From the Wonca President-Elect :
Embrace the Upcoming Generation
of Family Physicians
2
From the CEO’s Desk
:
The International Classification of Primary
3
Care (ICPC-2) - A Wonca Product
From the Editor
:
A Special Wonca 2007 Invitation to FP/GP
4
Journal Editors
FEATURE STORIES
5
• Call for Nominations for Wonca Award of Excellence in Health Care
• Wonca Establishes Working Party on Mental Health
• Register Online for Wonca 2007 in Singapore
Wonca REGIONAL NEWS
7
• Asia Pacific Holds Research Workshop in Bangkok
• Letter to Editor: Family Medicine and Culture in Argentina
and Greece
HEALTH AND HEALTH SYSTEM NEWS
9
• Primary Care Contributions to Health Systems and Health:
International Comparisons
MEMBER AND ORGANIZATIONAL NEWS
12
• AAFP International Family Medicine Updates
• Walter Rosser - Wonca Global Family Doctor for January
RESOURCES FOR THE FAMILY DOCTOR
14
• Women in Training
• Wonca Europe Region Online
WONCA CONFERENCES 2007-2011 AT A GLANCE
17
GLOBAL MEETINGS FOR THE FAMILY DOCTOR
18
VOLUME 32
NUMBER 6
FEBRUARY 2007
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:
EMBRACE THE UPCOMING GENERATION
OF FAMILY PHYSICIANS
A perception exists in parts of the world over of
family doctors - - - dropped off the career ladder of
specialization, overlooked by the medical and scientific
community, undervalued, even more underpaid,
overburdened by trivial complaints and heartsick
patients, toiling away in isolation. And not seldom do
family physicians themselves contribute to this
perception - - - complaining comes to some as second
nature. It is a dangerous habit, as it may become a self-
fulfilling prophecy. Who in his or her right mind would
like to join the ranks and files of such a profession?
Some factors contribute to genuine concern for our
future: a physician shortage exists in many parts of the
world, and future career choices are often a complex
process. How can we make sure the best students opt
for family medicine? How can we help the most
accomplished to chose to work in conditions where
clinical uncertainty may be likely?
Yet, no reason for pessimism exists. In international
exchanges and visits I am continually deeply impressed
by the talents, the motivation, the drive of students,
residents and young colleagues. This was highlighted
during my visit early this year to the annual conference,
in Angers, of French residents. France, with all its
contributions to the world, is not directly associated
with a leading role in family medicine. The current
family medicine developments the country is witnessing
are more a catching-up with most of their fellow-
European neighbours.
Yet, here in Angers was a vibrant conference
organized by and for family medicine residents. The
National organization brings together residents from the
more than forty training programs that are run in the
major French cities. The conference started with a review
of the national structure of family physicians’
reimbursement and moved on to primary care research
and academic support of family practice. At about half
past seven in the evening, when one would expect
conference participants to be out at restaurants and
bars, the French residents were actively participating
from their chairs in the convention hall.
WONCA
News
FROM THE WONCA PRESIDENT-ELECT
2
But do not think partying was anathema to them.
Once the meeting closed, we adjourned for a diner party
of exquisite food and the awarding of annual prizes. We
celebrated for the family medicine resident awarded
with the best research project of the year. And we
celebrated the confident display of a new generation
entering family medicine. The same confidence of these
family medicine residents must have had impressed the
French government a few days earlier. In negotiations on
more investments in family medicine research and
teaching, it appears that French universities are moving
at last to engage in primary care – thanks to the
persistence of the French residents and Colleges (SNGE
and SFMG).
France is not the exception in Europe. In the
European arena, residents and young family physicians
are united in the Vasco Da Gama movement. For Wonca,
for international family medicine, this offers a most
welcome platform to work together. I commend this
group to everyone organizing international family
medicine conferences – to involve them closely in any
activity; I am sure it will add to the success of the
meetings.
But I think we should do more: there is a need for a
platform for residents and young family physicians in
every Wonca region, and most importantly, at our World
Conferences. We should engage them in all the Wonca
working parties and special interest groups.
Wonca is all about the future of family medicine - - -
that is our joint future. Let us embrace in our Wonca
structure the residents and young family physicians of
the world.
