WMJ_01_2025

Official Journal of The World Medical Association, Inc. Nr. 1, March 2025
vol. 71
Contents
Editorial   3
Invitation to 229th WMA Council Session   4
Embracing Polarisation as a Path Toward Common Ground:
An Associate Members Webinar   5
WMA at COP29 in Baku, Azerbaijan   7
A Report from the 156th WHO Executive Board Meeting: Junior Doctors’ Participation   11
Techquity: Achieving Health Equity through Innovation   15
Reinforcing the Humanity of Healthcare for Everyone Involved   18
Interview with National Medical Associations’ Leaders of the Pacific Region   21
Impact of U.S. Foreign Aid Policy Shifts on HIV/AIDS Programs in South Africa:
Challenges, Responses, and Strategies for Sustainability  31
Challenges and Successes of Ivorian Doctors in a Rapidly Changing Health System   34
Research Travel from the Global South: Challenges of Visa Delays and Denials   38
Four Years after the Military Coup:
Road to the WMA Medical Neutrality Policy Statement   41
South Africa’s Obesity Epidemic and the Role of Food Delivery Apps   45
WMA Members Commemorate World Cancer Day 47
WORLD MEDICAL ASSOCIATION OFFICERS,
CHAIRPERSONS AND OFFICIALS
Dr. Ashok PHILIP
President
Malaysia Medical Association
4th Floor, MMA House,
124 Jalan Pahang
53000 Kuala Lumpur
Malaysia
Dr. Otmar KLOIBER
Secretary General
World Medical Association
13 chemin du Levant
01212 Ferney-Voltaire
France
Dr. Jack RESNECK
Chairperson,
Finance and Planning Committee
American Medical Association
AMA Plaza, 330 N. Wabash,
Suite 39300
60611-5885 Chicago, Illinois
United States
Dr. Jacqueline KITULU
President- Elect
Kenya Medical Association
KMA Centre, PO Box 48502,
Chyulu Road, 4th Floor, Upper Hill
Nairobi
Kenya
Dr. Tohru KAKUTA
Vice-Chairperson of Council
Japan Medical Association
113-8621 Bunkyo-ku, Tokyo
Japan
Dr. Zion HAGAY
Chairperson,
Socio Medical Affairs Committee
Israeli Medical Association
2 Twin Towers, 35 Jabotinsky St.,
P.O. Box 3566
52136 Ramat-Gan
Israel
Dr. Lujain ALQODMANI
Immediate Past President
Kuwait Medical Association
123 Fifth Avenue,
1202
Kuwait
Mr. Rudolf HENKE
Treasurer
German Medical Association
(Bundesärztekammer)
Herbert-Lewin-Platz 1
(Wegelystrasse)
10623 Berlin
Germany
Dr. Jacques de HALLER
Chairperson,
Associate Members
Swiss Medical Association
(Fédération des Médecins Suisses)
Elfenstrasse 18, C.P. 300
3000 Berne 15
Switzerland
Dr. Jung Yul PARK
Chairperson of Council
Korean Medical Association
Samgu B/D 7F 8F 40
Cheongpa-ro,
Yongsan-gu
04373 Seoul
Republic of Korea
Dr. Steinunn
THÓRDARDÓTTIR
Chairperson,
Medical Ethics Committee
Icelandic Medical Association
Hlidasmari 8
201 Kópavogur
Iceland
www.wma.net
OFFICIAL JOURNAL OF THE WORLD
MEDICAL ASSOCIATION
Editor in Chief
Dr. Helena Chapman
Milken Institute School of Public Health, George Washington University, United States
editor-in-chief@wma.net
Assistant Editor
Mg. Health. sc. Maira Sudraba
Latvian Medical Association
lma@arstubiedriba.lv, editor-in-chief@wma.net
Journal design by
Erika Lekavica
dizains.el@gmail.com
Publisher
Latvian Medical Association
Skolas Street 3, Riga, Latvia
ISSN 0049-8122
Opinions expressed in this journal – especially those in authored contributions –
do not necessarily reflect WMA policies or positions
3
Editorial
Editorial
BACK TO CONTENTS
As our global medical community welcomes the new year,
we renew our enthusiasm for planned activities within our
institutions and professional medical societies. As World
Health Organisation (WHO) leaders reflected upon 2024,
they touted global achievements, including the adoption of
high-level resolutions, the launch of evidence-based reports and
guidelines, reported disease elimination in selected countries,
and successful immunization campaigns. They simultaneously
acknowledged the urgent call to action to address the non-
communicable disease and mental health burden, tackle
antimicrobial resistance risks, strengthen local country office
capacity to implement community-based solutions, and reduce
misinformation and disinformation. A new year offers an
opportunity to leverage clinical, public health, and research
expertise to examine global health and medical ethics topics that
directly influence health system preparedness. To support these
collective efforts,theWorld Medical Association (WMA) shared
six press releases that advocate for protecting health professionals
and facilities during conflicts, sustaining global leadership
diplomacy, promoting optimal working conditions for
junior doctors, and taking steps to combat air pollution, and
ensuring safety for health professionals and patients.
The World Economic Forum launched the Global Risks Report
2025, highlighting the accelerated pace of evolving generative
artificial intelligence technology across all sectors and the need
for digital safety to foster safe virtual platforms. The document
presented key findings, such as declined optimism, profound
geopolitical and geoeconomic tensions, increased societal
fragmentation, short- and long-term environmental threats,
and technological risks. Hence, these evidence-based findings
offer timely insight for global leaders to detect junctures
where multidisciplinary and multisectoral collaborations can
lead to sustainable solutions. These efforts are particularly
important now, as the world has witnessed various shifts over
the past year, including economic inflation (e.g. COVID-19
recovery), extreme weather events, humanitarian crises and
armed conflicts, and transitions in political governance, with
unknown impacts to unravel throughout the year.
As WMA members represent more than 114 national medical
associations (NMAs), they have a leading role in driving
global collaborations that mitigate health risks, incorporate
expertise to address these challenges, and stress the humanistic
touch in healthcare service delivery. In this issue, five NMA
leaders of the Pacific region described leadership experiences,
ongoing NMA activities,and perceived strengths and challenges
in medical education. Also, WMA members representing
11 countries of the Americas, Asian, European, and Pacific
regions shared perspectives and reflections on physicians’
contributions to improve cancer care initiatives, as part of
a commemoration for World Cancer Day. These efforts are
illustrated by the words of Henry Ford: “Coming together is a
beginning, staying together is progress, and working together is
success.”These scientific accomplishments and future endeavours
will help advance discussions on national and global issues
affecting physicians at the 229th WMA Council Meeting in
Montevideo, Uruguay, from 24-26 April 2025.
Also, in this issue, Dr. Jacques de Haller provided an overview
of key discussion topics during the Associate Members webinar
focusing on polarisation. Dr. Ankush Bansal and colleagues
shared a summary of the WMA delegation’s participation
at COP29 in Azerbaijan in November 2024, and Dr. Pablo
Estrella Porter and Dr. Jeazul Ponce Hernández showcased
junior doctors’ participation in the 156th WHO Executive
Board Meeting in February 2025. Dr. Jesse Ehrenfeld
discussed techquity as the use of innovative technology
to advance health equity. Dr. Gregory Makoul and Dr.
Calum MacKichan stressed three overarching tasks that can
reinforce the humanity of healthcare for health professionals
and patients. Dr. Michael Mncedisi Willie and colleagues
analysed the impacts of international policy shifts on HIV/
AIDS programs in South Africa. Dr. Anderson N’dri described
how Ivorian doctors have navigated a rapidly changing
health system. Dr. Cliffland Mosoti and colleagues illustrated
travel barriers (including visa applications) for researchers
in the Global South. Dr. Wunna Tun defined the concept of
medical neutrality and shared the rationale leading to the draft
WMA Statement on medical neutrality. Finally, Dr.
Siyabonga Jikwana and Dr. Michael Mncedisi Willie
highlighted the growing obesity epidemic and role of food
delivery apps in South Africa.
We are excited to connect at the 229th WMA Council Meeting
in Montevideo!
Helena Chapman, MD, MPH, PhD
Editor in Chief of the World Medical Journal
editor-in-chief@wma.net
4
Dear colleagues,
It is a tremendous honor for
the Medical Union of Uruguay
(Sindicato Médico del Uruguay,
SMU) (https://www.smu.org.uy/),
a union organisation that celebrates
105 years of history, to host the
229th Council Session of the World
Medical Association (WMA), which
will be held on 24-26 April 2025.
The SMU was founded in 1920,
motivated by the labor movement
and the defense of Uruguayan
doctors’ labor rights. The first statutes
set objectives that transcended
beyond labor rights and expanded to
improving population health. These
historical actions have established
a framework to strengthen the
resiliency of the Uruguayan health
system by improving the quality of
healthcare, ensuring the inclusion of
bioethics principles, and defending
human rights.
This year, Uruguay celebrates 200
years of independence. As two major
national accomplishments, Uruguay
was the first country (second in the
world) to successfully implant the
pacemaker in 1960, by Dr. Orestes
Fiandra and Dr. Roberto Rubio, as
well as serve as a model across Latin
America for the implementation
of the Integrated National Health
System (Sistema Nacional Integrado
de Salud, SNIS) in 2007.
Montevideo, the capital of the
Eastern Republic of Uruguay, has
served as host for four WMA
Council Sessions. Our organisation
is hopeful that this new Council
Session will be even more productive
than past meetings, with the
participation of global medical
leaders with diverse clinical expertise.
We are committed to ensuring a
high-quality meeting agenda and
social networking events, so that you
have a pleasant stay, can enjoy the
unique historical and cultural sites,
and connect with the kindness of the
Uruguayan people.
Last year, the WMA celebrated 80
years, marking the informal meeting
of doctors convened at the British
Medical Association (BMA) House
in London in November 1944. This
meeting offered a space to discuss
the creation of a new international
medical organisation that would
replace the International Association
of Medical Professionals, which was
founded in 1925 and suspended at
the beginning of the Second World
War. In April 2025, we will celebrate
the 81st anniversary of the launch
of this organisation that became the
voice of organised medicine.
Our organisation thanks the WMA
for allowing our members to serve an
integral role in the development and
revision of WMA declarations that
provide ethical guidance to doctors
around the world. We are proud to
have contributed content, exchanged
information, and learned from our
colleagues, especially during the
revisions of the International Code
of Medical Ethics, the Declaration
of Geneva, and the Declaration of
Helsinki.
We welcome your visit to Uruguay!
Sindicato Médico del Uruguay (SMU)
Montevideo, Uruguay
secretaria@smu.org.uy
Jose Minarrieta
Invitation to 229th WMA Council Session
Invitation to 229th WMA Council Session
BACK TO CONTENTS
5
According to the Webster’s
Dictionary, “polarisation” was
recognised as the “Word of 2024”
and defined as “division into two
sharply distinct opposites; especially, a
state in which the opinions, beliefs, or
interests of a group or society no longer
range along a continuum but become
concentrated at opposing extremes”
[1]. We may feel resigned to the
divisions that seem to define modern
society in an increasingly polarised
world; however, this phenomenon is
not an inevitable development. By
rethinking our approach to conflict
and differences, we can foster deeper
understanding and collaboration,
even in the most contentious
environments. Typically, in a global
organisation dealing mostly with
medical ethics, cultural and political
differences play a major role in our
academic discussions that cross
national borders.
In September 2024, the World
Medical Association (WMA)
Associate Members organised a two-
session webinar on polarisation. As
polarisation may present significant
challenges for all organisations,
including our Association, the
Associate Members Steering
Committee agreed on the importance
to confront and address this threat
before fronts harden, and a culture of
conflict and opposition replaces our
traditional benevolent and attentive
listening. Our Steering Committee
invited Professor Michelle LeBaron
(University of British Colombia’s
Allard School of Law), specialised
in cross-cultural dispute resolution,
to moderate the exchanges.
Contributions from several past,
acting, and future WMA presidents
and WMA Council members also
enriched the academic debates.
This brief report highlights key
discussion topics presented during
this webinar, including understanding
the roots of polarisation, considering
the role of conflict as a catalyst
for change, balancing emotions
and reason and building trust, and
moving beyond the status quo. The
webinar concluded with offering
practical steps for addressing
polarisation in future scientific and
community dialogue.
Understanding the Roots of
Polarisation
Polarisation frequently stems
from a lack of understanding and
recognition of diverse perspectives.
When individuals feel unheard or
stereotyped, they may push their
ideas forcefully, leading to further
division. This dynamic is exacerbated
by ethnocentrism, defined as the
“attitude that one’s own group, ethnicity,
or nationality is superior to others” [2].
Acknowledging our differences as
inevitable, yet surmountable, can help
mitigate this tendency and foster
mutual respect. In other words, the
key to countering this dynamic lies
in finding common ground and
resisting the urge to focus solely
on any differences.
The collective discussion emphasised
that the real challenge might not
be polarisation itself, but rather
the contempt that arises in the
presence of differences. Contempt
fosters an “us versus them” mentality,
eroding the possibility of finding
common ground. To counter this, it
is essential to humanize those who
hold opposing views, rather than first
attempting to change their minds.
This sentiment was reflected in one
participant’s expressed comment:
“When contempt enters the picture, then
we have failed to find common ground.”
Considering the Role of Conflict as
a Catalyst for Change
Conflict, far from being purely
destructive, is a natural and necessary
agent of social change. It drives
progress by challenging established
norms and fostering new ideas.
However, Professor LeBaron
emphasised that not all conflicts are
created equal and identified three
levels of conflict. First, the material
level includes tangible issues like
policies and resources, which are
measurable and often the starting
point of disputes. Second, the
symbolic level describes conflicts that
delve into deeper meanings and
values, such as debates on life and
morality in the context of abortion,
which can feel like personal attacks
that challenge core belief systems.
Third, the relational level illustrates
the dynamics of interactions between
individuals or groups, where mutual
respect and acknowledgment are
critical. Understanding these levels
allows us to engage with conflict
more effectively, as an “energetic
form” that drives change, rather
than an obstacle. As Marie-Caroline
Richards aptly stated, “Conflict is
not personal; what becomes personal is
how we learn from it and deepen our
humanity” [3].
Jacques de Haller
Embracing Polarisation as a Path Toward Common Ground
BACK TO CONTENTS
Embracing Polarisation as a Path Toward Common Ground:
An Associate Members Webinar
6
Balancing Emotions and Reason
and Building Trust
Constructively addressing differences
and conflicting points of view requires
the involvement of the whole of each
person. In her presentation, Professor
LeBaron highlighted the importance
of connecting emotions, reason, and
trust in conflict resolution. While
it may seem logical to downplay
emotions in favour of rationality,
emotions are a profound source
of wisdom which should not be
discarded. They provide the capacity
to embrace common ground and
view conflicts not as insurmountable
barriers, but rather as opportunities
for growth. Furthermore, contrary
to common belief that trust is a
prerequisite for working together, it
was argued that trust and distrust
coexist in relationships. An inflection
point in any discussion occurs when
participants acknowledge each
other’s perspectives and recognise
the coexistence of trust and distrust.
This acknowledgment creates space
for exploring deeper truths and
finding shared values, even amidst
disagreements.
Moving Beyond the Status Quo
The webinar underscored the
importance of individuals breaking
free from habitual, standard
responses to polarisation, noting that
common ground becomes elusive
as soon as they prioritise proving
their own version of the truth over
understanding others. Moving
forward requires a significant shift
from a compulsive problem-solving
mindset to an exploration and
reflection perspective. Furthermore,
it is imperative to examine what
conflict reveals about an organisation’s
values and direction, and rather than
rushing to resolutions, embrace crises
and challenges as opportunities for
growth. Conflict, when approached
with openness and creativity, can
be transformed into an energetic
force for positive change. This
meaning is expressed through the
reflections of Louise Diamond
(renowned peacebuilder and co-
founder of the Institute for Multi-
Track Diplomacy), that being open
to conflict is a conscious decision,
rather than a natural tendency, and
Marie-Caroline Richards, “If we can
stand on the heat of conflict, then our
colours will be deepened” [3].
Practical Steps for Addressing
Polarisation
The webinar offered several
actionable strategies for countering
polarisation that could be adapted
for daily life, including:
1. Humanising opposing
perspectives: To focus not on
changing others’ minds, but rather
on understanding and respecting
their humanity.
2. Acknowledging differences: To
recognise that differences are
unavoidable, but need not be
divisive.
3. Fostering dialogue: To create
spaces for open and honest
communication, where emotions
and logic are dually valued.
4. Embracing conflict: To view
conflicts as opportunities to
deepen understanding and drive
progress.
A Renaissance of Ideas
Polarisation and conflict are
inevitable in any dynamic society;
however, they need not lead
to division and contempt. By
embracing these challenges and
seeking common ground, we can
transform moments of tension into
opportunities for growth, connection,
and progress. We live in a time
reminiscent of the Renaissance,
where foundational ideas are being
questioned and reshaped. This period
of transformation offers a chance
to reimagine how we engage with
different analyses and perspectives.
As we navigate this era of contested
ideas and shifting paradigms, let us
remember that the work of bridging
divides begins with a willingness to
listen, reflect, and grow together.
With all this in mind, the WMA
will surely be well endowed for the
future!
References
1. Merriam-Webster. 2024 word
of the year: polarisation [Inter-
net]. 2024 [cited 2025 Jan 20].
Available from: https://www.
merriam-webster.com/wordplay/
word-of-the-year
2. Merriam-Webster. Ethnocen-
trism [Internet].2025 [cited 2025
Jan 20]. Available from: https://
www.merriam-webster.com/dic-
tionary/ethnocentrism
3. Richards MC. Centering in pot-
tery, poetry, and the person, 2nd
ed. Hanover: Wesleyan Universi-
ty Press; 1989.
Jacques de Haller, MD
Chair, Associate Members,
World Medical Association
mail@jdehaller.ch
BACK TO CONTENTS
Embracing Polarisation as a Path Toward Common Ground
7
World Medical Association at COP29 in Baku, Azerbaijan
World Medical Association at COP29 in Baku, Azerbaijan
World Medical Association (WMA)
members attended the 29th
Conference of the Parties (COP29)
to the United Nations Framework
Convention on Climate Change
(UNFCCC) in Baku, Azerbaijan,
from 11 to 23 November 2024 [1].
The WMA delegation, led by Dr.
Lujain Alqodmani and Dr. Ankush
Bansal, consisted of four in-person
(Dr. Ankush K. Bansal, Dr. Lujain
Alqodmani, Dr. Ahmed Aboushady,
Dr. Jeazul Ponce Hernández)
and three virtual delegates (Dr.
Suryakanta Acharya, Dr. Lekha
Rathod, Dr. Johanna Schauer-Berg),
representing Austria, Egypt, India,
Kuwait, Luxembourg, Mexico, and
the United States (Photos 1-2).
Although the COP29 host imposed
new limitations (only one WMA
delegate could be credentialed as an
in-person delegate per conference
day), this COP had equal numbers
of virtual and in-person delegates
representing the WMA.
Notably, the COP29 finance
goal established that high-
income countries agreed to the
climate finance goal of US$1.3
trillion by 2035, supporting low-
and middle-income countries to
develop and scale-up mitigation and
adaptation strategies. However, the
final agreement was for US$300
billion annually by 2035. There was
also no agreement on the shares of
high-income countries (e.g. United
Kingdom, European Union, United
States) that would be required
to pay into this fund. The deal
omitted sub-targets, eliminating
or reducing fossil fuel subsidies,
and the principle of “polluter pays”
will likely be insufficient for health
mitigation and adaptation strategies.
Ultimately, these efforts will not
align with the WMA Declaration
of Delhi on Health and Climate
Change adopted in October 2017
[2].
Ankush K. Bansal
Lujain Alqodmani
Suryakanta Acharya
Lekha Rathod
Ahmed Aboushady
Jeazul Ponce Hernández
Johanna Schauer-Berg
BACK TO CONTENTS
8
World Medical Association at COP29 in Baku, Azerbaijan
Two discussions on key global
topics were postponed to the
COP30 in Belem, Brazil. First, the
Just Transition Work Programme
(JTWP), which aims to guarantee a
right to health and a clean, healthy,
sustainable environment and duly
reflected in the WMA Resolution on
Protecting the Future Generation’s
Right to Live in a Healthy
Environment from October 2020,
did not move appreciably forward
towards adoption [3]. Instead, the
discussion on the JTWP has been
postponed to the 62nd session of
the Subsidiary Body for Scientific
and Technological Advice and the
Subsidiary Body for Implementation
(SB62) meeting, which will be
held in Bonn, Germany, to be
held the 16-26 June 2025. Second,
discussions on national adaptation
plan advancement were stalled due
to disagreements on intersectionality
and gender equality. Progress on the
global goal on adaptation, however,
did receive further refinement,
specifically on the education and
health of youth.
As a specific milestone at COP29,
the Baku COP Presidency’s
Continuity Coalition on Climate
and Health was launched by the
World Health Organisation and
the Azerbaijan’s COP29 presidency
[4]. This initiative represents a
formal collaboration between the
presidencies of the COP26 (United
Kingdom), COP27 (Egypt), COP28
(United Arab Emirates), COP29
(Azerbaijan), and upcoming COP30
(Brazil). It aims to bridge efforts
across presidencies to enable more
coordinated action on health
priorities based on established
commitments related to the Paris
Agreement. However, beyond the
signed letter of intent, it is unclear
whether the initiative will truly
drive sustained action and elevate
health within the climate agenda.
During the conference proceedings,
several Member States provided
information about climate policy,
including policy implementation
within their national borders and in
partnership with other countries. For
example, the United States stated
to the WMA delegation that 29%
of all U.S. healthcare facilities are
tracking emissions. Furthermore, the
United States is working with the
United Kingdom’s National Health
Service, Norway, and Germany
on global supply procurement
interventions to reduce Scope 3
emissions. However, the impacts of
the United States’ withdrawal from
the Paris Agreement and pause on
climate program financing and non-
military foreign aid in January 2025,
are unknown.
As part of the Junior Doctors
Network (JDN) delegation, Dr.
Jeazul Ponce Hernández (in-
person) and Dr. Lekha Rathod
(virtual) contributed to the event
proceedings, ensuring continuous
Photo 1. Dr. Jeazul Ponce Hernández (left) and Dr. Ankush
Bansal (right) during Week 2 of the COP29. Credit: WMA
Photo 2. As a virtual delegate, Dr. Suryakanta Acharya
monitored the meeting proceedings and negotiations in No-
vember 2024. Credit: WMA
Photo 3. WMA collaborations with global health professionals, as part of the Global Climate and Health Alliance, in
November 2024. Credit: WMA
BACK TO CONTENTS
9
World Medical Association at COP29 in Baku, Azerbaijan
and effective engagement that
prioritises health on the global
climate agenda throughout
sessions. Informative materials
about health and climate change
were extensively disseminated
through social media channels.
Notably, the JDN has launched a
WMA-JDN podcast with special
episodes relevant for global
physicians (https://open.spotify.com/
show/6Rpvhj9GdEspLvpKHOvHtl),
highlighting the strategic
importance of these communication
initiatives for connecting with
broader audiences.
At this global event, the WMA
delegation collaborated with global
physicians, nurses, pharmacists,
scientists, and students in the
climate and health space during
the Global Climate and Health
Alliance (GCHA) and daily policy
meetings (Photos 3-4). Specifically,
the WMA delegation contributed
to discussions in various negotiation
meetings and party outreach, as well
as helped evaluate the presence,
activity, and influence on state
parties by the health community.
Although the WMA delegation
was unable to secure speaking
engagements at roundtables or side
events during COP29, due to the
reduced permitted attendance, we
look forward to collaborating with
WMA members and other global
leaders to present scientific talks
and moderate events at COP30.
References
1. World Health Organisation.
Health at COP29 (11
November – 22 November 2024,
Baku, Azerbaijan) [Internet].
2024 [cited 2025 Mar 1].
