From the Wonca President-elect :
Towards a GP in Every Community in
2
the World
From the CEO’s Desk
:
The World Health Organization and Wonca
3
From the Editor
:
The 18th Wonca World Conference in
5
Singapore is Coming
FEATURE STORIES
6
•Register and Submit Abstracts Online for Wonca World 2007 in
Singapore
•Women Family Doctors in Practice
Wonca REGIONAL NEWS
9
•Wonca CIMF Iberoamericana: un Congreso Soñado, un
Congreso para Soñar
•Wonca Iberocamericana-CIMF’s Regional Conference: Dreamed
About, and a Dream
•More than 3,000 Gather for Wonca Europe in Florence
•The Women’s Track at the Wonca Europe Regional Conference
HEALTH AND HEALTH SYSTEM NEWS
11
•Dr Margaret Chan to be WHO’s next Director-General
•New Zealand Government Approves More Training places for GPs
MEMBER AND ORGANIZATIONAL NEWS
15
•News from the International Federation of Primary Care Research
Networks
•Sam Evergreen Receives Wonca Europe Award of Excellence in
Health Care
•John Howard Stands Down as Chairman of the RCGP International
Committee
RESOURCES FOR THE FAMILY DOCTOR
16
•SBMFC Invites Researchers from Developing Countries to Publish
•Kanu Gopal Bala - Wonca Global Family Doctor for December
WONCA CONFERENCES 2007-2011 AT A GLANCE
18
GLOBAL MEETINGS FOR THE FAMILY DOCTOR
19
VOLUME 32
NUMBER 6
DECEMBER 2006
CONTENTS
Wonca website:
http://www.GlobalFamilyDoctor.com
Wonca President
Prof Bruce Sparks, South Africa
2 Cruden Bay Road
Greenside
Johannesburg 2193
South Africa
Tel: 27 11 646 2140
Fax: 27 11 717 2558
Email: brucespa@global.co.za
Wonca Chief Executive Officer
Dr Alfred W T Loh
Wonca Administrative Manager
Ms Yvonne Chung
World Organization of Family Doctors
College of Medicine Building
16 College Road # 01-02
Singapore 169854
Tel: 65 6224 2886
Fax: 65 6324 2029
Email: admin@wonca.com.sg
Wonca President-Elect
Prof Chris van Weel, Netherlands
Wonca Immediate Past President
Dr Michael Boland, Ireland
Honorary Treasurer
Richard Roberts, MD, USA
Wonca Regional Presidents
Prof Khaya Mfenyana, Africa
Warren A Heffron, MD, North America
A/Prof Goh Lee Gan, Asia Pacific
Prof Igor Svab, Europe
Dr Shatendra K Gupta, Middle East
South Asia
Dr Adolfo Rubinstein,
Iberoamericana-CIMF
Wonca Executive Members at Large
Dr Javier Dominguez del Olmo, Mexico
Prof Michael Kidd, Australia
Richard Roberts, MD, USA
Chair, Bylaws and Regulations
Dan Ostergaard, MD, USA
Chair, Publications & Communications
Dr Geoffrey D Martin, Australia
Editor, Wonca News and Editorial Office
Marc L Rivo, MD
4566 Prairie Avenue
Miami Beach, Florida 33140, USA
Tel: 305 671 7327
Fax: 305 674 8839
Email: marcrivo@aol.com
WONCA GLOBAL SPONSORS
FROM THE WONCA PRESIDENT-ELECT:
TOWARDS A GP IN EVERY COMMUNITY
IN THE WORLD
Wonca, the World Organisation of Family Doctors, is
the world academic body of general practitioners. Its
aim is to promote the highest quality of general practice
around the world. Wonca is an organisation of
organisations: national colleges of general practice/
family medicine. Collaboration with its member
organisations is important but in order to fulfil its
ambitions, the contributions of individual general
practitioners and other primary care experts in the world
are essential.
