Building the foundation for research, policy, and advocacy to strengthen Family Medicine in the South Asia

September, 2022

Dr. Tariq Aziz, President WONCA South Asia Region (SAR)
Dr. Hina Jawaid, Chair WONCA SAR Primary Care Research Network
Dr. Ramakrishna Prasad, Editor WONCA SAR Journal


South Asia, constituting India, Pakistan, Bangladesh, Nepal, Sri Lanka, Bhutan, the Maldives, and Afghanistan represents the most populous region in the world. Unfortunately, despite obvious need, the field of primary care and family medicine in this region is underdeveloped and at a nascent stage. As a result, strengthening primary care systems and family medicine in South Asia needs to be a global imperative.  Towards this goal, besides advocacy, educational programs, and support for clinical family medicine practice, fostering research in Primary Care by practicing family physicians is critical. 

Any field, for it to stay relevant and to effectively achieve its stated mission, needs to produce its own knowledge through research. This knowledge gleaned through research translates into patient care, practice models, education, and advocacy for health strengthening and reform. 

Efforts by WONCA South Asia Region

Since Nov 2021, as a part of the current leadership committee of WONCA South Asia, we have taken several concrete steps to build the foundation for primary care research in South Asia. 

We aimed to nurture a cadre of researchers in family medicine and primary care who contribute the primary care/family medicine perspective to improve patient outcomes, efficiency, transparency and sustainability of health care delivery in the South Asian context. Additionally, we wanted to create a platform for family medicine/primary care clinicians, health services researchers, and other experts to address the common, but complex, issues surrounding contemporary health care in the South Asian context to harness synergies and increase impact.

Accomplishments thus far: 

a) Establishing regular communication between leaders. -       Apart from attending numerous meetings (in person or online) both regionally and globally President SAR Dr Tariq Aziz attended the WONCA council in person at the Royal College of general Practitioners in London UK on 27th June 2022.

b) Seeding research teams that involve several young FP investigators from across South Asia 
- Challenges faced by practicing Family physicians in South Asia in conducting research. (study underway)
- Climate change and Health disclosure: A multinational cross-sectional study of South Asian Physicians’ knowledge and perception about health effects of climate change. (manuscript submitted to an international journal ‘Family Practice’)
- Breast cancer knowledge among health professionals: A pre-post knowledge -based intervention study (manuscript submitted for publication in PubMed indexed journal)
- Knowledge and use of different types of contraceptive methods to prevent pregnancy and STIs among women in the reproductive age group. (Study underway)

c) Monthly Research, Leadership, and Policy seminar series 

So far, the following have been conducted: 
-  Supporting Primary Care Research by Dr Ramakrishna Prasad & Dr Hina Jawaid on 28th Dec 2021
-  Research overview & Study design: Basic tips for beginners by Dr Basharat Ali & Dr Tehzeeb Zulfiqar on 11th March 2022
-  Rural Primary Care Practice, Research & Leadership by Dr Pavitra Mohan on 30th May 2022
-  Developing Family Medicine/Primary Care Education, Faculty and Leadership in South Asia: Lessons from an African context by Dr Kenneth Yakubu on 20th Aug 2022
-  Research Ethics and Plagiarism by Dr Mariam Hasan scheduled for 14th September 2022

d) Advocacy and writing in the lay press: 

Newspaper columns, written by eminent Family Medicine faculty who are actively involved in teaching, training and research work locally, nationally and regionally. Dr. Hina Jawaid and Dr. Abdul Jalil Khan from Pakistan have been writing a series of articles on primary care and other health related issues on a regular basis. Articles on obesity and breastfeeding were co-authored by Dr. Tehzeeb Zufiqar and Dr. Marriam Sheraz. List of their published columns include:

