh
Chief Executive Officer
World Organization of Family Doctors
WONCA
News
FROM THE EDITOR / FEATURE STORIES
5
FEATURE STORIES
WONCA COUNCIL ELECTS
LEADERSHIP, SETS GOALS
FOR NEW TRIENNIUM
The Wonca World Council met in
Singapore July 21-23 preceding the
opening of the 18th Wonca World
Conference. In three fully packed
days, the Wonca Council completed
an ambitious global agenda of work,
celebrated several noted
accomplishments, elected new
leadership and reaffirmed the goals
for the new Triennium.
During the opening roll call of
attendees, the Wonca Council
welcomed its new member
organizations and celebrated its
record-breaking triennium
membership growth. Today, Wonca
represents 119 member
organizations from 115 nations/
national entities. A major leap
forward in Wonca’s relations with
nations was brought by the
Carribbean College of Family
Physicians, which represents family
physicians from 16 different national
entities. Wonca’s membership
includes 12 Associate Member
Organizations and 10 Organizations
in Collaborative Relations. This is
exciting growth for a relatively
young organization of 35 years,
established in 1972 with only 18
founding member organizations, and
with only 50 member organizations
as recently as 1994. In only the first
7 years of the 21st century, Wonca’s
gained more new member
organizations than during its first
quarter century (see table below).
Wonca global span reaches
countries representing 85% of the
world’s population. The Wonca
Council recognized Dr Nabil Kurashi
from Saudi Arabia who was chosen
by his fellow member organizations
in the emerging Eastern
FROM THE EDITOR:
SETTING SAIL IN THE NEW TRIENNIUM
This is the first issue of Wonca News published since the world’s family
doctors gathered the end of July for the 18th Wonca World Conference in
Singapore.
This issue reports on some of the key highlights of Singapore’s family
doctor reunion. Subsequent issues of Wonca News will continue to report on
other highlights from Singapore, including Wonca’s newly elected leadership,
the important work of its working parties, task forces and special interest
groups, and the important accomplishments of Wonca’s Regions and
member organizations. However, those who were fortunate to be able to
come to Singapore recognize that such stories cannot adequately capture
the scope, richness and diversity of that which will be forever recorded as
the 18th Wonca World Conference.
This issue also provides an early compass reading of Wonca’s direction in
the new Triennium. Wonca President Chris Van Weel and CEO Alfred Loh
both comment on Wonca’s vital role of supporting the family doctor to best
meet people’s health needs in every community in every part of the globe.
They described the course set by the Wonca Council for the World
Organization of Family Doctors. They provide insight into what will
subsequently be reported as Wonca’s goals, strategic action plan and
measures of success in the new Triennium.
This issue also provides an early barometric check from the World Health
Organization and several countries that the winds may be favorable this
Triennium for Wonca’s family doctors. Articles indicate that primary health
care and the role of the family doctor continue to be as relevant today, or
more so, in the attainment of the Millenium Development Goals and in
global, regional and national plans to reform health systems towards the
goals of health care equity, quality, affordability and satisfaction.
As we set sail in the new Triennium, please continue to send me your
articles, photos and other milestones in our collective journey to share in
the pages of Wonca News. I wish you all a safe, successful and joyous
journey.
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)
WONCA
News
FEATURE STORIES
6
Mediterranean Region to work with the Wonca Executive and fellow Regions
towards the establishment of a new Wonca Region in that part of the globe
in the upcoming Triennium.
The Wonca Council held a strategic planning breakout session to review
Wonca’s Goals for the upcoming Triennium. The Wonca Council endorsed the
set of goals that were established in the 1998 Wonca World Council meeting
in Killarney, Ireland. The goals for the upcoming Triennium were:
* Develop general practice/family medicine in areas of greatest need
* Support general practice/family medicine research
* Promote the role of the family doctor as leader of the primary care team
* Support general practice/family medicine education
* Improve communication/collaboration within Wonca
* Secure adequate funding for Wonca
In reaffirming the above goals, the Wonca Council adopted in a motion
its overriding priority of promotion of primary care and family medicine
around the world: “Every family a family doctor”. In addition, Council urged
to place more emphasis on equity in Wonca and in (primary) health care.
The Wonca Executive was asked to consider “equity” as a new goal or part
of a set of values for Wonca to exemplify as the organization implements
programs that cuts across all the above goals, to include attention to
geographic region, language, socioeconomic status, and gender.
To promote gender equity within the organization, the Wonca Council
adopted the Hamilton Equity Recommendations Statement (see
accompanying article), presented by the Wonca Working Party on Women
and Family Medicine (WWPWFM). The recommendations set in motion a
review of Wonca’s Bylaws and Regulations on gender balance. The Wonca
Executive established a group to address issues of gender equity chaired by
the President and will include appropriate representatives from the
Executive Committee, Bylaws Committee and the WWPWFM. This work will
start soon in the new triennium. The Wonca Council also adopted the
WWPWFM report entitled, “Ten Steps towards Gender Equity”.
Bruce Sparks Addressing Wonca Council, with
Alfred Loh (left) and Chris Van Weel (right)
Wonca Council Celebrates its Diversity
A part of the Council meeting
was directed at a consultation of
the WHO Committee on the Social
Determinants of Health. The Deputy
Chair of the Committee, Dr David
Satcher, presented the interim report
and invited Council members to
comment. Also in this session, the
importance of equity in order to be
able to provide high quality care
was stressed. In a separate
contribution to this issue, Prof Jan
De Maeseneer reviews the work of
the WHO Committee.
The Wonca Council elected,
ratified or appointed its leaders for
the upcoming 2007-2010 Triennium.
They are:
* Prof Chris van Weel, from The
Netherlands, President
* Prof Bruce L. W. Sparks, South
Africa, Past President
* Prof Rich Roberts, United States,
President-elect
* Professor Igor Svab, Slovenia,
Regional President of Europe
* Dr Preethi Wijegoonewardene,
Sri Lanka, Regional President of
Middle East South Asia
0
10
20
30
40
50
60
1970s
1980s
1990s
2000s
Wonca Membership Growth By Decade
# by Decade
WONCA
News
FEATURE STORIES
7
* Dr Donald Li, Hong Kong, Regional President of Asia-
Pacific
* Dr Alain Montegut, United States, Regional President
of North America
* Prof Khaya Mfenyana, South Africa, Regional
President of Africa
* Prof Adolfo Rubinstein, Argentina, Regional
President of Iberoamericana-CIMF
* Dr Javier Dominguez del Omo, Mexico, Member-at-
Large
* Prof Iona Heath, United Kingdom, Member-at-Large
* Pro Michael Kidd, Australia, Member-at-Large
* Prof Rich Roberts, Chair, Nominating and Awards
Committee
* Prof Michael Kidd, Chair, Finance Committee and
Honorary Treasure
* Dr. Iona Heath, Chair, Membership Committee
* Dr Dan Ostergaard, United States, Chair, Bylaws and
Regulations Committee
* Dr Geoff Martin, Australia, Chair, Publications
Committee
* Dr Marc Rivo, United States, Editor, Wonca News
* Prof Niels Bentzen, Norway, Chair, Wonca
International Classification Committee
* Dr Javier Dominguez del Omo, Chair, Working Party
on Quality in Family Medicine
* Prof Ian Cooper, South Africa, Chair, Working Party on
Rural Practice
* Dr Peter Schattner, Chair, Working Party on
Informatics
* Prof Michael Kidd, Australia, Chair, Working Party on
Education
* Prof Walter Rosser, Canada, Chair, Working Party on
Research
* Dr Amanda Howe, Canada, Chair, Working Party on
Women and Family Medicine
* Chair, Dr Gabriel Ivbijaro, United Kingdom, Working
Party on Mental Health
* Prof Rick Botelho, United States, Convenor, Tobacco
Cessation Special Interest Group
* Prof Rick Botelho, United States, Convenor,
Behaviour Change Special Interest Group
* Dr Alan Abelsohn, Convenor, Environment Special
Interest Group
* Prof Manfred Maier, Austria, Convenor, Ethical Issues
Special Interest Group
* Dr Garth Brink, Convenor, Travel Medicine Special
Interest Group
The Wonca Council conferred a series of awards of
honors to distinguished Wonca leaders. Wonca’s
International Triennium Award for Excellence in Health
Care – The Five Star Doctor Award was given to Arthur
Kaufman of the United States. This International Award
is given to a family doctor who is outstanding in five
categories: 1) care provider,
2) decision maker, 3) health care manager, 4)
community leader, and 5) communicator.
