From the CEO’s Desk: Final report December 2020

December 2020

December, 2020

Garth Manning (CEO 2012-2020) writes his final column for WONCA News reflecting on achievements and changes during his CEO time:

After over eight years in post, it’s time for my last report as WONCA CEO. COVID-19 has so radically altered our lives during 2020, and it is not the transition and handover that we had envisaged, but all of us – the old WONCA team and the new – have worked tirelessly to ensure as seamless a transition as possible.

Some Thanks

Slightly unusually, I will begin, rather than end, with my thanks, but this is - at least in part - to stress the importance of three ladies who have massively helped and assisted me throughout my entire time as CEO.

First is Dr Nongluck Suwisith, who has been an outstanding Chief Admin Officer for my entire eight years. Nongluck has been unceasing in her support to the organization, to family medicine and to me personally, and we could not have achieved as much as we have without her unswerving support. Thank you, Nongluck.

Next is Dr Karen Flegg, WONCA Editor for the past 10 years. Karen has been a superb editor, producing good copy month after month for WONCA News and ensuring that the website is up to date. She has provided huge encouragement to our Member Organizations (MO), our Working Parties (WP), Special Interest Groups (SIG) and Young Doctor Movements (YDM). We have had many interesting – and sometimes robust – discussions during our times together, but all in a spirit of total mutual respect. Karen is stepping down as editor at the same time as my departure, but she still has a huge amount to offer WONCA and I hope very much that she will return in some capacity in the future.

The final “thank you” is to my long-suffering wife, Monica Burns. Many of you will have met Monica at Councils and conferences over the years and she too has been a stalwart supporter of family medicine and of WONCA. Monica is a health strategist and health finance expert, though not a medical doctor, but her career has been spent advising countries on health financing and the strong case for developing a PHC/family-medicine-based system to offer the Starfield triad of better outcomes at lower cost and with better patient satisfaction. She does actually hold honorary Fellowship of the Royal College of GPs in UK for her work on family medicine development, an honour rarely bestowed on non-doctors. Monica has tolerated my long absences whether in Bangkok or further afield, and has always been there to support me in times of stress (yes…there were a few!).

Presidents and Executives

I have been privileged to work under four Presidents and four Executive Committees. Each President inevitably had his or her own management style, but I learned much from each of them and I thank them for their patience and collegiality. As CEO you can spend more time with your President than you do with your partner, so a relaxed and friendly, but professional, relationship makes the job so much easier. So my sincere thanks to Rich Roberts (2010-13); Michael Kidd (2013-16); Amanda Howe (2016-18) seen together in Prague in 2013 and Donald Li (2018-21)

Past presidents' parting comments from
Rich Roberts, Michael Kidd, Amanda Howe
Current President, Donald Li's comments in
"From the President: December 2020"
Each Executive too has operated in a different way, and it takes some adapting to the new ways of a new Executive. This has been one of the drawbacks of a two-year term, as Executive members now have relatively little time to do the forming-storming-norming-performing stages of group dynamic (Tuckman’s stages of team development). The CEO role becomes even more crucial in these circumstances as he is the one person with the institutional memory and knowledge to facilitate Executive’s work and decision-making.

Key Achievements

There are many achievements over the eight years of which we are particularly proud. In no particular order:

Finances –

In late 2012 WONCA was in dire straits financially. Sponsorship had virtually dried up, whilst income from membership and conferences was variable (and conference income is, regrettably, falling year on year), and certainly insufficient to make up for the sponsorship deficit. To be frank, income simply did not match expenditure, and so one of my first tasks was to sit with the then-Hon Treasurer, Dr Francine Lemire, to recalibrate the budget for 2013 to make it much more realistic. I – and WONCA – owe a huge debt of thanks to Francine for fully supporting the difficult decisions we had to make, but she and her successors – Donald Li, Job Metsemakers and Val Wass – have continued to be fully supportive and entirely realistic in their budget estimates and projections. Thanks to their support we have been able to show a surplus in every year of my CEO-ship – from 2013 onwards - and even in this exceptional year we are likely to break even or even to show a small surplus.

