WMJ_2024_03

Official Journal of The World Medical Association, Inc. Nr. 3, September 2024
vol. 70
Contents
Editorial   3
Interview with the WMA Secretary General   4
Invitation to the WMA General Assembly in Helsinki, October 2024   7
Report on the Roundtable Discussion on Antimicrobial Resistance –
Looking Towards UN High-Level Meeting on AMR and Beyond   9
Reflections on the Value of the UN High-Level Meeting on Pandemic,
Prevention, Preparedness, and Response One Year Later   14
Junior Doctors Network’s Leadership at the World Health Summit 2023   19
Junior Doctors’ Perspectives on Barriers and Solutions to Equitable Access
to Global Health Opportunities    23
Pharmaceutical Policy in Afghanistan   27
African Health Leadership: A Physician’s Perspective   29
Interview with National Medical Associations’ Leaders of the African Region    32
Interview with National Medical Associations’ Leaders of the European Region  42
WMA Members Highlight National Initiatives to Safeguard Patient Safety 49
WORLD MEDICAL ASSOCIATION OFFICERS,
CHAIRPERSONS AND OFFICIALS
Dr. Lujain ALQODMANI
President
Kuwait Medical Association
123 Fifth Avenue,
1202
Kuwait
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. Ashok PHILIP
President-Elect
Malaysia Medical Association
4th Floor, MMA House,
124 Jalan Pahang
53000 Kuala Lumpur
Malaysia
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. Osahon ENABULELE
Immediate Past President
Nigerian Medical Association
8 Benghazi Street,
off Addis Ababa Crescent
Wuse Zone 4, P.O. Box 8829
Wuse, Abuja
Nigeria
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
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Over the past few months, extreme weather events, disease
outbreaks, and infodemic management have collectively
challenged health professionals in their daily practice.Reports of
record-breaking high temperatures during the summer months,
torrential rainfall in Africa, Asia, and Europe, and projections
of the most active hurricane season on record demonstrate the
observable impacts of climate change on the delicate balance
within our planet’s ecosystems. The emergence of disease
outbreaks,such as mpox,oropouche virus,and highly pathogenic
avian influenza virus, has helped drive global discourse about
health system preparedness and response, as well as the
evaluation of national action plans for pandemic preparedness
(including reducing risk of potential zoonotic transmission).
The rapid spread of misinformation and disinformation hinders
the delivery of accurate health recommendations with patients,
families, and communities, as well as the opportunity to build
public trust and rapport.
To address this global burden, WMA leaders underscored the
urgent need for global solidarity as a means to quickly respond
to climate change adaptation and mitigation efforts, support the
negotiations of the Pandemic Agreement, improve global health
workforce training, and streamline public health messaging.
As the impacts of anthropogenic phenomena on the aquatic,
atmospheric, and terrestrial ecosystems cannot be overlooked,
alterations or loss of natural biodiversity and animal habitats,
chemical and plastic pollution, and the introduction of non-
native species remain significant threats to humanity. Hence, the
question remains: How can global health professionals leverage
their expertise, develop robust One Health collaborations to
address these endemic and emerging health risks, and fortify
medical education and training across our countries?
As global leaders attend the 79th session of the UN General
Assembly from 20-30 September 2024, which consists of
High-Level Meetings on the Summit of the Future, General
Debate, Sea-Level Rise, Antimicrobial Resistance (AMR),
and Elimination of Nuclear Weapons, they share the urgent
message for international cooperation and collaboration to
combat diverse global crises and conflicts that affect public
health and environmental sustainability. Over these next
months, additional key global meetings will highlight
innovative strategies to accelerate progress to achieving the
Sustainable Development Goals, including the Group on Earth
Observations (GEO) Symposium and Regional Meetings
(Africa, Americas, Asia-Oceania, Europe), World One Health
Congress, and the UN/WHO Regional Conference on Space
Technology for Advancing Global Health. These timely events
– together with reports from leading agencies like the multi-
agency’s United in Science 2024 – support knowledge exchange,
propel interactive debates, and allow for expanded networks
for collaborative climate action.
The Finish Medical Association invites WMA members and
relevant guests to attend the WMA General Assembly in
Helsinki, Finland, from 16-19 October 2024. At this event,
WMA members can offer their perspectives to scholarly
debates on timely global health and medical ethics topics and
build connections with other NMAs. As WMA members have
participated in several regional expert meetings on the WMA
Declaration of Helsinki revisions in Johannesburg, Munich, and
Washington, DC, they can articulate any final comments for the
overall consensus and subsequent consideration for adoption.
In this issue, Dr. Otmar Kloiber shared his perspectives
on WMA activities as well as his leadership achievements
over his tenure as WMA Secretary General. Ms. Marr,
Dr. Julia Tainijoki, Dr. Caline Mattar, Dr. Lesley Ogilvie, and
Mr. Ashrit Challa offer a high-level summary of the
roundtable discussion on AMR ahead of the UN
High-Level Meeting on AMR in September 2024.
Dr. Mike Kalmus Eliasz, Dr. Yassen Tcholakov, Dr. Maria Inês
Francisco Viva, Dr. Marie-Claire Wangari, and Dr. Wenzhen
(Jen) Zuo presented reflections on the UN High-Level Meeting
on Pandemic, Prevention, Preparedness, and Response in
September 2023. Dr. Jeazul Ponce Hernández, Dr. Francisco
Franco Pêgo, Dr. Flora Wendel, Dr. Marie-Claire Wangari, and
Dr. Balkiss Abdelmoula described the Junior Doctors Network
(JDN)’s participation in the World Health Summit 2023. Dr.
Marie-Claire Wangari, Dr. Deena Mariyam, Dr. Lekha Rathod,
and the WMA-JDN Working Group on WHO Activities
examined JDN perspectives on barriers and solutions to the
equitable access of global health opportunities. Finally, Ms.
Tabasom Fayaz described pharmaceutical policy in Afghanistan.
WMA members are inspirational leaders who contribute
their clinical and surgical expertise in daily practice and at
national and international meetings. As they are acutely
aware of challenges facing medical education and training,
ethics, and public health across their countries, we encourage
them to prepare scientific analyses and commentaries for the
World Medical Journal. In this issue, two remarkable articles
from eight NMAs in Africa and Europe described leadership
experiences, ongoing NMA activities, and perceived strengths
and challenges in medical education. Dr. Johannes Steinhart,
Dr. François Arnault, Dr. Philippe Cathala, Dr. Simon Kigondu,
Dr. John Baptist Nkuranga, Dr. Mvuyisi Mzukwa, Dr. Tomás
Cobo Castro, Dr. Sofia Rydgren Stale, and Dr. Herbert
Luswata, representing the NMAs from Austria, France,
Kenya, Rwanda, South Africa, Spain, and Sweden, respectively,
expressed their valuable viewpoints for ongoing discourse. Also,
WMA members representing 14 countries of the African,
Americas, Eastern Mediterranean Region, and South-East
Asian regions highlighted national policies and activities that
promote patient safety practices related to World Patient Safety
Day 2024.
We look forward to exciting discussions and networking
opportunities at the WMA General Assembly in Helsinki!
Helena Chapman, MD, MPH, PhD
Editor in Chief of the World Medical Journal
editor-in-chief@wma.net
4
For this interview, Dr. Otmar Kloiber,
the WMA Secretary General, shares
his perspectives on WMA activities
as well as his leadership achievements
over his tenure with Dr. Helena
Chapman, the WMJ Editor in Chief.
How would you describe your role as
General Secretary, and how has the
WMA evolved as an organisation
over your WMA tenure?
As Secretary General, my role is
to operationalize the aims of the
WMA, promote the application
and development of medical ethics,
and advocate for better patient
care and equity in order to protect
human rights in healthcare. I joined
the WMA after many countries,
especially in central and eastern
Europe, became democracies or
at least less authoritarian, and old
blocks of power had disappeared.
The world was opening up
politically, which helped significantly
to increase our membership. Since
that time, the WMA has become a
more vibrant community, with more
active engagement in global health
activities and healthcare advocacy at
all levels.
What do you consider to be the
WMA’s top three most important
leadership achievements over the
past decade?
First, we have made major changes
in the WMA governance, which
corrected the perception of the
WMA as a club of wealthy countries.
We now represent the largest portion
of physicians globally. Second, we
have engaged in addressing major
global health challenges, such as
social determinants of health, One
Health, climate crisis, and research
ethics. With the Declaration of
Taipei, we have provided a blueprint
for transferring our principles of
research ethics into the research world
of large databases and biobanks [1].
Finally, we have held global
discussions to defend, develop, and
update our core documents, including
the Declaration of Geneva and the
International Code of Medical Ethics
[2,3]. We also needed to adapt to
new developments in medicine and
adopt a more modern language, while
remaining true to our principles
and traditions of caring, ethics, and
science. This year, I am confident that
we will finalise discussions on one of
our key documents, and will complete
the revision of the Declaration of
Helsinki in October 2024.
How would you describe the
observed impact of the WMA
declarations, resolutions, and
statements in the health sector?
Please share two examples that you
have observed during your WMA
tenure.
During my WMA tenure, I have
observed three specific examples
with significant global impact.
First, the Declaration of Helsinki,
which is referenced in national
and international law, has become
the cornerstone of research
ethics worldwide [4]. Second, in
collaboration with regional and
national physician organisations, we
strongly advocate for our professional
autonomy. Over time, we have
witnessed that professional autonomy
has been under attack from multiple
stakeholders. Some governments and
commercial entities have attempted
to commoditise healthcare and
subordinate medical decision-
making to commercial interests,
rather than serving the interests of
patients or communities. Finally,
we lead efforts to raise attention to
human rights violations in individual
or national cases, and although not
always successful, we remain vigilant.
Most recently, we participated in
a movement that convinced the
Parliament of Gambia to maintain
the prohibition of female genital
mutilation [5].
How does the WMA manage
international discourse throughout
the year, including contentious
debates and disagreements that may
arise on complex medical ethics
topics? Please share two examples
of how contentious debates were
addressed during your WMA
tenure.
There have always been, and probably
always will be, divergent opinions
on ethical questions, particularly
concerning the beginning and end
of human life. It is important to
note that divergent views on medical
ethics issues often exist within
countries rather than just between
countries. Over the past decades, our
approach has been to engage in open
and inclusive debate on these issues.
Although a lengthy and resource-
intensive process, we are convinced
that this approach produces the
Otmar Kloiber
Interview with the WMA Secretary General
Interview with the WMA Secretary General
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5
best results. For example, we have
discussed issues ranging from gamete
donation, embryo transfer, and
surrogate motherhood to abortion,
physician-assisted suicide, and
euthanasia. Although controversial
topics, we were able to discuss them
thoroughly and eventually address
them through the development of
WMA policies.
How can the WMA help support
specific national challenges faced
by national medical associations
(NMAs), including medical
education and training and health
policy reform. Please share two
examples of how the WMA has
helped support NMAs during your
WMA tenure.
When managing diverse
national issues, the WMA acts
at the request of our NMAs.
If in a country there is no NMA in
our membership, then the WMA
may speak out independently.
Over the past year, the WMA has
supported several specific situations
of significant concern. For example,
the WMA supported the Indian
Medical Association in their struggle
against a government policy that
grants traditional healers more
rights to practise modern medicine
and surgery without any relevant
education and training. Similarly, the
WMA joined the Korean Medical
Association in their objection
against the government’s attempts
to either satisfy a small group of
voters or place pressure on Korean
physicians by allowing practitioners
of traditional Korean medicine to
use western medical technologies
without appropriate education [6].
The WMA has also supported
Korean physicians in their protest
against nearly doubling the number
of medical students without first
creating the necessary university
resources [7].
However, if pressing concerns arise
in several countries simultaneously,
NMAs may be unaware that
they are affected by issues,
such as the commoditization
of healthcare and the increasing loss
of professional autonomy. For
example, some governments are
prohibiting their medical residents
from seeking employment abroad,
rather than offering decent working
conditions. These actions that target
professional groups represent civil
conscription, and may qualify as
forced labour and constitute a human
rights violation.
Please describe three ongoing
WMA initiatives that help address
specific challenges facing the global
medical community over the next
five years.
By the nature of the WMA, most
initiatives are focused on identifying
pressing global challenges in medical
ethics and collectively developing a
relevant and timely policy to help
guide NMAs in their advocacy,
decision-making, and educational
activities. Over the next five years,
three specific focus areas include
supporting pandemic preparedness,
reducing risks of antimicrobial
resistance (AMR), and combatting
the climate crisis. To that extent, we
have revised our policies on emergency
preparedness and engaged actively
with the World Health Organization
on fostering action against AMR.We
have also actively participated in the
Conference of the Parties (commonly
called COP) of the United Nations
Framework Convention on Climate
Change (UNFCCC), where we
collectively advocate for more
political action on climate adaptation
and mitigation, noting the direct or
indirect consequences on health and
well-being.
References
1. World Medical Association.
Declaration of Taipei on Ethical
Considerations regarding
Health Databases and Biobanks
[Internet]. 2016 [cited 2024 Aug
10]. Available from: https://www.
wma.net/policies-post/wma-dec-
laration-of-taipei-on-eth-
ical-considerations-regar-
ding-health-databases-and-bio-
banks/
2. World Medical Association.
Declaration of Geneva [Internet].
2017 [cited 2024 Aug 10].
Available from: https://www.
wma.net/policies-post/wma-dec-
laration-of-geneva/
3. World Medical Association.
International Code of Medical
Ethics [Internet]. 2022 [cited
2024 Aug 10]. Available from:
https://www.wma.net/policies-
p o s t / w m a – i n t e r n a t i o n –
al-code-of-medical-ethics/
4. World Medical Association.
Declaration of Helsinki: Ethical
Principles for Medical Research
involving Human Subjects
[Internet]. 2013 [cited 2024 Aug
10]. Available from: https://www.
wma.net/policies-post/wma-dec-
laration-of-helsinki-ethical-prin-
ciples-for-medical-research-in-
volving-human-subjects/
5. World Medical Association.
WMA Council Resolution
Calling for the Immediate
Withdrawal of the Bill Lifting
the Ban on Female Genital
Mutilation in Gambia [Internet].
2024 [cited 2024 Aug 10].
Available from: https://www.
wma.net/policies-post/wma-
council-resolution-calling-for-
the-immediate-withdrawal-of-
the-bill-lifting-the-ban-on-fe-
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Interview with the WMA Secretary General
6
male-genital-mutilation-in-gam-
bia/
6. World Medical Association.
World Medical Association
clarifies position on collective
action and condemns government
interference in Korean Medical
Association [Internet]. 2024
[cited 2024 Aug 10]. Available
from: https://www.wma.net/
news-post/world-medical-asso-
ciation-clarifies-position-on-col-
l e c t i v e – a c t i o n – a n d – c o n –
demns-government-interfer-
ence-in-korean-medical-associa-
tion/
7. World Medical Association.
World Medical Association
stands firm in support of Korean
Medical Association amid
government-induced crisis
[Internet]. 2024 [cited 2024
Aug 10]. Available from:
https://www.wma.net/news-
post/world-medical-associ-
ation-stands-firm-in-sup-
port-of-korean-medical-asso-
ciation-amid-government-in-
duced-crisis/
Otmar Kloiber, MD
Secretary General (2005-current)
World Medical Association
otmar.kloiber@wma.net
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Interview with the WMA Secretary General
7
Dear Colleagues and Esteemed
Members of the World Medical
Association (WMA),
It is with great pleasure that we
invite you to join us for the WMA
General Assembly, which will be
held in Helsinki, Finland, from
16-19 October 2024. This year’s
gathering will be particularly
significant as we celebrate the 60th
anniversary of the Declaration of
Helsinki, a foundational document
that has guided the ethical standards
of medical research for the past six
decades.
Theme: Equality in Healthcare
Our theme for this year – Equality in
Healthcare – reflects one of the most
urgent and pressing issues of our time.
Despite tremendous advancements in
medicine, disparities in healthcare
access and quality continue to persist
across populations, communities, and
countries. This assembly will bring
together thought leaders, healthcare
professionals, and advocates from
around the world to discuss how we
can collectively work towards more
equitable health systems, ensuring
that everyone, regardless of race,
gender, socioeconomic status or
geography, receives the healthcare
they need and deserve.
Celebrating 60 Years of the
Declaration of Helsinki
The Declaration of Helsinki has
stood as a pillar of ethical guidance
in medical research for the past six
decades, shaping the conduct of
clinical trials and the protection of
research participants worldwide.
Its principles have become the
cornerstone of ethical medical
practice, ensuring that the rights,
safety, and well-being of patients
remain paramount in research efforts.
This anniversary is timely to reflect
on the Declaration’s profound impact
on global health, as well as renew
our commitment to upholding its
values in an ever-changing medical
landscape. Helsinki, the birthplace
of the Declaration of Helsinki, is a
fitting location for this important
dialogue. Over the course of the
meeting, we will reflect on the
progress made since the Declaration’s
adoption in 1964, as well as hear the
results of a two-year renewal process
and explore how we can apply its
principles to the challenges of today
– particularly in advocacy efforts for
equal access to healthcare.
A Comprehensive Program
The event will serve as a vital
platform for physicians to connect,
share knowledge, and influence the
future direction of medical ethics
and medicine. It is comprised of
the General Assembly proceedings
as well as preceding meetings of
the Statutory Committees and the
Council. We encourage all WMA
members to take part in this historic
event. Your voice and your expertise
are essential in shaping the future of
global healthcare and ensuring that
the principles of equality, dignity,
and ethical responsibility remain at
the core of our profession.
Invitation to the WMA General Assembly
in Helsinki, October 2024
Invitation to the WMA General Assembly in Helsinki, October 2024
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8
The Host City and Association
We invite you to explore our
beautiful capital and its surroundings.
Helsinki is known for its blend
of modern urban culture, history,
architecture, design, and natural
beauty. As saunas are a significant
part of Finnish culture, Helsinki
offers many opportunities to
experience them, including on the
way from the official meeting hotel
to the conference centre in the
harbour.
This will be the third WMA General
Assembly that the Finnish Medical
Association (FMA) has hosted.
Established in 1910, the FMA is a
professional organisation and trade
union representing more than 90%
of Finnish physicians. It plays a
significant role in the development
of the medical profession in Finland,
advocating for the rights and interests
of physicians and ensuring high
standards in medical practice.
We are proud of this opportunity to
host this event, and we will do our
best to make your visit successful
and memorable. Mark your calendars
for 16-19 October 2024, and join
us in Helsinki, as we celebrate 60
years of the Declaration of Helsinki
and reaffirm our commitment to
advancing equality in healthcare for
all.
Warm regards,
Niina Koivuviita, MD
President,
Finnish Medical Association
niina.koivuviita@laakariliitto.fi
https://www.laakariliitto.fi/
Invitation to the WMA General Assembly in Helsinki, October 2024
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9
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Report on the Roundtable Discussion on Antimicrobial Resistance
The World Medical Association
(WMA) collaborated with the
Global Antimicrobial Resistance
(AMR) Research and Development
(R&D) Hub to host a roundtable
discussion on AMR on the sidelines
of the 77th World Health Assembly
in Geneva, Switzerland in May 2024.
This event was held in preparation
for and anticipation of the United
Nations General Assembly (UNGA)
High-Level Meeting (HLM) on
AMR, which will take place on
26 September 2024, in New York.
Invited participants represented a
range of sectors and backgrounds
and were brought together to
discuss four key themes: Access
and Innovation, Health Systems
and Health Workforce Education,
Stewardship, and One Health.
This article aims to summarise
the key messages and highlight
perceived gaps in the Zero Draft of
the UNGA HLM on AMR political
declaration, as discussed during the
roundtable.
Background on the AMR Situation
AMR is estimated to have been
directly responsible for 1.3 million
deaths globally in 2019, with
approximately 4.95 million deaths
associated with AMR in the same
year [1]. In addition to mortality
figures, AMR also results in
significant economic burden, with the
World Bank estimating that AMR
could result in a 3.8% reduction
in global gross domestic product
(GDP) by 2050, amounting to
a US $3.4 trillion loss each year [2].
AMR could push 24 million more
people into extreme poverty by 2030
if left unchecked and reduce global
life expectancy by 1.8 years by 2035
[2,3]. Moreover, the burden of
AMR is unequal, with low- and
middle-income countries (LMICs)
disproportionately affected by drug-
resistant infections. As LMICs
often have the greatest unmet needs
for diagnostics, therapeutics, and
vaccines, AMR only widens these
gaps in healthcare access and bolsters
existing inequities.
In 2016, the first UNGA HLM on
AMR stressed the urgency of action
in the resultant political declaration
[4]. In response, several initiatives
were launched, and progress was
well underway until the coronavirus
disease 2019 (COVID-19) pandemic
brought efforts to a standstill.
Resources were diverted from
AMR efforts, with surveillance and
stewardship programs also falling by
the wayside, resulting in increased
global rates of AMR incidence
[4]. Currently, we are at a critical
junction in the aftermath of the
COVID-19 pandemic, with another
UNGA HLM on AMR rapidly
approaching. While it is crucial that
the resultant UNGA declaration
reflects the necessary progress, much-
needed political commitments, and
defined monitoring targets, the
implementation path post-UNGA
remains challenging. Multiple
avenues of collaboration and
Report on the Roundtable Discussion on Antimicrobial Resistance –
Looking Towards the UN High-Level Meeting on AMR and Beyond
Kristy Marr
Lesley Ogilvie
Julia Tainijoki
Ashrit Challa
Caline Mattar
10
BACK TO CONTENTS
alignment among global actors are
essential if we hope to accelerate
progress at all levels and facets of the
AMR challenge we face today.
Outcomes of Roundtable
Discussions
This invitation-only roundtable
event was convened to unite
stakeholders in the AMR field to
share expertise, explore synergies,
and make recommendations for next
steps. An overview of the discussions
from the expert dialogue as well as
the suggestions for strengthening
the UNGA political declaration on
AMRareprovidedbelow,withtheaim
of driving action against AMR at the
highest political levels. Suggestions
are categorised into four key thematic
areas, which were the basis of our
discussion subgroupings and were
handpicked to ensure diversity in
geographic representation, sector,
and professional background among
roundtable members.
Theme 1: Access and Innovation of
AMR Diagnostics and Treatment
Recognising that the lack of new
antimicrobials and rising resistance
endangers vulnerable populations,
necessitating urgent prioritisation
and incentives for development and
access, participants raised that the
access and innovation sections of the
Zero Draft of the political declaration
required a clearer statement of
intent and greater ambition. While
including specific global research
and development (R&D) targets
in the declaration was thought to
be challenging, they suggested that
– at a minimum – a mechanism
for establishing such targets in the
future should be outlined. There was
general consensus that this could
involve a political mandate and
commitment for the forthcoming
Independent Panel on Evidence for
Action against AMR to develop these
targets. However, the role of this
Panel and its relationship with the
Quadripartite organisations would
need to be clearly defined.
Participants also highlighted that the
declaration should include specific
wording on supporting existing
global initiatives, acknowledging
the progress that has been made on
access and innovation since 2016. For
example, this progress has included
initiatives such as CARB-X (https://
carb-x.org/), GARDP (https://gardp.
org/), the Global AMR R&D Hub
(https://globalamrhub.org/), and
country-specific pull incentive pilots
[5,6]. They highlighted the call to
recognise the WHO pipeline analyses
and priority lists as foundational to
ongoing work in this area [7-9].
In the Zero Draft, participants
commented that financing was
largely siloed around National Action
Plans (NAPs). The requirement
to establish financing targets for
new antibacterials and give greater
considerations to the complexities
of diagnostic funding from an R&D
perspective was expressed, given that
diagnostics often exceed the costs
of antibiotics. They agreed on the
importance of increased emphasis
on push and pull incentives as
sustainable strategies for long-
term innovation and new economic
models de-linked from revenues.
