From the Wonca President:
2
From the CEO’s Desk
:
3
From the Editor
:
7
FEATURE STORIES
7
Wonca REGIONAL NEWS
13
HEALTH AND HEALTH SYSTEM NEWS
15
MEMBER AND ORGANIZATIONAL NEWS
17
RESOURCES FOR THE FAMILY DOCTOR
19
WONCA CONFERENCES 2005-2010 AT A GLANCE
20
GLOBAL MEETINGS FOR THE FAMILY DOCTOR
21
VOLUME 30
NUMBER 6
DECEMBER 2004
CONTENTS
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 News Editor
Marc L Rivo, MD
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
Wonca News Editorial Office
Marc L Rivo, MD
4566 Prairie Avenue
Miami Beach Florida 33140 USA
Tel: 305 671 7327
Fax: 305 671 4770
Email: marcrivo@aol.com
Wonca website:
http://www.GlobalFamilyDoctor.com
FROM THE WONCA PRESIDENT:
WORLD FAMILY DOCTORS: CARING FOR
PEOPLE
There is a tide in the affairs of men,
Which, taken at the flood, leads on to fortune;
Omitted, all the voyage of their life
Is bound in shallows and in miseries.
On such a full sea are we now afloat,
And we must take the current when it serves,
Or lose our ventures.
William Shakespeare (Julius Caesar) 1564-1616
Orlando has come and gone and Wonca continues to
grow and expand its activities. The representatives of
the first seventeen member organisations who founded
Wonca in 1972 could hardly have imagined that within
32 years the body would have swelled to 100
organisations in 83 countries. These countries
collectively constitute 80.5% of the World’s population.
The seeds had been sown in 1964 at the first
international congress hosted in Montreal by the then
College of General Practice of Canada. The previous
triennium edition of Wonca News chronicled the recent
activities of the organisations and in the present
edition, the office holders of the growing number of
committees, working parties and special interest groups
are itemised.
I wish to pay a special tribute to Michael Boland for
his leadership and vision during the last triennium. The
achievements during his ‘reign’ are difficult to emulate. A
tribute too, to our CEO, Alfred Loh, for his administrative
tenacity and governance, and who with Yvonne Chung
have guided our organisation during this period. I hope
and trust that with the giants in family medicine on my
executive committee, we will continue to grow and
develop. Of immediate concern is expansion of our
membership into Africa, the Middle East and Small
Island Developing States (SIDS) globally. While
representing only 20% of the globe’s population the
remaining 113 countries yet to join Wonca, include some
of the poorer nations, with the poorest health care for
their populations. Wonca’s activities in these countries
will require considerable support and cross-
subsidisation by our more affluent member
organisations.
While it will be ‘business as usual’ for the existing
activities of Wonca, the health priorities outlined in the
WONCA
News
FROM THE WONCA PRESIDENT
2
UN Millennium Goals, in the UNICEF/WHO strategy for
Integrated Management of Childhood Illness (IMCI), and
by the global concern for poverty, malnutrition and
violence, will set the agenda for some newer priorities
for Wonca particularly in developing countries. These
include interventions, which family practitioners should
and can address in their practices and clinics such as
attention to underweight children under five, increasing
measles immunisation rates in under 1-year-olds;
numerous HIV/AIDS initiatives for adults and children;
encouraging direct observed treatment for tuberculosis;
and lobbying for access to affordable drugs on a
sustainable basis. The IMCI programme aims to reduce
the annual 10.5 million deaths in children under five and
promote improved growth and development in this age
group. The recently published 2005 UNICEF report “The
State of the World’s Children: Childhood under threat”
emphasises the burden of suffering of children. It states
that more than half the world’s children are suffering
extreme deprivations from poverty, war and HIV/AIDS,
conditions that are effectively denying children a
childhood and holding back the development of
nations. What should Wonca members be doing to
assist?