The Wonca Council conferred the award of
Fellowship of Wonca, its highest award, to the following
distinguished Wonca leaders:
* Dr Michael Boland, Ireland
* Professor Henk Lamberts, The Netherlands
* Professor Zorayda (Dada) Leopando, The Phillipines
* Professor John Murtagh, Australia
* Dr Luis Pisco, Portugal
* Professor Maurice Wood, United States
The Wonca Council conferred the award of Honorary
Life Membership to the following distinguished Wonca
leader:
* Dr Phillip Evans, United Kingdom
The Wonca Council received an energizing report,
presentation and promotional video on the upcoming
19th Wonca World Conference, in 2010, in Cancun,
Mexico, Host Organizing Committee Chair,
Dr Javier Dominguez del Olmo.
The Wonca Council received five outstanding bids
from Wonca Europe member organizations representing
Austria, the Czech Republic, Greece, Italy and Spain, to
host the 20th Wonca World Conference in 2013. The
Wonca Council selected the bid by the Czech Society of
General Practice, presented by Dr Bohumil Seifert and
Vaclav Benes, to serve as the Host Organizing
Committee for the 20th Wonca World Conference to be
held in Prague in 2013.
WONCA CELEBRATES AT THE 18TH WORLD
CONFERENCE IN SINGAPORE
More than 2000 delegates from 78 countries
gathered in Singapore from July 24-27 for the 18th World
Conference.
The conference theme, “Genomics and Family
Medicine”, brought to Singapore a group of world-
renowned plenary speakers. At the opening session,
Wonca President Bruce Sparks, Wonca Asia-Pacific
Regional President Goh Lee Gan, and Singapore Host
Organizing Committee Chair Tan See Leng welcomed the
delegates and formally begun the world conference. The
opening session featured two distinguished Guests of
Honor who focused on the state of health and health
from a national and global perspective, Singapore
Minister of Health Mr Khaw Boon Wan and Dr Shigeru
WONCA
News
FEATURE STORIES
8
Omi, Regional Director of Western
Pacific Regional Office of the World
Health Organisation.
WHO Western Pacific Regional Office Director
General Shigeru Omi, with Wonca Executive
Member Michael Kidd, and Wonca Asia-Pacific
Regional President Goh Lee Gan
An outstanding and diverse
group of morning and afternoon
plenary speakers included Dr Francis
Collins, Director of National Human
Genome Research Institute in the
United States; Professor Yvonne
Carter, Dean of the Warwick Medical
School in the United Kingdom; Dr
Spencer Wells, Population Geneticist
with National Geographic; Professor
Edison Liu, Executive Director of
Genome Institute of Singapore; and
Professor Michael Kidd, Head of the
Discipline of General Practice in the
University of Sydney, Australia.
In addition to the plenary
sessions, Scientific Committee Chair
Lee Kheng Hock and members
provided a diverse scientific
program, with more than 29
symposia and 24 workshops with
almost 150 papers presented, plus
more than 500 free papers and
poster sessions. In addition,
delegates visited the trade and
technology exhibitions, featuring a
vast sampling of education, practice,
business and service resources for
the family doctor and medical
group.
Conference delegates, guests
and family were treated to a
dazzling array of social programs,
culinary delights and inspiring sights
centered within a dynamic,
beautiful, and unique multicultural, South East Asian nation. The Singapore
Night Safari highlighted the social calendar, treating visitors to the
experience of exploring wildlife in a tropical jungle at night. Singapore
offered the delegates an unforgettable blend of Eastern and Western history,
traditions and contemporary experiences, and emphasized with an
exclamation point that the 18th Wonca World Conference truly was a global
celebration to remember.
WONCA ENDORSES HAMILTON GENDER EQUITY
RECOMMENDATIONS
Soon after the conference began, delegates to the 18th Wonca World
Conference in Singapore noticed that many Wonca Executive and Wonca
Council members were sporting large, bright, pink buttons with “HER,
Wonca, 2007” on their lapels. That is because the Wonca World Council at
its triennial meeting on July 23
rd
2007, unanimously endorsed The HER
Statement, or The Hamilton Equity Recommendations, in a historic move. At
the closing ceremony, the 2007 Wonca World Conference adopted three
resolutions, one concerning Gender Equity.
The HER Statement was developed in August 2006, in Hamilton, Ontario,
Canada, at a remarkable five day meeting of the Wonca Working Party on
Women and Family Medicine (WWPWFM), where 25 women leaders in family
medicine assembled from 16 different countries, and deliberated about how
to further the cause of gender equity in Wonca. The Statement was carefully
worded to include a key Preamble, which explained the underlying
conceptual context of how promoting the empowerment of women could be
the single most significant step that Wonca could take to improve health for
all, followed by four key recommendations.
Wonca WWPWFM Participants at the Historic Hamilton Meeting
The WWPWFM was established at the 16th World Conference in Durban
in 2001 to promote gender equity in health and the role of women family
doctors working in Wonca, to highlight their special contributions, and to
reduce the barriers facing them, thereby enabling them to reach their full
WONCA
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FEATURE STORIES / REGIONAL NEWS
9
WONCA REGIONAL NEWS
INTERNATIONAL
CONFERENCE IN BUENOS
AIRES FOCUSES ON
PRIMARY CARE
Nearly 30 years after the
International Conference on Primary
Health Care in Alma Ata (1978) and
taking into account that the year
2015 is set to measure compliance
with the Millennium Development
Goals (MDGs), the Government of
Argentina convened from August 13
to 15 an International Conference on
Health for Development focused on
primary health care. The goal was to
share experiences and reflections
among the regions and the
countries of the world on the
lessons learned from implementing
Alma Ata’s Primary Health Care
potential and enhance the contribution of family physicians/general
practitioners around the world to clinical care, women’s health, education,
research and leadership in family medicine.
In June 2006, Dr. Alfred Loh wrote in Wonca News that participation of
women in various Wonca committees and past Councils had been very
limited, “so it could be safely concluded that the issue of gender imbalance
needs to be addressed at both national and global levels”. He called upon
the WWPWFM to submit a set of recommendations to Wonca Executive for
its consideration.