Wonca’s objective to promote excellence of general
practice and primary care is subordinate to its mission
of improving health, globally. In pursuing this, there are
two core considerations. First, the effectiveness of
individual medical care depends to a large extent on the
structure of the health care system. Where primary care
is provided and generalists take care of unselected
health problems as the basic point of service, health
care outcomes are the best. This is independent of a
countries’ level of development, population
characteristics or geography.
The second consideration is that health is
determined by multiple factors, of which individual
medical care is only one. Promoting and improving the
health status of individuals and communities means
operating in this multifactor context and linking
individual health care to social, cultural and economical
actions. Only under conditions of physical, mental and
social safety, prosperity and protection against health
threats is it possible to help individuals to improve and
maintain their health.
The logical consequence in pursuing the Wonca
mission in the long term is general practices in every
community around the world, with GPs well trained,
educated and supported, functioning under a primary
care oriented health care system and operating in an
integrated inter-sectorial approach to the society they
serve. This is a truly long-term (one may even say:
unrealistic) ambition. At this moment, only a minority of
countries around the world operate in this way and in
most countries GPs lack recognition as a medical
specialty and the specialty training that has to go with
WONCA
News
FROM THE WONCA PRESIDENT
2
it. But some important progress has been made, as 82
countries –with the unfortunate exception of Russia and
India, all the large ones –and more than hundred
academic organisations of primary care are united in
Wonca. Even though in many of these countries the
population health status and development of general
practice is poor, this is a major achievement: general
practice now has at its disposal a global forum for its
academic development that brings together leaders in
primary care.
This forum enables general practice to think globally
and act locally. It allows the innovation of primary care,
but as important as the de-novo development is transfer
and exchange of products Wonca member organisations
have developed themselves. The richness of Wonca is
the vast collective resources and experiences of its
member organisations. Particularly when operating in a
regional structure the flow of exchange is powerful, as
the experiences in Europe, Asia-Pacific, North America
and the Ibero-Americana region show. The grouping of
member organisations in a regional structure, tuned to
the realities and traditions of that region are vital for
general practice to reach out to every community. At
this moment Wonca is currently working hard to get this
perspective right for Africa, the Middle East and the
former Soviet Republics.
A number of key aspects of general practice
development can only evolve under global direction and
this is where contributions of individual primary care
experts around the world are vital. Through the work of
Wonca working parties, special interest groups,
dedicated experts and other global organisations –the
WHO being most prominent – much is possible. The
following summarises the current achievements.
A basic requirement of primary care development is
insight into the health status and health threats of the
population under care. Only on the basis of empirical
data is it possible to address the specific needs of that
community and its individual members. For this, a
classification that befits the realities of primary care is
needed and this is the importance of the International
Classification of Primary Care (ICPC) developed by the
Wonca International Classification Committee. To be able
to classify access to practices, patients and populations
is needed. This is usually the first step in building
general practice research and the Working Party on
Research is currently building practice-based research
networks and research expertise around the world.
Informatics – the domain of yet another Working Party –
plays an ever more important role in reaching
WONCA
News
FROM THE WONCA PRESIDENT
3
practitioners and practices. Wonca is currently
collaborating with the WHO in an action plan to address
social determinants of health.
Two other Wonca groups exemplify the importance of
the patients’ and practitioners’ context on health and
health care. A substantial part of primary care is
provided in isolated rural areas, the challenge of the
Working Party for Rural Practice. For health in the
community the safety and wellbeing of families is
crucial, The Women and Family Medicine Working Party
promotes the health and wellbeing of women as
patients, carers and physicians.
The historically strongest contribution Wonca has
made is in the field of teaching and education. The
need of undergraduate students’ exposure to general
practice and specialty training in general practice prior
to certification are generally accepted – even though the
reality in many countries leaves much to be desired. The
current collaboration with the NETWORK Towards Unity
for Health, the network of primary care oriented medical
schools is taking this forward. The focus of the Working
Party on Education will in the future be directed at
professional development and quality of care, in
collaboration with the Working Party on Quality
Assurance. A point on Wonca’s agenda is also the in-
depth exploration of the clinical field of general practice.
Respiratory and mental health problems (Special
Interest Group Neurology and Psychiatry) have already
demonstrated the importance of this.
