1. 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

2. 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. 3/22

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

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

6. 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
3.2 Reduce neonatal mortality to at least as low as 12 per 1,000 live births
5 - 13
7 - 27
3.2 Under-5 mortality to at least as low as 25 per 1,000 live births
6 - 15
8 - 32
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

7. 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

8. 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

9. 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

10. WHO EMRO Technical Support 2014-2016
10/22

11. WHO EMRO Technical Support 2014-2016
11/22

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

13. 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

14. 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

15. 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

16. 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

17. 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

18. 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

19. 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

20. 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

21. Online Training for Building Capacities of GP in Family Medicine
Sequence of Events ( )
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

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    
26/26