WONCA President's Rio opening address

Boa noi-Tay, mai uss amigors (Good evening my friends).
WONCA da as boas windas para os medicos de familia der todo mundo e ow bello Rio de Janeiro (WONCA welcomes the family doctors of the world to beautiful Rio de Janeiro.  A o agra day so ous nossos an fi tree ois, os medicos de familia do Brazil. (I thank our hosts, the family doctors of Brazil). A o dayzajo a todos vosaysh oon excellente congresso. (I wish you all a wonderful conference).
Obrigado (Thank you). E agora a o vo falla en inglesh  (And now I will speak in English).

WONCA welcomes the family doctors of the world to beautiful Rio de Janeiro for our 2016 world conference.

I thank our hosts, the family doctors of Brazil, for all the preparation that has gone into making this conference an extraordinary global health event.

I also welcome those of you who are here at your very first WONCA world conference.  Could you please stand up if this is the first time you have attended a WONCA world conference. Welcome to you all.  Welcome to our WONCA family of family doctors.

Some of you might be asking, what is WONCA?  The answer is, you are WONCA.  WONCA is the family doctors of the world. WONCA brings the family doctors of the world together.

WONCA was founded 46 years ago, in 1972, by colleges and academies of family medicine and general practice from 18 countries. 

At our very first World Conference, held in 1972 in Melbourne in Australia, our first WONCA world president, Dr Monty Kent-Hughes, said, “The future of our professional discipline will depend on our ability to work together in the service of humanity.”

And that is what we have been doing ever since, working together to advance our global mission to improve the quality of life of the peoples of the world through fostering high standards of care in family medicine.  We are here for our patients and for our communities; for the people who trust us for their medical care and advice.

Our last WONCA world conference was in 2013.  Working together, we have seen significant growth over the past three years and now, through our member organisations, WONCA represents over 550,000 family doctors in more than 150 countries and territories, in all parts of the world.  And WONCA’s 550,000 members each year deliver over 3 billion consultations to our patients.  That is the extent of the work that we do.

I pay tribute to the wonderful work over the past three years of the members of your WONCA world executive, including our president-elect, Professor Amanda Howe, from the United Kingdom. On Friday Amanda will take over the presidency of WONCA and will become our global organisation’s first woman president.

Our WONCA executive also includes the presidents of our seven regions, our three elected members at large, and our Young Family Doctor representative, all supported by our Chief Executive Officer, Dr Garth Manning, and our secretariat staff based in Bangkok.

This week our WONCA world council, involving all our member organisations from around the world, has been meeting here in Rio.  I am pleased to advise that elections were held for your new president-elect and that Dr Donald Li from Hong Kong will serve as WONCA world president from 2018 to 2020.  Congratulations Donald.

Over the past three years WONCA has had three main goals.

Our first goal has been a commitment to better understand the strength of each of our member organisations in each region of the world, and to expand WONCA’s influence by supporting the development of new member organisations in more low- and middle-income countries.  Through the work of our regional presidents, we now have a solid understanding of the status of family medicine development in each region, and we are also working with family doctors in many countries which are not yet WONCA members to assist in the development of new colleges and societies.

It has been wonderful over the last three years to see interest in WONCA membership from many new family doctor organisations, especially from nations of Africa, the Middle East and Central Asia.  Since 2013 we have welcomed 22 new member organisations to our WONCA family.  We have also welcome new individual members from many countries which have yet to form their own family doctor organisations, including, in the past year alone, the Maldives, Bhutan, Honduras, the Cook Islands and Ethiopia. 

Two weeks ago I was in Africa, in Ethiopia, and I met with the young family doctors who have just formed the Ethiopian Society of Family Physicians.  This is the society’s inaugural president, Dr Yohannes Yimer, at work in his clinic with one of the community health workers.

At this world conference, among our 5,000 registered delegates, we have been joined by family doctors from at least 113 countries. This includes many countries and territories which do not yet have membership of WONCA, including Albania, Botswana, Burkina Faso, Cambodia, Chad, Democratic Republic of Congo, Greenland, Liberia, Madagascar, Malawi, Mali, Mozambique, Namibia, Rwanda, and Tanzania.  We hope to welcome all these family doctors into our global family and I invite you to visit the WONCA booth in the exhibition area to talk about how WONCA can work with you to support family medicine in your country.

Our second goal of the past three years has been a commitment to support young family doctors through the development of young family doctor movements in all seven regions of the world.  We recognise the importance of the next generation of family doctors to the future of family medicine. 

One of the great grassroots innovations of WONCA has been the development of our young family doctor movements.  Over the previous decade we had seen the development of young family doctor groups in the WONCA Europe, South and Central America, Asia Pacific, and South Asia regions.

Over 2013 and 2014, we saw the establishment of new young family doctor groups in Africa, the Middle East and North America.

We now have WONCA young family doctor movements in every region of the world.  This is a landmark achievement. 