Sub-Saharan Africa accounts for 75% of worldwide
peoples living with HIV/AIDS and for most of the related
9589 deaths globally per day. A major priority of Wonca
will be to support and train primary care doctors in the
region to manage patients and their families and to
meet the health care needs of the escalating HIV/AIDS
orphan problem. Pre-emptive involvement in the Indian
Sub-continent is also required to address the rising
prevalence in that region.
Family doctors are also ideally placed to address the
international initiatives for the prevention and
management of chronic and non-communicable
conditions, such as hypertension, diabetes, obesity,
alcohol abuse, chronic respiratory diseases and smoking
related disorders. Since almost every patient with
chronic disease has a primary care practitioner, (doctor,
nurse or village health worker), I hope Wonca will be
able to develop and enhance collaborative strategies
with WHO, other international professional bodies,
health foundations and funders, patient advocacy
groups and others to lessen the burden of these
conditions and their devastating complications.
Adolescent health too is an area of increasing concern
and need.
A fortuitous window of opportunity has been created
by the decision of Council meeting in Orlando to
establish the category of Institutional Membership which
WONCA
News
FROM THE WONCA PRESIDENT / FROM THE CEO’S DESK
3
will include Departments of Family
Medicine and family practice training
sites. Such collaborative member-
ship would not only encourage
academic exchange between Wonca
regions but also facilitate
international networks for primary
care research, educational
programmes, and guideline and
protocol development. These
activities, together with joint
projects between Wonca’s various
working parties, committees and
SIGs could herald a new era in
Wonca’s global activities. I am
also encouraged by our recent
discussions on mutual activities
and interests with WHO and other
organisations in collaborative status
with Wonca.
To paraphrase Brutus’s words
prior to confronting the gathering
troops of Mark Anthony and
Octavius at Philippi, we are indeed
floating on a sea full of
opportunities and must use the
prevailing current of global
challenges to fulfil the destiny of
our founders and indubitably be an
organisation of family doctors truly
‘caring for the peoples of the World.’
I am humbled and honoured by
the trust that all in Wonca have
placed in me and I will do all that I
can to discharge my duties in
fulfilment of that trust.
Professor Bruce Sparks
President
World Organization of Family
Doctors
FROM THE CEO’S DESK:
THE ORLANDO WONCA WORLD COUNCIL
The recent Wonca World Council was held over two and a half days at
the Rosen Plaza Hotel in Orlando, Florida, USA. It started on Sunday, 10
th
October 2004 with the outgoing Wonca World President, Dr Michael Boland
as Chair. Before the start of the Council Meeting proper, Dr Dan Ostergaard,
Chair of the Host Organizing Committee (HOC) for the Wonca Conference
2004 welcomed all present and introduced Dr Michael Fleming, President of
the AAFP, who also welcomed the Council delegates to Orlando and to the
17
th
Wonca World Conference that was to take place on 13-17 October 2004.
Before the names of the individual country representatives were read
out, a special announcement was made to acknowledge the Member
Organizations from Wonca’s newest and 6
th
region, Wonca Iberoamericana-
CIMF. The 11 country members were invited to take their respective seats at
the Council table. This was met by enthusiastic and welcoming applause by
all at the World Council. This formal recognition of the 6
th
Region was
indeed a very historic moment for The World Organisation of Family Doctors
(Wonca)
Over the two and a half days of World Council deliberations, numerous
issues of importance were discussed. It would not be possible for me in the
limited space of the CEO’s Column to provide readers with all that was
discussed.
I will highlight only the issues that are of interest and directly impacts
on the member.
Conference Levy & the Bid Process for Wonca Conferences
The World Council discussed extensively the issues of the bid process for
Wonca World and Regional Conferences and also the Conference levies.
Wonca Executive presented to Council draft guidelines on how to overcome
the disadvantages of the present system.
The CEO explained the rationale behind the draft guidelines. He said that
the method of determining the Wonca levies for Regional and World
Conferences had been dependent on competitive bids submitted by
interested Member Organizations (MOs) at the Regional and World Councils.