The endorsement of the HER Statement is a significant step forward.
Time will tell whether the initial formal steps taken by Wonca as a result of
these resolutions actually significantly impact on the serious and presently
entrenched gender imbalance in Wonca, globally and nationally.
The “Hamilton Equity Recommendations” statement endorsed, reads as
follows:
1. Cognizant of the fundamental aspiration of all individuals, families,
communities and peoples to achieve and maintain the highest quality of
life;
2. Recognizing the centrality of improved and optimal health to the
achievement of the highest quality of life;
3. Recalling the important provisions of the charters, declarations and
instruments of the United Nations, WHO, UNDP and other international
organizations regarding human rights, equity, development, health and
human dignity;
4. Convinced of the centrality of women’s and girls’ status as a determinant
of the health of women and children, and of the families and
communities of which they are part, throughout the world;
5. Recognizing that the elimination of gender inequality (as well as other
violations of universal human rights) is an important prerequisite for
development, including the improvement and achievement of optimal
health;
6. Affirming that the improvement and achievement of optimal health is
dependent on high standards and levels of health care provision,
organization, teaching and research;
7. Convinced that general practice/family medicine is the cornerstone of the
achievement of high standards and levels of health care provision,
organization, teaching and research throughout the world;
8. Noting the global benefit of organization and knowledge exchange
between general practice/family medicine organizations and practitioners,
and between general practice/family medicine and other organizations
concerned with health and medical care;
The WWPWFM urges the general practice/family medicine organizations
of the world that are constituted as the World Organization of National
Colleges, Academies and Academic Associations of General Practitioners/
Family Physicians (Wonca) to adopt the following fundamental
recommendations regarding gender equity:
1. Enshrine the principle of gender equity within Wonca governance by
amending the Wonca By-laws and Regulations, as proposed by the
WWPWFM.
2. Implement gender equity in all
activities of Wonca, in particular
the scientific programs of its
triennial, regional, and rural
meetings.
3. Promulgate the pivotal role of
gender as a key determinant of
health.
4. Promote the equitable inclusion
and advancement of women
general practitioners/family
physicians in Wonca.
Those interested in obtaining
additional information on the
WWPWFM may visit their website
at
www.womenandfamilymedicine.com,
may join the WWPWFM listserve
(contact lcandib@massmed.org), or
contact Amanda Howe, Chair
WWPWFM at
Amanda.howe@uea.ac.uk.
10
WONCA
News
REGIONAL NEWS
Strategy, and actions that are necessary to achieve the
MDGs.
This high level international conference convened
Ministers of Health and other high level representatives
from more than 60 countries, including WHO Director
General, Margaret Chan, the Director of PAHO, Mirta
Roses, DHalfdan T. Mahler (the former Director of WHO
at the time of the Declaration of Alma-Ata), Michael
Marmott, Phil Musgrove, and Phillip Evans. Participants
debated and discussed the future and directions of
primary care worldwide in preparation for the next 2008
WHO World Report that will be dedicated to revisiting
primary health care 30 years after Alma-Ata.
I was invited as a Regional President of Wonca
Iberoamericana CIMF and had the opportunity to talk
with important WHO officials, such as PAHO Director
Roses, about the necessity to emphasize the role of
family doctors within family health teams and the
involvement of Wonca as a key NGO to contribute to the
WHO Primary Health Care world report.
WHO General Director Dr Margaet Chan (left) ; the Argentine Minister
of Health, Dr. Ginés González García; and PAHO/WHO Director Dra.
Mirta Roses Periago (right) at the opening session of the Conference
The activities went smoothly. Each day began and
ended with presentation of keynote speakers, followed
by a panel constituted by different experts, and then
delegates were broken in small groups session to
discuss the evolving documents. Over the last two days
of the Conference, sessions were held in which the
Ministers and / or their representatives arrived to the
final conclusions, summarized in the Declaration
described below. .
DECLARATION: Towards a health strategy for equity,
based on primary health care August 17th 2007 Buenos
Aires, Argentina
We, the Ministers of Health and representatives of
the Ministries of Health attending the International
Conference of Health for Development: “Rights, facts
and realities”, have gathered in the City of Buenos Aires
on August 16th and 17th, 2007, to analyze the
achievements and difficulties in the implementation of
the Primary Health Care Strategy and with the object to
foster the strengthening of already established
consensus and generate new proposals, tending
towards the establishment of a strategy of an equity
based comprehensive health care.
Whereas, and taking into account that:
1. We reaffirm that the enjoyment of the highest
attainable standard of health is one of the
fundamental rights of every human being with out
distinction as to race, religion, political belief or
economic or social condition. This is a key
responsibility of the State, together with the
participation of the citizens.
2. We acknowledge that the efforts of the public
policies and societies must be oriented towards
human development. This implies that said efforts
require an orientation towards the improvement of
quality of life for the people, against poverty and
exclusion, ensuring equal opportunities and the
development of the capacities of the persons and
their communities.
3. Health is an outcome of different and dynamic
social, economic, cultural and environmental
determinants. Responsibility for it belongs to
everyone. Although it goes far beyond the curative,
disease oriented medical care, health service
systems have a key role in bringing sectors
together including the community. This implies a
need for policies by the State and the
collaboration and commitment from all the sectors:
public organizations, private sector, community
organizations, international organizations and each
citizen.
4. We acknowledge that health is fundamental to
secure the objectives of development agreed to
internationally, including those stated in the
Millennium Declaration, and that these objectives
create an opportunity to integrate health as an
essential part of development and therefore, to
increase the political commitment and the
resources destined to the sector.
5. We affirm that equity, solidarity and universality
should govern health and development systems
and policies.
6. The Primary Health Care (PHC) strategy is based on
values and principles that remain relevant and
which must guide the structure and operation of
the health systems at all levels and for all.
7. Health problems do not respect boundaries
between states and jurisdictions. Further more, old
problems of poverty and exclusion still exist today,
and new challenges exist related to the
environment, demographic changes, unhealthy
lifestyles, and emerging and reemerging diseases.
8. The Primary Health Care (PHC)
strategy must be capable of
dealing with both old health
problems as well as the new
and emerging ones.
9. Nearly 30 years after the Alma
Ata Declaration the health
situation of a great part of
humanity is deplorable and
large parts of humanity do not
enjoy equitable,
comprehensive, or even basic
health care.
10. Health human resources are
generally not trained to
respond to socially complex
health problems involving
prevention, promotion, inter-
sectoral cooperation, client-
provider relations and
community participation.
11. We are very far from reaching
the Goals related to health
contained in the Millennium
Declaration. We acknowledge
that international and national
policies, including social and
economic policies, have
affected our ability to meet the
MDGs and develop equitable
health systems.
12. It is imperative that we solve
these difficulties and develop a
new implementation plan for
the strategy that brings us
nearer not only to reaching the
Objectives of the Millennium
Declaration, but to the full
implementation of the values
and principles of Primary
Health Care.
We accept the following principles:
13. Health is a cause and
generating factor of
development and growth of a
nation. For this reason, we
consider health as an
investment and not as an
expenditure, and also a
responsibility of the State and
society as a whole.