I was at a WONCA meeting recently in Costa Rica in Central America, and a representative from the Pan-American Regional Office of the World Health Organization was there and he said, “Today’s young family doctors are the ugly ducklings of the health care system.”

I thought this was a rather impolite thing to say, until I recalled Hans Christian Anderson’s story of The Ugly Duckling, “the homely little bird born in a barnyard who suffers verbal and physical abuse from the other birds and animals around him until, much to his delight, and to the surprise of everyone, he matures into a beautiful swan, the most beautiful bird of all.”

Perhaps the young doctor members of WONCA are the ugly ducklings of global health care, destined to become beautiful swans working as family doctors in their own communities. Our conference organisers tell me that 1/3 of the delegates at this conference are young family doctors.  Could I invite all the young doctors in the room, those doctors in training, those who have completed training in the past five years and all medical students, to please stand up.  Ladies and gentlemen, the future swans of global health care.

Our third goal over the past three years has been a commitment to strengthening WONCA’s work with the World Health Organization, the WHO, to expand the role of family medicine in strengthening primary health care in all countries and supporting universal health coverage, access to health care for all people.

WONCA’s relationship with the WHO received a major boost with the keynote address at our world conference in Prague in 2013 by WHO Director-General, Dr Margaret Chan.  

The support for family medicine from Dr Chan continues.  At a recent major medical meeting in Hong Kong, Dr Chan stood up and stated, “I love family medicine”.  All the family doctors in the audience stood up and clapped.  All the doctors from other specialties looked disappointed that Dr Chan doesn’t love their disciplines as much as she loves ours.

Dr Chan recognises the contributions family doctors, and the members of our teams, make in delivering high quality comprehensive primary care and working to ensure universal health coverage.

In recognition of the work of the family doctors of the world, your WONCA World Council has endorsed, for release today, the WONCA Rio Statement on the contribution of family doctors to Universal Health Coverage.

• The World Organization of Family Doctors (WONCA) calls for all countries to increase the number of family doctors in order to achieve high quality comprehensive primary care and universal health coverage.

• Effective strategies include: improving the skills of doctors already working in the community; recognising Family Medicine as a specialty and enhancing the academic basis of the discipline; strengthening the family medicine experience of all medical students; actively recruiting more medical graduates into more postgraduate family medicine training programs; giving all family doctors and members of their teams the resources to carry out their work, recognising their contribution, and ensuring their retention in the workforce – all in order to deliver excellent integrated cost-effective people-centred care.

Ladies and gentlemen, I invite you to express your support for our WONCA Rio statement through acclamation.

WONCA works closely with our many global health partners, and especially the World Health Organization.  WONCA is recognised by the WHO as the voice of family medicine and we strive to support and influence the development of global health policy by the WHO and the roll out of global health programs. The WHO has appointed a liaison person to work with WONCA, Dr Hernan Montenegro, and shortly we will hear from Hernan.

The family doctors in each of our seven regions have been very active over the past three years, and I wish to highlight the work especially of our family medicine colleagues here in South and Central America, our Iberoamericana Region.  Over the past three years we have had a regional WONCA conference in Montevideo in Uruguay, a global rural family medicine conference held in Gramado here in Brazil, and two influential primary care summits with Health Ministers from across the region, one in Quito in Ecuador, the other in San Juan in Costa Rica.

As family doctors we understand the huge challenges which affect many of our communities and we support our patients to deal with very challenging circumstances.  Among the many major initiatives of our regions, I wish to highlight the Istanbul statement, released by our WONCA Europe region in 2015, stating that people who are “refugees should have access to equitable, affordable, and high-quality health care services in all countries”.

WONCA has also been active developing new publications to support your work in family medicine, and I am pleased to now launch ten new WONCA publications.

In Prague in 2013, Dr Margaret Chan launched the new edition of our WONCA guidebook on the contribution of family medicine to improving health systems.  I am please today to launch the translations of our Guidebook into Vietnamese, into Slovak, and, thanks to our Brazilian Society of Family Doctors, into Portuguese.

WONCA’s working party on education has developed new standards to support the continuing professional development of family doctors in all countries of the world, and I am pleased to launch the new WONCA Global Standards for Continuing Professional Development for Family Doctors.

Our WONCA working party on Education has worked with the medical journal, Education for Primary Care, to produce a special WONCA edition published to coincide with this conference.

Our WONCA working party on Rural Practice has produced a remarkable resource, Rural Medical Education Guidebook, a how-to book of practical strategies and ideas for training health care workers for rural practice.

Our WONCA working party on the Environment has produced a book of stories about how family doctors are working in and with their local communities to tackle serious environmental challenges.

Our WONCA working party on Research has produced a new book, International Perspectives on Primary Care Research, led by working party chair, Felicity Goodyear-Smith from New Zealand, and Bob Mash from South Africa.  I am pleased to launch this important new publication and commend it to you all.