As part of the efforts to make WONCA financially much more sustainable, I developed and introduced consultancy services in a variety of areas. This had been one of the recommendations of the 2010 GROW Report (Group to Re-design the Operations of WONCA) and has developed year on year to provide a further income stream for WONCA. Consultancy is reported on more fully below.

Management Accounts continue to be produced each month, and circulated to WONCA Executive, so that all are up to date with our financial situation. In my early days budgets occupied a disproportionately large amount of time at every Executive meeting but, thankfully, as income has improved year on year, budget revisions have tended to be minor revisions only.

Council –

Council is the governing body of WONCA and is a vital part of our governance mechanism. The 2013 Council endorsed the move from a three-year cycle to one of two years, and so we scheduled meetings for 2016, 2018, 2020 and so on. Of course, COVID then hit, causing us to postpone our next meeting to 2021, but the two-year cycle will then resume, with subsequent meetings scheduled for 2023 and 2025.

Photo: Rio Council members 2016

Moving to a two-year cycle undoubtedly improved our governance, but at some cost to the Secretariat. We are a very lean team, with only me and three others running the Secretariat, and Council places a huge strain on the team. By moving to a two-year cycle we barely had time to compete the follow-up from one Council before the next Council loomed on the horizon. Nevertheless, we were pleased with a number of the initiatives which we established, including:
• Introducing voting paddles, to better reflect the number of votes held by each country.
• Projecting all voting issues onto large screens, in English and Spanish, to make clearer to Council members what exactly the vote was about.
• Introducing simultaneous translation of Council proceedings into Spanish.
• Introducing coloured name badges to signify the status of each attendee

We believe that all of these measures have helped to enhance the process of Council, and we have been gratified at how smoothly our three Council meetings (Prague, Rio de Janeiro and Korea) have gone.

Membership –

WONCA started in 1972 with just 18 members. By 2000, this had grown to 66 Member Organizations (MOs), and today we have over 130 MOs in 150 countries and territories. This represents some 550,0000 family doctors in every continent. In addition, we benefit from the support of the 34 Academic Department Members and the 10 Organizations in Collaborative Relationship (OCR).

Encouragingly, new applications for membership have continued. Between 2013 and 2016 we welcomed 13 new Full Members (including two mergers and three upgrades from Associate) as well as one Member pro tem, seven Academic Members and one Organization in Collaborative Relationship. Between 2016 and 2018 these were joined by a further four full MOs, and since 2018 we have welcomed a further eight full MOs, one Associate Member and four Academic Members.

Direct Membership has ebbed and flowed a little, but since the introduction of Life Direct Membership (LDM) in 2015 we have been delighted to recognise 270 new LDMs.

Photo: WONCA News, August 2015 - Garth Manning and Michael Kidd with well known Life Direct Members from India, Jyoti and Ramnik Parekh

Diversity -

I can’t claim full credit for WONCA’s greater diversity, but I’m proud that in my time as CEO we have moved the organization on from one that was rather perceived as an “old boys” network (and white old boys at that) to one where we have much greater diversity in terms of gender, race, colour and sexual orientation.

We now have robust Gender Equity Standards for WONCA. We have celebrated our first woman President (Amanda Howe) with a second (Anna Stavdal) assuming office at the next Council and have seen much greater female representation on Executive and on key WONCA committees and groups.

