Rural Round-up: annual report highlights

John Wynn-Jones, chair WONCA Working Party on Rural Practice has provided his final annual report before handing over to Bruce Chater. This is an edited version of the report. The full version will be available in the WONCA Annual report 2018-19:

Structure

Our success in attracting rural practitioners from around the world, meant that we needed to change our structure and as a result we established three tiers of membership .

• The executive: Each executive member has a portfolio to manage. Executives are chosen by the Council and meet at least once (video/audio) during the year in addition to face to face meetings.

• The Council: The council aims to be gender, age, geographically and demographically equitable. We try to ensure that each WONCA region is represented in this way. The membership of the council is limited to approximately 60. Anyone can put their name forward for membership of the council.

• The Assembly: Everyone who is either a rural health professional, rural academic or a rural health stakeholder is entitled to join the assembly. Assembly meetings take up a day during our annual conferences.

We communicate with each other through a number of media vehicles. The Google Group remains the backbone with over a thousand members. We also run Facebook and Twitter pages.

The Executive

There has been a significant change in the composition with nearly 50% of the posts taken up by young doctors. Each member has a portfolio and they have a responsibility to report annually to the council and to the assembly.

Chair: John Wynn-Jones UK
Hon Secretary and Chair-elect: Bruce Chater -Australia
Treasurer; Policy; Immediate Past Chair: Ian Couper -South Africa
Publicity: Dave Schmitz -USA
Communications: Jo Scott Jones New -Zealand
Research: Zakiur Rahman -Bangladesh
Education: Barb Doty - USA
Clinical Practice: Bikash Gauchan -Nepal
Developing Countries (LMICs): Pratyush Kumar -India
Students and Young Doctors (Rural Seeds) - Mayara Floss- Brazil; Veronika Rasic - Croatia + UK

Rural Seeds

Rural Seeds has been in existence for two years following it’s launch at the 14th World Rural Health Conference in Cairns in 2017. It has three joint chairs/coordinators Mayara Floss (Brazil), Amber Wheatley (British Virgin Islands +UK) and Veronika Rasic (Croatia + UK). Rural Seeds works closely with the WONCA young doctor groups but it is a separate network which is rural task orientated rather than regionally represented.

Its achievements over the last two years include:
• Rural Family Medicine Café
• Rural Success Stories Rural (an extensive blog gathering success stories in rural health care)
• Global mentoring programme for rural medical students and young doctors

Working Party achievements over the last triennium

• Equity: Working to achieve equity has been our driving force over the last three years. We have worked successfully towards equity within WWPRP but our greatest challenge will be working to reduce the global rural/urban divide which remains omnipresent from the richest to the poorest countries (ILO 2015). If the world is to achieve anything like Universal Health Coverage by the year 2030, the rural challenge must be addressed. We have tirelessly pursued this goal over the last three years and will continue to do so with increased vigour. Our Delhi Declaration: Alma Ata revisited, endorsed at the WONCA World Rural Health Conference in April 2018 identifies six major themes.

This document is our manifesto for the future:
o Equity and access to care
o Rural Proofing of Policy
o Health System Development
o Developing and educating a workforce fit for purpose
o Realigning the research agenda
o People and communities

• Working in partnership: We have continued to work with other WONCA groups and will continue to do so. We have shared workshops and other activities with Education, Indigenous, Research, Women and Family Medicine, Emergency and Family Violence. We continue to work with WONCA Regional Groups, WHO, Towards Unity for Health, ICOH, Darwin International Institute for the Study of Compassion, American Association of Family Medicine and other organisations.

• Priority areas: We signalled our intention to prioritise certain areas. We have now a permanent and productive link with China. Attempts to develop a establish a rural network in Asia Pacific has not moved on any further from a rural meeting at the last Asia Pacific Conference. Links with South America continue to grow. Finally we are delighted that we have established a rural network in Africa (WoRA). The chair attended the WONCA Africa Conference in Kampala in June and gave a keynote presentation. We aim to hold the WONCA World Rural Health Conference in Kampala in 2021

• Conferences:
o 15th WONCA World Rural Health Conference, New Delhi, India. This conference attracted over a thousand delegates from around the world. We always want our conferences to leave a lasting legacy and we believe that this has done so in India. We were honoured by the participation of the Vice-President of India and 2 Health Ministers. The timing was perfect as it coincided with major changes in India, aimed at securing access to health care for its poor and rural inhabitants. We were delighted to host a National Consultation on Strengthening Rural Primary Care in India.
We launched the Delhi Declaration: Alma Ata revisited.
o Future planned conferences are
   -October 2019: Albuquerque, New Mexico
   -April 2020: Dhaka, Bangladesh
   -2021 Kampala, Uganda

Working with WHO

WWPRP has a close working relationship with WHO, in particular with the Human Resources for Health Directorate. Our recent activities to date with WHO include:

• In a response to the lack of emphasis on rural health care in the draft Astana declaration we launched our own rural response to the 40th anniversary of Alma Ata, called the Delhi Declaration: Alma Ata Revisited. We were honoured and delighted when WHO put this on their website (see attachment) The Declaration is available in seven different world languages. It has also been endorsed by a number of national organisations. https://www.who.int/hrh/news/2018/delhi_declaration/en/
   o We contributed to the Astana declaration. “We will strive for the retention and availability of the PHC workforce in rural, remote and less developed areas.”

• Finally, we were approached by WHO in October 2018 to undertake a rapid response project to carry out a comprehensive literature review into “Pathways and Pipelines for Rural Training” across all professional groups in LMICs and use the information gained and our extensive rural network to develop a checklist to help LMICs to introduce their own training pathways. We were fortunate to be able to commission an excellent team at Monash University to help us with this work.

• The Rural Workforce Pathways Checklist has been well received by WHO and is out for review. We intend to launch the checklist at the conference in Albuquerque.

Finally

As I finish as chair, I would like to thank all those that have helped me with my work across WONCA. A special thanks to Garth, Nongluck, the WONCA Secretariat, Karen Flegg and the three WONCA Presidents (Michael, Amanda and Donald). I would also like to thank my colleagues in WWPRP, the Executive and a very special thanks to Bruce Chater, who as secretary made it all possible. It has been a great honour and a rich and rewarding experience.