Over the years, these bids have become more aggressive as there had been
some financially highly profitable conferences in the past. This had caused
some MOs to put up offers of high levies as one of the incentives for
Councils to select them as hosts.
There were several disadvantages in this approach, which required
Wonca to re-look at how to improve the procedure. The disadvantages were:
1. The increase in the quantum of levy offered, caused the registration
WONCA
News
FROM THE CEO’S DESK
4
fee of the conference to correspondingly increase
and that cost was passed onto the delegates.
2.The higher registration fee could cause difficulty
to some potential attendees from the poorer
member countries and discouraged other
potential delegates from attending, hence
keeping attendances at such conferences down.
3.MOs successful in such bids (with high levies
offered) may find themselves having difficulties
meeting their commitment to Wonca and the
Region, when the registration numbers did not
meet up to expectations. This led to unpleasant
and prolonged negotiations between the HOC
and Wonca to find a fair and equitable solution
to the problem situation. It also meant that the
risk taking involved in the hosting of the
conference was passed from the host Member
Organization to Wonca, which was never the
intention when the conferences were offered to
the MOs to host.
4.A lower than expected attendance, as a
consequence of the higher registration fee, could
result in financial difficulties for the HOC and its
MO. This was one outcome Wonca should try to
avoid if at all possible for its MOs.
Following considerable debate and discussions,
World Council adopted the following proposals :
1.That the use of levies as part of the bid
process
in securing the hosting of World Conferences by
interested MOs be abandoned.
2. That a Member Organization wishing to host a
Wonca World Conference be advised of the levy
to be paid to Wonca World. The amount of the
levy would to be decided on each occasion by
Wonca World Executive. As a guide, a levy of
US$60.oo was recommended.
3. That the agreement to host a Wonca World
Conference between the Host Organising
Committee (and its parent organization) and
Wonca be in the form of a legal contract
specifying the respective duties and obligations
of the HOC and Wonca World.
4. That the concept of ‘Designated Regional
Conference’ be dropped and that all Regional
Conferences using the Wonca name and Regional
logo will be requested to include a levy for
Wonca World. The Wonca World Executive in
consultation with the Regional Presidents of the
respective Regions would decide the amount of
the levy.
As a general guide, a levy of US$30 could be
considered.
Council also voted unanimously in favour of the
proposal to have a contractual agreement between
Wonca World and the Host Organization of the Wonca
Conference.
Revision in the Fee Structure for Wonca Direct
Members.
At its past meetings, Executive had discussed the
issue of the financial dues of Wonca Direct Members
(DM) and felt that it was time that some changes be
introduced. It became clear with recent cost analysis
that Wonca World was incurring substantial financial
loss in processing the DMs following the earlier decision
some years ago to divide the DM dues between Wonca
World and the Regions. In brief, it was costing Wonca
almost US$45 to process and service a Direct Member
per year, which, ironically, meant that the more Direct
Members Wonca had, the more Wonca was losing
financially. In those Regions where part of the DM dues
were apportioned to the Region, Wonca World was in
fact subsidising substantially the Direct Member whilst
the Region received the full apportioned dues.
Executive felt that this current arrangement was not
tenable in the long term and requested World Council to
review the situation with some recommendations it had
proposed.
After much clarification and discussion, World
Council adopted the following:
1.In principle agreement to an increase in the Direct
Membership Dues, except for developing
countries, which would remain unchanged for the
3 year category at US$100.
2.Using the “Wonca World” category of membership
as a working basis, Council recommended that
the proposed new dues of US$75 for a 1-year
membership, and US$165 for 3-years membership
be the upper limit of the fee increase. The other
dues structures where applicable for the Regions
would have to be re-worked and fine tuned with
the respective Regions.
WONCA
News
FROM THE CEO’S DESK
5
3.To keep the dues increase to a minimum, Wonca
should consider a one-time non-refundable
joining fee of an agreed US$ amount.
World Council requested that the changes in the
financial dues structure be effective as from 1
st
January
2005. The CEO was to draw up the new format and
obtain the agreement of all Regional Presidents before
implementing the new structure.