Participants inquired about how
to appropriately signal these next
steps towards resource mobilisation
through the G7 and G20.
Furthermore, it was emphasised that
most prescribed antibiotics today
are generics, and the supply chain
remains unstable due to manufacturer
consolidation. The discussion ended
with pragmatism, underscoring the
urgency to plan for the replacement
of life-saving antibiotics, as failing to
do so would leave nothing to preserve
their access in the future.
Theme 2: Health Systems and
Health Workforce Education
Participants acknowledged that
strong health systems and a well-
resourced workforce are fundamental
to combat AMR through prevention,
diagnosis, treatment, and public
education. The Zero Draft placed
insufficient emphasis on education
and training of medical professionals
related to AMR. They agreed that
there must be a greater emphasis
on and investment in preparing the
workforce for AMR, both within
the language of the Zero Draft and
through the strengthening or
establishment of education
frameworks. Participants stressed
the importance of educating patient
communities alongside medical
professionals, including engaging
patients in discussions about AMR
and the development of NAPs.
Participants believed that creating
stronger systems for sharing
information can propel health
personnel and patient communities to
spearhead government-level change
in combat AMR.
Participants also expressed the
need for greater levels of education
during training, including significant
investment into health infrastructure
for all healthcare roles. They
commented that physicians, dentists,
nurses, and pharmacists tend to
represent the majority workforce,
often overlooking ‘invisible personnel’
in the health workforce, such as
administrators, patient escorts,
and cleaners. Improving education
systems and enabling healthcare
professionals to spend more time
with patients were seen as essential
steps to strengthen healthcare team
collaborations in AMR initiatives.
Furthermore, they shared their
concern about the lack of investment
in dissemination of available
information including tools to
enhance understanding of AMR.
Report on the Roundtable Discussion on Antimicrobial Resistance
11
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One suggestion was to include the
terms “Investment” and “Patient
Voice”in the Zero Draft to reflect the
importance of these concepts.
Theme 3: Stewardship to Reduce
the Burden of AMR
Discussions centred on the fact that
antimicrobial stewardship (AMS) is
essential to combat AMR, addressing
overprescription, misuse, and
educational gaps, while promoting
global collaboration and policy
reform within the health system. The
political resolution should clearly
defineandoutlinethekeycomponents
of AMS. Participants acknowledged
that clear, accessible guidelines
should extend beyond physicians
to include nurses and community
health educators, considering the
disparities between high- and low-
resource settings. A simplified set of
guidelines was viewed as essential to
ensure effective implementation of
AMS principles at the community
level, supported by meaningful
surveillance data that reflect local
resistance patterns. They highlighted
that guidance on usage, especially
for new antibiotics coming to the
market, should be aligned with the
implementation of an appropriate
stewardship plan.
Participants stressed that access to
essential antibiotics is foundational
to successful stewardship and should
be prioritised in the declaration’s
opening paragraphs. Without
access, healthcare professionals face
the difficult dilemma of balancing
stewardship measures with patient
health needs, as well as recognising
direct links between human and
animal health. They also emphasised
that universal health coverage is a
vital component of AMS, to ensure
the effective implementation of
diagnostics or infection prevention
and control.
Building on this narrative, the
participants hoped that the
declaration would offer an
opportunity to broaden the scope
of AMS, advocating for a holistic,
society-wide approach that includes
stewardship at the community
level, consideration of behavioural
changes, and attention to commercial
determinants. Civil society
organisations and health professional
associations can play a key role in
this expanded approach to AMS.
The discussions ended with
the recognition that the draft
declaration does not adequately
recognise how women and children
disproportionately bear the impacts
of AMR, facing higher risks and
challenges in accessing adequate
treatments, such as paediatric
formulations.
Theme 4: One Health Approach
Participants suggested that the
term “One Health” be replaced with
“intersectoral,” “cross-sectoral” or
“multisectoral” in the draft political
declaration, as it may minimise
any potential political setbacks
or challenges associated with
definitions of “One Health”. Other
participants commented that the
term “One Health” could be used in
the introduction or preamble and
removed from the main text. This
discourse was highlighted as the
“One Health” term and concept
are not yet well entrenched in some
countries, with additional translation
issues in other languages.
Participants also discussed how
other relevant terms are defined and
incorporated into the declaration.
First, the term “animal” was found
to be often poorly defined and
oversimplified in the context of AMR.
A need for antimicrobial use to be
species- or sector-specific, potentially
through the introduction of an
animal-focused version of the WHO
Access, Watch, Reserve (AWaRe)
Classification was raised. This
system would account for the varying
impacts of different antibiotics
and classes on AMR, emphasising
the importance of appropriate use.
Second, the term “integrated
surveillance” was questioned due to
the challenges in its implementation,
noting that a more suitable approach
might be mono-sectoral surveillance
with integrated or coordinated
analysis.
Some participants viewed the
inclusion of global targets as
polarising and a potential barrier
to adoption of the resolution,
recognising that targets should
be evidence-based, inclusive, and
appealing to politicians. They
believed that such targets could
be adapted by regions or countries
and reevaluated over time. This
conversation emphasised the
necessity of true multisectoral
collaboration, with participants
raising that the Quadripartite
organization’s One Health AMR
Priority Research Agenda had not
been included in the declaration
[10]. In the research arena, the
benefits of considering the social and
behavioural aspects of AMR and
a greater focus on implementation
research to improve the delivery of
interventions was voiced. Overall,
participants agreed that the “One
Health” concept should be integrated
into all aspects of AMR policy, not
simply treated as a separate entity.
Key Messages and
Recommendations
• The lack of new antimicrobials
and rising resistance endangers
vulnerable populations,
necessitating urgent prioritisation
and incentives for development
and access.
• Urgent planning is needed to
ensure adequate supply of generic
antibiotics and address the
consolidation of suppliers.
Report on the Roundtable Discussion on Antimicrobial Resistance
12
• Strong health systems and a well-
resourced workforce are essential to
combat AMR through prevention,
diagnosis, treatment, and public
education.
• Education frameworks for
healthcare professionals, patients,
and communities at large should
be more widely disseminated,
and governments should ensure
patient voices are included in NAP
considerations.
• AMS is essential to combat
AMR, addressing overprescription,
misuse, and educational gaps while
promoting global collaboration
and policy reform.
• Ensuring access to essential
antibiotics is the foundation
for successful stewardship, as
healthcare professionals face
difficult choices between applying
stewardship measures and
safeguarding the health of their
patients.
• A greater focus on behaviour
change and implementation
science would assist in improving
the delivery of AMR interventions.
References
1. Antimicrobial Resistance Col-
laborators. Global burden of bac-
terial antimicrobial resistance
in 2019: a systematic analysis
[published correction appears in
Lancet. 2022;400(10358):1102].
Lancet. 2022;399(10325):629-55.
2. World Bank. Drug-resistant in-
fections: a threat to our economic
future. Washington, DC: World
Bank; 2017. Available from:
https://www.worldbank.org/en/
topic/health/publication/drug-
resistant-infections-a-threat-to-
our-economic-future
3. Global Leaders Group on An-
timicrobial Resistance. Towards
specific commitments and action
in the response to antimicrobial
resistance. Geneva: Global Lead-
ers Group on Antimicrobial Re-
sistance; 2024. Available from:
https://www.amrleaders.org/re-
sources/m/item/glg-report
4. United Nations. United Nations
General Assembly (71st session;
2016–2017). Political declara-
tion of the high-level meeting
on antimicrobial resistance: res-
olution/adopted by the Gener-
al Assembly. A/RES/71/3. New
York: UN; 2016. Available from:
https://digitallibrary.un.org/re-
cord/845917
5. Global AMR R&D Hub. In-
centivising the development of
new antibacterial treatments:
2023 progress report by the
Global AMR R&D Hub and
WHO. Geneva: Global AMR
R&D Hub and WHO; 2023.
Available from: https://glo-
balamrhub.org/publications/
incentivising-the-develop-
ment-of-new-antibacterial-treat-
ments-2023/
6. Ogilvie L, Beyer P. Incentivis-
ing the development of new an-
tibacterial treatments: 2022 pro-
gress report by the Global AMR
R&D Hub and WHO. Gene-
va: Global AMR R&D Hub;
2022. Available from: https://
globalamrhub.org/publica-
tions/incentivising-the-develop-
ment-of-new-antibacterial-treat-
ments/
7. World Health Organization.
WHO bacterial priority patho-
gens list, 2024: bacterial patho-
gens of public health importance
to guide research, development
and strategies to prevent and
control antimicrobial resistance.
Geneva: WHO; 2024. Available
from: https://www.who.int/pub-
lications/i/item/9789240093461
8. World Health Organization.
2023 antibacterial agents in clin-
ical and preclinical development:
an overview and analysis. Gene-
va. WHO; 2024. Available from:
https://iris.who.int/bitstream/
handle/10665/376944/978924
0094000-eng.pdf
9. Gigante V, Alm RA, Melchi-
orri D, Rocke T, Arias CA,
Czaplewski L, et al. Multi-year
analysis of the global preclinical
antibacterial pipeline: trends and
gaps. Antimicrob Agents Chem-
other. 2024; 68(8):e0053524.
10. World Health Organization,
Food and Agriculture Organ-
ization of the United Nations,
United Nations Environment
Programme, World Organi-
sation for Animal Health. A
One Health priority research
agenda for antimicrobial resist-
ance. Geneva: WHO; 2023.
Available from: https://www.
who.int/publications/i/item/
9789240075924
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Report on the Roundtable Discussion on Antimicrobial Resistance
13
Authors
Kristy Marr, MIPH
Scientific Programme Officer,
Global AMR R&D Hub
Berlin, Germany
kristy.marr@dzif.de
Julia Tainijoki, MD
Medical and Advocacy Advisor,
World Medical Association
julia.seyer@wma.net
Caline Mattar, MD
World Medical Association
caline.mattar@wma.net
Lesley Ogilvie, PhD
Director of Secretariat,
Global AMR R&D Hub
Berlin, Germany
lesley.ogilvie@dzif.de
Ashrit Challa
Intern, World Medical Association
ashrit009@gmail.com
BACK TO CONTENTS
Report on the Roundtable Discussion on Antimicrobial Resistance
14
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Reflections on the Value of the UN High-Level Meeting on Pandemic,
Prevention, Preparedness, and Response One Year Later
In September 2023, Member States
gathered at the United Nations (UN)
High-Level Meeting on Pandemic
Prevention Preparedness and
Response (PPR) in New York,against
the backdrop of the UN General
Assembly [1]. The meeting was
supposed to provide leadership at the
‘highest level’ to reset the system for
PPR in the wake of the coronavirus
disease 2019 (COVID-19) pandemic
and was called for by the Independent
Panel for Pandemic Preparedness and
Response (IPPPR) and other parties
[2]. Hence, it is worth reflecting on
the impact of High-Level Meeting,
as negotiations continue in Geneva
to try and develop a pandemic
agreement or convention following
the extension of the International
Negotiation Bureau (INB) (https://
inb.who.int) at the World Health
Assembly (WHA) in May 2024 and
ahead of the UN General Assembly
in September 2024.
In September 2023, members of
the World Medical Association
(WMA)’s Junior Doctors Network
(JDN) collectively analysed all 114
statements delivered at the UN High-
Level Meeting on PPR to understand
Member State’s stated priorities on
PPR and the level of prioritisation
within governments. JDN members
subsequently agreed with the post-
meeting consensus from academics
and civil society, which concluded
that this event was particularly
underwhelming, in terms of keeping
pandemic threats on the agenda of
heads of government, delivering new
policy commitments, and creating
new accountability mechanisms [3].
The only tangible outcome of the
political declaration was a future
UN Secretary General’s report and
a subsequent meeting to take place
in 2026 [4]. Two questions remain:
What was the added value of having
health negotiations in New York? To
improve PPPR at the global level,
would it have been better to invest
efforts into ‘real action’ happening in
Geneva-based processes or following
discussions at the G7 or G20?
Participants
For a meeting labelled as ‘High-
Level,’ the meeting surprisingly
lacked the expected stature, especially
when compared to representation at
previous High-Level Meetings. Only
13 Heads of State and 16 Ministers
of Foreign Affairs participated
in this meeting. Over half of the
representation were Ministers of
Health, which somewhat diminishes
the purpose of a High-Level
Meeting outside of the World Health
Organization (WHO). Notably,
except for the President of the
European Union Council,none of the
Heads of State present represented
G7, G20 or BRICS countries [5].
This potentially signifies that health
is considered lower on the priority
list of country leaders than during
the COVID-19 pandemic. Notably,
Reflections on the Value of the UN High-Level Meeting on
Pandemic, Prevention, Preparedness, and Response One Year Later
Mike Kalmus Eliasz
Marie-Claire Wangari
Yassen Tcholakov
Wenzhen ( Jen) Zuo
Maria Inês Francisco Viva
15
BACK TO CONTENTS
leaders from four (France, the United
Kingdom, Russia, and China) of
the five permanent members of the
UN Security Council chose not
to participate in the UN General
Assemblyatall[6].Thegenderbalance
of representation also remained a
cause of significant disappointment,
whilst better than most WHAs: only
one-third of representatives were
women, despite the overwhelming
evidence of the gendered impact of
the recent pandemic [7].
Meeting Discussions
The High-Level Meeting was notable
more for what was unsaid than said.
Specific calls to action were scarce,
with only a handful of countries
(United Kingdom, Australia,
Germany, Uganda, Sweden, Angola,
Spain) making new commitments,
often without clear financial pledges
or reiterating previous promises
from forums like the G7 or G20
[8]. Countries from the Global
South vocalised their discontent over
vaccine access during the COVID-19
pandemic, highlighting the need
for stronger local manufacturing
capabilities.
With simultaneous High-Level
Meetings on Tuberculosis and
Universal Health Coverage taking
place on the same day, there was
very limited integration with PPR
with very few statements cross
referencing the other meetings.
There were nods by many Member
States to incorporate a One Health
approach, and some did allude
to interlinkages between climate
change, but references to upstream
prevention were mostly missing from
the discussion. Some Caribbean
nations also reiterated reforms from
previous debates, including a halt on
debt repayments during pandemics.
Over half of the speakers supported
amendments to the International
Health Regulations (IHR) and
progress for the INB, yet they did
not articulate specific expectations for
the negotiations in Geneva. During
such negotiations, there was little
to no mention of the High-Level
Meeting, and it would be hard to link
the updated IHR adopted in May
2024 to this process. Unfortunately,
most statements focused on what
national governments had done
during the recent pandemic, rather
than looking forward to the future.
This was highlighted by the lack of
engagement with the Global Health
Threats Council as a proposed
concrete outcome of the meeting,
which was acknowledged by only
one Member State. The definitive
outcome was the decision to convene
another High-Level Meeting on
PPR in 2026 [4].
The Political Context
Holding a High-Level Meeting for
health and shifting health discussions
to New York seem less effective in
galvanising global health actions
than in previous years, leading to
broad, lowest common denominator,
non-specific political statements.
Negotiators in New York in private
will often cite a lack of competence
and technical expertise on health
topics, which is shown in the
meeting’s outcomes, especially noting
a handover of decision-making to
Geneva. The lack of relevance is
also exemplified by how German
delegates articulated their redlines on
intellectual property in discussions
around the Pandemic Accord much
more clearly at the World Health
Summit in Berlin in October 2023
than in New York in September 2023
[9].
On 18 September 2023, two days
prior to the High-Level Meeting
on PPR, the President of the UN
General Assembly received a letter
from seven countries (Belarus,
Bolivia, Cuba, Eritrea, North Korea,
Russia, Syria, Venezuela, Zimbabwe)
opposing any attempt to formally
adopt any draft outcome documents
of four of the UN High-Level
Meetings taking place in New York.
This response prioritised meetings as
an opportunity to push back against
what they described as universal
coercive measures (sanctions).
Although the declaration was
ultimately adopted by consensus
in September 2023, widespread
dissatisfaction remained. The
frustrations included attaching
reservations ranging from opposition
to the inclusion of gender and
intellectual property, matters to
unilateral coercive measures, and
process issues such as countries
expressing that the voice of the Global
South was ignored [10].
The meeting occurred against a
backdrop of strained multilateralism
and multiple competing crises such as
inflation, conflict and climate change,
for which global consensus remained
elusive and exhausted needed political
bandwidth. Concomitantly with
the High-Level Meeting on PPPR,
important meetings of the UN
Security Council on Ukraine and
a Climate Ambition Summit were
also held with greater engagement by
senior government leaders, reflective
of the pandemic fatigue and how the
world has moved on [11].
These events underscore the current
complexities of international
cooperation, particularly in health
policy, and prompt critical questions
about the future of multilateralism
and the pursuit of global health goals
in a fracturing world and distrust
between the Global North and South.
The adoption of the updated IHR in
Geneva in May 2024, demonstrated
that agreement can be achieved on
contentious issues [12]. It remains to
Reflections on the Value of the UN High-Level Meeting on Pandemic,
Prevention, Preparedness, and Response One Year Later
16
BACK TO CONTENTS
be seen whether the INB can reach
a Pandemic Agreement finalised and
overcome key issues on issues such as
intellectual property, benefit sharing,
and financing.
The Value of High-Level Meetings
for Health
High-Level Meetings for health
have historically had widely
variable impacts, with the session
on HIV/AIDS in 2001 standing
out, contributing to a significant
surge in financial commitments
and subsequent reductions in HIV-
related mortality rates. However,
subsequent High-Level Meetings
– Non-Communicable Diseases in
2011, Antimicrobial Resistance in
2018, Universal Health Coverage
in 2019, and Tuberculosis in 2023
– have resulted in comparatively
limited financial pledges, primarily
raising the policy profile of these
issues within the government and
driving changes for interagency work
within the UN [13]. This puts the
effectiveness of High-Level Meetings
for health issues into question, as
decision-making increasingly shifts
to smaller groups like the G7, G20,
and BRICS. The preference of
many leaders to attend the G20 over
the UN General Assembly points
towards a focus on smaller forums,
as developing a consensus may be
easier and quicker. Since the G7
and BRICS are comprised of
countries with the largest economic,
technological, and manufacturing
capacities, there may be more
ideological alignment in such
forums, albeit lacking the universal
legitimacy of UN global processes
[14,15].
Despite the focus on smaller forums
and increasing polarisation, universal
actions are still essential to global
health. It is crucial to remember
the historical successes achieved
even during tense periods (such as
the Cold War), including smallpox
eradication and the adoption of key
UN conventions including the 1979
Convention on the Elimination of
All Forms of Discrimination Against
Women and the 1989 Convention on
the Rights of the Child at the UN
and last year the UN adopted a
landmark,‘High Seas Treaty’[16-18].
For academics, activists, and
policymakers alike, working to
ensure the next opportunities to drive
progress on health issues at the UN
should still be embraced as possible
avenues to galvanise action. We
agree with the authors of this recent
analysis on Non-Communicable
Diseases High-Level Meetings:
“HLMs play an important role in
galvanising high-level engagement from
national leaders and serve as a vehicle for
high-level advocacy…To make the most
of these meetings, other sectors need to be
activated, and health advocates should
focus on the supporting elements that link
international declarations to funding
decisions and the implementation of
policies and programmes that make a
difference to people and families around
the world” [19].
In summary,the High-Level Meeting
on PPR in 2024 did not contribute to
a world better prepared to respond
to pandemic threats. It failed due to
an unfavourable political backdrop;
a preference by negotiators and the
WHO for pandemic discussions
to remain primarily on the domain
of Geneva and a visible absence of
political leadership and attention. In
2024, the Antimicrobial Resistance
High-Level Meeting and the UN
Summit for the Future provide
interesting opportunities to galvanise
policy commitments on key health
issues, if the lessons of this High-
Level Meeting are heeded.
References
1. United Nations. Adopting
landmark declaration, General
Assembly calls for strengthening
high-level international
coordinationtoimprovepandemic
prevention, preparedness,
response [Internet]. 2023 [cited
2024 Aug 15]. Available from:
https://press.un.org/en/2023/
ga12533.doc.htm
2. The Independent Panel for
Pandemic Preparedness and
Response. COVID-19: make
it the last pandemic [Internet].
2021 [cited 2024 Aug 15].
Available from: https://
theindependent panel.org/
wp-content/uploads/2021/05/
COVID-19-Make-it-the-Last-
Pandemic_final.pdf
3. Pandemic Action Network.
Pandemic Action Network
statement on the UN high-
level meeting on pandemic
prevention, preparedness, and
response political declaration
[Internet]. 2023 [cited 2024 Aug
15].Available from: https://www.
pandemicactionnetwork.org/
news/pandemic-action-network-
statement-on-the-un-high-
level-meeting-on-pandemic-
prevention-preparedness-and-
response-political-declaration/
4. United Nations. Political
declaration of the United
Nations General Assembly
high-level meeting on pandemic
prevention, preparedness and
response [Internet]. 2023 [cited
2024 Mar 10]. Available from:
https://digitallibrary.un.org/
record/4022577?v=pdf
5. United Nations. UN high-
level meeting on pandemic
preparedness and response (20
September 2023): espeaker list
Reflections on the Value of the UN High-Level Meeting on Pandemic,
Prevention, Preparedness, and Response One Year Later
17
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[Internet]. 2023 [cited 2024
Aug 15]. Available from: https://
espeakers.unmeetings.org/64c91
3355249900f9c253c9801082023
6. Fillion S. UN General Assembly:
snubs and fragmentation
[Internet]. The Lowy Institute.
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www.lowyinstitute.org/the-
interpreter/un-general-assembly-
snubs-fragmentation
7. van Daalen KR, Chowdhury M,
Dada S, Khorsand P, El-Gamal
S, Kaidarova G, et al. Does
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9. Anderson S. No pandemic accord
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healthpolicy-watch.news/no-
pandemic-accord-without-
intellectual-property-protection-
says-german-health-minister
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response to global health
challenges, adopting declarations
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universal coverage, fighting
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11. Baczynska G, Pamuk H. Notable
remarks on Ukraine at UN
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council-2023-09-20/
12. World Health Organization.
World Health Assembly
agreement reached on wide-
ranging, decisive package of
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International Health Regulations
[Internet]. 2024 [cited 2024
Aug 15]. Available from:
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item/01-06-2024-world-health-
assembly-agreement-reached-on-
wide-ranging–decisive-package-
of-amendments-to-improve-the-
international-health-regulations-
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negotiations-on-a-proposed-
pandemic-agreement
13. Rodi P, Obermeyer W, Pablos-
Mendez A, Gori A, Raviglione
MC. Political rationale, aims,
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14. Patrick S, Klein E. United
Nations, divided [Internet].
Carnegie Endowment for
International Peace. 2023 [cited
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org/2023/09/28/united-nations-
divided-world-pub-90659
15. Tareen A. The UN and the
G20: efficiency vs. legitimacy?
[Internet]. Centre for
International Governance
Innovation. 2023 [cited 2024
Aug 15]. Available from: https://
www.cigionline.org/articles/un-
and-g20-efficiency-vs-legitimacy
16. United Nations. Convention
on the elimination of all forms
of discrimination against
women [Internet]. 1979 [cited
2024 Aug 15]. Available from:
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record/10649?v=pdf
17. United Nations International
Children’s Emergency Fund.
Convention on the rights of
the child [Internet]. 1989
[cited 2024 Aug 15]. Available
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child-rights-convention
18. United Nations. Beyond borders:
whynew’highseas’treatyiscritical
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[cited 2024 Aug 15]. Available
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19. Akselrod S, Collins TE, Berlina
D, Collins A, Allen LN. The
impact of UN high-level
meetings on non-communicable
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implementation. BMJ Glob
Health. 2023;8(10):e012186.