1) Breast Cancer: myths, reality, and solutions! (Article published in The Daily Times newspaper on14th Nov 2020)
2) The mystery of unsafe injections in Pakistan. (Article published in The Daily Times newspaper on 12th Jan 2021)
3) Primary care in Pakistan: current situation and way forward. (Article published in The Daily Times newspaper on 17th March 2021)
4) Diabetes: No time to lose. (Published in The News on Sunday 9th May 2021 in the News on Sunday)
5) The way to universal health coverage. (Published in The News on Sunday 27th June 2021)
6) Primary Care transformation). (Published in The News on Sunday 18th July 2021)
7) A call for medical education reforms). (Published in The News on Sunday 15th Aug 2021)
8) Need for leadership in primary healthcare). (Published in The News on Sunday 19th Sept 2021)
9) Little awareness about breast cancer). (Published in The News on Sunday 31st Oct 2021)
10) Medical licensing. (Column published in The News on Sunday on 16th Jan 2022)
11) Nutritional needs in early years of life. (Column published in The News on Sunday on 27th March 2022)
12) Dealing with obesity. (Column published in The News on Sunday on 3rd April 2022)
13) Training primary care doctors. (Column published in The News on Sunday on 5th June 2022)
14) Training primary-care doctors — II (Column published in The News on Sunday on 19th June 2022)
15) The cost of coping. (Column published in The News on Sunday on 17th July 2022)
16) Guest Editorial: Burden of the disease (Column published in The News on Sunday on 31st July 2022)
17) All the reasons to breastfeed (Column published in The News on Sunday on 7th Aug 2022)

e) Select peer reviewed publications (2021-2022)

1) Prasad, Ramakrishna & Krishna, Sudhir. (2022). The Indian Science Establishment and Public Health: Critical Need for Transdisciplinary Learning, Collaboration, and Leadership. Journal of Indian Institute of Science 2022
2) Prasad, Ramakrishna & Rao, Badakere. (2020). Embracing our larger role: Family Physicians as catalysts of social and planetary well-being. Journal of Indian Institute of Science 2022
3) Johnston, Esther & Samaratunga, Nath & Prasad, Ramakrishna & Birkland, Bassim & Von Pressentin, Klaus & Prasad, Shailendra. (2022). Building the foundation for universal healthcare: Academic family medicine’s ability to train family medicine practitioners to meet the needs of their community across the globe. African Journal of Primary Health Care & Family Medicine. ISSN: (Online) 2071-2936, (Print) 2071-2928 P. 2071-2928. 10.4102/phcfm.v14i1.3506.
4) Simha, Aditya & Prasad, Ramakrishna & Ahmed, Sana & S Dinesh, Akshay & Rao, Naren. (2022). Effect of national cultural dimensions and HIV prevalence rates on stigma towards people living with HIV/AIDS. Psychology, Health & Medicine. 1-7. 10.1080/13548506.2022.2057557.
5) Anwari, Colis & Balasubramanian, Swaathi & Sawant, Prathamesh & Kuri, Ushna & Anand, Ashoojitkaur & Rao, Badakere & Prasad, Ramakrishna. (2021). Elder Care: The Need for Interprofessional Collaboration between Family Physicians, Clinical Pharmacists, and Physiotherapists in Home Based Primary Care Teams.
6) Warnky, David & Balachandra, Swathi & Prasad, Ramakrishna & Sykes, Kevin & Lall, Dorothy & Bhojani, Upendra. (2021). The community health impasse: What can family physicians learn about integration of social determinants of health from the challenges, diversity, and worldview of primary healthcare practices located in Southern India?. Journal of Family Medicine and Primary Care. 10. 10.4103/jfmpc.jfmpc_971_21.
7) Simha, Aditya & Ahmed, Sana & Prasad, Ramakrishna & S Dinesh, Akshay & Kandasamy, Arun & Rao, Naren. (2021). Effect of national cultural dimensions and consumption rates on stigma toward alcohol and substance use disorders. The International journal of social psychiatry. 207640211028611. 10.1177/00207640211028611.
8) Balasubramanian, Swaathi & Anand, Ashoojitkaur & Sawant, Prathamesh & Rao, Badakere & Prasad, Ramakrishna. (2021). Managing Mental Health Problems in a Family and Community. Journal of Family Medicine and Primary Care. 10. 10.4103/jfmpc.jfmpc_1236_20.
9) Balachandra, Swathi & Sawant, Prathamesh & Prasad, Ramakrishna & Huilgol, Poorva. (2021). Antimicrobial resistance (AMR) at the community level: An urban and rural case study from Karnataka. Journal of Family Medicine and Primary Care. 10.4103/jfmpc.jfmpc_888_20.
10) Simha, Aditya & Prasad, Ramakrishna & Ahmed, Sana & Rao, Naren. (2021). Effect of gender and clinical-financial vulnerability on mental distress due to COVID-19. Archives of Women's Mental Health. 23. 10.1007/s00737-020-01097-x.
11) Babra Naveed, Khadija Amna Arif, Hina Jawaid, Zia-ul-Hassan (2022) Antibiotics Prescribing Practices for Sore Throat in a Sub-Urban
Primary Care Clinic. Biomedica Volume 38(2):94-98 June 2022 DOI 
12) Hina Jawaid, Marriam Sheraz, Khudija Amna Arif  Zia Ul Hasan Hina Akhter (2022) Barriers in the use of Colostrum, Breast Milk and Supplemental Feeds: Assessing Maternal Knowledge & practices. Journal of Medical & Dental College (JUMDC) Vol 5, issue1 Jan2022  
13) Khudija Amna Arif, Hina Jawaid, Marriam Sheraz, Zia Ul Hasan, Babra Naveed, Hina Akhter (2021) Exploring Dietary Practices, Perceptions and Knowledge of Mothers of Toddlers visiting Primary Care Physicians.
Journal of Sheikh Zayed Medical College, Vol 12 No 4 (2021) DOI: https//  
14) Ayesha Zafar, Mohsin Shafiq, Basharat Ali, Wolfgang Sadee, Abdul Rauf Shakoori, Farah Rauf Shakoori Tuberculosis 2022 Association of IRGM promoter region polymorphisms and haplotype with pulmonary tuberculosis in Pakistani (Punjab) population journal Tuberculosis 136 (2022) 102233 DOI: 10.1016/ 

