Strong family practice and universal health coverage in the Middle East

From the President - November 2014


On World Family Doctor Day this year, 19 May 2014, the Regional Director for the World Health Organization (WHO) Eastern Mediterranean Region, Dr Ala Alwan, released a media statement underscoring the importance of family medicine in the delivery of quality primary health care, and accelerating progress towards universal health coverage, in the nations of the WHO Eastern Mediterranean Region.

The Eastern Mediterranean Region covers 22 nations from Morocco to Somalia in Northern Africa, and from Lebanon to Pakistan in the Middle East and South Asia. It is a region that includes countries with great wealth, countries with great poverty and inequity, and countries affected by serious civil conflict.

Photo: Al-Watayyah health center in Muscat with Dr Najlaa Jaafar, seen here with Dr Ahmed Al-Wehaibi, a family physician working for the Ministry of Health in Oman

In his statement, Dr Alwan advised that improving access to quality health care services is one of the key priorities for health system strengthening in his region and that the WHO is committed to “expanding the provision of integrated people-centered health services that address the major burden of ill-health and are based in primary health care.” Family practice is seen as “a cost-effective model that ensures delivery of comprehensive, continuous and coordinated health care services for all members of the family.”

I was invited recently by the World Health Organization to assist the Oman Ministry of Health in a review of the rollout of that nation’s national primary health care strategy.

The achievements of Oman over the past forty years in reforming the nation’s health care system, and tackling the major health care challenges facing its population of four million people, have been a remarkable success. So much so, that in 2010 the United Nations Development Programme ranked Oman as the most improved nation in the world in terms of development during the preceding 40 years.

This has been the result of strong policy-led development with a focus on health promotion and disease prevention, on the training of a workforce of skilled family doctors, community nurses and other health care professionals, and on the construction of community health centers across the country to meet local primary health care needs.

These primary health care developments have been successful in improving child and maternal health, tackling infectious and chronic diseases and increasing life expectancy. Primary care has become the gatekeeper in Oman to other health services thereby containing health care expenditure. The system of primary health care in Oman has resulted in a health system with fewer health inequalities and better health outcomes including lower morbidity and mortality rates.

Photo: Public health campaign in Oman aimed at preventing the spread of Middle East Respiratory Syndrome-coronavirus (MERS)

The new national primary health care strategy provides the opportunity to further strengthen the health system in Oman to meet current and future community needs. It enables Oman to continue to develop high quality, safe, evidence-based primary care services and ensure these services are person-centred and integrated across the health system. It continues the training of a skilled workforce of caring, competent, compassionate and trustworthy health care professionals who are accessible and well supported in their important roles. And it ensures the safety and quality of primary care services to the people of Oman through the provision of excellent practices and infrastructure that meet current and future community needs. It also continues the existing strong focus on health promotion, disease prevention, screening and early intervention, and the management of non-communicable diseases and comorbidities.

In Oman, as in many countries, one of the biggest challenges is the shortage of trained family doctors and the fact that existing training programs need more support to meet the need for family doctors to support the population’s needs of primary care. The WONCA member organization in Oman, the Oman Family and Community Medicine Society, is working with the national government on strengthening the training of family doctors.

Photo: Public health campaign in Oman on the health risks of smoking a shisha (“hubbly bubbly”), which can be the equivalent of smoking up to 200 cigarettes

Dr Alwan and his colleagues in the WHO have recognized that new strategies and approaches are needed to address the gaps in primary care provision in the nations of the Eastern Mediterranean Region, and that each nation needs clear policies and strategies, based on evidence and community engagement, to ensure strong family practice in each nation.

In November, WONCA representatives will be meeting with the WHO and representatives of the 22 nations of the region in Cairo to assist in examining ways to strengthen service provision through a family practice approach, with the goal of achieving universal health coverage, access to health care for all people, in all nations of the region.

Michael Kidd
WONCA President