Incorporation of Wonca and Wonca Trust
As this was the first Wonca World Council to be held
since the move of the Wonca World Secretariat from
Melbourne, Australia to Singapore, Executive felt that it
was necessary that World Council be fully briefed on the
processes involved in the incorporation of Wonca as a
legal entity.
The CEO explained in detail to Council the legal
status of Wonca and why the establishment of the
respective companies, World Organization of Family
Doctors Limited (Wonca Ltd)”, and Wonca International
Incorporated (Wonca Inc) and the Wonca Trust, was
necessary in the interest of the Wonca.
He reported that in the first 27 years of its 31 years
existence, Wonca had not been registered as a legal
entity due to its unique nature and the jurisdictions
within which it had been operating, and into which
Wonca did not neatly fit. For all intent and purposes,
Wonca was an unincorporated ‘club’ of international
members that had been operating on trust and
goodwill, bound contractually by its Bylaws. As Wonca
had no express domicile, (ie. it was not registered
anywhere), it could be problematic in future if any legal
issues arose.
As Wonca evolved into an organization with
increasing intellectual properties (eg, ICPC, Guidebook),
this made Wonca (the non-legal entity) vulnerable.
Therefore, with the advice of Wonca’s Honorary Legal
advisor, Executive had embarked upon the best course
of action in the interest of the Organization, that would
give Wonca legal standing.
(In my earlier CEO’s Column I had written quite
substantially on the two legal entities formed for Wonca,
namely World Organisation of Family Doctors Ltd (Wonca
Ltd) and Wonca International Incorperated (Wonca Inc). I
shall not repeat the details in this Column).
The CEO reported to Council that the Directors of
Wonca International Inc were the President of Wonca,
the President Elect of Wonca, and the CEO of Wonca.
These three persons were also the three shareholders,
which meant that each person owned 33% of Wonca’s
assets and this would form part of their estate at death.
This was found to be again an untenable situation
for the Organisation. Therefore, in consultation with
Wonca’s Honorary Legal Advisor, it was advised that the
Wonca Trust be established.
Wonca Trust
The CEO went on to explain to Council the nature of
a Trust. He said that a Trust is a special type of legal
entity arising from a relationship between the Settlor,
the Trustee and the Beneficiary. By setting up the Wonca
Trust, Wonca’s assets, formerly in the name of the three
shareholders, would now be transferred to that Trust
which is owned by Wonca, the Organization. The
Executive Committee would be the Trustee of the Wonca
Trust.
The CEO told Council that he felt that the whole
incorporation process of Wonca had been a worthwhile
and necessary exercise in the prudent management of
the Organization as Wonca is now a legal entity.
The Council commended the CEO on facilitating the
incorporation of Wonca and agreed that the Wonca Trust
be set up.
Wonca accepts its 100
th
Member Organisation
In his report to World Council, Professor Warren
Heffron commented that 2002 - 2004 had been an
exciting triennium with the largest ever number of
organizations admitted into Wonca Membership.
Since the last Council Meeting in May 2001 in South
Africa, 27 new organizations have become Member
Organizations (this included 4 OCRs), and one
Organization, Centro Studi e Ricerche in Medicina
Generale (CSeRMEG), Italy, was upgraded from Associate
Member to Full Member.
He added that at the time of preparing his report,
Wonca had 97 Member Organizations in 79 countries;
(this included 9 OCRs). With the resolution passed at
the Executive Meeting in St Augustine to accept the
resignation of the IMA College of General Practitioners,
India, this brought the number to 96 Organizations in
Wonca.
Prof Heffron then proceeded to announce the names
of the four new Member Organisations whose
applications were approved at the recent Wonca
Executive held in St Augustine. These were (in
alphabetical order) :
The Costa Rican Association of Specialist in Family
and Community Medicine
The Dominican Society of Family Medicine
The Latvia Association of Rural Family Doctors and
The Paraguayan Society of Family Medicine
This makes the Paraguayan Society of Family
Medicine, the 100
th
Member Organisation of Wonca. This
announcement was met with significant applause and
expressions of congratulations to the Organisation.
