Valedictory address – Dr Margaret Mungherera, WMA President 2013-2014

Durban ICC, South Africa

The Guest of Honour,

The Chair of the World Medical Association Council, Dr. Mukesh Haikerwal

The Immediate Past President, Dr. Cecil Wilson

The President Elect, Dr. Xavier Deau

The Secretary General, Dr. Otmar Kloiber

Council Members, delegates, observers, ladies and gentlemen,

I want to begin by again thanking our hosts, the South African Medical Association for having accorded us such warm hospitality.

Then I want to pay tribute to those physicians and other health workers who are on ground working very hard to overcome the Ebola outbreaks in Sierra Leone, Guinea, Liberia and until recently, Nigeria.

As is the African culture, I ask for a moment of silence to remember all those physicians who have succumbed to the Ebola hemorrhagic fever since the outbreaks started in West Africa.

Over the last one year I have listened carefully to physicians, speak of their work and the issues that confront them. What strikes me is that the challenges of physicians working in high income countries are the same as those of physicians working in poorer countries. The only difference is the scale. Physicians everywhere are concerned about the increasing burden of chronic diseases and the need for something to be done about the lifestyles of people. Physicians everywhere are faced with an increasing plethora of stakeholders inside and outside the health sector and the challenge of finding ways of engaging more effectively with them.  Everywhere you go, physicians are concerned about the increasing work load, the wider scope of work, the bureaucracy and fears of litigation. Physicians all over the world have recognized the need to strengthen inter- professional collaboration and team work.

And In Low and Middle Income countries in Asia, South America and Africa, physicians are particularly concerned about the massive brain drain resulting in a human resource for health crisis and unsatisfied with the response of governments and the lack of priority given to health especially when allocating funding. In many areas of the world, physicians are confronted with harassment and their right to clinical independence is threatened by governments which should be protecting them. Unfortunately, in many places, these incidences do not get reported because the physicians themselves fear the repercussions of reporting or have nowhere to report.

What is encouraging however is the resolve, the commitment and the passion with which physicians all over the world regardless of the challenges they face, continue to do their work. It is for instance inspiring when you hear of the courage shown by the Turkish Medical Society in protecting their physicians.

One important challenge facing physicians is the Information Age. Physicians indeed need to play their part in contributing to the global movement to build what is referred to as the Information Society. WMA should be at the forefront of advocacy for instance in Africa against the negative perceptions policy makers have towards ICT and especially social media and lobby strongly for the cost of ICT infrastructure to come down. These are among the major causes of the lack of or underdevelopment of e-health approaches that you find in Low and Middle Income countries.

The Information Age, global security and the global economy are among the key challenges for global health in the 21st Century. The physicians of the 21st century therefore are likely to face challenges that are very different from those that were faced by the physicians of the 20th Century. Physicians of the 21stCentury will be required to be more effective change agents, stronger human rights advocates, patients’ advocates, more effective communicators with patients and communities they serve. They will also increasingly be expected to play a larger role in convincing governments and other stakeholders, as to why it makes economic and development sense to invest more in health.

NMAs of the 21st Century therefore must play different roles from the NMAs of the 20th Century.  NMAs must speak out against violence and other injustices their physicians face. They must be at the forefront of civil society advocacy campaigns. And they must advocate more strongly for the right to health of the communities they serve.

The WMA will continue to provide opportunities for NMAs to develop their leadership capacity by providing guidelines, training modules, networking opportunities and the leadership development course at the INSEAD in Singapore. NMAs must make an effort to access these resources and use them to build the capacity of their physicians so they are able to do the action and advocacy required

The WMA must be more proactive in reaching out especially to those NMAs in poor countries.  In response to requests by the membership, WMA has embarked on a process to strengthen the advocacy capacity of NMAs.

Over the last one year, I have played my role and represented WMA at a total of 15 global meetings, speaking about the role of WMA and the potential roles for NMAs in addressing issues of brain drain, regulation, medical education, access to quality health care for patients and protection of health workers in armed conflict and other emergencies, the Social Determinants of Health, Mental Health, Violence against Women, Violence in the Health care setting, Patient Safety, ethical issues around health care, post 2015 priorities and health system challenges in Low and Middle Income countries. And as a Rotarian, I am eager to see that WMA works closely with Rotary International and that NMAs participate actively in the campaign to eradicate polio from this planet.