Available from: https://www.
who.int/teams/environment-
climate-change-and-health/
climate-change-and-health/
advocacy-partnerships/talks/
health-at-cop29
2. World Medical Association.
WMA Declaration of Delhi
on Health and Climate Change
[Internet]. 2017 [cited 2025
Mar 1]. Available from: https://
www.wma.net/policies-post/
wma-declaration-of-delhi-on-
health-and-climate-change/
3. World Medical Association.
WMA Resolution on Protecting
the Future Generation’s Right to
Live in a Healthy Environment
[Internet]. 2020 [cited 2025
Mar 1]. Available from: https://
www.wma.net/policies-post/
wma-resolution-on-protecting-
the-future-generations-right-to-
live-in-a-healthy-environment/
4. World Health Organisation.
Baku COP29 advances health-
climate commitments with
new coalition [Internet[. 2024
[cited 2025 Mar 1]. Available
from: https://www.who.int/
news/item/18-11-2024-baku-
cop29-advances-health-climate-
commitments-with-new-coalition
BACK TO CONTENTS
Photo 4. Dr. Ankush Bansal (second from left), met with Dr. John Balbus, Director of the U.S. Department of Health and
Human Services’ Office of Climate Change and Health Equity (left), and the U.S. delegation (right) on 19 November 2024.
Credit: WMA
10
World Medical Association at COP29 in Baku, Azerbaijan
BACK TO CONTENTS
Authors
Ankush K. Bansal, MD,
FACP, FACPM, SFHM
Chair, Workgroup on
Environment & Delegation
Co-Chair for COP29,
World Medical Association
WMA Delegation
Co-Chair for COP29
President-Elect, Physicians for Social
Responsibility (United States)
Westlake, Florida, United States
dr.akb1@gmail.com
Lujain Alqodmani, BMSc,
MBBS, MIHMEP
President & Delegation
Co-Chair for COP29,
World Medical Association
WMA Delegation
Co-Chair for COP29
Director of Global Action and
Project Portfolio, EAT
Kuwait City, Kuwait
lujainalq@gmail.com
Johanna Schauer-Berg, MD, MPH
Member, Workgroup on
Environment & Associate Member,
World Medical Association
Research associate, Institute of General
Practice, Family and Preventive
Medicine, PMU Salzburg
Salzburg, Austria
j.schauer-berg@posteo.de
Suryakanta Acharya, MD
Associate Member, World
Medical Association
Clinical Oncologist, Assam
Cancer Care Foundation
Lakhimpur, India
suryaoncology@gmail.com
Lekha Rathod, MBBS, MSc
Associate Member, World
Medical Association
Co-chair, JDN-WMA Planetary
Health Working Group
Luxembourg City, Luxembourg
lrathod95@gmail.com
Ahmed Aboushady, MD, MPH
Associate Member, World
Medical Association
Research Specialist, Brigham
and Women’s Hospital
Boston, Massachusetts, United States
a.taboushady@gmail.com
Jeazul Ponce Hernández,
MD, MPH, MSc
Communications Director,
Junior Doctors Network
Attending Doctor at the Public
Health System of Castilla y
León (SACYL), Spain
Research assistant, Department
of Public Health, Complutense
University of Madrid
Salamanca, Spain
jeazulponce@gmail.com
11
The 156th World Health
Organisation (WHO) Executive
Board (EB156) session was held
from 3-11 February 2025, at the
WHO headquarters in Geneva,
Switzerland. This session provided
a critical platform to discuss global
health priorities, ranging from
universal health coverage, pandemic
preparedness to mental health, non-
communicable diseases, and the
rapidly evolving implications of
climate change on health. During
the week, delegates from Member
States, international health agencies,
and Non-State Actors reviewed
progress on strategic objectives, heard
updates on emerging priorities, and
set the agenda for the subsequent
World Health Assembly (WHA).
At the WHO EB156, three Junior
Doctors Network (JDN) delegates
joined World Medical Association
(WMA) medical advisors at the
WHO headquarters, participating in
the event (Photos 1-2). A total of 5
JDN members (including 3 members
of the Organizing Committee for
the JDN pre-WHA and 2 JDN
Working Group Chairs) virtually
contributed to preparing statements
and social media messaging. This
dual approach enabled direct on-site
engagement while simultaneously
broadening social media reach.
At the WHO EB156, key agenda
items included the reaffirmation
of universal health coverage and
commitments to increase health
financing, decisions on the WHO’s
2026–2027 Programme Budget
and the proposed 20% increase
in assessed contributions, and
discussions on strengthening
emergency preparedness [1,2].
These essential discussions were
timely, particularly in light of the
forthcoming WHO Pandemic Treaty
negotiations. Further emphasis was
placed on leveraging innovation and
technology to broaden access to
care, as well as on fostering global
collaboration among nations and
stakeholders to address ongoing and
emerging health threats.
In his opening remarks, WHO
Director-General, Dr. Tedros
Adhanom, underscored the
daunting challenges and noteworthy
achievements of the previous year.
Reflecting on a close call in Yemen,
where he experienced firsthand
the daily insecurities that many
communities endure, Dr. Tedros
highlighted successes such as the
adoption of the new 14th General
Programme of Work and progress
toward concluding a new Pandemic
Agreement. He stressed the need
for mobilising broader resources,
expanding WHO’s donor base,
and continuing organisation-wide
reforms to strengthen health systems
worldwide [3].
Pablo Estrella Porter
Report from the 156th WHO Executive Board Meeting
Report from the 156th WHO Executive Board Meeting:
Junior Doctors’ Participation
Jeazul Ponce Hernández
Photo 1. Dr. Pablo Estrella Porter, Dr. Jeazul Ponce Hernández, and Dr. Saksham Mehra at the 156th World Health
Organisation Executive Board Meeting in February 2025. Credit: JDN WMA.
BACK TO CONTENTS
12
Statements Delivered during the
Event
One highlight of the WMA’s
participation at WHO EB156 was
the delivery of six WMA statements
(https://www.wma.net/news-
press/inter­ventions/), with some
statements endorsed by multiple
professional organisations
(“constituency statements”) while
others were delivered on behalf of
the WMA. These Non-State Actor
statements played a crucial role
in WHO meetings by providing
diverse, frontline perspectives that
complemented Member State
discussions and helped shape more
inclusive global health policies.
1. Universal Health Coverage
(Constituency Statement) [4]
This statement underscored the
importance of integrating medical
imaging into primary healthcare
to enhance disease detection and
treatment. It highlighted the rising
burden of both communicable and
non-communicable diseases in
low- and middle-income countries,
the vital role that imaging played
in guiding patient management,
and the need for international
collaboration to expand imaging
capacity. It also called on the
WHO and Member States to
align financing and strategic
plans for strengthening imaging
infrastructure at all levels of care.
2. Follow-up to the Political
Declaration on the Prevention
and Control of Non-
Communicable Diseases (WMA
Statement) [5]
The statement emphasised that
non-communicable diseases were
driven by social and commercial
determinants, requiring
comprehensive and equitable
policy interventions. It called for
greater investment in prevention,
early diagnosis, and primary care
services to reduce the global non-
communicable disease burden.
It also highlighted the need for
a trained, well-supported health
workforce to manage increasing
non-communicable disease cases.
Finally, it urged upcoming UN
high-level meetings to prioritise
health workforce investments for
resilient healthcare systems.
3. Mental Health and Social
Connection (WMA Statement) [6]
Focusing on mental health
as integral to universal health
coverage, the statement called
for system-wide integration of
mental health services, particularly
at the primary care level. It
promoted collaboration across
sectors to address stigma, reduce
suicide, and improve access to
culturally sensitive interventions.
It specifically highlighted the role
of marginalised populations in
mental health planning. Overall,
the statement aimed to foster
global mental health security
and resilience as part of WHO’s
Comprehensive Mental Health
Action Plan.
4. Health and Care Workforce
(Constituency Statement) [7]
This statement highlighted
unethical recruitment practices
that siphoned skilled health
professionals from lower-income
countries, compromising their
local health systems. It called
for immediate compliance with
the Global Code of Practice to
protect vulnerable regions and
bolster in-country capacity. The
signatories emphasised prioritising
safe and decent working
conditions, addressing violence
against health professionals, and
ensuring fair compensation. They
also distinguished between fully
licensed health professionals and
community health workers to
safeguard patient safety and care
quality.
5. Universal Health and
Preparedness Review (WMA
Statement) [8]
The statement described the
value of the Universal Health
and Preparedness Review
platform for strengthening global
health security and resilience.
It advocated for multisectoral
collaboration and peer learning
to bolster pandemic preparedness,
particularly in resource-limited
settings. Equity and transparency
remained central to building trust
and ensuring underserved regions
received adequate support. The
WMA reaffirmed its readiness
to help with training, awareness,
and integrating One Health
approaches globally.
6. Climate Change and Health
(Constituency Statement) [9]
Recognising climate change as a
pressing global health emergency,
this document commended the
WHO’s Draft Global Action Plan
on Climate Change and Health.
It stressed the importance of
involving health professionals
and civil society in all stages of
climate-health strategies, from
development to evaluation.
Building resilient health systems,
especially in vulnerable regions,
and reducing carbon footprints
were key focal points. Urgent
mitigation, such as phasing out
fossil fuels, was urged to protect
communities from the health
impacts of climate change.
Report from the 156th WHO Executive Board Meeting
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13
Leadership by JDN Members
Since the JDN establishment in
2010, JDN members have actively
participated in global health policy
discussions at different WHO events
(like WHA and EB meetings). They
have consistently provided youth-
led perspectives on pressing health
issues, contributed to developing
statements, and supported the
WMA in advocating for equitable,
high-quality healthcare worldwide.
This specific engagement in the
WHO EB156 proceedings marked
historical steps, where JDN members
led the preparation of four of the
six statements (Non-Communicable
Diseases, Mental Health, Universal
Health and Preparedness Review,
Climate Change). Members of the
JDN Management Team, JDN
Working Groups, and pre-WHA
Workshop Organizing Committee
assumed active roles in drafting,
coordinating with WMA medical
advisors, and delivering statements
on the WHO EB156 floor.
In addition to helping deliver
statements, JDN members used
the opportunity to meet with
other WHO staff members on
ongoing JDN projects, such as the
Quadripartite Working Group on
Youth Engagement on antimicrobial
resistance. They connected with
WHO Youth Council members and
other Non-State Actors to explore
future engagement opportunities,
including the upcoming pre-WHA
workshop. They further underscored
the importance of collaboration with
other youth-led health associations
and emphasised the political
inclusion and participation of young
professionals. Noting the common
misconception that a political
position is needed to have influence,
JDN members recognise that the
JDN-WMA offers a platform and
opportunity to raise their voices.
To extend their reach to a broader
audience, JDN members recorded
two podcast episodes with WMA
advisors that will be available on the
JDN podcast channel in Summer and
Fall 2025 (https://open.spotify.com/
show/6Rpvhj9GdEspLvpKHOvHtl).
As health professionals, we play
an essential role in addressing
situations that affect population
health and well-being. Given our
direct experience with patient
care and clinical practice, we must
actively participate in shaping health
policies, contributing our insights to
ensure decisions reflect the realities
of healthcare delivery. Engaging in
these discussions helps represent
our profession, our patients, and our
fellow health professionals effectively
at all levels. Active participation and
leadership demonstrated by junior
doctors at WHO EB156 have
significantly reinforced the visibility
and voice of young professionals in
global health policies.
References
1. Global Health Council. 5 key
takeaways from WHO Executive
Board Meeting [Internet]. 2025
[cited 2025 Mar 9]. Available
from: https://globalhealth.org/5-
key-takeaways-from-who-execu-
tive-board-meeting/
2. Funds for NGOs. WHO’s
156th Executive Board Meet-
ing: shaping the future of glob-
al health [Internet]. 2025 [cited
2025 Mar 9]. Available from:
https://news.fundsforngos.
org/2025/03/06/whos-156th-
executive-board-meeting-shap-
ing-the-future-of-global-health/
Photo 2. Dr. Pablo Estrella Porter, Dr. Jeazul Ponce Hernández, and Dr. Saksham Mehra at the 156th World Health Or-
ganisation’s Executive Board Meeting in February 2025. Credit: JDN WMA.
Report from the 156th WHO Executive Board Meeting
BACK TO CONTENTS
14
3. World Health Organisation.
WHO Director-General’s open-
ing remarks at the 156th ses-
sion of the Executive Board – 3
February 2025 [Internet]. 2025
[cited 2025 Mar 9]. Available
from: https://www.who.int/di-
rector-general/speeches/detail/
who-director-general-s-opening-
remarks-at-the-156th-session-
of-the-executive-board-3-febru-
ary-2025
4. World Medical Association.
Item 6: universal health cov-
erage [Internet]. 2025 [cit-
ed 2025 Mar 9]. Available
from: https://www.wma.net/
wp-content/uploads/2025/02/
UHC_Final_constituency-state-
ment-for-WHO-EB-Feb-2025_
Resolution-on-Strengthen-
ing-Medical-Imaging-capaci-
ty_Jan31.pdf
5. World Medical Association.
Item 7: follow-up to the po-
litical declaration of the third
high-level meeting of the Gen-
eral Assembly on the prevention
and control of non-communi-
cable diseases [Internet]. 2025
[cited 2025 Mar 9]. Available
from: https://www.wma.net/
wp-content/uploads/2025/02/
E B 1 5 6 – W M A – s t a t e –
ment-Non-Communicable-Dis-
eases-item-7.pdf
6. World Medical Association.
Item 8: mental health and so-
cial connection [Internet]. 2025
[cited 2025 Mar 9]. Available
from: https://www.wma.net/
wp-content/uploads/2025/01/
EB156-WMA-statement-Men-
tal-Health-item-8.pdf
7. World Medical Association.
Item 12: health and care work-
force [Internet]. 2025 [cited 2025
Mar 9]. Available from: https://
www.wma.net/wp-content/up-
loads/2025/02/156-EB-con-
s t i t u e n c y – s t a t e –
ment-item-12-HRH-FINAL.
pdf
8. World Medical Association.
Item 18: universal health and
preparedness review [Internet].
2025 [cited 2025 Mar 9]. Avail-
able from: https://www.wma.net/
wp-content/uploads/2025/02/
EB156-WMA-statement-Pan-
demic-preparedness-item-18.pdf
9. World Medical Association.
Item 22: climate change and
health [Internet]. 2025 [cit-
ed 2025 Mar 9]. Available
from: https://www.wma.net/
wp-content/uploads/2025/02/
EB156-WHPA-Constituency-
Statement-ClimateChange_FI-
NAL-30.01.pdf
Authors
Pablo Estrella Porter, MD, MPH
Chair, Junior Doctors Network,
World Medical Association
Hospital Clínico Universitario
de Valencia
Valencia, Spain
pestrellaporter@gmail.com
Jeazul Ponce Hernández,
MD, MPH, MSc
Communications Director,
Junior Doctors Network
Physician, Public Health System
of Castilla y León
Research assistant,
Department of Public Health,
Complutense University of Madrid
Salamanca, Spain
jeazulponce@gmail.com
Report from the 156th WHO Executive Board Meeting
BACK TO CONTENTS
15
There are many reasons to be
excited about emerging technology
like augmented intelligence (AI)
and AI-enabled tools in healthcare,
helping to provide the opportunity
to expand access to care to high-risk
communities and solve longstanding
health inequities for historically
marginalised populations. This is
true in the United States and around
the world as technology evolves at a
rapid pace.
However, physicians have learned
from experience that if health
technology is not designed and built
correctly and does not leverage the
clinical knowledge and expertise of
physicians, these technologies run
the risk of failing to deliver on their
exciting promise. Additionally, these
technologies have the possibility of
exacerbating existing health inequities
and creating even worse outcomes for
patients. The same challenge is true
for health data tools, which also hold
tremendous potential to help identify
and address disparities in treatment
as well as mitigate unjust differences
in disease incidence through early
risk assessment and prevention.
The American Medical Association
(AMA) Approach
One important piece of the
American Medical Association
(AMA)’s strategic priorities is to
drive the future of medicine through
the design and development of
better health technology. To do so,
physicians must be given a seat
at the table when digital health
tools are in the concept-stage. The
AMA is accomplishing this task
in a number of ways, including our
California-based health technology
venture studio called Health2047
and our AMA Physicians Innovation
Network, which allows physicians
to connect with technology
entrepreneurs on exciting new
projects.
For technology to effectively address
deeply rooted health inequities in
the United States, we have to be
intentional about our actions, such as
prioritising funding and supporting
the launch and scaling of solutions
that meaningfully advance health,
racial, and social justice. In addition,
the investment and allocation of
resources in new technology must
mirror the diverse make-up of our
country.
Techquity
Techquity is not a term that is
widely known, but its aim is clear:
the strategic design, development,
and deployment of technology to
advance health equity. What is
better understood is that our best
chance to address longstanding
health inequities through technology
is to incorporate health equity into
technology in the earliest stages so
that common biases are not baked
into the design. This is something
to which the AMA is committed
and has been working toward as a
component of our broader strategic
work to address health inequities in
the United States.
Solving Health Inequities in the
United States and Abroad
The AMA has made advancing
health equity and improving health
outcomes for marginalised groups
a strategic focus since the creation
of its Center for Health Equity in
2019. Our organisational plan on
equity lays out a multi-pronged
strategic approach to advance health
equity through state and federal
advocacy, by working upstream to
address social determinants of health,
by building alliances with other
physician and health organisations,
and by developing equity-centred
programs and robust education
and teaching models, among other
actions. It also includes leveraging
data and health information
technology to address widespread
disparities in our healthcare system,
and helping ensure health technology
tools, such as AI, are built through
an equity lens.
The need for this work grows by
the day. Across the United States,
Black, Hispanic, Indigenous peoples
and other historically marginalised
groups face growing health inequities
that too often lead to serious health
consequences. Much of it is rooted
in bias and racism within our
healthcare system but is also due
to limited access to physician care.
Black and Hispanic populations
in the United States, for example,
face disproportionately higher rates
of chronic disease, including heart
disease, which is the leading cause
of death in the country and globally.
In fact, nearly half of Black women
in the United States over the age of
20 have heart disease, but a small
minority of those – just one in five
– believes she is personally at risk.
There is much work to be done
to educate individual patients on
heart disease and how to achieve
Jesse M. Ehrenfeld
Techquity: Achieving Health Equity through Innovation
Techquity: Achieving Health Equity through Innovation
BACK TO CONTENTS
16
better blood pressure control. These
challenges, while unique within the
United States, are mirrored globally
with different populations and gaps
in health outcomes.
The Perils of Poorly Designed
Health Technology
It is not only important, but
necessary, to build health technology
through an equity lens because
technology does not always work the
same for people of all race and ethnic
backgrounds. This lesson was learned
the hard way during the COVID-19
pandemic. Pulse oximeter devices,
which played a critical role by
measuring the blood oxygen level
of a patient with COVID-19,
routinely conveyed inaccurate blood-
oxygen information in patients with
dark skin pigmentation. This was
a problem that was well-known in
medicine for more than 30 years, and
yet it was allowed to persist until a
deadly pandemic brought its inherent
flaws to light.
Pulse oximeters are widely used to
inform medical decision-making and
make critical decisions in acute care
settings, so it is essential that these
devices are accurate and reliable
for all people. The risks posed by
inaccurate readings is typically an
overestimate of oxygen levels in
patients with dark skin pigmentation,
resulting in these patients being less
likely to receive supplemental oxygen
and life-saving treatment. The fact
that this problem has not been fixed
underscores a lack of urgency in
addressing implicit bias in medical
technologies. This is just one of
many examples of technology that
was conceptualised and built without
adequate input from those who could
have called out this obvious – and
deadly – flaw.
Eliminating Bias in Digital Health
So how do we prevent bias from
being built into the DNA of new
health technology? That is a question
at the heart of the AMA’s work to
advance equity-centred technology.
We are taking a collaborative
approach to tackle these challenges,
such as the AMA’s In Full Health
initiative that was launched in
2022. The In Full Health initiative,
which grew out of our Strategic
Plan on Health Equity, is built
on five principles for advancing
equity-centred innovation to not
only improve health outcomes for
patients but increase investment in
technology from underrepresented
communities.
The In Full Health initiative seeks
to:
• Understand how structural racism,
sexism and bias impact health
innovation resource allocation,
so that steps can be taken to
dismantle them;
• Assess the value of all health
innovation solutions by their
impact on health equity as a
fundamental metric;
• Invest in health innovations
designed by innovators building
from and for historically
marginalised communities;
• Utilise health innovation
investment models that support
asset ownership and wealth
development within historically
marginalised communities; and
• Engage technology industry
influencers in addressing systems-
level barriers and needs.
Despite decades of increasing
investment in health innovation,
the reality is that venture capital
investing topped US$10 billion
in the United States in 2023, and
investments in technology start-
ups by Black, Hispanic, Indigenous
people and women represent less
than 10 percent of this total. That
is a concerning trend that In Full
Health seeks to correct.
Equitable Data Standards
The AMA also actively advocates
for more equitable data standards
and enhanced interoperability,
and we support the inclusion of
social determinants of health, race,
ethnicity, sexual orientation, gender
identity, and disability data elements
in the United States Core Data for
Interoperability. These standards
enable consistent data collection
and better identification of health
disparities.
We have joined with the Association
of American Medical Colleges
and the Accreditation Council
for Graduate Medical Education
to create the Physician Data
Collaborative (the Collaborative),
which is examining opportunities
to use physician demographic
data to advance health equity.
The Collaborative uses existing
data relationships to model and
document the processes by which
the simplification of data sharing can
be accomplished, including simple
data sharing agreements based upon
principles to support research using
demographic data.
Additionally, we are involved in
initiatives to enhance electronic health
data exchange, aiming to ensure that
health IT systems can effectively
share and use data to identify and
address health inequities. As part
of those efforts, the AMA was a
founding member of the Gravity
Project (https://thegravityproject.
net/), a Robert Wood Johnson-
funded initiative with more than
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Techquity: Achieving Health Equity through Innovation
17
2,500 participants from organisations
and entities representing healthcare,
social services, payers, technology
vendors, and government agencies
working to develop consensus-
driven data standards to support the
collection, use, and exchange of social
determinants of health data.
Principles for AI Development,
Deployment and Use
The AMA also made equity-
centred design and development
in AI technology an integral
part of its Principles for AI
Development, Deployment and
Use that were released in Fall 2024.
These principles build on existing
AMA policies on AI that go
back to 2018, and they encourage
comprehensive government approach
to AI governance policies to mitigate
risks to patients. They focus on
seven specific areas: 1) governance
policies; 2) transparency in the use
of and required disclosures by AI
enabled systems and technologies;
3) special considerations for the use
of generative AI; 4) liability; 5) data
privacy; 6) cybersecurity; and 7)
payor use of AI.
The key elements of the AMA’s
approach include that:
• Above all else, healthcare AI
must be designed, developed, and
deployed in a manner which is
ethical, equitable, responsible and
transparent.
• Compliance with national
governance policies is necessary
to develop AI in an ethical
and responsible manner to
ensure patient safety, quality,
and continued access to care.
Voluntary agreements or voluntary
compliance is not sufficient.
• Healthcare AI requires a risk-
based approach where the level of
scrutiny, validation, and oversight
should be proportionate to the
potential overall or disparate harm
and consequences the AI system
might introduce.
The principles also emphasise that
clinical decisions influenced by AI
must be made with specified human
intervention points during the decision-
making process. As the potential for
patient harm increases, the point in
time when a physician should utilize
their clinical judgment to interpret
or act on an AI recommendation
should occur earlier in the care
plan. And of course, implementation
and utilisation of AI in a clinical
setting should avoid exacerbating
the physician burden and should be
designed and deployed in harmony
with the clinical workflow.
Technology vs Humanity or
Technology and Humanity?
Achieving equity-centred design
in health technology is, at its core,
about maintaining humanity in
medicine as technology rapidly
advances. To quote Dr. Abraham
Verghese, author of Cutting for
Stone, “The way here is not to think
technology versus humanity, but to ask
how they come together where the sum
can be greater than the parts for an
equitable, inclusive, human and humane
care and practice in medicine.” If we do
not fix the foundational problems in
technology design and development
at the front end that is, if we are not
intentional about eliminating bias
and incorporating better data sets at
the very beginning of this process,
we are simply going to perpetuate
these longstanding biases and widen
existing inequities.
