Journey For Scaling up Family Practice Universal Health Coverage Conference Khartoum, 22nd- 24th January 2017 Dr Hassan Salah, Medical Officer, Primary and Community Health Care, WHO EMRO

Family Practice Presentation Outline IV III II I RC 2016 Resolutions UHC and SDG FP Elements Challenges RC 2016 Resolutions Presentation Outline IV III II I Family Practice

3/22

Expanding Universal Health Coverage I. UHC and SDG 4/22

Target 3.8: “Achieve universal health coverage, including financial risk protection, access to quality essential health-care services ……..” 5/22

Selected Indicators for SDG3 Group 1 Group 2 Group 3 3.1 Reduce the global maternal mortality ratio to less than 70 per 100,000 live births 4 - 17 9 - 121 178 - 732 3.2 Reduce neonatal mortality to at least as low as 12 per 1,000 live births 5 - 13 7 - 27 34 - 85 3.2 Under-5 mortality to at least as low as 25 per 1,000 live births 6 - 15 8 - 32 42 - 137 3.4 Reduce by one third premature mortality from non-communicable diseases through prevention and treatment and promote mental health and well-being 18% of countries reported comprehensive provision, screening, management services and medicine for NCD in primary health care. I. UHC and SDG 6/22

Characteristics of Family Practice Approach Delivery of comprehensive, continuous, integrated and community-oriented services by a family physician and multidisciplinary team Defined catchment population Availability of sufficient trained health workforce and multidisciplinary team Provision of quality essential health services package II. Family Practice Characteristics and Elements 7/22

II. Family Practice Characteristics and Elements 8/22 Essential Health Services Package Maternal & Newborn Emergency Child & Immunization Communicable & Non Comm. Diseases Education & Nutrition Food Safety, Environmental & School health Mental Pharmacy & Lab II. Family Practice Characteristics and Elements 8/22

Family Practice Elements 9/22 Quality Improvement & Accreditation Program Essential Health Services Package Essential Medicine List Information System Family Practice Elements Staff Pattern Referral System Standard Equipment Standard Treatment Guidelines Family Registration & Folder GPs Training Physician Roster Training Programs (JD) Community Engagement 9/22

WHO EMRO Technical Support 2014-2016 10/22

WHO EMRO Technical Support 2014-2016 11/22

WHO EMRO Technical Support 2014-2016 III. Family Practice Challenges 12/22

Major Family Practice Challenges Family Medicine Departments Communities Low community awareness Limited demand of family physicians Limited political commitment (G2& G3) MoH provides less than 50% of OPS Patchy implementation of EHSP Fragmented District Health Management Provides more than 50% of outpatient services Lack capacity to effectively engage with PHS Weak enforcement of regulations Major Family Practice Challenges Private Health Sector Ministries of Health 20% of medical schools have FM Departments Low production of Family Medicine specialists Lack of exposure to FM at undergraduate level Family Medicine Departments 13/22

Strengths/Opportunities Weaknesses /Challenges Most of PHC physicians are GPs Only 46 certified family physicians working in PHC facilities 5 Medical schools offer FM degree Average 435 family physicians /year Political support FP as an overarching concept for UHC Support of Medical Specialized Board Increasing demand on FM specialty Migration of 61% of newly graduated family physics within 2 years Only 24% of PHC facilities provide full EHSP Limited quality of PHC services More than 50% of PHC facilities do note have minimum eq./fur. Private health sector provides more than 60% of outpatient services 4,916 PHC unit/center 6 States provide FP services FMoH endorsed 2015 Family Practice Policy Limited FP implementation Hyperlink to family Practice Video

WHO Strategies to Increase Number of Family Physicians 2030 Strategy 1: Increase Number of Family Medicine Specialists Directed to Newly Medical Graduates 2020 Strategy 2: Bridging Program for GP in Family Medicine Directed to GPs > 5 Years of Experience 2016 IV. WHO Strategies 15/22

Strategy 1: Increase Number of Family Medicine Specialists 3 family physicians/10,000 population by 2030   Increase annual production of family physicians every year (specific % based on country population projections) Strengthen family medicine departments capacities to produce the needed numbers of family physicians by 2030 Starting from 2020, all medical schools graduates have to be specialized within five years of graduation IV. WHO Strategies 16/22

WHO Recommended Action to reach 3 Family Physicians/10,000 Recommended Action to Increase Family Physicians Production by 2030 Group 1 Countries Family Physician/10,000 Based on Country Annual Increase Year 2015 Year 2030 Bahrain 1.84 Kuwait 0.64 Oman 0.4 Qatar Saudi Arabia 0.25 UAE 0.05 Average 0.31 WHO Recommended Action to reach 3 Family Physicians/10,000 Annual % increase FP/10,000 Year 2030 10 17 15 20 36 3.40 3.40 1.49 2.93 0.90 2.96 1.16 2.88 0.76 3.56 0.15 3.08 0.79 3.34 IV. WHO Strategies 17/22

Recommended Action to Increase Family Physicians Production by 2030 Group 2 Countries Family Physician/10,000 Based on Country Annual Increase Year 2015 Year 2030 Egypt 0.05 0.29 Iran 0.10 1.33 Iraq 0.27 0.52 Jordan 0.33 0.80 Lebanon 0.09 0.82 Libya 0.17 0.34 Morocco 0.01 0.19 Palestine 0.12 Syria Tunisia 0.20 1.07 Average 0.11 0.62 WHO Recommended Action to reach 3 Family Physicians/10,000 Annual % increase FP/10,000 Year 2030 29 3.51 10 3.10 25 3.39 19 3.19 16 3.17 30 3.05 31 3.04 39 3.11 38 3.08 13 3.03 3.25 18/22

Family Physician/10,000 Based on Country Recommended Action to Increase Family Physicians Production by 2030 Group 3 Countries Family Physician/10,000 Based on Country Annual Increase Year 2015 Year 2030 Afghanistan * 0.01 0.03 Djibouti * 0.00 Somalia * Sudan 0.13 1.19 Pakistan * Yemen * * Country with very limited family medicine training capacity IV. WHO Strategies 19/22

3,105 5,000 8,000 3,837 168,803 General Physicians (Generalist Doctors) Working in Public Primary Care facilities 951 216 2,009 4,700 14,973 6,107 9,500 1,065 1,645 436 369 20/22

Online Training for Building Capacities of GP in Family Medicine Sequence of Events (2015-2017) 2015 2016 2017 Assessment of PHC facilities in 22 countries Developing “ Online Training Course of GP in Family Medicine” Regional Consultation “Training Course to Improve Skills of GP ….” ToT: Afghanistan, Egypt, Iran, Iraq, Jordan, Libya, Morocco, Oman, Palestine, Sudan, Tunisia and UAE RC 63rd Resolution for Agenda item 4a. establish bridging programs for GP Workplan : Egypt, Iran, Jordan, Oman, Saudi Arabia and UAE Sudan Federal Ministry of Health to join WHO online training in 2017 21/22

Department of Health System Development Hassan Salah, MD, MPH Medical Officer, Primary and Community Health Care Integrated Service Delivery Team Department of Health System Development World Health Organization - EMRO   Email:  salahh@who.int 26/26