The Urgent Case of Family Medicine

In the 67th session of the WHO Regional Committee for Europe which was held in Budapest on 10th - 14th September 2017, the framework for action towards a sustainable health workforce in the WHO European Region was presented and debated. The framework adapts the Global Strategy on Human Resources for Health: Workforce 2030 in the European context, and has four strategic objectives: a) transform education and performance; b) align planning and investment; c) build capacity, and; d) improve analysis and monitoring.

Introducing the framework and draft resolution, the Director of the Division of Health Systems and Public Health, Dr Hans Kluge, noted:

“The health workforce is the beating heart of any health system, and the cornerstone of universal health coverage."

The Director-General of WHO, Dr Tedros Adhanom Ghebreyesus, attended the session and while argued that the health personnel is a pillar for achieving universal health coverage, he specifically highlighted the importance of the primary care workforce.

Linda Mans, Wemos global health advocate, delivered a statement released by Medicus Mundi International, and endorsed by WONCA Europe; she noted that health systems and competent, sustainable, health workforces required financial investments.

Finally, on the occasion of the discussion of the framework, WONCA Europe has released a statement on Family Medicine, focusing on the educational needs (both undergraduate and postgraduate) and the policies for retaining and, when necessary, supporting the migration and emigration of family doctors. The statement was delivered by Dr Anna Stavdal, President of WONCA Europe.

WONCA Europe Statement: The Urgent Case of Family Medicine

WONCA Europe welcomes the framework for action for a sustainable health workforce in the WHO European Region, and acknowledge the focus on education as one of the strategic objectives that can accelerate progress towards achieving universal health coverage by providing the appropriate workforce. We also welcome the focus on the contextualised education that addresses the needs of the population, the accreditation of the educational institutions, and the monitoring and addressing the international mobility of health labour. 

We would like to draw your attention to the educational needs of the professions related to family medicine / general practice.

The World Health Assembly WHA 60.12 Resolution (2009) urged member states: “(5) to train and retain adequate numbers of health workers, with appropriate skill mix, including primary health care nurses, midwives, allied health professionals and family physicians, able to work in a multidisciplinary context, in cooperation with non-professional community health workers in order to respond effectively to people’s health needs.”

Acknowledging that both undergraduate and postgraduate education is not meeting the needs of the future workforce and producing adequate number of primary care health workers, we believe it is crucial to highlight the following gaps in our sector:

1. No minimum standards exist for the undergraduate family medicine curriculum, and there is scarce or non-existent early clinical exposure to primary health care at medical schools across the member states.
2. There is little recognition of the interdependence of the health professions and promotion of interdisciplinary education and collaboration.
3. Specialist training programmes where they exist in the WHO European region, vary considerably in length and content.
4. The regulation of the quality of the specialist training, as well as the lifelong learning, is deemed insufficient in many contexts.
5. There is not enough investment in teaching the teachers of family medicine.
6. Little has been done to support the migration and emigration of family doctors, and the recognition of their professional identity, which also ensures respect to the context of relocation.

In spite of political strategies aimed at strengthening primary health care, we are still witnessing: the entrenched attitudes in medical schools where training is focused on secondary and tertiary care; a lack of standardised quality education and regulation in primary health care; insufficient policies for retaining family doctors, and; an increasing mobility of health workforce. This situation aggravates the mismatch between the educational offering and population needs. 

We urge:

1. Once and for all, each member state and educational institution to fully recognise the discipline and specialty of family medicine with its own educational content, research, evidence base and clinical activity.
2. Member states and educational institutions to promote a shared strategy for the establishment of shared minimum standards for the undergraduate curriculum and ensure increased exposure to primary health care and reflect the patient journey through different health care settings.
3. Member states and educational institutions to seek a common core set of standards for the specialist training and continuous professional developmentfor family medicine in all European countries. Provision should also be made for training the teachers of family medicine.
4. Member states to develop appropriate strategies for career development and lifelong learning as means for retaining health care professionals.
5. Human Resources for Health (HRH) departments and units to work closely with the appropriate stakeholders to support the development of contextualised curricula, and a transparent pathway for the migrating health care professionals.
6. The WHO Regional Office for Europe to support member states in building capacity and strengthening primary care and family medicine in all the countries of the region.

The statement can be found and shared from here.