Jesse M. Ehrenfeld, MD, MPH
178th President,
American Medical Association
Senior Associate Dean,
Medical College of Wisconsin
Director, Advancing a Healthier
Wisconsin Endowment
Milwaukee, Wisconsin, United States
jehrenfeld@mcw.edu
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Techquity: Achieving Health Equity through Innovation
18
Reinforcing the Humanity of Healthcare for Everyone Involved
Reinforcing the Humanity of Healthcare
BACK TO CONTENTS
When physicians, whether in
training or in practice, recite the
WMA Declaration of Geneva
(“Modern Hippocratic Oath”), they
pledge to dedicate their lives to the
service of humanity [1]. However, in
many countries, regions, and settings,
the healthcare system makes it
exceedingly difficult for physicians
and other health professionals to
prioritise the human aspect of care.
On a daily basis, health professionals
and patients face barriers that
compromise the humanity of
healthcare, negatively affecting the
experience, delivery, and outcomes
of care while exacerbating burnout
and moral injury [2].
Given this state of affairs, the
first author (GM) facilitated a
workshop at the 2022 International
Conference on Communication
in Healthcare (Glasgow,
Scotland) to explore how effective
communication can reinforce
the humanity of contemporary
healthcare. A working group of
health professionals, researchers,
and educators with expertise in
healthcare communication left the
session with a commitment
to develop an international,
interdisciplinary consensus
statement. Published in 2024, the
Glasgow Consensus Statement
on Effective Communication in
Clinical Encounters is the outcome
of a disciplined process firmly
grounded in evidence and experience
[3].
The Glasgow Consensus Statement
recognises that, while advances
such as multidisciplinary teamwork
and digital technology have
improved many aspects of care,
they have engendered a more
transactional ecosystem marked by
fragmentation for patients alongside
inefficient workflows and unrealistic
administrative burdens for clinicians
[4,5]. The fundamental implication
is clear: “the increasingly transactional
nature of clinical encounters can
dehumanize the care experience for
patients and health professionals
across disciplines and specialties” [3].
Working group members outlined
a set of interconnected premises
to build a clear foundation for
issuing recommendations. For
instance, they highlighted the
need for applicability to all health
professionals (i.e. not just doctors)
and stipulated that high-quality
healthcare must efficiently address
health issues while recognising
the humanity of all parties
involved (i.e. not just patients).
The working group’s
recommendations took the form
of overarching tasks, which are
“longitudinal and woven throughout
encounters as well as episodes of care”
[3], along with incremental tasks that
were adapted and refined from the
Kalamazoo Consensus Statement on
effective communication in medical
encounters, published in 2001
[6]. This brief report highlights
the three overarching tasks as
articulated within the Glasgow
Consensus Statement in the context
of encounters between health
professionals and patients [3]. It also
summarizes a recent development
that expanded their scope beyond
clinical encounters, demonstrating
that these tasks have practical value
regardless of role or setting.
Overarching Tasks
Connect as humans. A fundamental
communication task included in
earlier consensus statements focused
on building a relationship [6].
This may seem unattainable given
the realities of everyday practice,
especially in short or ‘one-off’
consultations where a patient is
unlikely to see a particular health
professional on a regular basis.
However, human connection, which
can be demonstrated by respecting
the “patient’s dignity, uniqueness,
individuality and humanity”,
is possible in all interpersonal
interactions [7]. Indeed, human
connections are a pathway to
therapeutic, trusting relationships,
whether episodic or sustained over
time, and there is good evidence
that human connection has benefits
for patients and health professionals
[8].
Gregory Makoul
Calum MacKichan
19
BACK TO CONTENTS
Understand the patient’s perspective.
Drawn from the Kalamazoo
Consensus Statement, this task
supports therapeutic partnerships
by addressing what matters most
to each person receiving care [6,9].
Identifying an individual’s needs is a
central pillar of person-centred care
and an antidote to ‘conveyer belt’
healthcare. This task can include
exploring ideas, beliefs, feelings,
expectations and/or preferences to an
extent relevant and proportionate to
the moment. While different clinical
situations may require varying depth
of exploration, taking the patient’s
perspective and context into account
can pre-empt the misalignment of
goals, thereby improving outcomes
that are valued by patients as well
as saving resources and time [10].
Be responsive. Effective
communication requires adapting
to different situations and patients,
and even the same patient in
different situations. People with
similar health issues may have
very different needs, goals, barriers,
literacy levels, language preferences,
cultural practices, and expectations
for the encounter. Encounters
may vary in terms of duration and
intent. Moreover, tone, emotion,
and demeanour can change during
the course of a single encounter.
Meeting patients’ needs in the
context of their life and health
status is at the heart of delivering
person-centred care. As there is
no ‘one size fits all’ model of an
effective encounter, it is important
to develop a repertoire of skills and
strategies that can be applied as
needed to accomplish essential tasks
[11].
A Broader Scope
It is important to note that these
tasks are not about being ‘nice’;
they are geared entirely toward
being effective. Taking that aim
a step further, a subset of the
original working group organised a
symposium on “Using the Glasgow
Consensus Statement in the Real
World” at the 2024 International
Conference on Communication in
Healthcare (Zaragoza, Spain). A
clear line of continuity ran through
the presentations on leadership,
teaching, assessment, research, and
policy: The experience and delivery
of healthcare will improve if the
overarching tasks are applied, not just
to patients and families, but also in
interactions with trainees, colleagues,
community members, and policy
makers. Accordingly, the symposium
presenters advocated for a slight
modification in the wording of
one task (from ‘understand the
patient’s perspective’ to ‘focus on
understanding’), yielding a broadly
applicable set of overarching tasks.
Building on the logic of broadening
the view beyond clinical encounters,
the first author (GM) worked
with Planetree to expand the
Glasgow Consensus Statement’s
description of person-centred care as
“compassionate, collaborative care that
focuses on the needs of each patient as
a whole person” [3]. Planetree is an
international non-profit organisation
that provides education, consulting,
and recognition to support and
sustain truly person-centred care.
The refreshed definition – “Person-
Centered Care is compassionate,
collaborative care that improves
outcomes by focusing on what matters
to everyone involved in healthcare
experiences” – benefited from the
participation of a broad range of
Planetree stakeholders and is now
featured on the organisation’s website
guide future work in the field
[12]. Explicitly highlighting “what
matters to everyone involved” is an
important reminder that reinforcing
the humanity of healthcare requires
paying attention to the needs and
perspectives of health professionals,
patients, families, and communities.
The overarching tasks, coupled with
the Planetree definition of person-
centred care, provide tangible
touchstones for everyday clinical
practice as well as healthcare writ
large. We strongly believe that
national medical associations can
play a vital role in disseminating
this simple but powerful approach,
illustrating how it applies to
encounters between clinicians and
patients, educators and trainees,
leaders and team members, advocates
and policy makers, and others who
are dedicated to improving the
experience and delivery of care.
While system-level challenges that
risk dehumanising healthcare are
likely to persist, leaders can use
the Glasgow Consensus Statement
in concert with the expanded
scope to facilitate change within
operations under their control
[3]. In a healthcare ecosystem where
interactions often feel transactional
and processes may feel overwhelming,
this triad – connect as humans, focus
on understanding, be responsive – can
reinforce the humanity of healthcare
for everyone involved.
References
1. World Medical Association.
WMA Declaration of Geneva
[Internet]. 2017 [cited 2024 Nov
25]. Available from: https://www.
wma.net/policies-post/wma-dec-
laration-of-geneva/
2. Dean W, Morris D, Llorca PM,
Talbot SG, Fond G, Duclos
A, et al. Moral injury and the
global health workforce crisis
– insights from an internation-
al partnership. N Engl J Med.
2024;391:782-5.
Reinforcing the Humanity of Healthcare
20
BACK TO CONTENTS
3. Makoul G, Noble L, Gulbrand-
sen P, van Dulmen S; Consensus
Working Group. Reinforcing
the humanity in healthcare: the
Glasgow Consensus Statement
on effective communication in
clinical encounters. Patient Educ
Couns. 2024;122:108158.
4. Stange KC. The problem of frag-
mentation and the need for inte-
grative solutions. Ann Fam Med.
2009;7:100-3.
5. Porter J, Boyd C, Skandari MR,
Laiteerapong N. Revisiting the
time needed to provide adult
primary care. J Gen Int Med.
2023;38:147-55.
6. Makoul G. Essential elements
of communication in medical
encounters: the Kalamazoo con-
sensus statement. Acad Med.
2001;76:390-3.
7. Busch IM, Moretti F, Travaini
G, Wu AW, Rimondini M. Hu-
manization of care: key elements
identified by patients, caregiv-
ers, and healthcare providers.
A systematic review. Patient.
2019;12:461-74.
8. Street RL Jr, Makoul G, Aro-
ra NK, Epstein RM. How does
communication heal? Path-
ways linking clinician-patient
communication to health out-
comes. Patient Educ Couns.
2009;74:295-301.
9. Barry MJ, Edgman-Levitan S.
Shared decision making–pin-
nacle of patient-centered care. N
Engl J Med. 2012;366:780-1.
10. Weiner SJ, Schwartz A. Listen-
ing for what matters: avoiding
contextual errors in health care,
2nd ed. Oxford: Oxford Univer-
sity Press; 2023.
11. Lussier MT, Richard C. Be-
cause one shoe doesn’t fit all: a
repertoire of doctor-patient re-
lationships. Can Fam Physician.
2008;54:1089-92.
12. Planetree. Person-centered Care
[Internet]. 2025 [cited 2025 Jan
31]. Available from: https://www.
planetree.org
Members of the Glasgow
Consensus Statement Working
Group: Margarida Braga (Portugal),
Marianne Brouwers (Netherlands),
Judy Chang (United States),
Glyn Elwyn (United States), Pål
Gulbrandsen (Norway), Monique
Heijmans (Netherlands), Michael
Kaffman (Israel), Jéssica Leão
(Brazil), Marie-Thérèse Lussier
(Canada), Calum MacKichan
(Belgium), Gregory Makoul
(United States), Lorraine Noble
(United Kingdom), Arwen Pieterse
(Netherlands), Shakaib Rehman
(United States), Claude Richard
(Canada), Anna Udvardi (Hungary),
Sandra van Dulmen (Netherlands)
and Jonathan Ward (United
Kingdom).
Authors
Gregory Makoul, PhD, MS
Founder, Wisdomics
Strategic Advisor, Planetree
Faculty of Medicine,
Yale School of Medicine
New Haven, Connecticut,
United States
gmakoul@wisdomics.org
Calum MacKichan, PhD
Communication Officer,
Standing Committee of
European Doctors (CPME)
Co-Chair Policy and Practice,
International Association for
Communication in Healthcare (EACH)
Brussels, Belgium
calum.mackichan@cpme.eu
Reinforcing the Humanity of Healthcare
21
Interview with National Medical Associations’
Leaders of the Pacific Region
Interview with National Medical Associations’ Leaders of the Pacific Region
Dr. Danielle McMullen, Dr. Hector
Santos, Jr., and Dr. TaegWoo Kim,
the Presidents of the national
medical associations (NMAs) of
Australia, Philippines, and Republic
of Korea, respectively, Dr. Maria
Minerva Calimag, Past President
of the NMA of the Philippines,
and Dr. Brian Chang, Secretary-
General of the NMA of Taiwan,
join the interview with Dr. Helena
Chapman, the WMJ Editor in
Chief. They share their perspectives
on their leadership experiences,
ongoing NMA activities, strengths
and existing challenges in medical
education, and how the World
Medical Association (WMA) can
support NMA initiatives in the
Pacific region.
As you reflect upon your journey as
NMA president, please describe one
memorable experience, one challenge
and how you resolved the challenge,
and one hope for the future of
medicine.
Australia: As NMA president,
one significant highlight has
been meeting my National
Medical Association colleagues
at a Confederation of Medical
Associations in Asia and Oceania
(CMAAO) event last year in the
Philippines. It was remarkable
to see the similarity of different
healthcare issues that we face each
day, despite quite different health
systems. One challenge facing
Australian healthcare has been the
workforce shortage of doctors, and
governments’ actions to try and
solve this shortage by expanding
the scope of non-medical health
professionals and introducing new
non-medical workforces working
autonomously. We are deeply
concerned that this action will
fragment patient care, and if not
done correctly, will lead to worse
outcomes. Instead, we should be
pursuing genuine team-based
care approaches, using each team
member to their full potential while
ensuring true collaboration and
medical involvement. I hope that
the future of medicine in Australia
reflects this goal – that our doctors
can enjoy fulfilling careers working
in well-supported teams, and that
our patients have access to high-
quality care when and where they
need these services.
Philippines: Reflecting on my
journey as the Philippine Medical
Association (PMA) President,
from 2014-2016 and 2022-2024,
I am filled with a profound sense
of gratitude and responsibility [1].
The post-pandemic era presented
unique challenges and opportunities,
allowing me to grow personally
and professionally while driving
impactful changes in the medical
fraternity. Being elected as the
PMA President for four terms is
a feat that many physician-leaders
Maria Minerva Calimag
Brian Chang
TaegWoo Kim
Danielle McMullen
Hector Santos, Jr.
BACK TO CONTENTS
22
have not had the chance to
experience. One memorable
professional experience was when
the Professional Regulations
Commission recognised the PMA
– twice – as the Most Outstanding
Professional Organisation out of
46 other professional organisations
in the Philippines. My most
memorable personal experience was
when I was selected to lead other
national medical associations in the
Asia and Oceania region, as the
41st President of the CMAAO for
2024-2025 (https://www.cmaao.org/
aboutus/current-leaders/).
However, my time as president
was not without challenges. First,
the coronavirus disease 2019
(COVID-19) pandemic had left
profound scars on the medical
community’s mental well-being,
with many healthcare professionals
experiencing burnout and depression.
Collaborating with mental health
professionals, I immediately
spearheaded the development
of a comprehensive support
program, including offering regular
counselling sessions, organising
stress management workshops, and
creating safe spaces for healthcare
professionals to express their feelings
and concerns. These efforts, coupled
with fostering a culture of openness
and acceptance, gradually eased the
mental strain on our community.
Witnessing the positive impact
of these initiatives reinforced my
belief in resilience and the power of
communal support.
Looking towards the future, I
hope that governments will adopt
universal health care and medical
centres will embrace holistic primary
care services. While technological
advancements continue to push the
boundaries of medical possibilities,
I envision a future where medicine
marries innovation with compassion.
Personalised patient care, effective
mental health integration, and
preventive strategies should become
the gold standards, where the
healthcare ecosystem focus shifts
from treating illnesses to proactively
maintaining well-being and health.
To realize this vision, it is crucial
to keep nurturing young, passionate
professionals who are skilled and
empathetic to strengthen the
physician-patient relationships.
As we continue to heal from the
pandemic’s reverberations, I am
optimistic that this holistic approach
will lead to a healthier society, where
everyone has access to inclusive,
comprehensive care.
As I reflect on the experiences,
challenges, and aspirations from
my presidential tenure, I am filled
with optimism about the future of
medicine. Embracing technological
advances, addressing mental health
head-on, and cultivating a holistic
healthcare system are fundamental
stepping stones. I am enthusiastic
about the journey ahead, ready to
work alongside my peers toward a
future where healthcare evolves into
a beacon of innovation, compassion,
and inclusivity.
Republic of Korea: I was inaugurated
as the 43rd president of the Korean
Medical Association (KMA) on 8
January 2025, during a prolonged
national healthcare crisis that
has persisted for over one year.
Before my presidency, I served
as the chairman of the KMA
Emergency Response Committee,
leading efforts to prevent the
government’s unilateral enforcement
of medical policies, including an
excessive increase in medical school
admissions. In this role, I earned
the trust of medical students and
residents, who are the primary
stakeholders and victims of the
crisis. As a result, I was elected as
KMA president with broad support
from the entire medical community.
Currently, the Republic of Korean
government is pushing forward
with a drastic increase in medical
school enrolment, from 3,058
to 4,567 students per year – a
surge of 1,508 students without
adequate preparation. Despite
repeated warnings that the existing
medical education infrastructure is
insufficient to accommodate such an
increase, the government continues
to implement this policy without due
consideration. As a result, medical
students and residents have been
resisting by submitting resignations
and requesting leaves of absence, a
movement that has now lasted for
one year. With nearly 7,600 students
expected to be educated under an
infrastructure originally designed
for 3,058 students, the sustainability
of medical education and training
is at serious risk. As the KMA
president, I am fully committed to
restoring stability and normalcy to
the Republic of Korea’s healthcare
system.
Taiwan: During my tenure with
the Taiwan Medical Association
(TMA), one memorable experience
was leading a national campaign to
enhance mental health awareness
among citizens. TMA members
interacted with community members
of all ages, encouraging open
conversations about mental health in
order to reduce stigma. Our primary
challenge was the overwhelming
demand on our healthcare system
during the COVID-19 pandemic
and resulting burnout among
medical staff, and in response,
we established support networks
and prioritised communication
to help alleviate stress. Looking
to the future, I hope for a more
integrated approach to healthcare
that emphasises prevention and
holistic care, ensuring access to
comprehensive services for all
citizens.
Interview with National Medical Associations’ Leaders of the Pacific Region
BACK TO CONTENTS
23
How would you describe the current
opportunities for NMA members
to help influence health care policy-
making activities in your country?
Australia: The Australian Medical
Association (AuMA) has a strong
and proud history working with
our government on a wide range
of health-related policy issues.
Underpinning the AuMA’s policy
and advocacy is the Vision for
Australia’s Health 2024-2027
document (https://www.ama.com.au/
vision-for-australias-health), which
proposed sensible and targeted
reforms that would help address
these issues in our health system.
AuMA’s reform ideas focus on
five pillars: general practice, public
hospitals, private health, a health
system for all, and a health system
for the future. With a federal
election in Australia in 2025,
there are many opportunities for
the AuMA and our members to
influence the health policy of the
future in Australia, and we will be
taking every opportunity to do so.
Philippines: The PMA members
have numerous opportunities to
influence healthcare policy-making
activities within the Philippines. By
participating in legislative advocacy,
PMA members collaborate
with government officials and
policymakers to draft and promote
laws that address pressing health
concerns and improve the healthcare
system. Engaging in public forums
and stakeholder meetings also
provides PMA members with
platforms to voice their expert
opinions, ensuring that decisions
made at the policy level are informed
by evidence-based medical practices
and the real-world experiences of
healthcare professionals.
Moreover, PMA members are
involved in research initiatives
and data collection efforts,
contributing critical insights that
shape national health priorities.
This involvement not only aids in
creating effective health policies,
but also helps in monitoring and
evaluating the outcomes of these
policies, ensuring that they meet the
intended goals. Additionally, PMA
members work in partnership with
non-governmental organisations,
educational institutions, and
international bodies to foster
collaborative efforts aimed at public
health improvements, which can
lead to a broader influence on
policy-making.
By leveraging media platforms,
PMA members raise public
awareness on vital health issues,
thereby mobilising public support
for policy changes. Serving as
educators and advisors, they play
a crucial role in informing both
policymakers and the public about
the complexities of health issues,
advocating for necessary reforms
and budget allocations. The PMA
also creates special interest groups
within its membership to provide
targeted expertise and advocacy
on specific health issues, such as
infectious diseases, maternal health,
and mental health. Notable advocacy
groups and healthcare movements
include the Healthcare without
Harm–Philippines (HCWH-PH),
Healthcare Professionals Alliance
Against COVID-19 (HPAAC), Sin
Tax Coalition, Philippine Alliance
Against Tuberculosis (PhilCAT),
Coalition Against Fake Medicines,
Safe Medicines Network, Health
Action Information Network
(HAIN), Coalition Against
Cannabis Legalization, Empowering
Networks against Dengue, Diabetes
Philippines, Mental Health PH,
and Rotary Club of Healing Hands.
Through these diverse advocacy
groups, PMA members significantly
impact healthcare policy-making
and contribute to the overall
health and well-being of the
Filipino population.
Republic of Korea: As the
representative body of the medical
community, the KMA has actively
participated in government
committees, parliamentary
discussions, and various policy
forums to advocate for diverse
perspectives in healthcare. We
have also organised national
and specialty-specific academic
conferences and policy discussions to
fulfil our role as an expert advisory
body in healthcare policymaking.
While we have consistently engaged
with the government to contribute
expert opinions, there have been
instances where we had to express
strong opposition through protests
and strikes when policies were
pushed forward without proper
consultation.
Currently, despite the KMA’s
repeated advice, the government is
pushing ahead with excessive and
impractical policy changes, leading
medical students and residents to
resist by resigning and taking leaves
of absence. In December 2024, the
government even issued a quasi-
martial law directive to suppress
their legitimate protest. Trust
between the government and the
medical community has completely
collapsed, and urgent efforts are
needed to rebuild this trust. Despite
these challenges, the KMA remains
dedicated to its primary mission –
conducting research on healthcare
policies and advocating for
evidence-based improvements. We
hope to restore cooperation with
the government to ensure better
healthcare for the nation.
Taiwan: The Taiwan Medical
Association (TMA) members
have significant opportunities to
influence healthcare policy-making
Interview with National Medical Associations’ Leaders of the Pacific Region
BACK TO CONTENTS
24
through evidence-based policy
lobbying. By leveraging robust
data and research, we can advocate
for policies that truly reflect the
unique needs of our population.
Establishing strong communication
channels with health authorities
can ensure that our voices are heard
in the decision-making process.
Moreover, we always prioritise the
best interests of physicians, patients,
and their families at the centre of
our health policies, aligning our
advocacy efforts with the ultimate
goal of improving community health
outcomes. Through collaboration
and a unified approach, we can
effectively shape a better healthcare
landscape for all citizens.
How do perceive the physician-
patient relationship and rapport in
the clinical setting in your country?
Australia: As measured in the
Governance Institute of Australia’s
yearly Ethics Index (https://www.
governanceinstitute.com.au/ethics-
index/), the Australian public
perceives the ethical behaviours
of the health sector and general
practitioners as very high, especially
amongst a range of occupations.
In order to maintain the public’s
trust and confidence in the
medical profession, the various
Australian medical regulatory and
professional organisations work
together to promote a very high
standard of ethical behaviour,
standards of practice, competency,
and professional conduct through
an open and accountable process
of profession-led regulation.
This collaboration also involves
responding to new and ongoing
challenges that could potentially
compromise the physician-patient
relationship, patient safety or
healthcare access if not managed
appropriately, such as the expansion
of non-medical practitioner’s
scope of practice or the increased
use of artificial intelligence in
healthcare. The AuMA provides
a particularly strong leadership
role in highlighting the sanctity of
the physician-patient relationship
through its Code of Ethics and a
range of position statements and
guidelines, which collectively guide
doctors in their relationships with
patients, colleagues, other healthcare
professionals, and society.
Philippines: As healthcare leaders
at the helm of our national
medical association, we perceive the
physician-patient relationship in the
Philippines as a pivotal element of
effective healthcare. We engage with
patient groups like the Philippine
Alliance of Patient Organisations
(PAPO) to confirm that our health
initiatives are grounded in trust,
empathy, and open communication,
and where physicians actively
listen and engage with patients as
partners in their health journey.
Shared decision-making is
encouraged, fostering collaboration
and empowering patients in their
treatment choices. By prioritising
confidentiality, continuity of care,
and constructive feedback, we aim
to cultivate enduring, compassionate
relationships that enhance patient
satisfaction and healthcare outcomes,
ultimately advancing the nation’s
medical standards.
Cultural sensitivity and respect for
diverse backgrounds are paramount,
ensuring that care respects patients’
beliefs and values. The PMA has
mobilised healthcare professionals,
resources, and community
partnerships to launch the Reaching
the Unreached Flagship Program
(“Kultura Komunikasyón at
Katutubong Wikà para sa Kalusugan
at Kaunlaran ng mga Katutubò”)
in 2022, as a groundbreaking
initiative that extends healthcare
access to remote, marginalised,
and isolated communities lacking
adequate medical services in the
Philippines. The program, which
emphasises preventive care, health
education, and the provision of
essential medical services (e.g.
vaccinations, check-ups, screenings),
collaborates with local governments
and organisations to establish long-
term healthcare infrastructure and
empower local health professionals.
Through this initiative, the
PMA has demonstrated their
commitment to the broader goal
of nationwide health improvement
and the elimination of health
disparities, supporting healthcare
equity and enhancing the well-
being of all Filipinos, particularly
those in geographically challenging
and economically disadvantaged
locations.