Prof Heffron was thanked for a task well carried out.
Wonca Academic Membership
At the 2001 Wonca World Council at Alpine Heath,
South Africa, the proposal for an academic membership
category for Wonca was made to Council. This proposal
was accepted by Council and the Wonca Executive was
tasked to report back at the next World Council on the
specific recommendations.
Prof Sparks, who was the Chair of the Ad-hoc
Committee to look into the proposal, reported to the
Orlando World Council that the Wonca Academic
Memberships details had been thoroughly discussed at
Executive and the technical specifics had been included
in the Bylaws and Regulations (Sept 2003) Document.
The Academic Department category of membership
would become effective once the Wonca Bylaws and
Regulations (Sept 2003) were ratified at the next Council
Meeting in July 2007, in Singapore.
He gave the details as follows :
Fee and conditions
1.The membership would be to the Departments of
FM/GP as a whole unit.
2.The individuals of the Department would not be
considered
as
Direct Members.
3.The Academic Department Membership dues would
be US$100 per annum, renewable on an annual
basis. This dues was calculated to cover the base
cost of US$45 of processing membership, plus the
cost of producing the various publications given to
members.
Benefits of Academic Membership
1.Wonca Directory (one copy)
2.Wonca News (six issues annually)
3.Web-based services
(eg. research database, networking opportunities,
educational networks, professional exchanges).
Following some discussions and clarifications given
by Prof Sparks, Council accepted the recommendation of
the Executive that the Academic Membership Category
be set up.
Bid for the 19
th
Wonca World Conference in 2010
Three Member Organisations made bids to host the
19
th
Wonca World Conference to be held in 2010. These
were :
The Greek Association of General Practitioners
The Mexican College of Family Medicine
The Chinese Taipei Association of Family Medicine
Each bidding Organisation was given a 20 minute
time slot to make a presentation to Council at the end
of the first day of the Council Meeting.
The voting by Council for the Host for the 19
th
Wonca
World Conference was held on the morning of the final
day of Council Meeting on 12 October 2004.
The Mexican College of Family Medicine was voted
by Council to be the Host for the 19
th
Wonca World
Conference in 2010 and the venue will be at the Cancun
Congress Centre in Mexico.
Several other important issues were discussed by the
World Council. They will be the subject of some of the
CEO’s Columns in future issues of Wonca News in the
coming year.
Dr Alfred Loh
CEO
December 2004
WONCA
News
FROM THE CEO’S DESK
6
FEATURE STORIES
FAMILY DOCTORS FROM
96 COUNTRIES GATHER
FOR 17
TH
WONCA WORLD
CONFERENCE
Some 7,000 family doctors, the
largest world’s gathering of family
physicians and general practitioners
in more than a decade congregated
in Orlando, Florida from October 13
to 17, 2004 for the 17
th
Wonca World
Conference and the 2004 Scientific
Assembly of the American Academy
of Family Physicians. Wonca
participants totaled more than 2500,
including 1,813 physicians, 183
health care professionals and 672
accompanying persons. In addition,
Wonca participants mingled with
more than 5,000 other physicians
and thousands of exhibitors
attending the AAFP Scientific
Assembly. In all, the Wonca World
and AAFP meetings drew 20,773
physicians, health care
professionals, exhibitors and others
to Orlando from 96 countries across
the globe.
Wonca participants and guests
were treated to a joint Wonca 2004
and AAFP Assembly opening
ceremony that shared the rich
diversity and exuberance of the
world and its family doctors through
a slide presentation, songs and
dance. Opening greetings were
given by AAFP dignitaries and by
Wonca President Michael Boland
and Wonca Executive member Dan
Ostergaard, who also served as
Chair of the AAFP’s Host Organizing
Committee (HOC).