Reflections on the Value of the UN High-Level Meeting on Pandemic,
Prevention, Preparedness, and Response One Year Later
18
Reflections on the Value of the UN High-Level Meeting on Pandemic,
Prevention, Preparedness, and Response One Year Later
BACK TO CONTENTS
Authors
Mike Kalmus Eliasz, MBBS,
MSc, MRCPCH, DTM&H
Honorary Clinical Fellow
The Pandemic Institute,
University of Liverpool
Liverpool, United Kingdom
mkeliasz@liverpool.ac.uk
Yassen Tcholakov, MD, MScPH, MIH
Assistant Professor, Department
of Global and Public Health,
McGill University
Montreal, Canada
yassen.tcholakov@mcgill.ca
Maria Inês Francisco Viva, MD
NOVA Medical School
Lisbon, Portugal
inem.viva@gmail.com
Marie-Claire Wangari, MBChB
Graduate student in Global Health,
Liverpool School of Tropical Medicine,
Liverpool, United Kingdom
Independent Global Health Consultant
WMA-JDN Chair (2023/2024)
Nairobi, Kenya
mcwangari.wm@gmail.com
Wenzhen (Jen) Zuo,
MD, CCFP, MPH
Resident, Public Health and
Preventive Medicine,
University of British Columbia
British Columbia, Canada
wenzhen.zuo@gmail.com
19
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Junior Doctors Network’s Leadership at the World Health Summit 2023
The World Health Summit (WHS)
2023, held from October 15-17,
2023, in Berlin, Germany (https://
www.worldhealthsummit.org/),
stands as one of the most significant
conferences dedicated to global
health. This prestigious event gathers
a diverse array of stakeholders,
including representatives from the
scientific, political, private, and
public sectors, to address pressing
global health challenges. Unlike the
World Health Assembly (WHA)
and the World Health Organization
(WHO) meetings, which have more
rigid formats, the WHS offers a
unique program structure. It features
parallel sessions that not only
encourage in-depth scientific
discourse, but also provide
ample networking opportunities
and foster collaboration across
different sectors and
disciplines. This distinctive format
allows participants to engage with
a broader spectrum of ideas and
initiatives, making the WHS a crucial
platform for shaping the future of
global health.
Under the theme, “A Defining Year
for Global Health Action,” the
WHS 2023 program delved into
eight critical topics that align closely
with the mandates and priorities
of the World Medical Association
(WMA) and the Junior Doctors’
Network (JDN). These agenda
topics included: 1) learning lessons
from the coronavirus disease 2019
(COVID-19) pandemic for future
prevention efforts; 2) preparedness
and response to address global crises;
3) emphasis on universal health
coverage (UHC); 4) sustainable
health for people and the planet; 5)
G7/G20 measures to strengthen
global health equity and security; 6)
digital technologies for global health;
7) WHO’s 75th anniversary; and
8) innovations to combat tuberculosis
[1]. Attendees were able to reflect on
the WHO’s achievements over the
past 75 years, while they recognised
that universal health coverage serves
as the cornerstone to global health
equity and novel technology can help
expand access to care and ultimately
improve health outcomes. Notably,
the launch of the global financing
facility pledging event was a crucial
moment for securing financial
commitments to support global
health initiatives.
The WHS 2023 YouTube channel
( ht t p s: // w w w.y o ut u b e . c o m /
WorldHealthSummit) captured key
discussions during the conference
sessions, offering further insight
into the decisions that will shape
the global health landscape in the
coming years. The JDN delegation
gained insight on these pressing
health topics and contributed to the
dialogue, particularly in areas where
junior doctors can lead and drive
local and global change. Their active
participation highlighted the crucial
role young professionals play in
Junior Doctors Network’s Leadership
at the World Health Summit 2023
Jeazul Ponce Hernández
Marie-Claire Wangari
Francisco Franco Pêgo
Balkiss Abdelmoula
Flora Wendel
20
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developing innovative solutions for
the future of healthcare. By learning
updates on scientific and policy
initiatives to address the current
challenges in global health topics,
junior doctors can identify ongoing
projects, align their professional
interests, and join leadership
teams across their countries. This
engagement can empower them to
make meaningful contributions to
the evolving landscape of global
health, ensuring that their voices are
integral to shaping the future.
JDN Participation
During the WHA in May 2023, the
WHS organisers contacted the JDN
leadership, as they had proposed an
agenda that would highlight youth
engagement at the WHS in October
2023. The WMA Secretariat agreed
with these plans, and the JDN
secured five placements to attend the
WHS for the first time. Although it
was challenging to attend the WHS
immediately following the JDN
Management Team term transition,
an open call among the JDN
Management Team and Working
Groups Chairs resulted in a prompt
assembly of three participants –
Dr. Francisco Franco Pêgo (Portugal),
Dr. Jeazul Ponce Hernández (Spain),
and Dr. Flora Wendel (Germany).
At the event, the JDN delegation
networked with several health
organisations to identify synergies
and foster connections for future
collaborations. They attended various
scientific sessions on WMA primary
topics and prioritised sessions that
explored strategies for increasing the
capacity of healthcare professionals
globally, addressing workforce
shortages, and ensuring that junior
doctors are actively involved in
policy-making and leadership roles.
Highlights on Health Workforce
and Youth Engagement
This article will describe high-level
highlights on four WHS sessions,
including early career engagement,
future of global health, global health
research and policy, and UHC. It
will also underscore the critical role
of youth leadership and engagement
in shaping the future of global
health. These sessions provided a
platform for the JDN delegation to
actively contribute to discussions that
were directly aligned with the JDN
mission, where they could advocate
for and empower early-career
physicians on the global stage.
Youth Side Program: Hosted by
the German Medical Students’
Organization, the Youth Side
Program is quickly becoming a
central platform for empowering
early-career professionals through
targeted capacity-building, advocacy
training, and representation. During
the WHS, the program featured
an intensive two-day capacity-
building session complemented
by two networking events. These
activities provided essential updates
on expanding youth engagement in
both clinical and public health sectors
as well as equipping participants with
the skills and connections needed
to drive meaningful change in
their respective fields. Additionally,
delegates emphasised the importance
of professional networking
and fostered meaningful youth
participation within the WHS and
the wider global health community.
Post the High-Level Meetings: Youth’s
Vision for the Future of Global Health:
Organised by the International
Federation of Medical Students’
Associations (IFMSA) and the
International Pharmaceutical
Students’ Federation (IPSF), this
session was a cornerstone of the main
program, dedicated to amplifying
youth voices and ensuring their active
involvement in shaping global health
policies (https://www.youtube.com/
watch?v=EopfaijotXs). The session
specifically focused on sharing critical
perspectives and the vision of youth
Junior Doctors Network’s Leadership at the World Health Summit 2023
Photo 1. Dr. Jeazul Ponce Hernández, Dr. Francisco Franco Pêgo, and Dr. Flora Wendel (left to right) as the JDN delegation at the
World Health Summit in May 2023. Credit: JDN
21
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in accelerating progress towards
UHC and applying innovative
technologies for global health
security, which are central topics
toward achieving health equity.
Junior doctors and stakeholders met
to brainstorm on timely solutions
related to UHC and global health
security as well as identify crucial
action points following the High-
Level Meetings during the United
Nations General Assembly. The
session offered an opportunity for
delegates to reflect on the growing
recognition within the WHS
community that youth engagement
is essential for building sustainable
health solutions.
Research and Policy in Global Health
(GLOHRA):The GLOHRA alliance,
organised by the German Alliance for
Global Health Research, is funded
by the German Federal Ministries
for Education, Research, and
Economic Cooperation, dedicated to
strengthening global health research
in Germany. The session centred
on tackling the complex challenges
and opportunities in global health
research and policy, with a strong
emphasis on fostering South-South
collaborations among academics,
policymakers, and communities.
It convened a diverse range of
perspectives from researchers, public
health institutes, and policymakers,
addressing issues spanning from
infectious diseases to health systems
and implementation research. One
key focus was on the importance
of policy training for early career
professionals and the pivotal
role of national public health
institutions in turning research
into actionable policies. Delegates
emphasised successful country-
specific approaches and the
necessity of critical enablers such as
infrastructure and networks. They
also highlighted steps on how
government institutions can integrate
lessons learned from previous
programs as well as provide financial
support for research opportunities.
A Promise Forgotten? Putting Universal
Back into Health Coverage: The
political will to promote UHC
was widely debated, building
upon the conference discussions
on UHC-related topics and the
Political Declaration adopted
at the United Nations General
Assembly in September 2023.
Delegates made a call to join
Junior Doctors Network’s Leadership at the World Health Summit 2023
Photo 2. Group photo of the youth attendees at the World Health Summit in May 2023. Credit: World Health Summit
22
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international efforts that promote
primary health system development,
highlighting the importance of
health professionals working directly
with affected populations and
understanding community needs.
To further emphasise the urgency
of strengthening health systems
globally, delegates also stressed the
critical role of fostering community
trust and ensuring equitable access to
care, recognising that UHC cannot
be truly achieved without addressing
the unique challenges of vulnerable
populations. Additionally, there
was a strong appeal for sustained
global solidarity and cooperation
to guarantee that international
commitments translate into tangible
improvements in health outcomes for
all.
Conclusion
As emerging leaders in global
health, JDN members have a unique
opportunity to collaborate and
engage actively in future WHS
events, thereby amplifying the voice
of junior doctors on the global stage.
By developing a strategic advocacy
plan aligned with JDN priorities
and the WMA’s policy papers and
position statements, JDN members
can effectively articulate physicians’
perspectives and secure prominent
rolesasspeakersortrainersinscientific
forums. Additionally, identifying
and securing funding opportunities
is crucial to ensure the sustainable
participation of JDN members in
upcoming WHS events, which is
essential for advancing the agenda
of meaningful youth involvement in
global health. These efforts will not
only strengthen JDN’s presence at
these global health meetings, but will
also lay the groundwork for impactful
participation in WHS 2024.
Reference
1. World Health Summit. World
Health Summit 2023: “a defining
year for global health action”
[Internet]. 2023 [cited 2024 Aug
10].Available from: https://www.
worldhealthsummit.org/about/
history/2023.html
Authors
Jeazul Ponce Hernández,
MD, MPH, MSc
WMA/JDN Publications
Director (2023/2024)
PhD student in Public Health,
University Complutense of Madrid
Madrid, Spain
jeazulponce@gmail.com
Francisco Franco Pêgo, MD
WMA-JDN Socio-Medical
Affairs Officer (2023/2024)
General Training Resident, Central
Lisbon University Hospital Center
Lisboa, Portugal
ffpego@gmail.com
Flora Wendel, MD
WMA-JDN Working Group Chair on
Primary Health Care (2022/2023)
Resident, General Practice
and Family Medicine
Research Assistant, Chair of
Public Health and Health Services
Research, LMU Munich
Munich, Germany
florakuehne@gmail.com
Marie-Claire Wangari, MBChB
Graduate student in Global Health,
Liverpool School of Tropical Medicine,
Liverpool, United Kingdom
Independent Global Health Consultant
WMA-JDN Chair (2023/2024)
Nairobi, Kenya
mcwangari.wm@gmail.com
Balkiss Abdelmoula, MD, MPH
WMA-JDN Deputy
Chair (2023/2024)
Family Medicine Specialist and
Global Health Consultant
Sfax, Tunisia
abdelmoula.balkiss@gmail.com
Junior Doctors Network’s Leadership at the World Health Summit 2023
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Global health conferences and
meetings are crucial for knowledge
exchange and professional growth,
but recent reports suggest that
there is an underrepresentation of
stakeholders from low- and middle-
income countries (LMICs) due
to neo-colonial patterns in global
health [1]. Decolonizing global
health, a concept that has recently
gained traction, aims to remove all
forms of supremacy within global
health practice and create a future
with no more pervasive remnants
of colonisation [2,3]. In addition,
with more than half of the world’s
population being under 30 years of
age, increased youth representation
at global health conferences is
essential for the meaningful
engagement of young people to
accelerate progress toward the
Sustainable Development Goals as
well as contribute to timely policy
and health decision-making [4].
The following article explores junior
doctors’ perspectives on barriers and
solutions related to the equitable
access to global health opportunities.
Existing Barriers
As junior doctors seek additional
learning experiences at conferences,
in order to complement their medical
training, they can experience diverse
challenges before, during, and after
the conference. First, young people
are often unaware of engagement
opportunities with key stakeholders,
have inadequate support and
guidance from mentors and
senior staff, and observe limited
transparency and reporting from
international organisations [5]. In
fact, junior doctors may lack
continuous mentorship when they
first start on their global health
journey. Second, understanding the
pathways for attending meetings,
including navigating the registration
process, can be laborious due to
bureaucratic and non-transparent
procedures. Third, strict conference
agendas may hinder speaking
opportunities for young participants,
who are often assigned an observer
status and are limited to verbally
sharing their perspectives. Fourth,
most United Nations (UN)
member states and World Medical
Association (WMA) country
delegations do not include or invite
young people to form part of the
meeting delegations [6]. Finally,
junior doctors, who represent
different languages and cultures,
are constantly challenged when
engaging with stakeholders,
especially due to language and
structural barriers [7].
Furthermore, financial and
administrative barriers remain a
significant hurdle for junior doctors
to travel and contribute to global
health meetings. Indeed, junior
doctors’ access to global health
opportunities, including attending
the World Health Assembly (WHA)
sessions, is considerably impacted
by logistical complexities, namely
those associated with cross-border
and international travel. This is
especially relevant since many High-
Level Meetings take place in New
York City or Geneva, for which an
entry visa is needed for participants
from LMICs [8]. Visa procurement
can be a costly and time-consuming
endeavour, with no guarantee that
complete documentation will be
available in time for scheduled travel.
[9,10].
Applying a gender representation
lens, cultural, social, and institutional
variables may also influence the
unequal participation of male and
female delegates at WHA sessions
[11]. Between the 74-year span
from 1948 to 2021, although more
female delegates have attended
WHA sessions, more males (83%)
than females (30% at its peak
in 2017-2018) have represented
these delegations [11]. As women
represent more than 70% of the
Marie-Claire Wangari
Junior Doctors’ Perspectives on Barriers and Solutions
to Equitable Access to Global Health Opportunities
Deena Mariyam Lekha Rathod
Junior Doctors’ Perspectives on Barriers and Solutions to Equitable Access to Global Health Opportunities
24
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health workforce, working across
clinical and community settings, their
collective leadership role in global
health governance continues to be
significantly overlooked.
Recommendations
Junior doctors have faced financial
challenges, administrative
complexities such as visa procedures,
difficulties in taking time off
from clinical responsibilities, and
knowledge and language barrier gaps;
nevertheless, these lived experiences
have helped shape their commitment
to continuous learning and
professional development.The WMA
Junior Doctors Network (JDN)
Working Group on World Health
Organization (WHO) Activities
conducted an internal evaluation of
JDN members’ perspectives to better
understand the specific challenges
related to junior doctors’ attendance
at global health meetings. Between
September 2022 and February
2023, Working Group members
developed and shared a preliminary
questionnaire with JDN and WMA
members, reviewed the submitted
responses, and developed a consensus
on three potential recommendations
to address existing challenges.
Recommendation 1: Incorporating
and empowering youth representatives
in conference delegations and offering
financial and administrative support.
To increase youth representation
in global health conferences, global
health and youth organisations
should offer junior doctors partial or
complete funding to cover visa and
travel costs, especially for participants
living in LMICs or geographically
distant from the meeting location
[12]. WMA members can advocate
for the establishment of a fundraising
sub-committee to work with national
member associations and disseminate
timely funding opportunities, with
priority given to candidates from
LMICs. Also, the WHO and the
WMA may be able to offer fast-
track support for visa processing,
including providing visa letters
that confirm the selection of youth
representatives and the key role that
youth representatives play in ensuring
meaningful conference engagement.
Organising committees of scientific
conferences, together with global
organisations (including national
medical associations), should provide
ample time for attendees to navigate
the visa application process.
WMA and JDN leaders can promote
an open dialogue to better understand
explicit barriers that hinder junior
doctors’ participation in global
scientific events and subsequently
develop novel approaches to empower
their future contributions. For
example, essential networking
and professional development
opportunities can help guide junior
doctors in their training, including
establishing a mentorship or buddy
system that can match experienced
doctors with junior doctors. Also,
the promotion of equitable gender
representation should remain on
the forefront of global dialogue
and conference proceedings toward
ensuring equal participation in
plenary and scientific sessions,
interactive workshops, and other
networking opportunities.
Recommendation 2: Supporting
hybrid platforms and digitalisation of
conference materials
With technological advancements,
lessons learned during the coronavirus
disease 2019 (COVID-19) pandemic,
and the push for environmental
sustainability,the world has embraced
the digitalisation of conference
materials, hybrid conferences, and
live streaming. These adaptations
have helped committees of scientific
conferences use digitisation
technology (e.g. mobile applications,
interactive web applications) to
facilitate the engagement of global
audiences in major conferences.
Since these applications have
provided a platform to organise
conference agendas (instead
of printed booklets), hybridise
conference sessions, and network
with colleagues, junior doctors can
effectively plan their conference
agenda and travel logistics. As junior
doctors attend these hybrid meetings
and conferences, albeit lack of in-
person engagement and networking
opportunities, they can expand their
international networks without the
logistical conundrums of complicated
travel processes including visa
acquisition [9,10].
Mobile or web applications can
support the session hybridisation,
offering a space for junior doctors
to contribute online and in-person,
and hence increasing engagement
in sessions by asking questions and
sharing lived experiences. Taking
into consideration the benefits of
digital technologies, committees of
scientific conferences should ensure
that hybrid conferences are engaging
for all attendees. Furthermore,
junior doctors who represent their
national medical associations or other
organisations (like the WMA) can
request guidance from authorities on
specific expectations and deliverables,
as a result of their participation in
these external meetings.
Recommendation 3: Improving
communication and dissemination
of opportunities to junior doctors to
represent their lived experiences at
relevant conferences.
Communication efforts towards
potential conference attendees,
including junior doctors, should
be diverse and incorporate various
channels (e.g. emails, newsletters,
social media, website updates). Since
Junior Doctors’ Perspectives on Barriers and Solutions to Equitable Access to Global Health Opportunities
25
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official communications and activities
are conducted in diverse languages,
junior doctors can help promote
inclusivity and cultural exchange
and even pursue language training
as part of their continuing education
[13,14]. As junior doctors may
choose to participate in international
events, like the WHO Simulation
or pre-WHA workshops, they can
also register for keynote lectures,
roundtable discussions, skills-
based courses, communication and
diplomacy activities, and simulation
exercises.
Conclusion
Juniordoctorscalluponlocal,regional,
and global health organisations to
develop strategies that enhance their
access to global health opportunities
integral to their professional growth.
The current barriers, such as financial
constraints, extensive administrative
procedures, and lack of departmental
approval, hinder their participation
in international conferences, adding
to the anxiety and strain experienced
by these health professionals. As
observed at previous WMA and
WHA meetings and findings from
the JDN internal evaluation, JDN
members embody a strong desire
to contribute to solutions that
promote their inclusion in global
health meetings. To address these
challenges, it is essential to initiate
an open dialogue within
organisations (like WHO and
WMA) that focuses on providing
financial and administrative
support, digitising conference
registration processes, and enhancing
communication about available
global health opportunities. By
implementing these strategies, we
can move towards decolonizing
global health and ensure equitable
participation, thereby amplifying
the voices of junior doctors from all
backgrounds and fostering a more
inclusive global health community.
References
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Junior Doctors’ Perspectives on Barriers and Solutions to Equitable Access to Global Health Opportunities
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Acknowledgements:
The JDN-WMA Working Group
on WHO Activities (now retired)
collectively prepared this article as
one final project, with the guidance
of the Working Group Chair from
2021-2022. The Working Group
members include: Jamie Colloty,
Laura Jung, Laura Charlotte
Kalkman, Deena Mariyam, Caitlin
Pley, Pablo Daniel Estrella Porter,
Lekha Rathod, Mehr Muhammad
Adeel Riaz, Yassen Tcholakov,
Wunna Tun, Marie-Claire Wangari,
and Mercy Wanjala.
Authors
Marie-Claire Wangari, MBChB
Graduate student in Global Health,
Liverpool School of Tropical Medicine,
Liverpool, United Kingdom
Independent Global Health Consultant
WMA-JDN Chair (2023/2024)
Nairobi, Kenya
mcwangari.wm@gmail.com
Deena Mariyam, MBBS,
MSc Public Health
General Practitioner & WMA-
JDN Secretary (2023/2024)
Bangalore, India & Dubai,
United Arab Emirates
deenamariyam4@gmail.com
Lekha Rathod, MBBS, MIH
WMA-JDN Planetary Health Working
Group Co-Chair (2022/2024)
lrathod95@gmail.com
Junior Doctors’ Perspectives on Barriers and Solutions to Equitable Access to Global Health Opportunities
27
After 40 years of war and political
unrest, the Afghan people are
suffering from incalculably adverse
medical complications that are
worsened by extreme weather
events (like drought), impacts of
conflict (resulting in internally
displaced populations), and attacks
on healthcare facilities (increasing
trauma cases). The country’s low life
expectancy of 63 years, coupled with
the high annual infant mortality rate
of 58 deaths per 1,000 live births,
are clear indications of severe public
health issues and a lack of adherence
to medical regulations [1,2].To make
matters worse, citizens must contend
with a healthcare system that lacks
treatment options and funding,
including limited assistance from
international health organisations.
Although it is recognised that
patients’ medical concerns can
be promptly addressed through
evidence-based medical practices
for diagnosis, treatment, and
prevention, there is limited universal
adherence to the healthcare system’s
regulations in Afghanistan’s health
facilities. Healthcare professionals
in Afghanistan have highlighted
that weak governance, lack of supply
chain management, and corruption
are giving rise to a thriving trade in
altered medications coming from
neighbouring countries and placing
millions of people at risk [3]. As
a result of this weak governance
and corruption, illegal activities
frequently occur in Afghanistan,
including smuggling, importation,
and alteration of medications
for communicable and non-
communicable diseases.
Afghanistan’s National Health
Policy 2015-2020 was adopted
in 2015, highlighting five policy
areas: governance, institutional
development, public health, health
services, and human resources [4].
According to this policy, the National
Medicines and Health Regulatory
Authority was strengthened and
updated to help mitigate nationwide
public health risks [5]. With the
governmental transition in 2021, this
national policy has not been updated
to reflect pressing health issues.
The lack of evidence-based
regulations existed even before the
most recent government came to
power; however, the isolation of
the new government makes any
external involvement impossible.
Poor regulatory oversight has enabled
illegal imports, impacting the
quality of medication in
Afghanistan. In a global self-
benchmarking assessment, which
was established to rate national
healthcare systems on a scale of 1
(lowest) to 5 (highest), the World
Health Organization (WHO)
concluded that Afghanistan scored
2 for pharmacovigilance and 1 in
quality control, inspection, and
clinical trials in 2017 [5]. The scores
from the benchmarking assessment
are still extremely low running the
national healthcare system.
In addition to poor regulatory
authority, Afghanistan’s Anti-
Corruption Monitoring and
Evaluation Committee noted that
the trade in illegal imports
thrives because of corruption,
border issues, quality assessments,
and poor governance [3]. The
committee found that at least
half of the country’s pharmaceutical
import market comprises illegally
imported products. Although this
illicit importation and smuggling
could be reduced if rules and
regulations were followed, the
financial incentives have led to
increased production, importation,
and distribution of low-quality
pharmaceuticals throughout the
country. With an estimated 450
foreign pharmaceutical suppliers,
of which 250-300 suppliers are
in Pakistan, medications that are
prohibited from being sold in
Pakistan are frequently shipped to
Afghanistan [3]. Prescription drugs
(e.g. benzodiazepines, opioids)
and heroin were the most reported
drug types used among the Afghan
population [6]. Although the
healthcare system is unprepared
to address drug dependence and
addiction, developing solutions to
manage altered medications and
substance use will help reduce public
accessibility.