Republic of Korea: On the ground,
patients and the general public
generally hold a high level of trust
in medical professionals. However,
despite this trust, the Republic
of Korea has an exceptionally
high number of medical lawsuits
compared to other countries. Even
in cases of unavoidable medical
accidents, physicians are frequently
held criminally liable, which
eventually erodes trust in the
medical profession over time.
This legal environment has led
to an increasing reluctance (and
subsequent decline) among doctors
to enter high-risk specialties such
as emergency medicine, obstetrics
and gynecology, and pediatrics,
causing delays in urgent medical
care. Consequently, the rapport
between the public and the medical
community is deteriorating due to
systemic failures and the breakdown
of trust between the government
and the medical profession, rather
than the quality of physician-patient
interactions. Without policy reforms
to address issues such as excessive
legal liability, essential medical fields
Interview with National Medical Associations’ Leaders of the Pacific Region
BACK TO CONTENTS
25
will continue to struggle, ultimately
harming both doctors and patients.
Taiwan: In Taiwan, the physician-
patient relationship is influenced
by our National Health Insurance
system, a universal healthcare
system that ensures that all citizens
can seek and receive high-quality,
comprehensive medical services. As
some patients feel entitled to high-
quality medical treatment due to
their contributions to the system,
their lack of appreciation and
respect for these healthcare resources
and physicians can result in strained
physician-patient interactions and
rapport. Moreover, physicians often
express concerns about potential
medical malpractice, which can make
them hesitant to pursue aggressive
treatment options. Overall, fostering
mutual respect and understanding
between physicians and patients are
essential for improving rapport and
confidence in clinical settings.
How would you describe the
anticipated challenges in medical
education over the next decade in
your country?
Australia: The AuMA is advocating
for responsive, sustainable, inclusive,
and quality medical education in
Australia. Doctors in training are
the future of our health workforce,
and they must be equipped with
the necessary support to excel
in the speciality of their choice.
Australia has one of the most
effective medical education systems,
where medical students complete a
clinically-integrated medical degree,
and then two years of generalist
training in hospitals, before selecting
a speciality (including general
practice/family medicine) and
completing further training through
one of our learned specialist
medical colleges should they wish.
Anticipated challenges include
ensuring that doctors in training
undertaking specialist postgraduate
medical education are supported
and engaged in their learning and
institution’s governance. Support
for trainees include ensuring that
trainees receive feedback regarding
exam performance, that training and
workplaces are free from bullying,
harassment, and discrimination, and
that they have the opportunity to
undertake rural training should they
wish.
The AuMA also strongly advocates
for flexible training, reflecting the
changing needs of the medical
workforce and the shift in societal
attitudes for greater flexibility
in work and education. The
introduction of flexible medical
work and training practices
promotes equal opportunity and
diversity, enhances the participation
of doctors in the workforce, and
supports sustainable medical
workforce retention and growth.
It also encourages innovation,
promotes doctors’ well-being, and
strengthens the delivery of high-
quality medical care and training.
Philippines: Over the next decade,
medical education in the Philippines
and other countries faces challenges
like rapid advancements in medical
technologies, necessitating constant
curriculum updates and faculty
expertise in areas such as artificial
intelligence, telemedicine, and
personalised medicine. Increasing
student diversity demands equitable
educational experiences and
elimination of biases. Balancing
theoretical knowledge with practical
skills requires innovative teaching
and more clinical exposure.
Addressing mental health and well-
being among students is crucial due
to high stress levels and burnout.
Funding constraints pose difficulties
in expanding facilities and hiring
qualified staff, potentially affecting
education quality.
Integrating global health perspectives
into medical education is becoming
increasingly important. As global
health challenges like pandemics,
climate change, and cross-border
diseases arise, it is crucial for
medical curricula to reflect these
issues, preparing students for a
globalised healthcare environment.
Addressing these challenges
requires a proactive approach from
educational institutions, government
bodies, and healthcare professionals
to ensure the development of
competent and adaptable medical
professionals in the Philippines and
the Pacific region.
Republic of Korea: The government’s
abrupt and authoritative increase
in medical school admissions has
created significant challenges for
medical education. When students
currently on leave return to
school, the total number of first-
year medical students will exceed
7,000. However, there has been no
corresponding expansion in lecture
halls, faculty numbers, or other
essential educational infrastructure.
This lack of preparation threatens
to degrade both medical education
and the overall quality of healthcare.
Furthermore, increasing legal risks
and exploitative, low-paid working
conditions in residency training
programs in essential medical fields
have led to the growing reluctance
among junior doctors to enter these
specialties. Addressing these issues
and eliminating unfair working
conditions require urgent reforms in
medical policies. Additionally, with
the rise of artificial intelligence in
medicine, future physicians must be
prepared for the evolving changes
it will bring to the field. There is
also a growing need for education in
health system science to help future
doctors understand healthcare from
a broader societal and policy-driven
perspective.
Interview with National Medical Associations’ Leaders of the Pacific Region
BACK TO CONTENTS
26
Taiwan: As medical education in
Taiwan will face several anticipated
challenges, continuous medical
education will be essential to
ensure quality care as healthcare
demands evolve. First, academic
leaders will need to discuss how
artificial intelligence will impact
future healthcare delivery, and
hence identify best practices for
incorporating artificial intelligence
concepts into medical school
curriculum. Second, physicians will
need to expand their knowledge
beyond traditional healthcare
topics, including understanding
administration, law and regulations,
infection control, sexual equity,
medical ethics, and long-term
care, to meet the growing needs
of the global population. Third,
by developing and refining their
skills in social communication and
understanding corporate social
responsibility, physicians can help
foster community engagement and
address broader health issues for
Taiwan. Adapting our education
system to encompass these diverse
areas while maintaining a strong
foundation in clinical skills will be
a key challenge moving forward to
support the health needs of Taiwan
and the Asia-Pacific region.
From the medical education
perspective, how has your NMA
responded to the existing and
emerging health challenges within
your country?
Australia: The AuMA does not
provide medical education within
Australia, but rather shares strong
clinician-led feedback with key
institutions involved in funding
medical education, establishing
standards, and delivering training. A
key challenge facing Australia, like
many other countries, is ensuring
that patients have access to the
care they need, no matter where
they live. Our system of medical
education and training and its
reform are critical to addressing
this challenge, particularly with our
widespread geography and large
rural population. We continue to
support doctors’ access to high-
quality training experiences in rural
areas, which can encourage more
doctors to live and work in these
areas. We also promote opportunities
for doctors to explore better funding
models to encourage more doctors
to train in underserviced specialties,
including through the private sector.
Philippines: The PMA plays
a pivotal role in shaping the
landscape of medical education and
professional development in the
Philippines. The PMA participates
in shaping medical education
policies, standards and guidelines
as a member of the Commission
on Higher Education Technical
Panel for Medical Education. In
undergraduate medical education,
the PMA collaborates with various
academic institutions and regulatory
bodies to ensure that the medical
curriculum remains relevant
and aligned with contemporary
advancements in healthcare.
These steps involve advocating for
curricular updates that integrate
modern medical technologies, global
health perspectives, and the essential
balance between foundational
medical knowledge and practical
skillsets.
The PMA recognises the crucial
need for lifelong learning and
supports structured programs
that enhance the competency
and skills among medical trainees
in internship, residency, and
fellowship programs. First, the
PMA Commission on Professional
Specialization collaborates with the
Association of Philippine Medical
Colleges to provide a venue for
the discussion of issues that impact
training programs. Second, the
PMA actively organizes virtual and
face-to-face seminars, workshops,
and conferences for the continuing
professional development of
healthcare professionals so they
may stay informed about the latest
medical research, technologies, and
best practices. These programs
are designed to foster a culture of
continuous learning, encouraging
doctors to keep abreast of new
developments in their field and
improve patient care standards.
They focus not only on medical
knowledge, but also on leadership,
communication, and ethical practices
within the healthcare sector.
By endorsing and sometimes
developing continuing professional
development activities, the PMA
ensures that doctors maintain
their professional competence and
are equipped to tackle emerging
healthcare challenges effectively.
To support these efforts, the
PMA liaises with the Professional
Regulation Commission through
the Committees of Continuing
Professional Development (CPD)
and the Committee on Career
Progression and Specialization –
Credit Accumulation Transfers
(CPSP-CATs) to engender the
mandate of the Association of
Southeast Asian Nations (ASEAN)
Qualifications Framework. Overall,
the PMA’s comprehensive
approach to medical education and
professional development ensures
that the medical community in
the Philippines remains dynamic,
competent, and prepared to meet
the ever-evolving demands of the
healthcare industry.
Republic of Korea: The Republic
of Korea is facing a rapidly
aging population and a record-
low birth rate, leading to an
impending demographic crisis.
The national health system has
observed increased demands for
Interview with National Medical Associations’ Leaders of the Pacific Region
BACK TO CONTENTS
27
chronic disease management, elderly
care, and elective, quality-of-life
medical services. To address these
fundamental issues, the KMA has
taken an active role in advocating
for a multidisciplinary approach
to the low birth rate crisis. We
have established committees,
organised public forums, and even
launched fundraising initiatives
to create a more supportive
environment for childbirth and
parenting. Additionally, the KMA
is actively involved in ensuring
that the government’s chronic
disease management initiatives are
implemented effectively. We have
established a Chronic Disease
Management Committee to
provide expert input and policy
recommendations, ensuring that
these programs align with best
practices in healthcare delivery.
Taiwan: The TMA, along with
the 23 specialty societies, have
recognised the evolving healthcare
landscape and have proactively
implemented continuous medical
education and training programs
to address existing and emerging
health challenges in Taiwan. They
have collaborated with educational
institutions to integrate critical
topics, such as artificial intelligence,
long-term care, and social
communication, into the curriculum
and ensure that future physicians
are well-equipped to meet
contemporary healthcare demands.
By collaborating with specialty
societies, they can incorporate
specialised training tailored to
the unique needs of various
medical fields, which enriches the
educational landscape and fosters
a culture of lifelong learning. In
response to public health crises,
such as the COVID-19 pandemic,
they have organised workshops
and webinars to disseminate best
practices to healthcare professionals,
which has enhanced their
readiness to tackle emerging health
issues effectively.
From your perspective and national
experiences, how has the COVID-19
pandemic affected medical education
in your country?
Australia: During the COVID-19
pandemic, the profession observed
the need to make significant
changes in how doctors train
and assess medical education
for the next generation. Medical
schools and colleges responded
quickly to this call and supported
the implementation of many
innovative changes including online
assessments, which are now well
entrenched in these academic
programs.
Philippines: The COVID-19
pandemic brought about profound
changes in medical education in the
Philippines, forcing institutions to
rapidly adapt to new circumstances.
As lockdown measures necessitated
the closure of physical classroom,
medical schools swiftly transitioned
to online hybrid and hyflex learning,
including video conferencing tools
and learning management systems
to maintain educational delivery.
This transition highlighted the issue
of accessibility, as many students
living in rural areas had limited
access to reliable internet and digital
devices, which further exacerbated
educational inequalities.
Curriculum adaptations became
necessary, with a shift in focus from
practical, hands-on experiences
to more theoretical knowledge,
given the restrictions on physical
interactions. To compensate for
the reduced clinical exposure, vital
in medical training, institutions
increased the use of virtual
simulations and clinical case
discussions, offering alternative,
albeit less tactile, forms of practical
learning. Educators were prompted
to innovate their teaching methods,
using interactive online tools such as
quizzes, fora, and video assignments
to keep student engagement high.
Assessment methods also evolved,
as traditional in-person exams were
replaced with online assessments,
prompting schools to develop
new strategies that maintained
academic integrity and fairness.
The pandemic’s pressures also
heightened mental health concerns
among students and faculty, leading
institutions to bolster mental health
support services and awareness
initiatives. Moreover, the pandemic
underscored the importance of
telemedicine and interdisciplinary
learning, pushing these themes into
the curriculum to better prepare
future healthcare professionals.
While these challenges were
significant, they also sparked
innovation, likely leaving a lasting
impact on the landscape of medical
education in the Philippines.
Republic of Korea: During the
COVID-19 pandemic, medical
students were forced to transition
from in-person to online learning,
significantly reducing hands-on
clinical experience. With hospitals
overwhelmed by COVID-19
patients, many students lost
opportunities for clinical training,
raising concerns about a decline
in their practical skills, including
procedural techniques and physical
examination skills.
As a result, the importance of
internship and residency training
has become even more pronounced,
offering time for medical graduates
to refine these practical skills.
At the same time, the pandemic
accelerated innovation in medical
education, leading to the widespread
adoption of innovation technology
(IT)-driven learning methods.
Interview with National Medical Associations’ Leaders of the Pacific Region
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28
Moving forward, medical education
must continue evolving to balance
traditional hands-on training with
new, flexible, and technology-driven
teaching approaches.
Taiwan: The COVID-19 pandemic
has significantly impacted medical
education in Taiwan, leading
to an increased emphasis on
infection control and emerging
pathogens, which are now essential
components of continuous medical
education for license renewal. In
the academic setting, the pandemic
helped accelerate the adoption of
online learning for medical and
interprofessional education, which
enabled broader access to training
resources, reinforced the value of
adaptability and lifelong learning,
and highlighted the importance of
digital literacy among educators and
learners. In the clinical setting, the
pandemic helped raise awareness
of the value of effective healthcare
teamwork as well as risk factors
that influence optimal mental health
and well-being, which led to the
integration of wellness initiatives
into curricula.
How does your NMA leadership
implement the WMA policies in the
organisation?
Australia: The AuMA regularly
promulgates new and updated
WMA policies to our members and
others through our media channels.
In fact, many WMA policies are
referenced within our own position
statements and resolutions. On
occasion, we will formally adopt
a WMA declaration, statement
or resolution to serve as formal
AuMA policy, as observed with the
Declaration of Seoul, Declaration
of Geneva, Declaration of Tokyo,
and Regulations in Times of Armed
Conflict and Other Situations of
Violence. These particular policies
are highlighted on our website and
mentioned in our own advocacy
through submissions, media and
communications channels, and
written documents or meetings with
government ministers and other
external stakeholders.
Philippines: Advocacy is a critical
area where the PMA aligns with
WMA policies. The Association
actively lobbies for health policies
that resonate with WMA
principles, often collaborating
with governmental and non-
governmental organisations to
influence health legislation. Ethical
guidelines from the WMA, such
as the Declaration of Geneva, are
integrated into the PMA’s Code of
Ethics of the Medical Profession,
promoting ethical and professional
integrity among practitioners.
Through its active involvement
at the CMAAO and the Medical
Association of Southeast Asian
Nations (MASEAN), the PMA
leadership is actively involved in
global medical fora, staying abreast
of new WMA developments
and policies. Insights from these
engagements are integrated into
local strategic plans, ensuring
that the PMA enhances medical
practices in the Philippines and
contributes to the global healthcare
agenda. Overall, the PMA’s strategic
alignment with WMA policies
strengthens the quality of healthcare
and upholds ethical standards within
the medical community.
As Immediate Past President of the
PMA and the current President of
the CMAAO, I joined the WMA
Pacific Regional Meeting on the
2024 Revision of the Declaration
of Helsinki in Tokyo, Japan, from
29 November to 1 December
2023. Specifically, I presented
the topic entitled, Emergency
Use Authorization, Compassionate
Use and Research Ethics during
Health Emergencies. We joined
fellow advocates in the campaign
towards centring human health in
the Global Plastic Treaty held in
Hanoi, Vietnam, from 27-29 March
2024, as well as the International
Leadership Summit of Medical
Associations on tuberculosis
eradication in Kochi, India, from
1-2 June 2024 [2,3].
Republic of Korea: The KMA
actively integrates WMA policies
and guidelines into our national
healthcare framework, ensuring that
South Korean physicians are aligned
with global medical ethics and
standards. We reference key WMA
declarations, such as the Declaration
of Geneva, the Declaration of
Helsinki, and the International
Code of Medical Ethics, to
strengthen domestic medical ethics
policies. Additionally, we leverage
WMA policies when advocating
for legal and systemic reforms
that protect physicians’ rights and
improve the healthcare environment.
By incorporating international best
practices into national policies, the
KMA aims to uphold the highest
ethical and professional standards
in the Republic of Korea’s medical
community.
Taiwan: The TMA leadership
actively implements WMA policies
through a structured approach. After
each WMA meeting, they promptly
document the discussions on
medical ethics, sociomedical affairs,
and key policies. When the WMA
requires minor or major revisions
of statements, the TMA convenes
expert meetings for extensive
discussions, allowing members to
provide informed recommendations.
Additionally, new WMA statements
are translated into Mandarin and
published in the Taiwan Medical
Journal, ensuring that physicians
can stay informed about relevant
policies. This systematic approach
Interview with National Medical Associations’ Leaders of the Pacific Region
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29
facilitates the effective integration of
WMA policies into the organisation
and enhances the overall quality of
medical practice in Taiwan.
How can the WMA support the
ongoing NMA activities in your
country?
Australia: The WMA can use
its global platform to continually
highlight and advocate for issues
important to Australia and the
Pacific region. Some key issues
that influence the delivery of
quality healthcare for patients and
communities include understanding
the health impacts of climate change
and natural disasters and promoting
and protecting physicians’ clinical
independence and professional
autonomy.
Philippines: The WMA can play
a pivotal role in supporting the
ongoing activities of the PMA in
multiple ways. First, the WMA can
support professional development
by organising joint conferences,
webinars, and workshops, which can
allow PMA members to enhance
their knowledge and skills through
a global perspective. They can
provide valuable guidance, targeted
workshops, and training resources
that enhance the competencies and
high ethical standards of healthcare
professionals in specific medical
fields. Access to a comprehensive
repository of global medical research
and publications through the WMA
can further aid the professional
growth of Filipino doctors. Second,
the WMA can provide advocacy and
policy support that bolsters PMA’s
collaborative efforts on health policy
initiatives that address significant
national issues like universal
healthcare and medical ethics. The
WMA can help amplify the impact
of PMA’s public health campaigns
against emerging challenges, such as
pandemic preparedness, prevention
of non-communicable diseases, and
vaccinations. Working collaboratively
with the PMA on campaigns to
improve healthcare access and
quality, especially in underserved
regions, is invaluable.
Third, the WMA can help facilitate
networking opportunities between
the PMA and other national medical
associations, fostering an exchange
of knowledge and expertise and
potentially leading to collaborative
international research and public
health projects. Encouraging
cultural exchanges between medical
professionals from different
countries can expand understanding
and incorporate diverse healthcare
practices, benefiting both doctors
and patients. Sharing educational
materials, research outputs, and other
resources will bolster the PMA’s
educational endeavours. In summary,
the WMA’s support through
professional development, advocacy,
capacity building, networking,
resource sharing, ethical guidance,
and public health initiatives can
significantly enhance the PMA’s
efforts to improve healthcare
standards and professional practice
in the Philippines. Moreover, the
PMA welcomes the opportunity to
have a Filipino physician lead at the
WMA.
Republic of Korea: The WMA
has been an invaluable ally in
supporting the KMA’s efforts to
address critical healthcare issues,
such as opposing the mandatory
installation of surveillance cameras
in operating rooms, preventing
the enactment of the controversial
Nursing Act, and advocating against
excessive increases in medical
school enrolment. Through public
statements, video campaigns, and
social media outreach, the WMA
has helped amplify the KMA’s
concerns on the international stage.
We urge the WMA to champion
the universal rights of physicians
worldwide and ensure that medical
professionals can practice in a
system that prioritises both ethical
standards and patient well-being.
Taiwan: The WMA can support
ongoing NMA activities in Taiwan
by facilitating conferences that
bring WMA leaders and local
stakeholders together to address
timely health issues, as previously
observed each year in Geneva and
Taipei City. These conferences, often
attended by the Taiwanese President
and the Taiwanese Minister of
Health and Welfare, would help
ensure that health policies are more
readily accepted by the government
and the public. The WMA’s support
for physicians emphasises their
vital leadership role within multi-
professional teams, empowering the
NMA to advocate effectively for the
interests of physicians. Furthermore,
WMA upholds the principle that
health is a fundamental right,
free from political interference,
and supports Taiwan’s bid to join
the World Health Organisation
and other international health
organisations, demonstrating
resilience against political pressures.
This collaboration enhances the
NMA’s efforts to promote health
equity and improve healthcare
delivery in Taiwan.
References
1. The Philippines Medical Associa-
tion. Unprecedented legacy: Presi-
dent Calimag lead the PMA for a
historic fourth term [Internet].The
Physician. 2023 [cited 2025 Feb
1]. Available from: https://www.
philippinemedicalassociation.org/
wp-content/uploads/2023/09/
PMA-Newsletter-2023-2024-
First-Issue-F.pdf
Interview with National Medical Associations’ Leaders of the Pacific Region
BACK TO CONTENTS
30
Interview with National Medical Associations’ Leaders of the Pacific Region
2. Health Care without Harm. Open
letter from health professionals on
the plastics treaty [Internet]. 2024
[cited 2025 Feb 1]. Available from:
https://global.noharm.org/focus/
plastics/open-letter
3. STOP TB Partnership. First ever
international leadership summit of
medical associations on achieving
UNHLM targets to end TB con-
cludes with the Kochi Declaration
[Internet]. 2024 [cited 2025 Feb
1]. Available from: https://www.
stoptb.org/news/first-ever-inter-
national-leadership-summit-med-
ical-associations-achieving-un-
hlm-targets-end-tb
Authors
Maria Minerva Calimag, MD, PhD
Immediate Past President, Philippine
Medical Association (PMA)
President, Confederation of
Medical Associations in Asia
and Oceania (CMAAO)
Manila, Philippines
mpcalimag@ust.edu.ph
Brian Chang, MD, PhDc
Secretary-General, Taiwan
Medical Association
Taipei, Taiwan
intl@mail.tma.tw
TaegWoo Kim, MD
President, Korean Medical
Association (KMA)
Seoul, Republic of Korea
intl@kma.org
Danielle McMullen, MBBS(Hon),
FRACGP, DCH, GAICD
President, Australian
Medical Association
Brisbane, Australia
president@ama.com.au
Hector Santos, Jr., MD
President, Philippine Medical
Association (PMA)
Manila, Philippines
drhecsan@yahoo.com
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31
The United States Agency for
International Development (USAID)
is pivotal in supporting global health
initiatives, particularly in the fight
against HIV/AIDS [1]. Through its
partnerships and funding, the USAID
advances clinical research, expands
access to life-saving treatments, and
strengthens healthcare systems to
improve patient outcomes. In South
Africa, where HIV/AIDS remains a
significant public health challenge,
the USAID has been instrumental
in supporting antiretroviral therapy
(ART) programs, prevention
initiatives, and clinical trials for
innovative interventions, including
pre-exposure prophylaxis (PrEP) [2].
In particular, the USAID collaborates
with non-governmental organisations
(NGOs) such as the South African
National AIDS Council (SANAC),
the Right to Care, and the Treatment
Action Campaign (TAC), which play
a critical role in community outreach,
patient advocacy, and service delivery
[3]. By working alongside these
NGOs and other stakeholders, the
USAID helps scale up evidence-
based strategies that enhance
HIV/AIDS prevention, treatment,
and care services, ensuring that
communities receive comprehensive
and sustainable interventions.
As illustrated in Figure 1, USAID’s
funding through the U.S. President’s
Emergency Plan for AIDS Relief
(PEPFAR) accounted for 24% of
Impact of U.S. Foreign Aid Policy Shifts on HIV/AIDS
Programs in South Africa: Challenges, Responses,
and Strategies for Sustainability
HIV/AIDS Programs in South Africa
BACK TO CONTENTS
Siyabonga Jikwana
Lesiba Arnold Malotana
Ref ilwe Mokgetle
Musa Gumede
Michael Mncedisi Willie
72,5
19,2
3,2
2,9
2,2
67,6
23,1
4,5
2,9
2,0
69,3
24,3
1,7
2,9
1,7
0
10
20
30
40
50
60
70
80
Government of South
Africa
U.S. President’s
Emergency Plan for
AIDS Relief (PEPFAR)
Global Fund to Fight
AIDS, Tuberculosis,
and Malaria
Private Medical
Insurance
Non-Governm ental
Organizations and
Foundations
Expenditure
on
HIV/AIDS
programs
in
South
Africa
(%)
2017/18 2018/19 2019/20
Figure 1. Entities funding HIV/AIDS treatment, prevention, and care programs in South Africa, 2017-2020 [4].
