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WMJ_2024_03<\/a><\/p>\n

Official Journal of The World Medical Association, Inc. Nr. 3, September 2024
\nvol. 70
\nContents
\nEditorial\u2008\u2008\t\t\t\t\t\t\t\t\t3
\nInterview with the WMA Secretary General\u2008\u2008\t\t\t\t\t 4
\nInvitation to the WMA General Assembly in Helsinki, October 2024\u2008\u2008\t\t 7
\nReport on the Roundtable Discussion on Antimicrobial Resistance \u2013
\nLooking Towards UN High-Level Meeting on AMR and Beyond\u2008\u2008\t\t\t 9
\nReflections on the Value of the UN High-Level Meeting on Pandemic,
\nPrevention, Preparedness, and Response One Year Later\u2008\u2008\t\t\t\t 14
\nJunior Doctors Network\u2019s Leadership at the World Health Summit 2023\u2008\u2008\t\t 19
\nJunior Doctors\u2019 Perspectives on Barriers and Solutions to Equitable Access
\nto Global Health Opportunities \u2008\u2008\t\t\t\t\t\t\t 23
\nPharmaceutical Policy in Afghanistan\u2008\u2008\t\t\t\t\t\t 27
\nAfrican Health Leadership: A Physician\u2019s Perspective\u2008\u2008\t\t\t\t 29
\nInterview with National Medical Associations\u2019 Leaders of the African Region \u2008\u2008\t 32
\nInterview with National Medical Associations\u2019 Leaders of the European Region\u2008\t 42
\nWMA Members Highlight National Initiatives to Safeguard Patient Safety\t\t 49
\nWORLD MEDICAL ASSOCIATION OFFICERS,
\nCHAIRPERSONS AND OFFICIALS
\nDr. Lujain ALQODMANI
\nPresident
\nKuwait Medical Association
\n123 Fifth Avenue,
\n1202
\nKuwait
\nDr. Otmar KLOIBER
\nSecretary General
\nWorld Medical Association
\n13 chemin du Levant
\n01212 Ferney-Voltaire
\nFrance
\nDr. Jack RESNECK
\nChairperson,
\nFinance and Planning Committee
\nAmerican Medical Association
\nAMA Plaza, 330 N. Wabash,
\nSuite 39300
\n60611-5885 Chicago, Illinois
\nUnited States
\nDr. Ashok PHILIP
\nPresident-Elect
\nMalaysia Medical Association
\n4th Floor, MMA House,
\n124 Jalan Pahang
\n53000 Kuala Lumpur
\nMalaysia
\nDr. Tohru KAKUTA
\nVice-Chairperson of Council
\nJapan Medical Association
\n113-8621 Bunkyo-ku, Tokyo
\nJapan
\nDr. Zion HAGAY
\nChairperson,
\nSocio Medical Affairs Committee
\nIsraeli Medical Association
\n2 Twin Towers, 35 Jabotinsky St.,
\nP.O. Box 3566
\n52136 Ramat-Gan
\nIsrael
\nDr. Osahon ENABULELE
\nImmediate Past President
\nNigerian Medical Association
\n8 Benghazi Street,
\noff Addis Ababa Crescent
\nWuse Zone 4, P.O. Box 8829
\nWuse, Abuja
\nNigeria
\nMr. Rudolf HENKE
\nTreasurer
\nGerman Medical Association
\n(Bundes\u00e4rztekammer)
\nHerbert-Lewin-Platz 1
\n(Wegelystrasse)
\n10623 Berlin
\nGermany
\nDr. Jacques de HALLER
\nChairperson,
\nAssociate Members
\nSwiss Medical Association
\n(F\u00e9d\u00e9ration des M\u00e9decins Suisses)
\nElfenstrasse 18, C.P. 300
\n3000 Berne 15
\nSwitzerland
\nDr. Jung Yul PARK
\nChairperson of Council
\nKorean Medical Association
\nSamgu B\/D 7F 8F 40
\nCheongpa-ro,
\nYongsan-gu
\n04373 Seoul
\nRepublic of Korea
\nDr. Steinunn
\nTH\u00d3RDARD\u00d3TTIR
\nChairperson,
\nMedical Ethics Committee
\nIcelandic Medical Association
\nHlidasmari 8
\n201 K\u00f3pavogur
\nIceland
\nwww.wma.net
\nOFFICIAL JOURNAL OF THE WORLD
\nMEDICAL ASSOCIATION
\nEditor in Chief
\nDr. Helena Chapman
\nMilken Institute School of Public Health, George Washington University, United States
\neditor-in-chief@wma.net
\nAssistant Editor
\nMg. Health. sc. Maira Sudraba
\nLatvian Medical Association
\nlma@arstubiedriba.lv, editor-in-chief@wma.net
\nJournal design by
\nErika Lekavica
\ndizains.el@gmail.com
\nPublisher
\nLatvian Medical Association
\nSkolas Street 3, Riga, Latvia
\nISSN 0049-8122
\nOpinions expressed in this journal \u2013 especially those in authored contributions \u2013
\ndo not necessarily reflect WMA policies or positions
\n3
\nEditorial
\nEditorial
\nBACK TO CONTENTS
\nOver the past few months, extreme weather events, disease
\noutbreaks, and infodemic management have collectively
\nchallenged health professionals in their daily practice.Reports of
\nrecord-breaking high temperatures during the summer months,
\ntorrential rainfall in Africa, Asia, and Europe, and projections
\nof the most active hurricane season on record demonstrate the
\nobservable impacts of climate change on the delicate balance
\nwithin our planet\u2019s ecosystems. The emergence of disease
\noutbreaks,such as mpox,oropouche virus,and highly pathogenic
\navian influenza virus, has helped drive global discourse about
\nhealth system preparedness and response, as well as the
\nevaluation of national action plans for pandemic preparedness
\n(including reducing risk of potential zoonotic transmission).
\nThe rapid spread of misinformation and disinformation hinders
\nthe delivery of accurate health recommendations with patients,
\nfamilies, and communities, as well as the opportunity to build
\npublic trust and rapport.
\nTo address this global burden, WMA leaders underscored the
\nurgent need for global solidarity as a means to quickly respond
\nto climate change adaptation and mitigation efforts, support the
\nnegotiations of the Pandemic Agreement, improve global health
\nworkforce training, and streamline public health messaging.
\nAs the impacts of anthropogenic phenomena on the aquatic,
\natmospheric, and terrestrial ecosystems cannot be overlooked,
\nalterations or loss of natural biodiversity and animal habitats,
\nchemical and plastic pollution, and the introduction of non-
\nnative species remain significant threats to humanity. Hence, the
\nquestion remains: How can global health professionals leverage
\ntheir expertise, develop robust One Health collaborations to
\naddress these endemic and emerging health risks, and fortify
\nmedical education and training across our countries?
\nAs global leaders attend the 79th session of the UN General
\nAssembly from 20-30 September 2024, which consists of
\nHigh-Level Meetings on the Summit of the Future, General
\nDebate, Sea-Level Rise, Antimicrobial Resistance (AMR),
\nand Elimination of Nuclear Weapons, they share the urgent
\nmessage for international cooperation and collaboration to
\ncombat diverse global crises and conflicts that affect public
\nhealth and environmental sustainability. Over these next
\nmonths, additional key global meetings will highlight
\ninnovative strategies to accelerate progress to achieving the
\nSustainable Development Goals, including the Group on Earth
\nObservations (GEO) Symposium and Regional Meetings
\n(Africa, Americas, Asia-Oceania, Europe), World One Health
\nCongress, and the UN\/WHO Regional Conference on Space
\nTechnology for Advancing Global Health. These timely events
\n\u2013 together with reports from leading agencies like the multi-
\nagency\u2019s United in Science 2024 \u2013 support knowledge exchange,
\npropel interactive debates, and allow for expanded networks
\nfor collaborative climate action.
\nThe Finish Medical Association invites WMA members and
\nrelevant guests to attend the WMA General Assembly in
\nHelsinki, Finland, from 16-19 October 2024. At this event,
\nWMA members can offer their perspectives to scholarly
\ndebates on timely global health and medical ethics topics and
\nbuild connections with other NMAs. As WMA members have
\nparticipated in several regional expert meetings on the WMA
\nDeclaration of Helsinki revisions in Johannesburg, Munich, and
\nWashington, DC, they can articulate any final comments for the
\noverall consensus and subsequent consideration for adoption.
\nIn this issue, Dr. Otmar Kloiber shared his perspectives
\non WMA activities as well as his leadership achievements
\nover his tenure as WMA Secretary General. Ms. Marr,
\nDr. Julia Tainijoki, Dr. Caline Mattar, Dr. Lesley Ogilvie, and
\nMr. Ashrit Challa offer a high-level summary of the
\nroundtable discussion on AMR ahead of the UN
\nHigh-Level Meeting on AMR in September 2024.
\nDr. Mike Kalmus Eliasz, Dr. Yassen Tcholakov, Dr. Maria In\u00eas
\nFrancisco Viva, Dr. Marie-Claire Wangari, and Dr. Wenzhen
\n(Jen) Zuo presented reflections on the UN High-Level Meeting
\non Pandemic, Prevention, Preparedness, and Response in
\nSeptember 2023. Dr. Jeazul Ponce Hern\u00e1ndez, Dr. Francisco
\nFranco P\u00eago, Dr. Flora Wendel, Dr. Marie-Claire Wangari, and
\nDr. Balkiss Abdelmoula described the Junior Doctors Network
\n(JDN)’s participation in the World Health Summit 2023. Dr.
\nMarie-Claire Wangari, Dr. Deena Mariyam, Dr. Lekha Rathod,
\nand the WMA-JDN Working Group on WHO Activities
\nexamined JDN perspectives on barriers and solutions to the
\nequitable access of global health opportunities. Finally, Ms.
\nTabasom Fayaz described pharmaceutical policy in Afghanistan.
\nWMA members are inspirational leaders who contribute
\ntheir clinical and surgical expertise in daily practice and at
\nnational and international meetings. As they are acutely
\naware of challenges facing medical education and training,
\nethics, and public health across their countries, we encourage
\nthem to prepare scientific analyses and commentaries for the
\nWorld Medical Journal. In this issue, two remarkable articles
\nfrom eight NMAs in Africa and Europe described leadership
\nexperiences, ongoing NMA activities, and perceived strengths
\nand challenges in medical education. Dr. Johannes Steinhart,
\nDr. Fran\u00e7ois Arnault, Dr. Philippe Cathala, Dr. Simon Kigondu,
\nDr. John Baptist Nkuranga, Dr. Mvuyisi Mzukwa, Dr. Tom\u00e1s
\nCobo Castro, Dr. Sofia Rydgren Stale, and Dr. Herbert
\nLuswata, representing the NMAs from Austria, France,
\nKenya, Rwanda, South Africa, Spain, and Sweden, respectively,
\nexpressed their valuable viewpoints for ongoing discourse. Also,
\nWMA members representing 14 countries of the African,
\nAmericas, Eastern Mediterranean Region, and South-East
\nAsian regions highlighted national policies and activities that
\npromote patient safety practices related to World Patient Safety
\nDay 2024.
\nWe look forward to exciting discussions and networking
\nopportunities at the WMA General Assembly in Helsinki!
\nHelena Chapman, MD, MPH, PhD
\nEditor in Chief of the World Medical Journal
\neditor-in-chief@wma.net
\n4
\nFor this interview, Dr. Otmar Kloiber,
\nthe WMA Secretary General, shares
\nhis perspectives on WMA activities
\nas well as his leadership achievements
\nover his tenure with Dr. Helena
\nChapman, the WMJ Editor in Chief.
\nHow would you describe your role as
\nGeneral Secretary, and how has the
\nWMA evolved as an organisation
\nover your WMA tenure?
\nAs Secretary General, my role is
\nto operationalize the aims of the
\nWMA, promote the application
\nand development of medical ethics,
\nand advocate for better patient
\ncare and equity in order to protect
\nhuman rights in healthcare. I joined
\nthe WMA after many countries,
\nespecially in central and eastern
\nEurope, became democracies or
\nat least less authoritarian, and old
\nblocks of power had disappeared.
\nThe world was opening up
\npolitically, which helped significantly
\nto increase our membership. Since
\nthat time, the WMA has become a
\nmore vibrant community, with more
\nactive engagement in global health
\nactivities and healthcare advocacy at
\nall levels.
\nWhat do you consider to be the
\nWMA\u2019s top three most important
\nleadership achievements over the
\npast decade?
\nFirst, we have made major changes
\nin the WMA governance, which
\ncorrected the perception of the
\nWMA as a club of wealthy countries.
\nWe now represent the largest portion
\nof physicians globally. Second, we
\nhave engaged in addressing major
\nglobal health challenges, such as
\nsocial determinants of health, One
\nHealth, climate crisis, and research
\nethics. With the Declaration of
\nTaipei, we have provided a blueprint
\nfor transferring our principles of
\nresearch ethics into the research world
\nof large databases and biobanks [1].
\nFinally, we have held global
\ndiscussions to defend, develop, and
\nupdate our core documents, including
\nthe Declaration of Geneva and the
\nInternational Code of Medical Ethics
\n[2,3]. We also needed to adapt to
\nnew developments in medicine and
\nadopt a more modern language, while
\nremaining true to our principles
\nand traditions of caring, ethics, and
\nscience. This year, I am confident that
\nwe will finalise discussions on one of
\nour key documents, and will complete
\nthe revision of the Declaration of
\nHelsinki in October 2024.
\nHow would you describe the
\nobserved impact of the WMA
\ndeclarations, resolutions, and
\nstatements in the health sector?
\nPlease share two examples that you
\nhave observed during your WMA
\ntenure.
\nDuring my WMA tenure, I have
\nobserved three specific examples
\nwith significant global impact.
\nFirst, the Declaration of Helsinki,
\nwhich is referenced in national
\nand international law, has become
\nthe cornerstone of research
\nethics worldwide [4]. Second, in
\ncollaboration with regional and
\nnational physician organisations, we
\nstrongly advocate for our professional
\nautonomy. Over time, we have
\nwitnessed that professional autonomy
\nhas been under attack from multiple
\nstakeholders. Some governments and
\ncommercial entities have attempted
\nto commoditise healthcare and
\nsubordinate medical decision-
\nmaking to commercial interests,
\nrather than serving the interests of
\npatients or communities. Finally,
\nwe lead efforts to raise attention to
\nhuman rights violations in individual
\nor national cases, and although not
\nalways successful, we remain vigilant.
\nMost recently, we participated in
\na movement that convinced the
\nParliament of Gambia to maintain
\nthe prohibition of female genital
\nmutilation [5].
\nHow does the WMA manage
\ninternational discourse throughout
\nthe year, including contentious
\ndebates and disagreements that may
\narise on complex medical ethics
\ntopics? Please share two examples
\nof how contentious debates were
\naddressed during your WMA
\ntenure.
\nThere have always been, and probably
\nalways will be, divergent opinions
\non ethical questions, particularly
\nconcerning the beginning and end
\nof human life. It is important to
\nnote that divergent views on medical
\nethics issues often exist within
\ncountries rather than just between
\ncountries. Over the past decades, our
\napproach has been to engage in open
\nand inclusive debate on these issues.
\nAlthough a lengthy and resource-
\nintensive process, we are convinced
\nthat this approach produces the
\nOtmar Kloiber
\nInterview with the WMA Secretary General
\nInterview with the WMA Secretary General
\nBACK TO CONTENTS
\n5
\nbest results. For example, we have
\ndiscussed issues ranging from gamete
\ndonation, embryo transfer, and
\nsurrogate motherhood to abortion,
\nphysician-assisted suicide, and
\neuthanasia. Although controversial
\ntopics, we were able to discuss them
\nthoroughly and eventually address
\nthem through the development of
\nWMA policies.
\nHow can the WMA help support
\nspecific national challenges faced
\nby national medical associations
\n(NMAs), including medical
\neducation and training and health
\npolicy reform. Please share two
\nexamples of how the WMA has
\nhelped support NMAs during your
\nWMA tenure.
\nWhen managing diverse
\nnational issues, the WMA acts
\nat the request of our NMAs.
\nIf in a country there is no NMA in
\nour membership, then the WMA
\nmay speak out independently.
\nOver the past year, the WMA has
\nsupported several specific situations
\nof significant concern. For example,
\nthe WMA supported the Indian
\nMedical Association in their struggle
\nagainst a government policy that
\ngrants traditional healers more
\nrights to practise modern medicine
\nand surgery without any relevant
\neducation and training. Similarly, the
\nWMA joined the Korean Medical
\nAssociation in their objection
\nagainst the government\u2019s attempts
\nto either satisfy a small group of
\nvoters or place pressure on Korean
\nphysicians by allowing practitioners
\nof traditional Korean medicine to
\nuse western medical technologies
\nwithout appropriate education [6].
\nThe WMA has also supported
\nKorean physicians in their protest
\nagainst nearly doubling the number
\nof medical students without first
\ncreating the necessary university
\nresources [7].
\nHowever, if pressing concerns arise
\nin several countries simultaneously,
\nNMAs may be unaware that
\nthey are affected by issues,
\nsuch as the commoditization
\nof healthcare and the increasing loss
\nof professional autonomy. For
\nexample, some governments are
\nprohibiting their medical residents
\nfrom seeking employment abroad,
\nrather than offering decent working
\nconditions. These actions that target
\nprofessional groups represent civil
\nconscription, and may qualify as
\nforced labour and constitute a human
\nrights violation.
\nPlease describe three ongoing
\nWMA initiatives that help address
\nspecific challenges facing the global
\nmedical community over the next
\nfive years.
\nBy the nature of the WMA, most
\ninitiatives are focused on identifying
\npressing global challenges in medical
\nethics and collectively developing a
\nrelevant and timely policy to help
\nguide NMAs in their advocacy,
\ndecision-making, and educational
\nactivities. Over the next five years,
\nthree specific focus areas include
\nsupporting pandemic preparedness,
\nreducing risks of antimicrobial
\nresistance (AMR), and combatting
\nthe climate crisis. To that extent, we
\nhave revised our policies on emergency
\npreparedness and engaged actively
\nwith the World Health Organization
\non fostering action against AMR.We
\nhave also actively participated in the
\nConference of the Parties (commonly
\ncalled COP) of the United Nations
\nFramework Convention on Climate
\nChange (UNFCCC), where we
\ncollectively advocate for more
\npolitical action on climate adaptation
\nand mitigation, noting the direct or
\nindirect consequences on health and
\nwell-being.
\nReferences
\n1.\t World Medical Association.
\nDeclaration of Taipei on Ethical
\nConsiderations regarding
\nHealth Databases and Biobanks
\n[Internet]. 2016 [cited 2024 Aug
\n10]. Available from: https:\/\/www.
\nwma.net\/policies-post\/wma-dec-
\nlaration-of-taipei-on-eth-
\nical-considerations-regar-
\nding-health-databases-and-bio-
\nbanks\/
\n2.\t World Medical Association.
\nDeclaration of Geneva [Internet].
\n2017 [cited 2024 Aug 10].
\nAvailable from: https:\/\/www.
\nwma.net\/policies-post\/wma-dec-
\nlaration-of-geneva\/
\n3.\t World Medical Association.
\nInternational Code of Medical
\nEthics [Internet]. 2022 [cited
\n2024 Aug 10]. Available from:
\nhttps:\/\/www.wma.net\/policies-
\np o s t \/ w m a – i n t e r n a t i o n –
\nal-code-of-medical-ethics\/
\n4.\t World Medical Association.
\nDeclaration of Helsinki: Ethical
\nPrinciples for Medical Research
\ninvolving Human Subjects
\n[Internet]. 2013 [cited 2024 Aug
\n10]. Available from: https:\/\/www.
\nwma.net\/policies-post\/wma-dec-
\nlaration-of-helsinki-ethical-prin-
\nciples-for-medical-research-in-
\nvolving-human-subjects\/
\n5.\t World Medical Association.
\nWMA Council Resolution
\nCalling for the Immediate
\nWithdrawal of the Bill Lifting
\nthe Ban on Female Genital
\nMutilation in Gambia [Internet].
\n2024 [cited 2024 Aug 10].
\nAvailable from: https:\/\/www.
\nwma.net\/policies-post\/wma-
\ncouncil-resolution-calling-for-
\nthe-immediate-withdrawal-of-
\nthe-bill-lifting-the-ban-on-fe-
\nBACK TO CONTENTS
\nInterview with the WMA Secretary General
\n6
\nmale-genital-mutilation-in-gam-
\nbia\/
\n6.\t World Medical Association.
\nWorld Medical Association
\nclarifies position on collective
\naction and condemns government
\ninterference in Korean Medical
\nAssociation [Internet]. 2024
\n[cited 2024 Aug 10]. Available
\nfrom: https:\/\/www.wma.net\/
\nnews-post\/world-medical-asso-
\nciation-clarifies-position-on-col-
\nl e c t i v e – a c t i o n – a n d – c o n –
\ndemns-government-interfer-
\nence-in-korean-medical-associa-
\ntion\/
\n7.\t World Medical Association.
\nWorld Medical Association
\nstands firm in support of Korean
\nMedical Association amid
\ngovernment-induced crisis
\n[Internet]. 2024 [cited 2024
\nAug 10]. Available from:
\nhttps:\/\/www.wma.net\/news-
\npost\/world-medical-associ-
\nation-stands-firm-in-sup-
\nport-of-korean-medical-asso-
\nciation-amid-government-in-
\nduced-crisis\/
\nOtmar Kloiber, MD
\nSecretary General (2005-current)
\nWorld Medical Association
\notmar.kloiber@wma.net
\nBACK TO CONTENTS
\nInterview with the WMA Secretary General
\n7
\nDear Colleagues and Esteemed
\nMembers of the World Medical
\nAssociation (WMA),
\nIt is with great pleasure that we
\ninvite you to join us for the WMA
\nGeneral Assembly, which will be
\nheld in Helsinki, Finland, from
\n16-19 October 2024. This year\u2019s
\ngathering will be particularly
\nsignificant as we celebrate the 60th
\nanniversary of the Declaration of
\nHelsinki, a foundational document
\nthat has guided the ethical standards
\nof medical research for the past six
\ndecades.
\nTheme: Equality in Healthcare
\nOur theme for this year \u2013 Equality in
\nHealthcare \u2013 reflects one of the most
\nurgent and pressing issues of our time.
\nDespite tremendous advancements in
\nmedicine, disparities in healthcare
\naccess and quality continue to persist
\nacross populations, communities, and
\ncountries. This assembly will bring
\ntogether thought leaders, healthcare
\nprofessionals, and advocates from
\naround the world to discuss how we
\ncan collectively work towards more
\nequitable health systems, ensuring
\nthat everyone, regardless of race,
\ngender, socioeconomic status or
\ngeography, receives the healthcare
\nthey need and deserve.
\nCelebrating 60 Years of the
\nDeclaration of Helsinki
\nThe Declaration of Helsinki has
\nstood as a pillar of ethical guidance
\nin medical research for the past six
\ndecades, shaping the conduct of
\nclinical trials and the protection of
\nresearch participants worldwide.
\nIts principles have become the
\ncornerstone of ethical medical
\npractice, ensuring that the rights,
\nsafety, and well-being of patients
\nremain paramount in research efforts.
\nThis anniversary is timely to reflect
\non the Declaration\u2019s profound impact
\non global health, as well as renew
\nour commitment to upholding its
\nvalues in an ever-changing medical
\nlandscape. Helsinki, the birthplace
\nof the Declaration of Helsinki, is a
\nfitting location for this important
\ndialogue. Over the course of the
\nmeeting, we will reflect on the
\nprogress made since the Declaration\u2019s
\nadoption in 1964, as well as hear the
\nresults of a two-year renewal process
\nand explore how we can apply its
\nprinciples to the challenges of today
\n\u2013 particularly in advocacy efforts for
\nequal access to healthcare.
\nA Comprehensive Program
\nThe event will serve as a vital
\nplatform for physicians to connect,
\nshare knowledge, and influence the
\nfuture direction of medical ethics
\nand medicine. It is comprised of
\nthe General Assembly proceedings
\nas well as preceding meetings of
\nthe Statutory Committees and the
\nCouncil. We encourage all WMA
\nmembers to take part in this historic
\nevent. Your voice and your expertise
\nare essential in shaping the future of
\nglobal healthcare and ensuring that
\nthe principles of equality, dignity,
\nand ethical responsibility remain at
\nthe core of our profession.
\nInvitation to the WMA General Assembly
\nin Helsinki, October 2024
\nInvitation to the WMA General Assembly in Helsinki, October 2024
\nBACK TO CONTENTS
\n8
\nThe Host City and Association
\nWe invite you to explore our
\nbeautiful capital and its surroundings.
\nHelsinki is known for its blend
\nof modern urban culture, history,
\narchitecture, design, and natural
\nbeauty. As saunas are a significant
\npart of Finnish culture, Helsinki
\noffers many opportunities to
\nexperience them, including on the
\nway from the official meeting hotel
\nto the conference centre in the
\nharbour.
\nThis will be the third WMA General
\nAssembly that the Finnish Medical
\nAssociation (FMA) has hosted.
\nEstablished in 1910, the FMA is a
\nprofessional organisation and trade
\nunion representing more than 90%
\nof Finnish physicians. It plays a
\nsignificant role in the development
\nof the medical profession in Finland,
\nadvocating for the rights and interests
\nof physicians and ensuring high
\nstandards in medical practice.
\nWe are proud of this opportunity to
\nhost this event, and we will do our
\nbest to make your visit successful
\nand memorable. Mark your calendars
\nfor 16-19 October 2024, and join
\nus in Helsinki, as we celebrate 60
\nyears of the Declaration of Helsinki
\nand reaffirm our commitment to
\nadvancing equality in healthcare for
\nall.
\nWarm regards,
\nNiina Koivuviita, MD
\nPresident,
\nFinnish Medical Association
\nniina.koivuviita@laakariliitto.fi
\nhttps:\/\/www.laakariliitto.fi\/
\nInvitation to the WMA General Assembly in Helsinki, October 2024
\nBACK TO CONTENTS
\n9
\nBACK TO CONTENTS
\nReport on the Roundtable Discussion on Antimicrobial Resistance
\nThe World Medical Association
\n(WMA) collaborated with the
\nGlobal Antimicrobial Resistance
\n(AMR) Research and Development
\n(R&D) Hub to host a roundtable
\ndiscussion on AMR on the sidelines
\nof the 77th World Health Assembly
\nin Geneva, Switzerland in May 2024.
\nThis event was held in preparation
\nfor and anticipation of the United
\nNations General Assembly (UNGA)
\nHigh-Level Meeting (HLM) on
\nAMR, which will take place on
\n26 September 2024, in New York.
\nInvited participants represented a
\nrange of sectors and backgrounds
\nand were brought together to
\ndiscuss four key themes: Access
\nand Innovation, Health Systems
\nand Health Workforce Education,
\nStewardship, and One Health.
\nThis article aims to summarise
\nthe key messages and highlight
\nperceived gaps in the Zero Draft of
\nthe UNGA HLM on AMR political
\ndeclaration, as discussed during the
\nroundtable.
\nBackground on the AMR Situation
\nAMR is estimated to have been
\ndirectly responsible for 1.3 million
\ndeaths globally in 2019, with
\napproximately 4.95 million deaths
\nassociated with AMR in the same
\nyear [1]. In addition to mortality
\nfigures, AMR also results in
\nsignificant economic burden, with the
\nWorld Bank estimating that AMR
\ncould result in a 3.8% reduction
\nin global gross domestic product
\n(GDP) by 2050, amounting to
\na US $3.4 trillion loss each year [2].
\nAMR could push 24 million more
\npeople into extreme poverty by 2030
\nif left unchecked and reduce global
\nlife expectancy by 1.8 years by 2035
\n[2,3]. Moreover, the burden of
\nAMR is unequal, with low- and
\nmiddle-income countries (LMICs)
\ndisproportionately affected by drug-
\nresistant infections. As LMICs
\noften have the greatest unmet needs
\nfor diagnostics, therapeutics, and
\nvaccines, AMR only widens these
\ngaps in healthcare access and bolsters
\nexisting inequities.
\nIn 2016, the first UNGA HLM on
\nAMR stressed the urgency of action
\nin the resultant political declaration
\n[4]. In response, several initiatives
\nwere launched, and progress was
\nwell underway until the coronavirus
\ndisease 2019 (COVID-19) pandemic
\nbrought efforts to a standstill.
\nResources were diverted from
\nAMR efforts, with surveillance and
\nstewardship programs also falling by
\nthe wayside, resulting in increased
\nglobal rates of AMR incidence
\n[4]. Currently, we are at a critical
\njunction in the aftermath of the
\nCOVID-19 pandemic, with another
\nUNGA HLM on AMR rapidly
\napproaching. While it is crucial that
\nthe resultant UNGA declaration
\nreflects the necessary progress, much-
\nneeded political commitments, and
\ndefined monitoring targets, the
\nimplementation path post-UNGA
\nremains challenging. Multiple
\navenues of collaboration and
\nReport on the Roundtable Discussion on Antimicrobial Resistance \u2013
\nLooking Towards the UN High-Level Meeting on AMR and Beyond
\nKristy Marr
\nLesley Ogilvie
\nJulia Tainijoki
\nAshrit Challa
\nCaline Mattar
\n10
\nBACK TO CONTENTS
\nalignment among global actors are
\nessential if we hope to accelerate
\nprogress at all levels and facets of the
\nAMR challenge we face today.
\nOutcomes of Roundtable
\nDiscussions
\nThis invitation-only roundtable
\nevent was convened to unite
\nstakeholders in the AMR field to
\nshare expertise, explore synergies,
\nand make recommendations for next
\nsteps. An overview of the discussions
\nfrom the expert dialogue as well as
\nthe suggestions for strengthening
\nthe UNGA political declaration on
\nAMRareprovidedbelow,withtheaim
\nof driving action against AMR at the
\nhighest political levels. Suggestions
\nare categorised into four key thematic
\nareas, which were the basis of our
\ndiscussion subgroupings and were
\nhandpicked to ensure diversity in
\ngeographic representation, sector,
\nand professional background among
\nroundtable members.
\nTheme 1: Access and Innovation of
\nAMR Diagnostics and Treatment
\nRecognising that the lack of new
\nantimicrobials and rising resistance
\nendangers vulnerable populations,
\nnecessitating urgent prioritisation
\nand incentives for development and
\naccess, participants raised that the
\naccess and innovation sections of the
\nZero Draft of the political declaration
\nrequired a clearer statement of
\nintent and greater ambition. While
\nincluding specific global research
\nand development (R&D) targets
\nin the declaration was thought to
\nbe challenging, they suggested that
\n\u2013 at a minimum \u2013 a mechanism
\nfor establishing such targets in the
\nfuture should be outlined. There was
\ngeneral consensus that this could
\ninvolve a political mandate and
\ncommitment for the forthcoming
\nIndependent Panel on Evidence for
\nAction against AMR to develop these
\ntargets. However, the role of this
\nPanel and its relationship with the
\nQuadripartite organisations would
\nneed to be clearly defined.