Singapore, 24 – 28 July 2007 is the scene of the
upcoming 18
th
Wonca World Conference, and
preparations of the 19
th
World Conference, 26 – 30 May
2010 in Cancun, Mexico, are already well under way.
These promise to present the best of general practice to
a world audience and are a ‘must’ for everyone with an
interest in the development of general practice beyond
his or her own region. In-between, a run of regional
conferences provides attractive opportunities to meet.
The period 2007 – 2010 is also an important period
to make progress on the world forum of general
practice. In my view there are three priorities:
• Strengthening regional structures. Most international
(academic) organisations operate on a regional level
and the development of regional structures in Africa,
the Middle East and the former Soviet Republics
should be urgently addressed. But the regional
structure should feed into an even stronger global
presence: through Wonca, general practice is one of
the few disciplines with a potent world body, of
which we must make the most.
• Building primary care research. For too long, general
practice research has been conspicuous in its
absence. Without empirical data on health problems
and care in the community it is not possible to
foster health of populations. This makes the building
of a global general practice research capacity
mandatory.
• Development of clinical expertise. GPs take care of
the majority of health problems in the community,
and this makes it important to engage in evidence-
based recommendations that fit into the general
practice setting.
This is the structure general practice through Wonca
has to offer, but it is void unless it can count on the
involvement and intellectual contributions of GPs and
other primary care experts around the world. Wonca is
keen to engage as many as possible to improve the
health of people through excellent general practice,
grounded in the principles that all individuals are equal
– and are entitled to the best care irrespective of their
background – and each of them is unique, requiring care
tailored to their individual, personal needs.
If you would like to join one of the groups, be an
individual member of Wonca or just know more, please
visit the Wonca website, www.globalfamilydoctor.com.
Professor Chris van Weel
President-elect
World Organization of Family Doctors
(Editor’s note: Due to personal circumstances, Wonca
president Bruce Sparks has been unable to write his
President's column. For that reason this Wonca News
features a 'From the the President-elect' column. Wonca
News acknowledges our gratitude to the Royal College
of General Practitioners, and The New Generalist, that
had published this paper previously)
WONCA
News
FROM THE CEO’S DESK
4
FROM THE CEO’S DESK:
THE WORLD HEALTH ORGANIZATION AND WONCA
Wonca’s relationship with The World Health Organization (WHO) dates
back to September 1979 when Wonca Executive took the decision that the
organization should enter into a two year working relationship with WHO
with the view to admission as a Non-Government Organisation (NGO) of
WHO. The Wonca Classification Committee through its activities then
became involved with the corresponding division of WHO in the area of
disease classification.
Dr Henk Lamberts was appointed the official Wonca representative as
Chair of the Wonca Classification Committee and together with
Dr Rajakumar of Malaysia and
Dr Maurice Woods of USA, were to develop relationships with WHO in four
identified areas:
• Classification of Diseases
• Health Information System
• Mental Health
• Health Manpower Development and Training.
In the subsequent years, work in two of the four agreed areas of co-
operation, namely Classification of Diseases through the work of the Wonca
Classification Committee and Mental Health through Dr Maurice Woods and
his Committee, were actively pursued.
Five years later, in 1984, the Executive Board of WHO formally admitted
Wonca into official NGO status with a three yearly review. This has
continued without a break up to the present and the next review of Wonca’s
status as an NGO in collaborative relations with WHO will be at the end of
2006.
Currently Wonca has several areas of collaboration with the world body
and these we hope will increase in the years ahead. Some of the ongoing
collaborations include:
1
The Global Alliance against Chronic Respiratory Diseases (GARD): A WHO
Initiative in which Wonca is a founding member to address the increasing
burden of respiratory problems globally.
2
The WHO International Advisory Group for the Revision of ICD-10 Mental
and Behavioural Disorders: A Wonca representative, Dr Gabriel Ivbijaro
from the Wonca Working party on Mental Health, is a member of the
Group to provide the primary health care perspective.