32
HIV/AIDS expenditure in 2019-
2020 (increased from 19% in 2017-
2018), while the South African
government incurred 69% of HIV/
AIDS expenditure in 2019-2020
(decreased from 73% in 2017-2018)
[4,5]. The significance of PEPFAR
lies in its critical source of financial
support for global HIV/AIDS
interventions, enabling countries like
South Africa to sustain and expand
their healthcare programs despite
challenges in domestic funding [5].
PEPFAR’s contribution has been
instrumental in addressing the
HIV epidemic, providing essential
resources for treatment, prevention,
and care programs. Furthermore,
the private sector and domestic
organisations, which had minimal
financial contributions (less than
1.0%) to HIV/AIDS programs, were
not included in the illustration.
In January 2025, U.S. leadership
announced a 90-day pause on
international funding, citing
alignment with agency priorities
and national interest, with potential
impacts on PEPFAR, USAID, and
the Joint United Nations Programme
on HIV/AIDS (UNAIDS) activities
[6]. After the announcement,
PEPFAR support continued for
90 days (excluding some HIV
prevention services), while USAID
suspended thousands of HIV-related
health grants in Africa. These
funding cuts have disrupted HIV-
related healthcare services, leading to
suspended services at health centres
such as OUT Lesbian, Gay, Bisexual,
and Transgender (LGBT) Wellbeing
and the Wits Reproductive Health
and HIV Institute (Wits RHI),
leaving patients without access to
life-saving ARV medication [6].
Similarly, the closure of centres
providing PrEP and other HIV
prevention services has heightened
the risk of HIV transmission
in vulnerable communities (like
orphaned children with HIV) and
has led to workforce reductions
[6]. While the government funds
the broader HIV/AIDS programs,
as depicted in Figure 1, donor
funding for NGOs supports access
to non-government funded HIV/
AIDS clinical research, innovations
(e.g. injectable treatments), and
other related services. Sustaining
these donor-funded initiatives is
critical, given that South Africa has
the highest HIV prevalence rates
reported in Africa and one of the
highest prevalence rates globally.
As global priorities shift and
economic constraints tighten,
traditional donor funding becomes
increasingly unpredictable [7,8].
Figure 2 illustrates how NGOs can
adapt their financial and operational
strategies to generate revenue
through service provision and other
income-generating activities, which
can reduce reliance on donors and
enhance financial stability. These
non-profit organisations can turn
to social enterprise models, such
as impact investing and strategic
partnerships to maintain credibility
and accountability, promote
transparency, and secure sustainable
funding for HIV/AIDS programs
[9,10].
In December 2020, UNAIDS
set ambitious targets for 2025,
recognising the key clinical cascade
to diagnose, treat, and achieve viral
suppression for all people living with
HIV, and hence accelerating global
progress to ending the HIV/AIDS
epidemic by 2030. These targets aim
for 95% of people living with HIV to
know their status, 95% of diagnosed
individuals to receive sustained
ART, and 95% of those on ART to
achieve viral suppression to reduce
inequalities in treatment coverage and
accelerate HIV incidence reductions
across all populations and regions
[11]. However, shifts in U.S. foreign
aid policy have broader implications
for global HIV prevention and
treatment efforts, particularly by
altering funding levels and program
priorities. These changes hinder
progress toward UNAIDS targets,
deepening healthcare disparities and
impeding efforts to reduce HIV
incidence, particularly in resource-
limited settings.
HIV/AIDS Programs in South Africa
Figure 2. Sustainable strategies for non-governmental organisations in aid-dependent countries [9,10].
BACK TO CONTENTS
33
To support the UNAIDS targets
and end the HIV/AIDS epidemic,
healthcare professionals have an
indispensable role in leveraging
their clinical and research expertise
and leading the implementation
of national HIV/AIDS programs
that safeguard national progress and
prevent any setbacks. They must
work collaboratively with NGOs
and government agencies that have
established priorities related to HIV
prevention, treatment, and care,
promoting long-term partnerships
and investing in research and
capacity building activities. Moreover,
these organisations should remain
informed about emerging funding
opportunities, technological
advancements, and best practices
in governance to ensure they
remain effective and competitive in
addressing HIV-related challenges.
Patients who have received support
and access to treatments through
PEPFAR programs can continue
to benefit from care accessible
through government facilities.
Ultimately, the collective efforts of
health practitioners, NGOs, and
government initiatives must converge
to ensure that the progress made in
combating HIV/AIDS transmission
is sustained and further expanded,
securing a future where access to
care is equitable, and the epidemic is
finally eradicated.
References
1. U.S. Agency for International
Development. U.S. foreign
assistance by country: South
Africa [Internet]. 2023 [cited
2025 Mar 1]. Available from:
https://www.foreignassistance.gov/
cd/south%20africa/
2. Milimu JW, Parmley L,
Matjeng M, Madibane M,
Mabika M, Livingston J, et al.
Oral pre-exposure prophylaxis
implementation in South
Africa: a case study of USAID-
supported programs. Front
Reprod Health. 2024;6:1473354.
3. The Global Health Delivery
Project. Political leadership in
South Africa: HIV [Internet].
2015 [cited 2025 Mar 1].
Available from: https://www.
globalhealthdelivery.org/ghd/files
4. Joint United Nations Programme
on HIV/AIDS. National AIDS
spending assessment plus
(NASA+) [Internet]. UNAIDS.
2020 [cited 2025 Mar 1].
Available from: https://www.
unaids.org/sites/default/files/
media/documents/NASAreport_
southafrica_2017-2020_en.pdf
5. Kaiser Family Foundation. The
U.S. President’s Emergency Plan
for AIDS Relief (PEPFAR)
[Internet]. 2024 [cited 2025 Mar
1]. Available from: https://www.
kff.org/global-health-policy/the-
u-s-presidents-emergency-plan-
for-aids-relief-pepfar
6. Adeyinka DA, Ologunagba
B, Olakunde BO. US funding
cuts as a catalyst for African-
led HIV solutions. Lancet HIV.
2025;12(4):e248-9.
7. Cordery C, Belal AR, Thomson
I. NGO accounting and
accountability: past, present
and future. Account Forum.
2019;43(1):1-15.
8. Banks N, Hulme D, Edwards
M. NGOs, states, and donors
revisited: still too close
for comfort? World Dev.
2015;66:707-18.
9. Murphy H. Rethinking the
roles of non-governmental
organisations at the World Trade
Organisation. Aust J Int Aff.
2012;66(4):468-86.
10. Arhin A, Adam MA, Kumi
E. Facing the bullet? Non-
governmental organisations’
(NGOs’) responses to the
changing aid landscape in
Ghana. Int J Volunt Nonprofit
Organ. 2018;29(2):348-60.
11. Joint United Nations Programme
on HIV/AIDS. 2025 AIDS
targets [Internet]. UNAIDS;
2025 [cited 2025 Mar 1].
Available from: https://
www.unaids.org/sites/default/
files/2025-AIDS-Targets_en.pdf
Authors
Michael Mncedisi Willie, DBA
Council for Medical Schemes
Pretoria, South Africa
m.willie@medicalschemes.co.za
Siyabonga Jikwana, MPH
Department of Public Health Medicine,
University of Pretoria and
Gauteng Department of Health
Johannesburg, South Africa
siyabonga.jikwana@gauteng.gov.za
Lesiba Arnold Malotana, MPM
Gauteng Department of Health
Johannesburg, South Africa
arnold.malotana@gauteng.gov.za
Refilwe Mokgetle, MPH
Gauteng Department of Health
Johannesburg, South Africa
refilwe.mokgetle@gauteng.gov.za
Musa Gumede, PhD
Chief Executive and Registrar,
Council for Medical Schemes
Pretoria, South Africa
m.gumede@medicalschemes.co.za
HIV/AIDS Programs in South Africa
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34
Like many countries in sub-
Saharan Africa, the Ivory Coast,
a West African country with 31
million residents, is undergoing
significant changes in its healthcare
landscape. The nation has started
to modernise its health system in
2020 by reorganising the structure
of 33 health regions (from 20) and
113 health districts (from 86) and
seeking to improve population health
outcomes. The life expectancy, at
just 55 years, is among the lowest
globally, and maternal mortality rates
remain alarmingly high at 645 per
100,000 live births [1,2]. Ivorian
doctors, regarded as the backbone of
healthcare delivery, find themselves at
the forefront of this transformation.
Before 2010, the Ivorian healthcare
system was characterised by
chronic underfunding, worsened by
sociopolitical crises that hindered
investments in infrastructure and
medical personnel training. This
healthcare fragility reflected the
country’s economic challenges, where
growth was unstable and access to
care remained limited for a large part
of the population. Although Ivorian
doctors face a host of challenges,
ranging from resource constraints to
an increasing disease burden, they
have achieved remarkable successes
that underscore their resilience and
dedication. By understanding how
they have managed these challenges
in clinical and community practice,
we can better appreciate the critical
role of healthcare professionals
in building a healthier and more
equitable society in the Ivory Coast
and the African continent. This
article aims to describe the key
challenges faced by Ivorian doctors
and highlight their indispensable
role in shaping the future of national
healthcare service delivery.
Challenges Faced by Ivorian
Doctors
As Ivorian doctors leverage their
valuable medical expertise across
the healthcare system each day, they
encounter numerous challenges that
affect their daily practice. Their
commitment is constantly tested,
as they manage high healthcare
demands with limited resources over
diverse clinical work environments.
These obstacles influence the
physical and mental health outcomes
(including risk of burnout) of doctors
and other health professionals.
Despite government efforts to
improve the healthcare sector, these
workplace limitations compromise
patients’ quality of care as well as
health professionals’ motivation and
morale.
Limited Resources and
Infrastructure
Ivorian doctors frequently
observe insufficient resources
and infrastructure in their daily
clinical, community, and surgical
practice, which directly impact the
quality of care provided to citizens.
Despite ongoing efforts to improve
healthcare infrastructure, significant
barriers remain in the Ivorian
primary healthcare sector. According
to the World Health Organisation
(WHO), only 60% of healthcare
facilities are equipped to conduct
basic diagnostic procedures, such as
blood tests and ultrasounds, as of
2023 [3]. This resource shortage is
particularly evident in rural areas,
where the Ivorian Ministry of
Health reported that more than 40%
of healthcare facilities lacked reliable
access to electricity or running water
in 2022 [4]. Additionally, the African
Development Bank highlighted that
70% of rural hospitals experienced
frequent stockouts of essential
medicines in 2023, forcing health
professionals to use makeshift
solutions that ultimately undermine
patient care [5]. This disparity
highlights the urgent need for
sustained investments in healthcare
infrastructure to ensure equitable
access to quality care.
Human Resource Shortages
The Ivory Coast faces a significant
shortage of health professionals (e.g.
doctors, nurses, midwives), especially
in rural areas. The World Bank
estimated that the country had
11 health professionals per 10,000
people in 2023, which is well below
the WHO’s recommended threshold
of 23 per 10,000 people [3,6]. As
this shortage is particularly acute
in rural areas, where some districts
have a doctor to population ratio
of 1:50,000, the strain on health
professionals in these regions is
immense, leading to high rates of
burnout and attrition. In 2022,
the Ivorian Ministry of Health
conducted a survey that found that
30% of newly graduated doctors
leave the public health system within
their first five years of practice,
citing low salaries and poor working
conditions [4]. The government
has attempted to address this issue
Anderson N’dri
Ivorian Doctors in a Rapidly Changing Health System
Challenges and Successes of Ivorian Doctors
in a Rapidly Changing Health System
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35
Ivorian Doctors in a Rapidly Changing Health System
through various initiatives, such as
increasing the capacity of medical
schools and offering scholarships
for rural service, but the retention
of health professionals remains a
significant challenge.
Brain Drain
The emigration of skilled medical
professionals, commonly referred
to as “brain drain,” continues to
undermine the Ivorian healthcare
system. Each year, approximately
15% of newly trained doctors
leave the country in search of
opportunities abroad, according
to a 2022 report by the African
Union [7]. This exodus is driven by
a combination of factors, including
inadequate compensation, limited
opportunities for specialisation, and
challenging working conditions in
domestic healthcare facilities. The
financial impact of the brain drain
is substantial, as training a single
doctor costs the Ivorian government
approximately 12,470,000 CFA
Francs (equivalent of US$20,000),
yet the country loses millions of
dollars annually as professionals
migrate. The WHO has emphasised
the need to invest in retention
strategies, including salary increases,
career development programs, and
improved working environments,
to curb this trend and ensure a
sustainable healthcare workforce in
Africa [2].
Disease Burden
Like other African nations, the Ivory
Coast has a complex and evolving
disease burden characterised by the
coexistence of infectious and non-
communicable diseases. Of the three
leading causes of mortality due to a
single infectious agent, tuberculosis,
HIV/AIDS, and malaria remain
a significant health and economic
burden. Although the nation counts
on the National Tuberculosis
Program, National HIV Program
(Programme National de Lutte
Contre le Sida, PNLS), National
Malaria Control Programme, the
nation has not meet established
goals set by global strategies. First,
according to the WHO, tuberculosis
had a reported incidence rate of
119 cases per 100,000 people in
2023, with declining mortality rates
since 2015 [6]. Second, the Joint
United Nations Programme on
HIV/AIDS (UNAIDS) confirmed
that an estimated 420,000 adults
and children were living with HIV,
adults (ages 15-49) had a 1.8%
HIV prevalence rate, and 9,400
AIDS-related deaths were recorded
in 2023 [8]. Third, according to
the 2021 Demographic and Health
Survey, an estimated 7.3 million
malaria cases and 14,906 deaths were
reported (predominantly Plasmodium
falciparum), as a leading cause of
morbidity and mortality among
children under five, with increasing
prevalence from 18% in 2011 to 26%
in 2021 [9].
Beyond infectious diseases, non-
communicable diseases (NCDs) were
associated with 36% of deaths in
2019, with current increasing trends
due to urbanisation and lifestyle
changes, signalling an urgent need for
preventive strategies and improved
chronic disease management [10].
In 2013, an epidemiological review
of cancer cases reported from the
Anatomic Pathology Laboratory of
Abidjan teaching hospitals (1984-
2009) concluded that the most
common cancer types in adults
were cervical (33% of cases among
women) and skin (21% of cases
among men) cancers, and in children
were Burkitt’s lymphoma (34%) [11].
The cancer burden is associated with
few specialised centres, late diagnoses,
high treatment costs, and viral risk
factors (e.g. human papillomavirus,
hepatitis B and C) [9]. In 2023, the
Ivorian Ministry of Health reported
that 25% of Ivorian adults were
diagnosed with hypertension and 8%
with diabetes. The dual infectious
and chronic disease burden places
considerable demands on healthcare
professionals, who must navigate
the complexities of managing
both acute and chronic conditions
with limited resources. Hence,
strengthening screening programs,
expanding healthcare accessibility,
and implementing subsidy policies
are essential to reducing the burden
of NCDs and protect population
health.
Successes and Milestones
Despite the numerous challenges
and deficiencies within the Ivorian
healthcare system, doctors have
demonstrated resilience and
commitment to patient care, making
significant progress in improving
health outcomes across the country.
These achievements stand as a
testament to the dedication of Ivorian
doctors, who navigate challenges and
strive to make a positive difference
for patients and families within the
healthcare system. Notably, efforts
to expand universal health coverage
and strengthen disease surveillance
and emergency response have
increased access to essential medical
services for vulnerable populations
as well as improved the country’s
ability to effectively manage health
crises. Additionally, investments in
medical education and training have
contributed to a new generation
of well-equipped healthcare
professionals, ensuring continuous
improvement in service delivery.
Improved Healthcare Access
Ivorian health leaders have made
notable strides in improving access to
healthcare services across the country.
In 2019, the country implemented
universal health coverage (Couverture
Maladie Universelle, CMU), marking
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36
Ivorian Doctors in a Rapidly Changing Health System
a significant step toward providing
affordable care for all citizens.
According to the Ivorian Ministry
of Health, the CMU program had
enrolled over 4 million people (30%
of the population) by 2023, with
doctors serving as advocates and
educators within their communities.
Their efforts have contributed to
increasing utilisation of healthcare
services, particularly in rural areas, as
well as expanding access to maternal
and child healthcare, with a reported
15% reduction in maternal mortality
rates since its implementation [12].
The program’s success underscores
the importance of strong partnerships
among healthcare professionals,
policymakers, and community
leaders.
Advances in Medical Training and
Education
The Ivorian Ministry of Health
has strongly supported the
continued expansion of medical
training programs coupled with the
establishment of specialised clinical
specialties to support the health
needs of the Ivory Coast population.
Universities in Abidjan and other
cities now offer advanced degrees
in clinical disciplines, including
cardiology, oncology, and surgery.
In 2022, the National Institute of
Public Health highlighted the 20%
increase in the number of medical
graduates over the past decade [12].
Partnerships with international
institutions, such as those in France
and Morocco, have provided
opportunities for Ivorian doctors
to gain expertise in cutting-edge
medical practices. Upon returning to
the Ivory Coast, these professionals
bring valuable knowledges and
skills that enhance the overall
quality of care. The National Health
Development Plan, 2021-2025 (Plan
National de Développement Sanitaire,
2021-2025) has also prioritised
investments in healthcare education,
including the recruitment of
experienced faculties to train the next
generation of doctors [13].
Public Health Initiatives and
Disease Control
Ivorian doctors have demonstrated
exceptional leadership in managing
public health crises. During
the coronavirus disease 2019
(COVID-19) pandemic, they worked
tirelessly to treat patients, implement
preventive measures, and raise
awareness about the importance of
vaccination. Similarly, in the fight
against HIV/AIDS and malaria,
doctors have collaborated with
international organisations to develop
and implement effective treatment
and prevention programs. The
UNAIDS found that 92% of people
living with HIV in the Ivory Coast
were receiving antiretroviral therapy
in 2023, which had increased from
85% in 2018, demonstrating the
country’s commitment to combating
this disease burden [14].
Innovation in Healthcare Delivery
Faced with resource constraints,
Ivorian doctors have embraced novel
approaches to streamline healthcare
delivery to urban and rural residents,
including mobile clinics, telemedicine
platforms, and community outreach
programs. These innovations have
bridged gaps in service delivery,
ensuring that patients receive timely
and effective care regardless of their
geographic location. In 2022, the
African Health Observatory reported
a 30% increase in patient satisfaction
rates, specifically in regions where
telemedicine services were introduced
[15]. Given the growing influence
of social media in today’s digital
landscape, the Ivorian healthcare
system has increasingly leveraged
these platforms to enhance public
health awareness and education.
Through targeted campaigns,
real-time information sharing, and
interactive engagement, social media
serves as a vital tool for health
promotion, disease prevention, and
community outreach across the
country.
Looking Ahead
The future of healthcare in the Ivory
Coast holds immense potential for
residents, but realising this promise
will require sustained effort and
collaboration. Addressing systemic
challenges such as infrastructure
deficits, workforce shortages, and the
dual disease burden will be essential
to building a resilient and equitable
health system. To address emerging
health risks across Africa, investments
in medical education, infrastructure,
and public health programs must
remain a priority. Fostering public-
private partnerships can help
mobilize resources needed to drive
innovation and improve outcomes. As
the Ivory Coast continues its journey
toward a healthier future, successes
achieved by Ivorian doctors serve as
a powerful reminder of their critical
role in advancing healthcare. Their
resilience, ingenuity, and commitment
to their communities offer hope for a
brighter and healthier tomorrow.
References
1. World Bank. Life expectancy at
birth, female (years) – Côte d’Ivo-
ire [Internet]. 2022 [cited 2025
Feb 1]. Available from: https://
data.worldbank.org/indicator/SP.
DYN.LE00.FE.IN?locations=CI
2. World Health Organisation.
Birth plan helps reduce maternal
deaths in Côte d’Ivoire [Internet].
2023 [cited 2025 Feb 10]. Avail-
able from: https://www.afro.who.
int/photo-story/birth-plan-helps-
reduce-maternal-deaths-cote-
divoire
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37
3. Ahmat A, Asamani JA, Abdou Il-
lou MM, Millogo JJS, Okoroafor
SC, Nabyonga-Orem J, et al. Es-
timating the threshold of health
workforce densities towards uni-
versal health coverage in Africa.
BMJ Glob Health. 2022;7(Suppl
1):e008310.
4. Ministry of Health and Public
Hygiene, Government of Côte
d’Ivoire. Annual report on health
in Ivory Coast 2022. Abidjan:
Ministry of Health and Public
Hygiene; 2022. French.
5. Ministry of Health and Public
Hygiene, Government of Côte
d’Ivoire. Healthcare workforce
statistics [Internet]. 2022 [cited
2025 Feb 1]. French. Available
from: https://www.sante.gouv.ci/
statistiques
6. World Health Organisation.
World health statistics [Inter-
net]. 2023 [cited 2025 Feb 1].
Available from: https://www.
who.int/data/gho/publications/
world-health-statistics
7. African Union. Brain drain in Af-
rica: challenges and solutions. Ad-
dis Ababa: African Union; 2022.
8. Alwihda Info. Côte d’Ivoire: des
avancées dans la lutte contre le
paludisme, le VIH, la tuberculose
et les cancers [Internet]. 2024 [cit-
ed 2025 Feb 1]. French. Available
from: https://www.alwihdainfo.
com/Cote-d-Ivoire-des-avancees-
dans-la-lutte-contre-le-palud-
isme-le-VIH-la-tuberculose-et-
les-cancers_a136518.html
9. National Institute of Statis-
tics; ICF 2022. Enquête démo-
graphique et de santé de Côte
d’Ivoire, 2021. Rockville: INS/
Côte d’Ivoire et ICF; 2022.
French. Available from: https://
dhsprogram.com/pubs/pdf/
PR140/PR140.pdf
10. Ministry of Health and Public
Hygiene, Government of Côte
d’Ivoire. Report on health indi-
cators 2022. Abidjan: Ministry of
Health and Public Hygiene; 2022.
French.
11. Effi AB, Koffi KE, Aman NA,
Doukouré B, N’dah KJ, Koffi
KD, et al. Épidémiologie descrip-
tive des cancers en Côte d’Ivoire
[Descriptive epidemiology of can-
cers in Cote d’Ivoire]. Bull Can-
cer. 2013;100(2):119-25. French.
12. Government of Côte d’Ivoire.
CMU: more than 7.8 million
people registered as of Novem-
ber 13, 2023. Government News.
2023 [cited 2025 Feb 1]. French.
Available from: https://www.gouv.
ci/_actualite-article.php?recor-
dID=15987&d=1
13. Ministry of Health and Public
Hygiene, Government of Côte
d’Ivoire. Plan National de Dével-
oppement Sanitaire (PNDS)
2021-2025. Abidjan: Ministry of
Health and Public Hygiene; 2021.
French. Available from: https://
extranet.who.int/countryplan-
ningcycles/planning-cycle-files/
plan-national-de-developpe-
ment-sanitaire-2021-2025
14. Centers for Disease Control and
Prevention. HIV prevention and
treatment in Côte d’Ivoire [In-
ternet]. 2022 [cited 2025 Feb 1].
Available from: https://www.cdc.
gov/global-health/countries/cote-
d-ivoire.html
15. African Health Observatory.
Telemedicine in sub-Saharan Af-
rica: bridging gaps in healthcare
delivery. Geneva: WHO; 2022.
Anderson N’dri, MD
Psychiatry resident,
Psychiatric Hospital of Bingerville,
University Felix Houphoët,
Boigny of Cocody
Chair person, JDN Ivory Coast
Abidjan, Ivory Coast
andersondri001@gmail.com
Ivorian Doctors in a Rapidly Changing Health System
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38
Research Travel from the Global South:
Challenges of Visa Delays and Denials
Research Travel from the Global South: Challenges of Visa Delays and Denials
International conferences and
academic events provide vital
opportunities for researchers to
share knowledge, build networks,
and advance their careers. However,
researchers from the Global
South often encounter systemic
barriers to travel, particularly in
obtaining visas to attend events in
the Global North. These barriers
disproportionately impact early-
career researchers, undermining
equitable global knowledge
exchange and perpetuating academic
inequalities. For example, African
individuals faced approximately 30%
of the Schengen visa denials, nearly
double to the global average of 17%
in 2022 [1]. This commentary will
describe the root causes of systemic
barriers, the lack of inclusive visa
policies, and their career impacts of
researchers from the Global South.