As high-quality, safe, and effective
medications are a pillar of the
healthcare system, compromised
medications can lead to a major
collapse of its infrastructure. It can be
challenging, however, to distinguish
between legitimate and fraudulent
pharmaceuticals, especially since
labels and directions may not be in
Dari (official language of
Afghanistan). In addition,
incompliance to regulations and
guidelines can further complicate
the scenario and lead to major public
health adversities. This dilemma
Tabasom Fayaz
Pharmaceutical Policy in Afghanistan
Pharmaceutical Policy in Afghanistan
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28
calls upon physicians and leading
health organisations worldwide to
help create a system that connects
healthcare professionals to patients
to ensure that correct medications
are prescribed. Additional pressure
on Afghan health leaders can help
prioritise the purchase of medications
imported from countries in the
Eastern Mediterranean and
European regions, which can
reduce illegal importations. Robust
efforts to strengthen the healthcare
systems of low-income countries
(like Afghanistan) can lead to the
prioritisation and adherence to
evidence-based clinical practices and
regulations, and most importantly,
improve patient health outcomes.
References
1. World Bank. Country:
Afghanistan [Internet]. 2024
[cited 2024 Aug 15]. Available
from:https://data.worldbank.org/
country/afghanistan
2. United Nations International
Children’s Emergency Fund.
Country profile: Afghanistan
[Internet]. 2024 [cited 2024 Aug
15]. Available from: https://data.
unicef.org/country/afg/
3. Independent Joint Anti-
Corruption Monitoring and
Evaluation Committee. VCA
report on pharmaceuticals
importation process [Internet].
2014 [cited 2024 Aug 16].
Available from: https://www.baag.
org.uk/sites/default/files/resources/
attachments/2014 _11_19_
Pharmaceutical_VCAENGLISH.
pdf
4. World Health Organization.
Afghanistan national health
policy, 2015-2020 [Internet].
2015 [cited 2024 Aug 27].
Available from: https://extranet.
who.int/countryplanningcycles/
planning-cycle-files/afgha­nistan-
national-health-poli­cy-2015-2020
5. World Health Organization.
WHO Afghanistan country
office 2019 [Internet]. 2018
[cited 2024 Aug 16]. Available
from: https://www.emro.who.
int/images/stories/afghanistan/
who_at_a_glance_2019_feb.pdf
6. Hall WD, Degenhardt L.
Afghanistan has a sizeable
problem with opioid use. Lancet.
2014;2(1):e577-8.
Tabasom Fayaz, BSc, MSc
Northeastern University
Boston, Massachusetts, United States
fayaz.t@northeastern.edu
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29
The Coalition of African National
Member Association (CANMA)
came into inception in 2018, with
the sole vision of uniting African
National Member Associations
(NMAs) to have one common
voice in the advocacy and policy
arena. Currently, the coalition is
composed of 20 member countries
including Kenya (interim chair),
Cote d’Ivoire, Democratic Republic
of Congo, Ethiopia, Gambia,
Ghana, Lesotho, Malawi, Mali,
Mozambique, Namibia, Nigeria,
Rwanda, Senegal, Somalia, South
Africa, Tanzania, Uganda, Zambia,
and Zimbabwe.
The Landscape of Health
Leadership in Africa
Currently, the main issue plaguing
African NMAs is the rise of
physician migration out of the
continent. From Nigeria’s mass
migration of citizens including health
personnel termed “Japa” to Kenya’s
bilateral health professional exchange
with Cuba and the United Kingdom,
many nations have their physician-
patient ratios plummeting due to
volatile working conditions in their
countries [1-3]. Physician migration
in Africa is largely driven by the
pursuit of better working conditions,
higher salaries, and advanced training
opportunities abroad, which are often
limited in their home countries.
Additionally, political instability,
inadequate healthcare infrastructure,
and limited career advancement
prospects further contribute to
this exodus (“brain drain”), which
exacerbates healthcare challenges in
already resource-strapped regions.
Despite the high number of emigrant
physicians from the continent,
efforts have been made to train more
physicians in the continent’s medical
schools. In East Africa, universities
have allowed cross-border training
of undergraduate health professional
students in Burundi, Ethiopia,
Rwanda, Somalia, South Sudan,
Tanzania, and Uganda [4]. Although
this initiative is a start, more adaptive
leadership and governance systems
nationally and regionally are needed
to bridge the low physician-patient
ratio in the Africa region.
The Physician’s Journey to
Leadership
Traditional medical students take an
average of six years of undergraduate
training, where the first two years
focus on pre-clinical sciences (e.g.
human anatomy, medical physiology,
biochemistry), followed by four
years of clinical training in various
clinical departments. After these six
years of medical school, graduates
proceed to complete a one- to two-
year licensing internship year, as
required by their country’s Ministry
of Health. After the internship is
completed, physicians can practice
as General Practitioners or proceed
to a post-graduate specialisation that
lasts between one to seven years,
depending on the specialty
requirements and modality of training
[5]. In Kenya, medical students
undergo six years of undergraduate
training, followed by a mandatory
one-year licensing internship under
the Ministry of Health, and then they
either select to pursue general practice
or postgraduate training [6,7].
African physicians often seek
valuable professional development
and networking opportunities for
knowledge exchange on best practices
in health systems strengthening.
Specifically, they have the
opportunity to join and contribute
as associate members to the various
organisations, such as the CANMA
at the regional level, Commonwealth
Medical Association (CMA) at
the sub-regional level, and World
Medical Association (WMA) at the
global level. Despite opportunities
to join regional and global medical
associations, few African physicians
have held senior leadership positions
in these organisations since their
inception. Reflecting upon the
historical timeline, the WMA and
the Junior Doctors Network (JDN)
have had less than 10 African
physicians serve in senior WMA
or JDN management leadership
positions since 1947 and 2010,
respectively. Given the rise in
physician numbers from the African
continent, specialist associations
should provide more sensitisation
on the importance of regional
representation in global health
leadership.
Future Directions in African Health
Leadership
Looking to the future, empowering
the next generation of African
healthcare leaders is essential to
address the continent’s unique
challenges. By fostering innovative
approaches and inclusive leadership,
African health systems can be
strengthened to improve access
Marie-Claire Wangari
African Health Leadership: A Physician’s Perspective
African Health Leadership: A Physician’s Perspective
BACK TO CONTENTS
30
and equity. As the global landscape
evolves, African leaders can drive
sustainable health solutions that meet
the needs of their communities. The
African region, given the potential
for cross-cultural collaborations
through various health associations
and coalitions, has a bright future of
producing future global health leaders
through two specific actions.
Identifying emerging trends and
promoting cross-border collaborations:
The African continent serves as
the cradle of primary healthcare,
and with the rise of telemedicine,
the region has a chance to pave the
wave to new frontiers of medicine in
implementation science and primary
healthcare services. In conjunction
with the national Ministries of
Health’s efforts, this is further
amplified by the efforts of regional
health bodies, such as the Africa
Centre for Diseases and Control
(Africa CDC)’s New Public Health
Order for Africa and the World
Health Organization Regional
Office for Africa (WHO AFRO)’s
multisectoral strategy to promote
health and well-being [8,9]. These
positive strides can help propel efforts
to expedite the attainment of universal
health coverage for African nations.
Furthermore, by addressing complex
national and regional challenges,
African countries are pursuing
stronger regional integration to reap
the benefits of larger markets [10].
Through collaborative efforts, leaders
can tackle issues such as infectious
disease outbreaks, inadequate
healthcare infrastructure, and health
disparities more effectively and
efficiently.
Supporting key mentorship opportunities
for professional development: Direct
mentorship and coaching in the
health professions are pivotal
towards supporting education
and training and strengthening
healthcare systems [11]. Mentoring
specifically involves the informal
conveyance of knowledge, social
capital, and support, that recipients
perceive to be pertinent to their work,
career, and personal or professional
development. During their formative
academic training, health professional
students can benefit from mentorship
programs, which provide guidance,
career development, and emotional
support. Notably, it can ensure that
new professionals are well-prepared
to meet the complex challenges of
modern healthcare systems. Despite
these observed benefits of mentorship
programs, however, many institutions
in Sub-Saharan Africa have not fully
embraced the inclusion into their
programs [12]. By fostering a culture
of mentorship, experienced leaders
can share their knowledge,
experiences, and insights across
generations, which helps build a
resilient and capable future workforce.
Conclusion
The article underscores that
adaptive leadership, cross-border
collaborations,and robust mentorship
programs, can effectively address
challenges and foster the next
generation of healthcare leaders.
Concerted efforts are needed to
increase African representation in
global health leadership and harness
innovative approaches that can
strengthen health systems across the
continent. By bridging generational
gaps and promoting knowledge
transfer, mentorship programs
can support a resilient healthcare
workforce that can drive sustainable
improvements in global health
systems. Moreover, promoting cross-
border collaborations is essential to
leverage expertise to improve the
quality of healthcare at the national
and regional level. Now is the time
for African healthcare leaders to
unite, collaborate, and mentor,
ensuring a brighter future for health
to over 1.5 billion persons living on
the continent.
References
1. Okunade SK, Awosusi OE. The
Japa syndrome and the migration
of Nigerians to the United King-
dom: an empirical analysis. Com-
parative Migration Studies.
2023;11(27).
2. Nyambura MW. Kenya ends
doctors-swap deal with Cuba
[Internet]. 2023 [cited 2024 Jul
6]. Available from: https://na-
tion.africa/kenya/news/kenya-
ends-doctors-swap-deal-with-
cuba–4398520
3. Ministry of Labour and Social
Protection, Government of
Kenya. Speech during the
first joint meeting between all
agencies involved in the
implementation of the Bilateral
Agreement between Kenya
and the United Kingdom for
collaboration on health care
workforce [Internet]. 2021
[cited 2024 Jul 6]. Available
from: https://www.labour.go.ke/
sites/default/files/2022-10/CS-
Speech-during-first-joint-meet-
ing-on-UK-BLA-18th-au-
gust-2021.pdf
4. Nyaga B.EAC nationals qualified
to work as doctors in Kenya
[Internet]. KBC TV. 2017
[cited 2024 Jul 6] Availa-
ble from: https://kbctv.co.ke/
blog/2017/03/19/eac-national-
doctors-qualified-to-work-in-
kenya
5. Odongo CO, Talbert-Slagle K.
Training the next generation
of Africa’s doctors: why medi-
cal schools should embrace the
team-based learning pedagogy.
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African Health Leadership: A Physician’s Perspective
31
BMC Med Educ. 2019;19:403.
6. Kenya Medical Practitioners
and Dentists Council. Bachelor
of Medicine and Bachelor of
Surgery core curriculum
[Internet]. n.d. [cited 2024 Sep
1] Available from: https://kmp-
dc.go.ke/resources/mbchb.pdf
7. Kenya Medical Practitioners
and Dentists Council. National
guidelines for internship training
of medical and dental officer in-
terns [Internet]. 2019 [cited
2024 Sep 1] Available from:
https://kmpdc.go.ke/resourc-
es/NATIONAL%20GUIDE-
LINES%20FOR%20INTERN-
SHIP%20TRAINING%20
O F % 2 0 M E D I C A L % 2 0
AND%20DENTAL%20OF-
FICER%20INTERNS.pdf
8. Africa Centres for Diseases and
Control and Prevention. Call
to action: Africa’s New Pub-
lic Health Order [Internet].
2022 [cited 2024 Jul 31]
Available from: https://af-
ricacdc.org/wp-content/up-
loads/2022/09/Call-to-Action-
NPHO-Final-CTA-20-Sep-
Edited.pdf
9. World Health Organization
Regional Committee for Africa.
Regional multisectoral strategy to
promote health and well-being,
2023–2030 in the WHO African
Region: report of the Secretariat
[Internet]. 2023 [cited 2024 Aug
14]. Available from: https://iris.
who.int/handle/10665/372393
10. World Bank.Regional integration
removes barriers to development
in Africa [Internet]. 2023 [cited
2024 Aug 18]. Available from:
https://www.worldbank.org/
en/results/2023/12/08/region-
al-integration-removes-barri-
ers-to-development-in-africa
11. Manzi A, Hirschhorn LR,
Sherr K, Chirwa C, Baynes C,
Awoonor-Williams JK, et al.
Mentorship and coaching to
support strengthening health-
care systems: lessons learned
across the five Population Health
Implementation and Train-
ing partnership projects in sub-
Saharan Africa. BMC Health
Serv Res. 2017;17(Suppl 3):831.
12. Tamale E, Atuhairwe I,
Ssemwogerere A. Muhimbura B,
Atimango L, Malinga PD, et
al. Knowledge, attitudes, and
practices of health professions
students on mentorship: a
cross-sectional study at a sub-
Saharan African medical school.
Discov Educ. 2023;3:27.
Marie-Claire Wangari, MBChB
Graduate student in Global Health,
Liverpool School of Tropical Medicine,
Liverpool, United Kingdom
Independent Global Health Consultant
WMA-JDN Chair (2023/2024)
Nairobi, Kenya
mcwangari.wm@gmail.com
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African Health Leadership: A Physician’s Perspective
32
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Dr. Simon Kigondu, Dr. John Baptist
Nkuranga, Dr. Mvuyisi Mzukwa, and
Dr. Herbert Luswata, the Presidents
of the national medical associations
(NMAs) of Kenya, Rwanda, South
Africa, and Uganda, respectively,
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
African 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.
Kenya: The Kenya Medical
Association (KMA) had the privilege
and honour to host the World
Medical Association (WMA)’s
223rd
Council Session, which
was held from 20-23 April 2023.
Following many months of planning
and preparation, the KMA welcomed
guests from all over the world to
the Ole Sereni Hotel, a scenic hotel
overlooking the Nairobi National
Park. WMA meetings were
successfully conducted, and WMA
members participated in the opening
dinner at the Kenyatta International
Conference Centre, one of Nairobi’s
iconic venues.They also had a fruitful
tour to the Nairobi National Park
that culminated in a dinner within
the park at the club house.
At the same time, the KMA has
experienceddiversechallengesoverthe
past few years, including widespread
inflation,lawsuits related to large loan
repayments, and financial challenges
directly connected to reduction of
pharma industry support. However,
there is hope for a good future of
medicine in Kenya. The number of
medical schools has grown from two
in 2000 to 13 in 2024, which has led
to an increase in the numbers of
trained doctors, specialists, and
subspecialists and hence improve
quality healthcare. One of the most
important pillars of a healthcare
system is adequate doctor-patient
ratios.
Rwanda: One memorable experience
was when the Rwanda Medical
Association (RMA) hosted the
successful 74th WMA General
Assembly, which brought together
leading medical professionals from
around the world and fostered
collaboration and knowledge
exchange among more than 50
national medical associations. It was
rewarding to showcase Rwanda’s
development and recovery progress
30 years after the genocide against
the Tutsi as well as RMA’s continued
contributions to the global medical
community. The experience left a
lasting impression on organisers,
and coupled with positive feedback
from participants, RMA members
gained confidence and built trust with
the Ministry of Health and other
participating government agencies.
When coronavirus disease 2019
(COVID-19) cases surged in Rwanda
in early 2022, RMA members aimed
to support the government response
Interview with National Medical Associations’
Leaders of the African Region
Interview with National Medical Associations’ Leaders of the African Region
Simon Kigondu Herbert Luswata Mvuyisi Mzukwa
John Baptist Nkuranga
33
BACK TO CONTENTS
measures through the “Operation
Save the Neighbour” initiative.
They integrated doctors into home-
based care teams, incorporated
data with patients’ and doctors’
geolocations, and aligned this
information with community health
professionals who could visit, assess,
and treat COVID-19 cases in their
neighbourhood. Within two weeks,
home-based visits had increased from
30% to 92%, with 82% of patients
having regular oxygen monitoring
from home, contributing to decreased
mortality rates. This approach
strengthened support and rapport
among doctors, community health
professionals, and patients, which
has increased overall confidence in
telemedicine consultations.
One significant challenge in Rwanda
is the retention of doctors within
the health workforce, primarily due
to poor remuneration, incentives,
and sometimes poor working
environments. As this “brain drain”
has increased demand for medical
professionals in the country, the
RMA is focusing on advocating for
better compensation and working
conditions for doctors, in efforts to
promote the retention of a sustainable
health workforce. RMA members
actively engage policymakers,
contribute to research initiatives that
examine the driving factors of health
workforce retention, and strengthen
RMA membership services including
establishing a career guidance
program and fostering a supportive
membership network.
South Africa: One recent memorable
experience that highlighted the
South African Medical Association
(SAMA)’s influence occurred during
the COVID-19 pandemic, namely
the rollout of the vaccination
programme. As the pandemic swept
across South Africa, the SAMA
played a crucial role in shaping the
national response, demonstrating its
leadership and advocacy capabilities
in a time of crisis. The SAMA’s
commitment to improving access to
life-saving medications showcased
its dedication to public health and
solidified its role as a key player in
South African healthcare.
One significant challenge, however,
was the health workforce shortage
that was exacerbated by the
emigration of medical professionals
seeking employment and academic
opportunities abroad. This “brain
drain” left the public health sector
understaffed and overburdened,
affecting the quality of care provided
to patients. Using a multi-faceted
approach, the SAMA called upon
the government, advocating for better
working conditions, competitive
salaries for healthcare professionals,
and policies that would encourage
current students to pursue the
medical profession. Additionally,
the SAMA launched initiatives
to support and retain medical
professionals within the country,
including continuous professional
development programmes and
partnerships with international
medical associations to foster
exchange programmes that allowed
for professional growth without
permanent relocation. Through these
efforts, the SAMA managed to stem
the tide of emigration and helped to
rebuild a robust health workforce.
Looking to the future, the SAMA
hopes for a more equitable healthcare
system where all South Africans have
access to high-quality medical care,
regardless of their socioeconomic
status. This vision includes the
integration of advanced medical
technologies and innovations that
can improve patient outcomes and
streamline healthcare delivery. The
SAMA envisions a future where
preventative care is prioritised,
reducing the burden of chronic
diseases and ensuring that the
healthcare system is sustainable.
Moreover, the SAMA aspires to see
a stronger emphasis on mental health
services, recognising the critical role
that mental well-being plays in overall
health. By fostering a collaborative
environment among healthcare
professionals, policymakers, and
communities, the SAMA aims to
build a resilient healthcare system
that can adapt to future challenges
and continue to improve the health
and well-being of all South Africans.
Uganda: As President of the Uganda
Medical Association (UMA), I am
honoured to have led our dedicated
and resilient team through successful
advocacy efforts to improve the
welfare of health professionals in
Uganda.Asaresultofnegotiationsand
industrial action during December
2021, Ugandan health professionals
achieved a salary increment of over
100%,and they are still advocating for
adjustments concerning specialists’
salaries. Collective advocacy has
also led to policy developments that
have resulted in new public service
structures in the health sector, and
the creation of doctor positions at
the parish level (e.g. Health Center
111 in May 2024). These national
achievements will help to address
unemployment among junior
doctors and improve access to quality
health care services for the observed
population growth of 24.2 million in
2000 to 47.25 million in 2014.
The UMA is leading efforts to explore
two specific challenges for healthcare
professionals in Uganda. First, the
UMA’s Human Resource survey
conducted in January 2024, which
aimed to examine human resource
coverage and gaps, highlighted the
21-62% (average of 42%) human
resource coverage and 58% human
resource gap in public health facilities
in Uganda. To address this gap,
the Uganda government is been
actively involved in negotiations to
Interview with National Medical Associations’ Leaders of the African Region
34
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expand recruitment of healthcare
professionals. In June 2024, the
Uganda Ministry of Health indicated
that they can only employ 38% of
available healthcare professionals in
the country, and that more strategies
should be embraced to combat this
unemployment challenge such as
exporting health professional services
to other countries and supporting
training and recruitment for the
private health sector.
Second, the Uganda government
adopted a proposal to stop paying
allowances to medical interns and
introduce self-sponsored internships
in May 2023, which was prompted
by reduced external funding due to
the controversial anti-homosexuality
bill. However, the UMA believed
that alternative solutions existed,
such as increasing local funding
and prioritising wages for these
allowances, which consider the
valuable contributions of medical
interns to the health sector. UMA
members vigorously advocated for
the prioritisation of these allowances,
and our efforts were met with
initial resistance, leading to hospital
crises based on delayed deployment
and a lack of medical interns. The
situation escalated to the point
where Ugandan doctors considered
launching a nationwide industrial
strike in 2023. However, through
persistent negotiations, the UMA
and the health system successfully
secured the deployment of medical
interns (doctors, nurses, pharmacists)
with a negotiated pay. This
outcome demonstrates the UMA’s
commitment to fighting for the
rights and welfare of health
professionals, even in the face of
adversity.
The future of medicine is promising
in Uganda, with robust relationships
between the government and
healthcare professionals and good
political will towards the improved
welfare of healthcare professionals.
The Abuja Declaration, which
emphasises the need for 15%
allocation of the health budget to
the health sector, represents the most
advanced health policy (including
the national health insurance
scheme) in the African region to
date. Moving forward, the UMA
hopes to advocate for expanding the
current 8.2% allocation of the health
budget in Uganda, to align with the
recommended 15% allocation, and
hence increase access of healthcare
services to the public. Although an
alternative financing model for the
health sector was introduced to the
Parliament of Uganda, the national
health insurance scheme legislation
was formulated in 2023, but not yet
approved or adapted into the health
sector.
How would you describe the current
opportunities for NMA members to
help influence health care policy-
making activities in your country?
Kenya: First, the KMA has various
thematic committees that focus on
different aspects of healthcare. The
thematic committees can develop
policy position papers for the
Association that are submitted to
the Ministry of Health and other
relevant health authorities for review
and policy guidance. A case in
point is the drafting of memoranda
to the Parliament and Senate of
Kenya on pressing issues including
human resources for health and
healthcare financing. Second, KMA
members are frequently requested
to serve as members of various
Ministry of Health task forces and
share their professional opinions on
various thematic areas related to the
taskforces. Third, since the KMA
has representation in the Kenya
Medical Practitioners and Dentists
Council (KMPDC), members can
help improve medical training and
medical practice by contributing to
the Council’s mandate of regulating
the medicine and dental training,
practice, and licencing within
healthcare institutions. Finally, the
KMA serves as a member of the
National Health Insurance Fund
(NHIF) and proposed as a board
member of the new Social Health
Authority. The KMA’s input is
useful to help guide and oversee the
management of healthcare financing
in Kenya.
Rwanda: The opportunities for
advancing healthcare are enormous,
particularly in the context of ongoing
advocacy efforts that influence key
decision-making and policies. The
COVID-19 pandemic has placed the
role of healthcare professionals in the
spotlight, underscoring their critical
contributions to the healthcare
system. In response to pressing
society needs, Rwanda has initiated
the 4×4 strategy, as a comprehensive
plan designed to quadruple the
number of healthcare professionals
over the next four years and engage
the health workforce to address
unmet healthcare needs for citizens.
The threat of the health workforce
loss (due to physician migration) has
prompted a renewed commitment
to consider the welfare of healthcare
professionals, including concerted
effort to enhance monetary incentives
and improve working conditions.
To address this challenge, the
Rwanda Ministry of Health is taking
significant strides towards building
a resilient healthcare system that
meets the needs of its population.
Leaders have established policies and
guidelines that foster collaborations
with RMA members, to ensure that
the voices of healthcare professionals
are integrated into the development
of policies and decision-making
processes, which can foster a sense
of ownership and commitment
among the health workforce.
Interview with National Medical Associations’ Leaders of the African Region
35
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South Africa: The SAMA views
the current landscape as ripe with
opportunities for its members
to play a crucial role in shaping
healthcare policy in South Africa.