3
The International Classification of Primary Care (ICPC-2): This Wonca
product, is a member of the WHO Family of International Classification
(FIC). Members of the Wonca International Classification Committee are in
discussions with the WHO to map the ICPC to the other classifications in
the WHO FIC.
4
WHO Initiative on Social Determinants of Health: Wonca has Dr Jan de
Maeseneer as representative and member of the Knowledge Network of
Health Systems in this Initiative.
5
WHO Framework on Tobacco
Control: Wonca is supporting
WHO with on-going work in
raising global awareness and
development of educational
tools for clinical practice via its
Task Force on Tobacco Cessation.
6
Wonca-WHO Guidebook Project:
Wonca Member Organizations are
translating into their native
language the Wonca-WHO
publication, “Improving Health
Systems: The Contribution of
Family Medicine” and partnering
with their Ministers of Health and
other leaders to strengthen the
role of the family doctor in their
country.
7
The Patient at the Centre of Care
Initiative of the Western Pacific
Region of WHO: The Wonca CEO
is a member of the Reference
Group to give advice on the
Initiative.
The recent election of
Dr Margaret Chan as the Director-
General of the WHO marks a new
chapter in the relation between
WHO and Wonca. Dr Chan will take
up her post in January, 2007.
Dr Margaret Chan is no stranger
to Wonca. In her capacity as Director
of Health of Hong Kong, she has
been involved on several occasions
in Wonca activities associated with
the Hong Kong College of Family
Physicians and with the Wonca
Secretariat when it was located in
Hong Kong.
Dr Chan served as the Director of
Health of Hong Kong for nine years
before joining the WHO as Director
of the Department for Protection of
the Human Environment in 2003.
She then rose to be Assistant
Director-General for Communicable
Diseases and Representative of the
Director-General for Pandemic
Influenza. She has a medical degree
from the University of Western
Ontario, Canada and a master’s
WONCA
News
FROM THE CEO’S DESK / FROM THE EDITOR
5
FROM THE EDITOR:
THE 18TH WONCA WORLD CONFERENCE IN SINGAPORE
IS COMING
Now is the time to plan for Singapore. The last of three summer-fall
Wonca Regional Conferences and the Wonca World Rural Health Conference
are all pleasant memories. The next major opportunity for family doctors to
reunite is in Singapore from July 24 to 27 at the 18th Wonca World
Conference.
The deadline for submitting abstracts for the 18th Wonca World
Conference is December 31, 2006. Please submit your abstracts online at
www.Wonca2007.com. Also, online registration for Singapore is open at
www.Wonca2007.com.
This issue of Wonca News continues to report on important gatherings of
Wonca’s Regions, Working Parties and Member Organizations in the year
leading up to the 18
th
Wonca World Conference in Singapore. More than
3,000 family doctors and other participants from Europe and 64 different
countries around the world met from August 27-30 for the Wonca Europe
Regional Conference in Florence, Italy. Some 2,300 delegates from more
than 30 countries celebrated in Buenos Aires, Argentina from October 11-14
the historic, first Wonca CIMF Iberoamericana CIMF Regional Congress.
This issue reports on other highlights of the Wonca Europe Regional
Conference in Florence. These include meetings of the Wonca Working Party
on Women and Family Medicine and the International Federation of Primary
Care Research Networks. While in Florence, Wonca Europe Regional
President Igor Svab presented Sam Everington with the Wonca-Europe
Excellence in Health Care: The 5 Star Doctor Award, also reported in this
issue.
These and many other family doctor gatherings continue to crescendo
towards the triennial meeting of all meetings – the 18
th
Wonca World
Conference in Singapore. Please send me news that you would like to share
with your fellow family doctors as Singapore approaches.
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)
degree in public health from the
National University of Singapore.
In her submission to the WHO
Executive Board and in her speech
to the World Health Assembly,
Dr Chan made special mention of
efforts to control tobacco including
the full implementation of the
Framework Convention on Tobacco
Control. Dr Chan also emphasized:
(1) the importance of integrated
primary health care as the
cornerstone of national health
systems; (2) the growing burden of
chronic diseases in the world that
needs to be addressed urgently;
and (3) the importance of women
and child health.