Visa Delays and Denials
Visa application processes for
researchers from the Global South
are frequently characterised by
excessive delays and unexplained
denials. Researchers with impeccable
credentials, clear travel objectives,
and legitimate invitations to present
at conferences often experience
processing times extending far
beyond standard timelines. For
example, one Kenyan researcher, who
was invited to a conference held in
Germany, reported waiting over
three months for a visa, only to
receive a denial one week before
the event [2]. Such delays render
it impossible for researchers to
attend time-sensitive academic
events, creating missed opportunities
for knowledge dissemination and
professional growth [2].
Compounding these challenges is
the presumption that applicants
from the Global South may overstay
or migrate. Despite providing
evidence of return commitments,
such as employment contracts,
academic affiliations or family
ties, young researchers often face
unwarranted scrutiny. This systemic
bias is particularly detrimental
to early-career academics, whose
professional development relies
heavily on international exposure
[3]. While high-level restrictions are
imposed by countries in the Global
North, it is crucial to note that visa
and passport discrimination against
citizens in low- and middle-income
countries are also practiced by
countries in the Global South [4].
Outsourced Visa Processing and
Degraded Diplomatic Presence
The outsourcing of visa processing
services can exacerbate inefficiencies
and raise costs for applicants. Many
countries in the Global North have
reduced their diplomatic presence
in the Global South, delegating
visa responsibilities to third-party
agencies or embassies of other
nations. For instance, Portugal
relies on the Greek Embassy in
Kenya for visa processing, leading
to protracted waiting times for
appointments and interviews. One
Nigerian researcher, who was invited
to present his research on the lack
of legal protection for women and
children in Nigerian state camps at
a conference, described waiting six
weeks for an appointment and two
additional months for visa approval,
ultimately missing the conference
entirely [5].
Outsourced visa centres often
prioritise profit over service
quality, charging high fees for
“premium” appointments while
offering inadequate support.
Applicants may encounter arbitrary
decisions, lost documents, or
inconsistent communication, further
complicating an already opaque
process. These inefficiencies erode
trust in the visa system and impede
diplomatic objectives intended to
foster international collaboration.
Diplomatic Objectives vs. Practical
Barriers
Embassies are ostensibly tasked
with facilitating travel as part
Cliffland Mosoti Marie-Claire Wangari Mehr Muhammad Adeel Riaz
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39
of their diplomatic mandate.
Streamlining visa processes for
academic travellers, particularly
young researchers with verified
credentials, should align with these
objectives. However, the current
system often operates more like a
lottery, with outcomes dependent on
arbitrary factors rather than merit or
compliance. For example, a Ugandan
researcher, who was invited to
present groundbreaking research on
renewable energy at a conference
held in the United Kingdom, was
denied a visa without explanation,
despite providing sponsorship
letters, proof of accommodation,
and a return flight ticket. Such cases
highlight the disconnect between
diplomatic goals of fostering global
partnerships and the practical
barriers imposed by restrictive visa
policies [6].
Recommendations
The systemic challenges in visa
processing for researchers in public,
private, and academic settings are
substantial and negatively impact
essential scientific knowledge
exchange and networking.
The authors propose four
recommendations that can minimise
travel restrictions for global health
researchers and expand their
contributions to scientific dialogue
in the region and world. These
recommendations aim to create a
fairer, more efficient visa process
that promotes global academic
exchange and addresses systemic
inequities in international mobility.
Transparency in visa decisions.
Embassies and visa centres should
provide clear and detailed reasons
for visa rejections, which will
enable applicants to identify and
address deficiencies in subsequent
applications, fostering fairness
and efficiency [2]. This openness
not only enhances trust in the
application process but also
empowers applicants with the
knowledge needed to improve their
chances of approval.
Prioritisation of academic travel. Visa
applications submitted by researchers
with verified academic invitations
should be fast-tracked, which
would ensure timely participation in
international conferences and other
academic events as well as promote
global collaboration [3]. Expediting
such applications would strengthen
knowledge exchange and innovation
by enabling researchers to contribute
their expertise on a global stage
without unnecessary delays.
Strengthening diplomatic presence.
Countries must invest in well-
staffed embassies in the Global
South, which can reduce reliance
on outsourced visa centres, enhance
the efficiency and accessibility of
visa services, and foster stronger
diplomatic ties [5]. Specifically,
governments should establish
and enforce robust standards
of affordability, efficiency, and
accountability for third-party visa
processing agencies, which can
guarantee that outsourced services
align with the needs of applicants
and maintain public trust.
Early-career friendly policies.
Embassies should adopt policies that
address the unique challenges faced
by early-career researchers, which
can reduce systemic biases, support
academic mobility, and empower
the next generation of scholars and
innovators [7]. Such policies would
foster inclusivity and confirm that
emerging researchers have equal
opportunities to access international
academic and professional
development experiences.
Conclusion
The barriers faced by researchers
from the Global South in obtaining
visas for international academic
travel highlight significant inequities
in the global knowledge economy.
Addressing these challenges requires
a commitment to transparency,
efficiency, and fairness in visa
policies. By implementing reforms
that prioritise academic mobility
and equitable access, the global
academic community can foster
inclusive collaboration and ensure
that diverse voices contribute to the
advancement of knowledge.
References
1. Maru MT. Rejected: the im-
pact of visa bias on Africa–Eu-
rope relations [Internet]. 2024
[cited 2025 Feb 2]. Availa-
ble from: https://www.hen-
leyglobal.com/publications/
global-mobility-report/2024-ju-
ly/rejected-impact-visa-bias-afri-
caeurope-relations
2. Adeyemo W. Systemic barriers to
academic mobility: a perspective
from the Global South. Journal
of International Education Poli-
cy. 2023;15(3):45-58.
3. Global Visa Index. Analysing
delays and denials in visa ap-
plications: a focus on academic
travel. Global Mobility Report.
2023;12(1):89-101.
4. Bandara S, Zeinali Z, Blandi-
na DM, Ebrahimi OV, Essar
MY, Senga J, et al. Imagining
a future in global health with-
out visa and passport inequi-
ties. PLOS Glob Public Health.
2023;3(8):e0002310.
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40
Research Travel from the Global South: Challenges of Visa Delays and Denials
5. Mbatha P, Ribeiro L. Outsourced
visa processing: challenges and
implications for the Global
South. Diplomatic Affairs Quar-
terly. 2022;19(2):134-50.
6. United Nations Educational, Sci-
entific and Cultural Organisation.
Barriers to knowledge exchange
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munity. Paris: UNESCO Press;
2021. Available from: https://
unesdoc.unesco.org/ark:/48223/
pf0000380063
7. Wangari MC, Mariyam D, Rath-
od L. Junior doctors’ perspectives
on barriers and solutions to eq-
uitable access to global health
opportunities. World Medical
Journal. 2024;70(3):23-6.
Authors
Cliffland Mosoti, BDS
General Dentist & Graduate Student
in MPH (Applied Epidemiology),
Amref International University
Assistant Secretary General,
Kenya Dental Association
Nairobi, Kenya
mosoticliffland@gmail.com
Marie-Claire Wangari, MBChB
Graduate Student in Global Health,
Liverpool School of Tropical Medicine,
Liverpool, United Kingdom
Independent Global Health
Consultant & Immediate Past
Chair, WMA-JDN (2024/2025)
Nairobi, Kenya
mcwangari.wm@gmail.com
Mehr Muhammad Adeel Riaz, MBBS
Director of Youth Affairs, Gender
Interactive Alliance, Pakistan
Socio-medical Affairs Officer,
WMA-JDN (2024/2025)
Mailsi, Pakistan
adeelriaz369@gmail.com
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41
The topic of medical neutrality
has become increasingly relevant in
today’s world, particularly for those
healthcare professionals working
in armed conflict and civil unrest.
Medical neutrality, which represents
a social contract in times of war and
peace, serves as a vital component of
humanitarian law and medical ethics
that protects healthcare professionals
and patients and ensures equitable
access to care for all individuals.
In theory, medical neutrality
dictates that all sick and wounded
individuals, whether combatants
or civilians, should receive care
without discrimination, and that
medical facilities and transport
should be protected and not targeted
during conflicts [1]. This principle
is enshrined in international
humanitarian law, particularly
the Geneva Conventions, which
emphasises the protection of medical
personnel and facilities [2,3].
As a doctor working in Myanmar,
I have witnessed first-hand the
devastating consequences when
medical neutrality was compromised
during the coup d’état on 1 February
2021 [4,5]. Myanmar’s health
system has been severely impacted
by the military regime, leading to
a collapse in healthcare services
and infrastructure [6]. The selective
distribution of medical supplies, such
as vaccines being largely limited to
military-controlled areas, further
erodes the principle of providing care
based solely on medical need [7].
The increasing use of air and drone
strikes to bomb healthcare facilities
and capture family members of
healthcare professionals by Myanmar
military and security forces represents
a significant violation of medical
neutrality, as healthcare facilities are
supposed to be protected zones [8,9].
Recognising the urgent need for
clarity and action regarding medical
neutrality, I recommended that
the World Medical Association
(WMA) adopt an official declaration
outlining specific measures to
protect healthcare professionals
in conflict zones. Based on my
personal experiences and expertise
in international humanitarian law
(like the Geneva Conventions), the
proposed declaration should achieve
two objectives: 1) establish a clear
definition of medical neutrality to be
universally understood and applied
across different contexts; and 2)
strengthen protections for healthcare
professionals against attacks and
coercion during conflicts. It should
focus more on medical neutrality
and the Geneva Conventions, rather
than also explaining complementary
International Committee of the Red
Cross (ICRC) principles,, urge all
mechanisms to reinforce international
humanitarian law, and hold violators
accountable for breaches of medical
neutrality. It should also emphasise
the need for education and training
programs for healthcare professionals
on their rights and responsibilities
under international law.
In April 2022, in preparation for
the 220th WMA Council Session
held in Paris, I submitted a draft
statement on medical neutrality to
the WMA, requesting that members
review the statement and contribute
content to enhance the discernment
of this guiding principle. Given that
my national medical association
(NMA) operates under the control
of a military regime that disregards
medical neutrality, I consulted and
collaborated with colleagues in
other NMA delegations who could
present the statement in our name
to the Council. In October 2024,
the WMA General Assembly in
Helsinki provided a long series
of amendments, and the Council
circulated the draft among its
constituents’ members for feedback.
After the meeting, we were tasked
with submitting a “compromised
version” by April 2025, in time for
the 229th WMA Council Session
held in Montevideo, which would
incorporate the comments and
suggested revisions received from
constituents and associate members.
This revised document aims to reflect
diverse perspectives, strengthen its
applicability, effectively promote and
protect medical neutrality globally,
reinforce accountability mechanisms,
and uphold the integrity of
healthcare in conflict zones.
The Essence of Medical Neutrality
Medical neutrality reinforces the
ethical principles of impartiality,
non-discrimination, and respect for
human dignity that are at the core
of medical practice. Physicians are
bound by guiding documents, such
as the Declaration of Geneva and
the Physician Pledge, to treat all
individuals without discrimination
[1,10]. However, the reality on the
ground often starkly contrasts with
these legal frameworks. Health
professionals in Myanmar are
operating in fear due to targeted
Wunna Tun
Road to the WMA Medical Neutrality Policy Statement
Four Years after the Military Coup: Road to the
WMA Medical Neutrality Policy Statement
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42
violence following the military coup,
demonstrating a clear contrast to
the ethical obligations outlined in
the Declaration of Geneva and the
Physician Pledge. Myanmar military
and security force attacks on health
professionals and facilities directly
endanger lives and compromise
the ability to provide impartial
care, highlighting the erosion of
medical ethics in the face of political
violence [11]. The bombing of health
facilities and health professionals by
the military is a blatant violation
of medical neutrality and ethical
principles that protect healthcare
facilities, demonstrating a clear
departure from the standards set
forth in the ethical foundation of the
medical profession that emphasise
the preservation of life and the
provision of care [12-14].
Yet, in conflict zones, this
commitment is frequently challenged
by external pressures from military
authorities or conflicting ideologies.
Since international organisations,
like the United Nations, have not
accepted a universal definition of
medical neutrality in key documents,
this ambiguity leads to inconsistent
interpretations and applications,
creating loopholes that allow
violations to go unpunished [3]. In
my experience, this lack of clarity
can have deadly consequences, as
it emboldens those who disregard
medical neutrality and leaves
healthcare professionals vulnerable.
Real-World Implications
Beyond the physical dangers,
healthcare professionals in war zones
frequently face complex ethical
dilemmas that test the boundaries
of medical neutrality. For example,
when two patients from opposing
political sides (military vs civilian)
require life-saving treatment
simultaneously, how does a physician
remain impartial? On a daily basis,
healthcare professionals often
face threats for providing care to
individuals deemed “enemies” or are
forced to make agonising decisions
that weigh their ethical obligations
against their personal and family
safety. On a personal note, I have
witnessed civilian doctors being
coerced by military authorities to
prioritise certain patients or even
withhold care entirely, creating an
atmosphere of fear and conflict that
compromises the ability of healthcare
professionals to act according to
their ethical obligations. These
scenarios underscore the need for a
clear definition and application of
medical neutrality for all stakeholders
(healthcare professionals, military
personnel, policymakers), which
can uphold the ethical principles
that guide the medical profession,
maintain trust in healthcare systems,
safeguard the integrity of medical
care during crises, and address the
duties and obligations of physicians
in conflict zones.
Despite challenges of upholding
medical neutrality in war zones,
the principle itself has far-reaching
implications for global society.
The ongoing humanitarian crisis
in Myanmar highlights the far-
reaching implications of violating
medical neutrality, as healthcare
systems are severely impacted,
leaving populations without access
to essential medical care. Despite
international laws protecting medical
neutrality, enforcement remains weak,
and healthcare professionals face
significant risks in conflict zones
like Myanmar [15,16]. Despite its
strong foundation in international
law, medical neutrality is frequently
violated across the globe, leaving
healthcare professionals vulnerable
and underscoring the need for more
effective measures to uphold this
principle globally [3,17]. Establishing
effective accountability mechanisms is
critical to deter violations and protect
fundamental human rights, especially
those healthcare professionals who
risk their lives to provide care.
Respect for medical neutrality
can contribute to broader peace
and stability by reducing violence
against healthcare professionals and
facilities, creating an environment
where medical services can operate
effectively, and fostering trust
between healthcare professionals
and the communities they serve.
There is an alarming trend of
breaches in medical neutrality, which
are increasingly recognised as war
crimes under international law due
to their detrimental impacts on
civilian populations and healthcare
professionals. Holding perpetrators
accountable is crucial to ensure that
such violations are not tolerated,
thereby upholding the integrity of
medical practice amidst warfare [18].
Medical neutrality is a cornerstone of
the medical profession, representing
a social contract in which healthcare
professionals commit to treating
all patients impartially, and society
pledges to protect them during times
of peace and conflict. This principle
extends beyond traditional warfare
to encompass civil unrest and state
emergencies, where it demands the
consistent provision of care without
bias or discrimination. However,
ensuring medical neutrality in such
contexts presents unique challenges,
particularly when legal protections
under the Geneva Conventions
do not explicitly apply [1]. Unlike
international armed conflicts, civil
unrest and non-international armed
conflicts often lack the robust legal
frameworks provided by the Geneva
Conventions [1,3]. In such situations,
the principles of medical neutrality
are frequently governed by domestic
law, which may be inconsistently
enforced and create vulnerabilities for
healthcare professionals and facilities,
as they may face interference,
Road to the WMA Medical Neutrality Policy Statement
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43
targeting or obstruction from state or
non-state actors. In both situations,
state actors and armed groups have
a critical responsibility to respect and
uphold medical neutrality, including
refraining from targeting healthcare
personnel, facilities, or transport
systems as well as ensuring that
medical services can operate freely
without interference.
Role of International Organisations
In cases where state militaries
themselves are implicated in attacks
on healthcare systems, international
actors must intervene through
diplomatic pressure, advocacy,
and accountability mechanisms.
International bodies must take
a more active role in promoting
and enforcing medical neutrality
standards, including advocating
for policies that protect healthcare
professionals and ensuring that
violations are investigated and
prosecuted effectively. First,
international organisations, such as
the United Nations and the WMA,
should develop a clear, comprehensive
definition of medical neutrality that
can be consistently applied in all
contexts. Second, the International
Criminal Court (ICC) and the
International Court of Justice (ICJ)
must establish effective mechanisms
for investigating and prosecuting
violations of medical neutrality,
ensuring that those responsible are
held accountable under international
law [18,19]. Third, the establishment
of a United Nations Special
Rapporteur on Medical Neutrality
could significantly enhance efforts
to hold violators accountable. Finally,
civil society organisations and
advocacy groups can play a crucial
role in raising awareness about
medical neutrality and pressing for
policy changes that will better protect
healthcare facilities and personnel.
Conclusion
The principle of medical neutrality
is essential for protecting healthcare
professionals and preserving human
dignity during armed conflicts.
Our collective responsibility should
protect this principle for the benefit
of all individuals seeking care, and
our shared humanity must prevail
over political divisions. As healthcare
professionals, we must learn from the
experiences of our colleagues who
are serving in healthcare systems
in conflict zones – including my
personal experiences as a frontline
doctor in Myanmar – and advocate
for clearer definitions, stronger
protections, and greater awareness
around medical neutrality. In line
with this commitment, NMA
contributions to the declaration on
medical neutrality will be discussed
at the WMA Council Meeting in
April 2025, as an opportunity to
strengthen global accountability
mechanisms and ensure that
healthcare systems remain sanctuaries
of compassion and humanity even
amidst the chaos of war.
References
1. Kent AK. Geneva Convention
relative to the protection of ci-
vilian persons in time of war
and additional protocol. In:
Bernat FP, Frailing K, Gelst-
horpe L, Kethineni S, Pasko
L (eds). The Encyclopedia of
Women and Crime, 1st ed. Ho-
boken: Wiley-Blackwell; 2019.
Available from: https://doi.
org/10.1002/9781118929803.
ewac0232
2. Guzhva VS, Raghavan S,
D’Agostino DJ. Aviation le-
gal and regulatory framework.
Elsevier eBooks. 2018;101-39.
3. Kurtz LR. Encyclopedia of vi-
olence, peace, and conflict, 3rd
ed. San Diego: Academic Press;
2022.
4. British Medical Association.
Statement of solidarity with My-
anmar [Internet]. 2021 [cited
2025 Feb 17]. Available from:
https://www.bma.org.uk/news-
and-opinion/statement-of-soli-
darity-with-myanmar
5. Oo M. Army doctor handed
death penalty for alleged sup-
port of resistance [Internet].
Myanmar Now. 2023 [cited
2025 Feb 17]. Available from:
https://myanmar-now.org/
en/news/army-doctor-hand-
ed-death-penalt y-f or-al-
leged-support-of-resistance/
6. Paddock RC. Myanmar’s health
system is in collapse, “obliterat-
ed” by the regime [Internet]. New
York Times. 2022 [cited 2025
Feb 17]. Available from: https://
www.nytimes.com/2022/04/19/
world/asia/myanmars-coup-doc-
tors.html
7. Krugman A. In Myanmar, health
care has become a battleground
[Internet]. Council on Foreign
Relations. 2024 [cited 2025 Feb
17]. Available from: https://www.
thinkglobalhealth.org/article/
myanmar-health-care-has-be-
come-battleground
8. Insecurity Insight. Increasing
use of air and drone strikes in
attacks on health care in Myan-
mar – February 2024 [Internet].
ReliefWeb. 2024 [cited 2025
Feb 17]. Available from: https://
reliefweb.int/report/myanmar/
increasing-use-air-and-drone-
strikes-attacks-health-care-my-
anmar-february-2024
Road to the WMA Medical Neutrality Policy Statement
BACK TO CONTENTS
44
9. RFA Burmese. Junta helicop-
ter drops bomb on hospital
where war refugees were being
treated [Internet]. Radio Free
Asia. 2023 [cited 2025 Feb
17]. Available from: https://
www.rfa.org/english/news/
myanmar/hospital-bomb-jun-
ta-04252023150525.html
10. Parsa-Parsi RW. The revised
Declaration of Geneva: a mod-
ern-day physician’s pledge. JA-
MA. 2017;318(20):1971-2.
11. Green L. “Our health work-
ers are working in fear”: after
Myanmar’s military coup, one
year of targeted violence against
health care [Internet]. Physi-
cians for Human Rights. 2022
[cited 2025 Feb 17]. Available
from: https://phr.org/our-work/
resources/one-year-anniversa-
ry-of-the-myanmar-coup-detat/
12. Sajid I. At least 22 killed, doz-
ens injured in bombing by junta
in central Myanmar [Internet].
Com.tr. 2025 [cited 2025 Mar
1]. Available from: https://
www.aa.com.tr/en/asia-pacific/
at-least-22-killed-dozens-in-
jured-in-bombing-by-junta-in-
central-myanmar/3464080
13. Barnabas Aid. Myanmar military
bomb two churches and a hospital
in Christian-majority Chin State
[Internet]. 2024 [cited 2025 Feb
17]. Available from: https://www.
barnabasaid.org/us/news/myan-
mar-military-bomb-two-church-
es-and-a-hospital-in-chris-
tian-majority/
14. The Irrawaddy. As patients slept
in Chin State hospital, Myan-
mar military jets dropped bombs
[Internet]. 2024 [cited 2025 Feb
17]. Available from: https://www.
irrawaddy.com/news/burma/
as-patients-slept-in-chin-state-
hospital-myanmar-military-jets-
dropped-bombs.html
15. Root RL, Lusan NN. In Myan-
mar’s worsening conflict, health
workers deliver care and dodge
death [Internet]. The New Hu-
manitarian. 2023 [cited 2025
Feb 17]. Available from: https://
www.thenewhumanitarian.org/
news-feature/2023/04/12/myan-
mar-conflict-health-workers
16. Htet AS, Soe ZW, Aye WT,
Maung C, Lien L, Ottersen
OP, et al. 3 years after the My-
anmar military coup – the peo-
ple are suffering. Lancet. 2024;
403(10440):1966-9.
17. Bhuyan SS, Ebuenyi I, Bhatt J.
Persisting trend in the breach of
medical neutrality: a wake-up
call to the international com-
munity. BMJ Glob Health.
2016;1(3):e000109.
18. Leaning J. War crimes
and medical science. BMJ.
1996;313(7070):1413-5.
19. Benton A, Atshan S. “Even war
has rules”: on medical neutrality
and legitimate non-violence. Cult
Med Psychiatry. 2016;40(2):151-
8.
Wunna Tun, MBBS, MD
Fellow, Medical Education
JDN Secretary
Yangon, Myanmar
onlinewunna@gmail.com
Road to the WMA Medical Neutrality Policy Statement
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45
South Africa’s Obesity Epidemic and the
Role of Food Delivery Apps
South Africa’s Obesity Epidemic and the Role of Food Delivery Apps
BACK TO CONTENTS
On-demand food delivery services
provided by app-based platforms,
such as UberEats, DoorDash,
GrabFood, and Meituan, have
seen a surge in popularity across
numerous African countries [1]. The
COVID-19 pandemic led to social
distancing measures and increased
remote working, driving demand for
food delivery services that provided
safe, contactless interactions. These
apps allowed consumers to browse
restaurant menus, read reviews,
select convenient payment options,
and track their orders all from
the comfort of their homes. As
hybrid and remote working patterns
become more prevalent, technological
advancements shape consumer
lifestyles, reinforcing the growing
dependence on digital solutions for
everyday conveniences.
In South Africa, food delivery
services have transformed the urban
landscape, integral to national
economy, and have contributed
significantly to job creation such as
delivery drivers and app developers
[2]. In 2024, Shoprite reported that
their Checkers Sixty60 app had an
estimated 60% increase in sales and
1.4 million downloads (of 5.2 million
total downloads) [3]. Established
in 2019, this app has emphasised
its strategic focus on convenience,
efficient last-mile delivery service,
launch of dark stores, introduction
of premium products, and extensive
expansion across 539 locations [2].
