From the President: Alma Ata 40 – our chance is now

Photo: Nigerian doctors celebrate World Family Doctor Day

May was a very busy month – starting with a very enjoyable and informative trip to visit our members in the Caribbean College of Family Physicians; then the World Health Assembly in Geneva; followed by the WONCA Europe conference in Krakow; and then our WONCA World Executive in Warsaw!

I also spoke at the International Federation of Medical Students’ preconference in Geneva, and made contributions in the World Federation of Public Health Associations – with whom we now are an official ‘Organisation in Collaboration’.

We celebrated World Family Doctor Day on 19 May – which gives another important opportunity to recognise your hard work and achievements!

Photo: Multiple activities in China organised jointly by three WONCA Member Organizations

I am always inspired by the interactions with colleagues as we go about our work, and want to thank all those with whom I have had contact this month – including our hardworking Executives and Secretariats, both for WONCA World and for WONCA Europe. So well done to all, working at all levels to develop and recognise family medicine.

But the political environment is less reassuring. At the World Health Organisation, we experienced a new level of access for WONCA, with the President being invited to join the International Advisory Group for the Alma Ata 40th (AA40) anniversary activities, and some of our academic colleagues being involved with the development of technical documents for the AA40 programme of work. However, the major WHO strategic emphasis on achieving universal health coverage (UHC) through strengthening primary care often seems to lack detail, and to focus on a very basic package of care.

The definition of UHC is that all people should be able to obtain the health services they need without suffering significant financial hardship , and that they should get coverage for a range of health promoting, preventive, curative, rehabilitative and palliative services. Service delivery at the primary care level is therefore crucial, ensuring access to integrated health services working for the person and their community across all priority health problems. This requires well trained medical and other workers located close to the population they service - but many of the discussions at WHO do not seem to include any vision of how the medical workforce should reformed in UHC. This risks leaving the hospital specialist sector to expand further, and that care will continue to be costly due to lack of coordination and early intervention.

We therefore ALL need to make the voice of family medicine heard at country level, to influence your national WHO delegation as they start to read and comment on the AA40 declaration and documents.

I previously sent an advocacy document to all member organisations, and intend to follow this up with a new report and briefing. We shall also be using social media more to get these messages across. But I ask you – each of you reading this – to act on this now. Contact your member organisations leaders, make sure they are in touch with the country level leads for WHO, and help them understand that family doctors in the primary health care team are essential to the meaningful and cost effective achievement of UHC. A community health worker or community nurse will need a doctor with whom they work, in order to refer, advise, diagnose and plan treatment together: also to work on population health needs, and deliver effective care without excess use of hospitals and medications. Finally, we must ask them to recognise and act on the maldistribution of the health workforce – no country can achieve UHC when the rural areas have inadequate workforce, and people are entitled to a full package of care wherever they live. We are acting now to influence what comes out for AA40, and to get family medicine visible in that work: but we need all of you to help!

Amanda Howe