Chris van Weel
President-elect
World Organization of Family Doctors (Wonca)
(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 President-elect” Column)
WONCA
News
FROM THE CEO’S DESK
3
FROM THE CEO’S DESK:
THE INTERNATIONAL CLASSIFICATION OF
PRIMARY CARE (ICPC-2) - A WONCA
PRODUCT
At the first Wonca General Assembly in Melbourne,
Australia in 1972, it was resolved that a special Working
Party be established to consider and develop an agreed
classification in general practice/family medicine that
would be clearly related to the International
Classification of Disease (ICD) of the World Health
Organisation (WHO). Dr Robert Westbury of Canada was
appointed by Wonca Executive then to be the Convenor.
At the General Assembly in 1974, Dr Westbury
announced that an International Classification of Health
Problems in Primary Care (the ICHPPC) had been
developed to enable general practitioners/family
physicians to classify problems, as opposed to diseases,
which they encountered in their daily work. He also
reported that doctors in 300 practices in 9 countries
had tested this classification with further refinements
recommended.
By August 1976, after several rounds of
consultations, Dr Westbury was able to announce that
the ICHPPC had been finalized and distributed to all
Wonca Member Organisations. Work on the Primary
Care Classification system continued for several years
after that. By the end of 1978, ICHPPC-2 (the version
aligned to ICD-9) was distributed to Wonca Member
Organisations in typed form.
The printed version was published by Oxford
University Press (OUP) towards the end of 1979 with an
advanced payment of royalty of AUD$5,000 paid by
OUP. This was used to finance ongoing meetings of the
Classification Committee that by this time was working
on a conceptually new classification, namely Reasons
for Encounter Classification under the leadership of
Dr Henk Lamberts and a Glossary for Primary Care under
Dr Jack Froom. The Committee continued to work
enthusiastically on a number of classifications, some in
collaboration with WHO, during the years that followed.
The International Classification of Family Medicine
(ICFM) was jointly developed by WHO and the Wonca
Classification Committee by 1986. It was edited by
Dr Henk Lamberts and Dr Maurice Woods after WHO
decided not to endorse the classification and was
published by OUP in a new agreement that gave OUP
the exclusive publishing rights to the printed version in
the English language. It was published as the
International Classification of Primary Care (ICPC) under
the auspices of Wonca.
The years following 1986 saw the use of the ICPC
being propagated by Wonca as the preferred
classification for Primary Care at its international
meetings and forums. Several primary care research
centres received permission from Wonca for the free use
of ICPC for their research projects.
The classification also drew interest from the non-
English speaking member organizations within Wonca as
the value of ICPC became more widely acknowledged
and accepted. As of 2006, ICPC has been translated
into 17 languages globally (Chinese, Czech, Danish,
Dutch, French, Greek, German, Japanese, Portuguese,
Romanian, Russian, Spanish, Azeri, Serbian, Finnish,
Swedish, and Turkish).
In December 2003, Wonca received the good news
that the WHO-Family of International Classications (FIC)
Network of the WHO Collaborating Centres had
endorsed ICPC as a member of the WHO-FIC. They had
concluded that the ICPC fulfilled the requirements for
membership as being a well developed, well used and
well maintained product. ICPC was hence accepted into
the Family of International Classifications as a
classification to be used for health information
registration in Primary Care around the world.
This membership of the WHO-FIC resulted in greater
interest in ICPC globally and enquiries began to be
received by the Wonca Secretariat on the purchase of
national rights for the exclusive use of ICPC by certain
countries. The Wonca Executive, based on the GDP and
GDP per capita of the country, then established a
formula for the calculation of national licenses for ICPC.
As of end 2006, two national licenses for ICPC have
been purchased from Wonca by the governments of
Belgian and Norway. In addition, the Portuguese
Association of General Practitioners has purchased a
national license. Several countries has expressed
interest in the English language version of ICPC .
However, with the publishing rights residing with OUP,
Wonca was unable to make the licenses available to
these countries.