WONCA has worked in partnership with an Irish organization, iHeed, with the support of Hewlett Packard, to produce a new publication, Achieving Universal Health Coverage : Technology for Innovative Primary Care Education.  I am pleased to launch this report which we expect will influence the continuing development of innovative technology and social media to support the education of the world’s primary care workforce.

Finally I am delighted to launch our new WONCA publication, Family Medicine : The Classic Papers.  In this book WONCA , with the support of 33 family doctor leaders from across the world, has endeavoured to collect in one place the classic papers from family medicine.  It captures some of the most important ideas and research carried out in, or about, family medicine over the past 100 years, demonstrates the board scope of primary health care delivered by family doctors around the world, and we hope will serve as an inspiration to current family doctors as well as to doctors in training and medical students.

All these publications are available at the WONCA booth in the exhibition area.

WONCA has a number of working parties and special interest groups, which you are welcome to join.  Our working parties are the power house of our global organisation, with family doctors from across the world coming together to advance important areas of family medicine including education, research, rural practice, quality and safety, mental health, ethics, digital health, environmental health, and the contributions of women in family medicine.

WONCA’s oldest working party is our working party on classification, called WICC, which continues its excellent work supporting the updating and ongoing development of WONCA’s International Classification of Primary Care (ICPC).

WONCA’s newest working party was established at our last world conference in Prague.  It is our working party on Indigenous and Minority Group Health Issues and the members have been raising awareness of key issues, advocating for Indigenous people and members of minority groups, and establishing links with Indigenous doctor groups around the world.

We also have special interest groups in areas including cancer and palliative care, care of the elderly, migrant health, point of care testing, and complexities in health.  This week our WONCA world council has approved the establishment of nine new WONCA special interest groups and I am pleased to announce the establishment of our special interest groups in:

• Health equity

• Family violence

• Non-Communicable Diseases

• Men’s Health

• Conflict and Catastrophe Medicine

• Genetics

• Emergency Medicine/Urgent Care

• Quaternary Prevention and Overmedicalisation

• Workers’ Health

In order to celebrate the achievements of family doctors around the globe, WONCA has established World Family Doctor Day, held on May 19 each year. This initiative continues to grow and it is wonderful each year to see World Family Doctor Day activities underway all around the world celebrating the contributions family doctors make to the lives of their individual patients and to the health and wellbeing of their communities. 

One of the great privileges of being WONCA president is having the opportunity to visit our member organisations, individual family doctors, medical educators and researchers, Ministers of Health and health policy makers in countries all around the world.  During my three and a half year term as WONCA president, I have visited over 70 countries and have had the remarkable opportunity to learn about the challenges and successes of family medicine in many parts of the world and to be inspired by your work as family doctors in rural and urban settings all around the world.

I wish to pay tribute especially to our host nation, Brazil.  In recent weeks, the world’s attention has been on Brazil and the Olympic and Paralympic Games. In my opinion, Brazil deserved the first gold medal of the Olympic Games, not for sporting achievement, but for the work it has done in ensuring universal health access, by all people in this nation, including the most marginalized and vulnerable.  On one of my first visits as WONCA president, in 2013, I came to Rio de Janeiro, and Inez Padula, our regional president, took me to visit this family medicine clinic in one of this city’s favelas, the shanty towns.  Here I met a young family doctor Euclides Colaço and his colleagues. This is Euclides in one of the bright consulting rooms in this clinic.  Euclides works with a family medicine resident, two nurses and six community agents, or community health workers, working as a team, to provide comprehensive clinic-based and home-based care to a defined population of 4,500 people. 

This visit allowed me to see the renowned “Family Health Team” model of Brazil in action.  This is Euclides and one of the community health agents in his team, Maria, in front of a map showing the geographic area they are responsible for. They are expected to know about the health status of every single person living in the area shared in blue.

The community health agents in Brazil have a key role to play.  They go out into the community and visit everybody in every house and bring those in need of assessment and assistance to the clinic, or the community health agents escort the doctor or one of the nurses on a home visit. 

This is true comprehensive primary care delivered to an entire community.  And there are now over 40,000 such teams in operation across the entirety of Brazil, providing care to a large percentage of the entire population of 200,000,000 people.  It is a very impressive model and I hope you take the opportunity to see this in action for yourself during the week ahead.

At this week’s WONCA world council meeting, WONCA established a new award, the WONCA Global Health Award.  This award is to be presented each year to the country judged as being the most successful in delivering universal health coverage through family practice.  I am very pleased to announce that the very first recipient of the WONCA Global Health Award is the nation of Brazil.  The award is made in recognition of the huge strides Brazil has made towards achieving universal health coverage through the Family Health Team model.  I am pleased that Dr Daniel Soranz, Secretary of Health for the city of Rio de Janeiro, has agreed to accept the award of behalf of Brazil.  

Michael Kidd
WONCA President

2^nd November 2016