Health Care – WMA – The World Medical Association

Adopted by the 72^nd WMA General Assembly (online), London, United Kingdom, October 2021

PREAMBLE

Surgery and anesthesia care encompass all clinical fields and all health care providers dealing with surgical disease and pathologies. This includes, but is not limited to anesthesia, obstetrics and gynaecology and surgery including all of its subspecialties. They have historically been a neglected part of global health with very little investments made in developing surgical health systems, while an estimated quarter of the burden of disease worldwide can be attributed to surgical diseases. Moreover, the majority of the world’s population lacks access to safe, timely and affordable surgical care.

A workforce of 20 surgical, anesthesia and obstetric physician providers for every 100.000 members of the population is necessary to provide 80% of the world population essential and emergency surgical care within 2 hours. This includes emergency surgical and obstetric care such as caesarian sections and surgical care to prevent death and disability due to illnesses likely to benefit from surgical treatment such as injuries, cataracts and cancer. The majority of low- and middle-income countries (LMICs) fall far below this target, with the need being especially great in the poorest regions of the world.

Surgeon shortages may be exacerbated by a lack of gender equity in the surgical workforce which remains a challenge. Despite the fact that in a number of countries, there are more female than male medical students, men still outnumber women by far in the surgical workforce.

Surgery and anesthesia care have been proven to be cost-effective, especially in LMICs. Surgical interventions are as cost-effective as common public health interventions like malaria bed nets, HIV drugs or childhood vaccinations.

Sixty percent of cancer patients and eighty percent of trauma patients will need some form of surgical intervention throughout their treatment. Considering both non-communicable diseases (NCDs) and injuries are on the rise globally, the demand for surgical care is expected to continue to increase.

In 2015 the World Health Assembly recognized surgery and anesthesia care as a vital component of Universal Health Coverage (UHC) through their Resolution 68.15 “Strengthening emergency and essential surgical care and anesthesia as a component of universal health coverage”.

RECOMMENDATIONS

WMA recommends that the relevant national authorities:

Integrate quality surgical and anesthesia care in all levels of health care, including comprehensive primary health care in order to realize UHC and Sustainable Development Goals by 2030.

Develop specific surgery and anesthesia guidelines and policies for their respective countries or jurisdictions adapted to local needs and capacities.

Implement policies regulating the process of task shifting in surgery and anesthesia care in line with the “WMA Resolution on Task Shifting from the Medical Profession”.

Invest in health system strengthening and advocate for increased financing and budgetary allocation for surgery and anesthesia care without depriving other areas of necessary funds.

Provide the necessary infrastructure and procurement lines for hospitals to deliver safe, high-quality surgical care.

Ensure policies, including narcotic and regulated drugs policies, do not hamper access to necessary surgical medications including analgesia and anesthetic agents.

Create clinical protocols or guidelines at the national or regional level to assure antibiotics use in the peri-operative period are prescribed in a sustainable manner and in line with applicable antimicrobial resistance guidelines.

Include surgical care and diseases in relevant courses to fight the dogma that surgical care is too expensive and complex to provide in low-resource settings.

Offer equitable residency training opportunities to locally trained medical students of both genders in the field of surgery and anesthesia based on scientifically projected needs of the country or region in line with the “WMA Statement on Gender Equality” and contributing to the Global strategy on human resources for health: Workforce 2030.

Allow adaptive training and work schedules to accommodate the potential need for maternity or paternity leave, and a healthy work-life balance, in order to make training programs more accessible irrespective of the trainee’s family responsibilities.

Seek regional, national and international collaboration in clinical and academic domains where local capacity and resources may be lacking and where exposure could be beneficial to those from areas without high capacity or resources, such as through bilateral exchange programs.

Support national initiatives on surgical data collection, capacity building, advocacy, policy planning and systems strengthening through collaboration with NGOs, universities, research initiatives, local communities, development banks, governmental organizations, and other stakeholders;

WMA commits to:

Advocate at local, regional and national, and international fora in favor of person-centered care creating a more holistic health care system, offering medical, surgical, mental health and preventive health services in a national UHC approach, supporting WHA Resolution 68.15 “Strengthening emergency and essential surgical care and anesthesia as a component of universal health coverage”.