The establishment of an Organizational Equity Committee (OEC) by the 2010 Cancun Council greatly assisted the process. OEC has achieved a number of objectives so far, including a concise, but really useful, document on Conference Equity Standards. It also composed the WONCA Statement on LGBTQ Health which was endorsed by the 2018 Council. We have had a gay President, and we now have a Special Interest Group on LGBTQ Health, and these are all cause for celebration of the increasing diversity of WONCA.
WONCA Statement on LGBTQ Health 2018

Young Doctors –

We constantly repeat the mantra, but it is a truism that the young doctors of today are the future of our specialty of family medicine. That said, there have been a number of welcome developments with regard to Young Doctors during my time in office. The first major advance was the introduction of a YDM representative onto the WONCA Executive. Council endorsed the move in 2013, and Executive set about recruiting this new representative through open competition. After a number of assessment stages, Dr Raman Kumar of India became our first YDM rep, serving from 2014 to 2016. With effect from the 2016 Council, YDM recruitment and election was via the same process as all other WONCA officer positions, with the selection decided by votes of the WONCA Council. Dr Ana Nunes Barata (Portugal) was elected at the 2016 meeting and re-elected in 2018.

Photo: WONCA News April 2015 - Michael Kidd with members of the Waynakay Movement for Young Doctors in the Iberoamericana region

But this period also saw the creation of YDM Chapters in Africa (AfriWON); Middle East (Al Razi) and North America (Polaris). This means that each of WONCA’s seven regions now has an active YDM movement. The YDMs have also developed an exchange programme for young doctors, which they oversee and manage. This FM360 programme of exchanges has been very popular, though sadly has had to be temporarily halted in 2020 due to COVID-19. More on the YDM.

Communications -

WONCA is its members, and so an important focus in the past eight years has been to further improve our communications with our members. As well as additional development of the website, and publication of the regular WONCA News 10 or 11 times annually, two new initiatives have greatly boosted our links and interactions.

The first of these has been that, in addition to the monthly WONCA News, we have also circulated a weekly e-update, highlighting features in WONCA News and also using it to promote events and publications which might have missed the news cycle. The second venture was the launch of an Annual Report. This has given an opportunity for all Executive members, Statutory Committees, WPs, SIGs and YDMs to report on their activities to our members during the reporting period. It has also allowed us to circulate the audited accounts to all members. The 2019-20 Annual Report – our seventh – has recently been completed and can be accessed on our website.

see all Annual Reports
We have still not managed to fully embrace and utilise social media to its full advantage, but in the new Secretariat there will be a dedicated Communications Officer and part of her remit will be to engage much more via social media with our members.

Working Parties and Special Interest Groups

WONCA is fortunate indeed to have so many vibrant specialist groups, which act as expert groups advising the President and Executive, and often acting as our representatives at meetings with WHO and others. All members give willingly and freely of their time, and it has been a pleasure and a privilege to work with so many great people.

When I started, WONCA had 10 WPs, and a further group - Indigenous and Minority Groups Health Issues – was added in 2013.

In 2012 we also had just four SIGs and over the years we have added a further 13 groups:
• Adolescent and Young Adult Health
• Conflict and Catastrophe Medicine
• Emergency Medicine
• Emerging Practice Models
• Family Violence

• Genomics
• Health Equity
• LGBTQ Health
• Men’s Health
• Non-Communicable Diseases (NCDs)
• Point of Care Testing
• Quaternary Prevention and Overmedicalisation
• Workers’ Health

Photo above: Garth Manning with some Chairs of WONCA groups and Executive members in Rio in 2016

Sadly, the SIG on Men’s Health did not prosper but all other SIGs have thrived and expanded.

Consultancy

As part of the efforts to make WONCA financially much more sustainable, I developed and introduced consultancy services in a variety of areas. This had been one of the recommendations of the 2010 GROW Report and it was hugely assisted by the development, by our WP on Education, of “WONCA Standards for Postgraduate Family Medicine Education”, which were endorsed by Council in 2013. These have formed the basis for providing WONCA accreditation to family medicine residency programmes which meet the standards. Initial requests were primarily from China, but more recently we have also undertaken visits to programmes in Canada, Japan and Bahrain, and we are currently processing a request from a residency programme in USA.