The Wonca Executive, in 2004, endorsed a proposal
to re-acquire the publishing rights of the English
language version of ICPC back from OUP. After several
communications via email between the Wonca CEO and
OUP, an agreement was reached in that OUP would
WONCA
News
FROM THE CEO’S DESK / FROM THE EDITOR
4
return the publishing rights back to
Wonca. This agreement was finalized
in January 2007. Henceforth, this
will allow the use of the ICPC-2e
electronic version of in a large
number of the English speaking
countries that are members of
Wonca, as the book form of the
classification could now be
produced in its entirety or as a
manual in English.
Whilst it is likely that the
national Ministries of Health of most
countries will be the agencies keen
to acquire the national licenses for
ICPC-2e, it may be a financially
rewarding and a good move if the
Member Organisations of Wonca in
these countries take the initiative of
acquiring the national license for
themselves. To encourage this,
Wonca Executive has agreed that
Wonca Member Organisations be
given a 20% rebate on the national
licensing fee. The ICPC-2e is a
Wonca product and should,
therefore, be used to benefit Wonca
Member Organisations, their family
doctors and all those who care for
our patients around the world.
Dr Alfred Loh
Chief Executive Officer
World Organization of Family
Doctors
FROM THE EDITOR:
A SPECIAL WONCA 2007 INVITATION TO FP/GP
JOURNAL EDITORS
This issue of Wonca News continues to report on important gatherings of
Wonca’s Regions, Working Parties and Member Organizations in the months
leading up to the 18
th
Wonca World Conference in Singapore from July 24-27,
2007.
I would like to extend a special Wonca 2007 invitation to the Editors of
the 50 or so FP/GP journals of Wonca member organizations. The FP/GP
journal editors and publication staffs serve an important role for Wonca by
disseminating key clinical, professional and organizational information to
our membership. They report on the country’s health and health care trends
that affect the organization’s political viability and influence. They record
and archive the history of our member organizations and their role in the
health of the public. They publish key articles, reports and publications in
the areas of practice, teaching and research that strengthen our specialty.
Editors of our FP/GP journals, or their designee, are invited to an FP/GP
Editors Forum in Singapore held in conjunction with the 18
th
Wonca World
Congress in Singapore. The purpose of the FP/GP Editors Forum is to
facilitate networking around the key FP/GP content areas, such as clinical
practice and evidenced based medicine, practice management, research,
medical education and family medicine development/association news.
Please email me if you plan to join us in Singapore, or if another
representative will join us on your behalf. Your recommendations for agenda
items are most welcome.
For those who have yet to register for the 18
th
Wonca World Conference
in Singapore, please register online at www.Wonca2007.com. I am looking
forward to our Wonca FP/GP Editors reunion in Singapore!
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
5
FEATURE STORIES
CALL FOR NOMINATIONS FOR WONCA
AWARD OF EXCELLENCE IN HEALTH
CARE
Nominations are called for the Wonca Award of
Excellence in Health Care, otherwise known as “The 5-
Star Doctor” Award.
This is an award to be conferred on physicians, who
in the opinion of the Wonca World Council have made a
significant impact on the health of individual and
communities, through personal contributions to health
care and the profession. It was instituted to increase the
global development of Family Medicine, global
networking and partnerships. The award is preferably
given to those who are still active in the field for which
they are nominated. Nominations are not limited to
Wonca members.
The award will be offered on a Regional
(ie, “Regional” applies to the Wonca Regions as defined
in the Wonca Bylaws and Regulations, currently
constituting the Africa, Asia-Pacific, Europe,
Iberoamericana-CIMF, North America and Middle East
South Asia Regions) and Global basis. The Regional
Awards may be awarded on an annual basis and the
Global Award is being awarded every third year. The
award will take the form of a crystal trophy and a
certificate presented during the July 2007 Wonca World
Conference in Singapore.
The closing date for nominations for the Wonca
Award for Excellence in Health Care: The Five-Star
Doctor is March 31, 2007.
Suitably motivated and validated nominations for
Regional Awards should be submitted to the Wonca
Chairman of the Nominating and Awards Committee.
They will be forwarded to the relevant Regional
President for regional consideration. The Global Award
will be chosen from the recipients of Regional Awards
for that triennium.