Adopted by the 70^th WMA General Assembly, Tbilisi, Georgia, October 2019

PREAMBLE

The WHO constitution states that “the extension to all people of the benefits of medical, psychological and related knowledge is essential to the fullest attainment of health”. Access to relevant, reliable, unbiased, up-to-date and evidence-based healthcare information is crucial for the public, patients and health personnel for every aspect of health, including (but not limited to) health education, informed choice, professional development, safety and efficacy of health services, and public health policy.

Lack of access to healthcare information is a major contributor to morbidity and mortality, especially in low- and middle-income countries, and among vulnerable groups in all countries.

Healthcare information is only useful if it is relevant, appropriate, timely, updated, understandable and accurate. It covers a broad spectrum of issues and refers to diseases, treatments, services, as well as the promotion and preservation of health.

Health literacy is a key factor in understanding how health services work and how to use them. Health professionals need access to adequate training and support to communicate with patients with low health literacy or with those who have difficulty understanding healthcare information, for example because of a disability.

Globally, thousands of children and adults die needlessly because they do not receive basic life-saving interventions. Some interventions may be available locally but are simply not provided due to indecision, delays, misdiagnosis and incorrect treatment. Failure to provide basic life-saving interventions more commonly affects those who are socioeconomically disadvantaged.

In the case of children with acute diarrhea, for example, the widespread misconception among parents that they should withhold fluids, and among health workers that they should give antibiotics rather than oral rehydration, contributes to thousands of unnecessary deaths every day worldwide.

Governments have a moral obligation to ensure that the public, patients and health workers have access to the healthcare information they need to protect their own health and the health of those for whom they are responsible. This obligation includes providing adequate education, in form and content, to identify and use such information effectively.

The public, patients and healthcare workers need easy, reliable access to evidence-based, relevant healthcare information as part of a learning process throughout the life-course to enhance understanding, and to make informed and conscious decisions about their health, healthcare options and the health care they receive. These groups need information in the right language, and in a format and technical level that is understandable to them, with relevant services signposted as appropriate. This should take into account the characteristics, customs and beliefs of the population to which it is directed, and a feedback process should be established. The public, patients and families need information that is appropriate to their specific context and situation, which may change over time. They need guidance on when and how to make important health decisions, which are usually best made when there is time to consider, understand and discuss the issue at hand.

Meeting the information needs of the public, patients and healthcare providers is a prerequisite for the realisation of quality universal health coverage and the UN Sustainable Development Goals (SDGs).” UN SDG Target 3.8 on universal health coverage specifically aims to deliver ‘quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all’. Achieving this requires empowerment of the public and patients, as well as health workers, with the healthcare information they need to recognize and assume their rights and responsibilities to access, use and provide appropriate services and to prevent, diagnose and manage disease.

The development and availability of evidence-based, relevant healthcare information depends on the integrity of the global healthcare information system. This system comprises researchers, publishers, systematic reviewers, producers of end-user content (including academic publishers, health education, journalists and others), information professionals, policymakers, frontline health professionals and patient representatives, among others.

RECOMMENDATIONS

Recognizing this, the World Medical Association and its constituent members on behalf of their physician members, will support and commit to the following actions:

Promote initiatives to improve access to timely, current, evidence-based healthcare information for health professionals, patients and the public to support appropriate decision-making, lifestyle changes, care-seeking behaviour and improved quality of care – thereby upholding the right to health.
Promote standards of good practice and ethics to be met by information providers, guaranteeing reliable and quality information that is produced with the participation of physicians, other health professionals, and patient representatives.
Support research to identify enablers and barriers to the availability of healthcare information, including how to improve the production and dissemination of evidence-based information for the public, patients and health professionals, and measures to increase health literacy and the ability to find and interpret such information.
Ensure that health professionals have access to evidence-based information on diagnosis and treatment of diseases, including unbiased information on medicines. Particular attention should be paid to those working in primary care in low- and middle-income countries.
Combat myths and misinformation around healthcare through validated scientific and clinical evidence, and by urging the media to report responsibly on health issues. This includes the study of health-related beliefs stemming from cultural or sociological differences. This will improve the effectiveness of health promotion activities and allow the dissemination of healthcare information to be adequately targeted to different segments of the population.
Urge governments to recognize their moral obligation to take measures to improve the availability and use of evidence-based healthcare information. This includes:
- resources to select, compile, integrate and channel scientifically validated information and knowledge. This should be adapted to target various different recipients;
- measures to increase availability of healthcare information for healthcare workers and patients at health centres;
- leveraging modern communication technology and social media;
- policies that support efforts to increase the availability and use of reliable healthcare information.
Urge governments to provide the political and financial support needed for ‘WHO’s function to ensure access to authoritative and strategic information on matters that affect peoples’ health’, based on the WHO General Programme of Work 2019-23.