14. Equitable health care is a key
factor for development and can
stimulate equitable approaches
in other fields. This requires
priority and strong public
policies which involve all
stakeholders.
15. In order to achieve equity
based health care, it is
imperative to strive towards
universal and comprehensive
coverage. In doing so, policies
and programs need to be
gender-responsive, inclusive,
non-discriminatory, and
prioritize vulnerable groups.
Therefore we commit to develop
processes that:
16. Take into account the values
and principles of Primary
Health Care, to guide the
policies, structure and
functions of the health systems
at all levels for all.
17. Support the leadership and
stewardship role of the State
and the participation of
families, communities and all
other stakeholders in guiding
planning and where
appropriate, in the
implementation and support of
health programs and services
in a comprehensive and
intersectoral manner.
18. Determine the set of programs
and services necessary to
achieve equity-based health
care, that the countries can
implement according to their
national contexts.
19. Assure adequate financing of
the programs and services that
are considered necessary for
each country, ensuring
sustainability and working
towards universal coverage.
20. Incorporate into the design
and implementation of health
and development policies,
factors such as socio-economic
status, culture, ethnicity,
gender, age and disability.
21. Strive to eliminate inequities in
the quality of health services
within the countries.
22. Ensure that health systems do
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11
not reproduce inequities found
in other sectors and engage in
intersectoral collaboration to
promote social inclusion and
poverty reduction public
policies.
23. Strengthen relationships
between the health authorities
and educational institutions to
meet the needs of the
population by training health
workers to use interdisciplinary
approaches for new social,
environmental and health
problems.
24. To involve the health
authorities in intersectoral
collaboration to help develop
public policies of other sectors
when they affect health, such
as those aimed at improving
access to drinking water, safe
food, decent work, a healthy
environment and adequate
shelter.
25. Include into official
publications indicators to
measure equity.
26. Strengthen joint cooperation
between countries and
institutions in managing health
issues of local, national and
international concern.
27. Support rapid implementation
of the above-mentioned
actions, in a framework of
equity and social justice, to
achieve the enjoyment of the
highest attainable standard of
health, which is one of the
fundamental rights of every
human being with out
distinction to race, religion,
political belief or economical
or social condition.
Aldofo Rubinstein
adolfo.rubinstein@hospitalitaliano.org.ar
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Preethi Wijegoonewardene -
Middle East South Asia Regional
President
He has been an active family
physician for the past 24 years
before which he served in the state
Hospitals as a Medical Officer for
about 5 years.
As a family physician for several
decades, Preethi has made a
significant contribution to the
undergraduate teaching programmes
of the three Faculties of Medicine of
the Universities of Colombo,
Kelaniya and Sri Jayewardenepura.
He is also actively involved in
postgraduate teaching of general
practice in the Postgraduate Institute
of Medicine, University of Colombo
since 1985. He is an active member
of the Board of Study in Family
Medicine of the Postgraduate
Institute of Medicine, University of
Colombo since 1999 and has taken
responsibility in many of its
activities.
Preethi Wijegoonewardene - Middle East
South Asia Regional President
He is a senior lecturer of the
Faculty of Teachers of the College of
General Practitioners of Sri Lanka.
He serves in the international board
of the MRCGP International South
Asia Examination. He has been an
examiner for the Diploma in Family
Medicine in Colombo and India for
many years and for the MRCGP
International South Asia examination
in March 2007. He is also the senior
Vice President (Medical) of Ceylon
Hospitals Ltd (Durdans Hospital) - a
leading private multi disciplinary
hospital in Colombo.
In 2002 he was the President of
the Sri Lanka Medical Association
(which is the umbrella organization
of all doctors in the country, and the
oldest national organization of
doctors in Australasia). He brought
pride to the general practitioners, as
rarely has this honour been
bestowed on a Family Physician.
Dr. Wijegoonewardene has been
actively involved in the College of
General Practitioners of Sri Lanka
since 1985, and held office in the
Council for several years. As
President, he took the College
forward, and has proved himself to
be a leader in Family Medicine in Sri
Lanka. He is an extremely popular
figure amongst all colleagues in the
South Asian Region. He has worked
hard to impress on Health Planners,
the Ministry of Health, and the WHO
Regional Office that the family
physician plays a pivotal role in a
primary health care team of a
country. He has thus proved himself
to be a good team player, and an
excellent team leader. Most of all, he
is a leading family doctor in
Colombo, and has proved himself to
be popular, committed and loved by
the people he serves in his practice
community.
Preethi’s wife, Sunethra, supports
him in all his professional activities
and the couple’s many social
obligations. Preethi and Sunethra
have two children. Their son, Indika,
is a young doctor, who has just
completed internship from Manipa
Medical College, India and is hoping
to proceed to Australia for
postgraduate training. Their
daughter, Venya, is a final year law
student at the University of Bristol,
U.K and plans to study further in the
UK.
EURACT PATIENT
EMPOWERMENT COURSE HELD
IN BLED
A total of 56 participants from 12
countries attended the 16th EURACT
(European Academy of Teachers in
General Practice) International
Course on Patient Empowerment was
held in Bled, Slovenia from
September 18-22, 2007.
The aim of the course was to
work on “patient empowerment”, a
recent development in most Western
Health Care Systems. It means that
the patient is knowledgeable and
informed about his/her disease, is
willing and/or obliged to take self-
responsibility for his/her health, is
involved in medical decision-making,
is respected by health care
professionals. Therefore, patient
empowerment bridges two core
competencies of Family Medicine
and General Practice: person-
centeredness and the holistic
approach. Further, patient
empowerment can be seen as a new
framework for the patient-physician-
relationship and also as a measure
of quality improvement in health
care systems.
The aim of the course was to
teach participants the possibilities
for and forms of empowering
patients and the reasons for the
development of patient
empowerment (and of case
management programs). Course
participants learned how to assess
patient empowerment effects in
different case management
programs, and to appreciate the
difficulties in assessing its effects.
At end of the course, participants
learned to value the increasingly
important responsibility of patients
for their health, and recognize that
medical students and trainees
should learn about patient
empowerment.
HEALTH AND HEALTH
SYSTEM NEWS
WHO COMMISSION ON
SOCIAL DETERMINANTS
OF HEALTH MEETS WONCA
COUNCIL IN SINGAPORE
The late Dr Lee Young-Wook,
then Director General of the World
Health Organisation (WHO),
established the World Health
Organization’s (WHO) Commission on
Social Determinants of Health in
March 2005. The WHO endorsement
has been carried forward with the
support of the present WHO Director
General, Dr. Margaret Chan.
The Commission on Social
Determinants of Health (CSDH) seeks
to create a global movement for
health equity, rooted in shared
beliefs in social justice and human
rights. Realising the Commission’s
vision of a world in which people
have the freedom to lead the life
they have reason to value, requires
action on the social determinants of
health. The goal of the Commission
is to gather evidence, harness
national and local efforts, detail
what effective social action must
entail in order to maintain, promote,
and provide better health for all,
advocate for change and engage
with those responsible for health-
related decision making.
Professor David Satcher Addressing the Wonca
Council
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Professor Jan De Maeseneer Listening Intently
as Wonca Council Offer Recommendations to
the Commission Report
The goals of the CSDH are
pursued through a number of work
streams operating in parallel:
Knowledge Networks, Partner
Countries, Civil Society
Organisations, and Global Initiatives.