The criteria to be considered by the selection
committee/s will include the following. These criteria
apply to both Regional and Global Awards, and include:
•Impact on healthy care of individuals and community
•Contribution to regional / global development
•Community perspective and involvement
•Networking for the benefit of the community
•Innovative services
•Development of services in previously underserved /
disadvantaged areas
•Demonstrated support of colleagues in another
region / country / college
•Performance of academic work of quality and
relevance including teaching and research
•Development of models which could be applied to
other regions / areas
•Best meet the criteria of the “5-star” health
professional
*Care provider
*Decision maker
*Communicator
*Health Advisor and Community Leader
*Team member
Please complete the nomination form and send by
email or also hard copy to:
Professor Chris van Weel
Chair, Nominating and Awards Committee
World Organization of Family Doctors (Wonca)
#01-02 College of Medicine Building
16 College Road
Singapore 169854
Email : admin@wonca.com.sg
Fax : +(65) 6324 2029
The nomination form is available at the Wonca
online website at www.GlobalFamilyDoctor.com and by
contacting Yvonne Chung, Wonca Administrative
Manager, at the Wonca Secretariat in Singapore at the
above email, fax or mailing address.
Wonca Establishes Working Party on
Mental Health
A proposal to establish the Wonca Working Party on
Mental Health (formerly the Special Interest Group on
Psychiatry and Neurology) was approved by the Wonca
Executive during its October 2006 meeting in Buenos
Aries. The Wonca Working Party on Mental Health
(WWPMH) will serve as a focus for the development of
mental health issues for Wonca worldwide. This Working
Party provides the opportunity for the discipline of
Primary Care Mental Health to become a priority for
Wonca and the Wonca family, especially as mental
health issues have a major impact on our day-to-day
care of our patients.
WONCA
News
FEATURE STORIES
6
The mission and vision of the
Working Party on Mental Health is
to improve mental health care
around the world by providing a
universal gold standard of care for
mental health through
empowerment of primary care and
in collaboration with all interested
stakeholders.
WPA Conference in Istanbul in July 2006
showing our delegation of speakers talking
on ‘From Conception to Death: A Mental
Health Primary Care Pathway’
Wonca Europe Regional Meeting in Florence
in August 2006 showing our workshop held
on ‘Dementia Management in Primary Care’
Current objectives are to
•Promote standards of excellence
in the primary care management
of mental health, consistent with
patient and professional values
and with reference to evidence
based health care;
•Promote the concept of mental
health & well-being;
•Develop and promote mental
health research in primary care
and the primary care – mental
health interface
•Hold scientific meetings, which
may include sessions and
workshops, to present original
papers and to address broader
educational issues through
discussion, training and debate
during Wonca Regional and
World conferences;
•Promote and develop patient
information about mental health
issues;
•Develop and promote
appropriate literature for primary
care professionals using a variety
of resources, including Wonca
Online;
•Promote the discipline of primary
care mental health world-wide
through collaborative working
within Wonca, NGO’s,
government organisations,
patient groups & other medical
colleges;
•Address the issue of stigma
associated with mental health
conditions.
We plan to undertake the
following activities:
•Guideline development on
mental health issues
•Scientific presentations on
mental health issues
•Advice to Wonca and its member
organizations on mental health
issues
•Participation in Wonca activities
and conferences with a focus on
the mental health agenda
•Working with WHO to develop a
resource book on the integration
of mental health into primary
care
•Provision of a regular Working
Party newsletter and educational
materials
•Supporting the mental health
curriculum in primary care
education
•Organising regular online Primary
Care Mental Health Grand
Rounds
•Developing and supporting
postgraduate accreditation
programmes for General
Practitioners with a special
interest in mental health
In early 2007, the WWPMH met to
discuss and plan an implementation
timetable for our stated objectives
and prepare for the Wonca World
conference in Singapore. I would like
to encourage as many of you as
possible to join us in Singapore for
the Wonca World Conference, where
we will celebrate our new Working
Party status and will be holding a
pre-conference workshop for all our
members and interested parties.
Please get back to me with your
suggestions of issues or topics you
think we should cover in Singapore.
We will also use the opportunity to
make a mental health declaration at
the end of this meeting. I would be
grateful if you could let me know the
key topics this declaration should
cover.
