From the President: Family doctors tackling serious global health challenges
– examples from India and Africa
Photo: Low cost, effective care clinic in Vellore, India, providing subsidized primary care services, delivered by family doctors and the members of their teams, to the local community
Over 25% of the world’s population lives in South Asia, many in dire poverty with limited or no access to health care. WONCA continues to provide strong support, through our member organisations, for improvements in primary care access for the people of this region.
India in particular is struggling with universal health coverage. India faces the challenge of providing health care to all 1.2 billion people of this vast country, with 80% of the population living in rural areas. The national government of India, like the World Health Organization, has recognised that universal health care can only be achieved through strengthening of primary care, and the key to this is strong family medicine.
Last month I attended the WONCA South Asia Region annual conference held in Chennai in Southern India. Passionate committed family medicine pioneers from India, Bangladesh, Sri Lanka and Nepal, came together with enthusiastic young family doctors and medical students, and with friends from WONCA member organisations from around the world. The conference was organized by the three WONCA member organisations in India, the Indian Medical Association College of General Practitioners, the Federation of Family Physician Associations of India, and the Academy of Family Medicine of India. Our colleagues, led by Dr Abul Hasan, did a wonderful job organizing the meeting.
For the first time, colleagues from Bhutan joined a WONCA conference, led by Dr Chhabi Lal Adhikari from Paro. We welcome our colleagues from Bhutan to the WONCA family. WONCA South Asia Regional President, Professor Pratap Prasad, is working with our colleagues in Bhutan to support the introduction of postgraduate family medicine training.
One highlight was the program of events organised by the Spice Route Movement, WONCA South Asia’s organization for young family doctors, led by Dr Raman Kumar. Senior colleagues, Dr Ramnik Parekh and Dr Jyoti Parekh, who have been members of WONCA since its establishment, announced their commitment of generous financial support to enable participation of young doctors from the Spice Route Movement in international exchange programs.
The conference heard about many of the challenges facing family medicine in India. Many medical graduates seek to train to become consultant specialists and then subspecialise further becoming, what is called in India, a superspecialist. This focus on increasing specialisation has skewed health care expenditure away from community-based primary care to high technology tertiary care. It has resulted in a health care system with persisting huge inequities in health care access and outcomes.
Photo: Waiting area in the courtyard of the Shalom Family Medicine Centre in Vellore, India
This diversion of health care expenditure also means that India is struggling with universal health coverage. But things are turning around. I had the opportunity to visit one of the nation’s centres of excellence in family medicine at the Christian Medical College in Vellore where Dr Sunil Abraham and his team are leading the way in providing experience in community-based family medicine for all their medical students, and in providing opportunities for postgraduate training in family medicine, both onsite and by distance education. One of the innovations in Vellore is the low cost, effective care clinic, run by family doctors and the members of their teams, which provides highly subsidized, high quality primary and secondary care services to the poorest members of the local community.
Photo : New campaign of the Indian Medical Association College of General Practitioners raising community awareness about the contributions of family doctors to the health care of the people of India
One of the founders of WONCA was Dr Prakash Chand Bhatla from India, who wrote that “Every national health program should involve general practitioners. Education and motivation of the community has to be done on a personal basis. And who is nearer to the community than the family doctor?”
Who is nearer to the community than the family doctor? As family doctors we need to be engaged by our governments and international health organisations in the planning and delivery of national and local health programs. Family doctors are part of their local community and have the trust of their local community and can be part of ensuring the successful delivery of health care programs, especially to the most vulnerable members of our populations.
I hope over time, through initiatives like these, we will see the specialists in family medicine in India become recognized as the true superspecialists that they are.
Our thoughts are with our colleagues working in West Africa with people with Ebola. WONCA offers our condolences to those families who have lost loved ones to the Ebola outbreak, including the families of brave doctors, nurses and other health workers who have been infected while providing treatment and support to their patients.
WONCA has been in contact with our member organisations in West Africa and with individual members involved in the response to the Ebola outbreak that continues to affect hundreds of people. Many of our colleagues from other nations are also involved in the response, through global organisations like Médecins Sans Frontières (Doctors Without Borders) and the International Red Cross/Red Crescent, and through international response teams.
The World Health Organization (WHO) has reported that this is the largest outbreak ever recorded with the potential for further spread. Community education is essential, and so is the training and support of front line health workers. We remain concerned that community-based doctors and other primary care health providers have adequate access to appropriate protective personal equipment to ensure the safety of health personnel working with patients and their carers from affected communities.
The challenges witnessed in the initial response to the outbreak reinforce the essential need for strong primary care systems in every nation with well trained and suitably equipped primary care teams, and the ongoing need for strong and coordinated national and international support.