Also, the partnership between Pick
n Pay and Mr D apps has reshaped
online grocery shopping in South
Africa, offering users access to over
10,000 products at in-store prices and
earning loyalty rewards. Combining
Pick n Pay’s grocery expertise with
Mr D’s delivery technology has
evolved into a seamless, cost-effective
experience (https://www.pnp.co.za/).
These food delivery services have
driven a shift in eating habits, with
many individuals increasingly relying
on high-calorie, highly processed
takeaway meals, contributing to
unhealthy dietary patterns and
rising obesity levels. Obesity,
characterised by excessive body
fat, significantly increases the risk
of cardiovascular disease, diabetes,
and certain cancers, which not only
reduces life expectancy but also puts
immense pressure on healthcare
resources. Notably, the South Africa
National Department of Health
reported increases in the rates of
being overweight or obese in 2016,
affecting adults (68% females and
31% males) and children under
five years of age (13%) [4]. This
concerning trend in South Africa
aligns with global projections,
highlighting the growing burden of
obesity-related health issues and the
increasing strain these trends place
on healthcare systems worldwide [5].
Global advocacy for promoting
healthier dietary practices and more
active lifestyles is urgent across
populations of all ages [6]. Although
the United Nations Sustainable
Development Goals (SDGs) does
not explicitly mention “obesity”
(only non-communicable diseases),
at least 14 of the 17 SDGs are
congruent with obesity-related
health implications. Hence, fostering
collaborations among healthcare
professionals, policymakers, and
app developers can leverage their
expertise to collaborate on adapting
emerging technologies to support
national health systems. For example,
by modifying the app interface to
display calorie information and offer
smaller portion sizes, consumers
can more accurately evaluate the
nutritional value prior to their meal
purchase [7]. Medical professionals
are well-placed to lead local and
national public health initiatives that
educate and empower the public
to adopt actionable strategies to
improve dietary habits and reduce
non-communicable disease risks.
References
1. Bannor RK, Amponsah J. The
emergence of food delivery in
Africa: a systematic review.
Sustain Technol Entrep.
2024;3(2):100062.
2. Khumalo S. Food delivery apps
bring new hope to SA’s jobless,
but it’s not always a piece of
cake [Internet]. News24. 2022
[cited 2025 Jan 11]. Available
from: https://www.news24.com/
Siyabonga Jikwana
Michael Mncedisi Willie
46
fin24/companies/food-delivery-
apps-bring-new-hope-to-sas-
jobless-but-its-not-always-a-
piece-of-cake-20220205
3. Daily Investor. Checkers
reveals secret to Sixty60 success
[Internet]. Daily Investor. 2025
[cited 2025 Jan 11]. Available
from: https://mybroadband.
co.za/news/investing/577984-
checkers-reveals-secret-to-
sixty60-success.html
4. National Department of Health.
Strategy for the prevention
and management of obesity
in South Africa, 2023–2028.
Pretoria National Department
of Health; 2023. Available
from: https://www.health.gov.
za/wp-content/uploads/2023/05/
Obesity-Strategy-2023-2028_
Final_Approved.pdf
5. Koliaki C, Dalamaga M,
Liatis S. Update on the obesity
epidemic: after the sudden
rise, is the upward trajectory
beginning to flatten? Curr Obes
Rep. 2023;12(4):514-27.
6. Ralston J, Cooper K, Powis J.
Obesity, SDGs and ROOTS:
a framework for impact. Curr
Obes Rep. 2021;10(1):54.
7. Coughlin SS, Whitehead M,
Sheats JQ , Mastromonico
J, Hardy D, Smith SA.
Smartphone applications
for promoting healthy diet
and nutrition: a literature
review. Jacobs J Food Nutr.
2015;2(3):021.
Siyabonga Jikwana,
MPH, DrPH (Candidate)
Chief Director,
Health Economics and Finance,
Gauteng Department of Health
Johannesburg, South Africa
University of Pretoria,
School of Public Health Medicine
Pretoria, South Africa
siyabonga.jikwana@gauteng.gov.za
Michael Mncedisi Willie, DBA
Executive for Policy,
Research and Monitoring,
Council for Medical Schemes
Pretoria, South Africa
m.willie@medicalschemes.co.za
South Africa’s Obesity Epidemic and the Role of Food Delivery Apps
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47
The global cancer burden remains a
significant challenge across national
health systems, as leaders navigate
timely and cost-effective ways to
implement equitable and accessible
approaches to health service delivery
for optimal cancer care. According
to the International Agency for
Research on Cancer (IARC)’s
Global Cancer Observatory (GCO),
a total of 20 million new cases and
9.7 million deaths were reported
globally in 2022, where one in
five individuals are estimated to
develop cancer during the lifetime
[1]. Together with changing health
system priorities, the coronavirus
disease (COVID-19) pandemic,
natural disasters, armed conflicts,
and economic inflation have all
played a major role in disrupting
or slowing progress in reducing
cancer incidence and mortality
[2]. Hence, health leaders and
community stakeholders should
develop local and national health
initiatives to better understand the
modifiable risk factors related to the
incidence of cancer and other non-
communicable diseases, including
alcohol and tobacco use, sedentarism
and unhealthy diets leading to
obesity, and exposure to air pollution
(e.g. aerosols, particulate matter)
[1,3].
The IARC, supported by
population-based cancer registries
like the International Association
of Cancer Registries and the
Global Initiative for Cancer
Registry Development, offers data
visualisation tools and fact sheets
as a platform to examine the global
cancer burden (https://gco.iarc.fr/
today/en). Using this database, the
most reported cancers globally in
2022 were lung (2.5 million new
cases), breast (2.3 million cases
in women), and colorectal (1.9
million cases) cancers [1]. Also,
the leading global causes of cancer
mortality in 2022 were lung (1.8
million deaths), colorectal (900,000
deaths), liver (760,000 deaths), and
breast (670,000 deaths) cancers [1].
Further analyses on differences by
sex, however, found that leading
cancer diagnoses and mortality
in women were breast, lung, and
colorectal cancers, and in men were
lung, prostate, and colorectal cancers
[1,4].
Notably, the World Health
Assembly (WHA) adopted the
resolution WHA 70.12 (Cancer
prevention and control in the context
of an integrated approach) in 2017,
to encourage national governments
and the World Health Organisation
(WHO) to accelerate steps to
achieve the objectives of global
plans that aim to reduce cancer
incidence and mortality [5]. This
resolution is supported by the Global
Action Plan for the Prevention and
Control of Noncommunicable Disease
WMA Members Commemorate World Cancer Day
WMA Members Commemorate World Cancer Day
Credit:
Yuganov
Konstantin
/
shutterstock.com
BACK TO CONTENTS
48
2013-2020, which follows the
resolution A/RES/66/2 (Political
Declaration of the High-level
Meeting of the General Assembly on
the Prevention and Control of Non-
communicable Diseases) adopted in
2011, highlighting the importance
of national commitment and
international collaborations to
combat cancer risks [6]. It also
aligns with Goal 3 (Ensure healthy
lives and promote well-being for all
at all ages) (https://sdgs.un.org/
goals/goal3) of the 2030 United
Nations Agenda for Sustainable
Development, with specific targets
3.4 (by 2030, reduce premature
mortality from non-communicable
diseases by one-third) and 3.8 (achieve
universal health coverage).
To strengthen these global efforts
on cancer prevention and control,
the World Medical Association
(WMA) adopted the WMA
Statement on Solar Radiation
and Photoprotection at the 72nd
WMA General Assembly (online)
in London, United Kingdom, in
October 2021 [7]. This resolution
emphasised photoprotection as a
key strategy to reduce the risk of
ultraviolet solar exposure, as well
as supported skin cancer screen
campaigns to identify pre-cancerous
lesions. Also, the WMA approved
the WMA Statement on Human
Papillomavirus (HPV) Vaccination
at the 75th WMA General
Assembly in Helsinki, Finland, in
October 2024 [8]. This resolution
supports the global strategy to
eliminate cervical cancer, including
the 90–70–90 targets (90% of girls
with HPV vaccine by age 15, 70% of
women screened by age 35 and age
45, 90% of women diagnosed with
cervical disease receive treatment) by
2030 [9].
World Cancer Day (https://www.
worldcancerday.org/) is observed
annually on 4 February, in
commemoration of the adoption
of the Charter of Paris Against
Cancer, as part of the World
Summit Against Cancer for the
New Millenium held in Paris,
France, in 2000 [10]. The “United
by Unique” theme offers a space
to highlight ongoing efforts across
national cancer programs and
encourage global leaders in the
collective commitment to combat
cancer. It emphasises the people-
centred approach, with empathy
and compassionate care, to address
specific individual needs and
appreciate the humanistic side of
each patient’s cancer testimony
across age, socio-cultural, and
geographic distributions.
In this article, physicians from 11
countries – Argentina, Colombia,
Finland, India, Myanmar, Nepal,
Pakistan, Philippines, Trinidad and
Tobago, Turkey, and Uruguay –
shared national cancer statistics and
trends and highlighted local and
national actions that promote the
urgent need for improved cancer
care initiatives to meet health
priorities. They stressed that early
diagnostic screening and prevention
campaigns focused on modifiable
risk factors can help curb the
rising trends in non-communicable
disease risks. Finally, they shared
optimism that robust health
surveillance systems can help guide
clinical and community practice and
policy development by identifying
epidemiological trends, prioritising
early detection, and supporting
public health messaging and other
community advocacy efforts.
Argentina
Over the past two decades, the
Argentina health system has
reported striking statistics about
the high cancer burden, as the
third leading cause of mortality
(15.6% of all causes of mortality),
for the 46 million residents [11,12].
The IARC’s GCO reported an
estimated 130,878 new cancer cases
in Argentina in both sexes in 2020
[3]. According to the Argentina
Ministry of Health, colorectal cancer
is the second most common type
(12.1% of all cancers), and together
with lung cancer was described
as the second and third leading
causes of mortality in Argentina,
respectively [12,13]. Notably, breast
cancer was designated as the second
highest mortality rate in South
America [14].
Over the past two decades, the
Argentina Ministry of Health has
recognised that the epidemiological
and demographic transition affect
the increasing trends of non-
communicable diseases, and robust
programs for optimal cancer care
is essential for the 46 million
residents. First, health leaders
approved the Decree 1286, which
founded the National Institute
of Cancer (Instituto Nacional del
Cáncer) (https://www.argentina.gob.
ar/salud/inc) in 2010. Second, they
adopted the Resolution 1261/2011
in 2011, which established the
National Program on Cervical
Cancer Prevention (Programa
Nacional de Prevención de
Cáncer Cervicouterino, PNPCC).
As secondary prevention, the
HPV screening test was widely
implemented for the early detection
of pre-cancerous lesions [15]. They
also supported Resolution 2173/2013
in 2013, which formed the National
Program on Colorectal Cancer
Prevention and Early Detection
(Programa Nacional de Prevención
y Detección Temprana del Cáncer
Colorrectal, PNCCR). Finally,
health leaders adopted the Law
No. 27.674 (Decreto 399/2022) in
2022, which launched the National
Comprehensive Care Program for
Children and Adolescents with
Cancer (Programa Nacional de
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WMA Members Commemorate World Cancer Day
49
Cuidado Integral del Niño, Niña y
Adolescente con Cáncer), ensuring
equitable access to high-quality
care for children and adolescents
diagnosed with cancer.
To combat the cancer burden,
Argentinian physicians can
collaborate to raise public awareness
about cancer risk factors and
promote the importance of lifestyle
behavioural modifications and
screening tests. To reinforce clinical
training for health professionals, the
National Institute of Cancer offers
continuing education opportunities
such as webinars and courses
on cancer diagnoses, pathology,
treatment, and palliative care.
Working with local and national
leaders, physicians and other health
professionals can advocate for cost-
effective and accessible cancer
screening services to reach diverse
age groups, leading efforts to reduce
cancer morbidity and mortality rates
in Argentina and the Americas
region.
Colombia
The Colombia health system, which
serves an estimated 52 million
residents, recognises the changing
demographics including the expected
life expectancy of 77.9 years in 2024
(increase from 70.9 in 2000) [16].
According to the National Cancer
Institute (Instituto Nacional de
Cancerología, INC) (https://www.
cancer.gov.co/), an estimated 6,387
and 6,640 new cancer cases were
reported in Colombia in 2022
and 2023, respectively [17]. These
statistics reflect the cancer burden,
noting a 4% increase from 2022,
14.8% increase from 2021, and a
30% projected increase by 2030. To
manage national health priorities,
the Colombia health system
develops relevant health objectives
and policies for national programs,
but private insurance companies
(e.g. Health Promotion Companies
or Entidades Promotoras de
Salud, EPS) direct regulations,
implement the policies, and manage
the operational system. However,
the health system is perceived as
decentralised and fragmented, and
ineffective accountability and limited
resources have led to delays in
healthcare service delivery, including
cancer diagnostic procedures (e.g.
screening tests), medication delivery,
and palliative care. The EPS has
been responsible for managing,
financing, and ensuring the provision
of services of the Colombia public
health system since 1993.
Over the past decade, the Colombia
Ministry of Health and Social
Protection has observed significant
delays in healthcare service delivery
(e.g. diagnostic results exceeding
50 days), and in response, have
supported significant policies and
initiatives to promote population
health. First, health leaders
launched the National Development
Plan 2022-2026 (Plan Nacional de
Desarrollo 2022-2026), using the
“Colombia, Global Power of Life”
theme, that aims to strengthen the
health system and ensure universal
access to quality services such as
timely access to cancer diagnosis
and treatment to improve patient
outcomes and survival [18]. Second,
they adopted the Law 2360 (Ley
2360) de 2024, which expands on
the Law 1384 (Ley 1384) of 2010,
to ensure constitutional protection
for cancer patients [19]. Finally,
they approved the Resolution 3202
(Resolución 3202) of 2016, which
supports the Comprehensive Health
Care Routes (Rutas Integrales de
Atención en Salud) that provide
timely clinical services (including
screening), expand the national
oncology network, and reinforce
legal framework to protect cancer
patients.
Recognising the cancer burden
in Colombia and the Americas
region, health leaders supported the
first-ever Global Cervical Cancer
Elimination Forum in Cartagena de
Indias in March 2024, highlighting
the urgent need for national and
global action to reduce risk of
cervical cancer [20]. Notably, as
the INC commemorates its 90th
anniversary, the International
Congress used the “90 Years of
Transformation for Cancer Control
in Colombia” theme to reinforce
the commitment to person-centred
cancer care, health professionals’
education and training, and
robust research initiatives during
the event in Bogota on 26-28
February 2025 (https://www.
congresointernacionalinc.com/) [21].
By coordinating these national
and regional events, doctors can
lead efforts to prioritise clinical
and research initiatives to reduce
the burden of non-communicable
diseases (like cancer) in Colombia
and the Americas region by
strengthening early detection
(including screening tests) and
ensuring prompt treatment (without
delayed care). Understanding the
specific barriers to healthcare service
delivery at the local and national
level will help health leaders
advocate for political commitment
to guarantee sufficient resources
for patients’ care and their families.
Together, we can raise our voices to
increase public awareness on cancer
risks and demonstrate support for
optimal cancer care for all patients.
Finland
In Finland, a country of 5.6 million
residents, one in three Finns will
develop cancer at some point in
their lives. The most common
cancers in Finnish women and men
are breast and prostate cancers,
respectively, followed by lung cancer
(almost 3,000 new annual cancer
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WMA Members Commemorate World Cancer Day
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cases). The Finnish Cancer Registry,
which has maintained the national
registry on cancer cases in Finland
since 1953, reported an estimated
37,268 new cancer cases and 13,287
cancer deaths in 2022, and 70%
five-year relative survival rate of
cancer patients monitored between
2020 and 2022 [22]. At the same
time, colon cancer screening was
widely promoted across Finland,
and the Finnish health system
confirmed 77.3% participation rates
during this first annual campaign,
with 5.1% positive tests and a total
of 581 diagnosed cancers (0.2 % of
the total screened population). Due
to aging demographics, new cancer
cases are projected to increase
by 24%, with the largest increase
among melanoma cases, by 2040
[22].
In the early 2000s, cancer survival
rates in Finland were the best across
the Nordic countries, but while
other Nordic countries improved
over the past two decades, there has
only been a moderate development
in Finland. Although reasons for
this delay are unknown, current
efforts aim to find an explanation
for the observed difference and
promptly take action to correct the
trend [23]. Notably, in May 2024,
the Finnish Ministry of Social
Affairs and Health and the Finnish
Cancer Center (FICAN) (with
five regional cancer centres) signed
an agreement on preparing the
national cancer strategy by Spring
2025. This strategy will cover seven
elements (prevention, screening,
diagnostics, treatments, patient
rehabilitation and psychosocial
support, palliative and hospice care,
research) and will strengthen the
national implementation of the
European Union’s Beating Cancer
Plan and the European Union’s
Cancer Mission (https://fican.fi/en/).
In February 2025, FICAN,
Neurocenter Finland, and public
hospital biobanks launched a
collaborative initiative to strengthen
the adoption of personalised
medicine across the nation by
October 2026. Primary activities,
such as improving biobank
sample collection of pilot diseases,
standardising health data recording,
and ensuring expanded access to
biobank samples and associated
health data for research purposes,
will inform the preparation and
planning of Finland’s national
personalised medicine program
[24]. The Finnish Medical
Association urges Finnish doctors
to familiarize themselves with the
new cancer strategy and cancer
registry information and use them
to improve the prognosis of cancer
patients in Finland.
India
World Cancer Day, celebrated
annually on 4 February, holds
immense significance for India,
serving as a reminder of the
alarming annual increase in cancer
cases for over 14 billion residents
and the urgent need for collective
action. India’s cancer burden is
rapidly growing, with 1.46 million
cases in 2022 projected to rise to
1.57 million by 2025 [25]. In 2022,
the national crude incidence rate of
all cancers was 100.4 (per 100,000
population), with rates for females
(105.4) higher than males (95.6),
highlighting increased prevalence
of breast, lung, cervical, and oral
cancers [25]. A comprehensive
analysis of cancer data (1990-2021)
from the Global Burden of Disease
(GBD) 2021 report highlighted that
oral cancer incidence (one-third of
global cancer cases) and mortality
(increased by 11%) rates remain a
significant health burden for the
nation [26]. These epidemiological
trends underscore the urgency of
strengthening cancer prevention
and care in India, especially with
inadequate access to specialised care
across urban and rural communities.
To combat this national burden,
the India health system continues
to stive to deliver health awareness
campaigns and equitable healthcare
services for all citizens.
In India, the rising prevalence of
cancer (e.g. lung, oral, colorectal)
can be attributed to increasing age,
lifestyle changes (e.g. increased
tobacco use, alcohol consumption,
sedentary behaviour), rapid
urbanisation and industrialisation
(e.g. exposure to environmental
pollution), and dietary changes
(e.g. increased consumption of
processed and high-fat foods). To
address these challenges, the India
healthcare system has undertaken
several commendable initiatives
to promote awareness and deliver
localised care that emphasises
detection and preventive strategies
over the past two decades. First,
the National Programme for
Prevention and Control of Cancer,
Diabetes, Cardiovascular Diseases,
and Stroke (NPCDCS) serves as
a cornerstone initiative to enhance
healthcare systems, emphasising
the early detection, diagnosis,
and management of cancer [27].
Second, the Pradhan Mantri Jan
Arogya Yojana (PM-JAY) (https://
nha.gov.in/PM-JAY), launched in
2018 as part of Ayushman Bharat,
provides financial support for cancer
treatment, thereby improving access
to care (e.g. free chemotherapy
in district hospitals near patients’
hometowns) for economically
disadvantaged populations.
Third, Indian Medical Association
(IMA) leaders are collaborating with
non-governmental organisations and
professional societies to advocate
for education and supportive
services for the Indian population.
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They collaborate with the National
Tobacco Control Program to
encourage tobacco cessation
services as well as the Federation
of Obstetric and Gynaecological
Societies of India (FOGSI) to
enhance training in cervical cancer
vaccinations. Fourth, IMA members
have contributed to successful
advocacy efforts to incorporate
cervical cancer vaccinations in the
National Immunization Protocol
as well as cancer in the list of
notifiable diseases [28]. Finally, in
the Union Budget of 2025-2026,
the Health Ministry announced
that 200 Day Care Cancer Centres
would be developed in all district
hospitals of India over the next
three years. Also, the basic customs
duty exemption to 36 life-saving
drugs used for treating cancers, rare
diseases, and other severe conditions
will increase the drug affordability
and accessibility.
As the largest group of doctors
in India, the IMA regularly
coordinates community-driven
efforts and social media initiatives
that raise public awareness about
cancer risks and prevention, such as
the public awareness campaigns for
World No Tobacco Day (31 May),
World Head and Neck Cancer
Day (27 July), and Breast Cancer
Awareness Month (October). They
also support targeted educational
campaigns, including Tobacco
Free Youth Campaign (2023)
and WHO-endorsed “Screen
and Treat” program for cervical
cancer introduced in 2021 [29].
For World Cancer Day 2025,
IMA leaders shared educational
documents with clinical guidelines
and statistics with members across
the country, encouraging them
to combat myths and stigma by
presenting academic lectures,
coordinating symposia, recording
brief video messages, publishing
blog articles, and communicating
press releases with local journalists.
As a medical community, we must
embody the “United by Unique”
theme for World Cancer Day 2025-
2027, to champion patient-centred
care and innovative management
approaches in cancer prevention and
management.
Myanmar
Myanmar’s healthcare system, with
health professionals serving over 54
million residents and 130 ethnic
groups, has reported significant
milestones and challenges in
delivering optimal cancer care
over the past decade. In 2016,
the Myanmar Ministry of Health
adopted the Myanmar National
Comprehensive Cancer Control (2017-
2021), as a plan to prioritise cancer
control, in lieu of a specific national
cancer policy [30]. In 2020, health
leaders successfully introduced
the HPV vaccine, as efforts to
combat cervical cancer and ensure
equitable access to vaccinations
while adhering to strict COVID-19
safety measures [31]. Also, as they
successfully expanded the delivery
of radiation therapy services to
public and private sectors, other
low- and middle-income countries
incorporated these best practices
into their health systems [32]. As
time progressed, however, they began
to observe patients with financial
hardships in obtaining life-saving
medications to improve quality of
life, critical shortages of essential
personnel (e.g. radiation physicists,
technicians, oncology nurses) in
implementing multidisciplinary
approaches to cancer management,
and physicians with less confidence
in providing palliative care [33,34].
This situation underscores the
urgent need for comprehensive
cancer control measures and
improved healthcare access in
Myanmar. These observations were
exacerbated by the military coup
on 1 February 2021, with reports
of deliberate attacks on health
professionals and facilities by the
Myanmar military and security
forces, potentially constituting war
crimes and severely undermining
humanitarian efforts [35]. With
border closures and heavy military
attacks, supply networks were
disrupted, causing extreme inflation
and unsafe environments for cancer
patients [36]. In some cases, prison
officials unethically withheld life-
saving treatment from political
prisoners. The death of Mandalay
Minister Dr. Zaw Myint Maung,
due to inadequate medical care in
a military-controlled jail, highlights
the dire consequences of these
actions [37].
As Myanmar physicians, we must
raise awareness about the impact of
the military coup on cancer care and
advocate for international support
to ensure continuity of care for
patients. Ensuring the cross-border
delivery of cancer medications and
equipment can help address the
urgent healthcare needs of cancer
patients in Myanmar. This strategic
shift will fostering a coordinated
and sustainable approach to cancer
treatment, enhance the safety
and security of humanitarian
assistance, and ensure that medical
supplies and care reach those
most in need. Organisations such
as the WMA, Junior Doctors
Network (JDN), and the World
Federation of Medical Education
(WFME), can develop virtual
and in-person cancer education
and clinical training programs for
health professionals in Myanmar.
This call to action is crucial for
improving cancer awareness and
care in Myanmar as well as the
wider Asian Region amidst ongoing
violence and resource limitations,
with the ultimate goal of enhancing
patient-centred care and developing
effective management approaches.