At the Wonca Europe Regional
Conference in Paris: 17th - 20th
October 2007, we will be presenting
a session on ‘Recent Advances in
Primary Care Mental Health.’ We plan
to hold both theoretical and practical
skills sessions and hope that as
many of you as possible will be able
to attend and contribute. Please
send me any ideas about the
practical skills you would like the
teaching session to address. We also
plan to contribute to the 19
th
– 21
st
June 2008 – World Psychiatry
Association conference on
‘Depression and Relevant Psychiatric
Conditions in Primary Care’ in
Granada, Spain.
The WWPMH is soliciting
representation from individuals
interested in improving mental
health standards from our member
Colleges and all Wonca regions. If
you would like to support or
contribute to this Working Party
please register your interest by
contacting me.
Dr Gabriel Ivbijaro
Chair, Working Party on Mental
Health
gabriel.ivbijaro@gmail.com
WONCA
News
FEATURE STORIES / REGIONAL NEWS
7
Register Online for Wonca
World 2007 in Singapore
Singapore beckons! As we gear
up in our preparations for the 18
th
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. You may register
online for the 18
th
Wonca World
Conference 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
WONCA REGIONAL NEWS
ASIA PACIFIC HOLDS RESEARCH WORKSHOP IN
BANGKOK
This research workshop held in Bangkok on 7 November 2006 was a
follow-up of the Wonca Kingston Conference recommendations in March
2003 (van Weel C, Rosser WW (ed). Improving Health Globally and the Need
for Primary Care Research: Report of the Wonca Kingston Conference. Ann
Fam Med 2004;2Suppl). Following the Kingston Conference, Asia Pacific
took the momentum to organize a research meeting in Phuket, Thailand in
July 2004 to initiate the Research Network of the Asia Pacific. A meeting in
Genting, Malaysia in February 2005 followed this research meeting.
The Bangkok research workshop was held in the Royal Golden Jubilee, in
the heart of the bustling city of Thailand. The workshop was well attended
and well received. It attracted delegates from Thailand, Malaysia, Singapore,
Indonesia, Philippines, Korea, Taiwan and Australia among other countries.
The aim of the Bangkok research workshop was to report on the
experiences and progress from the Asia Pacific countries following the
Phuket and Genting meetings, and to discuss the future direction of the
research group in the region. We
tried to identify possible ways to
strengthen research collaboration
among countries.
The Bangkok research workshop
was held within the main conference
in order to attract as many
participants as possible as well as
to save costs and time in having to
attend another meeting. The title of
the workshop was “Research
networks in Asia Pacific region,
where are we and how do we go
from here?” Professor Goh Lee Gan,
the Regional President for WONCA
Asia Pacific, served as chair. He was
also a speaker (from Singapore).
The other speakers were: Professor
Somjit Prueksaritanond (Thailand),
Dr Zailinawati Abu Hassan
(Malaysia), Professor Justin Bielby
(Australia) and Professor Chris van
Weel (Netherlands). This was
followed by a lively discussion.
WONCA
News
REGIONAL NEWS
8
Professor Somjit Prueksaritanond
from Mahidol University, Thailand,
started off the session with a report
of the activities held in the Phuket
workshop in 2004. A steering group
was formed during that meeting
with the hope of starting and
driving the research network in the
region. At the end of the 3 days
conference four research proposals
were formulated.
This was followed by a
presentation on the progress made
in Malaysia by Dr Zailinawati Abu
Hassan. The Malaysian Primary Care
Research Group (MPCRG) is a special
interest group within the Academy
of Family Physicians of Malaysia
(AFPM) that was formed by the
Malaysian delegates who
participated in the Phuket meeting.
They have successfully run research
workshops bi-annually, mentoring
more than 10 research projects
during the past two years and had
managed to gather the main
stakeholders of primary care in the
country. Some of the barriers noted
was lack of funding, lack of
sustainable capacity building efforts
and the lack of success in attracting
practicing family doctors to be
involved in research.
Professor Justin Bielby observed
that primary care has diverse
backgrounds in Asia Pacific and
competitive leaders could work
together for the growth of the
region. He shared his experience of
how research development in
Australia flourished over past years.
With government support and