\nParticipants also highlighted that the
\ndeclaration should include specific
\nwording on supporting existing
\nglobal initiatives, acknowledging
\nthe progress that has been made on
\naccess and innovation since 2016. For
\nexample, this progress has included
\ninitiatives such as CARB-X (https:\/\/
\ncarb-x.org\/), GARDP (https:\/\/gardp.
\norg\/), the Global AMR R&D Hub
\n(https:\/\/globalamrhub.org\/), and
\ncountry-specific pull incentive pilots
\n[5,6]. They highlighted the call to
\nrecognise the WHO pipeline analyses
\nand priority lists as foundational to
\nongoing work in this area [7-9].
\nIn the Zero Draft, participants
\ncommented that financing was
\nlargely siloed around National Action
\nPlans (NAPs). The requirement
\nto establish financing targets for
\nnew antibacterials and give greater
\nconsiderations to the complexities
\nof diagnostic funding from an R&D
\nperspective was expressed, given that
\ndiagnostics often exceed the costs
\nof antibiotics. They agreed on the
\nimportance of increased emphasis
\non push and pull incentives as
\nsustainable strategies for long-
\nterm innovation and new economic
\nmodels de-linked from revenues.
\nParticipants inquired about how
\nto appropriately signal these next
\nsteps towards resource mobilisation
\nthrough the G7 and G20.
\nFurthermore, it was emphasised that
\nmost prescribed antibiotics today
\nare generics, and the supply chain
\nremains unstable due to manufacturer
\nconsolidation. The discussion ended
\nwith pragmatism, underscoring the
\nurgency to plan for the replacement
\nof life-saving antibiotics, as failing to
\ndo so would leave nothing to preserve
\ntheir access in the future.
\nTheme 2: Health Systems and
\nHealth Workforce Education
\nParticipants acknowledged that
\nstrong health systems and a well-
\nresourced workforce are fundamental
\nto combat AMR through prevention,
\ndiagnosis, treatment, and public
\neducation. The Zero Draft placed
\ninsufficient emphasis on education
\nand training of medical professionals
\nrelated to AMR. They agreed that
\nthere must be a greater emphasis
\non and investment in preparing the
\nworkforce for AMR, both within
\nthe language of the Zero Draft and
\nthrough the strengthening or
\nestablishment of education
\nframeworks. Participants stressed
\nthe importance of educating patient
\ncommunities alongside medical
\nprofessionals, including engaging
\npatients in discussions about AMR
\nand the development of NAPs.
\nParticipants believed that creating
\nstronger systems for sharing
\ninformation can propel health
\npersonnel and patient communities to
\nspearhead government-level change
\nin combat AMR.
\nParticipants also expressed the
\nneed for greater levels of education
\nduring training, including significant
\ninvestment into health infrastructure
\nfor all healthcare roles. They
\ncommented that physicians, dentists,
\nnurses, and pharmacists tend to
\nrepresent the majority workforce,
\noften overlooking \u2018invisible personnel\u2019
\nin the health workforce, such as
\nadministrators, patient escorts,
\nand cleaners. Improving education
\nsystems and enabling healthcare
\nprofessionals to spend more time
\nwith patients were seen as essential
\nsteps to strengthen healthcare team
\ncollaborations in AMR initiatives.
\nFurthermore, they shared their
\nconcern about the lack of investment
\nin dissemination of available
\ninformation including tools to
\nenhance understanding of AMR.
\nReport on the Roundtable Discussion on Antimicrobial Resistance
\n11
\nBACK TO CONTENTS
\nOne suggestion was to include the
\nterms \u201cInvestment\u201d and \u201cPatient
\nVoice\u201din the Zero Draft to reflect the
\nimportance of these concepts.
\nTheme 3: Stewardship to Reduce
\nthe Burden of AMR
\nDiscussions centred on the fact that
\nantimicrobial stewardship (AMS) is
\nessential to combat AMR, addressing
\noverprescription, misuse, and
\neducational gaps, while promoting
\nglobal collaboration and policy
\nreform within the health system. The
\npolitical resolution should clearly
\ndefineandoutlinethekeycomponents
\nof AMS. Participants acknowledged
\nthat clear, accessible guidelines
\nshould extend beyond physicians
\nto include nurses and community
\nhealth educators, considering the
\ndisparities between high- and low-
\nresource settings. A simplified set of
\nguidelines was viewed as essential to
\nensure effective implementation of
\nAMS principles at the community
\nlevel, supported by meaningful
\nsurveillance data that reflect local
\nresistance patterns. They highlighted
\nthat guidance on usage, especially
\nfor new antibiotics coming to the
\nmarket, should be aligned with the
\nimplementation of an appropriate
\nstewardship plan.
\nParticipants stressed that access to
\nessential antibiotics is foundational
\nto successful stewardship and should
\nbe prioritised in the declaration\u2019s
\nopening paragraphs. Without
\naccess, healthcare professionals face
\nthe difficult dilemma of balancing
\nstewardship measures with patient
\nhealth needs, as well as recognising
\ndirect links between human and
\nanimal health. They also emphasised
\nthat universal health coverage is a
\nvital component of AMS, to ensure
\nthe effective implementation of
\ndiagnostics or infection prevention
\nand control.
\nBuilding on this narrative, the
\nparticipants hoped that the
\ndeclaration would offer an
\nopportunity to broaden the scope
\nof AMS, advocating for a holistic,
\nsociety-wide approach that includes
\nstewardship at the community
\nlevel, consideration of behavioural
\nchanges, and attention to commercial
\ndeterminants. Civil society
\norganisations and health professional
\nassociations can play a key role in
\nthis expanded approach to AMS.
\nThe discussions ended with
\nthe recognition that the draft
\ndeclaration does not adequately
\nrecognise how women and children
\ndisproportionately bear the impacts
\nof AMR, facing higher risks and
\nchallenges in accessing adequate
\ntreatments, such as paediatric
\nformulations.
\nTheme 4: One Health Approach
\nParticipants suggested that the
\nterm \u201cOne Health\u201d be replaced with
\n\u201cintersectoral,\u201d \u201ccross-sectoral\u201d or
\n\u201cmultisectoral\u201d in the draft political
\ndeclaration, as it may minimise
\nany potential political setbacks
\nor challenges associated with
\ndefinitions of \u201cOne Health\u201d. Other
\nparticipants commented that the
\nterm \u201cOne Health\u201d could be used in
\nthe introduction or preamble and
\nremoved from the main text. This
\ndiscourse was highlighted as the
\n\u201cOne Health\u201d term and concept
\nare not yet well entrenched in some
\ncountries, with additional translation
\nissues in other languages.
\nParticipants also discussed how
\nother relevant terms are defined and
\nincorporated into the declaration.
\nFirst, the term \u201canimal\u201d was found
\nto be often poorly defined and
\noversimplified in the context of AMR.
\nA need for antimicrobial use to be
\nspecies- or sector-specific, potentially
\nthrough the introduction of an
\nanimal-focused version of the WHO
\nAccess, Watch, Reserve (AWaRe)
\nClassification was raised. This
\nsystem would account for the varying
\nimpacts of different antibiotics
\nand classes on AMR, emphasising
\nthe importance of appropriate use.
\nSecond, the term \u201cintegrated
\nsurveillance\u201d was questioned due to
\nthe challenges in its implementation,
\nnoting that a more suitable approach
\nmight be mono-sectoral surveillance
\nwith integrated or coordinated
\nanalysis.
\nSome participants viewed the
\ninclusion of global targets as
\npolarising and a potential barrier
\nto adoption of the resolution,
\nrecognising that targets should
\nbe evidence-based, inclusive, and
\nappealing to politicians. They
\nbelieved that such targets could
\nbe adapted by regions or countries
\nand reevaluated over time. This
\nconversation emphasised the
\nnecessity of true multisectoral
\ncollaboration, with participants
\nraising that the Quadripartite
\norganization\u2019s One Health AMR
\nPriority Research Agenda had not
\nbeen included in the declaration
\n[10]. In the research arena, the
\nbenefits of considering the social and
\nbehavioural aspects of AMR and
\na greater focus on implementation
\nresearch to improve the delivery of
\ninterventions was voiced. Overall,
\nparticipants agreed that the \u201cOne
\nHealth\u201d concept should be integrated
\ninto all aspects of AMR policy, not
\nsimply treated as a separate entity.
\nKey Messages and
\nRecommendations
\n\u2022\t The lack of new antimicrobials
\nand rising resistance endangers
\nvulnerable populations,
\nnecessitating urgent prioritisation
\nand incentives for development
\nand access.
\n\u2022\t Urgent planning is needed to
\nensure adequate supply of generic
\nantibiotics and address the
\nconsolidation of suppliers.
\nReport on the Roundtable Discussion on Antimicrobial Resistance
\n12
\n\u2022\t Strong health systems and a well-
\nresourced workforce are essential to
\ncombat AMR through prevention,
\ndiagnosis, treatment, and public
\neducation.
\n\u2022\t Education frameworks for
\nhealthcare professionals, patients,
\nand communities at large should
\nbe more widely disseminated,
\nand governments should ensure
\npatient voices are included in NAP
\nconsiderations.
\n\u2022\t AMS is essential to combat
\nAMR, addressing overprescription,
\nmisuse, and educational gaps while
\npromoting global collaboration
\nand policy reform.
\n\u2022\t Ensuring access to essential
\nantibiotics is the foundation
\nfor successful stewardship, as
\nhealthcare professionals face
\ndifficult choices between applying
\nstewardship measures and
\nsafeguarding the health of their
\npatients.
\n\u2022\t A greater focus on behaviour
\nchange and implementation
\nscience would assist in improving
\nthe delivery of AMR interventions.
\nReferences
\n1.\t Antimicrobial Resistance Col-
\nlaborators. Global burden of bac-
\nterial antimicrobial resistance
\nin 2019: a systematic analysis
\n[published correction appears in
\nLancet. 2022;400(10358):1102].
\nLancet. 2022;399(10325):629-55.
\n2.\t World Bank. Drug-resistant in-
\nfections: a threat to our economic
\nfuture. Washington, DC: World
\nBank; 2017. Available from:
\nhttps:\/\/www.worldbank.org\/en\/
\ntopic\/health\/publication\/drug-
\nresistant-infections-a-threat-to-
\nour-economic-future
\n3.\t Global Leaders Group on An-
\ntimicrobial Resistance. Towards
\nspecific commitments and action
\nin the response to antimicrobial
\nresistance. Geneva: Global Lead-
\ners Group on Antimicrobial Re-
\nsistance; 2024. Available from:
\nhttps:\/\/www.amrleaders.org\/re-
\nsources\/m\/item\/glg-report
\n4.\t United Nations. United Nations
\nGeneral Assembly (71st session;
\n2016\u20132017). Political declara-
\ntion of the high-level meeting
\non antimicrobial resistance: res-
\nolution\/adopted by the Gener-
\nal Assembly. A\/RES\/71\/3. New
\nYork: UN; 2016. Available from:
\nhttps:\/\/digitallibrary.un.org\/re-
\ncord\/845917
\n5.\t Global AMR R&D Hub. In-
\ncentivising the development of
\nnew antibacterial treatments:
\n2023 progress report by the
\nGlobal AMR R&D Hub and
\nWHO. Geneva: Global AMR
\nR&D Hub and WHO; 2023.
\nAvailable from: https:\/\/glo-
\nbalamrhub.org\/publications\/
\nincentivising-the-develop-
\nment-of-new-antibacterial-treat-
\nments-2023\/
\n6.\t Ogilvie L, Beyer P. Incentivis-
\ning the development of new an-
\ntibacterial treatments: 2022 pro-
\ngress report by the Global AMR
\nR&D Hub and WHO. Gene-
\nva: Global AMR R&D Hub;
\n2022. Available from: https:\/\/
\nglobalamrhub.org\/publica-
\ntions\/incentivising-the-develop-
\nment-of-new-antibacterial-treat-
\nments\/
\n7.\t World Health Organization.
\nWHO bacterial priority patho-
\ngens list, 2024: bacterial patho-
\ngens of public health importance
\nto guide research, development
\nand strategies to prevent and
\ncontrol antimicrobial resistance.
\nGeneva: WHO; 2024. Available
\nfrom: https:\/\/www.who.int\/pub-
\nlications\/i\/item\/9789240093461
\n8.\t World Health Organization.
\n2023 antibacterial agents in clin-
\nical and preclinical development:
\nan overview and analysis. Gene-
\nva. WHO; 2024. Available from:
\nhttps:\/\/iris.who.int\/bitstream\/
\nhandle\/10665\/376944\/978924
\n0094000-eng.pdf
\n9.\t Gigante V, Alm RA, Melchi-
\norri D, Rocke T, Arias CA,
\nCzaplewski L, et al. Multi-year
\nanalysis of the global preclinical
\nantibacterial pipeline: trends and
\ngaps. Antimicrob Agents Chem-
\nother. 2024; 68(8):e0053524.
\n10.\t World Health Organization,
\nFood and Agriculture Organ-
\nization of the United Nations,
\nUnited Nations Environment
\nProgramme, World Organi-
\nsation for Animal Health. A
\nOne Health priority research
\nagenda for antimicrobial resist-
\nance. Geneva: WHO; 2023.
\nAvailable from: https:\/\/www.
\nwho.int\/publications\/i\/item\/
\n9789240075924
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\nReport on the Roundtable Discussion on Antimicrobial Resistance
\n13
\nAuthors
\nKristy Marr, MIPH
\nScientific Programme Officer,
\nGlobal AMR R&D Hub
\nBerlin, Germany
\nkristy.marr@dzif.de
\nJulia Tainijoki, MD
\nMedical and Advocacy Advisor,
\nWorld Medical Association
\njulia.seyer@wma.net
\nCaline Mattar, MD
\nWorld Medical Association
\ncaline.mattar@wma.net
\nLesley Ogilvie, PhD
\nDirector of Secretariat,
\nGlobal AMR R&D Hub
\nBerlin, Germany
\nlesley.ogilvie@dzif.de
\nAshrit Challa
\nIntern, World Medical Association
\nashrit009@gmail.com
\nBACK TO CONTENTS
\nReport on the Roundtable Discussion on Antimicrobial Resistance
\n14
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\nReflections on the Value of the UN High-Level Meeting on Pandemic,
\nPrevention, Preparedness, and Response One Year Later
\nIn September 2023, Member States
\ngathered at the United Nations (UN)
\nHigh-Level Meeting on Pandemic
\nPrevention Preparedness and
\nResponse (PPR) in New York,against
\nthe backdrop of the UN General
\nAssembly [1]. The meeting was
\nsupposed to provide leadership at the
\n\u2018highest level\u2019 to reset the system for
\nPPR in the wake of the coronavirus
\ndisease 2019 (COVID-19) pandemic
\nand was called for by the Independent
\nPanel for Pandemic Preparedness and
\nResponse (IPPPR) and other parties
\n[2]. Hence, it is worth reflecting on
\nthe impact of High-Level Meeting,
\nas negotiations continue in Geneva
\nto try and develop a pandemic
\nagreement or convention following
\nthe extension of the International
\nNegotiation Bureau (INB) (https:\/\/
\ninb.who.int) at the World Health
\nAssembly (WHA) in May 2024 and
\nahead of the UN General Assembly
\nin September 2024.
\nIn September 2023, members of
\nthe World Medical Association
\n(WMA)\u2019s Junior Doctors Network
\n(JDN) collectively analysed all 114
\nstatements delivered at the UN High-
\nLevel Meeting on PPR to understand
\nMember State\u2019s stated priorities on
\nPPR and the level of prioritisation
\nwithin governments. JDN members
\nsubsequently agreed with the post-
\nmeeting consensus from academics
\nand civil society, which concluded
\nthat this event was particularly
\nunderwhelming, in terms of keeping
\npandemic threats on the agenda of
\nheads of government, delivering new
\npolicy commitments, and creating
\nnew accountability mechanisms [3].
\nThe only tangible outcome of the
\npolitical declaration was a future
\nUN Secretary General\u2019s report and
\na subsequent meeting to take place
\nin 2026 [4]. Two questions remain:
\nWhat was the added value of having
\nhealth negotiations in New York? To
\nimprove PPPR at the global level,
\nwould it have been better to invest
\nefforts into \u2018real action\u2019 happening in
\nGeneva-based processes or following
\ndiscussions at the G7 or G20?
\nParticipants
\nFor a meeting labelled as \u2018High-
\nLevel,\u2019 the meeting surprisingly
\nlacked the expected stature, especially
\nwhen compared to representation at
\nprevious High-Level Meetings. Only
\n13 Heads of State and 16 Ministers
\nof Foreign Affairs participated
\nin this meeting. Over half of the
\nrepresentation were Ministers of
\nHealth, which somewhat diminishes
\nthe purpose of a High-Level
\nMeeting outside of the World Health
\nOrganization (WHO). Notably,
\nexcept for the President of the
\nEuropean Union Council,none of the
\nHeads of State present represented
\nG7, G20 or BRICS countries [5].
\nThis potentially signifies that health
\nis considered lower on the priority
\nlist of country leaders than during
\nthe COVID-19 pandemic. Notably,
\nReflections on the Value of the UN High-Level Meeting on
\nPandemic, Prevention, Preparedness, and Response One Year Later
\nMike Kalmus Eliasz
\nMarie-Claire Wangari
\nYassen Tcholakov
\nWenzhen ( Jen) Zuo
\nMaria In\u00eas Francisco Viva
\n15
\nBACK TO CONTENTS
\nleaders from four (France, the United
\nKingdom, Russia, and China) of
\nthe five permanent members of the
\nUN Security Council chose not
\nto participate in the UN General
\nAssemblyatall[6].Thegenderbalance
\nof representation also remained a
\ncause of significant disappointment,
\nwhilst better than most WHAs: only
\none-third of representatives were
\nwomen, despite the overwhelming
\nevidence of the gendered impact of
\nthe recent pandemic [7].
\nMeeting Discussions
\nThe High-Level Meeting was notable
\nmore for what was unsaid than said.
\nSpecific calls to action were scarce,
\nwith only a handful of countries
\n(United Kingdom, Australia,
\nGermany, Uganda, Sweden, Angola,
\nSpain) making new commitments,
\noften without clear financial pledges
\nor reiterating previous promises
\nfrom forums like the G7 or G20
\n[8]. Countries from the Global
\nSouth vocalised their discontent over
\nvaccine access during the COVID-19
\npandemic, highlighting the need
\nfor stronger local manufacturing
\ncapabilities.
\nWith simultaneous High-Level
\nMeetings on Tuberculosis and
\nUniversal Health Coverage taking
\nplace on the same day, there was
\nvery limited integration with PPR
\nwith very few statements cross
\nreferencing the other meetings.
\nThere were nods by many Member
\nStates to incorporate a One Health
\napproach, and some did allude
\nto interlinkages between climate
\nchange, but references to upstream
\nprevention were mostly missing from
\nthe discussion. Some Caribbean
\nnations also reiterated reforms from
\nprevious debates, including a halt on
\ndebt repayments during pandemics.
\nOver half of the speakers supported
\namendments to the International
\nHealth Regulations (IHR) and
\nprogress for the INB, yet they did
\nnot articulate specific expectations for
\nthe negotiations in Geneva. During
\nsuch negotiations, there was little
\nto no mention of the High-Level
\nMeeting, and it would be hard to link
\nthe updated IHR adopted in May
\n2024 to this process. Unfortunately,
\nmost statements focused on what
\nnational governments had done
\nduring the recent pandemic, rather
\nthan looking forward to the future.
\nThis was highlighted by the lack of
\nengagement with the Global Health
\nThreats Council as a proposed
\nconcrete outcome of the meeting,
\nwhich was acknowledged by only
\none Member State. The definitive
\noutcome was the decision to convene
\nanother High-Level Meeting on
\nPPR in 2026 [4].
\nThe Political Context
\nHolding a High-Level Meeting for
\nhealth and shifting health discussions
\nto New York seem less effective in
\ngalvanising global health actions
\nthan in previous years, leading to
\nbroad, lowest common denominator,
\nnon-specific political statements.
\nNegotiators in New York in private
\nwill often cite a lack of competence
\nand technical expertise on health
\ntopics, which is shown in the
\nmeeting\u2019s outcomes, especially noting
\na handover of decision-making to
\nGeneva. The lack of relevance is
\nalso exemplified by how German
\ndelegates articulated their redlines on
\nintellectual property in discussions
\naround the Pandemic Accord much
\nmore clearly at the World Health
\nSummit in Berlin in October 2023
\nthan in New York in September 2023
\n[9].
\nOn 18 September 2023, two days
\nprior to the High-Level Meeting
\non PPR, the President of the UN
\nGeneral Assembly received a letter
\nfrom seven countries (Belarus,
\nBolivia, Cuba, Eritrea, North Korea,
\nRussia, Syria, Venezuela, Zimbabwe)
\nopposing any attempt to formally
\nadopt any draft outcome documents
\nof four of the UN High-Level
\nMeetings taking place in New York.
\nThis response prioritised meetings as
\nan opportunity to push back against
\nwhat they described as universal
\ncoercive measures (sanctions).
\nAlthough the declaration was
\nultimately adopted by consensus
\nin September 2023, widespread
\ndissatisfaction remained. The
\nfrustrations included attaching
\nreservations ranging from opposition
\nto the inclusion of gender and
\nintellectual property, matters to
\nunilateral coercive measures, and
\nprocess issues such as countries
\nexpressing that the voice of the Global
\nSouth was ignored [10].
\nThe meeting occurred against a
\nbackdrop of strained multilateralism
\nand multiple competing crises such as
\ninflation, conflict and climate change,
\nfor which global consensus remained
\nelusive and exhausted needed political
\nbandwidth. Concomitantly with
\nthe High-Level Meeting on PPPR,
\nimportant meetings of the UN
\nSecurity Council on Ukraine and
\na Climate Ambition Summit were
\nalso held with greater engagement by
\nsenior government leaders, reflective
\nof the pandemic fatigue and how the
\nworld has moved on [11].
\nThese events underscore the current
\ncomplexities of international
\ncooperation, particularly in health
\npolicy, and prompt critical questions
\nabout the future of multilateralism
\nand the pursuit of global health goals
\nin a fracturing world and distrust
\nbetween the Global North and South.
\nThe adoption of the updated IHR in
\nGeneva in May 2024, demonstrated
\nthat agreement can be achieved on
\ncontentious issues [12]. It remains to
\nReflections on the Value of the UN High-Level Meeting on Pandemic,
\nPrevention, Preparedness, and Response One Year Later
\n16
\nBACK TO CONTENTS
\nbe seen whether the INB can reach
\na Pandemic Agreement finalised and
\novercome key issues on issues such as
\nintellectual property, benefit sharing,
\nand financing.
\nThe Value of High-Level Meetings
\nfor Health
\nHigh-Level Meetings for health
\nhave historically had widely
\nvariable impacts, with the session
\non HIV\/AIDS in 2001 standing
\nout, contributing to a significant
\nsurge in financial commitments
\nand subsequent reductions in HIV-
\nrelated mortality rates. However,
\nsubsequent High-Level Meetings
\n\u2013 Non-Communicable Diseases in
\n2011, Antimicrobial Resistance in
\n2018, Universal Health Coverage
\nin 2019, and Tuberculosis in 2023
\n\u2013 have resulted in comparatively
\nlimited financial pledges, primarily
\nraising the policy profile of these
\nissues within the government and
\ndriving changes for interagency work
\nwithin the UN [13]. This puts the
\neffectiveness of High-Level Meetings
\nfor health issues into question, as
\ndecision-making increasingly shifts
\nto smaller groups like the G7, G20,
\nand BRICS. The preference of
\nmany leaders to attend the G20 over
\nthe UN General Assembly points
\ntowards a focus on smaller forums,
\nas developing a consensus may be
\neasier and quicker. Since the G7
\nand BRICS are comprised of
\ncountries with the largest economic,
\ntechnological, and manufacturing
\ncapacities, there may be more
\nideological alignment in such
\nforums, albeit lacking the universal
\nlegitimacy of UN global processes
\n[14,15].
\nDespite the focus on smaller forums
\nand increasing polarisation, universal
\nactions are still essential to global
\nhealth. It is crucial to remember
\nthe historical successes achieved
\neven during tense periods (such as
\nthe Cold War), including smallpox
\neradication and the adoption of key
\nUN conventions including the 1979
\nConvention on the Elimination of
\nAll Forms of Discrimination Against
\nWomen and the 1989 Convention on
\nthe Rights of the Child at the UN
\nand last year the UN adopted a
\nlandmark,\u2018High Seas Treaty\u2019[16-18].
\nFor academics, activists, and
\npolicymakers alike, working to
\nensure the next opportunities to drive
\nprogress on health issues at the UN
\nshould still be embraced as possible
\navenues to galvanise action. We
\nagree with the authors of this recent
\nanalysis on Non-Communicable
\nDiseases High-Level Meetings:
\n\u201cHLMs play an important role in
\ngalvanising high-level engagement from
\nnational leaders and serve as a vehicle for
\nhigh-level advocacy\u2026To make the most
\nof these meetings, other sectors need to be
\nactivated, and health advocates should
\nfocus on the supporting elements that link
\ninternational declarations to funding
\ndecisions and the implementation of
\npolicies and programmes that make a
\ndifference to people and families around
\nthe world\u201d [19].
\nIn summary,the High-Level Meeting
\non PPR in 2024 did not contribute to
\na world better prepared to respond
\nto pandemic threats. It failed due to
\nan unfavourable political backdrop;
\na preference by negotiators and the
\nWHO for pandemic discussions
\nto remain primarily on the domain
\nof Geneva and a visible absence of
\npolitical leadership and attention. In
\n2024, the Antimicrobial Resistance
\nHigh-Level Meeting and the UN
\nSummit for the Future provide
\ninteresting opportunities to galvanise
\npolicy commitments on key health
\nissues, if the lessons of this High-
\nLevel Meeting are heeded.
\nReferences
\n1.\t United Nations. Adopting
\nlandmark declaration, General
\nAssembly calls for strengthening
\nhigh-level international
\ncoordinationtoimprovepandemic
\nprevention, preparedness,
\nresponse [Internet]. 2023 [cited
\n2024 Aug 15]. Available from:
\nhttps:\/\/press.un.org\/en\/2023\/
\nga12533.doc.htm
\n2.\t The Independent Panel for
\nPandemic Preparedness and
\nResponse. COVID-19: make
\nit the last pandemic [Internet].
\n2021 [cited 2024 Aug 15].
\nAvailable from: https:\/\/
\ntheindependent panel.org\/
\nwp-content\/uploads\/2021\/05\/
\nCOVID-19-Make-it-the-Last-
\nPandemic_final.pdf
\n3.\t Pandemic Action Network.
\nPandemic Action Network
\nstatement on the UN high-
\nlevel meeting on pandemic
\nprevention, preparedness, and
\nresponse political declaration
\n[Internet]. 2023 [cited 2024 Aug
\n15].Available from: https:\/\/www.
\npandemicactionnetwork.org\/
\nnews\/pandemic-action-network-
\nstatement-on-the-un-high-
\nlevel-meeting-on-pandemic-
\nprevention-preparedness-and-
\nresponse-political-declaration\/
\n4.\t United Nations. Political
\ndeclaration of the United
\nNations General Assembly
\nhigh-level meeting on pandemic
\nprevention, preparedness and
\nresponse [Internet]. 2023 [cited
\n2024 Mar 10]. Available from:
\nhttps:\/\/digitallibrary.un.org\/
\nrecord\/4022577?v=pdf
\n5.\t United Nations. UN high-
\nlevel meeting on pandemic
\npreparedness and response (20
\nSeptember 2023): espeaker list
\nReflections on the Value of the UN High-Level Meeting on Pandemic,
\nPrevention, Preparedness, and Response One Year Later
\n17
\nBACK TO CONTENTS
\n[Internet]. 2023 [cited 2024
\nAug 15]. Available from: https:\/\/
\nespeakers.unmeetings.org\/64c91
\n3355249900f9c253c9801082023
\n6.\t Fillion S. UN General Assembly:
\nsnubs and fragmentation
\n[Internet]. The Lowy Institute.
\n2023 [cited 2024 Aug 15].
\nAvailable from: https:\/\/
\nwww.lowyinstitute.org\/the-
\ninterpreter\/un-general-assembly-
\nsnubs-fragmentation
\n7.\t van Daalen KR, Chowdhury M,
\nDada S, Khorsand P, El-Gamal
\nS, Kaidarova G, et al. Does
\nglobal health governance walk
\nthe talk? Gender representation
\nin World Health Assemblies,
\n1948\u20132021. BMJ Glob Health.
\n2022;7(8):e009312.
\n8.\t United Nations. Official
\nmeetings: Wednesday, 20
\nSeptember 2023 [Internet].
\n2023 [cited 2024 Aug 15].
\nAvailable from: https:\/\/journal.
\nun.org\/en\/new-york\/meeting\/
\nofficials\/82737462-22ca-4a7c-
\n719f-08db91d09951\/2023-09-20
\n9.\t Anderson S. No pandemic accord
\nwithout intellectual property
\nprotection, says German Health
\nMinister [Internet]. Health
\nPolicy Watch. 2023 [cited 2024
\nAug 15]. Available from: https:\/\/
\nhealthpolicy-watch.news\/no-
\npandemic-accord-without-
\nintellectual-property-protection-
\nsays-german-health-minister
\n10.\tUnited Nations. General
\nAssembly pledges improved
\nresponse to global health
\nchallenges, adopting declarations
\non pandemic prevention,
\nuniversal coverage, fighting
\ntuberculosis [Internet]. 2023
\n[cited 2024 Aug 15]. Available
\nfrom: https:\/\/press.un.org\/
\nen\/2023\/ga12542.doc.htm
\n11.\t Baczynska G, Pamuk H. Notable
\nremarks on Ukraine at UN
\nSecurity Council [Internet].
\nReuters. 2023 [cited 2024 Aug
\n15]. Available from: https:\/\/
\nwww.reuters.com\/world\/notable-
\nremarks-ukraine-un-security-
\ncouncil-2023-09-20\/
\n12.\tWorld Health Organization.
\nWorld Health Assembly
\nagreement reached on wide-
\nranging, decisive package of
\namendments to improve the
\nInternational Health Regulations
\n[Internet]. 2024 [cited 2024
\nAug 15]. Available from:
\nhttps:\/\/w w w.who.int\/news\/
\nitem\/01-06-2024-world-health-
\nassembly-agreement-reached-on-
\nwide-ranging–decisive-package-
\nof-amendments-to-improve-the-
\ninternational-health-regulations-
\n-and-sets-date-for-finalizing-
\nnegotiations-on-a-proposed-
\npandemic-agreement
\n13.\tRodi P, Obermeyer W, Pablos-
\nMendez A, Gori A, Raviglione
\nMC. Political rationale, aims,
\nand outcomes of health-related
\nhigh-level meetings and special
\nsessions at the UN General
\nAssembly: a policy research
\nobservational study. PLoS Med.