FROM THE EDITOR:
THE WONCA ‘FAMILY REUNION’ IN ORLANDO
Beginning in 1972 and every three years hence, family doctors from
around the world have come together for the Wonca World Council Meeting
and the World Conference of Family Doctors. This issue of Wonca News
highlights the 17
th
such Wonca ‘family reunion’ that took place in Orlando,
Florida, USA this past October.
Since the 16
th
Wonca global meetings in Alpine Health and Durban, South
Africa, in May 2001, both Wonca and the world at-large have undergone
significant changes and taken seemingly divergent paths. During the past
triennium, the world has seen the appearance of terrorism, civil conflict and
global pandemics, such as SARS, which suggests a path that appears less
harmonious and hopeful. Yet, this issue of Wonca News demonstrates that
the World Organization of Family Doctors has taken quite a different journey,
growing exponentially in size, diversity, richness, compatibility and
understanding. Indeed, the stories and photos demonstrate how far Wonca
has traveled during the last triennium in establishing one global family.
This issue of Wonca News also paints a challenging but hopeful picture
of the road that lies ahead in the upcoming triennium. . In his first
President’s Column, Professor Bruce Sparks describes the roadmap that will
guide this triennium’s journey. In his CEO’s column, Dr Alfred Loh
summarizes the key Executive Committee decisions that will have a bearing
on the mode and manner of Wonca’s journey. In addition, several articles
describe the influence of Wonca’s family doctors in meeting people’s health
needs in the European Union and around the world. The message of the
WHO Assistant Director-General, Dr Tim Evans, describes important
opportunities that Wonca may have in developing a global workforce of
family doctors.
As we embark on this new triennium, your reports and photos of your
journey are most welcome in future issues of Wonca News. I look forward
to reading your stories, and sharing them with our Wonca family.
Marc L. Rivo, MD, MPH
Editor, Wonca News
marcrivo@aol.com
4566 Prairie Avenue
Miami Beach, FL 33140 USA
1-305-674-8839 (fax)
WONCA
News
FROM THE EDITOR / FEATURE STORIES
7
DNA, convinced the audience that
genomic information will become
increasingly important to the care of
patients and that family physicians
can and should play a key role in
applying genomics in primary care.
Other keynote speakers also
raised the important role of family
doctors in addressing the world’s
health challenges. Doctor Godrey
Sikipa, a public health specialist
from Zimbabwe and member of the
United Nations Joint Program on
HIV/AIDS, shared that 90% of the
630,000 childhood cases of
maternally transmitted HIV are from
sub-Saharan Africa. Managing AIDS
effectively requires the doctor to
involve a patient’s family, hence
making it the province of family
physicians, said Sikipa. He noted
that 35 countries are facing
physician shortages, and he urged
family physicians to consider
rotations into the areas of need.
Keynote speaker Barbara
Starfield, M.D., M.P.H., presented
evidence that the best care is
primary care. The Professor of
Health Policy and Management at
the Johns Hopkins University School
of Public Health in the USA cited
numerous measures, such as infant
mortality and life expectancy
demonstrated that primary care-
oriented health systems are
associated with healthier
populations that live longer. Citing
international studies, Dr Starfield
said primary care “is more effective,
efficient and more equitable” than
specialty care and that increasing
the number of primary care
physicians is positively associated
with improved health outcomes.
The Scientific Program
Committee and its Chair, Dr Robert
Taylor, provided a dynamic and rich
educational array of plenary
speakers, workshops, and other
interactive venues. A total of 1,246
abstracts from 78 countries were
WONCA
News
FEATURE STORIES
8
accepted for the 17th World
Conference of Family Doctors. Eight
abstracts were submitted and
presented in Spanish. The Wonca
program book contained 1,224
abstracts from the meeting. The
abstracts included 574 oral
presentations, 483 posters, 106
workshops and 61 symposia.
Wonca delegates on their way to the
Scientific Assembly
Wonca delegates from Spain discuss a poster
board presentation
The Wonca participants from all
over the globe took full advantage
of Orlando’s warm and sunny