Within the various work streams,
efforts have been made globally to
expand the evidence base on social
determinants of health, and in
particular on effective action to
understand and deal with these
determinants. The Commission is
supported by a secretariat based in
the WHO Department of Equity,
Poverty and Social Determinants of
Health, in Geneva, Switzerland, and
the International Institute of Society
and Health, University College
London, England.
Leading the Commission on
Social Determinants of Health are 19
commissioners who are global and
national leaders from politics,
government, civil society and
academic fields.
The Chairman of the Commission
is Prof. Sir Michael Marmot. An
important member of the
Commission is Prof. David Satcher,
Director of the Center of Excellence
on Health Disparities at the
Morehouse School of Medicine, a
former United States Surgeon
General, and a family doctor.
The Commission has set up 9
Knowledge Networks arranged
around the teams of globalisation,
health systems, urban settings,
During the course keynote
presentations, group work, role-play,
poster sessions, fieldwork and
discussions were held. Country
reports concerning patient
empowerment were presented. A
selected number of key papers were
presented to the audience during
Saturday morning’s plenary session.
Three workshops on the same
patient empowerment theme will
take place in different regions of
Slovenia in November 2007,
December 2007 and in January
2008.
The 2008 course will be held
from September 16-20 at the Hotel
Jelovica in Bled, Slovenia. The theme
will focus on self-medication. There
is a 40 EURO reduction of the course
fee for EURACT members. A limited
number of sponsored places is
available through the EURACT
sponsorship programme. The 2008
course information is available at
the EURACT website: www.euract.org
or through the Slovene Family
Medicine Society at http://
www.drmed.org/
novica.php?id=10483.
Nena Kopcavar Gucek
nenagucek@gmail.com
employment and working
conditions, early child development,
social exclusion, women and gender
equity, measurement and evidence,
and priority public health
conditions. These Knowledge
Networks were established to
collect, collate and synthesize a
diverse range of evidence on:
plausible causal relations; key-areas
in which action should take place;
effective practices and interventions
for addressing socially determined
health inequities globally.
Prof. Jan De Maeseneer (Ghent
University) represents WONCA in the
Knowledge Network on Health
Systems. The team of Prof. De
Maeseneer provided a literature
review on primary health care as a
strategy for achieving equitable care
for the CSDH.
Given the global importance of
the Commission’s work, the Wonca
Executive scheduled a CSDH
workshop in Singapore on July 22nd
for the Wonca Council to review the
Commission draft report with Profs
Satcher and De Maeseneer. It
became very clear that the Wonca
Council was convinced that social
determinants are very relevant for
family physicians/general
practitioners all over the world.
Moreover, based on the work of
small groups in a “break-out
session”, Wonca formulated the
following suggestions to the
Commission:
* Promote family medicine and the
role of family doctors. Insure that
primary care is seen as a medical
“home” for all. It is clear that
there is still a way to go,
especially in developing
countries; therefore moving to a
“family doctor for every family”
will be incremental. In promoting
family medicine and primary
health care, we will have to
tackle some barriers: primary
care is sometimes seen as
providing only a “huge” or
“curative” care. Primary care also
includes preventive, chronic end-
of-life. Another barrier is that
primary care is sometimes felt to
be only for “the poor”. But those
with money also need primary
care. If not, there is a risk for
wasting resources. Over-
subspecialisation and
“verticalisation” of care carves up
and fragments primary care,
which negatively affects
everyone.
* Collect information on the value
of primary health care. The
Commission on Social
Determinants of Health should
collate information on the value
of primary care, the contribution
of primary care/family medicine/
general practice to providing
social equity and narrowing the
gaps of disparities of care. The
work of Starfield, the Graham
Center and the report by the
Commonwealth Fund give good
evidence to the Commission.
* Integrate public health and
primacy care. It is important to
identify and facilitate the
breakdown of the barriers
between public health and the
delivery of primary care health
services.
* Train family doctor leaders.
Encourage family doctors to be
leaders in the community -
including local, regional and
national levels. This should
include training in media
relations, public speaking, and
other leadership skills where
appropriate.
* Improve access to quality
primary care. It is important to
realise that the health care
system may also constitute a
barrier to health care. Therefore
it is important to focus on the
question “How can we improve
access?” How can we have a
more holistic approach? How can
we increase social accountability?
At a practice level, at the
member organisation level? At
WONCA level? What WONCA can
do is advocate for everybody to
have access to quality primary
care.
* Improve primary care research.
WONCA should stimulate the
development of research in the
understanding of behavioural
change for both individuals and
populations as a whole. WONCA
should contribute to medical
evidence and public health
evidence.
* Improve primary care financing:
The way health care is financed
is important. WONCA should
promote reimbursement for care,
which provides good community
outcomes.
* Enhance the contribution of the
family doctor within primary care
teams. Family physicians should
operate in the framework of the
primary health care team and
should link intersectorally with
community agencies.
* Share best primary care
practices. WONCA should create
a platform to share best
practices.
Prof. David Satcher responded in
a very positive way to the
suggestions by the audience. He
emphasized that the role of primary
health care and family physicians
will be of utmost importance in
order to address social determinants
of health. He invited Wonca to be
involved in the process and to give
feedback to the interim statement:
Achieving health equity: from root
causes to fair outcomes”.
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14
We would invite family
physicians all over the world to look
at the interim statement ( hrough
the website: http://www.who.int/
social_determinants/en) and to send
input and feedback to
Jan.DeMaeseneer@Ugent.be.
WONCA should take into account
the topic of social determinants of
health in the future orientation of its
activities.
Prof. Jan De Maeseneer, M.D., Ph.D.
Department of Family Medicine and
Primary Health Care, Ghent
University, Belgium.
Wonca Liaison person with CSDH.
(Editor’s note: Prof De Maeseneer’s
CSPH literature review on primary
health care’s contribution to equity
and health, “ Intersectoral Action
for Health in Belgium: A Multilevel
Contribution to Equity” can be read
in its entirety on Wonca’s online
Global Resource Directory at: http://
www.globalfamilydoctor.com/
education/GlobalResourceDirectory/
grdindex.asp?refurl=ed )
WHO DG MARGARET CHAN:
PRIMARY HEALTH CARE IS KEY
TO MILLENIUM DEVELOPMENT
GOALS
The World Health Organization,
under Director-General Dr Margaret
Chan, has refocused attention on
that central role of primary health
care in health system improvement.
At the August 16 International
Conference on Health for
Development in Buenos Aires, Dr
Chan spoke about primary health
care’s contribution to the Millennium
Development Goals. The following
is excerpted from Dr Chan’s speech:
WHO Director-General Dr Margaret Chan
“The topics being explored
embrace some of the most pressing
issues in public health today. How
can we realize the great potential of
health to drive human development,
as acknowledged in the Millennium
Development Goals? Obviously, if we
want better health to work as a
poverty reduction strategy, we must
reach the poor. And we must do so
with appropriate, high-quality care.
What role can primary health care
play in this quest?
More specifically, how can we
overcome major barriers, such as
weak health systems, inadequate
numbers of health care staff, and
the challenge of financing care for
impoverished people? You have
been exploring these issues during
the past three days, and I look
forward to your conclusions.