\n2022;19(1):e1003873.
\n14.\tPatrick S, Klein E. United
\nNations, divided [Internet].
\nCarnegie Endowment for
\nInternational Peace. 2023 [cited
\n2024 Aug 15]. Available from:
\nhttps:\/\/carnegieendowment.
\norg\/2023\/09\/28\/united-nations-
\ndivided-world-pub-90659
\n15.\tTareen A. The UN and the
\nG20: efficiency vs. legitimacy?
\n[Internet]. Centre for
\nInternational Governance
\nInnovation. 2023 [cited 2024
\nAug 15]. Available from: https:\/\/
\nwww.cigionline.org\/articles\/un-
\nand-g20-efficiency-vs-legitimacy
\n16.\tUnited Nations. Convention
\non the elimination of all forms
\nof discrimination against
\nwomen [Internet]. 1979 [cited
\n2024 Aug 15]. Available from:
\nhttps:\/\/digitallibrary.un.org\/
\nrecord\/10649?v=pdf
\n17.\t United Nations International
\nChildren’s Emergency Fund.
\nConvention on the rights of
\nthe child [Internet]. 1989
\n[cited 2024 Aug 15]. Available
\nfrom: https:\/\/www.unicef.org\/
\nchild-rights-convention
\n18.\tUnited Nations. Beyond borders:
\nwhynew’highseas’treatyiscritical
\nfor the world [Internet]. 2023
\n[cited 2024 Aug 15]. Available
\nfrom: https:\/\/news.un.org\/en\/
\nstory\/2023\/06\/1137857
\n19.\t Akselrod S, Collins TE, Berlina
\nD, Collins A, Allen LN. The
\nimpact of UN high-level
\nmeetings on non-communicable
\ndisease funding and policy
\nimplementation. BMJ Glob
\nHealth. 2023;8(10):e012186.
\nReflections on the Value of the UN High-Level Meeting on Pandemic,
\nPrevention, Preparedness, and Response One Year Later
\n18
\nReflections on the Value of the UN High-Level Meeting on Pandemic,
\nPrevention, Preparedness, and Response One Year Later
\nBACK TO CONTENTS
\nAuthors
\nMike Kalmus Eliasz, MBBS,
\nMSc, MRCPCH, DTM&H
\nHonorary Clinical Fellow
\nThe Pandemic Institute,
\nUniversity of Liverpool
\nLiverpool, United Kingdom
\nmkeliasz@liverpool.ac.uk
\nYassen Tcholakov, MD, MScPH, MIH
\nAssistant Professor, Department
\nof Global and Public Health,
\nMcGill University
\nMontreal, Canada
\nyassen.tcholakov@mcgill.ca
\nMaria In\u00eas Francisco Viva, MD
\nNOVA Medical School
\nLisbon, Portugal
\ninem.viva@gmail.com
\nMarie-Claire Wangari, MBChB
\nGraduate student in Global Health,
\nLiverpool School of Tropical Medicine,
\nLiverpool, United Kingdom
\nIndependent Global Health Consultant
\nWMA-JDN Chair (2023\/2024)
\nNairobi, Kenya
\nmcwangari.wm@gmail.com
\nWenzhen (Jen) Zuo,
\nMD, CCFP, MPH
\nResident, Public Health and
\nPreventive Medicine,
\nUniversity of British Columbia
\nBritish Columbia, Canada
\nwenzhen.zuo@gmail.com
\n19
\nBACK TO CONTENTS
\nJunior Doctors Network\u2019s Leadership at the World Health Summit 2023
\nThe World Health Summit (WHS)
\n2023, held from October 15-17,
\n2023, in Berlin, Germany (https:\/\/
\nwww.worldhealthsummit.org\/),
\nstands as one of the most significant
\nconferences dedicated to global
\nhealth. This prestigious event gathers
\na diverse array of stakeholders,
\nincluding representatives from the
\nscientific, political, private, and
\npublic sectors, to address pressing
\nglobal health challenges. Unlike the
\nWorld Health Assembly (WHA)
\nand the World Health Organization
\n(WHO) meetings, which have more
\nrigid formats, the WHS offers a
\nunique program structure. It features
\nparallel sessions that not only
\nencourage in-depth scientific
\ndiscourse, but also provide
\nample networking opportunities
\nand foster collaboration across
\ndifferent sectors and
\ndisciplines. This distinctive format
\nallows participants to engage with
\na broader spectrum of ideas and
\ninitiatives, making the WHS a crucial
\nplatform for shaping the future of
\nglobal health.
\nUnder the theme, \u201cA Defining Year
\nfor Global Health Action,\u201d the
\nWHS 2023 program delved into
\neight critical topics that align closely
\nwith the mandates and priorities
\nof the World Medical Association
\n(WMA) and the Junior Doctors\u2019
\nNetwork (JDN). These agenda
\ntopics included: 1) learning lessons
\nfrom the coronavirus disease 2019
\n(COVID-19) pandemic for future
\nprevention efforts; 2) preparedness
\nand response to address global crises;
\n3) emphasis on universal health
\ncoverage (UHC); 4) sustainable
\nhealth for people and the planet; 5)
\nG7\/G20 measures to strengthen
\nglobal health equity and security; 6)
\ndigital technologies for global health;
\n7) WHO\u2019s 75th anniversary; and
\n8) innovations to combat tuberculosis
\n[1]. Attendees were able to reflect on
\nthe WHO\u2019s achievements over the
\npast 75 years, while they recognised
\nthat universal health coverage serves
\nas the cornerstone to global health
\nequity and novel technology can help
\nexpand access to care and ultimately
\nimprove health outcomes. Notably,
\nthe launch of the global financing
\nfacility pledging event was a crucial
\nmoment for securing financial
\ncommitments to support global
\nhealth initiatives.
\nThe WHS 2023 YouTube channel
\n( ht t p s: \/\/ w w w.y o ut u b e . c o m \/
\nWorldHealthSummit) captured key
\ndiscussions during the conference
\nsessions, offering further insight
\ninto the decisions that will shape
\nthe global health landscape in the
\ncoming years. The JDN delegation
\ngained insight on these pressing
\nhealth topics and contributed to the
\ndialogue, particularly in areas where
\njunior doctors can lead and drive
\nlocal and global change. Their active
\nparticipation highlighted the crucial
\nrole young professionals play in
\nJunior Doctors Network\u2019s Leadership
\nat the World Health Summit 2023
\nJeazul Ponce Hern\u00e1ndez
\nMarie-Claire Wangari
\nFrancisco Franco P\u00eago
\nBalkiss Abdelmoula
\nFlora Wendel
\n20
\nBACK TO CONTENTS
\ndeveloping innovative solutions for
\nthe future of healthcare. By learning
\nupdates on scientific and policy
\ninitiatives to address the current
\nchallenges in global health topics,
\njunior doctors can identify ongoing
\nprojects, align their professional
\ninterests, and join leadership
\nteams across their countries. This
\nengagement can empower them to
\nmake meaningful contributions to
\nthe evolving landscape of global
\nhealth, ensuring that their voices are
\nintegral to shaping the future.
\nJDN Participation
\nDuring the WHA in May 2023, the
\nWHS organisers contacted the JDN
\nleadership, as they had proposed an
\nagenda that would highlight youth
\nengagement at the WHS in October
\n2023. The WMA Secretariat agreed
\nwith these plans, and the JDN
\nsecured five placements to attend the
\nWHS for the first time. Although it
\nwas challenging to attend the WHS
\nimmediately following the JDN
\nManagement Team term transition,
\nan open call among the JDN
\nManagement Team and Working
\nGroups Chairs resulted in a prompt
\nassembly of three participants \u2013
\nDr. Francisco Franco P\u00eago (Portugal),
\nDr. Jeazul Ponce Hern\u00e1ndez (Spain),
\nand Dr. Flora Wendel (Germany).
\nAt the event, the JDN delegation
\nnetworked with several health
\norganisations to identify synergies
\nand foster connections for future
\ncollaborations. They attended various
\nscientific sessions on WMA primary
\ntopics and prioritised sessions that
\nexplored strategies for increasing the
\ncapacity of healthcare professionals
\nglobally, addressing workforce
\nshortages, and ensuring that junior
\ndoctors are actively involved in
\npolicy-making and leadership roles.
\nHighlights on Health Workforce
\nand Youth Engagement
\nThis article will describe high-level
\nhighlights on four WHS sessions,
\nincluding early career engagement,
\nfuture of global health, global health
\nresearch and policy, and UHC. It
\nwill also underscore the critical role
\nof youth leadership and engagement
\nin shaping the future of global
\nhealth. These sessions provided a
\nplatform for the JDN delegation to
\nactively contribute to discussions that
\nwere directly aligned with the JDN
\nmission, where they could advocate
\nfor and empower early-career
\nphysicians on the global stage.
\nYouth Side Program: Hosted by
\nthe German Medical Students\u2019
\nOrganization, the Youth Side
\nProgram is quickly becoming a
\ncentral platform for empowering
\nearly-career professionals through
\ntargeted capacity-building, advocacy
\ntraining, and representation. During
\nthe WHS, the program featured
\nan intensive two-day capacity-
\nbuilding session complemented
\nby two networking events. These
\nactivities provided essential updates
\non expanding youth engagement in
\nboth clinical and public health sectors
\nas well as equipping participants with
\nthe skills and connections needed
\nto drive meaningful change in
\ntheir respective fields. Additionally,
\ndelegates emphasised the importance
\nof professional networking
\nand fostered meaningful youth
\nparticipation within the WHS and
\nthe wider global health community.
\nPost the High-Level Meetings: Youth\u2019s
\nVision for the Future of Global Health:
\nOrganised by the International
\nFederation of Medical Students\u2019
\nAssociations (IFMSA) and the
\nInternational Pharmaceutical
\nStudents\u2019 Federation (IPSF), this
\nsession was a cornerstone of the main
\nprogram, dedicated to amplifying
\nyouth voices and ensuring their active
\ninvolvement in shaping global health
\npolicies (https:\/\/www.youtube.com\/
\nwatch?v=EopfaijotXs). The session
\nspecifically focused on sharing critical
\nperspectives and the vision of youth
\nJunior Doctors Network\u2019s Leadership at the World Health Summit 2023
\nPhoto 1. Dr. Jeazul Ponce Hern\u00e1ndez, Dr. Francisco Franco P\u00eago, and Dr. Flora Wendel (left to right) as the JDN delegation at the
\nWorld Health Summit in May 2023. Credit: JDN
\n21
\nBACK TO CONTENTS
\nin accelerating progress towards
\nUHC and applying innovative
\ntechnologies for global health
\nsecurity, which are central topics
\ntoward achieving health equity.
\nJunior doctors and stakeholders met
\nto brainstorm on timely solutions
\nrelated to UHC and global health
\nsecurity as well as identify crucial
\naction points following the High-
\nLevel Meetings during the United
\nNations General Assembly. The
\nsession offered an opportunity for
\ndelegates to reflect on the growing
\nrecognition within the WHS
\ncommunity that youth engagement
\nis essential for building sustainable
\nhealth solutions.
\nResearch and Policy in Global Health
\n(GLOHRA):The GLOHRA alliance,
\norganised by the German Alliance for
\nGlobal Health Research, is funded
\nby the German Federal Ministries
\nfor Education, Research, and
\nEconomic Cooperation, dedicated to
\nstrengthening global health research
\nin Germany. The session centred
\non tackling the complex challenges
\nand opportunities in global health
\nresearch and policy, with a strong
\nemphasis on fostering South-South
\ncollaborations among academics,
\npolicymakers, and communities.
\nIt convened a diverse range of
\nperspectives from researchers, public
\nhealth institutes, and policymakers,
\naddressing issues spanning from
\ninfectious diseases to health systems
\nand implementation research. One
\nkey focus was on the importance
\nof policy training for early career
\nprofessionals and the pivotal
\nrole of national public health
\ninstitutions in turning research
\ninto actionable policies. Delegates
\nemphasised successful country-
\nspecific approaches and the
\nnecessity of critical enablers such as
\ninfrastructure and networks. They
\nalso highlighted steps on how
\ngovernment institutions can integrate
\nlessons learned from previous
\nprograms as well as provide financial
\nsupport for research opportunities.
\nA Promise Forgotten? Putting Universal
\nBack into Health Coverage: The
\npolitical will to promote UHC
\nwas widely debated, building
\nupon the conference discussions
\non UHC-related topics and the
\nPolitical Declaration adopted
\nat the United Nations General
\nAssembly in September 2023.
\nDelegates made a call to join
\nJunior Doctors Network\u2019s Leadership at the World Health Summit 2023
\nPhoto 2. Group photo of the youth attendees at the World Health Summit in May 2023. Credit: World Health Summit
\n22
\nBACK TO CONTENTS
\ninternational efforts that promote
\nprimary health system development,
\nhighlighting the importance of
\nhealth professionals working directly
\nwith affected populations and
\nunderstanding community needs.
\nTo further emphasise the urgency
\nof strengthening health systems
\nglobally, delegates also stressed the
\ncritical role of fostering community
\ntrust and ensuring equitable access to
\ncare, recognising that UHC cannot
\nbe truly achieved without addressing
\nthe unique challenges of vulnerable
\npopulations. Additionally, there
\nwas a strong appeal for sustained
\nglobal solidarity and cooperation
\nto guarantee that international
\ncommitments translate into tangible
\nimprovements in health outcomes for
\nall.
\nConclusion
\nAs emerging leaders in global
\nhealth, JDN members have a unique
\nopportunity to collaborate and
\nengage actively in future WHS
\nevents, thereby amplifying the voice
\nof junior doctors on the global stage.
\nBy developing a strategic advocacy
\nplan aligned with JDN priorities
\nand the WMA\u2019s policy papers and
\nposition statements, JDN members
\ncan effectively articulate physicians\u2019
\nperspectives and secure prominent
\nrolesasspeakersortrainersinscientific
\nforums. Additionally, identifying
\nand securing funding opportunities
\nis crucial to ensure the sustainable
\nparticipation of JDN members in
\nupcoming WHS events, which is
\nessential for advancing the agenda
\nof meaningful youth involvement in
\nglobal health. These efforts will not
\nonly strengthen JDN\u2019s presence at
\nthese global health meetings, but will
\nalso lay the groundwork for impactful
\nparticipation in WHS 2024.
\nReference
\n1.\t World Health Summit. World
\nHealth Summit 2023: \u201ca defining
\nyear for global health action\u201d
\n[Internet]. 2023 [cited 2024 Aug
\n10].Available from: https:\/\/www.
\nworldhealthsummit.org\/about\/
\nhistory\/2023.html
\nAuthors
\nJeazul Ponce Hern\u00e1ndez,
\nMD, MPH, MSc
\nWMA\/JDN Publications
\nDirector (2023\/2024)
\nPhD student in Public Health,
\nUniversity Complutense of Madrid
\nMadrid, Spain
\njeazulponce@gmail.com
\nFrancisco Franco P\u00eago, MD
\nWMA-JDN Socio-Medical
\nAffairs Officer (2023\/2024)
\nGeneral Training Resident, Central
\nLisbon University Hospital Center
\nLisboa, Portugal
\nffpego@gmail.com
\nFlora Wendel, MD
\nWMA-JDN Working Group Chair on
\nPrimary Health Care (2022\/2023)
\nResident, General Practice
\nand Family Medicine
\nResearch Assistant, Chair of
\nPublic Health and Health Services
\nResearch, LMU Munich
\nMunich, Germany
\nflorakuehne@gmail.com
\nMarie-Claire Wangari, MBChB
\nGraduate student in Global Health,
\nLiverpool School of Tropical Medicine,
\nLiverpool, United Kingdom
\nIndependent Global Health Consultant
\nWMA-JDN Chair (2023\/2024)
\nNairobi, Kenya
\nmcwangari.wm@gmail.com
\nBalkiss Abdelmoula, MD, MPH
\nWMA-JDN Deputy
\nChair (2023\/2024)
\nFamily Medicine Specialist and
\nGlobal Health Consultant
\nSfax, Tunisia
\nabdelmoula.balkiss@gmail.com
\nJunior Doctors Network\u2019s Leadership at the World Health Summit 2023
\n23
\nBACK TO CONTENTS
\nGlobal health conferences and
\nmeetings are crucial for knowledge
\nexchange and professional growth,
\nbut recent reports suggest that
\nthere is an underrepresentation of
\nstakeholders from low- and middle-
\nincome countries (LMICs) due
\nto neo-colonial patterns in global
\nhealth [1]. Decolonizing global
\nhealth, a concept that has recently
\ngained traction, aims to remove all
\nforms of supremacy within global
\nhealth practice and create a future
\nwith no more pervasive remnants
\nof colonisation [2,3]. In addition,
\nwith more than half of the world’s
\npopulation being under 30 years of
\nage, increased youth representation
\nat global health conferences is
\nessential for the meaningful
\nengagement of young people to
\naccelerate progress toward the
\nSustainable Development Goals as
\nwell as contribute to timely policy
\nand health decision-making [4].
\nThe following article explores junior
\ndoctors\u2019 perspectives on barriers and
\nsolutions related to the equitable
\naccess to global health opportunities.
\nExisting Barriers
\nAs junior doctors seek additional
\nlearning experiences at conferences,
\nin order to complement their medical
\ntraining, they can experience diverse
\nchallenges before, during, and after
\nthe conference. First, young people
\nare often unaware of engagement
\nopportunities with key stakeholders,
\nhave inadequate support and
\nguidance from mentors and
\nsenior staff, and observe limited
\ntransparency and reporting from
\ninternational organisations [5]. In
\nfact, junior doctors may lack
\ncontinuous mentorship when they
\nfirst start on their global health
\njourney. Second, understanding the
\npathways for attending meetings,
\nincluding navigating the registration
\nprocess, can be laborious due to
\nbureaucratic and non-transparent
\nprocedures. Third, strict conference
\nagendas may hinder speaking
\nopportunities for young participants,
\nwho are often assigned an observer
\nstatus and are limited to verbally
\nsharing their perspectives. Fourth,
\nmost United Nations (UN)
\nmember states and World Medical
\nAssociation (WMA) country
\ndelegations do not include or invite
\nyoung people to form part of the
\nmeeting delegations [6]. Finally,
\njunior doctors, who represent
\ndifferent languages and cultures,
\nare constantly challenged when
\nengaging with stakeholders,
\nespecially due to language and
\nstructural barriers [7].
\nFurthermore, financial and
\nadministrative barriers remain a
\nsignificant hurdle for junior doctors
\nto travel and contribute to global
\nhealth meetings. Indeed, junior
\ndoctors\u2019 access to global health
\nopportunities, including attending
\nthe World Health Assembly (WHA)
\nsessions, is considerably impacted
\nby logistical complexities, namely
\nthose associated with cross-border
\nand international travel. This is
\nespecially relevant since many High-
\nLevel Meetings take place in New
\nYork City or Geneva, for which an
\nentry visa is needed for participants
\nfrom LMICs [8]. Visa procurement
\ncan be a costly and time-consuming
\nendeavour, with no guarantee that
\ncomplete documentation will be
\navailable in time for scheduled travel.
\n[9,10].
\nApplying a gender representation
\nlens, cultural, social, and institutional
\nvariables may also influence the
\nunequal participation of male and
\nfemale delegates at WHA sessions
\n[11]. Between the 74-year span
\nfrom 1948 to 2021, although more
\nfemale delegates have attended
\nWHA sessions, more males (83%)
\nthan females (30% at its peak
\nin 2017-2018) have represented
\nthese delegations [11]. As women
\nrepresent more than 70% of the
\nMarie-Claire Wangari
\nJunior Doctors\u2019 Perspectives on Barriers and Solutions
\nto Equitable Access to Global Health Opportunities
\nDeena Mariyam Lekha Rathod
\nJunior Doctors\u2019 Perspectives on Barriers and Solutions to Equitable Access to Global Health Opportunities
\n24
\nBACK TO CONTENTS
\nhealth workforce, working across
\nclinical and community settings, their
\ncollective leadership role in global
\nhealth governance continues to be
\nsignificantly overlooked.
\nRecommendations
\nJunior doctors have faced financial
\nchallenges, administrative
\ncomplexities such as visa procedures,
\ndifficulties in taking time off
\nfrom clinical responsibilities, and
\nknowledge and language barrier gaps;
\nnevertheless, these lived experiences
\nhave helped shape their commitment
\nto continuous learning and
\nprofessional development.The WMA
\nJunior Doctors Network (JDN)
\nWorking Group on World Health
\nOrganization (WHO) Activities
\nconducted an internal evaluation of
\nJDN members\u2019 perspectives to better
\nunderstand the specific challenges
\nrelated to junior doctors\u2019 attendance
\nat global health meetings. Between
\nSeptember 2022 and February
\n2023, Working Group members
\ndeveloped and shared a preliminary
\nquestionnaire with JDN and WMA
\nmembers, reviewed the submitted
\nresponses, and developed a consensus
\non three potential recommendations
\nto address existing challenges.
\nRecommendation 1: Incorporating
\nand empowering youth representatives
\nin conference delegations and offering
\nfinancial and administrative support.
\nTo increase youth representation
\nin global health conferences, global
\nhealth and youth organisations
\nshould offer junior doctors partial or
\ncomplete funding to cover visa and
\ntravel costs, especially for participants
\nliving in LMICs or geographically
\ndistant from the meeting location
\n[12]. WMA members can advocate
\nfor the establishment of a fundraising
\nsub-committee to work with national
\nmember associations and disseminate
\ntimely funding opportunities, with
\npriority given to candidates from
\nLMICs. Also, the WHO and the
\nWMA may be able to offer fast-
\ntrack support for visa processing,
\nincluding providing visa letters
\nthat confirm the selection of youth
\nrepresentatives and the key role that
\nyouth representatives play in ensuring
\nmeaningful conference engagement.
\nOrganising committees of scientific
\nconferences, together with global
\norganisations (including national
\nmedical associations), should provide
\nample time for attendees to navigate
\nthe visa application process.
\nWMA and JDN leaders can promote
\nan open dialogue to better understand
\nexplicit barriers that hinder junior
\ndoctors\u2019 participation in global
\nscientific events and subsequently
\ndevelop novel approaches to empower
\ntheir future contributions. For
\nexample, essential networking
\nand professional development
\nopportunities can help guide junior
\ndoctors in their training, including
\nestablishing a mentorship or buddy
\nsystem that can match experienced
\ndoctors with junior doctors. Also,
\nthe promotion of equitable gender
\nrepresentation should remain on
\nthe forefront of global dialogue
\nand conference proceedings toward
\nensuring equal participation in
\nplenary and scientific sessions,
\ninteractive workshops, and other
\nnetworking opportunities.
\nRecommendation 2: Supporting
\nhybrid platforms and digitalisation of
\nconference materials
\nWith technological advancements,
\nlessons learned during the coronavirus
\ndisease 2019 (COVID-19) pandemic,
\nand the push for environmental
\nsustainability,the world has embraced
\nthe digitalisation of conference
\nmaterials, hybrid conferences, and
\nlive streaming. These adaptations
\nhave helped committees of scientific
\nconferences use digitisation
\ntechnology (e.g. mobile applications,
\ninteractive web applications) to
\nfacilitate the engagement of global
\naudiences in major conferences.
\nSince these applications have
\nprovided a platform to organise
\nconference agendas (instead
\nof printed booklets), hybridise
\nconference sessions, and network
\nwith colleagues, junior doctors can
\neffectively plan their conference
\nagenda and travel logistics. As junior
\ndoctors attend these hybrid meetings
\nand conferences, albeit lack of in-
\nperson engagement and networking
\nopportunities, they can expand their
\ninternational networks without the
\nlogistical conundrums of complicated
\ntravel processes including visa
\nacquisition [9,10].
\nMobile or web applications can
\nsupport the session hybridisation,
\noffering a space for junior doctors
\nto contribute online and in-person,
\nand hence increasing engagement
\nin sessions by asking questions and
\nsharing lived experiences. Taking
\ninto consideration the benefits of
\ndigital technologies, committees of
\nscientific conferences should ensure
\nthat hybrid conferences are engaging
\nfor all attendees. Furthermore,
\njunior doctors who represent their
\nnational medical associations or other
\norganisations (like the WMA) can
\nrequest guidance from authorities on
\nspecific expectations and deliverables,
\nas a result of their participation in
\nthese external meetings.
\nRecommendation 3: Improving
\ncommunication and dissemination
\nof opportunities to junior doctors to
\nrepresent their lived experiences at
\nrelevant conferences.
\nCommunication efforts towards
\npotential conference attendees,
\nincluding junior doctors, should
\nbe diverse and incorporate various
\nchannels (e.g. emails, newsletters,
\nsocial media, website updates). Since
\nJunior Doctors\u2019 Perspectives on Barriers and Solutions to Equitable Access to Global Health Opportunities
\n25
\nBACK TO CONTENTS
\nofficial communications and activities
\nare conducted in diverse languages,
\njunior doctors can help promote
\ninclusivity and cultural exchange
\nand even pursue language training
\nas part of their continuing education
\n[13,14]. As junior doctors may
\nchoose to participate in international
\nevents, like the WHO Simulation
\nor pre-WHA workshops, they can
\nalso register for keynote lectures,
\nroundtable discussions, skills-
\nbased courses, communication and
\ndiplomacy activities, and simulation
\nexercises.
\nConclusion
\nJuniordoctorscalluponlocal,regional,
\nand global health organisations to
\ndevelop strategies that enhance their
\naccess to global health opportunities
\nintegral to their professional growth.
\nThe current barriers, such as financial
\nconstraints, extensive administrative
\nprocedures, and lack of departmental
\napproval, hinder their participation
\nin international conferences, adding
\nto the anxiety and strain experienced
\nby these health professionals. As
\nobserved at previous WMA and
\nWHA meetings and findings from
\nthe JDN internal evaluation, JDN
\nmembers embody a strong desire
\nto contribute to solutions that
\npromote their inclusion in global
\nhealth meetings. To address these
\nchallenges, it is essential to initiate
\nan open dialogue within
\norganisations (like WHO and
\nWMA) that focuses on providing
\nfinancial and administrative
\nsupport, digitising conference
\nregistration processes, and enhancing
\ncommunication about available
\nglobal health opportunities. By
\nimplementing these strategies, we
\ncan move towards decolonizing
\nglobal health and ensure equitable
\nparticipation, thereby amplifying
\nthe voices of junior doctors from all
\nbackgrounds and fostering a more
\ninclusive global health community.
\nReferences
\n1.\t Vervoort D, Ma X, Bookholane
\nH, Nguyen TC. Conference
\ncancelled: the equitable flip side
\nof the academic surgery coin. Am
\nJ Surg. 2020;220(6):1539-40.
\n2.\t Hommes F, Monz\u00f3 HB, Ferrand
\nRA, Harris M, Hirsch LA,
\nBesson EK, et al. The words
\nwe choose matter: recognising
\nthe importance of language in
\ndecolonisingglobalhealth.Lancet
\nGlob Health. 2021;9(7):e897-8.
\n3.\t Abimbola S, Pai M. Will global
\nhealth survive its decolonisation?
\nLancet.2020;396(10263):1627-8.
\n4.\t World Health Organization.
\nEngaging young people for health
\nand sustainable development:
\nstrategic opportunities for the
\nWorld Health Organization and
\npartners. Geneva: WHO; 2018.
\nAvailable from: https:\/\/iris.who.
\nint\/handle\/10665\/274368
\n5.\t Rhee DS,Heckman JE,Chae SR,
\nLoh LC. Comparative analysis:
\npotential barriers to career
\nparticipation by North American
\nphysicians in global health. Int J
\nFamily Med. 2014;2014:728163.
\n6.\t Khorsand P, Chowdhury M,
\nWyns A, Velin L, Wangari MC,
\nCipriano G, et al. Envisioning
\nsustainable and equitable World
\nHealth Assemblies. BMJ Glob
\nHealth. 2022;7(5):e009231.
\n7.\t Binagwaho A,Allotey P,Sangano
\nE, Ekstr\u00f6m AM, Martin K. A
\ncall to action to reform academic
\nglobal health partnerships. BMJ.
\n2021;375:n2658.
\n8.\t Vervoort D. Dominique
\nVervoort: the visa conundrum
\nin global health [Internet]. BMJ
\nOpinion. 2019 [cited 2024 Aug
\n15]. Available from: https:\/\/
\nblogs.bmj.com\/bmj\/2019\/06\/21\/
\ndominique-vervoort-the-visa-
\nconundrum-in-global-health\/
\n9.\t Smeeth L, Kyobutungi C.
\nReclaiming global health. Lancet.
\n2023;401(10377):625-7.
\n10.\tVelin L, Lartigue JW, Johnson
\nSA, Zorigtbaatar A, Kanmounye
\nUS, Truche P, et al. Conference
\nequity in global health: a
\nsystematic review of factors
\nimpacting LMIC representation
\nat global health conferences.BMJ
\nGlob Health. 2021;6(1):e003455.
\n11.\t Van Daalen KR, Chowdhury M,
\nDada S, Khorsand P, El-Gamal
\nS, Kaidarova G, et al. Does
\nglobal health governance walk
\nthe talk? Gender representation
\nin World Health Assemblies,
\n1948-2021. BMJ Glob Health.
\n2022;7(8):e009312.
\n12.\tBasileFW,PetrusJ,GatesC,Perry
\nSH, Benjamin J, McKenzie K, et
\nal. Increasing access to a global
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\nresearch capacity: using an
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\ncommunity of practice. J Glob
\nHealth. 2022;12:03038.
\n13.\tSvadzian A, Vasquez NA,
\nAbimbola S,Pai M.Global health
\ndegrees: at what cost? BMJ Glob
\nHealth. 2020;5(8):e003310.
\n14.\tAdams LV, Wagner CM, Nutt
\nCT, Binagwaho A. The future of
\nglobal health education: training
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\nMed Educ. 2016;16(1):296.
\nJunior Doctors\u2019 Perspectives on Barriers and Solutions to Equitable Access to Global Health Opportunities
\n26
\nBACK TO CONTENTS
\nAcknowledgements:
\nThe JDN-WMA Working Group
\non WHO Activities (now retired)
\ncollectively prepared this article as
\none final project, with the guidance
\nof the Working Group Chair from
\n2021-2022. The Working Group
\nmembers include: Jamie Colloty,
\nLaura Jung, Laura Charlotte
\nKalkman, Deena Mariyam, Caitlin
\nPley, Pablo Daniel Estrella Porter,
\nLekha Rathod, Mehr Muhammad
\nAdeel Riaz, Yassen Tcholakov,
\nWunna Tun, Marie-Claire Wangari,
\nand Mercy Wanjala.