What has made a big impression on me however, are the discussions we have had during my interaction with many of you. Many NMAs have extended to me an invitation to visit them and as a result, I have spoken at a total of 10 annual general meetings in a period of only 12 months and have visited a total of 20 countries in 6 continents, some of them more than once. I have also had the pleasure to be invited by several of you to participate in your NMA activities – like the Medical Mission in Benin City in Nigeria, where I looked at the expressions of relief on the faces of mothers of ill children which made me even more convinced that this is what NMAs are supposed to do. The reception I received at the studios of Radio New Zealand further convinced me that the media can be an effective partner for NMAs in promoting health.

The WMA is making an effort to address many of these issues in the working groups and through collaboration with other organizations. The WMA of the 21st Century however cannot be the same as the WMA of the 20th Century. The roles are different and so are the expectations of the NMAs, physicians and other stakeholders.  This requires the WMA to review its institutions with a view to strengthen them based on the needs. The Council has introduced the idea of Round Table conferences as a means of fundraising. However, these efforts must be improved.

Two groups of people will be useful in propelling NMAs to cope with the new challenges of the 21stCentury. These are junior doctors and medical students. They are truly the future of the profession, the NMAs and the WMA. And through my own interaction this year with the Junior Doctors Network and the International Federation of Medical Students Associations, I have become more and more convinced that these 2 groups are ready to take on the mantle of leadership. As NMAs therefore, let us open our doors, provide them space to participate effectively in the NMAs and invite them to get involved in the leadership.

As far as Leadership is concerned, in 2015 the world celebrates 20 years since the Beijing Conference on Women. We shall be celebrating the achievements of the world in terms of empowerment of women in many areas including leadership.. The very first speech I made after my election as WMA President was the keynote speech at the Congress of the Medical Women International Association last year in Seoul, Korea. I spoke at great length about the roles that women physicians can and should play in influencing the health agendas in their countries and in strengthening the roles of their national medical associations. As I move around the world, I have been impressed by the work women physicians do in their national medical associations.

There are several NMAs that do not have or have very few women in their leadership. Yet there are benefits of allowing women to participate in the NMA leadership.  I have met and interacted with vibrant and committed women NMA Presidents in the US, in UK, in Ethiopia, in Sweden and in Rwanda and in South Africa. Having a woman as the NMA President is a good thing but what is even better is to have more women and achieve a gender balance within the leadership of the NMA. We are encouraging NMAs to involve themselves more in issues around women’s health and Violence against Women. Women leaders can more easily become actively involved in such programs because they are more likely to appreciate the related socio-cultural issues. It also encourages more women to join the profession and more importantly more women will be encouraged to take up positions of leadership within the profession. Our NMAs must therefore reflect what we would like to see in other public and private institutions and in society as a whole. Good examples of NMAs where I found gender balance in the governance structure were the Philippines Medical Association and the Ethiopian Medical Association. Maybe WMA should consider taking up the responsibility of leading the way and setting an example for NMAs.

Every WMA President gets to choose a theme around which he or she will do their advocacy work. I chose Africa as my theme. I set out to increase the focus of WMA on the African continent and particularly on the African NMAs. The reason contrary to what some people may think is not because I am an African. It is because Africa is part of the world and in fact, 11% of the world’s population lives on the African continent. Africa’s health therefore impacts on global health. And as has now finally been realized with the Ebola outbreaks, the world’s survival depends on Africa’s survival.

The African continent is the continent with the largest disease burden, one that is disproportionate to its population. For instance, with 11% of the world’s population, Africa has 45% of the world’s women dying from childbirth related complications and 62% of the world’s HIV patients. This huge disease burden can be attributed to natural disasters, wars, political instabilities etc. But the most significant causative factor is the weak health systems that African countries have especially those that are in the Sub Saharan region.

It is however, unfortunate that it has taken the recent Ebola outbreaks for the world to realize that it is the weak health systems of Africa that are the biggest threat to global health. Millions have been dying from Malaria and other diseases as a result of these weak health systems. And yet there is little done to strengthen these systems. In fact, the main problems that are making overcoming the Ebola outbreaks difficult is not lack of hospital beds or health workers but the lack of disease surveillance systems, epidemic preparedness and an effective epidemic response.

