Global development of family medicine, and lessons for China

· China Focus, Volume 4 Issue 2

Global development of family medicine, and lessons for China

Author: Kidd, Michael R.

This presentation will focus on the global development of family medicine and the lessons the rest of the world can learn from developments in China.

First a few words about the World Organization of Family Doctors (WONCA). WONCA is an organization for family physicians all over the world. WONCA represents more than 500,000 family physicians in more than 150 countries. It brings the family physicians of the world together, supports the highest standards of clinical care, education, training, and research, and also represents family medicine and general practice at the World Health Organization (WHO).

Dr. Monty Kent Hughes, the first WONCA president, said in 1972 that “the future of our professional discipline will depend on our ability to work together in the service of humanity.”

Since that time WONCA has brought us together. This year we will have the 21st WONCA World Family Medicine Conference on November 2–6 in Rio de Janeiro, Brazil. I hope you will be able to join us at our world conference.

One of WONCA’s missions is to support the development of the next generation of family physicians, including medical students and young physicians who have just graduated from medical school. We support family medicine development in all parts of the world. And we work in close cooperation with the WHO.

Dr. Margaret Chan, WHO Director-General, recently said: “I love family medicine.” Why does she love family medicine? It is because she realizes the importance of our work. She knows we can contribute to global health improvements by (1) effectively containing rising health care costs, especially through support for preventive care, health promotion, and improvements in chronic disease management and the management of comorbidities, (2) effectively managing the health care needs of the increasing proportion of elderly people in our nations, (3) effectively tackling the epidemics of both communicable and noncommunicable diseases in many countries, (4) tackling the workforce shortages affecting health care provision across the world, especially through supporting teamwork between primary care professionals, (5) effectively addressing the continuing rise in mental health problems affecting our populations, and (6) ensuring that high-quality health care is available to all people in every country, including health care for those people who may be disadvantaged. This means universal health coverage.

The integration of mental health into primary care is very important. WONCA has been working with the WHO to train family physicians and primary care nurses in how to manage both mental health concerns and physical problems.

We are learning from many countries, especially from China, about the need to make adjustments in health care delivery to meet local requirements. As President of WONCA, I have been fortunate to visit many countries. Family medicine is quite similar in most countries, and has its own features: (1) first-contact care, (2) comprehensiveness, (3) continuity of care, (4) coordination, (5) prevention, (6) person-centeredness, (7) family orientation, and (8) community orientation. We have strong evidence to demonstrate the importance of family medicine. Research evidence shows that a greater emphasis in a country on primary care and family medicine can be expected to lower the cost of care, improve the health of individuals through access to more appropriate services, and reduce the inequities in a population’s health, especially the inequities between rural and urban populations.

Family medicine is a way to ensure that all people, no matter where they live, can receive high-quality medical treatment. The major problem we are facing is how to provide health services that cover all parts of the world, and how to ensure that everyone, no matter in which country they live, can receive the medical treatment they need.

One important question is what percentage of medical graduates should be trained as family physicians. The answer is 50%. Many countries are training far too many consultant specialists, especially in high-cost procedural areas. They would do better to train more generalists, more family physicians, to better meet the health care needs of their communities and avoid unnecessary procedures and treatments.

The biggest challenge facing most countries around the world is how to achieve universal health coverage. How do we ensure access to health care for all people in every nation?

Last year the United Nations released the new Sustainable Development Goals. There is one goal for health, which states the goal to “ensure healthy lives and promote well-being for all at all ages.”

One contribution from WONCA to global family medicine has been the release of the WONCA Global Standards for Postgraduate Family Medicine Education. WONCA has commenced a process of accreditation of family medicine training programs against these standards.

The first family medicine training program in the world to receive accreditation against the WONCA Global Standards for Postgraduate Family Medicine Education was that of Shanghai Medical College of Fudan University in China.

The WONCA Global Standards for Postgraduate Family Medicine Education focus on nine key areas:

  • Mission and outcomes
  • Training process
  • Assessment of trainees
  • Trainees
  • Staffing
  • Training settings and educational resources
  • Evaluation of the training process
  • Governance and administration
  • Continuous renewal

Finally, what are some of the major challenges facing family medicine development around the world?

  • Training a family medicine workforce of physicians and nurses and other health workers to meet each nation’s needs
  • Upskilling the members of the existing primary care workforce of general practitioners and community nurses
  • Encouraging students and recent medical graduates to consider a career as a family physician
  • The recognition of family medicine as a medical specialty in its own right, with equal opportunities for career advancement and remuneration for family medicine specialists
  • The establishment of appropriately resourced clinics in communities
  • The tackling of community perceptions about family medicine and the building of trust in family physicians and the members of their primary care teams

Family medicine has the power to transform health care provision in China and the rest of the world.

In the words of Dr. Iona Heath, past president of the Royal College of General Practitioners in the United Kingdom, “I believe that family medicine is a force for good throughout the world.”