\nAuthors
\nMarie-Claire Wangari, MBChB
\nGraduate student in Global Health,
\nLiverpool School of Tropical Medicine,
\nLiverpool, United Kingdom
\nIndependent Global Health Consultant
\nWMA-JDN Chair (2023\/2024)
\nNairobi, Kenya
\nmcwangari.wm@gmail.com
\nDeena Mariyam, MBBS,
\nMSc Public Health
\nGeneral Practitioner & WMA-
\nJDN Secretary (2023\/2024)
\nBangalore, India & Dubai,
\nUnited Arab Emirates
\ndeenamariyam4@gmail.com
\nLekha Rathod, MBBS, MIH
\nWMA-JDN Planetary Health Working
\nGroup Co-Chair (2022\/2024)
\nlrathod95@gmail.com
\nJunior Doctors\u2019 Perspectives on Barriers and Solutions to Equitable Access to Global Health Opportunities
\n27
\nAfter 40 years of war and political
\nunrest, the Afghan people are
\nsuffering from incalculably adverse
\nmedical complications that are
\nworsened by extreme weather
\nevents (like drought), impacts of
\nconflict (resulting in internally
\ndisplaced populations), and attacks
\non healthcare facilities (increasing
\ntrauma cases). The country\u2019s low life
\nexpectancy of 63 years, coupled with
\nthe high annual infant mortality rate
\nof 58 deaths per 1,000 live births,
\nare clear indications of severe public
\nhealth issues and a lack of adherence
\nto medical regulations [1,2].To make
\nmatters worse, citizens must contend
\nwith a healthcare system that lacks
\ntreatment options and funding,
\nincluding limited assistance from
\ninternational health organisations.
\nAlthough it is recognised that
\npatients\u2019 medical concerns can
\nbe promptly addressed through
\nevidence-based medical practices
\nfor diagnosis, treatment, and
\nprevention, there is limited universal
\nadherence to the healthcare system\u2019s
\nregulations in Afghanistan\u2019s health
\nfacilities. Healthcare professionals
\nin Afghanistan have highlighted
\nthat weak governance, lack of supply
\nchain management, and corruption
\nare giving rise to a thriving trade in
\naltered medications coming from
\nneighbouring countries and placing
\nmillions of people at risk [3]. As
\na result of this weak governance
\nand corruption, illegal activities
\nfrequently occur in Afghanistan,
\nincluding smuggling, importation,
\nand alteration of medications
\nfor communicable and non-
\ncommunicable diseases.
\nAfghanistan\u2019s National Health
\nPolicy 2015-2020 was adopted
\nin 2015, highlighting five policy
\nareas: governance, institutional
\ndevelopment, public health, health
\nservices, and human resources [4].
\nAccording to this policy, the National
\nMedicines and Health Regulatory
\nAuthority was strengthened and
\nupdated to help mitigate nationwide
\npublic health risks [5]. With the
\ngovernmental transition in 2021, this
\nnational policy has not been updated
\nto reflect pressing health issues.
\nThe lack of evidence-based
\nregulations existed even before the
\nmost recent government came to
\npower; however, the isolation of
\nthe new government makes any
\nexternal involvement impossible.
\nPoor regulatory oversight has enabled
\nillegal imports, impacting the
\nquality of medication in
\nAfghanistan. In a global self-
\nbenchmarking assessment, which
\nwas established to rate national
\nhealthcare systems on a scale of 1
\n(lowest) to 5 (highest), the World
\nHealth Organization (WHO)
\nconcluded that Afghanistan scored
\n2 for pharmacovigilance and 1 in
\nquality control, inspection, and
\nclinical trials in 2017 [5]. The scores
\nfrom the benchmarking assessment
\nare still extremely low running the
\nnational healthcare system.
\nIn addition to poor regulatory
\nauthority, Afghanistan\u2019s Anti-
\nCorruption Monitoring and
\nEvaluation Committee noted that
\nthe trade in illegal imports
\nthrives because of corruption,
\nborder issues, quality assessments,
\nand poor governance [3]. The
\ncommittee found that at least
\nhalf of the country\u2019s pharmaceutical
\nimport market comprises illegally
\nimported products. Although this
\nillicit importation and smuggling
\ncould be reduced if rules and
\nregulations were followed, the
\nfinancial incentives have led to
\nincreased production, importation,
\nand distribution of low-quality
\npharmaceuticals throughout the
\ncountry. With an estimated 450
\nforeign pharmaceutical suppliers,
\nof which 250-300 suppliers are
\nin Pakistan, medications that are
\nprohibited from being sold in
\nPakistan are frequently shipped to
\nAfghanistan [3]. Prescription drugs
\n(e.g. benzodiazepines, opioids)
\nand heroin were the most reported
\ndrug types used among the Afghan
\npopulation [6]. Although the
\nhealthcare system is unprepared
\nto address drug dependence and
\naddiction, developing solutions to
\nmanage altered medications and
\nsubstance use will help reduce public
\naccessibility.
\nAs high-quality, safe, and effective
\nmedications are a pillar of the
\nhealthcare system, compromised
\nmedications can lead to a major
\ncollapse of its infrastructure. It can be
\nchallenging, however, to distinguish
\nbetween legitimate and fraudulent
\npharmaceuticals, especially since
\nlabels and directions may not be in
\nDari (official language of
\nAfghanistan). In addition,
\nincompliance to regulations and
\nguidelines can further complicate
\nthe scenario and lead to major public
\nhealth adversities. This dilemma
\nTabasom Fayaz
\nPharmaceutical Policy in Afghanistan
\nPharmaceutical Policy in Afghanistan
\nBACK TO CONTENTS
\n28
\ncalls upon physicians and leading
\nhealth organisations worldwide to
\nhelp create a system that connects
\nhealthcare professionals to patients
\nto ensure that correct medications
\nare prescribed. Additional pressure
\non Afghan health leaders can help
\nprioritise the purchase of medications
\nimported from countries in the
\nEastern Mediterranean and
\nEuropean regions, which can
\nreduce illegal importations. Robust
\nefforts to strengthen the healthcare
\nsystems of low-income countries
\n(like Afghanistan) can lead to the
\nprioritisation and adherence to
\nevidence-based clinical practices and
\nregulations, and most importantly,
\nimprove patient health outcomes.
\nReferences
\n1.\t World Bank. Country:
\nAfghanistan [Internet]. 2024
\n[cited 2024 Aug 15]. Available
\nfrom:https:\/\/data.worldbank.org\/
\ncountry\/afghanistan
\n2.\t United Nations International
\nChildren\u2019s Emergency Fund.
\nCountry profile: Afghanistan
\n[Internet]. 2024 [cited 2024 Aug
\n15]. Available from: https:\/\/data.
\nunicef.org\/country\/afg\/
\n3.\t Independent Joint Anti-
\nCorruption Monitoring and
\nEvaluation Committee. VCA
\nreport on pharmaceuticals
\nimportation process [Internet].
\n2014 [cited 2024 Aug 16].
\nAvailable from: https:\/\/www.baag.
\norg.uk\/sites\/default\/files\/resources\/
\nattachments\/2014 _11_19_
\nPharmaceutical_VCAENGLISH.
\npdf
\n4.\t World Health Organization.
\nAfghanistan national health
\npolicy, 2015-2020 [Internet].
\n2015 [cited 2024 Aug 27].
\nAvailable from: https:\/\/extranet.
\nwho.int\/countryplanningcycles\/
\nplanning-cycle-files\/afgha\u00adnistan-
\nnational-health-poli\u00adcy-2015-2020
\n5.\t World Health Organization.
\nWHO Afghanistan country
\noffice 2019 [Internet]. 2018
\n[cited 2024 Aug 16]. Available
\nfrom: https:\/\/www.emro.who.
\nint\/images\/stories\/afghanistan\/
\nwho_at_a_glance_2019_feb.pdf
\n6.\t Hall WD, Degenhardt L.
\nAfghanistan has a sizeable
\nproblem with opioid use. Lancet.
\n2014;2(1):e577-8.
\nTabasom Fayaz, BSc, MSc
\nNortheastern University
\nBoston, Massachusetts, United States
\nfayaz.t@northeastern.edu
\nBACK TO CONTENTS
\n29
\nThe Coalition of African National
\nMember Association (CANMA)
\ncame into inception in 2018, with
\nthe sole vision of uniting African
\nNational Member Associations
\n(NMAs) to have one common
\nvoice in the advocacy and policy
\narena. Currently, the coalition is
\ncomposed of 20 member countries
\nincluding Kenya (interim chair),
\nCote d\u2019Ivoire, Democratic Republic
\nof Congo, Ethiopia, Gambia,
\nGhana, Lesotho, Malawi, Mali,
\nMozambique, Namibia, Nigeria,
\nRwanda, Senegal, Somalia, South
\nAfrica, Tanzania, Uganda, Zambia,
\nand Zimbabwe.
\nThe Landscape of Health
\nLeadership in Africa
\nCurrently, the main issue plaguing
\nAfrican NMAs is the rise of
\nphysician migration out of the
\ncontinent. From Nigeria\u2019s mass
\nmigration of citizens including health
\npersonnel termed \u201cJapa\u201d to Kenya\u2019s
\nbilateral health professional exchange
\nwith Cuba and the United Kingdom,
\nmany nations have their physician-
\npatient ratios plummeting due to
\nvolatile working conditions in their
\ncountries [1-3]. Physician migration
\nin Africa is largely driven by the
\npursuit of better working conditions,
\nhigher salaries, and advanced training
\nopportunities abroad, which are often
\nlimited in their home countries.
\nAdditionally, political instability,
\ninadequate healthcare infrastructure,
\nand limited career advancement
\nprospects further contribute to
\nthis exodus (\u201cbrain drain\u201d), which
\nexacerbates healthcare challenges in
\nalready resource-strapped regions.
\nDespite the high number of emigrant
\nphysicians from the continent,
\nefforts have been made to train more
\nphysicians in the continent\u2019s medical
\nschools. In East Africa, universities
\nhave allowed cross-border training
\nof undergraduate health professional
\nstudents in Burundi, Ethiopia,
\nRwanda, Somalia, South Sudan,
\nTanzania, and Uganda [4]. Although
\nthis initiative is a start, more adaptive
\nleadership and governance systems
\nnationally and regionally are needed
\nto bridge the low physician-patient
\nratio in the Africa region.
\nThe Physician\u2019s Journey to
\nLeadership
\nTraditional medical students take an
\naverage of six years of undergraduate
\ntraining, where the first two years
\nfocus on pre-clinical sciences (e.g.
\nhuman anatomy, medical physiology,
\nbiochemistry), followed by four
\nyears of clinical training in various
\nclinical departments. After these six
\nyears of medical school, graduates
\nproceed to complete a one- to two-
\nyear licensing internship year, as
\nrequired by their country\u2019s Ministry
\nof Health. After the internship is
\ncompleted, physicians can practice
\nas General Practitioners or proceed
\nto a post-graduate specialisation that
\nlasts between one to seven years,
\ndepending on the specialty
\nrequirements and modality of training
\n[5]. In Kenya, medical students
\nundergo six years of undergraduate
\ntraining, followed by a mandatory
\none-year licensing internship under
\nthe Ministry of Health, and then they
\neither select to pursue general practice
\nor postgraduate training [6,7].
\nAfrican physicians often seek
\nvaluable professional development
\nand networking opportunities for
\nknowledge exchange on best practices
\nin health systems strengthening.
\nSpecifically, they have the
\nopportunity to join and contribute
\nas associate members to the various
\norganisations, such as the CANMA
\nat the regional level, Commonwealth
\nMedical Association (CMA) at
\nthe sub-regional level, and World
\nMedical Association (WMA) at the
\nglobal level. Despite opportunities
\nto join regional and global medical
\nassociations, few African physicians
\nhave held senior leadership positions
\nin these organisations since their
\ninception. Reflecting upon the
\nhistorical timeline, the WMA and
\nthe Junior Doctors Network (JDN)
\nhave had less than 10 African
\nphysicians serve in senior WMA
\nor JDN management leadership
\npositions since 1947 and 2010,
\nrespectively. Given the rise in
\nphysician numbers from the African
\ncontinent, specialist associations
\nshould provide more sensitisation
\non the importance of regional
\nrepresentation in global health
\nleadership.
\nFuture Directions in African Health
\nLeadership
\nLooking to the future, empowering
\nthe next generation of African
\nhealthcare leaders is essential to
\naddress the continent\u2019s unique
\nchallenges. By fostering innovative
\napproaches and inclusive leadership,
\nAfrican health systems can be
\nstrengthened to improve access
\nMarie-Claire Wangari
\nAfrican Health Leadership: A Physician\u2019s Perspective
\nAfrican Health Leadership: A Physician\u2019s Perspective
\nBACK TO CONTENTS
\n30
\nand equity. As the global landscape
\nevolves, African leaders can drive
\nsustainable health solutions that meet
\nthe needs of their communities. The
\nAfrican region, given the potential
\nfor cross-cultural collaborations
\nthrough various health associations
\nand coalitions, has a bright future of
\nproducing future global health leaders
\nthrough two specific actions.
\nIdentifying emerging trends and
\npromoting cross-border collaborations:
\nThe African continent serves as
\nthe cradle of primary healthcare,
\nand with the rise of telemedicine,
\nthe region has a chance to pave the
\nwave to new frontiers of medicine in
\nimplementation science and primary
\nhealthcare services. In conjunction
\nwith the national Ministries of
\nHealth\u2019s efforts, this is further
\namplified by the efforts of regional
\nhealth bodies, such as the Africa
\nCentre for Diseases and Control
\n(Africa CDC)\u2019s New Public Health
\nOrder for Africa and the World
\nHealth Organization Regional
\nOffice for Africa (WHO AFRO)\u2019s
\nmultisectoral strategy to promote
\nhealth and well-being [8,9]. These
\npositive strides can help propel efforts
\nto expedite the attainment of universal
\nhealth coverage for African nations.
\nFurthermore, by addressing complex
\nnational and regional challenges,
\nAfrican countries are pursuing
\nstronger regional integration to reap
\nthe benefits of larger markets [10].
\nThrough collaborative efforts, leaders
\ncan tackle issues such as infectious
\ndisease outbreaks, inadequate
\nhealthcare infrastructure, and health
\ndisparities more effectively and
\nefficiently.
\nSupporting key mentorship opportunities
\nfor professional development: Direct
\nmentorship and coaching in the
\nhealth professions are pivotal
\ntowards supporting education
\nand training and strengthening
\nhealthcare systems [11]. Mentoring
\nspecifically involves the informal
\nconveyance of knowledge, social
\ncapital, and support, that recipients
\nperceive to be pertinent to their work,
\ncareer, and personal or professional
\ndevelopment. During their formative
\nacademic training, health professional
\nstudents can benefit from mentorship
\nprograms, which provide guidance,
\ncareer development, and emotional
\nsupport. Notably, it can ensure that
\nnew professionals are well-prepared
\nto meet the complex challenges of
\nmodern healthcare systems. Despite
\nthese observed benefits of mentorship
\nprograms, however, many institutions
\nin Sub-Saharan Africa have not fully
\nembraced the inclusion into their
\nprograms [12]. By fostering a culture
\nof mentorship, experienced leaders
\ncan share their knowledge,
\nexperiences, and insights across
\ngenerations, which helps build a
\nresilient and capable future workforce.
\nConclusion
\nThe article underscores that
\nadaptive leadership, cross-border
\ncollaborations,and robust mentorship
\nprograms, can effectively address
\nchallenges and foster the next
\ngeneration of healthcare leaders.
\nConcerted efforts are needed to
\nincrease African representation in
\nglobal health leadership and harness
\ninnovative approaches that can
\nstrengthen health systems across the
\ncontinent. By bridging generational
\ngaps and promoting knowledge
\ntransfer, mentorship programs
\ncan support a resilient healthcare
\nworkforce that can drive sustainable
\nimprovements in global health
\nsystems. Moreover, promoting cross-
\nborder collaborations is essential to
\nleverage expertise to improve the
\nquality of healthcare at the national
\nand regional level. Now is the time
\nfor African healthcare leaders to
\nunite, collaborate, and mentor,
\nensuring a brighter future for health
\nto over 1.5 billion persons living on
\nthe continent.
\nReferences
\n1.\t Okunade SK, Awosusi OE. The
\nJapa syndrome and the migration
\nof Nigerians to the United King-
\ndom: an empirical analysis. Com-
\nparative Migration Studies.
\n2023;11(27).
\n2.\t Nyambura MW. Kenya ends
\ndoctors-swap deal with Cuba
\n[Internet]. 2023 [cited 2024 Jul
\n6]. Available from: https:\/\/na-
\ntion.africa\/kenya\/news\/kenya-
\nends-doctors-swap-deal-with-
\ncuba–4398520
\n3.\t Ministry of Labour and Social
\nProtection, Government of
\nKenya. Speech during the
\nfirst joint meeting between all
\nagencies involved in the
\nimplementation of the Bilateral
\nAgreement between Kenya
\nand the United Kingdom for
\ncollaboration on health care
\nworkforce [Internet]. 2021
\n[cited 2024 Jul 6]. Available
\nfrom: https:\/\/www.labour.go.ke\/
\nsites\/default\/files\/2022-10\/CS-
\nSpeech-during-first-joint-meet-
\ning-on-UK-BLA-18th-au-
\ngust-2021.pdf
\n4.\t Nyaga B.EAC nationals qualified
\nto work as doctors in Kenya
\n[Internet]. KBC TV. 2017
\n[cited 2024 Jul 6] Availa-
\nble from: https:\/\/kbctv.co.ke\/
\nblog\/2017\/03\/19\/eac-national-
\ndoctors-qualified-to-work-in-
\nkenya
\n5.\t Odongo CO, Talbert-Slagle K.
\nTraining the next generation
\nof Africa\u2019s doctors: why medi-
\ncal schools should embrace the
\nteam-based learning pedagogy.
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\nAfrican Health Leadership: A Physician\u2019s Perspective
\n31
\nBMC Med Educ. 2019;19:403.
\n6.\t Kenya Medical Practitioners
\nand Dentists Council. Bachelor
\nof Medicine and Bachelor of
\nSurgery core curriculum
\n[Internet]. n.d. [cited 2024 Sep
\n1] Available from: https:\/\/kmp-
\ndc.go.ke\/resources\/mbchb.pdf
\n7.\t Kenya Medical Practitioners
\nand Dentists Council. National
\nguidelines for internship training
\nof medical and dental officer in-
\nterns [Internet]. 2019 [cited
\n2024 Sep 1] Available from:
\nhttps:\/\/kmpdc.go.ke\/resourc-
\nes\/NATIONAL%20GUIDE-
\nLINES%20FOR%20INTERN-
\nSHIP%20TRAINING%20
\nO F % 2 0 M E D I C A L % 2 0
\nAND%20DENTAL%20OF-
\nFICER%20INTERNS.pdf
\n8.\t Africa Centres for Diseases and
\nControl and Prevention. Call
\nto action: Africa\u2019s New Pub-
\nlic Health Order [Internet].
\n2022 [cited 2024 Jul 31]
\nAvailable from: https:\/\/af-
\nricacdc.org\/wp-content\/up-
\nloads\/2022\/09\/Call-to-Action-
\nNPHO-Final-CTA-20-Sep-
\nEdited.pdf
\n9.\t World Health Organization
\nRegional Committee for Africa.
\nRegional multisectoral strategy to
\npromote health and well-being,
\n2023\u20132030 in the WHO African
\nRegion: report of the Secretariat
\n[Internet]. 2023 [cited 2024 Aug
\n14]. Available from: https:\/\/iris.
\nwho.int\/handle\/10665\/372393
\n10.\t World Bank.Regional integration
\nremoves barriers to development
\nin Africa [Internet]. 2023 [cited
\n2024 Aug 18]. Available from:
\nhttps:\/\/www.worldbank.org\/
\nen\/results\/2023\/12\/08\/region-
\nal-integration-removes-barri-
\ners-to-development-in-africa
\n11.\t Manzi A, Hirschhorn LR,
\nSherr K, Chirwa C, Baynes C,
\nAwoonor-Williams JK, et al.
\nMentorship and coaching to
\nsupport strengthening health-
\ncare systems: lessons learned
\nacross the five Population Health
\nImplementation and Train-
\ning partnership projects in sub-
\nSaharan Africa. BMC Health
\nServ Res. 2017;17(Suppl 3):831.
\n12.\t Tamale E, Atuhairwe I,
\nSsemwogerere A. Muhimbura B,
\nAtimango L, Malinga PD, et
\nal. Knowledge, attitudes, and
\npractices of health professions
\nstudents on mentorship: a
\ncross-sectional study at a sub-
\nSaharan African medical school.
\nDiscov Educ. 2023;3:27.
\nMarie-Claire Wangari, MBChB
\nGraduate student in Global Health,
\nLiverpool School of Tropical Medicine,
\nLiverpool, United Kingdom
\nIndependent Global Health Consultant
\nWMA-JDN Chair (2023\/2024)
\nNairobi, Kenya
\nmcwangari.wm@gmail.com
\nBACK TO CONTENTS
\nAfrican Health Leadership: A Physician\u2019s Perspective
\n32
\nBACK TO CONTENTS
\nDr. Simon Kigondu, Dr. John Baptist
\nNkuranga, Dr. Mvuyisi Mzukwa, and
\nDr. Herbert Luswata, the Presidents
\nof the national medical associations
\n(NMAs) of Kenya, Rwanda, South
\nAfrica, and Uganda, respectively,
\njoin the interview with Dr. Helena
\nChapman, the WMJ Editor in Chief.
\nThey share their perspectives on
\ntheir leadership experiences, ongoing
\nNMA activities, strengths and
\nexisting challenges in medical
\neducation, and how the World
\nMedical Association (WMA) can
\nsupport NMA initiatives in the
\nAfrican region.
\nAs you reflect upon your journey
\nas NMA president, please describe
\none memorable experience, one
\nchallenge and how you resolved
\nthe challenge, and one hope for the
\nfuture of medicine.
\nKenya: The Kenya Medical
\nAssociation (KMA) had the privilege
\nand honour to host the World
\nMedical Association (WMA)\u2019s
\n223rd
\nCouncil Session, which
\nwas held from 20-23 April 2023.
\nFollowing many months of planning
\nand preparation, the KMA welcomed
\nguests from all over the world to
\nthe Ole Sereni Hotel, a scenic hotel
\noverlooking the Nairobi National
\nPark. WMA meetings were
\nsuccessfully conducted, and WMA
\nmembers participated in the opening
\ndinner at the Kenyatta International
\nConference Centre, one of Nairobi\u2019s
\niconic venues.They also had a fruitful
\ntour to the Nairobi National Park
\nthat culminated in a dinner within
\nthe park at the club house.
\nAt the same time, the KMA has
\nexperienceddiversechallengesoverthe
\npast few years, including widespread
\ninflation,lawsuits related to large loan
\nrepayments, and financial challenges
\ndirectly connected to reduction of
\npharma industry support. However,
\nthere is hope for a good future of
\nmedicine in Kenya. The number of
\nmedical schools has grown from two
\nin 2000 to 13 in 2024, which has led
\nto an increase in the numbers of
\ntrained doctors, specialists, and
\nsubspecialists and hence improve
\nquality healthcare. One of the most
\nimportant pillars of a healthcare
\nsystem is adequate doctor-patient
\nratios.
\nRwanda: One memorable experience
\nwas when the Rwanda Medical
\nAssociation (RMA) hosted the
\nsuccessful 74th WMA General
\nAssembly, which brought together
\nleading medical professionals from
\naround the world and fostered
\ncollaboration and knowledge
\nexchange among more than 50
\nnational medical associations. It was
\nrewarding to showcase Rwanda’s
\ndevelopment and recovery progress
\n30 years after the genocide against
\nthe Tutsi as well as RMA\u2019s continued
\ncontributions to the global medical
\ncommunity. The experience left a
\nlasting impression on organisers,
\nand coupled with positive feedback
\nfrom participants, RMA members
\ngained confidence and built trust with
\nthe Ministry of Health and other
\nparticipating government agencies.
\nWhen coronavirus disease 2019
\n(COVID-19) cases surged in Rwanda
\nin early 2022, RMA members aimed
\nto support the government response
\nInterview with National Medical Associations\u2019
\nLeaders of the African Region
\nInterview with National Medical Associations\u2019 Leaders of the African Region
\nSimon Kigondu Herbert Luswata Mvuyisi Mzukwa
\nJohn Baptist Nkuranga
\n33
\nBACK TO CONTENTS
\nmeasures through the \u201cOperation
\nSave the Neighbour\u201d initiative.
\nThey integrated doctors into home-
\nbased care teams, incorporated
\ndata with patients’ and doctors’
\ngeolocations, and aligned this
\ninformation with community health
\nprofessionals who could visit, assess,
\nand treat COVID-19 cases in their
\nneighbourhood. Within two weeks,
\nhome-based visits had increased from
\n30% to 92%, with 82% of patients
\nhaving regular oxygen monitoring
\nfrom home, contributing to decreased
\nmortality rates. This approach
\nstrengthened support and rapport
\namong doctors, community health
\nprofessionals, and patients, which
\nhas increased overall confidence in
\ntelemedicine consultations.
\nOne significant challenge in Rwanda
\nis the retention of doctors within
\nthe health workforce, primarily due
\nto poor remuneration, incentives,
\nand sometimes poor working
\nenvironments. As this \u201cbrain drain\u201d
\nhas increased demand for medical
\nprofessionals in the country, the
\nRMA is focusing on advocating for
\nbetter compensation and working
\nconditions for doctors, in efforts to
\npromote the retention of a sustainable
\nhealth workforce. RMA members
\nactively engage policymakers,
\ncontribute to research initiatives that
\nexamine the driving factors of health
\nworkforce retention, and strengthen
\nRMA membership services including
\nestablishing a career guidance
\nprogram and fostering a supportive
\nmembership network.
\nSouth Africa: One recent memorable
\nexperience that highlighted the
\nSouth African Medical Association
\n(SAMA)\u2019s influence occurred during
\nthe COVID-19 pandemic, namely
\nthe rollout of the vaccination
\nprogramme. As the pandemic swept
\nacross South Africa, the SAMA
\nplayed a crucial role in shaping the
\nnational response, demonstrating its
\nleadership and advocacy capabilities
\nin a time of crisis. The SAMA\u2019s
\ncommitment to improving access to
\nlife-saving medications showcased
\nits dedication to public health and
\nsolidified its role as a key player in
\nSouth African healthcare.
\nOne significant challenge, however,
\nwas the health workforce shortage
\nthat was exacerbated by the
\nemigration of medical professionals
\nseeking employment and academic
\nopportunities abroad. This \u201cbrain
\ndrain\u201d left the public health sector
\nunderstaffed and overburdened,
\naffecting the quality of care provided
\nto patients. Using a multi-faceted
\napproach, the SAMA called upon
\nthe government, advocating for better
\nworking conditions, competitive
\nsalaries for healthcare professionals,
\nand policies that would encourage
\ncurrent students to pursue the
\nmedical profession. Additionally,
\nthe SAMA launched initiatives
\nto support and retain medical
\nprofessionals within the country,
\nincluding continuous professional
\ndevelopment programmes and
\npartnerships with international
\nmedical associations to foster
\nexchange programmes that allowed
\nfor professional growth without
\npermanent relocation. Through these
\nefforts, the SAMA managed to stem
\nthe tide of emigration and helped to
\nrebuild a robust health workforce.
\nLooking to the future, the SAMA
\nhopes for a more equitable healthcare
\nsystem where all South Africans have
\naccess to high-quality medical care,
\nregardless of their socioeconomic
\nstatus. This vision includes the
\nintegration of advanced medical
\ntechnologies and innovations that
\ncan improve patient outcomes and
\nstreamline healthcare delivery. The
\nSAMA envisions a future where
\npreventative care is prioritised,
\nreducing the burden of chronic
\ndiseases and ensuring that the
\nhealthcare system is sustainable.
\nMoreover, the SAMA aspires to see
\na stronger emphasis on mental health
\nservices, recognising the critical role
\nthat mental well-being plays in overall
\nhealth. By fostering a collaborative
\nenvironment among healthcare
\nprofessionals, policymakers, and
\ncommunities, the SAMA aims to
\nbuild a resilient healthcare system
\nthat can adapt to future challenges
\nand continue to improve the health
\nand well-being of all South Africans.
\nUganda: As President of the Uganda
\nMedical Association (UMA), I am
\nhonoured to have led our dedicated
\nand resilient team through successful
\nadvocacy efforts to improve the
\nwelfare of health professionals in
\nUganda.Asaresultofnegotiationsand
\nindustrial action during December
\n2021, Ugandan health professionals
\nachieved a salary increment of over
\n100%,and they are still advocating for
\nadjustments concerning specialists\u2019
\nsalaries. Collective advocacy has
\nalso led to policy developments that
\nhave resulted in new public service
\nstructures in the health sector, and
\nthe creation of doctor positions at
\nthe parish level (e.g. Health Center
\n111 in May 2024). These national
\nachievements will help to address
\nunemployment among junior
\ndoctors and improve access to quality
\nhealth care services for the observed
\npopulation growth of 24.2 million in
\n2000 to 47.25 million in 2014.
\nThe UMA is leading efforts to explore
\ntwo specific challenges for healthcare
\nprofessionals in Uganda. First, the
\nUMA\u2019s Human Resource survey
\nconducted in January 2024, which
\naimed to examine human resource
\ncoverage and gaps, highlighted the
\n21-62% (average of 42%) human
\nresource coverage and 58% human
\nresource gap in public health facilities
\nin Uganda. To address this gap,
\nthe Uganda government is been
\nactively involved in negotiations to
\nInterview with National Medical Associations\u2019 Leaders of the African Region
\n34
\nBACK TO CONTENTS
\nexpand recruitment of healthcare
\nprofessionals. In June 2024, the
\nUganda Ministry of Health indicated
\nthat they can only employ 38% of
\navailable healthcare professionals in
\nthe country, and that more strategies
\nshould be embraced to combat this
\nunemployment challenge such as
\nexporting health professional services
\nto other countries and supporting
\ntraining and recruitment for the
\nprivate health sector.
\nSecond, the Uganda government
\nadopted a proposal to stop paying
\nallowances to medical interns and
\nintroduce self-sponsored internships
\nin May 2023, which was prompted
\nby reduced external funding due to
\nthe controversial anti-homosexuality
\nbill. However, the UMA believed
\nthat alternative solutions existed,
\nsuch as increasing local funding
\nand prioritising wages for these
\nallowances, which consider the
\nvaluable contributions of medical
\ninterns to the health sector. UMA
\nmembers vigorously advocated for
\nthe prioritisation of these allowances,
\nand our efforts were met with
\ninitial resistance, leading to hospital
\ncrises based on delayed deployment
\nand a lack of medical interns. The
\nsituation escalated to the point
\nwhere Ugandan doctors considered
\nlaunching a nationwide industrial
\nstrike in 2023. However, through
\npersistent negotiations, the UMA
\nand the health system successfully
\nsecured the deployment of medical
\ninterns (doctors, nurses, pharmacists)
\nwith a negotiated pay. This
\noutcome demonstrates the UMA\u2019s
\ncommitment to fighting for the
\nrights and welfare of health
\nprofessionals, even in the face of
\nadversity.