As a respected body representing
medical professionals, SAMA
members can advocate for meaningful
change and engage in policymaking
through various channels, including
leveraging their clinical expertise
through active participation in
governmental advisory committees.
By serving on these committees,
members contribute to the
development of health policies that
are both practical and informed by
real-world challenges and solutions.
Additionally, SAMA members
can engage in public consultations
and forums organised by the
government and other stakeholders.
These platforms allow medical
professionals to voice their opinions,
provide feedback on proposed
policies, and suggest improvements.
The Association regularly organises
engagements, workshops, seminars,
and conferences, where members can
discuss pressing healthcare issues and
formulate collective positions that the
SAMA can present to policymakers.
This collaborative approach ensures
that the insights and expertise of a
wide range of medical professionals
are considered in the policy-making
process. The SAMA also encourages
its members to engage directly and
build strong relationships with
local communities and civil society
organisations to better understand
the health needs and concerns of the
population. Through this grassroots
engagement, SAMA members can
advocate for inclusive and effective
policies that address the specific
health challenges faced by different
communities.
Uganda: Currently, the UMA has
a significant opportunity to shape
the country’s health policies. As a
key stakeholder, UMA members
are regularly consulted by the
government to formulate and review
health-related policies, as they are
well-positioned with expertise and
technical knowledge to influence
policy changes that benefit the health
sector and the Ugandan population.
The Ugandan government values our
inputs and recognises the importance
of our contributions to national
discourse. I am truly humbled and
proud to lead the UMA, as an
organisation that plays a vital role in
shaping the future of healthcare in
Uganda.
How do perceive the physician-
patient relationship and rapport in
the clinical setting in your country?
Kenya: Kenya leaders have
recognised that physician-patient
relationships vary within the public
and private sectors. Public facilities
are characterised by high client flow,
high workload, and less than optimal
human resources for health capacity.
The physician-patient relationship
and rapport tend to be short in
order to minimise patient queues.
Management is less influenced by
patients, and treatment is often
constrained by limited diagnostics
and resources. On the other hand,
private facilities are generally for-
profit, and therefore physician-
patient interactions tend to last longer
with greater rapport, and patients are
directly involved in diagnostics and
various treatment modalities.
Rwanda: In Rwanda, the physician-
patient relationship is generally
characterised by high levels of trust
and mutual respect, which fosters a
positive rapport in clinical settings.
This trust contributes to an overall
sense of safety and confidence in
the medical care received, with
patients adhering to their physicians’
recommendations. To support the
relationship between healthcare
professionals and patients, the
Rwandan government created the
Patient Rights Charters, which serves
as a code of conduct with roles and
responsibilities for both healthcare
professionals and patients. It aims to
ensure that patient care is delivered
in a respectful and ethically sound
manner, reinforcing the positive
dynamics necessary in the physician-
patient relationship.
It is evident that the physician-
patient relationship is evolving
towards a more collaborative and
communicative model. However,
significant imbalances remain,
primarily due to patients’ lack of
awareness of their rights and available
protections within the healthcare
system. Many patients may not
feel empowered to ask questions
about their medical conditions,
often relying on unreliable sources
(e.g. friends, family members,
social media), which can lead to
misconceptions about medications
and treatment. Additionally, the
power dynamics in these relationships
can hinder effective engagement, as
many clinicians may feel that they
have authority over patients’ care. To
improve this dynamic, it is crucial to
educate patients about their rights
and ensure that healthcare providers
are trained on patients right and
effective communication strategies,
which can ultimately foster a culture
of mutual understanding and respect
as well as improve patient satisfaction
and health outcomes.
South Africa: The physician-patient
relationship and rapport in the clinical
setting is fundamental to the delivery
of quality healthcare. The SAMA
recognises that this relationship is
built on trust, communication, and
mutual respect, which are essential
for effective diagnosis, treatment, and
patient satisfaction. In South Africa,
where the healthcare landscape
is diverse and often strained by
Interview with National Medical Associations’ Leaders of the African Region
36
BACK TO CONTENTS
resource limitations, maintaining a
strong physician-patient rapport is
crucial yet challenging. The SAMSA
acknowledges the pressures faced by
physicians, including high patient
volumes and administrative burdens,
which can strain these relationships.
However, the Association advocates
for a patient-centred approach that
prioritises empathy, active listening,
and cultural competence. By
promoting continuous professional
development and ethical practices,
the SAMA strives to enhance the
quality of interactions between
physicians and patients, ensuring that
every patient feels heard, respected,
and cared for by physicians. This
commitment is seen as a cornerstone
for improving health outcomes and
fostering a more humane and effective
healthcare system in South Africa.
The physician-patient relationship
is constantly evolving due to various
factors, including technological
advancements, increased access to
online medical information, and the
integration of artificial intelligence.
As one notable example, the
Health Professionals Council of
South Africa’s swiftly responded to
the pandemic by allowing virtual
consulting, resulting in a shift that
fundamentally transformed the
physician-patient relationship.
Hence, it is essential to acknowledge
and adapt to these changes to ensure
the relationship remains effective and
patient-centred.
Uganda: The physician-patient
relationship in Uganda is built on
a strong foundation of efficient
communication, mutual respect,
confidentiality, and empathy. Our
healthcare professionals strive to
provide excellent care, and the
majority of patient interactions
are positive and respectful. When
instances of inappropriate conduct
are observed, however, the UMA
Ethics and Professionalism
Committee and the Uganda Medical
and Dental Practitioners Council
promptly address the ethical and
professional standards by discussing
the incident and agreeing upon
appropriate actions (including
sanctions). As President of the UMA,
I am committed to upholding the
highest standards of medical practice
and ensuring that our patients receive
the care that they deserve.
How would you describe the
anticipated challenges in medical
education over the next decade in
your country?
Kenya: The quality of medical
education and training remains a
challenge in Kenya. Medical schools
are domiciled in universities that do
not have university hospitals. Medical
students and trainees complete their
clinical rotations in hospitals that are
not administratively linked to the
university. Over the past few years,
many public universities dependent
on the exchequer, have had funding
challenges from government. In
efforts to increase their revenues,
they have increased admissions of
medical students to their programs
even beyond their quality capacity.
The Commission of University
Education (CUE), which oversees
university education, adopted a law
that made the input of the KMPDC
concerning medical training not
mandatory. The KMA has observed
that hospital programs have an
excess number of medical students
contrary to what the KMPDC
would recommend as capacity for
quality training. The trainees thus
complete their clinical rotations with
inadequate patient contact time,
decreasing the quality of education
and training. The KMA, through its
representatives in the KMPDC and
in Parliament, continues to advocate
for mandatory input of the KMPDC
on medical training in the CUE Act.
Rwanda: First, the RMA anticipates
significant gaps in knowledge
acquisition, as medical schools,
teaching hospitals, and research
centres are not rapidly evolving to
meet the current and future public
health challenges. With the rapidly
evolving technology, we foresee
shortages in incorporating essential
training resources, including
simulation lab resources, robotic, and
other advanced training technologies,
into medical education. Second,
there is a growing concern about the
shortage of medical school faculty in
the basic sciences, as these positions
are often less attractive for
professionals to pursue advanced
studies and such teaching careers.
As a result, this continued shortage
of qualified faculty could hinder
the quality of medical education.
Third, many trained professionals
are migrating to middle- and high-
income countries to seek improved
work environment and incentives,
which could result in a depletion
of trained professionals within
the country (“brain drain”) and
further exacerbate the health system
challenges.
South Africa: Over the next decade,
the SAMA anticipates several
significant challenges in medical
education, reflecting on broader
issues within the healthcare system
and the evolving landscape of
medical practice. First, there is an
urgent need to address the growing
demand for healthcare professionals
amid an ongoing shortage of medical
educators and clinical training
facilities. As the South African
population increases and the
burden of communicable and non-
communicable diseases continues to
rise, the strain on medical schools
and academic hospitals will likely
intensify. This shortage could hinder
the ability to provide high-quality
training and practical experience,
which are crucial for preparing future
physicians.
Interview with National Medical Associations’ Leaders of the African Region
37
Second, the integration of
advanced technology and digital
health solutions into the medical
curriculum will require additional
training for educators and students.
While technological advancements
offer significant potential to
enhance medical education
through simulation-based learning,
telemedicine, and electronic health
records, ensuring that both educators
and students are proficient in these
technologies will require substantial
investment and adaptation. To
incorporate these tools effectively,
the SAMA foresees the need for
comprehensive training programmes
and updates to the curriculum,
ensuring that graduates are well-
equipped to navigate a technologically
advanced healthcare environment.
Third, the SAMA recognises the
necessity of adapting medical
education to the evolving healthcare
needs of the South African
population, including a greater
emphasis on primary care,
preventative medicine, and chronic
disease management. Medical
education must therefore shift to
produce physicians who are skilled
in acute care, managing long-term
health conditions, and promoting
health and wellness. This shift will
entail changes in the curriculum,
as well as increased opportunities
for students to gain experience in
community health settings.
Additionally, efforts to increase
diversity in the medical profession,
especially from underrepresented
and disadvantaged backgrounds,
are essential to better reflect
the population’s demographics
and effectively address health
disparities. Some strategies may
include providing financial support,
developing mentorship programmes,
and targeting recruitment efforts to
ensure that the medical workforce
is diverse and inclusive. As medical
practice evolves, ethical and
professional dilemmas faced by
healthcare professionals are expected
to become more prominent. If
medical education places a stronger
emphasis on bioethics, professional
conduct, and legal aspects of medical
practice, students will be prepared
to navigate issues related to patient
autonomy, informed consent, and
ethical use of emerging medical
technologies throughout their career
path.
Finally, the demanding nature
of medical education, coupled
with the high levels of stress and
burnout experienced by healthcare
professionals, necessitates a proactive
approach to supporting medical
students’ mental health and well-
being. Some strategies include
providing access to counselling
services, promoting a healthy
work-life balance, and fostering a
supportive and inclusive educational
environment.
Uganda: The medical education
system in Uganda faces significant
challenges, notably the inadequate
supervisionofmedicalstudentsduring
graduate training and post-graduate
internships and residency. This is
largely attributed to the unregulated
number of admissions to medical
schools, which can compromise the
quality of healthcare professionals in
the future. As President of the UMA,
I am concerned about the potential
consequences of this observed trend
and urge health leaders to address
this issue promptly to ensure the
production of competent and skilled
healthcare professionals to support
the Ugandan health system. Over
the past few years, the UMA has
been working collaboratively with the
Ugandan government to develop an
internship policy related to medical
residents’ training and secured
financial compensation and good
welfare.
From the medical education
perspective, how has your NMA
responded to the existing and
emerging health challenges within
your country?
Kenya: The KMA serves as a leading
institution in Africa, maintaining
robust health professional training.
First, during the COVID-19
pandemic, the KMA partnered with
the Ministry of Health and other
leading health agencies to develop
a curriculum for training the health
workforce on infection prevention
and control. Second, as the CUE Act
clauserestrictstheconsiderationofthe
KMPDC’s contributions to national
discourse, the KMA has continued to
advocate for the KMPDC’s valuable
input on institutional requirements
related to medical education and
training programs.
Rwanda: The RMA is actively
advocating for increased incentives
for medical doctors and improving
working conditions of its members
and other healthcare professionals.
Since the beginning of this year, the
RMA initiated an ambitious career
guidance program to promote the
good of the profession, inspire young
professionals and create a support
network. It is also working on a
capacity building initiative to raise
awareness on patient rights, medical
ethics and ethical practices intended
to promote professionalism among all
cadres of medical doctors. The RMA
is also partnering with the Ministry
of Health on its ambitious 4X4
reform program to increase the
number of health workforce and
bridge the gap especially in rural areas
and primary healthcare settings.
South Africa: The SAMA has
pushed for a medical education that
is comprehensive and reflective of
the country’s health landscape, as
it recognises the urgent need to
address the high burden of both
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Interview with National Medical Associations’ Leaders of the African Region
38
communicable (HIV/AIDS,
tuberculosis, emerging zoonoses)
and non-communicable (diabetes,
hypertension,mentalhealthdisorders)
diseases. By ensuring that medical
students receive extensive training
in these critical areas, the SAMA is
helping to equip future healthcare
professionals with the knowledge and
skills needed to effectively manage
these health challenges. To keep pace
with the digital transformation of
healthcare, the SAMA supports the
integration of modern technologies
into medical education, including the
adoption of simulation-based learning
tools, telemedicine training, and the
use of electronic health records in the
curriculum. Additionally, the SAMA
encourages practising physicians to
pursue professional development
opportunities to keep them updated
on emerging technologies and
innovative practices.
The SAMA places a strong
emphasis on research and evidence-
based practice as a cornerstone of
medical education. By encouraging
and supporting medical research
initiatives,theSAMAaimstocultivate
a culture of inquiry and continuous
learning among medical students
and professionals. As research can
help generate local data and insights
that are crucial for addressing South
Africa’s specific health challenges,
the SAMA promotes the prompt
dissemination of research findings
through conferences, publications,
and collaborations with international
medical communities. Hence, South
African healthcare can benefit
from these global best practices
and innovations. Furthermore, the
SAMA has advocated for policies
and programmes that promote equity
and inclusion, such as providing
scholarships and financial support
to students from disadvantaged
backgrounds, to increase diversity
within the medical profession. The
SAMA believes that a diverse health
workforce is essential for delivering
culturally competent care and
reducing health disparities.
Uganda: I am proud to highlight
that our contributions and advocacy
efforts are aimed at maintaining
high-quality medical trainings in
Uganda and producing competent
healthcare professionals who can
provide high-quality care to our
citizens. The proposals include:
1) adding a standardised national
curriculum for all medical schools;
2) implementing a national entry
exam and exit exam into medical
schools; and 3) requiring that
national medical councils effectively
supervise medical students during
their clinical training and post-
graduate internships. Currently, the
UMA is actively advocating for the
finalisation of the internship policies
and the development of postgraduate
training regulations.
From your perspective and
national experiences, how has the
COVID-19 pandemic affected
medical education in your country?
Kenya: During the COVID-19
pandemic, most medical education
programs were virtual, which
enabled faculty to continue teaching
their course and their training for
faculty and students. This virtual
format worked well for theoretical
subjects, even noting increased class
attendance. Skills-based courses
(including physical examinations
with patients) and other soft skills
(like building rapport with patients)
that required physical contact,
however, were limited by their nature
of requiring physical contact, and
hence affected the quality of learning.
Rwanda: Like other disciplines,
medical education faced significant
disruptions during the COVID-19
pandemic in Rwanda, as institutions
were closed and medical students
were confined in their homes.
Although virtual learning platforms
were used for alternative clinical
training approaches, medical
students’ clerkships were disrupted
due to restricted hospital access. The
emergence of telehealth education
platforms provided an opportunity
to effectively adopt virtual education
platforms, and to this date, a
significant number of training courses
continue to be delivered virtually.
Although the pandemic hindered
growth of the health workforce, it
spurred innovation with medical
students participating in COVID-19
research, adapting to new academic
learning modalities (e.g. hybrid
education models), gaining interest in
digital health applications.
South Africa: The COVID-19
pandemic significantly disrupted
medical education in South Africa, as
traditional in-person lectures, hands-
on clinical training, and practical
assessments were abruptly halted due
to lockdown and social distancing
measures. It presented unprecedented
challenges that forced educational
institutions to adapt swiftly, and
simultaneously accelerated the
integration of digital tools and
e-learning in medical education. To
enable continuity in education, the
SAMA supported the adoption of
virtual classrooms, webinars, and
online simulation tools to replace
traditional teaching methods. As
not all students had reliable internet
access or suitable devices for online
learning, recognised as the “digital
divide”, the SAMA advocated for
solutions to these disparities, such as
providing data subsidies and lending
technological devices to students in
need.
One of the most significant impacts
of the pandemic on medical
education was the disruption of
clinical training. With hospitals
overwhelmed by COVID-19 cases
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Interview with National Medical Associations’ Leaders of the African Region
39
and the high risk of infection, many
medical students faced reduced access
to clinical rotations and hands-on
patient care experiences. The SAMA
recognised the critical importance
of clinical training in developing
competent physicians and worked
with healthcare institutions to
develop alternative training methods,
such as virtual clinical rounds,
telemedicine consultations, and
simulated patient interactions.
The COVID-19 pandemic prompted
a comprehensive evaluation of
medical curricula and educational
models, to better prepare academic
programs for such disruptions and
future doctors for public health
crises. The SAMA advocated for the
inclusion of public health emergency
preparedness, epidemiology, and
infectious disease management
in medical education, in order to
equip students with the knowledge
and skills necessary to respond
effectively to future pandemics or
health emergencies. The pandemic
also underscored the importance
of research and collaboration in
addressing global health crises. The
SAMA supported efforts to involve
medical students in research related
to the pandemic, fostering a culture
of inquiry and evidence-based
practice. Collaborative projects,
both within South Africa and
internationally, provided valuable
learning opportunities and
contributed to the broader
understanding of the virus and its
impact on global health security.
Uganda: I can attest that the
COVID-19 pandemic had a
devastating impact on education
(especially medical education) in
Uganda. Some medical schools
were forced to close, creating a
significant gap in human resources,
as many hospitals relied heavily on
post-graduate medical residents for
health service delivery. Although
other medical schools remained
opened, halting in-person academic
lectures for over one year, the shift
to virtual learning limited hands-on
training and physical interactions
with mentors and patients. The lack
of practical experience and direct
supervision compromised the quality
of training, posing a significant risk
to the competence of future
healthcare professionals. As the
health system recovers from the
pandemic’s impact on medical
education and training in Uganda,
UMA members are working tirelessly
to mitigate its effects and ensure
that our healthcare system emerges
stronger and more resilient.
How does your NMA leadership
implement the WMA policies in the
organisation?
Kenya: As active member of the
WMA, the KMA endeavours to have
as many as possible of its leaders and
members attend WMA activities
like the Council Meetings, General
Assemblies, and regional meetings.
In this manner, KMA members
can learn about WMA policies,
provide input at meetings, and
disseminate relevant policy guidance
for implementation at the local and
national levels.
Rwanda: RMA leadership actively
advocates for the adoption and
integration of some WMA policies
into national health policies, by
engaging with government bodies
and stakeholders and submitting
policy proposals. They participate in
national health forums to ensure that
relevant WMA policy statements
and guidelines can inform their
decision-making processes. The
RMA works to influence health
policies that align with international
standards and ethical practices set
by the WMA, ultimately aiming to
improve healthcare quality, patients’
rights protection, and patients’
health outcomes. To build capacity
within the medical community,
RMA members focus on establishing
leadership development programs
and training initiatives, designed
to equip members with the skills
necessary for ethical leadership and
advocacy. Mentorship programs
pair experienced professionals with
emerging leaders to guide their
development, while workshops and
seminars incorporate the topics of
ethics, human rights, and professional
conduct. This collaborative approach
helps build a cohesive and informed
medical community, aligned with
WMA principles and committed to
advancing healthcare standards.
South Africa: SAMA leadership
actively integrates WMA policies
into its strategic planning and
operational activities. This process
begins with a thorough review and
contextualisationofWMAguidelines,
to ensure that they align with South
Africa’s unique healthcare landscape
and needs. SAMA’s leadership
disseminates these policies through
official channels, including meetings,
seminars, and training sessions, so
that all members are aware of and
understand the WMA’s standards
and recommendations. Additionally,
the SAMA incorporates WMA
policies into its advocacy efforts, as
a framework to influence national
healthcare legislation and policy
development. The SAMA hopes to
influence these principles as globally
recognised best practices, thereby
enhancing the quality and integrity
of healthcare delivery in South
Africa.
Uganda: The UMA has been
represented at the WMA General
Assemblies, and members actively
participate in shaping WMA policies
and resolutions that guide the global
medical community. Notably, the
UMA adopts relevant WMA policies
and advocates for their integration
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Interview with National Medical Associations’ Leaders of the African Region
40
into Ugandan health policies
through our engagement with the
Parliament of Uganda. Through
this collaboration, we ensure that
Uganda’s health policies align with
international best practices and
standards, as we aim to improve
the health system that benefits our
patients and the community at large.
How can the WMA support the
ongoing NMA activities in your
country?
Kenya: As KMA leadership, we
occasionally request that the WMA
provide a statement on ongoing issues
affecting the medical profession in
Kenya to influence policy makers as
well as help connect the KMA with
potential resource partnerships. We
request that the WMA continue this
financial support as it is particularly
important for junior doctors who
may not have adequate resources
to participate in WMA and Junior
Doctors Network (JDN) activities.
Second, as the WMA supports
capacity building activities, the
WMA could offer leadership courses
to KMA leaders, which can help
strengthen their advocacy skills in
health leadership. Furthermore,
the WMA could offer exchange
programmes between the various
national medical associations inside
and outside of Africa, which could
help improve knowledge sharing
and foster collaborations within the
medical profession.
Rwanda: The WMA can support
the ongoing activities of the RMA
in several key ways. First, the
WMA can enhance the overall
growth of the RMA by providing
adaptable policy frameworks that
expand capacity building through
continuing professional development
and strengthen its advocacy efforts.
Second, by providing leadership
support in medical education and
research, the WMA can help improve
the quality of medical training
and research in Rwanda and equip
healthcare professionals with essential
skills needed to advance quality
medical education and evidence-
based practices.Third, the WMA can
facilitate partnerships with Rwandan
professional medical associations, by
enhancing collaborative efforts that
would positively impact healthcare
systems in Rwanda. Finally, the
WMA can serve as a resource
for consultation, allowing RMA
members to seek guidance on complex
issues where they may lack expertise,
thus benefiting from the broader
WMA network and opportunities for
knowledge exchange.
South Africa: By leveraging its
global influence, the WMA can
help amplify SAMA’s voice to
garner attention and resources from
global health organisations and
governments for pressing health
challenges in South Africa. WMA
leaders can offer expert guidance
on policy development, helping
the SAMA to craft and implement
policies that align with international
best practices and address local health
needs. Also, the WMA can assist the
SAMA by offering capacity-building
programmes and training initiatives
that can enhance SAMA members’
knowledge and skills in medical
ethics, leadership, public health, and
research. This support is especially
valuable in areas like emergency
preparedness and response, where
global expertise can significantly
strengthen local capabilities. Still,
the WMA can help secure funding
for collaborative research projects,
especially through international
research grants and partnerships,
which can generate data and insights
on specific health issues.
The WMA can help advocate for
increased resources and infrastructure
support for South Africa’s healthcare
system from international donors
and organisations, which can lead
to improved healthcare facilities,
better access to medical supplies, and
enhanced support for public health
initiatives, thereby strengthening the
overall healthcare system in South
Africa. Furthermore, with the recent
Declaration of Helsinki African
Regional meeting, WMA’s support
for SAMA’s hosting has enabled the
organisation to foster networking
and collaboration opportunities with
other national medical associations.
By facilitating connections and
partnerships, the WMA can help
the SAMA share best practices,
learn from other nation’s experiences,
and collaborate on global health
initiatives. This network can enhance
SAMA’s ability to manage local
health challenges while contributing
to the global medical community.
Uganda: We are pleased to leverage
our membership with the WMA
and request guidance on how to
obtain financial and asset support
from international agencies for UMA
initiatives. Currently, the UMA is
launching a fundraising campaign
to construct the headquarters
building, which will serve as a hub
for our activities. With the WMA’s
guidance, we hope to secure the
necessary resources to complete this
construction, which can enhance our
capacity to advocate for the optimal
welfare of healthcare professionals
and high-quality healthcare in
Uganda. The UMA has developed
initiatives to explore working with
international partners to expand
healthcare collaborations – including
the United Kingdom’s National
Health Services’ Royal College of
Physicians and Rwanda Ministry
of Health – as well as promote
opportunities for health professional
services to be exported to other
countries. We request the guidance
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Interview with National Medical Associations’ Leaders of the African Region
41
of WMA on how to identify and
facilitate reliable connections with
other countries, as one strategy
to address unemployment and
underemployment among healthcare
professionals in Uganda.