Dr Chan expressed the opinion
that good and well integrated
primary health care is the only way
to ensure fair, affordable, and
sustainable access to essential care
across a population.
Wonca fully supports Dr Chan
and endorses her priorities as she
takes on the role of Director-General
of the World Health Organization.
Wonca wishes Dr Margaret Chan
every success in her new role and
looks forward to increasing areas of
collaboration with her and her
colleagues in the WHO.
Dr Alfred Loh
Chief Executive Officer
World Organization of Family
Doctors
WONCA
News
FEATURE STORIES
6
FEATURE STORIES
REGISTER AND SUBMIT
ABSTRACTS ONLINE FOR
WONCA WORLD 2007 IN
SINGAPORE
Singapore beckons! As we gear
up in our preparations for the 18th
Wonca World Conference from 24-27
July, 2007, Singapore promises a
host of exciting attractions and
activities. Besides getting updates
on the latest advances that
genomics and biomedical sciences
have to offer, the scientific program
also promises a whole new
paradigm in delivery of lectures and
plenary sessions.
The deadline for submitting
abstracts is December 31, 2006.
Please submit your abstracts online
at www.Wonca2007.com. Also,
please register for the online at
www.Wonca2007.com.
Officially opened on 30 August
1995, Suntec Singapore is a world-
renowned, international venue that
has the perfect location for
meetings, conventions and
exhibitions. Suntec Singapore is
situated in the Central Business
District, only 20 minutes’ drive from
Changi International Airport. Suntec
Singapore is in the heart of a self-
contained, totally integrated events
infrastructure. In addition to its first-
class facilities, Suntec Singapore
offers direct access to 5,200 hotel
rooms, 1,000 retail stores, 300
restaurants and the region’s new
centre for the performing arts,
Esplanade – Theatres on the Bay.
The medical technology
exhibition will also provide a unique
business matching opportunity for
all family physicians and medical
groups wanting to scale up their
practice profiles and offer an
improved and vastly increased range
of point of care testing services for
their patients.
In addition to work and
academic schedules, the organizing
committee also promises to host a
dazzling array of social programs for
your partners and family members.
Thinking of bringing along your
loved ones? Fret not, as
arrangements have been made for
the more than 100 nurseries and
child care centers to take care of
your kids daily so that you can
attend all of our programs and
social activities with complete
freedom from worries of caring for
the needs of your young ones.
Shop till you drop, feast on
some of the greatest culinary
delights as well as attend world
class performances at our latest
state of the art architectural marvel,
the Esplanade. You will never have a
dull moment in Singapore, the city
that never sleeps!
So, stay tuned and make a date
with Singapore for the Wonca 2007
World Conference, 24 to 27 July
2007!
Dr Tan See Leng
Chairman
Host Organizing Committee
Wonca World Conference 2007
Email: contact@cfps.org.sg
Website: www.wonca2007.com
Women Family Doctors in
Practice
(This article is one of a series
done by the authors on behalf of
the Wonca Working Party on Women
and Family Medicine (WWPWFM)
published in Wonca News over the
past few months. Please see
www.womenandfamilymedicine.com
for the full monograph, literature
review, summary and annotated
bibliography on Women Family
Doctors in Practice.)
In many countries, although
women make up half or more of
practicing physicians, discrimination
on the basis of gender affects their
opportunities, access to medical
careers and choice of specialty. This
article promotes gender equity in
health care, through an
understanding of how gender
stereotyping and discrimination may
influence practice specialty choices
and other professional and personal
life options.
Family Medicine organizations
can be supportive of global gender
equity goals. In 2001, Wonca
adopted the Beijing Declaration and
Platform for Action and the
Millennium Development Goals,
both of which promote gender
equity for development and equal
access of women to education;
improvement in women’s access to
vocational training, science and
technology, and continuing
education; development of non-
discriminatory education and
training; and allocation of sufficient
resources for the implementation of
educational reforms.