\nThe future of medicine is promising
\nin Uganda, with robust relationships
\nbetween the government and
\nhealthcare professionals and good
\npolitical will towards the improved
\nwelfare of healthcare professionals.
\nThe Abuja Declaration, which
\nemphasises the need for 15%
\nallocation of the health budget to
\nthe health sector, represents the most
\nadvanced health policy (including
\nthe national health insurance
\nscheme) in the African region to
\ndate. Moving forward, the UMA
\nhopes to advocate for expanding the
\ncurrent 8.2% allocation of the health
\nbudget in Uganda, to align with the
\nrecommended 15% allocation, and
\nhence increase access of healthcare
\nservices to the public. Although an
\nalternative financing model for the
\nhealth sector was introduced to the
\nParliament of Uganda, the national
\nhealth insurance scheme legislation
\nwas formulated in 2023, but not yet
\napproved or adapted into the health
\nsector.
\nHow would you describe the current
\nopportunities for NMA members to
\nhelp influence health care policy-
\nmaking activities in your country?
\nKenya: First, the KMA has various
\nthematic committees that focus on
\ndifferent aspects of healthcare. The
\nthematic committees can develop
\npolicy position papers for the
\nAssociation that are submitted to
\nthe Ministry of Health and other
\nrelevant health authorities for review
\nand policy guidance. A case in
\npoint is the drafting of memoranda
\nto the Parliament and Senate of
\nKenya on pressing issues including
\nhuman resources for health and
\nhealthcare financing. Second, KMA
\nmembers are frequently requested
\nto serve as members of various
\nMinistry of Health task forces and
\nshare their professional opinions on
\nvarious thematic areas related to the
\ntaskforces. Third, since the KMA
\nhas representation in the Kenya
\nMedical Practitioners and Dentists
\nCouncil (KMPDC), members can
\nhelp improve medical training and
\nmedical practice by contributing to
\nthe Council\u2019s mandate of regulating
\nthe medicine and dental training,
\npractice, and licencing within
\nhealthcare institutions. Finally, the
\nKMA serves as a member of the
\nNational Health Insurance Fund
\n(NHIF) and proposed as a board
\nmember of the new Social Health
\nAuthority. The KMA\u2019s input is
\nuseful to help guide and oversee the
\nmanagement of healthcare financing
\nin Kenya.
\nRwanda: The opportunities for
\nadvancing healthcare are enormous,
\nparticularly in the context of ongoing
\nadvocacy efforts that influence key
\ndecision-making and policies. The
\nCOVID-19 pandemic has placed the
\nrole of healthcare professionals in the
\nspotlight, underscoring their critical
\ncontributions to the healthcare
\nsystem. In response to pressing
\nsociety needs, Rwanda has initiated
\nthe 4×4 strategy, as a comprehensive
\nplan designed to quadruple the
\nnumber of healthcare professionals
\nover the next four years and engage
\nthe health workforce to address
\nunmet healthcare needs for citizens.
\nThe threat of the health workforce
\nloss (due to physician migration) has
\nprompted a renewed commitment
\nto consider the welfare of healthcare
\nprofessionals, including concerted
\neffort to enhance monetary incentives
\nand improve working conditions.
\nTo address this challenge, the
\nRwanda Ministry of Health is taking
\nsignificant strides towards building
\na resilient healthcare system that
\nmeets the needs of its population.
\nLeaders have established policies and
\nguidelines that foster collaborations
\nwith RMA members, to ensure that
\nthe voices of healthcare professionals
\nare integrated into the development
\nof policies and decision-making
\nprocesses, which can foster a sense
\nof ownership and commitment
\namong the health workforce.
\nInterview with National Medical Associations\u2019 Leaders of the African Region
\n35
\nBACK TO CONTENTS
\nSouth Africa: The SAMA views
\nthe current landscape as ripe with
\nopportunities for its members
\nto play a crucial role in shaping
\nhealthcare policy in South Africa.
\nAs a respected body representing
\nmedical professionals, SAMA
\nmembers can advocate for meaningful
\nchange and engage in policymaking
\nthrough various channels, including
\nleveraging their clinical expertise
\nthrough active participation in
\ngovernmental advisory committees.
\nBy serving on these committees,
\nmembers contribute to the
\ndevelopment of health policies that
\nare both practical and informed by
\nreal-world challenges and solutions.
\nAdditionally, SAMA members
\ncan engage in public consultations
\nand forums organised by the
\ngovernment and other stakeholders.
\nThese platforms allow medical
\nprofessionals to voice their opinions,
\nprovide feedback on proposed
\npolicies, and suggest improvements.
\nThe Association regularly organises
\nengagements, workshops, seminars,
\nand conferences, where members can
\ndiscuss pressing healthcare issues and
\nformulate collective positions that the
\nSAMA can present to policymakers.
\nThis collaborative approach ensures
\nthat the insights and expertise of a
\nwide range of medical professionals
\nare considered in the policy-making
\nprocess. The SAMA also encourages
\nits members to engage directly and
\nbuild strong relationships with
\nlocal communities and civil society
\norganisations to better understand
\nthe health needs and concerns of the
\npopulation. Through this grassroots
\nengagement, SAMA members can
\nadvocate for inclusive and effective
\npolicies that address the specific
\nhealth challenges faced by different
\ncommunities.
\nUganda: Currently, the UMA has
\na significant opportunity to shape
\nthe country’s health policies. As a
\nkey stakeholder, UMA members
\nare regularly consulted by the
\ngovernment to formulate and review
\nhealth-related policies, as they are
\nwell-positioned with expertise and
\ntechnical knowledge to influence
\npolicy changes that benefit the health
\nsector and the Ugandan population.
\nThe Ugandan government values our
\ninputs and recognises the importance
\nof our contributions to national
\ndiscourse. I am truly humbled and
\nproud to lead the UMA, as an
\norganisation that plays a vital role in
\nshaping the future of healthcare in
\nUganda.
\nHow do perceive the physician-
\npatient relationship and rapport in
\nthe clinical setting in your country?
\nKenya: Kenya leaders have
\nrecognised that physician-patient
\nrelationships vary within the public
\nand private sectors. Public facilities
\nare characterised by high client flow,
\nhigh workload, and less than optimal
\nhuman resources for health capacity.
\nThe physician-patient relationship
\nand rapport tend to be short in
\norder to minimise patient queues.
\nManagement is less influenced by
\npatients, and treatment is often
\nconstrained by limited diagnostics
\nand resources. On the other hand,
\nprivate facilities are generally for-
\nprofit, and therefore physician-
\npatient interactions tend to last longer
\nwith greater rapport, and patients are
\ndirectly involved in diagnostics and
\nvarious treatment modalities.
\nRwanda: In Rwanda, the physician-
\npatient relationship is generally
\ncharacterised by high levels of trust
\nand mutual respect, which fosters a
\npositive rapport in clinical settings.
\nThis trust contributes to an overall
\nsense of safety and confidence in
\nthe medical care received, with
\npatients adhering to their physicians\u2019
\nrecommendations. To support the
\nrelationship between healthcare
\nprofessionals and patients, the
\nRwandan government created the
\nPatient Rights Charters, which serves
\nas a code of conduct with roles and
\nresponsibilities for both healthcare
\nprofessionals and patients. It aims to
\nensure that patient care is delivered
\nin a respectful and ethically sound
\nmanner, reinforcing the positive
\ndynamics necessary in the physician-
\npatient relationship.
\nIt is evident that the physician-
\npatient relationship is evolving
\ntowards a more collaborative and
\ncommunicative model. However,
\nsignificant imbalances remain,
\nprimarily due to patients’ lack of
\nawareness of their rights and available
\nprotections within the healthcare
\nsystem. Many patients may not
\nfeel empowered to ask questions
\nabout their medical conditions,
\noften relying on unreliable sources
\n(e.g. friends, family members,
\nsocial media), which can lead to
\nmisconceptions about medications
\nand treatment. Additionally, the
\npower dynamics in these relationships
\ncan hinder effective engagement, as
\nmany clinicians may feel that they
\nhave authority over patients\u2019 care. To
\nimprove this dynamic, it is crucial to
\neducate patients about their rights
\nand ensure that healthcare providers
\nare trained on patients right and
\neffective communication strategies,
\nwhich can ultimately foster a culture
\nof mutual understanding and respect
\nas well as improve patient satisfaction
\nand health outcomes.
\nSouth Africa: The physician-patient
\nrelationship and rapport in the clinical
\nsetting is fundamental to the delivery
\nof quality healthcare. The SAMA
\nrecognises that this relationship is
\nbuilt on trust, communication, and
\nmutual respect, which are essential
\nfor effective diagnosis, treatment, and
\npatient satisfaction. In South Africa,
\nwhere the healthcare landscape
\nis diverse and often strained by
\nInterview with National Medical Associations\u2019 Leaders of the African Region
\n36
\nBACK TO CONTENTS
\nresource limitations, maintaining a
\nstrong physician-patient rapport is
\ncrucial yet challenging. The SAMSA
\nacknowledges the pressures faced by
\nphysicians, including high patient
\nvolumes and administrative burdens,
\nwhich can strain these relationships.
\nHowever, the Association advocates
\nfor a patient-centred approach that
\nprioritises empathy, active listening,
\nand cultural competence. By
\npromoting continuous professional
\ndevelopment and ethical practices,
\nthe SAMA strives to enhance the
\nquality of interactions between
\nphysicians and patients, ensuring that
\nevery patient feels heard, respected,
\nand cared for by physicians. This
\ncommitment is seen as a cornerstone
\nfor improving health outcomes and
\nfostering a more humane and effective
\nhealthcare system in South Africa.
\nThe physician-patient relationship
\nis constantly evolving due to various
\nfactors, including technological
\nadvancements, increased access to
\nonline medical information, and the
\nintegration of artificial intelligence.
\nAs one notable example, the
\nHealth Professionals Council of
\nSouth Africa\u2019s swiftly responded to
\nthe pandemic by allowing virtual
\nconsulting, resulting in a shift that
\nfundamentally transformed the
\nphysician-patient relationship.
\nHence, it is essential to acknowledge
\nand adapt to these changes to ensure
\nthe relationship remains effective and
\npatient-centred.
\nUganda: The physician-patient
\nrelationship in Uganda is built on
\na strong foundation of efficient
\ncommunication, mutual respect,
\nconfidentiality, and empathy. Our
\nhealthcare professionals strive to
\nprovide excellent care, and the
\nmajority of patient interactions
\nare positive and respectful. When
\ninstances of inappropriate conduct
\nare observed, however, the UMA
\nEthics and Professionalism
\nCommittee and the Uganda Medical
\nand Dental Practitioners Council
\npromptly address the ethical and
\nprofessional standards by discussing
\nthe incident and agreeing upon
\nappropriate actions (including
\nsanctions). As President of the UMA,
\nI am committed to upholding the
\nhighest standards of medical practice
\nand ensuring that our patients receive
\nthe care that they deserve.
\nHow would you describe the
\nanticipated challenges in medical
\neducation over the next decade in
\nyour country?
\nKenya: The quality of medical
\neducation and training remains a
\nchallenge in Kenya. Medical schools
\nare domiciled in universities that do
\nnot have university hospitals. Medical
\nstudents and trainees complete their
\nclinical rotations in hospitals that are
\nnot administratively linked to the
\nuniversity. Over the past few years,
\nmany public universities dependent
\non the exchequer, have had funding
\nchallenges from government. In
\nefforts to increase their revenues,
\nthey have increased admissions of
\nmedical students to their programs
\neven beyond their quality capacity.
\nThe Commission of University
\nEducation (CUE), which oversees
\nuniversity education, adopted a law
\nthat made the input of the KMPDC
\nconcerning medical training not
\nmandatory. The KMA has observed
\nthat hospital programs have an
\nexcess number of medical students
\ncontrary to what the KMPDC
\nwould recommend as capacity for
\nquality training. The trainees thus
\ncomplete their clinical rotations with
\ninadequate patient contact time,
\ndecreasing the quality of education
\nand training. The KMA, through its
\nrepresentatives in the KMPDC and
\nin Parliament, continues to advocate
\nfor mandatory input of the KMPDC
\non medical training in the CUE Act.
\nRwanda: First, the RMA anticipates
\nsignificant gaps in knowledge
\nacquisition, as medical schools,
\nteaching hospitals, and research
\ncentres are not rapidly evolving to
\nmeet the current and future public
\nhealth challenges. With the rapidly
\nevolving technology, we foresee
\nshortages in incorporating essential
\ntraining resources, including
\nsimulation lab resources, robotic, and
\nother advanced training technologies,
\ninto medical education. Second,
\nthere is a growing concern about the
\nshortage of medical school faculty in
\nthe basic sciences, as these positions
\nare often less attractive for
\nprofessionals to pursue advanced
\nstudies and such teaching careers.
\nAs a result, this continued shortage
\nof qualified faculty could hinder
\nthe quality of medical education.
\nThird, many trained professionals
\nare migrating to middle- and high-
\nincome countries to seek improved
\nwork environment and incentives,
\nwhich could result in a depletion
\nof trained professionals within
\nthe country (\u201cbrain drain\u201d) and
\nfurther exacerbate the health system
\nchallenges.
\nSouth Africa: Over the next decade,
\nthe SAMA anticipates several
\nsignificant challenges in medical
\neducation, reflecting on broader
\nissues within the healthcare system
\nand the evolving landscape of
\nmedical practice. First, there is an
\nurgent need to address the growing
\ndemand for healthcare professionals
\namid an ongoing shortage of medical
\neducators and clinical training
\nfacilities. As the South African
\npopulation increases and the
\nburden of communicable and non-
\ncommunicable diseases continues to
\nrise, the strain on medical schools
\nand academic hospitals will likely
\nintensify. This shortage could hinder
\nthe ability to provide high-quality
\ntraining and practical experience,
\nwhich are crucial for preparing future
\nphysicians.
\nInterview with National Medical Associations\u2019 Leaders of the African Region
\n37
\nSecond, the integration of
\nadvanced technology and digital
\nhealth solutions into the medical
\ncurriculum will require additional
\ntraining for educators and students.
\nWhile technological advancements
\noffer significant potential to
\nenhance medical education
\nthrough simulation-based learning,
\ntelemedicine, and electronic health
\nrecords, ensuring that both educators
\nand students are proficient in these
\ntechnologies will require substantial
\ninvestment and adaptation. To
\nincorporate these tools effectively,
\nthe SAMA foresees the need for
\ncomprehensive training programmes
\nand updates to the curriculum,
\nensuring that graduates are well-
\nequipped to navigate a technologically
\nadvanced healthcare environment.
\nThird, the SAMA recognises the
\nnecessity of adapting medical
\neducation to the evolving healthcare
\nneeds of the South African
\npopulation, including a greater
\nemphasis on primary care,
\npreventative medicine, and chronic
\ndisease management. Medical
\neducation must therefore shift to
\nproduce physicians who are skilled
\nin acute care, managing long-term
\nhealth conditions, and promoting
\nhealth and wellness. This shift will
\nentail changes in the curriculum,
\nas well as increased opportunities
\nfor students to gain experience in
\ncommunity health settings.
\nAdditionally, efforts to increase
\ndiversity in the medical profession,
\nespecially from underrepresented
\nand disadvantaged backgrounds,
\nare essential to better reflect
\nthe population’s demographics
\nand effectively address health
\ndisparities. Some strategies may
\ninclude providing financial support,
\ndeveloping mentorship programmes,
\nand targeting recruitment efforts to
\nensure that the medical workforce
\nis diverse and inclusive. As medical
\npractice evolves, ethical and
\nprofessional dilemmas faced by
\nhealthcare professionals are expected
\nto become more prominent. If
\nmedical education places a stronger
\nemphasis on bioethics, professional
\nconduct, and legal aspects of medical
\npractice, students will be prepared
\nto navigate issues related to patient
\nautonomy, informed consent, and
\nethical use of emerging medical
\ntechnologies throughout their career
\npath.
\nFinally, the demanding nature
\nof medical education, coupled
\nwith the high levels of stress and
\nburnout experienced by healthcare
\nprofessionals, necessitates a proactive
\napproach to supporting medical
\nstudents\u2019 mental health and well-
\nbeing. Some strategies include
\nproviding access to counselling
\nservices, promoting a healthy
\nwork-life balance, and fostering a
\nsupportive and inclusive educational
\nenvironment.
\nUganda: The medical education
\nsystem in Uganda faces significant
\nchallenges, notably the inadequate
\nsupervisionofmedicalstudentsduring
\ngraduate training and post-graduate
\ninternships and residency. This is
\nlargely attributed to the unregulated
\nnumber of admissions to medical
\nschools, which can compromise the
\nquality of healthcare professionals in
\nthe future. As President of the UMA,
\nI am concerned about the potential
\nconsequences of this observed trend
\nand urge health leaders to address
\nthis issue promptly to ensure the
\nproduction of competent and skilled
\nhealthcare professionals to support
\nthe Ugandan health system. Over
\nthe past few years, the UMA has
\nbeen working collaboratively with the
\nUgandan government to develop an
\ninternship policy related to medical
\nresidents\u2019 training and secured
\nfinancial compensation and good
\nwelfare.
\nFrom the medical education
\nperspective, how has your NMA
\nresponded to the existing and
\nemerging health challenges within
\nyour country?
\nKenya: The KMA serves as a leading
\ninstitution in Africa, maintaining
\nrobust health professional training.
\nFirst, during the COVID-19
\npandemic, the KMA partnered with
\nthe Ministry of Health and other
\nleading health agencies to develop
\na curriculum for training the health
\nworkforce on infection prevention
\nand control. Second, as the CUE Act
\nclauserestrictstheconsiderationofthe
\nKMPDC\u2019s contributions to national
\ndiscourse, the KMA has continued to
\nadvocate for the KMPDC\u2019s valuable
\ninput on institutional requirements
\nrelated to medical education and
\ntraining programs.
\nRwanda: The RMA is actively
\nadvocating for increased incentives
\nfor medical doctors and improving
\nworking conditions of its members
\nand other healthcare professionals.
\nSince the beginning of this year, the
\nRMA initiated an ambitious career
\nguidance program to promote the
\ngood of the profession, inspire young
\nprofessionals and create a support
\nnetwork. It is also working on a
\ncapacity building initiative to raise
\nawareness on patient rights, medical
\nethics and ethical practices intended
\nto promote professionalism among all
\ncadres of medical doctors. The RMA
\nis also partnering with the Ministry
\nof Health on its ambitious 4X4
\nreform program to increase the
\nnumber of health workforce and
\nbridge the gap especially in rural areas
\nand primary healthcare settings.
\nSouth Africa: The SAMA has
\npushed for a medical education that
\nis comprehensive and reflective of
\nthe country\u2019s health landscape, as
\nit recognises the urgent need to
\naddress the high burden of both
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\nInterview with National Medical Associations\u2019 Leaders of the African Region
\n38
\ncommunicable (HIV\/AIDS,
\ntuberculosis, emerging zoonoses)
\nand non-communicable (diabetes,
\nhypertension,mentalhealthdisorders)
\ndiseases. By ensuring that medical
\nstudents receive extensive training
\nin these critical areas, the SAMA is
\nhelping to equip future healthcare
\nprofessionals with the knowledge and
\nskills needed to effectively manage
\nthese health challenges. To keep pace
\nwith the digital transformation of
\nhealthcare, the SAMA supports the
\nintegration of modern technologies
\ninto medical education, including the
\nadoption of simulation-based learning
\ntools, telemedicine training, and the
\nuse of electronic health records in the
\ncurriculum. Additionally, the SAMA
\nencourages practising physicians to
\npursue professional development
\nopportunities to keep them updated
\non emerging technologies and
\ninnovative practices.
\nThe SAMA places a strong
\nemphasis on research and evidence-
\nbased practice as a cornerstone of
\nmedical education. By encouraging
\nand supporting medical research
\ninitiatives,theSAMAaimstocultivate
\na culture of inquiry and continuous
\nlearning among medical students
\nand professionals. As research can
\nhelp generate local data and insights
\nthat are crucial for addressing South
\nAfrica\u2019s specific health challenges,
\nthe SAMA promotes the prompt
\ndissemination of research findings
\nthrough conferences, publications,
\nand collaborations with international
\nmedical communities. Hence, South
\nAfrican healthcare can benefit
\nfrom these global best practices
\nand innovations. Furthermore, the
\nSAMA has advocated for policies
\nand programmes that promote equity
\nand inclusion, such as providing
\nscholarships and financial support
\nto students from disadvantaged
\nbackgrounds, to increase diversity
\nwithin the medical profession. The
\nSAMA believes that a diverse health
\nworkforce is essential for delivering
\nculturally competent care and
\nreducing health disparities.
\nUganda: I am proud to highlight
\nthat our contributions and advocacy
\nefforts are aimed at maintaining
\nhigh-quality medical trainings in
\nUganda and producing competent
\nhealthcare professionals who can
\nprovide high-quality care to our
\ncitizens. The proposals include:
\n1) adding a standardised national
\ncurriculum for all medical schools;
\n2) implementing a national entry
\nexam and exit exam into medical
\nschools; and 3) requiring that
\nnational medical councils effectively
\nsupervise medical students during
\ntheir clinical training and post-
\ngraduate internships. Currently, the
\nUMA is actively advocating for the
\nfinalisation of the internship policies
\nand the development of postgraduate
\ntraining regulations.
\nFrom your perspective and
\nnational experiences, how has the
\nCOVID-19 pandemic affected
\nmedical education in your country?
\nKenya: During the COVID-19
\npandemic, most medical education
\nprograms were virtual, which
\nenabled faculty to continue teaching
\ntheir course and their training for
\nfaculty and students. This virtual
\nformat worked well for theoretical
\nsubjects, even noting increased class
\nattendance. Skills-based courses
\n(including physical examinations
\nwith patients) and other soft skills
\n(like building rapport with patients)
\nthat required physical contact,
\nhowever, were limited by their nature
\nof requiring physical contact, and
\nhence affected the quality of learning.
\nRwanda: Like other disciplines,
\nmedical education faced significant
\ndisruptions during the COVID-19
\npandemic in Rwanda, as institutions
\nwere closed and medical students
\nwere confined in their homes.
\nAlthough virtual learning platforms
\nwere used for alternative clinical
\ntraining approaches, medical
\nstudents\u2019 clerkships were disrupted
\ndue to restricted hospital access. The
\nemergence of telehealth education
\nplatforms provided an opportunity
\nto effectively adopt virtual education
\nplatforms, and to this date, a
\nsignificant number of training courses
\ncontinue to be delivered virtually.
\nAlthough the pandemic hindered
\ngrowth of the health workforce, it
\nspurred innovation with medical
\nstudents participating in COVID-19
\nresearch, adapting to new academic
\nlearning modalities (e.g. hybrid
\neducation models), gaining interest in
\ndigital health applications.
\nSouth Africa: The COVID-19
\npandemic significantly disrupted
\nmedical education in South Africa, as
\ntraditional in-person lectures, hands-
\non clinical training, and practical
\nassessments were abruptly halted due
\nto lockdown and social distancing
\nmeasures. It presented unprecedented
\nchallenges that forced educational
\ninstitutions to adapt swiftly, and
\nsimultaneously accelerated the
\nintegration of digital tools and
\ne-learning in medical education. To
\nenable continuity in education, the
\nSAMA supported the adoption of
\nvirtual classrooms, webinars, and
\nonline simulation tools to replace
\ntraditional teaching methods. As
\nnot all students had reliable internet
\naccess or suitable devices for online
\nlearning, recognised as the \u201cdigital
\ndivide\u201d, the SAMA advocated for
\nsolutions to these disparities, such as
\nproviding data subsidies and lending
\ntechnological devices to students in
\nneed.
\nOne of the most significant impacts
\nof the pandemic on medical
\neducation was the disruption of
\nclinical training. With hospitals
\noverwhelmed by COVID-19 cases
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\nInterview with National Medical Associations\u2019 Leaders of the African Region
\n39
\nand the high risk of infection, many
\nmedical students faced reduced access
\nto clinical rotations and hands-on
\npatient care experiences. The SAMA
\nrecognised the critical importance
\nof clinical training in developing
\ncompetent physicians and worked
\nwith healthcare institutions to
\ndevelop alternative training methods,
\nsuch as virtual clinical rounds,
\ntelemedicine consultations, and
\nsimulated patient interactions.
\nThe COVID-19 pandemic prompted
\na comprehensive evaluation of
\nmedical curricula and educational
\nmodels, to better prepare academic
\nprograms for such disruptions and
\nfuture doctors for public health
\ncrises. The SAMA advocated for the
\ninclusion of public health emergency
\npreparedness, epidemiology, and
\ninfectious disease management
\nin medical education, in order to
\nequip students with the knowledge
\nand skills necessary to respond
\neffectively to future pandemics or
\nhealth emergencies. The pandemic
\nalso underscored the importance
\nof research and collaboration in
\naddressing global health crises. The
\nSAMA supported efforts to involve
\nmedical students in research related
\nto the pandemic, fostering a culture
\nof inquiry and evidence-based
\npractice. Collaborative projects,
\nboth within South Africa and
\ninternationally, provided valuable
\nlearning opportunities and
\ncontributed to the broader
\nunderstanding of the virus and its
\nimpact on global health security.
\nUganda: I can attest that the
\nCOVID-19 pandemic had a
\ndevastating impact on education
\n(especially medical education) in
\nUganda. Some medical schools
\nwere forced to close, creating a
\nsignificant gap in human resources,
\nas many hospitals relied heavily on
\npost-graduate medical residents for
\nhealth service delivery. Although
\nother medical schools remained
\nopened, halting in-person academic
\nlectures for over one year, the shift
\nto virtual learning limited hands-on
\ntraining and physical interactions
\nwith mentors and patients. The lack
\nof practical experience and direct
\nsupervision compromised the quality
\nof training, posing a significant risk
\nto the competence of future
\nhealthcare professionals. As the
\nhealth system recovers from the
\npandemic\u2019s impact on medical
\neducation and training in Uganda,
\nUMA members are working tirelessly
\nto mitigate its effects and ensure
\nthat our healthcare system emerges
\nstronger and more resilient.
\nHow does your NMA leadership
\nimplement the WMA policies in the
\norganisation?
\nKenya: As active member of the
\nWMA, the KMA endeavours to have
\nas many as possible of its leaders and
\nmembers attend WMA activities
\nlike the Council Meetings, General
\nAssemblies, and regional meetings.
\nIn this manner, KMA members
\ncan learn about WMA policies,
\nprovide input at meetings, and
\ndisseminate relevant policy guidance
\nfor implementation at the local and
\nnational levels.
\nRwanda: RMA leadership actively
\nadvocates for the adoption and
\nintegration of some WMA policies
\ninto national health policies, by
\nengaging with government bodies
\nand stakeholders and submitting
\npolicy proposals. They participate in
\nnational health forums to ensure that
\nrelevant WMA policy statements
\nand guidelines can inform their
\ndecision-making processes. The
\nRMA works to influence health
\npolicies that align with international
\nstandards and ethical practices set
\nby the WMA, ultimately aiming to
\nimprove healthcare quality, patients\u2019
\nrights protection, and patients\u2019
\nhealth outcomes. To build capacity
\nwithin the medical community,
\nRMA members focus on establishing
\nleadership development programs
\nand training initiatives, designed
\nto equip members with the skills
\nnecessary for ethical leadership and
\nadvocacy. Mentorship programs
\npair experienced professionals with
\nemerging leaders to guide their
\ndevelopment, while workshops and
\nseminars incorporate the topics of
\nethics, human rights, and professional
\nconduct. This collaborative approach
\nhelps build a cohesive and informed
\nmedical community, aligned with
\nWMA principles and committed to
\nadvancing healthcare standards.
\nSouth Africa: SAMA leadership
\nactively integrates WMA policies
\ninto its strategic planning and
\noperational activities. This process
\nbegins with a thorough review and
\ncontextualisationofWMAguidelines,
\nto ensure that they align with South
\nAfrica\u2019s unique healthcare landscape
\nand needs. SAMA\u2019s leadership
\ndisseminates these policies through
\nofficial channels, including meetings,
\nseminars, and training sessions, so
\nthat all members are aware of and
\nunderstand the WMA\u2019s standards
\nand recommendations. Additionally,
\nthe SAMA incorporates WMA
\npolicies into its advocacy efforts, as
\na framework to influence national
\nhealthcare legislation and policy
\ndevelopment. The SAMA hopes to
\ninfluence these principles as globally
\nrecognised best practices, thereby
\nenhancing the quality and integrity
\nof healthcare delivery in South
\nAfrica.
\nUganda: The UMA has been
\nrepresented at the WMA General
\nAssemblies, and members actively
\nparticipate in shaping WMA policies
\nand resolutions that guide the global
\nmedical community. Notably, the
\nUMA adopts relevant WMA policies
\nand advocates for their integration
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\nInterview with National Medical Associations\u2019 Leaders of the African Region
\n40
\ninto Ugandan health policies
\nthrough our engagement with the
\nParliament of Uganda. Through
\nthis collaboration, we ensure that
\nUganda\u2019s health policies align with
\ninternational best practices and
\nstandards, as we aim to improve
\nthe health system that benefits our
\npatients and the community at large.
\nHow can the WMA support the
\nongoing NMA activities in your
\ncountry?
\nKenya: As KMA leadership, we
\noccasionally request that the WMA
\nprovide a statement on ongoing issues
\naffecting the medical profession in
\nKenya to influence policy makers as
\nwell as help connect the KMA with
\npotential resource partnerships. We
\nrequest that the WMA continue this
\nfinancial support as it is particularly
\nimportant for junior doctors who
\nmay not have adequate resources
\nto participate in WMA and Junior
\nDoctors Network (JDN) activities.
\nSecond, as the WMA supports
\ncapacity building activities, the
\nWMA could offer leadership courses
\nto KMA leaders, which can help
\nstrengthen their advocacy skills in
\nhealth leadership. Furthermore,
\nthe WMA could offer exchange
\nprogrammes between the various
\nnational medical associations inside
\nand outside of Africa, which could
\nhelp improve knowledge sharing
\nand foster collaborations within the
\nmedical profession.
\nRwanda: The WMA can support
\nthe ongoing activities of the RMA
\nin several key ways. First, the
\nWMA can enhance the overall
\ngrowth of the RMA by providing
\nadaptable policy frameworks that
\nexpand capacity building through
\ncontinuing professional development
\nand strengthen its advocacy efforts.
\nSecond, by providing leadership
\nsupport in medical education and
\nresearch, the WMA can help improve
\nthe quality of medical training
\nand research in Rwanda and equip
\nhealthcare professionals with essential
\nskills needed to advance quality
\nmedical education and evidence-
\nbased practices.Third, the WMA can
\nfacilitate partnerships with Rwandan
\nprofessional medical associations, by
\nenhancing collaborative efforts that
\nwould positively impact healthcare
\nsystems in Rwanda. Finally, the
\nWMA can serve as a resource
\nfor consultation, allowing RMA
\nmembers to seek guidance on complex
\nissues where they may lack expertise,
\nthus benefiting from the broader
\nWMA network and opportunities for
\nknowledge exchange.
