WONCA reaction to Astana Declaration

“Family practice is the best way to provide integrated health services at the primary health care level. With an emphasis on health promotion and disease prevention, family practice helps keep people out of hospitals, where costs are higher and outcomes are often worse. Strong political commitment is essential to improve access, coverage, acceptability and quality of health services, and to ensure continuity of care.
Dr Tedros Adhanom Ghebreyesus. Director General World Health Organization, October 2018


WONCA, the World Organization of Family Doctors, was represented at the Global Conference on Primary Health Care, in Astana, Kazakhstan by the WONCA President, Immediate Past President, President- Elect, Young Doctor Movement representative, and two Executive Members-at-large. We have reviewed the final version of the Astana Declaration. It was first shared on October 25, 2018 via web and adopted at the conference.
Astana Declaration
WONCA notes that the Declaration no longer includes the specific mentioning of family doctors or any other members of the primary healthcare teams. The prior public draft did include different disciplines needed in the Primary Health Care (PHC) team, but these have all been removed in the final version signed by Member States. While we had hoped and strongly advocated for Family Medicine to be specifically included in the declaration, we are encouraged that many of the documents supporting the Astana Declaration do include family doctors/general practitioners as key members of these teams. 

Family medicine was mentioned multiple times during the plenary sessions; in addition, several side events during the Global Conference on Primary Health Care highlighted the work and reach of family doctors, including the presentation of Family Practice in the Eastern Mediterranean Region: Universal health coverage and quality primary care.

On a more positive note, we have noted the Declaration expresses a commitment to “Primary health care and health services that are high quality, safe, comprehensive, integrated, accessible, available and affordable for everyone and everywhere, provided with compassion, respect and dignity by health professionals who are well-trained, skilled, motivated and committed;” something which describes the work and commitment of family doctors and the members of our primary care teams worldwide.

Furthermore, the declaration supports “Human resources for health” stating “We will create decent work and appropriate compensation for health professionals and other health personnel working at the primary health care level to respond effectively to people’s health needs in a multidisciplinary context. We will continue to invest in the education, training, recruitment, development, motivation and retention of the PHC workforce, with an appropriate skill mix. We will strive for the retention and availability of the PHC workforce in rural, remote and less developed areas. We assert that the international migration of health personnel should not undermine countries’, particularly developing countries’, ability to meet the health needs of their populations.” We welcome this part of the declaration, especially in its support of people living in rural and remote settings, and hope that all governments will engage in genuine support to strengthen primary health care for every person, in every family, in every community, in every country in the world.

The next steps need to include advocacy for the establishment of an academic department of Family Medicine/General Practice in every medical school, in every country, in every region of the world. We also note that the Astana Declaration states “PHC will be implemented in accordance with national legislation, contexts and priorities”. This means countries will need the political will to make a difference in primary health care for UHC, and that current existing legislation, and priorities may need to change in order to better support PHC. WONCA members shall also need to advocate for a true commitment by their governments to support strengthening primary health care in every country – which includes recognition and support for our role as family doctors in health systems.

In conclusion – WONCA re-states that family doctors are essential to high quality cost-effective primary health care. We need Family Medicine/General Practice leaders in every region to be attentive and active. The implementation phase, over the next year following the release of the Astana Declaration, is a most important time to advocate for family medicine - and to make our governments accountable to investing in Primary Health Care and including Family Medicine in the design of health systems around the world.

Please go to the website to see the supporting documents and background papers for the Declaration and thank you for all your efforts.

Link to the plenary and ministerial parallel sessions.

Photo of representative team (l to r)
Donald Li (President)
Ana Nunes Barata (Young Doctors' representative)
Pratyush Kumar (Member at large and rural doctor)
Anna Stavdal (President elect)
Amanda Howe (Immediate Past President) (rear)
Rosa Villanueva Carrasco (WONCA Iberoamericana CIMF)
Young resident from Duke University USA
Viviana Martinez Bianchi (WONCA WHO liaison)