African Governments have responded to the challenge of weak health systems by ratifying several international and regional declarations with several countries further developing national policies and health sector strategic plans and incorporating them into national development plans. Subsequently, massive amounts of funds from donor and foreign sources have been pumped into African health sectors for the purpose of implementing these policies. It is however estimated that 20-40% of these funds are wasted largely due to massive corruption and due to implementation that is not in line with the policies. The major cause of Africa’s weak health systems therefore is not a shortage of policies or road maps or funding. It is effective leadership to implement the policies and road maps. Let us hope however that it will not need many more Africans and others to die before the world realizes that the key solution to strengthening these systems lies in effective leadership from within Africa rather than from outside the continent.

A good leader has followers. A Malawian proverb says “A leader without followers is simply taking a walk”. Africa has too many leaders without followers, leaders simply taking a walk. A common example is the delay in the local response to the Ebola outbreaks by the governments affected, the African Union and others on the continent, clearly showing a lack of effective leadership. Developing leadership capacity should therefore be the main emphasis of any effort aimed at to strengthening health systems and reducing Africa’s disease burden.

The solutions for Africa’s health problems lie within the African continent. The international community must allow Africa to take charge of their health sector by helping Africa to develop its professional leadership.  So during my term as WMA President, I have spearheaded the WMA Africa Medical Initiative.  The Initiative set out to assess the strength of African NMAs. A capacity needs assessment has been carried out this year consisting of 4 regional consultative meetings held in Kenya, Nigeria, Tunisia and South Africa and as a result 8 key thematic areas have been identified. These are Organizational Strengthening, Migration and Retention, promoting quality Medical Education, improving physicians’ access to Continuing Professional Development, Social Determinants of Health, Universal Health Coverage, Research and Publication.

Over a period of 5 years, African NMAs irrespective of whether they are members or not) will be offered capacity building opportunities to enable them more effectively influence their health systems. We have introduced the WMA Initiative to the African Union, the African Development Bank and to 44 African Ministers of Health who I spoke to explaining the potential role of their NMAs in strengthening their health systems in their countries.

The next stage is for the identified Lead Facilitators to design the Program basing on the findings and then work with resource persons who have been identified from among NMAs outside Africa and from among African physicians in the diaspora in the UK. And anyone or NMA interested is welcome to participate.

The Program will involve online discussions, skills training workshops and conferences. Twinning is also being encouraged between strong NMAs outside the African continent and African NMAs. I want to therefore appreciate those NMAs outside the Africa region who have offered to twin with African NMAs- the New Zealand Medical Association, h will twin with Medical Association of Tanzania, the Japan Medical Association with the Malawi Medical Association and the Danish Medical Association with the Rwanda Medical Association.

African NMAs that have not yet joined the WMA have been invited to join. Our target is to see that at least 4 new African NMAs join WMA every year. This target has been met this year with NMAs of Kenya, Zambia, Rwanda and Lesotho applying to join. However, we still have 29 of the 54 countries in Africa which are not represented in the WMA. This is half, so we have a long way to go.

At this juncture I wish to thank the Danish Medical Association for offering to support the Chair of the Kenya Medical Association and the President of the Rwanda Medical Association to attend this meeting as observers. We shall need more of such support from other NMAs.

We again look forward to many more of you participating in this important initiative because again I say when the health of Africa is threatened, global health and survival is also threatened.

This flight of WMA 2014-15 took off on the 19th October 2013 in Fortaleza, Brazil. Some of you looked uneasy seeing an African woman from one of the poorest nations in the world taking charge and yes, the flight did experience some turbulence from time to time. Generally, it was a smooth flight. And as I was assured from the beginning by my by my good friends Vivienne and Ardis and Mzukisi, I have had tremendous support.  I have had an excellent co-pilot, Mukesh you have taught me a lot, and Otmar, you have been an excellent flight engineer, and the crew, Julia, Clarisse, Sunny, Anna, Lamine, Annabel and the volunteers, Salma and Stintje have been very supportive, and more importantly the passengers, that is you the constituent members have been exceptional.

Well now, a new Captain takes over. Xavier mon ami, I wish you all the best in this important and prestigious position. I pledge my support to you. I am very confident that with your commitment, and you being calm and clear headed you will take the WMA to greater heights.

I want to end by expressing sincere appreciation to my husband Richard and the rest of my family for their patience and unwavering support.

To all of you again, I say, thank you for this wonderful opportunity to serve. It has indeed been a wonderful year and thank you all for listening to me. NKOSI

Margaret Mungherera

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