Within the framework of the Health Care in Danger project, the World Medical Association (WMA), the International Committee of Military Medicine (ICMM), the International Council of Nurses (ICN) and the International Pharmaceutical Federation (FIP) were consulted by the ICRC with the aim of these organizations agreeing on a common denominator of ethical principles of health care applicable in times of armed conflict and other emergencies. These principles, which are the result of these consultations, are without prejudice to existing policy documents adopted by these organizations.

The “Ethical Principles of Health Care in Times of Armed Conflict and Other Emergencies” were adopted by the 65th General Assembly of the WMA, Durban (South Africa), October 2014 and officially launched by all partners in June 2015.

Adopted by the 66^th General Assembly, Moscow, Russia, October 2015
and rescinded and archived by the 72^nd WMA General Assembly (online), London, United Kingdom, October 2021

The WMA recognises that mass movement of people often follows disasters that flow from armed conflict or natural phenomena as populations seek to escape danger and deprivation. The current mass movement of the populations, to escape the effects of armed conflict including bombing, lack of access to utilities, clean water, and the destruction of homes, schools and hospitals, has been numerically larger than any mass movement of populations in over 70 years.

While the WMA recognises that countries may have concerns about their ability to absorb significant numbers of new migrants, we recognise that people fleeing warfare, or natural phenomena are doing so because they are desperate and often face life-threatening conditions. They are afraid for their health, safety and welfare, and that of the family members who accompany them.

Most countries have signed international treaties giving them binding obligations to offer aid and assistance to refugees and asylum seekers. The WMA believes that, when there are events, including on-going events such as conflict, which generate refugee crises, governments must increase their efforts to provide assistance to those in need.

This should include ensuring safe passage for refugees, and appropriate support after they enter countries offering refuge. Recognising that the disaster from which they have fled, and the vicissitudes of the journey, may have led to health problems it is essential that receiving countries establish systems to provide health care to refugees.

Governments should seek to ensure that refugees and asylum seekers are able to live in dignity within their country of refuge and make all efforts to enable their integration into their new society. The international community should seek to obtain a peaceful solution in Syria under which the population can either stay at home safely or, if they have already left, safely return home.

The WMA recognises that mass population movement cause significant stress on existing populations of countries as well on those who become refugees. We believe that governments and international agencies including the United Nations must make more concerted efforts to reduce the pressures that lead to such movements, including rapidly providing extensive relief after natural phenomena, and making more efforts to avert or stop armed conflict. Re-establishing security of food, water, housing, sewerage, education and health care, and improving public safety, should make a significant impact and reduce the numbers of refugees.

The WMA:

Recognises that the process of becoming a refugee is damaging to physical and mental health;
Commends those countries that have welcomed and cared for refugees, especially those currently fleeing Syria;
Calls on other countries to improve their willingness to receive refugees and asylum seekers;
Calls on national governments to ensure that refugees and asylum seekers are enabled to live in dignity by providing access to essential services;
Calls on all governments to work together to seek to end local, regional, and international conflicts, and to protect the health, safety and welfare of populations;
Calls on all governments to cooperate in providing immediate help to countries facing the effects of natural phenomena, remembering that those already the most socio-economically disadvantaged will face the most challenges;
Calls upon global media to report on the refugee crisis in a manner that respects the dignity of refugees and displaced persons, and to avoid bigotry and racial or other bias in reporting.

Adopted by the 191st WMA Council Session, Prague, April 2012

The WMA recognises that attacks on health care facilities, health care workers and patients are an increasingly common problem and the WMA Council denounces all such attacks in any country.

These often occur during armed conflict and also in other situations of violence, including protests against the state. Patients, including those injured during protests, often come from the poorest and most marginalised parts of the community and suffer a higher proportion of serious health problems than those from wealthier backgrounds.

Governments have an obligation to ensure that health care facilities and those working in them can operate in safety and without interference either from state or non-state actors, and to protect those receiving care.

Where services are not available to patients due to government action or inaction, the government, not the health practitioners, should be held responsible.