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Nepal
With the rising burden of cancer in
Nepal and around the world, World
Cancer Day serves as an essential
platform for raising awareness for
healthcare professionals and the
public on early detection, prevention
strategies, and access to cost-
effective treatment. For physicians
and stakeholders, it serves as
moment to reflect on the current
system and push for new policy
reforms to reduce the cancer burden
in Nepal. According to the IARC’s
GCO, there were 14,704 cancer-
related deaths in Nepal in 2022,
representing an age-standardised
mortality rate of 55.3 per 100,000
people, and 22,008 new cancer
cases, with an age-standardised
incidence rate of 81.6 per 100,000
people [38]. Lung, stomach, and
oral cancers were reportedly more
common in men, whereas breast,
cervix uteri, and lung cancers were
more common in women [38]. To
address the national cancer burden,
however, the Nepal health system
lacks a comprehensive national
cancer control program and a robust
national health insurance scheme
necessary to cover cancer treatment
costs and minimise financial
hardship for patients [39].
Over the past decade, the Nepal
Ministry of Health and Population
has implemented several initiatives
to improve cancer care for the 29
million residents. First, the Nepal
Health Research Council (https://
nhrc.gov.np/) led efforts to develop
the population-based cancer registry
in 2018, providing support to
evidence-based information across
urban and rural regions. Second,
leaders adopted the National Cancer
Control Strategy 2024-2030 in 2024,
which focuses on prevention through
incidence reduction, improved early
detection, and enhanced access to
treatment and palliative care [40].
Third, in 2025, they launched
a nationwide HPV vaccination
program targeting 1.6 million girls
(aged 10-15), prioritising areas with
low vaccine uptake such as Madhesh
Province and Kathmandu Valley
[41]. Fourth, since 2024, Nepal’s
membership in the Global Platform
for Access to Childhood Cancer
Medicines has granted free access
to 35 essential cancer medications
for paediatric patients [42]. Finally,
the Association of Medical Doctors
of Asia (AMDA), together with
other Nepalese physicians, regularly
lead hospital and community
campaigns at the Bir Hospital,
Marie Stopes Nepal, and Daiichi
Sankyo, offering cancer educational
and screening programs focusing
on prevention, early detection, and
treatment for women (e.g. breast
and cervical cancers) [43-45].
These local and national efforts
demonstrate the need for stronger
policy implementation and resource
allocation.
As physicians in Nepal, we stress the
need for increased funding, stronger
policies, increased public awareness,
and decentralisation of programs
in the rural setting. We also call
for international organisations to
share their experiences, expertise,
and knowledge to strengthen efforts
to provide optimal cancer care
in Nepal. Using the “United by
Unique” campaign theme, we must
be open to learning about each
cancer patient’s lived experiences
and collectively work to reinforce
the importance of cancer prevention
and early screening. Together, we
envision a healthcare setting where
patients and the public perceive
cancer as a preventable and treatable
condition.
Pakistan
World Cancer Day, held annually on
4 February, holds a deep significance
for physicians and other healthcare
professionals across Pakistan, as
a reminder of the ongoing battle
against cancer and the unique
challenges our nation faces in
addressing this global health burden.
According to the WHO and
Pakistan Medical Research Council
(PMRC) reports, cancer remains the
second-leading cause of mortality,
with approximately 178,000
new cases and 117,000 cancer-
related deaths reported annually
in Pakistan [46,47]. As the most
prevalent cancer in Pakistan, breast
cancer alone accounts for 38.5%
of cancer cases among Pakistani
women, which can lead to financial
hardship and emotional strain
among families. Rural communities,
however, face severe gaps in early
cancer diagnosis and treatment due
to limited diagnostic centres and
general lack of awareness. Notably,
cultural stigma often includes
misconceptions about cancer being
incurable, fear of social ostracisation,
and reluctance to discuss breast
health openly, which discourage
women from seeking timely medical
help.
Since the 1990s, the Pakistan
healthcare system has implemented
several noteworthy initiatives aimed
at improving cancer awareness and
care management. First, the National
Cancer Control Program, launched
in 1994, has expanded outreach by
integrating cancer screening services
in basic health units (BHUs)
and rural health centres (RHCs),
ensuring access for underserved
populations. Second, the Shaukat
Khanum Memorial Cancer Hospital
and Research Centre, established
in 1994, has conducted mobile
mammography camps, screenings
to over 100,000 women in rural
areas annually, and free follow-up
treatments for low-income patients.
Third, the Prohibition of Smoking
and Protection of Non-Smokers Health
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Ordinance of 2002, coupled with
recent bans on flavoured tobacco
products, has been instrumental
in reducing lung cancer rates,
particularly among urban youth.
Awareness campaigns, like those
organised by the Pink Ribbon
Pakistan Organisation (PRPO),
continue to play a pivotal role in
encouraging early breast cancer
screening through media advocacy
and partnerships with schools
and workplaces [48]. The PRPO
launched Pakistan’s first-ever breast
cancer awareness campaign in 2004,
and between 2006 and 2008, it was
responsible for coordinating the
Cancer Registry with the Ministry
of Health. Despite these efforts, one
cross-sectional study conducted in
a tertiary care hospital in Lahore
in 2009, revealed that only 13.9%
of female inpatients reported that
they practiced self-examination,
either being unaware of the exam
or believing that they did not need
to perform the exam [49]. A total
of 14.3% of female inpatients (9.5%
urban and 4.8% rural) reported that
clinical breast cancer screenings
were available [49]. In 2024, the
PRPO organised its annual breast
cancer awareness campaign with
educational seminars and free
screening camps, reaching over one
million women nationwide, which
led to a 20% increase in early breast
cancer detection rates.
Physicians in Pakistan, the
Asian region, and across the
globe must unite in advocating
for comprehensive cancer care
that leaves no one behind. Key
priorities include the establishment
of regional cancer registries to
collect precise health surveillance
data, which can justify the need
for targeted interventions, and the
expansion of telemedicine platforms
(like Sehat Kahani) to bridge access
gaps for remote consultations [50].
Also, clinical content on oncology
topics can be incorporated into
graduate and post-graduate medical
education and training, including
continuing education workshops
and online certificate programs
supported by collaborations between
the Pakistan Medical and Dental
Council (PMDC) and leading
cancer care centres. Finally, global
collaborations with the World
Cancer Day campaign and similar
initiatives can help advocate for
increased funding for research on
prevalent cancers (e.g. oral and
breast cancers). Health professionals
can lead efforts to foster community
engagement and policy advocacy, to
build a future rooted in equitable
and innovative cancer care.
Philippines
World Cancer Day holds deep
significance for Filipino healthcare
professionals, serving as a reminder
of the urgent need to improve
cancer awareness, prevention, and
treatment. In 2022, cancer was
identified as the third leading cause
of death in the country, with lung,
breast, and liver cancers as the top
three most common causes [51].
Despite growing awareness, many
Filipinos still struggle to access
timely diagnosis and treatment,
due to financial constraints, limited
specialised facilities, and disparities
in early detection services. These
national challenges highlight the
need for stronger healthcare policies
and expanded cancer care programs,
particularly for underprivileged
communities.
Recognising these gaps, the
Philippine government has taken
significant steps to improve cancer
care. The passage of the National
Integrated Cancer Control Act
(NICCA) of 2019 (Republic Act
No. 11215) laid the groundwork
for a more structured approach to
cancer prevention, early detection,
treatment, and patient support. It
introduced key initiatives such as
the Cancer Assistance Fund to help
ease financial burdens and mandated
the creation of the Philippine
Cancer Center, a dedicated
institution for research, treatment,
and innovation in cancer care [52].
To further strengthen these efforts,
the Department of Health and the
WHO recently launched the 2024-
2028 National Integrated Cancer
Control Program (NICCP) Strategic
Framework, outlining priorities and
capacity-building efforts to enhance
cancer services nationwide [53].
Medical organisations also play a
vital role in the coordination and
implementation of these health
initiatives. First, the Philippine
Medical Association, Philippine
Society of Medical Oncology,
Philippine Cancer Society,
Philippine Society of Oncologists
(PSO), and Quezon City Health
Department led efforts to launch
the “Act Now: 30-Day Screening to
Treatment” campaign in February
2025, offering free cancer screenings
and educational sessions to minimise
delays in diagnosis and treatment
[54]. Second, the Philippine College
of Surgeons Cancer Commission
Foundation (PCS CanCom),
Cancer Coalition Philippines, and
Philippine Cancer Society organised
the Philippine National Cancer
Summit 2025 on 27-28 February
2025, at Novotel Araneta City
in Cubao, Quezon City (https://
cancersummit.pcscancom.org/).
Using the “Stronger Philippines:
Building a Resilient Cancer Care
Ecosystem” theme, this summit
served as the nation’s premier
multi-sectoral, multidisciplinary, and
multi-stakeholder cancer conference,
underscoring the collective
commitment to advancing cancer
care in the country.
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Filipino physicians must take
proactive steps to enhance cancer
care by educating communities
about early detection, advocating
for better access to affordable care,
and pushing for policy reforms that
address systemic challenges in cancer
management. Collaborations with
the government, non-governmental
organisations, and community
groups are vital in addressing these
systemic challenges, ensuring that
cancer prevention, treatment, and
support services reach underserved
populations. Strengthening
investments in medical research,
advanced diagnostic tools, and
innovative treatment options can
further improve patient outcomes
and survival rates. By working
together, healthcare professionals
can not only reduce the cancer
burden in the Philippines but also
contribute to the global fight against
this disease, fostering a future where
quality cancer care is accessible to
all.
Trinidad and Tobago
World Cancer Day represents
an opportunity to brainstorm on
avenues to help improve care and
reduce healthcare disparities by
bridging the gap in cancer care
outcomes. Trinidad and Tobago, a
twin island nation in the Caribbean,
has a robust health system that
supports the health and well-being
of the 1.4 million residents. Since
cancer is one of the leading causes
of mortality in the Caribbean
region, Trinidad and Tobago is
strategically positioned to prioritise
clinical cancer care at the Regional
Health Authorities and support
epidemiological records at the
Dr. Elizabeth Quamina Cancer
Registry (established in 1994)
[55,56]. In 2018, a comprehensive
analysis of registry records between
1995 and 2009, highlighted that
the highest cancer incidence and
mortality rates were linked to
women (breast, cervix, uterus) and
men (colorectal, lung, prostate)
[56]. Notably, breast and prostate
cancer rates had increasing trends,
as compared to decreasing trends
in developed countries, marking
potential differences to explore
related to ancestry and geography
[55,56]. Hence, understanding the
epidemiology of cancer incidence,
mortality, and trends can help
guide clinical diagnostics, treatment
(chemotherapy, radiation therapy,
surgery), and prevention initiatives,
especially as some specialised
treatments (e.g. immunotherapies)
are not available locally in the public
sector.
Over the past decade, the Trinidad
and Tobago Ministry of Health has
pioneered key initiatives to offer
optimal cancer care for residents.
First, health leaders established the
National Oncology Programme
(NOP) (https://health.gov.tt/services/
cancer-care-and-treatment), which
supports the National Oncology
Centre as a major hub for cancer
diagnostic screening, treatment,
palliative care, and prevention in the
nation [57]. Second, they adopted
the National Strategic Plan for the
Prevention and Control of Non
Communicable Diseases: Trinidad and
Tobago 2017-2021, which highlights
the responsibilities of the National
Cancer Coordinating Committee
(NCCC) and the National Cancer
Registry (https://health.gov.tt/
national-cancer-registry) to support
national cancer care initiatives
and epidemiological surveillance,
respectively [58]. Third, non-
governmental organisations have
helped support national efforts
to enhance care of vulnerable
populations (including children). For
example, the SickKids-Caribbean
Initiative (SCI), a collaboration
initiated in 2013, has offered
valuable training to healthcare
professionals in seven Caribbean
countries, including Trinidad and
Tobago [59]. Finally, the Caribbean
Medical Journal, as the official
journal of the Trinidad and Tobago
Medical Association (T&TMA),
has shed light on the patient-
caregiver experience including the
psychological and emotional burden,
in its Palliative Care Series (https://
www.caribbeanmedicaljournal.org/
cmj-reflections/palliative-care-series/).
As a call to action, Trinidad and
Tobago doctors can lead efforts to
bridge knowledge and practice gaps
in cancer care across the nation and
Latin American and Caribbean
region. Collectively, they can
encourage doctors to network and
partner with ministries of health and
non-governmental organisations,
which can help navigate cancer care
through shared data and resources
and capacity building activities.
The medical community has the
clinical and public health expertise
to help strengthen healthcare system
resilience, leading to optimal patient
outcomes one patient and family at
a time. Reflecting on the sentiment
of Her Excellency Paula-Mae
Weekes, past president of Trinidad
and Tobago – “We must not become
weary. We must trust that in time we
will reap the benefits of our efforts.” –
we recognise the urgent need to be
resilient and strong in our efforts in
the fight against cancer in the Latin
American and Caribbean region.
Turkey
World Cancer Day serves as a
crucial reminder of the ongoing
and growing battle against cancer
for physicians in Türkiye. According
to the Turkish Ministry of Health
report of 2022, the total cancer
incidence in our country (per
100,000 persons) has risen from
133.5 in 2002 to 225.2 in 2018
[60,61]. Even though the IARC’s
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GCO reported that the age-
standardised incidence rate has
demonstrated a stable course in
2022, mortality increased from
83,163 cancer-related deaths in
2018 to 129,672 deaths in 2022
[62,63]. Cancer continues to be
a growing burden on our health
system that each physician must
remember every day, constituting a
dual local and global public health
crisis.
Despite healthcare advancements,
the Turkish health system faces
significant gaps, such as disparities
in access to early detection services
and treatment options between
urban and rural areas, areas affected
by the 2023 earthquake, and
different socioeconomic groups.
As these observed gaps call for
immediate attention to ensure
equitable cancer care across the
country, Türkiye has implemented
several initiatives that promote
cancer awareness and improving care
management. First, the National
Cancer Control Program focuses
on prevention strategies, including
public education campaigns
about risk factors (e.g. smoking,
unhealthy diets) and supports a
nationwide screening program
for breast, colorectal, and cervical
cancers [64]. Second, the Turkish
Society of Medical Oncology
and other community outreach
initiatives provide updated health
recommendations via online public
platforms. The Turkish Association
for Cancer Research and Control,
as a member of the Association of
European Cancer Leagues (ECL)
and the Union for International
Cancer Control (UICC), has
dedicated efforts toward early
detection and care of cancer patients
since 1947. Patient advocacy
groups, including the PI (Pembe
İzler – Turkish for Pink Marks)
Female Cancers Association, work
in collaboration with the European
Network of Gynaecological Cancer
Advocacy Groups (ENGAGe).
However, despite the WHO’s aim
to eliminate cervical cancer by 2030
with widespread vaccination and
screening programs, the Turkish
Ministry of Health has still not
included the HPV vaccine in its
national vaccination schedule [65].
Also, many targeted therapies
and novel anti-cancer agents lack
reimbursement by the social security
system. The cost of each treatment
cycle from the WHO Essential
Medicines complementary list (e.g.
nivolumab, pembrolizumab) is up to
10 times greater than the minimum
wage [66]. Considering that more
than 40% of the Turkish population
is employed on minimum wage,
lack of state reimbursement of
these recommended treatments
is depriving the community
of accessing the best standard
management [67].
As physicians committed to
enhancing cancer care management
locally and globally, our call to
action involves a multi-faceted
approach. We must advocate for
increasing the state budget allocated
to the health system, focusing on
cancer prevention, screening, and
treatment programs. Additional
financial support can include
establishing accessible cancer
centres with multidisciplinary teams,
ensuring reimbursement for standard
treatments, and implementing
smoking cessation and HPV
vaccination programs. Collaboration
among healthcare professionals is
vital, and sharing best practices
can lead us toward more effective
prevention and screening protocols
tailored to our population’s unique
needs.
Uruguay
As World Cancer Day provides an
invaluable opportunity to highlight
the importance of equitable cancer
care across the globe, countries of
the Latin America and Caribbean
region support national cancer
programs within the national
health systems, but notable regional
disparities exist. Within the Latin
America and Caribbean region, an
estimated 1.5 million new cancer
cases and 700,000 cancer-related
deaths were reported in 2020,
with projected increases due to
population growth, demographic
changes (e.g. aging), and risk factors
[68]. As physicians reflect on
national and global achievements,
they should identify areas that
demand immediate attention and
advocate for national interventions
to reduce cancer risks.
In Uruguay, cancer is the leading
cause of premature death (under 70
years of age), with breast cancer as
the most common in women, and
lung cancer as the primary cause
of mortality among all causes. The
Uruguay National Cancer Registry
reported an average of 8,244 annual
cancer-related deaths between 2016
and 2020 [69]. Notably, colorectal
cancer rates are the highest among
other Latin American countries
[70]. Despite the presence of
universal health coverage, ensuring
timely diagnoses and improving
access to innovative therapies remain
as significant challenges across the
Uruguay population.
The Uruguay Ministry of Health,
serving 3.4 million residents, has
undertaken several initiatives to
enhance cancer care and awareness.
First, the National Cancer
Prevention and Control Program
(PRONACAN) updated its
guidelines in 2024, to strengthen the
prevention of breast, colorectal, and
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WMA Members Commemorate World Cancer Day
56
cervical cancers, such as extending
HPV vaccination to vulnerable
populations [71-73]. Second, the
Anti-Tobacco Campaign, launched
in 2006, has encompassed plain
packaging regulations and strict
prohibitions on smoking in public
spaces, with reported reductions
in smoking prevalence. Third, the
Commission to Combat Cancer
(Comisión de Lucha Contra el
Cáncer) organizes annual population
education programs – such as
“Abrí el paraguas a la prevención
del cáncer de mama” (“Opening
the Umbrella to Prevent Breast
Cancer”), “Los colores del daño”
(“The Colors of Danger”), and “De
pulmón a pulmón” (“From Lung to
Lung”) – that raise awareness of
the most prevalent cancers. Fourth,
the National Resource Fund (Fondo
Nacional de Recursos) has expanded
universal coverage for several high-
cost cancer treatments, ensuring
equitable access to innovative
therapies for patients regardless of
socioeconomic status. Finally, the
Uruguay Cancer Society (Sociedad
de Oncología del Uruguay) is
actively engaged in promoting
continuous medical education for
oncologists and fostering closer ties
with the community through annual
educational campaigns (e.g. World
Cancer Day).
Physicians in Uruguay must
champion equitable access to cancer
care, with a particular focus on
underserved regions. Strengthening
primary care networks to facilitate
early detection and harnessing
digital health tools to address
geographic barriers should be our
top priorities. On a global scale, we
must collaborate to advance cancer
research, share best practices, and
advocate for policies that mitigate
risk factors such as tobacco and
alcohol consumption. Our united
efforts are crucial in building a
future where all patients receive
timely, effective, and affordable care.
Conclusion
The global observation of World
Cancer Day represents a pivotal
moment in society to raise public
awareness of cancer risks and
prevention, drive local and national
initiatives that promote patient-
centred care, and support novel
research applications that advance
cancer diagnostics, treatment,
and palliative care. The estimated
projection from 20 million new
cancer cases in 2022 to 35 million
cases by 2050 – or 70% increase –
highlights the need for emerging
research to further elucidate
epidemiological trends and risks
factors, including demographic
changes, exposure to environmental
hazards or pathogens, and
unhealthy lifestyle behaviours [1,2].
Over the next decade, public-
private partnerships can invest
in technological advancements
targeting genomic sequencing,
pharmaceuticals, clinical diagnostics,
and treatments for cancer care,
which can directly reduce morbidity
and mortality rates [74].
The World Cancer Day’s “United
by Unique” theme offers a platform
to better understand and appreciate
an individual’s lived experiences
living with cancer and navigating
cancer survivorship. Social science
research will be instrumental to
further study how physician-
patient communication and rapport,
family dynamics, and health system
interactions influence physical
and mental health outcomes
[75]. Effective communication
practices that promote dignity and
incorporate active listening, empathy,
respect, and transparency should
align with an individual’s needs
[76]. Sharing patients’ testimonies
with cancer diagnoses through
social media (e.g. podcasts, videos)
can illustrate courage, hope, and
perseverance, provide encouragement
to patients and families, and inspire
health professionals as they promote
patient-centred clinical care (https://
www.cdc.gov/cancer-survivors/
stories/index.html).
To address this non-communicable
disease burden across countries,
WMA members can leverage
their clinical expertise and skills
to foster robust collaborations
across disciplines and sectors and
advocate for the development of
timely policies that prioritise cancer
initiatives. This collective article
highlights global efforts to develop
sustainable partnerships with
community stakeholders and support
ongoing political commitment for
patient-centred cancer care and
investment in cancer research.
Notably, it recognises physicians’
leadership to build clinical capacity
by promoting cancer care initiatives
and strengthening education and
training programs across the
Americas, Asian, European, and
Pacific regions.
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Authors
Dilip Kumar Acharya, MBBS,
MS(Surgery), FMAS
Chairman, National Cancer and
Tobacco Control Committee,
Indian Medical Association
Indore, India
Damion Basdeo, MBBS, MRCP
(UK), Acute Medicine SCE (UK)
Internal Medicine, Registrar
Department of Internal Medicine
Sangre Grande Hospital
Campus, Sangre Grande
Trinidad and Tobago, West Indies
Dilip Bhanushali, MBBS
National President,
Indian Medical Association
New Delhi, India
Maria Minerva Calimag,
MD, MSc, PhD
Departments of Pharmacology and
Clinical Epidemiology, Faculty
of Medicine and Surgery,
University of Santo Tomas
Immediate Past President,
Philippine Medical Association
Manila, Philippines
Helena Chapman, MD, MPH, PhD
Milken Institute School of Public Health,
George Washington University
Washington DC, United States
Maymona Choudry, MD, MPH
School of Medicine, Ateneo de
Zamboanga University,
Zamboanga City, Philippines
Basilan Medical Center,
Basilan, Philippines
Kevon Dindial, MBBS, DM
Paediatrics, Subspeciality Affiliate
(Paediatric Haematology/Oncology)
Consultant Paediatric
Haematologist/Oncologist,
Department of Paediatrics,
Eric Williams Medical Sciences
Complex, San Juan,
Trinidad and Tobago, West Indies
Sarbari Dutta, MBBS, MD
Hony. Secretary General,
Indian Medical Association
New Delhi, India
Nihan Eren, MD
Medical Oncology Fellow and
Internal Medicine Specialist,
Istanbul University Oncology Institute
Istanbul, Türkiye
Jorge Alberto Iapichino, MD
President, Confederación Médica de
la República Argentina (COMRA)
Buenos Aires, Argentina
Krishna Jasani, MBBS, MD
(Community Medicine)
Department of Community
and Family Medicine,
All India Institute of Medical
Sciences (AIIMS)
Rajkot, Gujarat, India
Jay Bhushan Jha, MBBS, MD
Clinical Research Officer,
Nepal Medical Association
Kathmandu, Nepal
Anil Bikram Karki, MBBS, MS
President, Nepal Medical Association
Kathmandu, Nepal
Senior ENT Consultant, B. P.
Koirala Memorial Cancer Hospital
Bharatpur, Nepal
Mervi Kattelus, LL.M
Health Policy Advisor,
Finnish Medical Association
Helsinki, Finland
Naila Jamal Khattak, MBBS
Clinical Teaching Fellow, CMH
Multan Institute of Medical Sciences
Associate Member, WMA Pakistan
Multan, Punjab, Pakistan
Niina Koivuviita, MD,
Specialist in Internal Medicine
and Nephrology
President,
Finnish Medical Association
Helsinki, Finland
Pinar Saip, MD
Vice President, Turkish
Medical Association
Professor of Medical Oncology,
Istanbul University Oncology Institute
Istanbul, Türkiye
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WMA Members Commemorate World Cancer Day
62
Noelia Silveyra, MD
Secretary General,
Sociedad de Oncología Médica
y Pediátrica del Uruguay
Assistant Professor,
Department of Medical Oncology,
Universidad de la República
Montevideo, Uruguay
Ana María Soleibe Mejía, MD
President, Federación
Médica Colombiana
Bogota, Colombia
Sanjeeb Tiwati, MBBS, MD
General Secretary, Nepal
Medical Association
Assistant Professor, Department
of General Practice, Tribhuvan
University Teaching Hospital
Kathmandu, Nepal
Wunna Tun, MBBS, MD
Fellow, Medical Education
JDN Secretary
Yangon, Myanmar
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WMA Members Commemorate World Cancer Day