Authors
Simon Kigondu, MBChB (ObGyn)
President, Kenya Medical Association
Nairobi, Kenya
simonkigondu@gmail.com
Herbert Luswata, MD
President, Uganda Medical Association
Kampala, Uganda
luswataherbert@gmail.com
Mvuyisi Mzukwa, MBChB
President, South African
Medical Association
Pretoria, South Africa
ceo@samedical.org
John Baptist Nkuranga, MD,
Med Paeds, MMASc GH
President, Rwanda Medical Association
Kigali, Rwanda
rmasecretariat@gmail.com
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Interview with National Medical Associations’ Leaders of the African Region
42
BACK TO CONTENTS
Dr. Johannes Steinhart, Dr. François
Arnault, Dr.Tomás Cobo Castro, and
Dr.SofiaRydgrenStale,thePresidents
of the national medical associations
(NMAs) of Austria, France, Spain,
and Sweden, respectively, as well as
Dr. Philippe Cathala, Delegate for
European and International Affairs
of the NMA of France, join the
interview with Dr. Helena Chapman,
the WMJ Editor in Chief. They
share their perspectives on their
leadership experiences, ongoing
NMAactivities,strengthsandexisting
challenges in medical education, and
how the World Medical Association
(WMA) can support NMA initiatives
in the European 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.
Austria: In 2023, Austria witnessed
widespread negotiations on healthcare
reform with political leaders, and a
first draft gave rise to fears of negative
consequences for the healthcare
system. Only when the Austrian
Medical Chamber (AMC) finally
became involved, these negotiations
took place in a constructive and
purposeful atmosphere,and hence the
involvement of the AMC prevented
major healthcare dilemmas. These
timely improvements were related to
future patient care,such as eliminating
end dates for the implementation of
standardised nationwide contracts
and committing resources to reduce
administrative burden in health
institutions.
France: There have been many
significant moments in our French
Medical Council (Conseil National
de l’Ordre des Médecins, CNOM)
activities, including the development
ofrobustpoliciesandthemanagement
of challenging negotiations on
pressing health issues.Specifically,one
memorable experience (highlighted
by Dr. Philippe Cathala) is the
implementation of our mentorship
policy with junior doctors, as they
are the future of medicine, and it
is our collective responsibility to
contribute to their medical training.
To support this mentorship policy,
an annual ceremony has been
established in the local council,
chaired by Dr. Philippe Cathala,
where council members invite all
junior doctors from the region
and present them with the most
symbolic tools of our profession:
the stethoscope and code of
ethics. We are very pleased that
this initiative has inspired other
doctors at all levels of training, and
now several councils have followed
in our footsteps.
Spain: One of the most memorable
experiences during my term as
president of the Spanish General
Medical Council (CGCOM) was the
Interview with National Medical Associations’
Leaders of the European Region
Interview with National Medical Associations’ Leaders of the European Region
François Arnault
Sof ia Rydgren Stale
Philippe Cathala
Johannes Steinhart
Tomás Cobo Castro
43
BACK TO CONTENTS
approval of the new Code of Medical
Ethics. This document, which is
aligned with the WMA Code of
Medical Ethics, is the result of
years of work and multi-stakeholder
consensus, and sets the ethical and
professional principles that will
guide medical practise in Spain. The
approval ceremony, which was held
in 2023, was a moment of pride and
celebration for all persons involved.
Upon signing the document, I
remember that I felt a deep sense of
responsibility and commitment to
the values that the code represents.
This achievement not only reinforced
our commitment to medical ethics,
but also enhanced public confidence
in the medical profession. Over my
tenure, one of the most significant
challenges was the implementation of
the Continuing Medical Education
(CME) credits of the European
Union of Medical Specialists
(UEMS) in Spain and in Latin
America, as it comprised of a formal
agreement between CGCOM,
the European Union of Medical
Specialists (Union Européenne des
Médecins Spécialistes, UEMS),
and the Medical Confederation
of Latin America and the
Caribbean (Confederación Médica
Latinoamericana y del Caribe,
CONFEMEL). We envision a future
where medicine will be more precise,
less invasive, and more focused
on prevention and personalised
treatment, which will significantly
improve patient quality of life and life
expectancy.
Sweden: One memorable moment
as the Swedish Medical Association
(SMA) president was when I
posted, “I´m a physician, not a border-
policeman,” on social media, in
response to the government starting
an investigation to examine the
possibility of demanding physicians
and other employees in municipalities
and regions to report undocumented
migrants. Such an obligation to
report undocumented migrants
would be in opposition to the
important ethical principle that care
must be provided on the basis of
clinical need alone, regardless of the
care seeker´s legal status. It also goes
against the International Code of
Medical Ethics and threatens patient
safety. As health professionals and as
an NMA, it is important to speak out
against any proposal that prevents us
from fulfilling our duties. My post
went viral in Sweden, and many
physicians as well as representatives
from other professions and employers
raised their voices in support. I
believe that this community response
demonstrates the importance of
our medical ethics, how strongly we
feel about them, and how we can
hopefully make a difference when we
come together and use our collective
voice on pressing health issues. At
the same time, it offers an example
of a challenge that we face and one
approach to resolve the issue, by
working together with our SMA
members as well as organisations
from different parts of the healthcare
sector and society.
My hope for the future of medicine
is that we will see a development
towards a more equal healthcare
and universal health coverage, where
everyone can benefit from medical
advances and take full advantage
of new research findings. It is
important that the trust in research
and science remains high (and, where
necessary, increases) in society and
the general public, and specifically
among patients, politicians, and
decision makers. Healthcare needs
to be governed by science and ensure
strong professional autonomy for
the best of all patients.
How would you describe the current
opportunities for NMA members to
help influence health care policy-
making activities in your country?
Austria: The forementioned
involvement of the AMC in the
healthcare reform of 2023 shows
the important role that the AMC
plays in healthcare policy activities
(including constructive cooperation
with politicians and advocacy for
healthcare improvement) that focus
on patient care and the medical
profession. As the professional
organisation representing all Austrian
doctors, the AMC is committed to
positive developments in the Austrian
healthcare system by implementing
innovative approaches to offer the
best possible medical care for patients.
The AMC is comprised of various
committees that collectively advocate
for socially-oriented, modern
healthcare that is accessible to the
entire population through doctors
working in public and private sectors.
France: The CNOM, established in
1945, is the only institution in France
that unites all doctors, regardless
of their status, practice mode or
specialty. It was created by law
and entrusted with several public
service missions, defending the
independence and honour of the
medical profession throughout
French society. Upon my election as
president of the CNOM,I committed
to strengthening our contacts and
working relationships with all
institutional partners, including
public authorities, doctors’ unions,
health profession councils, patient
associations, members of the French
parliament, and elected officials from
various regions.
As a key player in discussions on the
evolution of the healthcare system,
CNOM members actively contribute
to numerous committees and serves
as experts with ministries, regional
health agencies, and French public
health organisations (e.g. National
Agency for the Safety of Medicines).
As a leading speaker for public
authorities, the Council provides
opinions on health-related bills and
decrees as well as conducts periodic
surveys on pressing topics such as
Interview with National Medical Associations’ Leaders of the European Region
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medical demographics, physician
safety, and continuity of care.
Spain: Currently, we have a direct
and collaborative relationship with
the administrations of central
and regional association in Spain.
Following the coronavirus disease
2019 (COVID-19) health crisis, the
CGCOM has led timely national
efforts that continue to strengthen the
medical profession, including forming
the State Public Health Agency,
developing and advocating for the
approval of the emergency medicine
specialty training, supporting an
increased number of specialist
training placements. As an
organisation, we recognise that our
members represent experts in their
clinical and surgical specialties, who
are frequently requested to provide
input to help national discourse on
pressing health issues. Upon each
request, we are increasingly aware
of our important role, working
with leading stakeholders (like the
government) in order to support
health system resiliency.
Sweden: The SMA, a labour union
and professions association, is a well-
respected organisation in Sweden.
Our representatives at local and
national levels are elected by our
members, and we encourage active
participation by individual members.
We work hard to prioritise the needs
of physicians and patients as well
as promote the continued positive
development of Swedish healthcare.
The SMA is often consulted as subject
matter experts for national inquiries
on healthcare issues, and we have
recurring meetings with the Minister
for Health Care. Although regional
and state representatives vote on final
decisions related to the adoption of
healthcare policies, guidelines, and
legislation, SMA members offer
robust perspectives to such discourse
that can help influence policy-making
activities.
How do perceive the physician-
patient relationship and rapport in
the clinical setting in your country?
Austria: As doctors, our top priority
is to be actively present for our
patients, offering quality time for
direct interactions to learn about their
personal needs and concerns. Trust
is the be-all and end-all in the
relationship between doctors and
their patients, and hence those who
trust their doctor will also adhere
more precisely to recommended
treatment. Since doctors acknowledge
that significant time is wasted on non-
medical work such as documentation,
the AMC has been a long-time
advocate for reducing bureaucratic
activities (e.g. writing discharge
letters, personnel management)
and expanding digital options
such as a standardised information
technology infrastructure (e.g.
extramural and intramural areas),
development of digital apps, and
national documentation assistants
that support electronic health records
(elektronische Gesundheitsakte,
ELGA).
France: The CNOM is the guarantor
of the patient-doctor relationship in
France, serving doctors in the interest
of patients. We understand that
today’s doctors face several challenges
in building a strong patient-doctor
relationship, including limited time
to conduct clinical responsibilities
due to the burden of administrative
tasks, working in large health teams,
patients who are more informed and
in control of their health, increasing
technicalities of clinical practice,
and the development and use of
novel technologies (e.g. artificial
intelligence). Some solutions to
these challenges may include health
professionals’ training, improved team
coordination and communication,and
the responsible use of technologies
in clinical practice. Since novel
technologies cannot replace the
individual medical consult, and must
require the doctor’s supervision, the
CNOM is currently preparing an
ethical and deontological framework
for the use of these new tools.
Spain: The doctor-patient
relationship is and will continue to
be the basis of medical practice, and
it is well safeguarded in Spain. This
fundamental bond remains visibly
strong among doctors in Spain, as
evidence of their strong vocation and
professionalism in medicine, albeit
experiencing multiple challenges like
infection control during the pandemic,
hospital surges, and overburdened
schedules. As the CGCOM is
absolutely committed to protecting
this doctor-patient relationship, we
launched an initiative in 2016,to make
the doctor-patient relationship part of
the intangible heritage of humanity.
Despite technological advancements,
medicine must continue to revolve
around this intimate and trusting
relationship between the doctor and
the patient.
Sweden: A good patient-physician
relationship is necessary for optimal
care. Of course, there are patients who
are dissatisfied with their healthcare
and their physician. Even threats and
violence against health professionals
occur, which is never acceptable and
something that we must work hard to
prevent. In general, though, I would
say that the relationship between
patients and physicians in Sweden is
a positive one. With the continuous
development of new treatments and
the strengthened position of patients
in healthcare, today´s patients often
have high expectations of what
healthcare can do for them. This
can stimulate cooperation between
patients and physicians as well as
encourage patients to be more active
participants in their care. At the same
time, increased patients’ expectations
necessitate that physicians are well
trained and given sufficient clinical
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45
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time with patients to discuss the
management plan in a respectful
and sensitive manner that fosters
understanding and trust.
How would you describe the
anticipated challenges in medical
education over the next decade in
your country?
Austria: There is what has been
referred to as an “unbalanced
mobility”of students in the European
Union (EU). Austria, in particular,
has a disproportionate number of
international medical students,
who leave the country after having
acquired their degree. Notably, most
medical students in Austria come
from Germany, as medical students
seeking opportunities to study abroad.
According to the German Minister
of Health, however, the nation has
trained an estimated 50,000 fewer
doctors than the country will likely
need for the next decade. Hence,
the AMC supports reforms like the
suggestion of the Austrian Minister
of Education, Martin Polaschek,
who proposed that EU member
states should be required to provide
a minimum quota of university
placements, with states who meet
or surpass their quotas being
compensated by those states who are
unable to meet these quotas.
Also, we need to ensure that young
doctors in Austria choose to stay and
work in the country. There are high
demands internationally, particularly
among Austria’s neighbours
(Germany and Switzerland), where
a common language and geographic
proximity present appealing
alternatives for Austrian doctors. We
have to stay competitive in the light
of the global migration of health
professionals, developing programs
and incentives to encourage doctors
to remain in Austria.
The medical profession has changed
significantly over the past generations:
100-hour work weeks for example
used to be common schedules in
hospitals. Positions in the public
healthcare sector were highly sought
after amongst doctors, who would
face stiff competition in the selection
process. However, these job offerings
have failed to keep up with the shift
in priorities and expectations of
younger generations who value
flexibility in the workplace, seek a
better work-life balance, and desire
more time with their families as well
as time to pursue interests outside
of work. For this reason, part-time
work models have risen in popularity.
We cannot afford to ignore these
professional changes in Austria
and recognise that if contracts with
social security providers and hospital
administration do not offer more
flexible and more attractive work
conditions, fewer doctors will seek
employment in the public healthcare
system and the existing workforce gap
will grow even larger.
France: In France, there are three
major challenges that the health
system will face over the next
decade. First, junior doctors who
complete their training do not often
identify with the available types
of medical practice. Young doctors
who complete their training do not
identify with the type of medical
practice being offered to them. This
is particularly evident in general
practice within local communities,
which should be at the core of
healthcare for the population. The
appeal of this specialised field is
declining, and young doctors are
increasingly inclined to choose
salaried positions or roles that do
not involve direct patient care, such
as aesthetic medicine. This is where
the real issue lies! It is pointless to
significantly increase the number of
medical students if we do not create
a strong appeal for the care sector.
Second, integration of artificial
intelligence and telemedicine into
training programs will require that
teachers and students refine their
skills of this rapidly changing
discipline. Third, it is important
to maintain rigorous and high-
quality training standards to
ensure patient safety. This is
crucial, especially in the context of
increasing international mobility
among doctors.
Spain: As doctors, we recognise that
there are enormous challenges in
the field of medical education and
training at national, regional, and
international levels. First, limited
time and incentives are offered to
doctors to pursue regular continuing
medical education, including
updates on clinical guidelines for
diagnosis, treatment, and prevention.
For example, Spanish doctors may
be granted five days to complete
such important training, which can
negatively influence the provision of
high-quality healthcare services to
patients and ultimately the health
system as a whole. Second, it is
important to harmonise medical
training in Spain, Europe, and
the world, ensuring that health
professionals are well-trained with the
knowledge and skills to treat patients.
Hence, together with UEMS, we
must promote a list of competencies
that represents a benchmark for all
countries, as well as guarantee that
medical training has received the
respective accreditation without any
conflicts of interest.
Sweden: In 2021, the government
of Sweden initiated fundamental
changes to our system of medical
education. Up until 2021, all doctors
received a medical degree upon
leaving the university (e.g. duration
of 5.5 years), and after an 18-month
internship, they could register as
medical practitioners and start their
speciality training. However, the
average waiting time to start the
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internship has been 11 months after
graduation, and this delay to educate
new specialists (e.g. duration of five
years) has exacerbated Sweden´s
shortage of specialist doctors. Since
2021, the new system includes
specific changes, where basic medical
education (medical degree and license
to practice medicine) is completed
at the university in six years (e.g.
addition of six months). Specialty
training then follows and incorporates
a new introductory training period
(e.g. total duration of a minimum of
5.5 years). Eventually, the 18-month
internship will be removed when the
previous system has been phased out
and replaced with the new system.
During this transition period, we
are closely monitoring (and working
to remove any unnecessary delays)
related to the implementation of
the new system. Overall, these
changes are timely for Sweden to
better harmonise with our European
neighbours’ education systems.
From the medical education
perspective, how has your NMA
responded to the existing and
emerging health challenges within
your country?
Austria: Conducting an annual
academic evaluation for training
within hospital departments, the
AMC analyses the current status
and can therefore react quickly
to incorporate any necessary
modifications. For years, the AMC
has advocated for a quality training,
where senior-level doctors are
assigned to each training program,
and sufficient resources are available
to allow time for teachers and
trainees to complete their training
and adopt an optimal work-life
balance. If we can guarantee high-
quality training, then we can
guarantee that our patients will be
cared for by highly trained doctors.
France: The CNOM proposes
the implementation of innovative,
modern, and simple solutions to
bring more flexibility to expand
healthcare services, meet patients’
needs, and increase the attractiveness
of the medical profession. After
the COVID-19 pandemic, the
CNOM launched the “Healing
Tomorrow” (“Soigner demain”
campain) in 2021, offering several
recommendations to national
leaders on how to optimise medical
education and training in France.
Regarding academic coursework,
national leaders can support the
curriculum reform that emphasises
infection control and prevention in
the first year of studies, and medical
ethics and CNOM missions in the
second cycle of studies. Encourage
second cycle medical study
internships in public and private
healthcare sectors, including
outpatient settings. Promote
internship placements in private
clinics and hospitals, during the third
cycle of medical studies, distributed
across the coutry, regardless of
specialty, to help students understand
how professionalisation is closely
aligned with local community needs
Leaders can support doctors who
wish to pursue part-time practice
within their designated specialty
field, as well as authorise the presence
of value mixed and shared practice
models without impairing social
rights, regardless of status (e.g.
hospital, salaried, private). In order to
meet local community needs, national
leaders can also offer physicians a
five-year community placement,
with significant salary, indemnity,
contractual incentives, and retirement
benefits. Finally, complementary
topics (e.g. “One Health” concept,
domestic and family violence) can be
incorporated into reflections on the
collective and social responsibility
of doctors, economic and social
implications of prescriptions, and
critical analysis of emerging health
threats.
Spain: Health leaders across Spain
are leading efforts to identify and
address health challenges with
sustainable solutions that strengthen
medical education and training as
well as the health system. In 2022,
the Government of Spain approved
the Decree 589/2022 (Real Decreto
589/2022), which sets the foundation
for all stages of competence-
based medical training, including
coordinating annual exams for
specialty training and establishing
the role of professional organisations
[1]. This regulation is pivotal as
an important first step, and our
CGCOM is enthusiastic to
contribute to advancing this
regulation and medical education and
training in Spain and Europe.
Sweden: There is significant ongoing
policy discussion regarding our
changing demographics, such as
how an ageing population will affect
healthcare demands, a predicted
future Sweden shares with many
other countries. One key issue is to
balance our physician workforce,
especially since Sweden faces a
nationwide shortage of specialist
doctors. The current imbalance is
partly due to the unnecessary delays
for medical graduates to begin
the internship, which is required
to receive a license to practice
and continue with their specialist
training. Swedish healthcare should
offer enough training positions
and ensure sustainable working
conditions for doctors, which will
also help recruit the next generation
of doctors. The SMA has published
several reports with experiences of
poor and unsustainable working
conditions from our members, noting
that almost one-third of junior
doctors have considered leaving the
medical profession. Moving forward,
employers should act to improve
these working conditions and offer
fair compensation for all doctors.
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From your perspective and
national experiences, how has the
COVID-19 pandemic affected
medical education in your country?
Austria: Due to the 2nd Covid-19 Act
of 2020, all deadlines in connection
with medical education, training, and
advanced education as well as medical
practice were suspended for the
duration of the COVID-19 pandemic.
This action is in accordance with
§ 36 b par. 4 of the Austrian Medical
Act 1998, namely for pandemic-
related measures such as quarantine,
leave of absence or childcare. In order
to ensure the quality of training, the
responsible attending physicians
documented and assessed trainees’
acquired knowledge, experience,
and skills. Furthermore, faculty used
digital teaching formats to teach
coursework, resulting in a massive
increase of online training courses,
and many congresses were cancelled
or postponed. All in all, I believe that
everything possible was done, even
during the pandemic, to offer junior
doctors the best possible medical
training.
France: During the COVID-19
pandemic, formal academic
coursework could not be delivered via
in-person format for several weeks.
Students in clinical internships were
focused primarily on prevention and
care activities, and albeit increased
workloads, they were fully committed
to assisting their senior colleagues.
The pandemic highlighted both
the resilience and vulnerabilities of
the medical education in France,
emphasising the importance of
adaptability, mental health awareness,
and the integration of technology
in training future healthcare
professionals.The medical curriculum
has incorporated an emphasis on
public health, infectious diseases,
and emergency preparedness topics,
reflecting on the lessons learned
during the pandemic.
Spain: Although the pandemic
slowed (and halted) the development
and adoption of regulations and
legislation in medical education,
we have uncovered positive aspects
such as telemedicine advancements,
greater training in digital skills, and
even virtual learning. The CGCOM
insists on the need for the measures
to be directly coordinated so that
training remains a prioritised pillar
within the reformed Spanish health
system. As medical professionals are
the main asset of the health system,
training is imperative to providing
quality medical care. Although the
pandemic slowed down such progress,
we should collectively push forward
and support advancements to medical
education and training.
Sweden: The COVID-19 pandemic
stressed one valuable lesson for
the medical discipline to protect
healthcare teams and patients in the
case of any catastrophic situation (e.g.
armed conflict, pandemic). Long-
term planning within the healthcare
system requires ample storage for
medical supplies and medicine as well
as regular training and continuous
medical education for all healthcare
personnel. My concern is that we
are beginning to forget some of the
lessons that we learned during the
COVID-19 pandemic. However, in
light of Sweden’s recent entry into
North Atlantic Treaty Organization
(NATO) and its demands on
preparedness, these issues continue to
be highly relevant.
How does your NMA leadership
implement the WMA policies in the
organisation?
Austria: The AMC is fully committed
to the WMA’s commitment to
providing people with the highest
international standards in medical
education, medical science, ethics,
and healthcare. In addition
to representing the common,
professional, social, and economic
interests of doctors working in
Austria, the AMC’s mission
statement promotes socially
orientated, modern healthcare
by doctors in public and private
practice that is accessible to the
entire population. Our doctors are
committed to a high standard of
medical care, with a particular focus
on ongoing quality management to
increase patient safety.
France: Once WMA policies are
adopted at the WMA General
Assembly or Council Meeting,
CNOM leaders disseminate the
statements and recommendations
within all levels of the CNOM.
These policies offer valuable support
and help reinforce our scientific
positions at the national level. Prior
to implementing these WMA
policies within the CNOM, members
carefully examine and analyse each
of the WMA’s proposals, initially
within the CNOM’s delegation for
European and International Affairs
(chaired by Dr. Philippe Cathala)
and subsequently by members in
section and session with all CNOM
members.
Spain: As the WMA has adopted
various initiatives, positions, and
statements, our CGCOM members
can use this information to broaden
their knowledge and simultaneously
adapt content to the context of
the medical profession in Spain.
Throughout my tenure as CGCOM
president, designated delegates of
different committees have prepared
and shared reports with internal
governing bodies, which can serve as
a reference point for working groups
or guiding documents for national
health authorities. As the medical
profession transcends frontiers, we
must leverage our expertise and
skills within national, regional, and
international settings.
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Sweden: The SMA strives to actively
participate in the WMA policy
activities, noting that the WMA-
adopted policies can be quite useful
in our daily activities. Specifically,
the SMA refers to WMA policies,
especially the ones on ethical issues,
when we contribute to interviews
by the media, present at meetings,
prepare scientific commentaries
or articles, and discuss topics with
SMA members. In fact, the WMA’s
core ethical policies, such as the
International Code of Medical
Ethics and the Declaration of
Geneva, have inspired our own
national code of medical ethics.
How can the WMA support the
ongoing NMA activities in your
country?
Austria: The fundamental framework
and central guiding principle of our
medical activities is to help patients,
behind which all political and
economic considerations take a back
seat. The strong international co-
operation within the WMA helps us
to achieve these goals in Austria as
well as internationally.