Social stereotypes which
attribute various qualities to an
individual simply based on sex,
ethnicity, or religion can limit
women’s opportunities in career
advancement in medicine. These
stereotypes are present in medicine,
as illustrated by expectations that
women will choose specialties like
pediatrics, obstetrics and
gynecology and family medicine,
which are thought to embrace
women’s attributes, while men are
expected to choose surgery,
cardiology, orthopedics, and
emergency medicine, which are
thought to embrace men’s
attributes. Some countries limit
WONCA
News
FEATURE STORIES
7
women physicians to family
medicine or gynecology.
Overcoming these prejudices and
stereotypes is important as both
women and men can contribute to
all specialties and much can be
gained from encouraging a culture
of gender equity within each
specialty.
That being said, several studies
have shown that women physicians
choose different models of practice
than men. In North America,
compared to men, women are more
likely to participate in group rather
than solo practice, and to choose
salaried positions over other forms
of remuneration and often receive
lower salaries than their men
colleagues. The number of hours
worked and visits billed are also
lower for women compared to men.
In family medicine, women are more
likely to do more ‘cradle to grave’
activities and men are more likely to
perform a wide range of non-
gynecological procedures.
Traditional gender attitudes in
different parts of the world have
influenced the way in which women
are valued in medicine. As the
number of women employed in a
given specialty increases, the
prestige and income potential for
that specialty declines. There is
concern that as medicine becomes
“feminized”, it will take on a lower
status, and become a “pink collar
profession”, as has been seen with
other woman-predominant
professions such as nursing and
teaching.
Commentators in industrialized
countries often attribute, correctly or
not, the recent trends among
physicians of a decline in hours of
work, number of patients seen and
services provided to the growing
number of women physicians. In
reality, there is a trend for younger
physicians of both sexes to seek
more balanced lifestyles and strive
to practice medicine in ways that
allow them to balance their
professional and personal lives
better.
In many places there is system-
level inequity for women physicians
in practice. Medicine has not
traditionally accommodated
physicians who wish to practice
part-time, and the definition of what
constitutes part-time work is
controversial. Many physicians, who
classify themselves as part-time,
work 40 hours per week, the
equivalent of full-time work in other
settings. Women who work part-time
report feeling guilty for not
contributing as much to health care,
being excluded from decision
making, being penalized for
overhead costs and having a
relatively higher clinical workload in
comparison to their full time
colleagues. However, studies have
shown personal satisfaction, patient
satisfaction, resource utilization,
preventative services and other
measures do not differ in full and
part-time work situations.
Lack of maternity leave policies
and overtly discriminatory sick
benefits that exclude pregnancy are
common for women physicians, as
are loss of benefits for part-time
physicians. Women in practice face
unique challenges arranging
coverage when they take maternity
leave. Unless a locum can be found,
the costs of overhead and staffing
may force a woman to shorten her
leave to durations far shorter than
she would recommend to her own
patients and shorter than what is
available to other working women.
Having a career in medicine
affects women’s and men’s lives
differently. Many women find it
challenging to combine marriage
and parenthood with their careers.
The complexity is magnified in dual-
physician marriages. In North
America, women in dual physician
marriages generally worked fewer
hours than women married to non-
physician professionals. Women
physicians with children spend more
time on childcare and household
maintenance than their male
partners. and women physicians
with children decreased their time
spent on professional activities,
especially when their children were
preschoolers. When childcare and
other household responsibilities
were also considered, women
physicians had less personal,
discretionary time than men
physicians.
The challenges for women
physicians described above are even
greater for women practicing in rural
settings. Reports from industrialized
countries show that women doctors
are currently even less likely than
their male colleagues to go into
rural practice because of the type of
practice, acuity of patients,
isolation, role strain, attitudes of the
community and the challenge of
spousal employment. In 2002, the
Wonca Working Party on Rural
Practice, developed a Policy on
Female Family Physicians in Rural
Practice directed at improving
recruitment, training, support,
structure of rural medical practice,
and representation and leadership
of women in rural practice. Rural
physicians suggested that concerns
for recruitment and retention of
women rural physicians (and men as
well) can be addressed through
flexible on-call duties, child care