Noting that recent and ongoing conflicts in Bahrain and Syria have seen physicians, other health care personnel and their patients attacked while in health care facilities, the WMA demands:

That states fulfill their obligations to all their citizens and residents, including political protestors, patients and health care workers, and protect health care facilities and their occupants from interference, intimidation or attack.
That governments enter into meaningful negotiations wherever such attacks are possible, likely or already occurring to stop the attacks and protect the institutions and their occupants, and
That governments consider how they can contribute positively to the work of the International Committee of the Red Cross on promoting the safety of health care provision through awareness of the concepts within their project Health Care in Danger.

Adopted by the 53^rd WMA General Assembly, Washington, DC, USA, October 2002,
revised by the 64^th WMA General Assembly, Fortaleza, Brazil, October 2013
and by the 72^nd WMA General Assembly (online), London, United Kingdom, October 2021

PREAMBLE

Since the start of the global HIV epidemic, women and girls in many regions have been disproportionately affected by HIV. Young women (aged 15-24), and adolescent girls (aged 10-19) in particular, account for a disproportionate number of new HIV infections.

Gender inequality contributes to the spread of HIV. It can increase infection rates and reduce the ability of women and girls to cope with the illness. Often, they have less information about HIV and fewer resources to take preventive measures. Sexual violence, a widespread violation of women’s rights, exacerbates the risk of HIV transmission.

Many women and girls living with HIV struggle with stigma and exclusion, aggravated by their lack of rights. Women widowed by AIDS or living with HIV may face property disputes with in-laws, complicated by limited access to justice to uphold their rights. Regardless of whether they themselves are living with HIV, women generally assume a disproportionate burden of care for others who are sick from or dying of AIDS, along with the orphans left behind. This, in turn, can reduce prospects for education and employment. It can also significantly reduce prevention of mother-to-child transmission (PMTCT) efforts and strategies.

Access to healthcare, including both preventative and therapeutic strategies, is a fundamental human right. This imposes an obligation on government to ensure that these human rights are fully respected and protected. Gender inequalities must be addressed and eradicated. This should impact every aspect of healthcare.

The promotion and protection of the reproductive rights of women are critical to the ultimate success of confronting and resolving the HIV/AIDS pandemic.

RECOMMENDATIONS

The WMA requests all national member associations to encourage their governments to undertake and promote the following actions:

Develop empowerment programs for women of all ages to ensure that women are better supported and free from discrimination. Such programs should include universal and free access to reproductive health education and life skills training,
Develop programme to provide HIV testing and post-exposure prophylaxis in the form of antiretrovirals to all survivors of assault.
Governments must provide universal access to antiviral therapy and treatment to all HIV infected women, protecting their health, and in the case of pregnant women, preventing mother to child transmission.
Provide universal HIV testing of all pregnant women, with patient notification of the right of refusal, as a routine component of perinatal care, and such testing should be accompanied by privacy protection, basic counseling and awareness of appropriate treatment, if necessary.
Patient notification should be consistent with the principles of informed consent. Universal and free access to antiretroviral therapy must also be provided to all HIV-positive pregnant women in order to prevent mother to child transmission of HIV.

Adopted by the 49^th WMA General Assembly, Hamburg, Germany, November 1997
and rescinded and archived by the 59^th WMA General Assembly, Seoul, October 2008
* This document has been replaced by the “WMA Statement of Access of Women and Children to Health Care”

PREAMBLE

For years women and girls in Afghanistan have been suffering increasing violations of their human rights; In 1996 a general prohibition was introduced on practice by women, which affected more than 40,000 women. Human rights organisations call this a “human rights catastrophe” for the women in Afghanistan. Women are completely excluded from social life, girls’ schools are closed, women students have been expelled from universities, and women and girls are stoned in the street. According to information from the United Nations on the human rights situation in Afghanistan (February, 1996) the prohibition on practice affects first of all women working in the educational and health sectors. In particular female doctors and nurses were prevented from exercising their profession. Although the health sector was on the brink of collapse under these restrictions, they have been eased only slightly. Without access to female doctors female patients and their children have no access to health care. Some female doctors have been allowed now to exercise their profession, but in general only under strict and unacceptable supervision (US Department of State, Afghanistan Report on Human Rights Practices for 1996, January 1997).

RECOMMENDATION

Therefore, the World Medical Association urges its national member associations to insist and call on their governments :

to condemn roundly the serious violations of the basic human rights of women in Afghanistan; and,
to take worldwide action aimed at restoring the fundamental human rights of women and removing the provision prohibiting women from practising their profession.
to insist on the rights of women to adequate medical care across the whole range of medical and surgical services, including acute, subacute and ongoing treatment.