We also started to receive requests to accredit practices, most especially from China. Many countries have developed their own practice accreditation standards and mechanisms but many have not yet progressed to that extent. As China has embarked on PHC reform, a number of practices wanted to be able to benchmark themselves against global standards. Such standards exist for hospitals (the best known perhaps being Joint Commission International [JCI]) but no global standards for family medicine clinics existed. We thus set about developing broad standards, concentrating on four key areas:
• Practitioners (which refers to the professions providing care and their qualifications)
• Patients (services provided meet the needs, values and beliefs of their patients)
• Provider activity (scheduling of care, patient records, tests and follow up, referrals)
• Premises (accessibility, privacy, accommodation, toilet facilities, equipment)

At its April 2017 meeting, WONCA Executive endorsed the standards developed and a number of practices (predominantly Hong Kong and China) have successfully undergone accreditation.

Photo: WONCA News, May 2019 - Garth Manning and Rich Roberts with some of the staff of the Beijing Eaton Medical Centre during an accreditation visit in China.

Accreditation can be defined as:
"A self-assessment and external peer assessment process used by health care organisations to accurately assess their level of performance in relation to established standards and to implement ways to continuously improve"

The WONCA standards for both residency programmes and for practices are openly accessible on the WONCA website. It is our hope that many health institutions will use these as a self-assessment tool, and also hope that countries will be encouraged to develop their own standards and accreditation mechanisms using those of WONCA as a template.

WONCA Global Standards on Practice Accreditation 2017WONCA CPD Standards 2016WONCA Standards for Postgraduate Family Medicine Education 2013

World Health Organization

Our members consistently tell us that one of the most important functions of WONCA is to advocate for family medicine with WHO and other international organizations. Our collaboration with WHO has expanded enormously during my time as CEO, assisted hugely by three very able and very dedicated WONCA-WHO Liaisons – Iona Heath; Luisa Pettigrew; and Vivi Martinez Bianchi.

As the collaboration has grown, so too have the challenges of trying to prioritise, as it is impossible to meet all of WHO’s demands and requests. Nevertheless, it has been hugely gratifying to see that WHO has increasingly realised the importance of PHC and family medicine in its goal of achieving Universal Health Coverage (UHC). We were incredibly privileged to welcome Dr Margaret Chan, the then-Director General of WHO, as our Guest of Honour at the world conference in Prague in 2013, and we have been pleased to welcome other WHO colleagues – Hernan Montenegro, Jim Campbell and Shannon Barkley among others – to our councils and conferences in Rio de Janeiro and Seoul.

Of course the pinnacle of all of this work was the signing of a Memorandum of Understanding between WONCA and WHO in January 2019, signed by our President, Dr Donald Li, and WHO Director General Dr Tedros Adhanom Ghebreyesus. This has reinforced the close link between our two organizations and – as we keep reminding WHO – there can never be UHC without PHC.

Photo: WONCA News, February 2019 - WONCA President, Donald Li, and Dr Tedros Adhanom Ghebreyesus, Director General of WHO sign a Memorandum of Understanding on behalf of both organisations.

Farewell

And so, after 8¼ years, my time as WONCA CEO comes to an end. It has been an honour and a privilege to serve, and I have met and worked with so many great people. I look forward to continuing my relationship with WONCA in a new capacity, and also look forward to meeting old friends at future WONCA events.

We now transition to a new Secretariat in Brussels. Let me now record my final thanks – to Anuta (Bee - on left in photo) and Mint (right), my other two great Secretariat staff. Bee has been with us for many years; Mint for a shorter time, but both have fully supported WONCA especially in the challenging times of a transition.

I am proud to be handing over the organization in a more robust and sustainable financial footing than I received it, and I wish Harris Lygidakis and his new team the very best wishes for the future. I have absolutely no doubt that they will take the organization in new directions, and in ways that I could only dream of, and I will watch the progress with interest and pride.

Until we meet again.

Garth Manning
CEO