From the President
Singapore and the Sustainable Development Goals

Photo: WONCA president with family medicine residents and Associate Professor Tan Boon Yeow during a recent visit to Singapore

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I recently visited Singapore and had the opportunity to meet with members of the College of Family Physicians Singapore, our WONCA member organization. The college was established in 1971, rapidly became a member of WONCA, and has hosted our World Conference in 1983 and again in 2007.

Singapore is a small city-state, with its population of 5.5 million people receiving excellent health care and enjoying some of the best life expectancy rates in the world.

I was reminded by college president, Associate Professor Lee Kheng Hock, that family medicine is not yet recognized as a medical specialty in Singapore. The good news is that the Academy of Medicine Singapore, the umbrella organization of all specialist disciplines in the country, has agreed to set up a chapter of family medicine physicians, and this has been approved by the Ministry of Health. Our colleagues in Singapore now need to advocate to ensure the specialty of family medicine is recognized by law in the Medical Registration Act.

The recognition of family medicine as a specialty matters. We need the brightest and the best of each nation’s medical students to see community-based primary care as a viable and exciting and worthwhile career choice, and to join us in a career in family medicine. We want our medical graduates to become family doctors by choice, not by accident.

Primary health care services are provided in Singapore by family doctors and community-based nurses, working either in one of the 1,500 private medical practitioner clinics, or in one of the network of 18 government polyclinics. The polyclinics are described as “one stop” comprehensive primary health care centres, and provide medical treatment, health screening and immunization, and health education services to the members of their local community.

This network of private and government clinics across Singapore ensures that primary health care services are accessible and affordable for all members of the population.

This focus on accessibility is part of the aim of the United Nations’ Sustainable Development Goals. In September 2015, the United Nations adopted 17 goals to ensure a more equitable world. Only one of the 17 goals is specifically about health, but all 17 have an impact on the health and well-being of humanity, and many will only be successful if nations invest in ensuring the health and well being of their populations.

The single health goal is about “ensuring healthy lives and promoting well being for all people at all ages”. This is the goal of universal health coverage, ensuring that every person and every family in every country of the world has access to health care.

Primary care provides the answer to universal health coverage, and health systems founded on strong primary care are critical “to ensuring healthy lives and promoting well-being for all at all ages”. We need an unambiguous commitment by the United Nations and other stakeholders to the development of high quality, comprehensive integrated primary health care in each country of the world.

If we are going to achieve universal health coverage across the world, then the way many of our nations invest in health care is going to have to change. We need to invest more in health promotion and preventive care, keeping people as well as possible for as long as possible. We will need to invest in early detection and community-based management of chronic diseases. And we will need to address the mental health concerns that affect so many people.

If health care is going to be accessible for all then our nations are going to have to make sacrifices. We need to work with our governments to determine what each nation needs to sacrifice to ensure that health care remains affordable and attains universal health coverage. That means fewer new shiny hospitals for politicians to open, and more well resourced community-based clinics with well-supported family health care teams of family doctors and community nurses.

This was the basis of WONCA’s statement on Health in the 2030 Agenda for Sustainable Development, which I delivered at the World Health Assembly in Geneva in May. Here is the content of our statement:

Primary care teams worldwide provide examples, from their daily practice, that illustrate their contribution across the Sustainable Development Goals (SDGs). This includes helping to improve people’s life chances and reduce health inequities; advocating for healthy lifestyles and environments; and promoting health in communities. When integrated into a nation’s health system, family doctors are trained to care for all aspects of peoples’ health including health promotion, disease prevention, acute, chronic, rehabilitative and palliative care. Family doctors provide this care to people over the life-course, within the community they serve, and in collaboration with other health professionals.

National governments, and other stakeholders, need to be ambitious in measuring and monitoring progress towards strengthening primary health care to meet the SDGs. This monitoring includes the use of indicators that capture the principles of equity, community participation, prevention, use of appropriate technology, and inter-sectoral collaboration. Evidence is clear that this monitoring needs to measure the elements that make primary care services successful: first contact care, continuity, comprehensiveness, coordination, and care that is person-centred with family and community orientation.

Health financing indicators need to track government expenditure in primary care, and provide information on the economic accessibility of primary care services. Indicators on the make-up and distribution of the primary care workforce are crucial.

Primary health care integrates many of the SDGs. However in order to realise the full potential of the contribution of primary health care to sustainable development, and indeed universal health coverage, a strong interdisciplinary primary health care workforce, including family doctors, is needed in all countries.

Michael Kidd
WONCA President