\nSouth Africa: By leveraging its
\nglobal influence, the WMA can
\nhelp amplify SAMA\u2019s voice to
\ngarner attention and resources from
\nglobal health organisations and
\ngovernments for pressing health
\nchallenges in South Africa. WMA
\nleaders can offer expert guidance
\non policy development, helping
\nthe SAMA to craft and implement
\npolicies that align with international
\nbest practices and address local health
\nneeds. Also, the WMA can assist the
\nSAMA by offering capacity-building
\nprogrammes and training initiatives
\nthat can enhance SAMA members\u2019
\nknowledge and skills in medical
\nethics, leadership, public health, and
\nresearch. This support is especially
\nvaluable in areas like emergency
\npreparedness and response, where
\nglobal expertise can significantly
\nstrengthen local capabilities. Still,
\nthe WMA can help secure funding
\nfor collaborative research projects,
\nespecially through international
\nresearch grants and partnerships,
\nwhich can generate data and insights
\non specific health issues.
\nThe WMA can help advocate for
\nincreased resources and infrastructure
\nsupport for South Africa\u2019s healthcare
\nsystem from international donors
\nand organisations, which can lead
\nto improved healthcare facilities,
\nbetter access to medical supplies, and
\nenhanced support for public health
\ninitiatives, thereby strengthening the
\noverall healthcare system in South
\nAfrica. Furthermore, with the recent
\nDeclaration of Helsinki African
\nRegional meeting, WMA\u2019s support
\nfor SAMA\u2019s hosting has enabled the
\norganisation to foster networking
\nand collaboration opportunities with
\nother national medical associations.
\nBy facilitating connections and
\npartnerships, the WMA can help
\nthe SAMA share best practices,
\nlearn from other nation\u2019s experiences,
\nand collaborate on global health
\ninitiatives. This network can enhance
\nSAMA\u2019s ability to manage local
\nhealth challenges while contributing
\nto the global medical community.
\nUganda: We are pleased to leverage
\nour membership with the WMA
\nand request guidance on how to
\nobtain financial and asset support
\nfrom international agencies for UMA
\ninitiatives. Currently, the UMA is
\nlaunching a fundraising campaign
\nto construct the headquarters
\nbuilding, which will serve as a hub
\nfor our activities. With the WMA\u2019s
\nguidance, we hope to secure the
\nnecessary resources to complete this
\nconstruction, which can enhance our
\ncapacity to advocate for the optimal
\nwelfare of healthcare professionals
\nand high-quality healthcare in
\nUganda. The UMA has developed
\ninitiatives to explore working with
\ninternational partners to expand
\nhealthcare collaborations \u2013 including
\nthe United Kingdom\u2019s National
\nHealth Services\u2019 Royal College of
\nPhysicians and Rwanda Ministry
\nof Health \u2013 as well as promote
\nopportunities for health professional
\nservices to be exported to other
\ncountries. We request the guidance
\nBACK TO CONTENTS
\nInterview with National Medical Associations\u2019 Leaders of the African Region
\n41
\nof WMA on how to identify and
\nfacilitate reliable connections with
\nother countries, as one strategy
\nto address unemployment and
\nunderemployment among healthcare
\nprofessionals in Uganda.
\nAuthors
\nSimon Kigondu, MBChB (ObGyn)
\nPresident, Kenya Medical Association
\nNairobi, Kenya
\nsimonkigondu@gmail.com
\nHerbert Luswata, MD
\nPresident, Uganda Medical Association
\nKampala, Uganda
\nluswataherbert@gmail.com
\nMvuyisi Mzukwa, MBChB
\nPresident, South African
\nMedical Association
\nPretoria, South Africa
\nceo@samedical.org
\nJohn Baptist Nkuranga, MD,
\nMed Paeds, MMASc GH
\nPresident, Rwanda Medical Association
\nKigali, Rwanda
\nrmasecretariat@gmail.com
\nBACK TO CONTENTS
\nInterview with National Medical Associations\u2019 Leaders of the African Region
\n42
\nBACK TO CONTENTS
\nDr. Johannes Steinhart, Dr. Fran\u00e7ois
\nArnault, Dr.Tom\u00e1s Cobo Castro, and
\nDr.SofiaRydgrenStale,thePresidents
\nof the national medical associations
\n(NMAs) of Austria, France, Spain,
\nand Sweden, respectively, as well as
\nDr. Philippe Cathala, Delegate for
\nEuropean and International Affairs
\nof the NMA of France, join the
\ninterview with Dr. Helena Chapman,
\nthe WMJ Editor in Chief. They
\nshare their perspectives on their
\nleadership experiences, ongoing
\nNMAactivities,strengthsandexisting
\nchallenges in medical education, and
\nhow the World Medical Association
\n(WMA) can support NMA initiatives
\nin the European region.
\nAs you reflect upon your journey
\nas NMA president, please describe
\none memorable experience, one
\nchallenge and how you resolved
\nthe challenge, and one hope for the
\nfuture of medicine.
\nAustria: In 2023, Austria witnessed
\nwidespread negotiations on healthcare
\nreform with political leaders, and a
\nfirst draft gave rise to fears of negative
\nconsequences for the healthcare
\nsystem. Only when the Austrian
\nMedical Chamber (AMC) finally
\nbecame involved, these negotiations
\ntook place in a constructive and
\npurposeful atmosphere,and hence the
\ninvolvement of the AMC prevented
\nmajor healthcare dilemmas. These
\ntimely improvements were related to
\nfuture patient care,such as eliminating
\nend dates for the implementation of
\nstandardised nationwide contracts
\nand committing resources to reduce
\nadministrative burden in health
\ninstitutions.
\nFrance: There have been many
\nsignificant moments in our French
\nMedical Council (Conseil National
\nde l\u2019Ordre des M\u00e9decins, CNOM)
\nactivities, including the development
\nofrobustpoliciesandthemanagement
\nof challenging negotiations on
\npressing health issues.Specifically,one
\nmemorable experience (highlighted
\nby Dr. Philippe Cathala) is the
\nimplementation of our mentorship
\npolicy with junior doctors, as they
\nare the future of medicine, and it
\nis our collective responsibility to
\ncontribute to their medical training.
\nTo support this mentorship policy,
\nan annual ceremony has been
\nestablished in the local council,
\nchaired by Dr. Philippe Cathala,
\nwhere council members invite all
\njunior doctors from the region
\nand present them with the most
\nsymbolic tools of our profession:
\nthe stethoscope and code of
\nethics. We are very pleased that
\nthis initiative has inspired other
\ndoctors at all levels of training, and
\nnow several councils have followed
\nin our footsteps.
\nSpain: One of the most memorable
\nexperiences during my term as
\npresident of the Spanish General
\nMedical Council (CGCOM) was the
\nInterview with National Medical Associations\u2019
\nLeaders of the European Region
\nInterview with National Medical Associations\u2019 Leaders of the European Region
\nFran\u00e7ois Arnault
\nSof ia Rydgren Stale
\nPhilippe Cathala
\nJohannes Steinhart
\nTom\u00e1s Cobo Castro
\n43
\nBACK TO CONTENTS
\napproval of the new Code of Medical
\nEthics. This document, which is
\naligned with the WMA Code of
\nMedical Ethics, is the result of
\nyears of work and multi-stakeholder
\nconsensus, and sets the ethical and
\nprofessional principles that will
\nguide medical practise in Spain. The
\napproval ceremony, which was held
\nin 2023, was a moment of pride and
\ncelebration for all persons involved.
\nUpon signing the document, I
\nremember that I felt a deep sense of
\nresponsibility and commitment to
\nthe values that the code represents.
\nThis achievement not only reinforced
\nour commitment to medical ethics,
\nbut also enhanced public confidence
\nin the medical profession. Over my
\ntenure, one of the most significant
\nchallenges was the implementation of
\nthe Continuing Medical Education
\n(CME) credits of the European
\nUnion of Medical Specialists
\n(UEMS) in Spain and in Latin
\nAmerica, as it comprised of a formal
\nagreement between CGCOM,
\nthe European Union of Medical
\nSpecialists (Union Europ\u00e9enne des
\nM\u00e9decins Sp\u00e9cialistes, UEMS),
\nand the Medical Confederation
\nof Latin America and the
\nCaribbean (Confederaci\u00f3n M\u00e9dica
\nLatinoamericana y del Caribe,
\nCONFEMEL). We envision a future
\nwhere medicine will be more precise,
\nless invasive, and more focused
\non prevention and personalised
\ntreatment, which will significantly
\nimprove patient quality of life and life
\nexpectancy.
\nSweden: One memorable moment
\nas the Swedish Medical Association
\n(SMA) president was when I
\nposted, \u201cI\u00b4m a physician, not a border-
\npoliceman,\u201d on social media, in
\nresponse to the government starting
\nan investigation to examine the
\npossibility of demanding physicians
\nand other employees in municipalities
\nand regions to report undocumented
\nmigrants. Such an obligation to
\nreport undocumented migrants
\nwould be in opposition to the
\nimportant ethical principle that care
\nmust be provided on the basis of
\nclinical need alone, regardless of the
\ncare seeker\u00b4s legal status. It also goes
\nagainst the International Code of
\nMedical Ethics and threatens patient
\nsafety. As health professionals and as
\nan NMA, it is important to speak out
\nagainst any proposal that prevents us
\nfrom fulfilling our duties. My post
\nwent viral in Sweden, and many
\nphysicians as well as representatives
\nfrom other professions and employers
\nraised their voices in support. I
\nbelieve that this community response
\ndemonstrates the importance of
\nour medical ethics, how strongly we
\nfeel about them, and how we can
\nhopefully make a difference when we
\ncome together and use our collective
\nvoice on pressing health issues. At
\nthe same time, it offers an example
\nof a challenge that we face and one
\napproach to resolve the issue, by
\nworking together with our SMA
\nmembers as well as organisations
\nfrom different parts of the healthcare
\nsector and society.
\nMy hope for the future of medicine
\nis that we will see a development
\ntowards a more equal healthcare
\nand universal health coverage, where
\neveryone can benefit from medical
\nadvances and take full advantage
\nof new research findings. It is
\nimportant that the trust in research
\nand science remains high (and, where
\nnecessary, increases) in society and
\nthe general public, and specifically
\namong patients, politicians, and
\ndecision makers. Healthcare needs
\nto be governed by science and ensure
\nstrong professional autonomy for
\nthe best of all patients.
\nHow would you describe the current
\nopportunities for NMA members to
\nhelp influence health care policy-
\nmaking activities in your country?
\nAustria: The forementioned
\ninvolvement of the AMC in the
\nhealthcare reform of 2023 shows
\nthe important role that the AMC
\nplays in healthcare policy activities
\n(including constructive cooperation
\nwith politicians and advocacy for
\nhealthcare improvement) that focus
\non patient care and the medical
\nprofession. As the professional
\norganisation representing all Austrian
\ndoctors, the AMC is committed to
\npositive developments in the Austrian
\nhealthcare system by implementing
\ninnovative approaches to offer the
\nbest possible medical care for patients.
\nThe AMC is comprised of various
\ncommittees that collectively advocate
\nfor socially-oriented, modern
\nhealthcare that is accessible to the
\nentire population through doctors
\nworking in public and private sectors.
\nFrance: The CNOM, established in
\n1945, is the only institution in France
\nthat unites all doctors, regardless
\nof their status, practice mode or
\nspecialty. It was created by law
\nand entrusted with several public
\nservice missions, defending the
\nindependence and honour of the
\nmedical profession throughout
\nFrench society. Upon my election as
\npresident of the CNOM,I committed
\nto strengthening our contacts and
\nworking relationships with all
\ninstitutional partners, including
\npublic authorities, doctors\u2019 unions,
\nhealth profession councils, patient
\nassociations, members of the French
\nparliament, and elected officials from
\nvarious regions.
\nAs a key player in discussions on the
\nevolution of the healthcare system,
\nCNOM members actively contribute
\nto numerous committees and serves
\nas experts with ministries, regional
\nhealth agencies, and French public
\nhealth organisations (e.g. National
\nAgency for the Safety of Medicines).
\nAs a leading speaker for public
\nauthorities, the Council provides
\nopinions on health-related bills and
\ndecrees as well as conducts periodic
\nsurveys on pressing topics such as
\nInterview with National Medical Associations\u2019 Leaders of the European Region
\n44
\nBACK TO CONTENTS
\nmedical demographics, physician
\nsafety, and continuity of care.
\nSpain: Currently, we have a direct
\nand collaborative relationship with
\nthe administrations of central
\nand regional association in Spain.
\nFollowing the coronavirus disease
\n2019 (COVID-19) health crisis, the
\nCGCOM has led timely national
\nefforts that continue to strengthen the
\nmedical profession, including forming
\nthe State Public Health Agency,
\ndeveloping and advocating for the
\napproval of the emergency medicine
\nspecialty training, supporting an
\nincreased number of specialist
\ntraining placements. As an
\norganisation, we recognise that our
\nmembers represent experts in their
\nclinical and surgical specialties, who
\nare frequently requested to provide
\ninput to help national discourse on
\npressing health issues. Upon each
\nrequest, we are increasingly aware
\nof our important role, working
\nwith leading stakeholders (like the
\ngovernment) in order to support
\nhealth system resiliency.
\nSweden: The SMA, a labour union
\nand professions association, is a well-
\nrespected organisation in Sweden.
\nOur representatives at local and
\nnational levels are elected by our
\nmembers, and we encourage active
\nparticipation by individual members.
\nWe work hard to prioritise the needs
\nof physicians and patients as well
\nas promote the continued positive
\ndevelopment of Swedish healthcare.
\nThe SMA is often consulted as subject
\nmatter experts for national inquiries
\non healthcare issues, and we have
\nrecurring meetings with the Minister
\nfor Health Care. Although regional
\nand state representatives vote on final
\ndecisions related to the adoption of
\nhealthcare policies, guidelines, and
\nlegislation, SMA members offer
\nrobust perspectives to such discourse
\nthat can help influence policy-making
\nactivities.
\nHow do perceive the physician-
\npatient relationship and rapport in
\nthe clinical setting in your country?
\nAustria: As doctors, our top priority
\nis to be actively present for our
\npatients, offering quality time for
\ndirect interactions to learn about their
\npersonal needs and concerns. Trust
\nis the be-all and end-all in the
\nrelationship between doctors and
\ntheir patients, and hence those who
\ntrust their doctor will also adhere
\nmore precisely to recommended
\ntreatment. Since doctors acknowledge
\nthat significant time is wasted on non-
\nmedical work such as documentation,
\nthe AMC has been a long-time
\nadvocate for reducing bureaucratic
\nactivities (e.g. writing discharge
\nletters, personnel management)
\nand expanding digital options
\nsuch as a standardised information
\ntechnology infrastructure (e.g.
\nextramural and intramural areas),
\ndevelopment of digital apps, and
\nnational documentation assistants
\nthat support electronic health records
\n(elektronische Gesundheitsakte,
\nELGA).
\nFrance: The CNOM is the guarantor
\nof the patient-doctor relationship in
\nFrance, serving doctors in the interest
\nof patients. We understand that
\ntoday\u2019s doctors face several challenges
\nin building a strong patient-doctor
\nrelationship, including limited time
\nto conduct clinical responsibilities
\ndue to the burden of administrative
\ntasks, working in large health teams,
\npatients who are more informed and
\nin control of their health, increasing
\ntechnicalities of clinical practice,
\nand the development and use of
\nnovel technologies (e.g. artificial
\nintelligence). Some solutions to
\nthese challenges may include health
\nprofessionals\u2019 training, improved team
\ncoordination and communication,and
\nthe responsible use of technologies
\nin clinical practice. Since novel
\ntechnologies cannot replace the
\nindividual medical consult, and must
\nrequire the doctor\u2019s supervision, the
\nCNOM is currently preparing an
\nethical and deontological framework
\nfor the use of these new tools.
\nSpain: The doctor-patient
\nrelationship is and will continue to
\nbe the basis of medical practice, and
\nit is well safeguarded in Spain. This
\nfundamental bond remains visibly
\nstrong among doctors in Spain, as
\nevidence of their strong vocation and
\nprofessionalism in medicine, albeit
\nexperiencing multiple challenges like
\ninfection control during the pandemic,
\nhospital surges, and overburdened
\nschedules. As the CGCOM is
\nabsolutely committed to protecting
\nthis doctor-patient relationship, we
\nlaunched an initiative in 2016,to make
\nthe doctor-patient relationship part of
\nthe intangible heritage of humanity.
\nDespite technological advancements,
\nmedicine must continue to revolve
\naround this intimate and trusting
\nrelationship between the doctor and
\nthe patient.
\nSweden: A good patient-physician
\nrelationship is necessary for optimal
\ncare. Of course, there are patients who
\nare dissatisfied with their healthcare
\nand their physician. Even threats and
\nviolence against health professionals
\noccur, which is never acceptable and
\nsomething that we must work hard to
\nprevent. In general, though, I would
\nsay that the relationship between
\npatients and physicians in Sweden is
\na positive one. With the continuous
\ndevelopment of new treatments and
\nthe strengthened position of patients
\nin healthcare, today\u00b4s patients often
\nhave high expectations of what
\nhealthcare can do for them. This
\ncan stimulate cooperation between
\npatients and physicians as well as
\nencourage patients to be more active
\nparticipants in their care. At the same
\ntime, increased patients\u2019 expectations
\nnecessitate that physicians are well
\ntrained and given sufficient clinical
\nInterview with National Medical Associations\u2019 Leaders of the European Region
\n45
\nBACK TO CONTENTS
\ntime with patients to discuss the
\nmanagement plan in a respectful
\nand sensitive manner that fosters
\nunderstanding and trust.
\nHow would you describe the
\nanticipated challenges in medical
\neducation over the next decade in
\nyour country?
\nAustria: There is what has been
\nreferred to as an \u201cunbalanced
\nmobility\u201dof students in the European
\nUnion (EU). Austria, in particular,
\nhas a disproportionate number of
\ninternational medical students,
\nwho leave the country after having
\nacquired their degree. Notably, most
\nmedical students in Austria come
\nfrom Germany, as medical students
\nseeking opportunities to study abroad.
\nAccording to the German Minister
\nof Health, however, the nation has
\ntrained an estimated 50,000 fewer
\ndoctors than the country will likely
\nneed for the next decade. Hence,
\nthe AMC supports reforms like the
\nsuggestion of the Austrian Minister
\nof Education, Martin Polaschek,
\nwho proposed that EU member
\nstates should be required to provide
\na minimum quota of university
\nplacements, with states who meet
\nor surpass their quotas being
\ncompensated by those states who are
\nunable to meet these quotas.
\nAlso, we need to ensure that young
\ndoctors in Austria choose to stay and
\nwork in the country. There are high
\ndemands internationally, particularly
\namong Austria\u2019s neighbours
\n(Germany and Switzerland), where
\na common language and geographic
\nproximity present appealing
\nalternatives for Austrian doctors. We
\nhave to stay competitive in the light
\nof the global migration of health
\nprofessionals, developing programs
\nand incentives to encourage doctors
\nto remain in Austria.
\nThe medical profession has changed
\nsignificantly over the past generations:
\n100-hour work weeks for example
\nused to be common schedules in
\nhospitals. Positions in the public
\nhealthcare sector were highly sought
\nafter amongst doctors, who would
\nface stiff competition in the selection
\nprocess. However, these job offerings
\nhave failed to keep up with the shift
\nin priorities and expectations of
\nyounger generations who value
\nflexibility in the workplace, seek a
\nbetter work-life balance, and desire
\nmore time with their families as well
\nas time to pursue interests outside
\nof work. For this reason, part-time
\nwork models have risen in popularity.
\nWe cannot afford to ignore these
\nprofessional changes in Austria
\nand recognise that if contracts with
\nsocial security providers and hospital
\nadministration do not offer more
\nflexible and more attractive work
\nconditions, fewer doctors will seek
\nemployment in the public healthcare
\nsystem and the existing workforce gap
\nwill grow even larger.
\nFrance: In France, there are three
\nmajor challenges that the health
\nsystem will face over the next
\ndecade. First, junior doctors who
\ncomplete their training do not often
\nidentify with the available types
\nof medical practice. Young doctors
\nwho complete their training do not
\nidentify with the type of medical
\npractice being offered to them. This
\nis particularly evident in general
\npractice within local communities,
\nwhich should be at the core of
\nhealthcare for the population. The
\nappeal of this specialised field is
\ndeclining, and young doctors are
\nincreasingly inclined to choose
\nsalaried positions or roles that do
\nnot involve direct patient care, such
\nas aesthetic medicine. This is where
\nthe real issue lies! It is pointless to
\nsignificantly increase the number of
\nmedical students if we do not create
\na strong appeal for the care sector.
\nSecond, integration of artificial
\nintelligence and telemedicine into
\ntraining programs will require that
\nteachers and students refine their
\nskills of this rapidly changing
\ndiscipline. Third, it is important
\nto maintain rigorous and high-
\nquality training standards to
\nensure patient safety. This is
\ncrucial, especially in the context of
\nincreasing international mobility
\namong doctors.
\nSpain: As doctors, we recognise that
\nthere are enormous challenges in
\nthe field of medical education and
\ntraining at national, regional, and
\ninternational levels. First, limited
\ntime and incentives are offered to
\ndoctors to pursue regular continuing
\nmedical education, including
\nupdates on clinical guidelines for
\ndiagnosis, treatment, and prevention.
\nFor example, Spanish doctors may
\nbe granted five days to complete
\nsuch important training, which can
\nnegatively influence the provision of
\nhigh-quality healthcare services to
\npatients and ultimately the health
\nsystem as a whole. Second, it is
\nimportant to harmonise medical
\ntraining in Spain, Europe, and
\nthe world, ensuring that health
\nprofessionals are well-trained with the
\nknowledge and skills to treat patients.
\nHence, together with UEMS, we
\nmust promote a list of competencies
\nthat represents a benchmark for all
\ncountries, as well as guarantee that
\nmedical training has received the
\nrespective accreditation without any
\nconflicts of interest.
\nSweden: In 2021, the government
\nof Sweden initiated fundamental
\nchanges to our system of medical
\neducation. Up until 2021, all doctors
\nreceived a medical degree upon
\nleaving the university (e.g. duration
\nof 5.5 years), and after an 18-month
\ninternship, they could register as
\nmedical practitioners and start their
\nspeciality training. However, the
\naverage waiting time to start the
\nInterview with National Medical Associations\u2019 Leaders of the European Region
\n46
\nBACK TO CONTENTS
\ninternship has been 11 months after
\ngraduation, and this delay to educate
\nnew specialists (e.g. duration of five
\nyears) has exacerbated Sweden\u00b4s
\nshortage of specialist doctors. Since
\n2021, the new system includes
\nspecific changes, where basic medical
\neducation (medical degree and license
\nto practice medicine) is completed
\nat the university in six years (e.g.
\naddition of six months). Specialty
\ntraining then follows and incorporates
\na new introductory training period
\n(e.g. total duration of a minimum of
\n5.5 years). Eventually, the 18-month
\ninternship will be removed when the
\nprevious system has been phased out
\nand replaced with the new system.
\nDuring this transition period, we
\nare closely monitoring (and working
\nto remove any unnecessary delays)
\nrelated to the implementation of
\nthe new system. Overall, these
\nchanges are timely for Sweden to
\nbetter harmonise with our European
\nneighbours\u2019 education systems.
\nFrom the medical education
\nperspective, how has your NMA
\nresponded to the existing and
\nemerging health challenges within
\nyour country?
\nAustria: Conducting an annual
\nacademic evaluation for training
\nwithin hospital departments, the
\nAMC analyses the current status
\nand can therefore react quickly
\nto incorporate any necessary
\nmodifications. For years, the AMC
\nhas advocated for a quality training,
\nwhere senior-level doctors are
\nassigned to each training program,
\nand sufficient resources are available
\nto allow time for teachers and
\ntrainees to complete their training
\nand adopt an optimal work-life
\nbalance. If we can guarantee high-
\nquality training, then we can
\nguarantee that our patients will be
\ncared for by highly trained doctors.
\nFrance: The CNOM proposes
\nthe implementation of innovative,
\nmodern, and simple solutions to
\nbring more flexibility to expand
\nhealthcare services, meet patients\u2019
\nneeds, and increase the attractiveness
\nof the medical profession. After
\nthe COVID-19 pandemic, the
\nCNOM launched the \u201cHealing
\nTomorrow\u201d (\u201cSoigner demain\u201d
\ncampain) in 2021, offering several
\nrecommendations to national
\nleaders on how to optimise medical
\neducation and training in France.
\nRegarding academic coursework,
\nnational leaders can support the
\ncurriculum reform that emphasises
\ninfection control and prevention in
\nthe first year of studies, and medical
\nethics and CNOM missions in the
\nsecond cycle of studies. Encourage
\nsecond cycle medical study
\ninternships in public and private
\nhealthcare sectors, including
\noutpatient settings. Promote
\ninternship placements in private
\nclinics and hospitals, during the third
\ncycle of medical studies, distributed
\nacross the coutry, regardless of
\nspecialty, to help students understand
\nhow professionalisation is closely
\naligned with local community needs
\nLeaders can support doctors who
\nwish to pursue part-time practice
\nwithin their designated specialty
\nfield, as well as authorise the presence
\nof value mixed and shared practice
\nmodels without impairing social
\nrights, regardless of status (e.g.
\nhospital, salaried, private). In order to
\nmeet local community needs, national
\nleaders can also offer physicians a
\nfive-year community placement,
\nwith significant salary, indemnity,
\ncontractual incentives, and retirement
\nbenefits. Finally, complementary
\ntopics (e.g. \u201cOne Health\u201d concept,
\ndomestic and family violence) can be
\nincorporated into reflections on the
\ncollective and social responsibility
\nof doctors, economic and social
\nimplications of prescriptions, and
\ncritical analysis of emerging health
\nthreats.
\nSpain: Health leaders across Spain
\nare leading efforts to identify and
\naddress health challenges with
\nsustainable solutions that strengthen
\nmedical education and training as
\nwell as the health system. In 2022,
\nthe Government of Spain approved
\nthe Decree 589\/2022 (Real Decreto
\n589\/2022), which sets the foundation
\nfor all stages of competence-
\nbased medical training, including
\ncoordinating annual exams for
\nspecialty training and establishing
\nthe role of professional organisations
\n[1]. This regulation is pivotal as
\nan important first step, and our
\nCGCOM is enthusiastic to
\ncontribute to advancing this
\nregulation and medical education and
\ntraining in Spain and Europe.
\nSweden: There is significant ongoing
\npolicy discussion regarding our
\nchanging demographics, such as
\nhow an ageing population will affect
\nhealthcare demands, a predicted
\nfuture Sweden shares with many
\nother countries. One key issue is to
\nbalance our physician workforce,
\nespecially since Sweden faces a
\nnationwide shortage of specialist
\ndoctors. The current imbalance is
\npartly due to the unnecessary delays
\nfor medical graduates to begin
\nthe internship, which is required
\nto receive a license to practice
\nand continue with their specialist
\ntraining. Swedish healthcare should
\noffer enough training positions
\nand ensure sustainable working
\nconditions for doctors, which will
\nalso help recruit the next generation
\nof doctors. The SMA has published
\nseveral reports with experiences of
\npoor and unsustainable working
\nconditions from our members, noting
\nthat almost one-third of junior
\ndoctors have considered leaving the
\nmedical profession. Moving forward,
\nemployers should act to improve
\nthese working conditions and offer
\nfair compensation for all doctors.
\nInterview with National Medical Associations\u2019 Leaders of the European Region
\n47
\nBACK TO CONTENTS
\nFrom your perspective and
\nnational experiences, how has the
\nCOVID-19 pandemic affected
\nmedical education in your country?
\nAustria: Due to the 2nd Covid-19 Act
\nof 2020, all deadlines in connection
\nwith medical education, training, and
\nadvanced education as well as medical
\npractice were suspended for the
\nduration of the COVID-19 pandemic.
\nThis action is in accordance with
\n\u00a7 36 b par. 4 of the Austrian Medical
\nAct 1998, namely for pandemic-
\nrelated measures such as quarantine,
\nleave of absence or childcare. In order
\nto ensure the quality of training, the
\nresponsible attending physicians
\ndocumented and assessed trainees\u2019
\nacquired knowledge, experience,
\nand skills. Furthermore, faculty used
\ndigital teaching formats to teach
\ncoursework, resulting in a massive
\nincrease of online training courses,
\nand many congresses were cancelled
\nor postponed. All in all, I believe that
\neverything possible was done, even
\nduring the pandemic, to offer junior
\ndoctors the best possible medical
\ntraining.
\nFrance: During the COVID-19
\npandemic, formal academic
\ncoursework could not be delivered via
\nin-person format for several weeks.
\nStudents in clinical internships were
\nfocused primarily on prevention and
\ncare activities, and albeit increased
\nworkloads, they were fully committed
\nto assisting their senior colleagues.
\nThe pandemic highlighted both
\nthe resilience and vulnerabilities of
\nthe medical education in France,
\nemphasising the importance of
\nadaptability, mental health awareness,
\nand the integration of technology
\nin training future healthcare
\nprofessionals.The medical curriculum
\nhas incorporated an emphasis on
\npublic health, infectious diseases,
\nand emergency preparedness topics,
\nreflecting on the lessons learned
\nduring the pandemic.
\nSpain: Although the pandemic
\nslowed (and halted) the development
\nand adoption of regulations and
\nlegislation in medical education,
\nwe have uncovered positive aspects
\nsuch as telemedicine advancements,
\ngreater training in digital skills, and
\neven virtual learning. The CGCOM
\ninsists on the need for the measures
\nto be directly coordinated so that
\ntraining remains a prioritised pillar
\nwithin the reformed Spanish health
\nsystem. As medical professionals are
\nthe main asset of the health system,
\ntraining is imperative to providing
\nquality medical care. Although the
\npandemic slowed down such progress,
\nwe should collectively push forward
\nand support advancements to medical
\neducation and training.
\nSweden: The COVID-19 pandemic
\nstressed one valuable lesson for
\nthe medical discipline to protect
\nhealthcare teams and patients in the
\ncase of any catastrophic situation (e.g.
\narmed conflict, pandemic). Long-
\nterm planning within the healthcare
\nsystem requires ample storage for
\nmedical supplies and medicine as well
\nas regular training and continuous
\nmedical education for all healthcare
\npersonnel. My concern is that we
\nare beginning to forget some of the
\nlessons that we learned during the
\nCOVID-19 pandemic. However, in
\nlight of Sweden\u2019s recent entry into
\nNorth Atlantic Treaty Organization
\n(NATO) and its demands on
\npreparedness, these issues continue to
\nbe highly relevant.
\nHow does your NMA leadership
\nimplement the WMA policies in the
\norganisation?