France: The WMA is an important
organisation for the CNOM, and we
are proud to be one of its founding
members. Today, the WMA provides
support by strongly reaffirming the
role and place of physicians in the
healthcare pathway, emphasising
ethics in clinical research, and
launching awareness campaigns on
crucial public health issues such as
vaccination, disease prevention, and
mental health. Furthermore, it plays
a major role by adopting guidelines
and policies based on best practices
in medical ethics. These actions are
only made possible with the support
of all NMAs and by strengthening
dialogue with other organisations,
such as CONFEMEL and the
Conference of Medical Councils
from French-speaking countries (la
Conférence Francophone des Ordres
des Médecins, CFOM).
Spain: In Spain, the WMA is highly
respected as a leading international
group of medical experts who
advocate for high ethical standards in
medical practise by adopting codes of
ethics and organising ethics training
activities. As the WMA General
Assembly passes different emergency
resolutions and declarations in any
field, the CGCOM forwards these
documents to legislators within
the Congress of Deputies, Senate,
Autonomous Communities, and
the Ministry of Health, who in
turn review and even post these
documents on institutional websites.
By providing this valuable support,
the WMA can help strengthen the
capacities of NMAs, improve the
quality of medical care, and foster a
collaborative environment for global
medicine.
Sweden: The WMA plays an
important role in developing and
communicating international
policies, especially in the area of
medical ethics, as well as in speaking
internationally against violations
of medical ethics and health-
related human rights. As a global
organisation representing physicians
from over 110 countries around
the world, the WMA has a strong
international voice. Its policies and
statements regarding current events
threatening physicians, healthcare
systems, and human rights are often
very helpful, offering a reference
for our NMA when developing
policies or addressing international
events. Hence, we would like to
encourage the WMA to continue
its important work in these areas.
Reference
1. Boletín Oficial del Estado,
Government of Spain. Real
Decreto 589/2022 [Inter-
net]. 2022 [cited 2024 Sep 1].
Available from: https://www.boe.
es/eli/es/rd/2022/07/19/589
Authors
François Arnault, MD
President, French Medical Council
(Conseil National de l’Ordre
des Médecins, CNOM)
Paris, France
international@ordre.medecin.fr
Philippe Cathala, PharmD, MD
Delegate for European and
International Affairs, French
Medical Council (Conseil National
de l’Ordre des Médecins, CNOM)
President, Conseil Départemental de
l’Hérault de l’Ordre des Médecins
Montpellier, France
cathala.philippe@ordre.medecin.fr
Tomás Cobo Castro, MD
President, Spanish General
Medical Council (CGCOM)
Madrid, Spain
internacional@cgcom.es
Sofia Rydgren Stale, MD
President, Swedish Medical Association
Stockholm, Sweden
ordforande@slf.se
Johannes Steinhart, MD
President, Austrian Medical Chamber
Vienna, Austria
j.steinhart@aerztekammer.at
Interview with National Medical Associations’ Leaders of the European Region
49
Patient safety, defined as “a framework
of organised activities that creates
cultures,processes,procedures,behaviours,
technologies and environments in
healthcare that consistently and
sustainably lower risks, reduce the
occurrence of avoidable harm, make
errors less likely and reduce the impact of
harm when it does occur”,underpins the
foundation of global health systems
[1]. Health professionals, who adhere
to the “first, do no harm”(primum non
nocere) ethical principle, understand
their indispensable role in leading
and contributing to high-quality
healthcare services that improves
patient outcomes. However, common
adverse events can include diagnostic
or medication errors, nosocomial
infections, and unsafe clinical or
surgical procedures (including blood
transfusions), leading to more than
three million annual premature
deaths [1].
Over the past two decades, global
leaders have developed and adopted
robust policies to guide health
professionals in the delivery of
high-quality healthcare services. In
2002, the World Health Assembly
(WHA) approved the WHA 55.18
(Quality of care: patient safety),
to encourage Member States to
establish evidence-based approaches
to improve healthcare service delivery
[2]. In 2004, the World Health
Organization (WHO) launched the
World Alliance for Patient Safety,
to offer a platform for global health
stakeholders to share resources and
collaborate on important patient
safety initiatives aligned with
six main action tracks (global
patient safety challenge, patients
for patient safety, reporting and
learning, research, solutions,
taxonomy) [3]. Subsequently, in
2009, the WHO published an
international conceptual framework
for patient safety to improve the
collection and organisation of patient
safety data (e.g. incident type and
characteristics, patient characteristics
and outcomes, contributing
factors and hazards, organisational
outcomes, detection, mitigating
factors, ameliorating actions, actions
taken to reduce risk) for analytical
purposes [4].
Notably, the WHA adopted the
resolution WHA 72.6 (Global action
on patient safety) in 2019, which
established World Patient Safety
Day annually on 17 September [5].
The past two themes – “Engaging
Patients for Patient Safety” for
2023 and “Improving Diagnosis
for Patient Safety” for 2024 –
have underscored patient safety
as a collaboration between health
professionals and patients and have
encouraged the continued dialogue
on existing barriers to achieving
patient safety and high-quality
healthcare services [6]. The Global
Patient Safety Action Plan 2021–2030,
launched in 2021, was comprised of
seven strategic objectives: 1) engage
patients and families as partners in
WMA Members Highlight National Initiatives
to Safeguard Patient Safety
WMA Members Highlight National Initiatives to Safeguard Patient Safety
Credit:
PeopleImages.com
–
Yuri
A
/
shutterstock.com
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50
safe care; 2) achieve results through
collaborations; 3) analyse and
share data to generate learning; 4)
translate evidence into actionable and
measurable improvement; 5) base
policies and action on the nature of
the care setting; 6) use both scientific
expertise and patient experience to
improve safety; and 7) instil a safety
culture in the design and delivery of
healthcare [7]. To support this action
plan, the WHO launched the Patient
Safety Rights Charter and the Global
Patient Safety Report 2024, which
outlines patients’ rights and offers a
comprehensive review and evaluation
of national patient safety initiatives,
respectively, in 2024 [8,9].
Health leadership and sustainable
political investment are crucial
to develop multidisciplinary and
multisectoral approaches to reinforce
health systems and support shared
decision-making between health
professionals and patients in
healthcare service delivery. In this
article, physicians from 14 countries
– Argentina, Côte d’Ivoire, Ecuador,
India, Kenya, Myanmar, Nigeria,
Philippines, Rwanda, South Africa,
Taiwan, Uganda, Uruguay, and
Yemen – offered insight on local
and national initiatives that
highlight the need for robust
patient safety practices across four
geographic regions. They described
relevant public policies, community
engagement activities, and
professional development trainings
to empower health professionals and
patients alike across global health
systems.
Argentina
The Argentina health system, which
supports 44 million residents, does
not collect reliable statistics on
patient safety and errors, due to
limited infrastructure for monitoring
adverse health events as well as health
professionals’ general reluctance to
report such errors. Health institutions
must adopt a culture of patient
safety to reduce and prevent patient
safety errors, offering continuing
education opportunities for health
professionals to refine their clinical
skills, avoid diagnostic errors that are
underestimated, including hospital-
acquired infections. Aligned with the
theme associated with World Patient
Safety Day 2024, improving health
professionals’ diagnostic capabilities
can help avoid preventable errors that
lead to harm, disability, mortality,
and affiliated malpractice lawsuits.
Over the past decade, the Argentina
Ministry of Health has strived to
develop relevant legislation and
guidelines that promote patient
safety.First,the National Program for
Quality Assurance in Medical Care
(Programa Nacional de Garantía de la
Calidad de la Atención Médica) was
adopted by Secretarial Resolution No.
432 (Resolución Secretarial N°432)
in 1992, endorsed by the National
Executive Power (Poder Ejecutivo
Nacional, PEN) Decree No. 1424
(Decreto PEN Nº1424) in 1997, and
ratified by the PEN Decree No. 178
(Decreto PEN N°178) in 2017 [10,11].
These laws called for the development
of high-quality instruments to assess
quality management and patient
safety [10,11]. Second, the Actions
for Patient Safety in the Healthcare
Field (Acciones para la Seguridad
de los Pacientes en el Ámbito de la
Atención Sanitaria) was adopted in
2019 and updated in 2021, followed
by the Tools for Self-Assessment of
Good Practices for Improving Quality
in Healthcare Services (Herramienta
para la Autoevaluación de Buenas
Prácticas para la Mejora de la Calidad
en los Servicios de Salud) in 2021,
presenting tangible measures to
enhance healthcare service delivery
and ultimately patient outcomes
[12,13]. Third, the Manual of
Patient Safety (Manual de Seguridad
del Paciente) was published in July
2022, providing concrete strategies
and actions for organisational
strategies in patient safety as well
as proposed indicators for program
evaluation [14].
COMRA supports all initiatives
that seek to prioritise patient safety,
as a fundamental step in the design,
execution, and evaluation of national
and global health systems. We
believe that healthcare professionals
must help prevent incidents by
making appropriate decisions that
avoid unnecessary risks to patient
safety in the clinical and community
workplace. As health leaders improve
monitoring systems for adverse event
reporting across institutions, they can
design evaluation tools to identify
gaps and address any limitations
in reporting schemes. We can also
develop capacity building
workshops that can facilitate
knowledge sharing as well as
establish a culture of continuous
learning and interdisciplinary
teamwork that prioritises patient
care.
Côte d’Ivoire
The Republic of Côte d’Ivoire, a sub-
Saharan African nation of 30 million
residents, shares its border with five
countries (Burkina Faso, Ghana,
Guinea, Liberia, Mali) and the Gulf
of Guinea has an abundance of natural
resources (e.g. copper, diamond,
gold, petroleum) and agricultural
crops (e.g. cocoa beans). Since
the first (2002-2007) and second
(2010-2011) civil wars, the nation
has experienced a rapid economic
growth to become classified as a low-
middle-income country. However,
poverty (35% of the population
living below the poverty line), food
insecurity and malnutrition (23% rate
of stunting), and gender inequalities
remain significant challenges for
health leaders [15]. In 2015, the
Government of Côte d’Ivoire
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51
launched the universal healthcare
program, and more recently has
established mobile enrollment
centres to expand access across
the nation [16]. For this reason,
healthcare professionals in the
country recognise World Patient
Safety Day as a unified global
commitment to minimising risks
and preventing harm in healthcare
settings as well as ensuring that every
patient receives safe and effective care.
Overthepastdecade,theGovernment
of Côte d’Ivoire has implemented
several initiatives to promote patient
safety across the population. First,
the implementation of the National
Health Development Plan (Plan
National de Développement Sanitaire,
PNDS) was adopted in 2011, and
then updated in 2015 and 2021, as
a comprehensive plan with specific
measures aimed at improving patient
safety (e.g. enhancing the quality
of healthcare services, increasing
access to essential medicines,
strengthening health infrastructure)
[17]. Second, the Ministry of
Health, in collaboration with various
non-governmental organisations, has
launched community campaigns to
educate the public on promoting safe
practices (e.g. proper medication use,
infection prevention, importance of
seeking timely medical care), as well
as seek to reduce common healthcare-
associated infections and improve
patient outcomes. Finally, use of
mobile technology, social media
platforms, and digital health tools
serve as a platform for sharing best
practices, reporting safety incidents,
and educating both healthcare
providers and the public about the
importance of patient safety [18,19].
As physicians in the Ivory Coast, the
African continent, and the world,
our call to action is clear: we must
advocate for and implement robust
patient safety practices at every
level of healthcare delivery. First, we
must promote a culture of safety by
encouraging open communication
among healthcare teams, patients,
and their families to ensure that safety
concerns are addressed promptly and
effectively. Second, all healthcare
professionals should receive regularly
training on the latest safety protocols
and best practices in patient care.
Third, health leaders should advocate
for policies that support resilient
health systems capable of responding
to emergencies and daily healthcare
challenges, without compromising
patient safety. Finally, partnering
with international and regional
organisations can offer a global
platform to exchange knowledge
and resources that can help improve
patient safety. Together, by making
patient safety a priority,we can ensure
that healthcare is safe for everyone,
everywhere.
Ecuador
World Patient Safety Day holds
significant importance for physicians
in Ecuador,as it highlights the critical
need to address gaps in patient safety
within our healthcare system. While
global patient safety initiatives are
recognized, Ecuador faces unique
challenges, such as limited resources
and varying levels of healthcare
quality across regions. According
to the WHO, 134 million adverse
events occur annually due to unsafe
care in hospitals, particularly in
low- and middle-income countries,
resulting in 2.6 million deaths [9].
The IBEAS study was conducted
across selected Latin American
countries (Argentina, Colombia,
Costa Rica, Mexico, and Peru) to
assess the prevalence of adverse
health events in hospitals, building
on the ENEAS study (involving
Spain) [20]. Without comprehensive
data reports on patient safety
incidents in Ecuador and the wider
Latin America and Caribbean
region, which directly impede the
development of targeted interventions
and policies, more robust patient
safety monitoring and reporting
systems should be established and
tailored to the needs of the Ecuador
healthcare system.
To address this burden, the Ecuador
Ministry of Health has implemented
numerous initiatives to promote
patient safety. First, leaders have
implemented the use of care audits
as an independent mechanism to
investigate patient harm, which is a
step toward improving accountability
and care standards [9]. Second,
they have developed patient safety
guidelines aligned with international
standards, including the Patient
Safety Manual in 2016, which aims
to improve care quality and reduce
adverse events [21]. Third, they have
integrated patient safety education
modules into the medical and nursing
school curricula, which can foster a
safety culture from early academic
training before clinical rotations.
Fourth, healthcare professionals
– including doctors, pharmacists,
dentists, nurses, midwives, as well
as patients themselves – can report
suspected adverse drug reactions,
therapeutic failures, medication
errors, and events supposedly
attributable to vaccination or
immunization through a web portal
managed by the National Agency
for Health Regulation, Control, and
Surveillance (ARCSA) [22]. Finally,
the emergence of patient advocacy
groups, although primarily focused
on specific conditions like cancer,
has the potential to evolve into
broader patient safety movements, as
observed with patients participating
in safety protocol role-playing
exercises in Spain. However, despite
these robust initiatives, more
attention to government policies and
public awareness campaigns must
expand these efforts.
As Ecuador physicians, our call
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to action remains to actively build
a patient-centred safety culture
that adheres to established safety
protocols and advocates for creating
national patient safety registries
and improved communication
strategies with patients. We must
prioritise health professionals’
training on delivering difficult
news with empathy to patients and
their families, recognizing that our
approach to health communication
can significantly impact clinician-
patient rapport, patients’ adherence
to clinical recommendations,
and overall patients’ physical and
mental health outcomes. Moreover,
fostering a collaborative environment
where patients are seen as integral
healthcare team members can
continue to strengthen the clinician-
patient relationship. By empowering
patients with accurate knowledge and
ensuring their active participation in
their care, we can enhance trust and
improve safety outcomes, ultimately
leading to a healthier and more
resilient healthcare system.
India
Since the United Nations reported
that India had the world’s largest
population (1.429 billion residents)
in 2023, when compared to China’s
population (1.426 billion residents),
this demographic trend presents
additional challenges for the national
health system, including primary
care services and patient safety [23].
Over the past 75 years, independent
from British rule, national health
leaders have successfully strengthened
health indicators (including reducing
maternal and child mortality rates)
[24]. With significant disruption
to healthcare services during
the coronavirus disease 2019
(COVID-19) pandemic, leaders
implemented successful vaccination
campaigns, supported digital
technologies and telemedicine
consultations, and established more
than 250,000 Health and Wellness
Centres [24]. As leaders continue to
scale-up and strengthen the health
system to address emerging health
risks, they recognise the health
burden of adverse reactions (e.g.
hospital-acquired infections, unsafe
surgeries and medications, faulty
medical devices) can affect millions
of patients each year, leading to
increased health expenditure, lack of
trust within health institutions, and
potential demoralisation and burnout
of health professionals [25].
As patient safety has gained
increasing attention in India, several
initiatives have adopted to enhance
patient safety across the health
system. In 2018, the India Ministry
of Health and Family Welfare
launched the National Patient Safety
Implementation Framework 2018-
2025 (NPSIF), a comprehensive
guideline and roadmap with six
objectives, 21 priorities, and 81
interventions, toward strengthening
patient safety at all levels of
healthcare service delivery [26]. This
document covers legal aspects, quality
assessments, workforce development,
infection control, and research,
aiming to reinforce institutional
frameworks, build a competent health
workforce, and establish reporting
systems of adverse effects. Also, over
the past decade, the Government
of India has established regulatory
bodies and legislature to monitor and
implement patient safety initiatives,
including the National Accreditation
Board For Hospitals and Healthcare
Providers (NABH) in 2005, National
Accreditation Board for Testing and
Calibration Laboratories (NABL)
in 1982, National Health Systems
Resource Centre (NHSRC) in 2007,
as well as the Clinical Establishments
Act of 2010, Pharmacy Practice
Regulations of 2015, and the Drug and
Cosmetics Act of 1940.
The Indian Medical Association
(IMA), in collaboration with the
Patient Safety and Access Initiative
India Foundation (PSAIIF), adopted
the Bangalore Declaration on 30
June 2024, which aimed to bridge
gaps and enhance collaborations
between doctors and patients across
the nation. IMA members believe
that all physicians have an obligation
to advocate for patient safety and
should collectively address existing
challenges, including limited health
system infrastructure (including
health workforce shortages) and
incompliance with evidence-based
clinical protocols (including infection
prevention and control) [27]. We
recognise the urgent need for robust
patient safety initiatives, including
offering continued education courses
on clinical guidelines and research for
health professionals and accelerating
the use of digital health technology
for reporting adverse events in health
institutions.
Kenya
Patient safety remains a critical
challenge in Kenya, with adverse
events affecting three in 10 patients
in hospital care settings [28]. Despite
having strong clinical policies and
documentation, the Kenya Ministry
of Health faces significant challenges
with their implementation, including
high unemployment among doctors
and insufficient training for health
professionals, which ultimately
impede patient safety initiatives
and quality of care for the Kenyan
population. One national study
reported that suboptimal systems
hindered the prompt identification
of critical illnesses, limited resources
for continuity of care, and disrupted
the flow of care, as major causes of
the delays in the healthcare service
delivery in Kenya’s public hospitals
[29]. These findings highlight the
need to reinforce strong clinical
policies related to standardised
effective and reliable healthcare
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priorities in Kenya.
The Kenya Ministry of Health,which
envisions a nation where safety and
quality are valued and promoted, has
launchedsignificanteffortstopromote
patient safety for 51 million residents.
First, leaders adopted the National
Policy on Patient Safety, Health Worker
Safety, and Quality of Care in 2022,
which is rooted in the Constitution
of Kenya 2010, Vision 2030, and the
Kenya Health Policy 2014-2030, aims
to ensure the provision of respectful
and responsive quality healthcare
for a healthy, productive, and
globally competitive country [29].
Second, Kenya prioritizes universal
health coverage (UHC), to provide
every citizen with access to quality
healthcare services without financial
difficulties or undue burden. Thus,
the policy emphasises strengthening
governance, protecting patients
from avoidable harm, ensuring
health professionals’ well-being, and
maintaining high-quality healthcare
services.TheKenyaCommunityHealth
Strategy, recognized as one of the key
initiatives for UHC implementation,
emphasises preventive measures by
recognising that community health is
the foundation of healthcare delivery
and providing policy direction for
community health services [30].
Kenya has robust community health
units (serving defined geographical
areas) that are supported by
community health assistants and
volunteers who provide promotive,
preventive, basic curative and
rehabilitative services.
To improve patient safety strategies,
the Kenya Ministry of Health
should enforce compliance with
international safety standards,
enhance healthcare professionals’
employment practices, and
strengthen medical licensing and
accreditation systems. Investing
in healthcare infrastructure and
continuous professional development,
particularly at the community level, is
crucial to improving patient outcomes,
reducing medical errors, and building
a resilient healthcare system. This
approach will ensure that healthcare
providers are equipped with up-to-
date skills and resources, enhancing
the quality of care delivered across all
healthcare system levels. Additionally,
prioritising community-level
interventions will empower local
health professionals and promote
patient safety from the ground up,
fostering a culture of accountability
and excellence in healthcare delivery.
To further enhance these efforts, the
Kenya Ministry of Health should
actively seek collaborations with
other African countries to share
best practices, innovative solutions,
and regional safety standards. By
working together, African nations
can collectively strengthen their
healthcare systems, address common
challenges,and drive progress towards
achieving safer and more efficient
care for all patients.
Myanmar
In Myanmar, patient safety initiatives
supported by the National League
for Democracy (NLD) government
leadership have been promising.
Based on recent patient safety baseline
assessments and recognition of
patient safety champions in 2018,
Myanmar’s State Counsellor Daw
Aung San Suu Kyi has led efforts
to increase medical standards in
public hospitals and improve patient
safety including blood transfusions,
immunisations, and surgical
procedures. The Ministry of Health
and Sports was drafting a new
National Health Policy in 2021, to
replace the 1993 policy, with patient
safety as one of the nine areas one,
when the Myanmar’s military and
security forces systematically attacked
civilian hospitals and clinics [31].
These Myanmar military and security
forces indiscriminate violence and
bombings have resulted in widespread
casualties, with over 18.6 million
persons seeking humanitarian need
(including 2.8 million internally
displaced persons) [32]. With
overburdened healthcare facilities
for war-related injuries and routine
medical care, this violence has
resulted in serious injuries and long-
term health consequences, including
increased health expenditure on
physical and mental health challenges
[33,34].
The Myanmar junta forces have also
established blockades and restricted
access to critical medical supplies
and humanitarian relief, which
have discouraged Myanmar health
professionals, local aid workers, and
volunteer humanitarian responders
from saving lives on the frontlines
[35]. They have demolished
important roadways that connect
varioustownsandcities,whichhinders
access to healthcare institutions
[36]. This forced displacement,
resulting in huge numbers of refugees
living in transitory, overcrowded,
and unhygienic circumstances,
can promote infectious disease
transmission and challenge to
provision of effective healthcare to
patients.
To address patient safety concerns,
leading international organisations
like the United Nations, World
Medical Association (WMA), and
Junior Doctors Network should take
immediate action beyond issuing
statements and declarations.They can
help provide essential medicine and
equipment directly to local frontline
humanitarian responders, including
ethnic civil society and community-
based organisations, via locally led
cross-border channels. These efforts
can help repair and restore destroyed
hospitals and clinics, ensuring that
medical facilities have adequate
equipment, supplies, and reliable
power and communication supply.
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Also, they can provide continued
education courses and training
(including relevant mental health
resources) to Myanmar healthcare
professionals, so that they can
effectively manage emergency and
trauma care and other conflict-related
health issues.
Nigeria
Patient safety is essential for effective
healthcare delivery across the world,
and although the African continent
is comprised of low- to high-income
nations, many remain challenged
to meet patient safety standards
[37]. The Nigerian health system,
serving 195 million residents, has
reported inadequate resources,
poor administrative regulations,
insufficient training opportunities in
patient safety for health professionals,
obsolete medical equipment and
supplies, and limited technologies
incorporated into healthcare visits
[38]. Notably, two studies across
Nigeria have reported poor healthcare
professionals’ adherence to patient
safety measures. First, in one hospital
in Enugu (eastern Nigeria), 51%
of surveyed surgeons perceived
poor patient safety during surgical
procedures and 38% regularly used
available institutional protocols
(including 11.3% to prevent wrong-
site surgery). A positive correlation
was associated with the duration of
surgical practice and their perception
of patient safety [39]. Second, in four
public hospitals in Kaduna (northern
Nigeria), 55% of participating
health professionals (doctors, nurses,
pharmacists) responded positively
that they consistently use strategies
that enhance patient safety, 36.8%
frequently reported adverse events,
and 51.4% perceived that hospital
managers and administrators support
patient safety [40].