When I took office at the start of
this year, I called for a renewed
emphasis on primary health care as
an approach to strengthening health
systems. The experiences and
recommendations coming from this
conference are extremely relevant to
public health today, both within
countries and for the work of WHO.
The Declaration of Alma-Ata
promoted primary health care as the
key to attaining an acceptable level
of health for all people in this
world. This was the heart of the
Health for All movement. Decades of
experience tell us that primary
health care is the best route to
universal access, the best way to
ensure sustainable improvements in
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15
health outcomes, and the best
guarantee that access to care will be
fair.
I would like to suggest four
principles that can guide us as we
explore ways to achieve equity-
based comprehensive health care
and look at the contribution of
primary health care. First, we must
maintain our commitment,
determination, and above all, our
sense of urgency. Second, we must
hold our politicians accountable for
the promises they make. Third, if we
want politicians to make the right
promises and keep them, we must
provide solid evidence. Primary
health care is not cheap. It is not a
bargain-basement way for
governments to fulfill their duty to
protect all citizens from risks and
dangers to health. We need a
better body of evidence
demonstrating costs and benefits,
best practices, interventions that
work best in specific situations, and
the impact of these interventions on
health outcomes. Finally, we must
never underestimate the power of
human ingenuity. This power goes
hand-in-hand with resolute
determination to reach a goal.
As my last remark, I believe that,
when we talk about primary health
care, we must also acknowledge the
great ingenuity of communities.
Human nature has certain
commonalities that transcend
differences of place, race, religion,
and culture. Compassion in the face
of suffering and a desire to help is
one common trait. Aspiration for a
better life is another. Time and time
again we see how, when
communities are given opportunities
they want and programmes they can
own, they are empowered to
achieve the lives they desire. Given
a hand up, they can indeed lift
themselves out of poverty and
improve their health.”
WHO Director General Margaret
Chan’s full speech to the conference
can be found at: http://www.who.int/
dg/speeches/2007/
20070816_argentina/en/index.html
Behavioral Changes Key to
Health Care Reform in Hong
Kong
The Bauhinia Foundation
Research Centre’s Health Care Study
Group of Hong Kong released a final
report “Development and Financing
of Hong Kong’s Future Health Care”
on 23 August 2007.
In releasing the highlights of its
final report, Dr Donald Li, Study
Group Convenor and Wonca Asia
Pacific Region President, said, “In
reforming Hong Kong’s health care
system, behavioral changes are
essential. No matter how much
funding is available, health care
resources will be exhausted if there
is insatiable demand and
indiscriminate use.”
Donald Li, Wonca Asia-Pacific Region
President
The report recommended that, to
ensure the sustainability and
responsiveness of Hong Kong’s
health care system in the long run,
efforts should be made to promote
behavioral changes in individuals,
government and service providers.
Individuals must assume greater
self-responsibility for own health
and more emphasis on disease
prevention and detection;
Government should increase public
emphasis on primary health care
and provide users with choice and
better services through shared
responsibility. Physicians and other
providers should seek to enhance
their service standards and fee
transparency.
Before finalizing its proposal, the
Study Group compared the pros and
cons of various health care financing
options, including heath insurance,
health care taxes as well as an
individual Medical Savings Account
(MSA) scheme that had been
proposed in a preliminary report.
The Study Group proposes in its
final report a new health care model
with a three-pillar framework
comprised of the following key
features and components. Pillar 1 is
a safety net; its scope and services
will not be less than what people
are getting today. Evidence-based or
beneficial essential items will always
remain as heavily subsided Pillar 1
services.
Pillar 2 is an added option for
those who do not want to rely on
the Pillar 1 system and offers
incentives for those adopting proper
health prevention and health
seeking behaviors. Pillar 2 is to
strengthen preventive health
services (e.g. initiation of family
doctor services, additional evidence-
based, age specific health screening,
etc) and to ensure access to quality
care in old age (e.g. dependency
care, hospice and palliative care,
visiting medical and nursing care,
etc). To instill a sense of joint
responsibility among individuals for
behavior modification, the Study
Group proposes that the
Government subsidize an average
50 percent of the costs of care.
Pillar 3 services are private
sector services not subsidized by
Government. Examples of such
services could include lifestyle
enhancement or maintenance,
cosmetic procedures, non-standard
formulary drugs, assisted
reproduction, some dental care, and
eye glasses.
The difference between Pillars 1
and 2 can be construed as a
difference in government subsidy to
support individuals to assume a
greater role in looking after one’s
health and well being.
In addition, the Study Group
proposed a mandatory Medical
Savings Account (MSA) scheme to
supplement Hong Kong’s successful
tax-based financing system. The
MSA is meant to foster desirable
health seeking behavior and
emphasize prevention and more
judicious use of health care
resources.
Under the scheme, account
holders will receive substantial
Government subsidy when using the
savings in the account to purchase
Pillar 2 services. They can choose
their preferred providers from a list
of Government approved providers,
which will include private
practitioners.
Funds in the MSA account could
be used anytime before the age of
65 to pay for fees and charges
under Pillar 1 and defined,
subsidized services under Pillar 2.
Users may also choose to
purchase government approved
health insurance plans where
available, such as hospitalization
plans after age 65, long term care
plans and possibly major illness
plans before age 65 using money
from the savings account.
As integral components of the
reform initiatives, the Study Group
also proposes enhancement of Hong
Kong’s primary health care. These
include promoting the establishment
of community-wide networks
delivering holistic primary health
care through integrated
WONCA
News
HEALTH AND HEALTH SYSTEM NEWS
16
17
WONCA
News
HEALTH AND HEALTH SYSTEM NEWS / MEMBER AND ORGANIZATIONAL NEWS
MEMBER AND
ORGANIZATIONAL NEWS
RICH ROBERTS – WONCA
PRESIDENT-ELECT
The Wonca Council, at its July
23rd meeting in Singapore, elected
Rich Roberts from the United States
as its President-elect.
Richard Roberts is Professor and
past Chair in the Department of
Family Medicine at the University of
Wisconsin School of Medicine &
Public Health in Madison, Wisconsin,
USA. A family physician and
attorney, he has practiced in
Belleville, a rural community of 1900
people, since 1987. In addition to
teaching students, residents, and
fellows, Doctor Roberts provides the
full scope of family medicine
services: he delivers babies, cares
for patients of all ages, performs
endoscopy and minor surgery, and
attends patients in the hospital,
including those in intensive care
units.
Safety Foundation and the National
Advisory Council of the California
Health Benefits Review Program. He
served on guidelines panels of the
AAFP, American College of
Cardiology, American Pain Society,
American Urological Association,
United States Agency for Health Care
Policy and Research, and World
Health Organization.
Possessing a wide range of
health care leadership experience,
Dr. Roberts was a founding officer of
the University of Wisconsin Medical
Foundation, the faculty practice for
nearly 1000 university physicians.
He served as an associate medical
director for two health plans, and as
a director on the boards of a health
maintenance organization and a
statewide independent practice
association. Early in his career, he
was the managing partner in a four-
physician group in a very rural and
underserved community.
Professor Roberts’s scholarship
has focused on the development of
decision support tools to improve
clinical care, especially in the areas
of primary care renewal, quality
improvement, maternity health,
medico-legal issues, and urinary
health. He has authored more than
130 publications, been an
investigator on a dozen grants, and
given more than 500 presentations.