The Path Forward: Priority Areas for future action, research, policy, and advocacy to strengthen Family Medicine in the South Asia: 

1. Using a range of research methods, including mapping tools and policy analyses, to 
a) Determine trends in the supply, training and distribution of the primary care workforce 
b) Evaluate and improve quality of care through accreditation, 
c) Evaluate payment models and their impact, 
d) To appraise workforce shortages and maldistribution, 
e) To conduct robust needs and systems assessment at multiple levels of the health system
2. Generation and contribution of data and policy analyses and advocate for solutions that bring family medicine and primary care perspectives to health policy deliberations at the local, state, and international levels
3. Establish partnerships and collaborations with individuals and institutions in order to accomplish the above in an impactful manner. 
4. Serve as an incubation space for primary care research, writing, and education by facilitating and supporting scholarship, writing, and publication in primary care especially among medical students, family medicine residents and faculty, and practicing family physicians and general practitioners

Through promoting research our aim is to encourage a shift from experience based to evidence based clinical practices among GPs and engage in health advocacy. Additionally, we must strive to further promote and nurture the core principles of Family Medicine and the ‘hidden curriculum’ that influences primary care at both undergraduate and postgraduate level. 

Notable contributors to research from WONCA South Asia Region (2021-2022)
1- Dr Tariq Aziz (President WONCA SAR)
2- Dr. Ramakrishna Prasad
3- Dr Hina Jawaid
4- Dr Basharat Ali
5- Dr. Raman Kumar
5- Dr Abdul Jalil Khan
6- Dr Tehzeeb Zulfiqar
7- Ms. Swaati Balasubramanian
8- Dr Waseem Ayesha Hana
9-  Dr Hassam Khan
10- Dr Ferdous Rehman
11- Dr Sankha Randenikumara
12- Dr Kinley Bhuti
13- Dr Husna
15- Dr Sadia Mustafa
16- Dr Marriam Sheraz
17- Dr Asif Rehman