\nAustria: The AMC is fully committed
\nto the WMA\u2019s commitment to
\nproviding people with the highest
\ninternational standards in medical
\neducation, medical science, ethics,
\nand healthcare. In addition
\nto representing the common,
\nprofessional, social, and economic
\ninterests of doctors working in
\nAustria, the AMC\u2019s mission
\nstatement promotes socially
\norientated, modern healthcare
\nby doctors in public and private
\npractice that is accessible to the
\nentire population. Our doctors are
\ncommitted to a high standard of
\nmedical care, with a particular focus
\non ongoing quality management to
\nincrease patient safety.
\nFrance: Once WMA policies are
\nadopted at the WMA General
\nAssembly or Council Meeting,
\nCNOM leaders disseminate the
\nstatements and recommendations
\nwithin all levels of the CNOM.
\nThese policies offer valuable support
\nand help reinforce our scientific
\npositions at the national level. Prior
\nto implementing these WMA
\npolicies within the CNOM, members
\ncarefully examine and analyse each
\nof the WMA\u2019s proposals, initially
\nwithin the CNOM\u2019s delegation for
\nEuropean and International Affairs
\n(chaired by Dr. Philippe Cathala)
\nand subsequently by members in
\nsection and session with all CNOM
\nmembers.
\nSpain: As the WMA has adopted
\nvarious initiatives, positions, and
\nstatements, our CGCOM members
\ncan use this information to broaden
\ntheir knowledge and simultaneously
\nadapt content to the context of
\nthe medical profession in Spain.
\nThroughout my tenure as CGCOM
\npresident, designated delegates of
\ndifferent committees have prepared
\nand shared reports with internal
\ngoverning bodies, which can serve as
\na reference point for working groups
\nor guiding documents for national
\nhealth authorities. As the medical
\nprofession transcends frontiers, we
\nmust leverage our expertise and
\nskills within national, regional, and
\ninternational settings.
\nInterview with National Medical Associations\u2019 Leaders of the European Region
\n48
\nBACK TO CONTENTS
\nSweden: The SMA strives to actively
\nparticipate in the WMA policy
\nactivities, noting that the WMA-
\nadopted policies can be quite useful
\nin our daily activities. Specifically,
\nthe SMA refers to WMA policies,
\nespecially the ones on ethical issues,
\nwhen we contribute to interviews
\nby the media, present at meetings,
\nprepare scientific commentaries
\nor articles, and discuss topics with
\nSMA members. In fact, the WMA\u2019s
\ncore ethical policies, such as the
\nInternational Code of Medical
\nEthics and the Declaration of
\nGeneva, have inspired our own
\nnational code of medical ethics.
\nHow can the WMA support the
\nongoing NMA activities in your
\ncountry?
\nAustria: The fundamental framework
\nand central guiding principle of our
\nmedical activities is to help patients,
\nbehind which all political and
\neconomic considerations take a back
\nseat. The strong international co-
\noperation within the WMA helps us
\nto achieve these goals in Austria as
\nwell as internationally.
\nFrance: The WMA is an important
\norganisation for the CNOM, and we
\nare proud to be one of its founding
\nmembers. Today, the WMA provides
\nsupport by strongly reaffirming the
\nrole and place of physicians in the
\nhealthcare pathway, emphasising
\nethics in clinical research, and
\nlaunching awareness campaigns on
\ncrucial public health issues such as
\nvaccination, disease prevention, and
\nmental health. Furthermore, it plays
\na major role by adopting guidelines
\nand policies based on best practices
\nin medical ethics. These actions are
\nonly made possible with the support
\nof all NMAs and by strengthening
\ndialogue with other organisations,
\nsuch as CONFEMEL and the
\nConference of Medical Councils
\nfrom French-speaking countries (la
\nConf\u00e9rence Francophone des Ordres
\ndes M\u00e9decins, CFOM).
\nSpain: In Spain, the WMA is highly
\nrespected as a leading international
\ngroup of medical experts who
\nadvocate for high ethical standards in
\nmedical practise by adopting codes of
\nethics and organising ethics training
\nactivities. As the WMA General
\nAssembly passes different emergency
\nresolutions and declarations in any
\nfield, the CGCOM forwards these
\ndocuments to legislators within
\nthe Congress of Deputies, Senate,
\nAutonomous Communities, and
\nthe Ministry of Health, who in
\nturn review and even post these
\ndocuments on institutional websites.
\nBy providing this valuable support,
\nthe WMA can help strengthen the
\ncapacities of NMAs, improve the
\nquality of medical care, and foster a
\ncollaborative environment for global
\nmedicine.
\nSweden: The WMA plays an
\nimportant role in developing and
\ncommunicating international
\npolicies, especially in the area of
\nmedical ethics, as well as in speaking
\ninternationally against violations
\nof medical ethics and health-
\nrelated human rights. As a global
\norganisation representing physicians
\nfrom over 110 countries around
\nthe world, the WMA has a strong
\ninternational voice. Its policies and
\nstatements regarding current events
\nthreatening physicians, healthcare
\nsystems, and human rights are often
\nvery helpful, offering a reference
\nfor our NMA when developing
\npolicies or addressing international
\nevents. Hence, we would like to
\nencourage the WMA to continue
\nits important work in these areas.
\nReference
\n1.\t Bolet\u00edn Oficial del Estado,
\nGovernment of Spain. Real
\nDecreto 589\/2022 [Inter-
\nnet]. 2022 [cited 2024 Sep 1].
\nAvailable from: https:\/\/www.boe.
\nes\/eli\/es\/rd\/2022\/07\/19\/589
\nAuthors
\nFran\u00e7ois Arnault, MD
\nPresident, French Medical Council
\n(Conseil National de l\u2019Ordre
\ndes M\u00e9decins, CNOM)
\nParis, France
\ninternational@ordre.medecin.fr
\nPhilippe Cathala, PharmD, MD
\nDelegate for European and
\nInternational Affairs, French
\nMedical Council (Conseil National
\nde l\u2019Ordre des M\u00e9decins, CNOM)
\nPresident, Conseil D\u00e9partemental de
\nl’H\u00e9rault de l\u2019Ordre des M\u00e9decins
\nMontpellier, France
\ncathala.philippe@ordre.medecin.fr
\nTom\u00e1s Cobo Castro, MD
\nPresident, Spanish General
\nMedical Council (CGCOM)
\nMadrid, Spain
\ninternacional@cgcom.es
\nSofia Rydgren Stale, MD
\nPresident, Swedish Medical Association
\nStockholm, Sweden
\nordforande@slf.se
\nJohannes Steinhart, MD
\nPresident, Austrian Medical Chamber
\nVienna, Austria
\nj.steinhart@aerztekammer.at
\nInterview with National Medical Associations\u2019 Leaders of the European Region
\n49
\nPatient safety, defined as \u201ca framework
\nof organised activities that creates
\ncultures,processes,procedures,behaviours,
\ntechnologies and environments in
\nhealthcare that consistently and
\nsustainably lower risks, reduce the
\noccurrence of avoidable harm, make
\nerrors less likely and reduce the impact of
\nharm when it does occur\u201d,underpins the
\nfoundation of global health systems
\n[1]. Health professionals, who adhere
\nto the \u201cfirst, do no harm\u201d(primum non
\nnocere) ethical principle, understand
\ntheir indispensable role in leading
\nand contributing to high-quality
\nhealthcare services that improves
\npatient outcomes. However, common
\nadverse events can include diagnostic
\nor medication errors, nosocomial
\ninfections, and unsafe clinical or
\nsurgical procedures (including blood
\ntransfusions), leading to more than
\nthree million annual premature
\ndeaths [1].
\nOver the past two decades, global
\nleaders have developed and adopted
\nrobust policies to guide health
\nprofessionals in the delivery of
\nhigh-quality healthcare services. In
\n2002, the World Health Assembly
\n(WHA) approved the WHA 55.18
\n(Quality of care: patient safety),
\nto encourage Member States to
\nestablish evidence-based approaches
\nto improve healthcare service delivery
\n[2]. In 2004, the World Health
\nOrganization (WHO) launched the
\nWorld Alliance for Patient Safety,
\nto offer a platform for global health
\nstakeholders to share resources and
\ncollaborate on important patient
\nsafety initiatives aligned with
\nsix main action tracks (global
\npatient safety challenge, patients
\nfor patient safety, reporting and
\nlearning, research, solutions,
\ntaxonomy) [3]. Subsequently, in
\n2009, the WHO published an
\ninternational conceptual framework
\nfor patient safety to improve the
\ncollection and organisation of patient
\nsafety data (e.g. incident type and
\ncharacteristics, patient characteristics
\nand outcomes, contributing
\nfactors and hazards, organisational
\noutcomes, detection, mitigating
\nfactors, ameliorating actions, actions
\ntaken to reduce risk) for analytical
\npurposes [4].
\nNotably, the WHA adopted the
\nresolution WHA 72.6 (Global action
\non patient safety) in 2019, which
\nestablished World Patient Safety
\nDay annually on 17 September [5].
\nThe past two themes \u2013 \u201cEngaging
\nPatients for Patient Safety\u201d for
\n2023 and \u201cImproving Diagnosis
\nfor Patient Safety\u201d for 2024 \u2013
\nhave underscored patient safety
\nas a collaboration between health
\nprofessionals and patients and have
\nencouraged the continued dialogue
\non existing barriers to achieving
\npatient safety and high-quality
\nhealthcare services [6]. The Global
\nPatient Safety Action Plan 2021\u20132030,
\nlaunched in 2021, was comprised of
\nseven strategic objectives: 1) engage
\npatients and families as partners in
\nWMA Members Highlight National Initiatives
\nto Safeguard Patient Safety
\nWMA Members Highlight National Initiatives to Safeguard Patient Safety
\nCredit:
\nPeopleImages.com
\n–
\nYuri
\nA
\n\/
\nshutterstock.com
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\n50
\nsafe care; 2) achieve results through
\ncollaborations; 3) analyse and
\nshare data to generate learning; 4)
\ntranslate evidence into actionable and
\nmeasurable improvement; 5) base
\npolicies and action on the nature of
\nthe care setting; 6) use both scientific
\nexpertise and patient experience to
\nimprove safety; and 7) instil a safety
\nculture in the design and delivery of
\nhealthcare [7]. To support this action
\nplan, the WHO launched the Patient
\nSafety Rights Charter and the Global
\nPatient Safety Report 2024, which
\noutlines patients\u2019 rights and offers a
\ncomprehensive review and evaluation
\nof national patient safety initiatives,
\nrespectively, in 2024 [8,9].
\nHealth leadership and sustainable
\npolitical investment are crucial
\nto develop multidisciplinary and
\nmultisectoral approaches to reinforce
\nhealth systems and support shared
\ndecision-making between health
\nprofessionals and patients in
\nhealthcare service delivery. In this
\narticle, physicians from 14 countries
\n\u2013 Argentina, C\u00f4te d\u2019Ivoire, Ecuador,
\nIndia, Kenya, Myanmar, Nigeria,
\nPhilippines, Rwanda, South Africa,
\nTaiwan, Uganda, Uruguay, and
\nYemen \u2013 offered insight on local
\nand national initiatives that
\nhighlight the need for robust
\npatient safety practices across four
\ngeographic regions. They described
\nrelevant public policies, community
\nengagement activities, and
\nprofessional development trainings
\nto empower health professionals and
\npatients alike across global health
\nsystems.
\nArgentina
\nThe Argentina health system, which
\nsupports 44 million residents, does
\nnot collect reliable statistics on
\npatient safety and errors, due to
\nlimited infrastructure for monitoring
\nadverse health events as well as health
\nprofessionals\u2019 general reluctance to
\nreport such errors. Health institutions
\nmust adopt a culture of patient
\nsafety to reduce and prevent patient
\nsafety errors, offering continuing
\neducation opportunities for health
\nprofessionals to refine their clinical
\nskills, avoid diagnostic errors that are
\nunderestimated, including hospital-
\nacquired infections. Aligned with the
\ntheme associated with World Patient
\nSafety Day 2024, improving health
\nprofessionals\u2019 diagnostic capabilities
\ncan help avoid preventable errors that
\nlead to harm, disability, mortality,
\nand affiliated malpractice lawsuits.
\nOver the past decade, the Argentina
\nMinistry of Health has strived to
\ndevelop relevant legislation and
\nguidelines that promote patient
\nsafety.First,the National Program for
\nQuality Assurance in Medical Care
\n(Programa Nacional de Garant\u00eda de la
\nCalidad de la Atenci\u00f3n M\u00e9dica) was
\nadopted by Secretarial Resolution No.
\n432 (Resoluci\u00f3n Secretarial N\u00b0432)
\nin 1992, endorsed by the National
\nExecutive Power (Poder Ejecutivo
\nNacional, PEN) Decree No. 1424
\n(Decreto PEN N\u00ba1424) in 1997, and
\nratified by the PEN Decree No. 178
\n(Decreto PEN N\u00b0178) in 2017 [10,11].
\nThese laws called for the development
\nof high-quality instruments to assess
\nquality management and patient
\nsafety [10,11]. Second, the Actions
\nfor Patient Safety in the Healthcare
\nField (Acciones para la Seguridad
\nde los Pacientes en el \u00c1mbito de la
\nAtenci\u00f3n Sanitaria) was adopted in
\n2019 and updated in 2021, followed
\nby the Tools for Self-Assessment of
\nGood Practices for Improving Quality
\nin Healthcare Services (Herramienta
\npara la Autoevaluaci\u00f3n de Buenas
\nPr\u00e1cticas para la Mejora de la Calidad
\nen los Servicios de Salud) in 2021,
\npresenting tangible measures to
\nenhance healthcare service delivery
\nand ultimately patient outcomes
\n[12,13]. Third, the Manual of
\nPatient Safety (Manual de Seguridad
\ndel Paciente) was published in July
\n2022, providing concrete strategies
\nand actions for organisational
\nstrategies in patient safety as well
\nas proposed indicators for program
\nevaluation [14].
\nCOMRA supports all initiatives
\nthat seek to prioritise patient safety,
\nas a fundamental step in the design,
\nexecution, and evaluation of national
\nand global health systems. We
\nbelieve that healthcare professionals
\nmust help prevent incidents by
\nmaking appropriate decisions that
\navoid unnecessary risks to patient
\nsafety in the clinical and community
\nworkplace. As health leaders improve
\nmonitoring systems for adverse event
\nreporting across institutions, they can
\ndesign evaluation tools to identify
\ngaps and address any limitations
\nin reporting schemes. We can also
\ndevelop capacity building
\nworkshops that can facilitate
\nknowledge sharing as well as
\nestablish a culture of continuous
\nlearning and interdisciplinary
\nteamwork that prioritises patient
\ncare.
\nC\u00f4te d’Ivoire
\nThe Republic of C\u00f4te d’Ivoire, a sub-
\nSaharan African nation of 30 million
\nresidents, shares its border with five
\ncountries (Burkina Faso, Ghana,
\nGuinea, Liberia, Mali) and the Gulf
\nof Guinea has an abundance of natural
\nresources (e.g. copper, diamond,
\ngold, petroleum) and agricultural
\ncrops (e.g. cocoa beans). Since
\nthe first (2002-2007) and second
\n(2010-2011) civil wars, the nation
\nhas experienced a rapid economic
\ngrowth to become classified as a low-
\nmiddle-income country. However,
\npoverty (35% of the population
\nliving below the poverty line), food
\ninsecurity and malnutrition (23% rate
\nof stunting), and gender inequalities
\nremain significant challenges for
\nhealth leaders [15]. In 2015, the
\nGovernment of C\u00f4te d\u2019Ivoire
\nWMA Members Highlight National Initiatives to Safeguard Patient Safety
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\n51
\nlaunched the universal healthcare
\nprogram, and more recently has
\nestablished mobile enrollment
\ncentres to expand access across
\nthe nation [16]. For this reason,
\nhealthcare professionals in the
\ncountry recognise World Patient
\nSafety Day as a unified global
\ncommitment to minimising risks
\nand preventing harm in healthcare
\nsettings as well as ensuring that every
\npatient receives safe and effective care.
\nOverthepastdecade,theGovernment
\nof C\u00f4te d\u2019Ivoire has implemented
\nseveral initiatives to promote patient
\nsafety across the population. First,
\nthe implementation of the National
\nHealth Development Plan (Plan
\nNational de D\u00e9veloppement Sanitaire,
\nPNDS) was adopted in 2011, and
\nthen updated in 2015 and 2021, as
\na comprehensive plan with specific
\nmeasures aimed at improving patient
\nsafety (e.g. enhancing the quality
\nof healthcare services, increasing
\naccess to essential medicines,
\nstrengthening health infrastructure)
\n[17]. Second, the Ministry of
\nHealth, in collaboration with various
\nnon-governmental organisations, has
\nlaunched community campaigns to
\neducate the public on promoting safe
\npractices (e.g. proper medication use,
\ninfection prevention, importance of
\nseeking timely medical care), as well
\nas seek to reduce common healthcare-
\nassociated infections and improve
\npatient outcomes. Finally, use of
\nmobile technology, social media
\nplatforms, and digital health tools
\nserve as a platform for sharing best
\npractices, reporting safety incidents,
\nand educating both healthcare
\nproviders and the public about the
\nimportance of patient safety [18,19].
\nAs physicians in the Ivory Coast, the
\nAfrican continent, and the world,
\nour call to action is clear: we must
\nadvocate for and implement robust
\npatient safety practices at every
\nlevel of healthcare delivery. First, we
\nmust promote a culture of safety by
\nencouraging open communication
\namong healthcare teams, patients,
\nand their families to ensure that safety
\nconcerns are addressed promptly and
\neffectively. Second, all healthcare
\nprofessionals should receive regularly
\ntraining on the latest safety protocols
\nand best practices in patient care.
\nThird, health leaders should advocate
\nfor policies that support resilient
\nhealth systems capable of responding
\nto emergencies and daily healthcare
\nchallenges, without compromising
\npatient safety. Finally, partnering
\nwith international and regional
\norganisations can offer a global
\nplatform to exchange knowledge
\nand resources that can help improve
\npatient safety. Together, by making
\npatient safety a priority,we can ensure
\nthat healthcare is safe for everyone,
\neverywhere.
\nEcuador
\nWorld Patient Safety Day holds
\nsignificant importance for physicians
\nin Ecuador,as it highlights the critical
\nneed to address gaps in patient safety
\nwithin our healthcare system. While
\nglobal patient safety initiatives are
\nrecognized, Ecuador faces unique
\nchallenges, such as limited resources
\nand varying levels of healthcare
\nquality across regions. According
\nto the WHO, 134 million adverse
\nevents occur annually due to unsafe
\ncare in hospitals, particularly in
\nlow- and middle-income countries,
\nresulting in 2.6 million deaths [9].
\nThe IBEAS study was conducted
\nacross selected Latin American
\ncountries (Argentina, Colombia,
\nCosta Rica, Mexico, and Peru) to
\nassess the prevalence of adverse
\nhealth events in hospitals, building
\non the ENEAS study (involving
\nSpain) [20]. Without comprehensive
\ndata reports on patient safety
\nincidents in Ecuador and the wider
\nLatin America and Caribbean
\nregion, which directly impede the
\ndevelopment of targeted interventions
\nand policies, more robust patient
\nsafety monitoring and reporting
\nsystems should be established and
\ntailored to the needs of the Ecuador
\nhealthcare system.
\nTo address this burden, the Ecuador
\nMinistry of Health has implemented
\nnumerous initiatives to promote
\npatient safety. First, leaders have
\nimplemented the use of care audits
\nas an independent mechanism to
\ninvestigate patient harm, which is a
\nstep toward improving accountability
\nand care standards [9]. Second,
\nthey have developed patient safety
\nguidelines aligned with international
\nstandards, including the Patient
\nSafety Manual in 2016, which aims
\nto improve care quality and reduce
\nadverse events [21]. Third, they have
\nintegrated patient safety education
\nmodules into the medical and nursing
\nschool curricula, which can foster a
\nsafety culture from early academic
\ntraining before clinical rotations.
\nFourth, healthcare professionals
\n\u2013 including doctors, pharmacists,
\ndentists, nurses, midwives, as well
\nas patients themselves \u2013 can report
\nsuspected adverse drug reactions,
\ntherapeutic failures, medication
\nerrors, and events supposedly
\nattributable to vaccination or
\nimmunization through a web portal
\nmanaged by the National Agency
\nfor Health Regulation, Control, and
\nSurveillance (ARCSA) [22]. Finally,
\nthe emergence of patient advocacy
\ngroups, although primarily focused
\non specific conditions like cancer,
\nhas the potential to evolve into
\nbroader patient safety movements, as
\nobserved with patients participating
\nin safety protocol role-playing
\nexercises in Spain. However, despite
\nthese robust initiatives, more
\nattention to government policies and
\npublic awareness campaigns must
\nexpand these efforts.
\nAs Ecuador physicians, our call
\nWMA Members Highlight National Initiatives to Safeguard Patient Safety
\nBACK TO CONTENTS
\n52
\nto action remains to actively build
\na patient-centred safety culture
\nthat adheres to established safety
\nprotocols and advocates for creating
\nnational patient safety registries
\nand improved communication
\nstrategies with patients. We must
\nprioritise health professionals\u2019
\ntraining on delivering difficult
\nnews with empathy to patients and
\ntheir families, recognizing that our
\napproach to health communication
\ncan significantly impact clinician-
\npatient rapport, patients\u2019 adherence
\nto clinical recommendations,
\nand overall patients\u2019 physical and
\nmental health outcomes. Moreover,
\nfostering a collaborative environment
\nwhere patients are seen as integral
\nhealthcare team members can
\ncontinue to strengthen the clinician-
\npatient relationship. By empowering
\npatients with accurate knowledge and
\nensuring their active participation in
\ntheir care, we can enhance trust and
\nimprove safety outcomes, ultimately
\nleading to a healthier and more
\nresilient healthcare system.
\nIndia
\nSince the United Nations reported
\nthat India had the world\u2019s largest
\npopulation (1.429 billion residents)
\nin 2023, when compared to China\u2019s
\npopulation (1.426 billion residents),
\nthis demographic trend presents
\nadditional challenges for the national
\nhealth system, including primary
\ncare services and patient safety [23].
\nOver the past 75 years, independent
\nfrom British rule, national health
\nleaders have successfully strengthened
\nhealth indicators (including reducing
\nmaternal and child mortality rates)
\n[24]. With significant disruption
\nto healthcare services during
\nthe coronavirus disease 2019
\n(COVID-19) pandemic, leaders
\nimplemented successful vaccination
\ncampaigns, supported digital
\ntechnologies and telemedicine
\nconsultations, and established more
\nthan 250,000 Health and Wellness
\nCentres [24]. As leaders continue to
\nscale-up and strengthen the health
\nsystem to address emerging health
\nrisks, they recognise the health
\nburden of adverse reactions (e.g.
\nhospital-acquired infections, unsafe
\nsurgeries and medications, faulty
\nmedical devices) can affect millions
\nof patients each year, leading to
\nincreased health expenditure, lack of
\ntrust within health institutions, and
\npotential demoralisation and burnout
\nof health professionals [25].
\nAs patient safety has gained
\nincreasing attention in India, several
\ninitiatives have adopted to enhance
\npatient safety across the health
\nsystem. In 2018, the India Ministry
\nof Health and Family Welfare
\nlaunched the National Patient Safety
\nImplementation Framework 2018-
\n2025 (NPSIF), a comprehensive
\nguideline and roadmap with six
\nobjectives, 21 priorities, and 81
\ninterventions, toward strengthening
\npatient safety at all levels of
\nhealthcare service delivery [26]. This
\ndocument covers legal aspects, quality
\nassessments, workforce development,
\ninfection control, and research,
\naiming to reinforce institutional
\nframeworks, build a competent health
\nworkforce, and establish reporting
\nsystems of adverse effects. Also, over
\nthe past decade, the Government
\nof India has established regulatory
\nbodies and legislature to monitor and
\nimplement patient safety initiatives,
\nincluding the National Accreditation
\nBoard For Hospitals and Healthcare
\nProviders (NABH) in 2005, National
\nAccreditation Board for Testing and
\nCalibration Laboratories (NABL)
\nin 1982, National Health Systems
\nResource Centre (NHSRC) in 2007,
\nas well as the Clinical Establishments
\nAct of 2010, Pharmacy Practice
\nRegulations of 2015, and the Drug and
\nCosmetics Act of 1940.
\nThe Indian Medical Association
\n(IMA), in collaboration with the
\nPatient Safety and Access Initiative
\nIndia Foundation (PSAIIF), adopted
\nthe Bangalore Declaration on 30
\nJune 2024, which aimed to bridge
\ngaps and enhance collaborations
\nbetween doctors and patients across
\nthe nation. IMA members believe
\nthat all physicians have an obligation
\nto advocate for patient safety and
\nshould collectively address existing
\nchallenges, including limited health
\nsystem infrastructure (including
\nhealth workforce shortages) and
\nincompliance with evidence-based
\nclinical protocols (including infection
\nprevention and control) [27]. We
\nrecognise the urgent need for robust
\npatient safety initiatives, including
\noffering continued education courses
\non clinical guidelines and research for
\nhealth professionals and accelerating
\nthe use of digital health technology
\nfor reporting adverse events in health
\ninstitutions.
\nKenya
\nPatient safety remains a critical
\nchallenge in Kenya, with adverse
\nevents affecting three in 10 patients
\nin hospital care settings [28]. Despite
\nhaving strong clinical policies and
\ndocumentation, the Kenya Ministry
\nof Health faces significant challenges
\nwith their implementation, including
\nhigh unemployment among doctors
\nand insufficient training for health
\nprofessionals, which ultimately
\nimpede patient safety initiatives
\nand quality of care for the Kenyan
\npopulation. One national study
\nreported that suboptimal systems
\nhindered the prompt identification
\nof critical illnesses, limited resources
\nfor continuity of care, and disrupted
\nthe flow of care, as major causes of
\nthe delays in the healthcare service
\ndelivery in Kenya\u2019s public hospitals
\n[29]. These findings highlight the
\nneed to reinforce strong clinical
\npolicies related to standardised
\neffective and reliable healthcare
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\n53
\npriorities in Kenya.
\nThe Kenya Ministry of Health,which
\nenvisions a nation where safety and
\nquality are valued and promoted, has
\nlaunchedsignificanteffortstopromote
\npatient safety for 51 million residents.
\nFirst, leaders adopted the National
\nPolicy on Patient Safety, Health Worker
\nSafety, and Quality of Care in 2022,
\nwhich is rooted in the Constitution
\nof Kenya 2010, Vision 2030, and the
\nKenya Health Policy 2014-2030, aims
\nto ensure the provision of respectful
\nand responsive quality healthcare
\nfor a healthy, productive, and
\nglobally competitive country [29].
\nSecond, Kenya prioritizes universal
\nhealth coverage (UHC), to provide
\nevery citizen with access to quality
\nhealthcare services without financial
\ndifficulties or undue burden. Thus,
\nthe policy emphasises strengthening
\ngovernance, protecting patients
\nfrom avoidable harm, ensuring
\nhealth professionals\u2019 well-being, and
\nmaintaining high-quality healthcare
\nservices.TheKenyaCommunityHealth
\nStrategy, recognized as one of the key
\ninitiatives for UHC implementation,
\nemphasises preventive measures by
\nrecognising that community health is
\nthe foundation of healthcare delivery
\nand providing policy direction for
\ncommunity health services [30].
\nKenya has robust community health
\nunits (serving defined geographical
\nareas) that are supported by
\ncommunity health assistants and
\nvolunteers who provide promotive,
\npreventive, basic curative and
\nrehabilitative services.
\nTo improve patient safety strategies,
\nthe Kenya Ministry of Health
\nshould enforce compliance with
\ninternational safety standards,
\nenhance healthcare professionals\u2019
\nemployment practices, and
\nstrengthen medical licensing and
\naccreditation systems. Investing
\nin healthcare infrastructure and
\ncontinuous professional development,
\nparticularly at the community level, is
\ncrucial to improving patient outcomes,
\nreducing medical errors, and building
\na resilient healthcare system. This
\napproach will ensure that healthcare
\nproviders are equipped with up-to-
\ndate skills and resources, enhancing
\nthe quality of care delivered across all
\nhealthcare system levels. Additionally,
\nprioritising community-level
\ninterventions will empower local
\nhealth professionals and promote
\npatient safety from the ground up,
\nfostering a culture of accountability
\nand excellence in healthcare delivery.
\nTo further enhance these efforts, the
\nKenya Ministry of Health should
\nactively seek collaborations with
\nother African countries to share
\nbest practices, innovative solutions,
\nand regional safety standards. By
\nworking together, African nations
\ncan collectively strengthen their
\nhealthcare systems, address common
\nchallenges,and drive progress towards
\nachieving safer and more efficient
\ncare for all patients.
\nMyanmar
\nIn Myanmar, patient safety initiatives
\nsupported by the National League
\nfor Democracy (NLD) government
\nleadership have been promising.
\nBased on recent patient safety baseline
\nassessments and recognition of
\npatient safety champions in 2018,
\nMyanmar\u2019s State Counsellor Daw
\nAung San Suu Kyi has led efforts
\nto increase medical standards in
\npublic hospitals and improve patient
\nsafety including blood transfusions,
\nimmunisations, and surgical
\nprocedures. The Ministry of Health
\nand Sports was drafting a new
\nNational Health Policy in 2021, to
\nreplace the 1993 policy, with patient
\nsafety as one of the nine areas one,
\nwhen the Myanmar’s military and
\nsecurity forces systematically attacked
\ncivilian hospitals and clinics [31].
\nThese Myanmar military and security
\nforces indiscriminate violence and
\nbombings have resulted in widespread
\ncasualties, with over 18.6 million
\npersons seeking humanitarian need
\n(including 2.8 million internally
\ndisplaced persons) [32]. With
\noverburdened healthcare facilities
\nfor war-related injuries and routine
\nmedical care, this violence has
\nresulted in serious injuries and long-
\nterm health consequences, including
\nincreased health expenditure on
\nphysical and mental health challenges
\n[33,34].
\nThe Myanmar junta forces have also
\nestablished blockades and restricted
\naccess to critical medical supplies
\nand humanitarian relief, which
\nhave discouraged Myanmar health
\nprofessionals, local aid workers, and
\nvolunteer humanitarian responders
\nfrom saving lives on the frontlines
\n[35]. They have demolished
\nimportant roadways that connect
\nvarioustownsandcities,whichhinders
\naccess to healthcare institutions
\n[36]. This forced displacement,
\nresulting in huge numbers of refugees
\nliving in transitory, overcrowded,
\nand unhygienic circumstances,
\ncan promote infectious disease
\ntransmission and challenge to
\nprovision of effective healthcare to
\npatients.
\nTo address patient safety concerns,
\nleading international organisations
\nlike the United Nations, World
\nMedical Association (WMA), and
\nJunior Doctors Network should take
\nimmediate action beyond issuing
\nstatements and declarations.They can
\nhelp provide essential medicine and
\nequipment directly to local frontline
\nhumanitarian responders, including
\nethnic civil society and community-
\nbased organisations, via locally led
\ncross-border channels. These efforts
\ncan help repair and restore destroyed
\nhospitals and clinics, ensuring that
\nmedical facilities have adequate
\nequipment, supplies, and reliable
\npower and communication supply.