Rich and his wife Laura, an
exercise physiologist and fitness
consultant, have 4 children, aged
15-25 years. He enjoys travel and
time with his family, movies,
reading, writing, and volunteering at
MEDIC, a free clinic run by medical
students.
IAN COUPER NEW CHAIR OF
Wonca WORKING PARTY ON
RURAL PRACTICE
Wonca’s Working Party on Rural
multidisciplinary teams; establishing
a primary care doctor’s register;
implementing quality assurance
mechanisms; emphasizing a life-
course-oriented health screening
approach; and building portable
electronic medical records to
facilitate seamless primary,
preventative and secondary care
system of delivery.
Those interested in learning
more about Health Care Reform in
Hong Kong may contact Donald Li at
dr2318@hotmail.com.
Rich Roberts – Wonca President Elect
For a decade, he served on and
chaired the Wonca Working Party on
Quality in Family Medicine. As
Honorary Treasurer and a member of
the Wonca Executive since 2004, Dr.
Roberts helped develop financial
reporting and accountability
strategies, clarify Wonca’s legal
rights to ICPC-2, and open dialogues
with Google and the World Patient
Safety Alliance. He has represented
Wonca to the Global High Blood
Pressure Stakeholders Group.
Professor Roberts has taught in
40 countries on 5 continents,
including the last 5 Wonca World
Congresses. He supervised medical
student exchanges between the U.S.
and West Africa. Working with the
College of Family Physicians of
Canada, he conceived, organized,
and led the six-country, week-long
SOAR Family Medicine International
Colloquium to share ideas on the
renewal of family medicine, which
was convened in Toronto in
September 2006. He led U.S.
delegations on primary care to
Brazil, Uzbekistan, and Vietnam, and
was a member of U.S. delegations
to six WHO International
Consultations on urinary health.
Dr. Roberts is a Past President of
the American Academy of Family
Physicians (AAFP). He is a Trustee
on the Boards of the American
Academy of Family Physicians
Foundation and the Interstate
Postgraduate Medical Association.
He is a member of the Board of
Governors of the National Patient
18
WONCA
News
HEALTH AND HEALTH SYSTEM NEWS / RESOURCES FOR THE FAMILY DOCTOR
Practice held its annual face-to-face meeting prior to the
18th World Conference of Family Doctors in Singapore.
At this meeting, Professor Ian Couper was inaugurated
as the new chairperson of the working party, for the
next triennium. He was handed the Scottish stag horn -
which serves as the chairperson’s gavel - by the
outgoing chair, Professor Jim Rourke, dean of Memorial
University Medical School in Newfoundland, Canada.
Professor Couper noted that he would not be following
in the footsteps of his two predecessors who both
became deans during their terms of office. (The first
chair, Professor Roger Strasser, from Australia, went on
to become founding dean of the new Northern Ontario
Medical School in Canada)
From left to right: Prof Jim Rourke handing over the stag horn, which
serves as the working party’s gavel, to Prof Ian Cooper, with Prof
Roger Strasser, the previous chair.
Professor Couper outlined a vision for the working
party of “rural doctors REACHing towards rural health” in
partnership with like-minded groups”, with the REACH
encapsulating:
* Repositioning and relationship - renewing the vision
and mission of the Working Party, and re-positioning
its relationships with Wonca and other organizations.
* Education - Promoting rural medical education, rural
medical schools, and rural clinical schools.
* Activism - Being an international voice for rural
medicine and health including political activism on
issues impacting rural health, such as determinants
of rural health.
* Conferencing and communication - Continuing to
organise conferences for educational and
communication purposes to promote rural health.
* Health for All Rural People (HARP) vision - Moving
the process forward of getting a HARP resolution
adopted by the World Health Assembly, in
collaboration with WHO, and developing greater
support from WHO for the HARP documents already
developed.
He also stressed the important need for
transformation of the membership of the working party,
indicating his desire to move towards equal
representation of both genders, and of developing and
developed countries, as well as including all regions
and junior doctors. (Wonca members with an interest in
the working party can contact Ian Couper on
couperid@medicine.wits.ac.za)
During the Working Party’s Singapore meeting, much
time was spent on discussing the 8th World Rural
Health Conference, which will be held in Calabar, Cross
River State, Nigeria, from 20th to 23rd February 2008.
This conference has the theme “Frontline Medicine -
from Disasters to Daily Care” and is expected to be a
very interesting meeting. Cross River State is a very
peaceful part of Nigeria, unaffected by the oil-related
troubles occurring in some other parts of the country.
(see related article in this issue, and
www.ruralwonca2008.net)
The Working Party also accepted in principle a bid
from Crete to hold the 9th World Rural Health
conference in June 2009.
RESOURCES FOR THE FAMILY DOCTOR
8TH WONCA WORLD RURAL HEALTH
CONFERENCE SET FOR CALABAR,
NIGERIA
Disaster and response to emergencies are receiving
increasing global attention. This stems from recent
experiences that range from Tsunami to Hurricanes,
earthquakes, plane crashes, etc, etc. Most often the
world watches as rural communities with very little
capacity to cope and respond are decimated. Also as
several countries face various challenges in improving
their medical systems including response to the HIV/
AIDS pandemic, where do rural people stand in these
matters? The 2008 Wonca Rural Health Conference to be
held in the city of Calabar, Cross River State, Nigeria, is
planned to reflect on these issues, with a focus on
disasters and the development of Rural Family Medicine
worldwide. It will also provide a forum for family
physicians, rural doctors and other stake holders, to
share experiences and try to proffer solutions to
WONCA
News
RESOURCES FOR THE FAMILY DOCTOR
19
Save Your Life: A Six-Step Plan for Staying
Healthy Longer
Save Your Life and the Lives of Those You Love: Your
GP’s 6-Step Guide to Staying Healthy Longer is an
authoritative but easy-to-understand preventative health
guide for adults endorsed by the Royal Australian
College of General Practitioners. Readers will learn
how to prevent or detect the 9 most common life-
threatening illnesses affecting people in their part of the
world: heart disease, stroke, cancer, lung disease,
depression, dementia, diabetes, kidney disease and
osteoporosis.
Save Your Life is written by practicing GPs Professors
Michael Kidd and Leanne Rowe and endorsed by the
Royal Australian College of General Practitioners. More
than 15,000 copies have been sold since its official
launch at the RACGP’s 50th Anniversary Conference in
July.
Leanne Rowe is a rural general practitioner and
Deputy Chancellor of Monash University. She is a former
Chairman of the Royal Australian College of General
Practitioners and holds academic appointments with the
University of Sydney and the University of Melbourne.
She is a past recipient of the Best Contribution to
Health Care in Australia’ awarded by the Australian
Medical Association.
Michael Kidd is Professor and Head of the
Department of General Practice at the University of
Sydney and works as a general practitioner in an inner
city suburb. He was president of the Royal Australian
College of General Practitioners from 2002-2006. He is a
member of the executive committee of the World
Organization of Family Doctors and their liaison person
with the World Health Organization.
Save Your Life is an essential reference for everyone
who cares about their own health or the health of
someone they love.
(Save Your Life and the Lives of Those You Love:
Your GP’s 6-Step Guide to Staying Healthy Longer Profs.
Michael Kidd and Leanne Rowe, Allen and Unwin
Publishers. Price: $27.95 UD)
problems in Rural Health in preparation for meeting the
objectives of the Millennium Development Goals in 2010
and beyond. The Conference with the theme Frontline
Medicine - From Disasters to Daily Care runs from 20th-
23rd February, 2008.
The programme will include plenary sessions and
workshops offering new perspectives on Disasters,
Practice, Training, Research, Rural Medicine and Rural
Health, Care of the Minority Groups and the future
development of Family Medicine; including issues and
controversies surrounding these areas with teaching and
training workshops for those who want to enhance their
clinical skills and expertise. There will be symposia to
cover the realms of Rural Family Practice, including
surgery, family counseling, practice management and
medico-ethical issues, while free papers and posters
segments have been designed to allow participants to
cross-fertilise ideas around the world.
The choice of the evergreen, clean, peaceful and
scenic city of Calabar offers an opportunity to savor the
warm and legendary hospitality of the people of Cross
River State of Nigeria. This peaceful and secure state is
distant from the oil-related troubles of the Delta region
of Nigeria, which make the headlines. Regular direct
flight connections from Lagos International Airport make
access to Calabar easy and safe. Drill monkeys are now
an endangered species but with the refuge created in
Cross River State there is still hope for the future. The
lowland Gorilla now known to exist in the Cross-River/
Cameroon mountain ranges has also become a
protected species and inhabits the Cross River National
Park. Other wonders of nature can be seen at Obudu
Ranch and various waterfalls in the State.
Attending the 2008 Wonca Rural Health Conference
will leave a lingering pleasant memory. Do not miss it.
For more information go to www.ruralwonca2008.net.
Dr Ndifreke E. Udonwa
Chairman, Conference Organising Committee
Email: nudonwa@yahoo.com
WONCA
News
CONFERENCES 2007 – 2013
20
WONCA CONFERENCES 2007 – 2013 AT A GLANCE
**Wonca Direct Members enjoy lower conference registration fees
See Wonca Website www.GlobalFamilyDoctor.com for upates & membership information
2007
17 – 20 Oct
European
Paris
Re-Thinking Primary Care in the European
Regional
FRANCE
Context: A New Challenge for General
Conference
Practice
2008
20-23 Feb
8
th
Wonca
Calabar
Frontline Medicine –
World Rural Conference
NIGERIA
from Disasters to Daily Care
4 – 7 Sept
Europe
Istanbul
Theme to be confirmed
Regional
TURKEY
Conference
1 – 5 Oct
Asia Pacific
Melbourne
A Celebration of Diversity
Regional
AUSTRALIA
Conference
2009
1-4 March
African
Johannesburg
Family Medicine
Regional Conference
SOUTH AFRICA
in the African Context
5 – 8 June
Asia Pacific
Regional
Hong Kong
Building Bridges
Conference
16 – 19 Sept
Europe
Basel
The Fascination of Complexity -
Regional
SWITZERLAND
Dealing with Individuals in a
Conference
Field of Uncertainty
2010
19 – 23 May
19
th
Wonca
Cancun
Millennium Development Goals:
World
MEXICO
the Contribution of Family Medicine
Conference
October
Europe
Malaga
Theme to be confirmed
Regional
SPAIN
Conference
2011
February 2011
Asia Pacific
Cebu
Paradigms of Family Medicine:
Regional
PHILIPPINES
Bridging Old Traditions with
Conference
New Concepts
2013
June
20
th
Wonca
Prague
Proposed theme:
World Conference
CZECH REPUBLIC
Family Medicine: Care for Generations
Information correct as of October 2007.
May be subject to change.
21
WONCA
News
GLOBAL MEETINGS FOR THE FAMILY DOCTOR
GLOBAL MEETINGS FOR THE
FAMILY DOCTOR
WONCA WORLD AND
REGIONAL CONFERENCE
CALENDAR
Wonca Europe Regional Conference,
Paris, 2007
Host:French National College of
Teachers in General
Practice
Theme:Rethinking Primary Care in
the European Context
Date:17-20 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
Email:cnge@cnge.fr
Web:www.cnge.fr
8
th
Wonca Rural Health Conference,
Nigeria 2008
Host:National Post-Graduate
Medical College of Nigeria
Theme:Frontline Medicine – From
Natural Disasters to Daily
Care
Date:20
th
– 23
rd
February 2008
Venue:Calabar, Cross River State,
Nigeria
Contact:Dr Ndifreke Udonwa
Chair Local Organizing
Committee
C/O Office of C.M.A.C
University of Calabar
Teaching Hospital,
GPO Box 147, Calabar
54001, Cross River State,
Nigeria
Tel:234 (0) 803 341 6810
Fax:234 (0) 87 232 053
Email:nudonwa@yahoo.com
Wonca Asia Pacific Regional
Conference, Melbourne 2008
Host:Royal Australian College of
General Practitioners
Theme:A Celebration of Diversity
Date:1-5 October 2008
Venue:Melbourne, Australia
Contact:The Meeting Planners
91-97 Islington Street
Collingwood Victoria 3066
Australia
Tel:613 9417 0888
Fax:613 9417 0899
Email:
wonca2008@meetingplanners.com.au
Web:
wonca2008@meetingplanners.com.au
Wonca Africa Regional Conference,
Johannesburg 2009
Host:South African Academy of
Family Practice/Primary
Care
Theme:A Celebration of Diversity
Date:1-4 March 2009
Venue:Johannesburg, South Africa
Wonca Europe Regional Conference,
Basel, Switzerland 2009
Host:Swiss Society of General
Medicine SSMG/SGAM
Theme:The Fascination of
Complexity - Dealing with
Individuals in a Field of
Uncertainty
Date:16-19 September 2009
Venue:Congress Center Basel,
Switzerland
Contact:Dr Bruno Kissling
Chair Host Organizing
Committee
Swiss Society of General
Medicine SSMG/SGAM
Elfenauweg 6, CH-3006
Bern
Switzerland
Tel:0041 352 48 50
Fax:0041 352 28 84
Email:bruno.kissling@hin.ch
Web:
www.woncaeurope2009.org
19th Wonca World Conference,
Cancun 2010
Host:Mexican College of Family
Medicine
Theme:Millennium Develop Goals:
The Contribution of Family
Medicine
Date:19-23 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:
jdo14@hotmail.com
MEMBER ORGANIZATION AND
RELATED MEETINGS
7th Austrian Winter Conference on
General Practice and Family
Medicine, 2008
Host:Austrian Society of General
Practice and Family
Medicine (ÖGAM)
Themes:– Patient care.
– Research and training in
general practice of topical
interest.
– Quality-oriented
continuing training in
clinical practice and
methods of didactics and
science.
Date:January 19 - 26, 2008
Location:Hotel Rote Wand, Zug/Lech
a. Arlberg, Austria
Chairs:Dr. Erwin Rebhandl,
President OEGAM
Prof. Manfred Maier,
Scientific Director
Contact:Christian Linzbauer
Secretary OEGAM
c/o Vienna Medical
Academy
Tel:0043 1 4051383-17
Fax:0043 1 4078274
Email:office@oegam.at
website:www.oegam.at/c1/
events.asp
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