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\n54
\nAlso, they can provide continued
\neducation courses and training
\n(including relevant mental health
\nresources) to Myanmar healthcare
\nprofessionals, so that they can
\neffectively manage emergency and
\ntrauma care and other conflict-related
\nhealth issues.
\nNigeria
\nPatient safety is essential for effective
\nhealthcare delivery across the world,
\nand although the African continent
\nis comprised of low- to high-income
\nnations, many remain challenged
\nto meet patient safety standards
\n[37]. The Nigerian health system,
\nserving 195 million residents, has
\nreported inadequate resources,
\npoor administrative regulations,
\ninsufficient training opportunities in
\npatient safety for health professionals,
\nobsolete medical equipment and
\nsupplies, and limited technologies
\nincorporated into healthcare visits
\n[38]. Notably, two studies across
\nNigeria have reported poor healthcare
\nprofessionals\u2019 adherence to patient
\nsafety measures. First, in one hospital
\nin Enugu (eastern Nigeria), 51%
\nof surveyed surgeons perceived
\npoor patient safety during surgical
\nprocedures and 38% regularly used
\navailable institutional protocols
\n(including 11.3% to prevent wrong-
\nsite surgery). A positive correlation
\nwas associated with the duration of
\nsurgical practice and their perception
\nof patient safety [39]. Second, in four
\npublic hospitals in Kaduna (northern
\nNigeria), 55% of participating
\nhealth professionals (doctors, nurses,
\npharmacists) responded positively
\nthat they consistently use strategies
\nthat enhance patient safety, 36.8%
\nfrequently reported adverse events,
\nand 51.4% perceived that hospital
\nmanagers and administrators support
\npatient safety [40].
\nTo address patient safety concerns,
\nthe Nigerian Federal Ministry
\nof Health and Social Welfare
\nlaunched the National Policy and
\nImplementation Strategy on Patient
\nSafety and Healthcare Quality in 2023,
\nas guidelines to improve the safety of
\nall medical procedures and enhance
\nthe quality of healthcare delivery [41].
\nAlso, health leaders have directed
\nsignificant efforts to educate health
\nprofessionals and the general public,
\nincluding regular participation in
\nWorld Patient Safety Day events. In
\n2023, the Nigeria Federal Ministry
\nof Health and Social Welfare, in
\ncollaboration with the Dr. Aneyo
\nStella Adadevoh Health Trust
\n(DRASA), organised a public walk
\nand public press briefing session as
\nwell as a two-day review workshop
\non policies and implementation
\nstrategies that promote patient safety
\nin Nigeria.
\nAs Nigerian physicians, we should
\ncollectively enforce current patient
\nsafety policies and advocate for new
\ngovernment policies, strategies,
\nand initiatives that expand health
\nsector funding, strengthen infection
\nprevention and control measures,
\nand reinforce the implementation of
\nclinical guidelines through regular
\nclinicalaudits.Also,healthinstitutions
\nand professional medical and nursing
\nassociations can develop capacity
\ntraining sessions on best practices in
\npatient safety,as part of the continued
\nprofessional development for all
\nhealth professionals. This national
\ncall for patient safety should be a
\npriority for all health professionals
\nacross Nigeria, encouraging medical
\nprofessional associations and
\nsocieties to collectively contribute
\nto minimising medical errors and
\nempowering patients as active
\nrecipients of healthcare services.
\nPhilippines
\nWorld Patient Safety Day calls on
\nFilipino physicians to prioritize
\npatient safety, address gaps in
\nhealthcare service delivery, and
\nenhance the quality of healthcare
\nservices. In the Philippines, existing
\nhealthcare system challenges include
\nhigh patient-nurse and patient-
\nphysician ratios, limited medical
\nsupplies, insufficient safety incident
\nreporting systems, and inconsistent
\nopportunities for professional
\ntraining on pressing health topics,
\nall of which directly impact the
\nquality of healthcare service delivery.
\nHence, the celebration of this day
\nestablishes a space for exchanging
\nideas, best practices, and updates to
\nencourage collective involvement
\nof patients and health professionals
\nin ensuring safe and high-quality
\npatient-centered care.
\nTo promote patient safety and harm
\nreduction, the Philippine College of
\nSurgeons implemented the WHO\u2019s
\nSafe Surgery Saves Lives program
\nin 2008. By 2010, the adoption of
\nthe Safe Surgery Checklist was still
\nlow, however, and compliance rates
\nranged from 0.15% to 3.6%. In
\nfact, hospitals with lower checklist
\nutilization experienced higher
\nmortality rates [42]. Similarly, clinical
\nmisdiagnoses among urban obstetric
\nproviders were estimated at 30%
\nin 2016, and specifically 25% for
\ncephalopelvic disproportion, 33%
\nfor postpartum hemorrhage, and
\n31% for pre-eclampsia conditions
\n[43]. Despite the establishment of a
\nnational pharmacovigilance system in
\n1994, researchers explored the use of
\ntext-based versus traditional paper-
\nbased systems to report adverse drug
\nreactions for resident physicians in
\na tertiary-level hospital in Manila,
\nconcluding that paper-based
\nsystems were preferred due to fewer
\nchallenges (e.g. proper reporting
\nsyntax, internet connectivity) [44].
\nWith additional support from the
\nDepartment of Health (DOH),
\nmany hospitals across the country
\nreported notable improvements in
\nachieving patient safety goals by
\n2018 [45].
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\n55
\nThe National Center for Patient
\nSafety, within the Government of
\nPhilippines\u2019 DOH, launched the
\nSafe Care Initiative in 2018, which
\nsupported health professionals\u2019
\ntraining, development of safety
\nprotocols, and auditing to improve
\npatient safety. In 2008, the DOH
\nestablished the National Policy on
\nPatient Health (Administrative Order
\nNo. 2008-0023), and later released
\nthe Revised Guidelines on Continuous
\nQuality Improvement (Administrative
\nOrder No. 2020-0034) in 2020, to
\nensure patient safety in healthcare
\nfacilities [46,47]. In observance of
\nWorld Patient Safety Day 2023,
\nthe DOH promoted the \u201cEngaging
\nPatients for Patient Safety; Elevate
\nthe Voice of Patients!\u201d theme to
\nunderscore the importance of patient-
\ncentred healthcare and decision-
\nmaking, diversity and inclusion
\nwithin the healthcare system, and the
\nneed for essential partnerships with
\nmedical professionals to create a safe
\nhealthcare environment for everyone
\n[48].
\nTo support academic training on
\npatient safety for health professional
\nstudents, trainees, and specialists,
\nthe Philippine Medical Association
\n(PMA) and the Philippine Nurses
\nAssociation (PNA) offer workshops,
\nwebinars, and professional
\ndevelopment programs on patient
\nsafety. The Philippine Alliance for
\nPatientSafety(PAPS)hoststheannual
\nNational Patient Safety Congress,
\nand the Philippine Alliance of
\nPatient Organizations (PAPO) is
\nactively involved in policymaking,
\nas part of the Health Technology
\nAssessment Council, ensuring
\nthe adoption of safe and effective
\nhealthcare technologies and
\nmedicines. Finally, the Philippine
\nCoalition Against Fake Medicines
\n(PCAFM) and the Safe Medicines
\nNetwork(SMN)aretwomultisectoral
\ncoalitions that lead advocacy efforts
\nfor strong legislative protections
\nthat combat counterfeit drugs and
\nenhance medication safety across the
\nnation.
\nAs World Patient Safety Day
\nemphasises the importance of patient-
\ncentred care and advocacy for patient
\nsafety standards, Filipino physicians
\nview this moment as an opportunity
\nto reaffirm their commitment to
\npromote patient-centred care in a
\nsafe and effective healthcare system.
\nTherefore, Filipino physicians are
\nurged to adopt and promote patient
\nsafety protocols, utilise systems for
\nreporting and learning from adverse
\nevents, and engage in continuous
\ntraining in patient safety. Specifically,
\nthey can collaborate with regional
\nand international organisations and
\nadvocate for stronger health policies
\nthat prioritise safety across the
\nPhilippines, Asia, and the globe.
\nRwanda
\nIn Rwanda, physicians recognise
\nthat patient safety is an integral
\npart of high-quality healthcare
\nservice delivery, which must support
\nsustained vigilance, foster a culture
\nof continuous improvement, and
\npromote health professionals\u2019
\nadherence to best practices and
\nstandards designed to protect
\npatients’ health and well-being
\n[49,50]. Although no published data
\non adverse events exist at the national
\nlevel, individual hospitals submit
\nincidentreportsthathelpshedlighton
\nthe burden of adverse events,which in
\nturn can inform government policies
\nand strategies on patient safety.In one
\nrecent study conducted with hospital
\nmanagers from 47 public hospitals in
\nRwanda, authors concluded that the
\nprevalence of adverse events and other
\nincidents was less than 1%, namely
\ndue to adverse drug incidents (25%),
\nloss to referrals and follow-up (25%),
\nand surgical site infections (20%)
\n[51]. Together with other countries,
\nRwandan health leaders recognise
\nand celebrate World Patient Safety
\nDay every year, to represent a shared
\ncommitment to ensuring that each
\npatient receives safe and quality care
\nacross health institutions [52,53].
\nTo prevent unintended harm or
\nadverse consequences to patients and
\ntheir community, Rwandan leaders
\nhave developed strategies, policies,
\nand initiatives to improve and advance
\npatient safety. First, the Rwanda
\nFourth Health Sector Strategic Plan
\nwas launched in 2018, with strategic
\nemphasis on quality and people-
\ncentred healthcare as a foundation for
\npromoting patient safety [50]. Each
\nhospital has pharmacovigilance and
\ndrug and therapeutic committees,
\nwhich are instrumental to monitoring,
\nreporting, and overseeing initiatives
\nthat prevent harm due to unintended
\nadverse reactions from medications
\n[49]. Second, the Rwanda Ministry
\nof Health developed Patient Rights
\nCharters and mandated the public
\ndisplay of patients\u2019 rights to care
\nin all health facilities, in efforts to
\nensure transparency and trust in
\nhealth services. Third, the Ministry
\nof Health initiated the hospital
\naccreditation process in 2012, first
\nwith referral hospitals and then all
\nhealth facilities, as a mechanism for
\nimproving quality and accountability
\nas well as patient satisfaction [52].
\nLeaders established customer care
\nservices in all hospitals to support
\nthe timely responses to patient
\nconcerns, allowing patients to give
\nfeedback on service received as well as
\nanonymous reporting of unpleasant
\nexperiences, which can objectively
\ninform improvement efforts. Finally,
\nstakeholders representing the local
\ngovernment, non-government
\nagencies, and civil societies supported
\ncapacity building on professional
\nethics and patient rights, such as
\nthe Health Development Initiative
\n(https:\/\/hdirwanda.org\/) as a local
\nnon-governmental organisation
\nthat recently organised an inter-
\nprofessional workshop on patients\u2019
\nrights.
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\n56
\nRwandan leaders understand
\nthat ensuring patient safety is a
\ncontinuous process, noting that
\nthere are always risks associated with
\nmedication errors and healthcare-
\nassociated infections [50]. Despite
\nrobust measures to improve quality of
\ncare and minimise healthcare-related
\nrisks to patients, Rwandan health
\nleaders call for reinvigorated efforts
\nto collaborate with all stakeholders
\nto implement more systemic changes
\nthat prioritises patients\u2019 interests.
\nAs Rwandan physicians understand
\ntheir critical role and contributions
\nto upholding and safeguarding the
\nfundamental \u201cdo no harm\u201d principle,
\nthey call for continued investment in
\nactions that further promote patient
\nsafety. Such efforts can include
\ndesigning comprehensive initiatives
\nfor patient and community education
\nand empowerment, improving
\nsafety within the clinical workplace,
\nrequiring rigorous monitoring
\nof incidents and transparency
\nin adverse event reporting, and
\npromoting positive physician-patient
\ncommunication. Rwandan physicians
\nagree that they can educate and
\nencourage patients to contribute to
\ncommunity-wide advocacy efforts
\nthat hold the healthcare system
\naccountable for the implementation
\nof evidence-based safety measures.
\nThey also highlight that self
\nreflection and continuous medical
\neducation are essential ingredients
\nfor cultivating behaviour change in
\nthe clinical setting and commit to
\nincreased vigilance and adherence
\nto clinical policies and guidelines
\n(including standard operating
\nprocedures) that protect patient safety
\nacross health institutions.
\nSouth Africa
\nPatient safety incidents often result
\nfrom poorly implemented safety
\npolicies and a culture that overlooks
\npatient safety in the public health
\nsector and human error in high-risk
\ninterventions in the private sector
\n[54]. In South Africa, patient
\nsafety within the health sector is
\ncomprised of protection for medical
\nand surgical procedures as well as
\nphysical health and well-being. First,
\nalthough evidence-based guidelines
\nare followed by health professionals
\nin clinical practice, ranging from
\nprescribingmedicationstoperforming
\nsurgical procedures, adverse events
\nmay occur resulting from procedures
\nor infection [54]. In fact, medico-
\nlegal liabilities in South Africa were
\nreported to exceed US$5 billion in
\n2020, with a 30% annual growth
\nrate, in the public sector, while the
\ncriminalisation of medical errors has
\nbecome rampant in the private sector
\n[55,56]. Second, the physical safety of
\npatients and health professionals has
\nbeen affected by robbery in medical
\nfacilities across the country, leading
\nto physical and psychological trauma
\n[57].
\nTo maintain high-quality patient
\nsafety management across the nation,
\nthree leading stakeholder institutions
\nmanage the administrative and
\npolicy requirements. First, the South
\nAfrica Department of Health (DoH)
\nmanages quality improvement
\nthrough the National Health
\nQuality Improvement Plan, as well as
\nimplementation of the Ideal Clinic
\nand the Ideal Hospital Frameworks
\n(https:\/\/www.idealhealthfacility.org.
\nza\/).Second,the Office of Healthcare
\nStandards (OHSC) (https:\/\/ohsc.
\norg.za\/) helps develop regulations
\nfor patient safety, inspections and
\nenforcement, and health facility
\ncertifications, to support quality
\nhealthcare assurance. Finally, the
\nOffice of the Health Ombud, which
\nis directly linked to the OHSC,
\nleads investigations of reported
\npatient safety incidents across health
\nfacilities. All reported incidents
\nadhere to the National Guideline for
\nPatient Safety Incident Reporting and
\nLearning in the Health Sector of South
\nAfrica, which represents collaborative
\nefforts on patient safety between the
\nDoH, OHSC, and the Office of the
\nHealth Ombud [58].
\nTo promote the culture of patient
\nsafety culture in South Africa and
\nthe wider African continent, it is
\nimperative for all health professionals
\nto understand the evidence-based
\nclinical guidelines that are appropriate
\nfor their daily clinical responsibilities
\nto patient care. Continuous
\nprofessional development on the best
\npractices for infection control and
\nadverse event reporting, coupled with
\nhealth system financing for products
\nand supplies, can equip health
\nprofessionals with the knowledge
\nand tools to uphold administrative
\npolicies. Since inadequate security
\nsystems in health facilities can impact
\npatient safety, security assurance
\nmodels for healthcare should be
\ndeveloped to improve the safety of
\npatients seeking healthcare in public
\nand private facilities in South Africa
\n[57].
\nTaiwan
\nThe Patient Safety Committee of
\nthe Taiwan Ministry of Health and
\nWelfare has continued to lead robust
\npatient safety initiative across health
\ninstitutions for over three decades.
\nIn 1999, the Ministry of Health
\nand Welfare (previously recognised
\nas the Department of Health until
\n2013), Taiwan Hospital Association,
\nTaiwan Non-Government Hospitals
\nand Clinics Association, and Taiwan
\nMedical Association established the
\nJoint Commission of Taiwan (JCT)
\n(https:\/\/www.jct.org.tw\/mp-2.html),
\nto promote patient safety through
\nthe delivery of quality of healthcare
\nservices. This initiative led to the
\nestablishment of the Taiwan Patient
\nSafety Reporting System (TPR) in
\n2005, as an anonymous, voluntary,
\nconfidential, and collaborative
\nlearning-based medical accident
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\n57
\nreporting system in Taiwan [59].
\nSpecifically, a total of 16,043
\nfacilities (including clinics) have
\njoined the TPR in Taiwan, and an
\nestimated 957,310 adverse events
\nwere reported between 2005 and
\n2022 [60]. After the launch of the
\nTaiwan Patient Safety Culture Survey
\nProject in 2009, the JCT highlighted
\nthe improvement of patient safety
\nindicators in community and regional
\nhospitals (including staff) from 2009
\nto 2016 [61].
\nOver the past decade, the Taiwan
\nMinistry of Health and Welfare has
\nadopted legislature and coordinated
\nnational projects to address patient
\nsafety concerns across health
\ninstitutions. First, the Childbirth
\nAccident Emergency Relief Act of
\n2015, namely Article 22, mandates
\nthat health institutions establish
\ninternal risk event management and
\nreporting mechanisms to analyse
\nthe primary causes of significant
\nchildbirth accidents, reduce the
\nrisk of childbirth accidents, and
\npropose action plans [62]. Second,
\nthe Medical Accident Prevention and
\nDispute Resolution Act of 2022, which
\nwas enacted in 2024, requires the
\nprompt reporting of any significant
\nharm or death resulting from medical
\nerrors for subsequent evaluation
\nby authorities. This policy aims to
\npromote an efficient medical dispute-
\nhandling mechanism, harmonious
\ndoctor-patient relationships, and
\npatient safety culture across health
\ninstitutions in Taiwan [63].
\nFurthermore, the Taiwan Ministry of
\nHealth and Welfare has prioritised
\nthree specific activities over the past
\ndecade. In 2012, the Pilot Program
\nfor Managing Childbirth Accident
\nDisputes was established, allowing
\nparticipating institutions to conduct
\ninspections and submit regular
\nquality reports. In 2022, experts
\nwere invited to create checklists on
\npostpartum haemorrhage bundle care
\nand pregnancy-induced hypertension
\nand preeclampsia bundle care, based
\non international obstetric care
\nmodels (including six key obstetrics
\nand gynaecology risk management
\nprinciples). In 2023, postpartum
\nhaemorrhage educational leaflets
\nwere designed to help healthcare
\nprofessionals and the general public
\nunderstand prenatal, intrapartum,
\nand postpartum care, and hence
\naim to lower the risk of postpartum
\nhaemorrhage and improve its clinical
\nmanagement.
\nThe Taiwan Medical Association
\nsupports the ambitious goals of the
\nTaiwan Ministry of Health and
\nWelfare published in the Annual
\nGoals for Patient Safety, 2024-
\n2025 [64]. These goals include
\nenhancing healthcare teamwork and
\ncommunication (including clinician-
\npatient rapport and engagement
\nwith families), improving surgical
\nand medication safety, ensuring
\nadherence to infection control
\nmeasures, preventing severe
\ninjuries (including patient falls),
\nprotecting vulnerable populations
\n(including pregnant women and
\ninfants), and ultimately fostering
\npatient safety culture (including
\nreporting mechanisms of patient
\nsafety incidents) [64]. As Taiwanese
\nphysicians provide compassionate
\ncare to over 23 million residents,
\nthey recognise World Patient Safety
\nDay each year and collectively
\nfocus on best clinical practices and
\npolicies to improve patient safety and
\nclinician-patient engagement across
\nhealth institutions in Taiwan.
\nUganda
\nIn Uganda, health professionals
\nrecognise World Patient Safety Day
\nas a day to reflect upon the \u201cdo no
\nharm\u201d principle and discuss strategies
\nthat can help improve patient safety
\nacross health institutions. However,
\nthe quality of healthcare is severely
\ncompromised with high clinician-
\npatient ratios, including a doctor-
\npatient ratio of 1:25,725 and a
\nnurse-patient ratio of 1:11,000,
\noverburdened schedules, limited
\ndocumentation, and inadequate
\nhealthcare infrastructure [65]. At the
\nsame time, as healthcare services have
\nlimited accessibility and availability,
\nlong distances from communities,
\nand high costs, patients frequently
\nseek non-traditional services that
\nmay contribute to self-medication
\nand unregulated herbal remedies. In
\n2014, one national report highlighted
\nthat 5-20% and 28% of hospitalised
\npatients in Ugandan health
\ninstitutions had experienced adverse
\ndrug reactions and hospital-acquired
\ninfections,respectively [66].Common
\nmedical errors were described
\nas delayed or failed diagnoses,
\ninteroperative complications, and
\naccidental needle stick injuries [66].
\nUganda leaders have undertaken
\nseveral initiatives to promote patient
\nsafety for health institutions serving
\nthe 45 million residents. First, the
\nUgandan Patient Safety Symposium,
\nwhich was held in September 2018,
\naimed to foster inclusive dialogue,
\nevaluate current and past patient
\nsafety initiatives, and develop a
\nframework for future action [67].
\nSecond, the Uganda Ministry of
\nHealth, together with community
\nstakeholders, adopted the Patient
\nand Client Rights Charters in 2019,
\nas a legal and regulatory framework
\nto improve healthcare service delivery
\nand ultimately health indicators in
\nUganda [68]. Third, the Uganda
\nMinistry of Health launched the
\nHealth Facility Quality of Care
\nAssessment Program in 2020, to
\nensure standard of care in hospitals
\nthrough quarterly evaluations, which
\nhas been implemented in 85% of
\nthe districts. Finally, the Patient-
\nCentred Care Movement Africa
\n(PaCeM-Afro), led by health
\nprofessional students and recognised
\nWMA Members Highlight National Initiatives to Safeguard Patient Safety
\nBACK TO CONTENTS
\n58
\nat the 74th WHA in May 2021, has
\ncontinued to advocate for patient-
\ncentred care through education,
\nresearch, and social media campaigns
\n[69].
\nAs physicians across Africa and the
\nworld, we must collectively advocate
\nfor comprehensive patient safety
\nguidelines and policies, as well as
\nhealthcare systems with Ministry
\nof Health oversight to ensure that
\npatients are free from harm and
\navoidable risks. We can continue
\nto educate patients on their rights
\nand responsibilities and support
\nsustained health professionals\u2019
\ntraining. Specifically, we can help
\nengage communities through the
\nPatient and Client Rights Charters,
\nand empower patients to work
\ncollectively with health professionals
\nin the delivery of high-quality
\nhealth services across Uganda [68].
\nUruguay
\nOver the past two decades, the
\nUruguay Ministry of Health has
\nguided the patient safety initiatives
\nbased on international data sources
\n(like the WHO), since national
\nreports have not examined incidence
\nand prevalence rates of adverse
\nhealth events. Taking the lead,
\nUruguay leaders joined the WHO
\nPatient Safety Alliance in 2006,
\nand participated in the first global
\nchallenge (\u201cClean Medicine is Safe
\nMedicine\u201d) that promoted the
\nimportance of optimal hand hygiene
\npractices in healthcare settings. To
\nsupport the initiatives of the national
\nhealth system, leaders adopted Law
\n18.995 (Ley 18.995) in 2012, which
\nensure the annual recognition of
\nNational Patient Safety Day on 14
\nApril, in addition to the WHO\u2019s
\nannual celebration of World Patient
\nSafety Day on 17 September [70].
\nHowever, with changing leadership
\nwithin the Ministry of Health,
\nwidespread initiatives on patient
\nsafety tend to be conducted annually
\nby non-governmental organisations
\nand professional associations, noting
\nthat 14 April offers reflections on
\npatient safety and 17 September
\nprovides formal activities to engage
\naudiences on patient safety.
\nUruguay Ministry of Health leaders
\ncontribute to strengthening the
\nnational health system through
\nlegislation and initiatives that
\npromote high-quality health service
\ndelivery for its 3.4 million residents.
\nFirst, health leaders were using a
\nself-assessment and guidance tool,
\nadapted from the United Kingdom\u2019s
\nNational Health Service seven-step
\ntool, to evaluate institutional needs
\nand establish primary guidelines for
\npreparing and implementing patient
\nsafety plans across institutions until
\n2019 [71]. Second, the Ordinance
\n660\/2006 (Ordenanza 660\/2006) of
\nthe Ministry of Health was adopted in
\n2006, outlining that the Commission
\nfor Patient Safety and Prevention
\nof Medical Errors (Comisi\u00f3n para
\nla Seguridad de los Pacientes y
\nPrevenci\u00f3n del Error en Medicina,
\nCOSEPA) has the responsibility of
\nstrengthening the culture of safety
\nfor health professionals, patients, and
\ntheir families in Uruguay [72]. They
\nalso approved the Ordinance 804\/022
\n(Ordenanza N\u00b0 804\/022) in 2022,
\nwhich reinforced previous legislation
\non patient safety and surveillance of
\nadverse events [73]. Finally, Uruguay
\nleaders conducted the first national
\nsurvey on the impact of disruptive
\nbehaviours in the health sector to
\nover 4,000 health professionals from
\nthe national health system in 2014,
\nnoting the need to address the high
\nincidence of negative behaviours
\n(e.g. derogatory comments, anger
\nepisodes) that hinder effective
\nteamwork, communication, and
\nsafety for health professionals and
\npatients alike [74]. Although these
\nachievements have helped lead patient
\nsafety efforts across the country,
\nevaluations related to the compliance
\nof patient security measures across
\ninstitutions have not been conducted
\nsince 2019.
\nAs Sindicato M\u00e9dico del Uruguay
\n(SMU) members representing diverse
\nclinical and surgical specialties,
\nour call to action is to promote
\nthe integration of safety protocols
\ninto clinical management (\u201csafety-
\ninspired clinical management\u201d) of
\nall healthcare activities. Notably,
\nwe recognised National Patient
\nSafety Day on 14 April 2024 (and
\nwill commemorate World Patient
\nSafety Day on 17 September 2024),
\nas events that will help align our
\nlocal and national efforts to reduce
\nadverse events in health settings [75].
\nUruguayan physicians, together with
\nour WMA colleagues,can continue to
\nlead efforts that empower the entire
\nhealthcare team to prioritise high-
\nquality patient-centred care across
\npublic and private sectors, as well as
\ndirectly involve family members in
\nthe clinical decision-making process.
\nYemen
\nFor Yemeni physicians,World Patient
\nSafety underscores the urgent need
\nto address critical issues within the
\nhealthcare system, which has endured
\nongoing conflict and resource
\nshortages since 2015 [76].The WHO
\nhas highlighted that preventable
\nmedical errors are a leading cause
\nof harm to patients globally, and the
\nsituation in Yemen is particularly
\ndire. The Yemen Ministry of
\nPopulation and Public Health
\nreported that hospital-acquired
\ninfections and medication errors
\nwere estimated at 20% and 15% in
\n2021, respectively, emphasising the
\nurgent need to improve patient safety
\npractices and infrastructure across the
\nnation [77,78].
\nDespite its challenging
\ncircumstances, Yemenis leaders have
\nWMA Members Highlight National Initiatives to Safeguard Patient Safety
\nBACK TO CONTENTS
\n59
\nadopted two significant policies and
\ninitiated several efforts to improve
\npatient safety. First, Law No. 26 was
\nadopted in 2002, which criminalised
\nhealth professionals who refrained
\nfrom treating patients in emergency
\nor disaster response scenarios [79].
\nLaw No. 4 was approved in 2009,
\nwhich dually defined roles and
\nresponsibilities related to
\ninfectious disease prevention and
\ncontrol, criminalising actions that
\nintentionally hinder appropriate
\nreporting measures or increase risk of
\ndisease transmission, and guarantee
\npatients\u2019 rights to immediate medical
\ncare in emergency scenarios [80].
\nSecond, the WHO\u2019s Safe Surgery
\nSaves Lives program was developed in
\n2009, aligning with WHO guidelines
\nto enhance surgical safety, and aimed
\nto standardise surgical procedures,
\nensure proper sterilisation, and
\ntrain healthcare professionals in
\nbest clinical practices. The National
\nPharmacovigilance Program,
\nestablished in 2009, was designed to
\nmonitor and evaluate adverse drug
\nreactions to improve medication
\nsafety [78]. Finally, community
\ncampaigns that promote hygiene
\npractices and vaccination adherence
\nhave been fundamental in raising
\npublic awareness and fostering a
\nculture of safety across the population.
\nPhysicians in Yemen and across the
\nglobe must take a proactive role in
\nenhancing patient safety, including
\nadvocating for robust healthcare
\npolicies, engaging in continuous
\nprofessional development, and
\nadhering to international safety
\nguidelines. Collaborations with
\nglobal health organisations can
\nprovide essential support and
\nresources to strengthen Yemen\u2019s
\nhealthcare system. By emphasising a
\npatient-centred approach, physicians
\ncan encourage patients to actively
\nparticipate in their care to reduce
\nerrors and improve safety outcomes.
\nBy fostering a culture of transparency,
\naccountability, and dedication to
\nexcellence in patient care, physicians
\ncan lead the way toward a safer and
\nmore resilient health system for the
\nglobal population.
\nConclusion
\nWorld Patient Safety Day 2024 offers
\nan opportune moment for global
\nhealth leaders to evaluate current
\npatient safety initiatives within health
\nsystems, identify risks to adverse
\nevents, and reinforce their political
\ncommitment to promoting a safety
\nculture. Together, they can endorse
\nthe Patient Safety Rights Charter
\nand collaborate on the
\nimplementation of the seven
\nstrategic objectives of the Global
\nPatient Safety Action Plan 2021\u20132030
\nacross national health systems [8,9].
\nUsing the \u201cImproving Diagnosis for
\nPatient Safety\u201d theme, they can also
\nincorporate evidence-based clinical
\nand surgical practices for patient-
\ncentred care as well as support health
\nprofessionals\u2019 engagement with
\npatients and families as partners in
\nhealthcare service delivery [6]. By
\nreflecting on the \u201cfirst, do no harm\u201d,
\nhealth professionals can apply the
\nOne Health concept to practise,
\nas they form robust strategic- and
\noperational-level partnerships with
\nhealth stakeholders and elucidate the
\ndrivers of unsafe clinical practices and
\npatient harm.
\nWith expertise across clinical and
\nsurgical disciplines, WMA members
\nserve diverse leadership roles in their
\nacademic and health institutions,
\nnational medical associations, and
\ncountries. They contribute evidence-
\nbased research findings and expert
\nperspectives to national and global
\ndiscourse on an array of topics,
\nincluding patient safety, to reinforce
\nhealth system resiliency. This
\ncollective article presents a valuable
\noverview of robust community
\ninitiatives and policies that support
\nhigh-quality healthcare services,
\nessential partnerships with health
\nstakeholders, provider-patient
\nrapport and communication, and
\npublic awareness, and hence optimal
\npatient outcomes. Specifically, it
\nhighlights clear examples of timely
\nhealth leadership and political
\ncommitment across the African,
\nAmericas, Eastern Mediterranean,
\nand South-East Asian regions that
\nexemplify global solidarity and action
\nto promote patient safety.
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