To address patient safety concerns,
the Nigerian Federal Ministry
of Health and Social Welfare
launched the National Policy and
Implementation Strategy on Patient
Safety and Healthcare Quality in 2023,
as guidelines to improve the safety of
all medical procedures and enhance
the quality of healthcare delivery [41].
Also, health leaders have directed
significant efforts to educate health
professionals and the general public,
including regular participation in
World Patient Safety Day events. In
2023, the Nigeria Federal Ministry
of Health and Social Welfare, in
collaboration with the Dr. Aneyo
Stella Adadevoh Health Trust
(DRASA), organised a public walk
and public press briefing session as
well as a two-day review workshop
on policies and implementation
strategies that promote patient safety
in Nigeria.
As Nigerian physicians, we should
collectively enforce current patient
safety policies and advocate for new
government policies, strategies,
and initiatives that expand health
sector funding, strengthen infection
prevention and control measures,
and reinforce the implementation of
clinical guidelines through regular
clinicalaudits.Also,healthinstitutions
and professional medical and nursing
associations can develop capacity
training sessions on best practices in
patient safety,as part of the continued
professional development for all
health professionals. This national
call for patient safety should be a
priority for all health professionals
across Nigeria, encouraging medical
professional associations and
societies to collectively contribute
to minimising medical errors and
empowering patients as active
recipients of healthcare services.
Philippines
World Patient Safety Day calls on
Filipino physicians to prioritize
patient safety, address gaps in
healthcare service delivery, and
enhance the quality of healthcare
services. In the Philippines, existing
healthcare system challenges include
high patient-nurse and patient-
physician ratios, limited medical
supplies, insufficient safety incident
reporting systems, and inconsistent
opportunities for professional
training on pressing health topics,
all of which directly impact the
quality of healthcare service delivery.
Hence, the celebration of this day
establishes a space for exchanging
ideas, best practices, and updates to
encourage collective involvement
of patients and health professionals
in ensuring safe and high-quality
patient-centered care.
To promote patient safety and harm
reduction, the Philippine College of
Surgeons implemented the WHO’s
Safe Surgery Saves Lives program
in 2008. By 2010, the adoption of
the Safe Surgery Checklist was still
low, however, and compliance rates
ranged from 0.15% to 3.6%. In
fact, hospitals with lower checklist
utilization experienced higher
mortality rates [42]. Similarly, clinical
misdiagnoses among urban obstetric
providers were estimated at 30%
in 2016, and specifically 25% for
cephalopelvic disproportion, 33%
for postpartum hemorrhage, and
31% for pre-eclampsia conditions
[43]. Despite the establishment of a
national pharmacovigilance system in
1994, researchers explored the use of
text-based versus traditional paper-
based systems to report adverse drug
reactions for resident physicians in
a tertiary-level hospital in Manila,
concluding that paper-based
systems were preferred due to fewer
challenges (e.g. proper reporting
syntax, internet connectivity) [44].
With additional support from the
Department of Health (DOH),
many hospitals across the country
reported notable improvements in
achieving patient safety goals by
2018 [45].
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The National Center for Patient
Safety, within the Government of
Philippines’ DOH, launched the
Safe Care Initiative in 2018, which
supported health professionals’
training, development of safety
protocols, and auditing to improve
patient safety. In 2008, the DOH
established the National Policy on
Patient Health (Administrative Order
No. 2008-0023), and later released
the Revised Guidelines on Continuous
Quality Improvement (Administrative
Order No. 2020-0034) in 2020, to
ensure patient safety in healthcare
facilities [46,47]. In observance of
World Patient Safety Day 2023,
the DOH promoted the “Engaging
Patients for Patient Safety; Elevate
the Voice of Patients!” theme to
underscore the importance of patient-
centred healthcare and decision-
making, diversity and inclusion
within the healthcare system, and the
need for essential partnerships with
medical professionals to create a safe
healthcare environment for everyone
[48].
To support academic training on
patient safety for health professional
students, trainees, and specialists,
the Philippine Medical Association
(PMA) and the Philippine Nurses
Association (PNA) offer workshops,
webinars, and professional
development programs on patient
safety. The Philippine Alliance for
PatientSafety(PAPS)hoststheannual
National Patient Safety Congress,
and the Philippine Alliance of
Patient Organizations (PAPO) is
actively involved in policymaking,
as part of the Health Technology
Assessment Council, ensuring
the adoption of safe and effective
healthcare technologies and
medicines. Finally, the Philippine
Coalition Against Fake Medicines
(PCAFM) and the Safe Medicines
Network(SMN)aretwomultisectoral
coalitions that lead advocacy efforts
for strong legislative protections
that combat counterfeit drugs and
enhance medication safety across the
nation.
As World Patient Safety Day
emphasises the importance of patient-
centred care and advocacy for patient
safety standards, Filipino physicians
view this moment as an opportunity
to reaffirm their commitment to
promote patient-centred care in a
safe and effective healthcare system.
Therefore, Filipino physicians are
urged to adopt and promote patient
safety protocols, utilise systems for
reporting and learning from adverse
events, and engage in continuous
training in patient safety. Specifically,
they can collaborate with regional
and international organisations and
advocate for stronger health policies
that prioritise safety across the
Philippines, Asia, and the globe.
Rwanda
In Rwanda, physicians recognise
that patient safety is an integral
part of high-quality healthcare
service delivery, which must support
sustained vigilance, foster a culture
of continuous improvement, and
promote health professionals’
adherence to best practices and
standards designed to protect
patients’ health and well-being
[49,50]. Although no published data
on adverse events exist at the national
level, individual hospitals submit
incidentreportsthathelpshedlighton
the burden of adverse events,which in
turn can inform government policies
and strategies on patient safety.In one
recent study conducted with hospital
managers from 47 public hospitals in
Rwanda, authors concluded that the
prevalence of adverse events and other
incidents was less than 1%, namely
due to adverse drug incidents (25%),
loss to referrals and follow-up (25%),
and surgical site infections (20%)
[51]. Together with other countries,
Rwandan health leaders recognise
and celebrate World Patient Safety
Day every year, to represent a shared
commitment to ensuring that each
patient receives safe and quality care
across health institutions [52,53].
To prevent unintended harm or
adverse consequences to patients and
their community, Rwandan leaders
have developed strategies, policies,
and initiatives to improve and advance
patient safety. First, the Rwanda
Fourth Health Sector Strategic Plan
was launched in 2018, with strategic
emphasis on quality and people-
centred healthcare as a foundation for
promoting patient safety [50]. Each
hospital has pharmacovigilance and
drug and therapeutic committees,
which are instrumental to monitoring,
reporting, and overseeing initiatives
that prevent harm due to unintended
adverse reactions from medications
[49]. Second, the Rwanda Ministry
of Health developed Patient Rights
Charters and mandated the public
display of patients’ rights to care
in all health facilities, in efforts to
ensure transparency and trust in
health services. Third, the Ministry
of Health initiated the hospital
accreditation process in 2012, first
with referral hospitals and then all
health facilities, as a mechanism for
improving quality and accountability
as well as patient satisfaction [52].
Leaders established customer care
services in all hospitals to support
the timely responses to patient
concerns, allowing patients to give
feedback on service received as well as
anonymous reporting of unpleasant
experiences, which can objectively
inform improvement efforts. Finally,
stakeholders representing the local
government, non-government
agencies, and civil societies supported
capacity building on professional
ethics and patient rights, such as
the Health Development Initiative
(https://hdirwanda.org/) as a local
non-governmental organisation
that recently organised an inter-
professional workshop on patients’
rights.
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Rwandan leaders understand
that ensuring patient safety is a
continuous process, noting that
there are always risks associated with
medication errors and healthcare-
associated infections [50]. Despite
robust measures to improve quality of
care and minimise healthcare-related
risks to patients, Rwandan health
leaders call for reinvigorated efforts
to collaborate with all stakeholders
to implement more systemic changes
that prioritises patients’ interests.
As Rwandan physicians understand
their critical role and contributions
to upholding and safeguarding the
fundamental “do no harm” principle,
they call for continued investment in
actions that further promote patient
safety. Such efforts can include
designing comprehensive initiatives
for patient and community education
and empowerment, improving
safety within the clinical workplace,
requiring rigorous monitoring
of incidents and transparency
in adverse event reporting, and
promoting positive physician-patient
communication. Rwandan physicians
agree that they can educate and
encourage patients to contribute to
community-wide advocacy efforts
that hold the healthcare system
accountable for the implementation
of evidence-based safety measures.
They also highlight that self
reflection and continuous medical
education are essential ingredients
for cultivating behaviour change in
the clinical setting and commit to
increased vigilance and adherence
to clinical policies and guidelines
(including standard operating
procedures) that protect patient safety
across health institutions.
South Africa
Patient safety incidents often result
from poorly implemented safety
policies and a culture that overlooks
patient safety in the public health
sector and human error in high-risk
interventions in the private sector
[54]. In South Africa, patient
safety within the health sector is
comprised of protection for medical
and surgical procedures as well as
physical health and well-being. First,
although evidence-based guidelines
are followed by health professionals
in clinical practice, ranging from
prescribingmedicationstoperforming
surgical procedures, adverse events
may occur resulting from procedures
or infection [54]. In fact, medico-
legal liabilities in South Africa were
reported to exceed US$5 billion in
2020, with a 30% annual growth
rate, in the public sector, while the
criminalisation of medical errors has
become rampant in the private sector
[55,56]. Second, the physical safety of
patients and health professionals has
been affected by robbery in medical
facilities across the country, leading
to physical and psychological trauma
[57].
To maintain high-quality patient
safety management across the nation,
three leading stakeholder institutions
manage the administrative and
policy requirements. First, the South
Africa Department of Health (DoH)
manages quality improvement
through the National Health
Quality Improvement Plan, as well as
implementation of the Ideal Clinic
and the Ideal Hospital Frameworks
(https://www.idealhealthfacility.org.
za/).Second,the Office of Healthcare
Standards (OHSC) (https://ohsc.
org.za/) helps develop regulations
for patient safety, inspections and
enforcement, and health facility
certifications, to support quality
healthcare assurance. Finally, the
Office of the Health Ombud, which
is directly linked to the OHSC,
leads investigations of reported
patient safety incidents across health
facilities. All reported incidents
adhere to the National Guideline for
Patient Safety Incident Reporting and
Learning in the Health Sector of South
Africa, which represents collaborative
efforts on patient safety between the
DoH, OHSC, and the Office of the
Health Ombud [58].
To promote the culture of patient
safety culture in South Africa and
the wider African continent, it is
imperative for all health professionals
to understand the evidence-based
clinical guidelines that are appropriate
for their daily clinical responsibilities
to patient care. Continuous
professional development on the best
practices for infection control and
adverse event reporting, coupled with
health system financing for products
and supplies, can equip health
professionals with the knowledge
and tools to uphold administrative
policies. Since inadequate security
systems in health facilities can impact
patient safety, security assurance
models for healthcare should be
developed to improve the safety of
patients seeking healthcare in public
and private facilities in South Africa
[57].
Taiwan
The Patient Safety Committee of
the Taiwan Ministry of Health and
Welfare has continued to lead robust
patient safety initiative across health
institutions for over three decades.
In 1999, the Ministry of Health
and Welfare (previously recognised
as the Department of Health until
2013), Taiwan Hospital Association,
Taiwan Non-Government Hospitals
and Clinics Association, and Taiwan
Medical Association established the
Joint Commission of Taiwan (JCT)
(https://www.jct.org.tw/mp-2.html),
to promote patient safety through
the delivery of quality of healthcare
services. This initiative led to the
establishment of the Taiwan Patient
Safety Reporting System (TPR) in
2005, as an anonymous, voluntary,
confidential, and collaborative
learning-based medical accident
WMA Members Highlight National Initiatives to Safeguard Patient Safety
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57
reporting system in Taiwan [59].
Specifically, a total of 16,043
facilities (including clinics) have
joined the TPR in Taiwan, and an
estimated 957,310 adverse events
were reported between 2005 and
2022 [60]. After the launch of the
Taiwan Patient Safety Culture Survey
Project in 2009, the JCT highlighted
the improvement of patient safety
indicators in community and regional
hospitals (including staff) from 2009
to 2016 [61].
Over the past decade, the Taiwan
Ministry of Health and Welfare has
adopted legislature and coordinated
national projects to address patient
safety concerns across health
institutions. First, the Childbirth
Accident Emergency Relief Act of
2015, namely Article 22, mandates
that health institutions establish
internal risk event management and
reporting mechanisms to analyse
the primary causes of significant
childbirth accidents, reduce the
risk of childbirth accidents, and
propose action plans [62]. Second,
the Medical Accident Prevention and
Dispute Resolution Act of 2022, which
was enacted in 2024, requires the
prompt reporting of any significant
harm or death resulting from medical
errors for subsequent evaluation
by authorities. This policy aims to
promote an efficient medical dispute-
handling mechanism, harmonious
doctor-patient relationships, and
patient safety culture across health
institutions in Taiwan [63].
Furthermore, the Taiwan Ministry of
Health and Welfare has prioritised
three specific activities over the past
decade. In 2012, the Pilot Program
for Managing Childbirth Accident
Disputes was established, allowing
participating institutions to conduct
inspections and submit regular
quality reports. In 2022, experts
were invited to create checklists on
postpartum haemorrhage bundle care
and pregnancy-induced hypertension
and preeclampsia bundle care, based
on international obstetric care
models (including six key obstetrics
and gynaecology risk management
principles). In 2023, postpartum
haemorrhage educational leaflets
were designed to help healthcare
professionals and the general public
understand prenatal, intrapartum,
and postpartum care, and hence
aim to lower the risk of postpartum
haemorrhage and improve its clinical
management.
The Taiwan Medical Association
supports the ambitious goals of the
Taiwan Ministry of Health and
Welfare published in the Annual
Goals for Patient Safety, 2024-
2025 [64]. These goals include
enhancing healthcare teamwork and
communication (including clinician-
patient rapport and engagement
with families), improving surgical
and medication safety, ensuring
adherence to infection control
measures, preventing severe
injuries (including patient falls),
protecting vulnerable populations
(including pregnant women and
infants), and ultimately fostering
patient safety culture (including
reporting mechanisms of patient
safety incidents) [64]. As Taiwanese
physicians provide compassionate
care to over 23 million residents,
they recognise World Patient Safety
Day each year and collectively
focus on best clinical practices and
policies to improve patient safety and
clinician-patient engagement across
health institutions in Taiwan.
Uganda
In Uganda, health professionals
recognise World Patient Safety Day
as a day to reflect upon the “do no
harm” principle and discuss strategies
that can help improve patient safety
across health institutions. However,
the quality of healthcare is severely
compromised with high clinician-
patient ratios, including a doctor-
patient ratio of 1:25,725 and a
nurse-patient ratio of 1:11,000,
overburdened schedules, limited
documentation, and inadequate
healthcare infrastructure [65]. At the
same time, as healthcare services have
limited accessibility and availability,
long distances from communities,
and high costs, patients frequently
seek non-traditional services that
may contribute to self-medication
and unregulated herbal remedies. In
2014, one national report highlighted
that 5-20% and 28% of hospitalised
patients in Ugandan health
institutions had experienced adverse
drug reactions and hospital-acquired
infections,respectively [66].Common
medical errors were described
as delayed or failed diagnoses,
interoperative complications, and
accidental needle stick injuries [66].
Uganda leaders have undertaken
several initiatives to promote patient
safety for health institutions serving
the 45 million residents. First, the
Ugandan Patient Safety Symposium,
which was held in September 2018,
aimed to foster inclusive dialogue,
evaluate current and past patient
safety initiatives, and develop a
framework for future action [67].
Second, the Uganda Ministry of
Health, together with community
stakeholders, adopted the Patient
and Client Rights Charters in 2019,
as a legal and regulatory framework
to improve healthcare service delivery
and ultimately health indicators in
Uganda [68]. Third, the Uganda
Ministry of Health launched the
Health Facility Quality of Care
Assessment Program in 2020, to
ensure standard of care in hospitals
through quarterly evaluations, which
has been implemented in 85% of
the districts. Finally, the Patient-
Centred Care Movement Africa
(PaCeM-Afro), led by health
professional students and recognised
WMA Members Highlight National Initiatives to Safeguard Patient Safety
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58
at the 74th WHA in May 2021, has
continued to advocate for patient-
centred care through education,
research, and social media campaigns
[69].
As physicians across Africa and the
world, we must collectively advocate
for comprehensive patient safety
guidelines and policies, as well as
healthcare systems with Ministry
of Health oversight to ensure that
patients are free from harm and
avoidable risks. We can continue
to educate patients on their rights
and responsibilities and support
sustained health professionals’
training. Specifically, we can help
engage communities through the
Patient and Client Rights Charters,
and empower patients to work
collectively with health professionals
in the delivery of high-quality
health services across Uganda [68].
Uruguay
Over the past two decades, the
Uruguay Ministry of Health has
guided the patient safety initiatives
based on international data sources
(like the WHO), since national
reports have not examined incidence
and prevalence rates of adverse
health events. Taking the lead,
Uruguay leaders joined the WHO
Patient Safety Alliance in 2006,
and participated in the first global
challenge (“Clean Medicine is Safe
Medicine”) that promoted the
importance of optimal hand hygiene
practices in healthcare settings. To
support the initiatives of the national
health system, leaders adopted Law
18.995 (Ley 18.995) in 2012, which
ensure the annual recognition of
National Patient Safety Day on 14
April, in addition to the WHO’s
annual celebration of World Patient
Safety Day on 17 September [70].
However, with changing leadership
within the Ministry of Health,
widespread initiatives on patient
safety tend to be conducted annually
by non-governmental organisations
and professional associations, noting
that 14 April offers reflections on
patient safety and 17 September
provides formal activities to engage
audiences on patient safety.
Uruguay Ministry of Health leaders
contribute to strengthening the
national health system through
legislation and initiatives that
promote high-quality health service
delivery for its 3.4 million residents.
First, health leaders were using a
self-assessment and guidance tool,
adapted from the United Kingdom’s
National Health Service seven-step
tool, to evaluate institutional needs
and establish primary guidelines for
preparing and implementing patient
safety plans across institutions until
2019 [71]. Second, the Ordinance
660/2006 (Ordenanza 660/2006) of
the Ministry of Health was adopted in
2006, outlining that the Commission
for Patient Safety and Prevention
of Medical Errors (Comisión para
la Seguridad de los Pacientes y
Prevención del Error en Medicina,
COSEPA) has the responsibility of
strengthening the culture of safety
for health professionals, patients, and
their families in Uruguay [72]. They
also approved the Ordinance 804/022
(Ordenanza N° 804/022) in 2022,
which reinforced previous legislation
on patient safety and surveillance of
adverse events [73]. Finally, Uruguay
leaders conducted the first national
survey on the impact of disruptive
behaviours in the health sector to
over 4,000 health professionals from
the national health system in 2014,
noting the need to address the high
incidence of negative behaviours
(e.g. derogatory comments, anger
episodes) that hinder effective
teamwork, communication, and
safety for health professionals and
patients alike [74]. Although these
achievements have helped lead patient
safety efforts across the country,
evaluations related to the compliance
of patient security measures across
institutions have not been conducted
since 2019.
As Sindicato Médico del Uruguay
(SMU) members representing diverse
clinical and surgical specialties,
our call to action is to promote
the integration of safety protocols
into clinical management (“safety-
inspired clinical management”) of
all healthcare activities. Notably,
we recognised National Patient
Safety Day on 14 April 2024 (and
will commemorate World Patient
Safety Day on 17 September 2024),
as events that will help align our
local and national efforts to reduce
adverse events in health settings [75].
Uruguayan physicians, together with
our WMA colleagues,can continue to
lead efforts that empower the entire
healthcare team to prioritise high-
quality patient-centred care across
public and private sectors, as well as
directly involve family members in
the clinical decision-making process.
Yemen
For Yemeni physicians,World Patient
Safety underscores the urgent need
to address critical issues within the
healthcare system, which has endured
ongoing conflict and resource
shortages since 2015 [76].The WHO
has highlighted that preventable
medical errors are a leading cause
of harm to patients globally, and the
situation in Yemen is particularly
dire. The Yemen Ministry of
Population and Public Health
reported that hospital-acquired
infections and medication errors
were estimated at 20% and 15% in
2021, respectively, emphasising the
urgent need to improve patient safety
practices and infrastructure across the
nation [77,78].
Despite its challenging
circumstances, Yemenis leaders have
WMA Members Highlight National Initiatives to Safeguard Patient Safety
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59
adopted two significant policies and
initiated several efforts to improve
patient safety. First, Law No. 26 was
adopted in 2002, which criminalised
health professionals who refrained
from treating patients in emergency
or disaster response scenarios [79].
Law No. 4 was approved in 2009,
which dually defined roles and
responsibilities related to
infectious disease prevention and
control, criminalising actions that
intentionally hinder appropriate
reporting measures or increase risk of
disease transmission, and guarantee
patients’ rights to immediate medical
care in emergency scenarios [80].
Second, the WHO’s Safe Surgery
Saves Lives program was developed in
2009, aligning with WHO guidelines
to enhance surgical safety, and aimed
to standardise surgical procedures,
ensure proper sterilisation, and
train healthcare professionals in
best clinical practices. The National
Pharmacovigilance Program,
established in 2009, was designed to
monitor and evaluate adverse drug
reactions to improve medication
safety [78]. Finally, community
campaigns that promote hygiene
practices and vaccination adherence
have been fundamental in raising
public awareness and fostering a
culture of safety across the population.
Physicians in Yemen and across the
globe must take a proactive role in
enhancing patient safety, including
advocating for robust healthcare
policies, engaging in continuous
professional development, and
adhering to international safety
guidelines. Collaborations with
global health organisations can
provide essential support and
resources to strengthen Yemen’s
healthcare system. By emphasising a
patient-centred approach, physicians
can encourage patients to actively
participate in their care to reduce
errors and improve safety outcomes.
By fostering a culture of transparency,
accountability, and dedication to
excellence in patient care, physicians
can lead the way toward a safer and
more resilient health system for the
global population.
Conclusion
World Patient Safety Day 2024 offers
an opportune moment for global
health leaders to evaluate current
patient safety initiatives within health
systems, identify risks to adverse
events, and reinforce their political
commitment to promoting a safety
culture. Together, they can endorse
the Patient Safety Rights Charter
and collaborate on the
implementation of the seven
strategic objectives of the Global
Patient Safety Action Plan 2021–2030
across national health systems [8,9].
Using the “Improving Diagnosis for
Patient Safety” theme, they can also
incorporate evidence-based clinical
and surgical practices for patient-
centred care as well as support health
professionals’ engagement with
patients and families as partners in
healthcare service delivery [6]. By
reflecting on the “first, do no harm”,
health professionals can apply the
One Health concept to practise,
as they form robust strategic- and
operational-level partnerships with
health stakeholders and elucidate the
drivers of unsafe clinical practices and
patient harm.
With expertise across clinical and
surgical disciplines, WMA members
serve diverse leadership roles in their
academic and health institutions,
national medical associations, and
countries. They contribute evidence-
based research findings and expert
perspectives to national and global
discourse on an array of topics,
including patient safety, to reinforce
health system resiliency. This
collective article presents a valuable
overview of robust community
initiatives and policies that support
high-quality healthcare services,
essential partnerships with health
stakeholders, provider-patient
rapport and communication, and
public awareness, and hence optimal
patient outcomes. Specifically, it
highlights clear examples of timely
health leadership and political
commitment across the African,
Americas, Eastern Mediterranean,
and South-East Asian regions that
exemplify global solidarity and action
to promote patient safety.
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Authors
Shaif Al-Wajih, MBBS
Faculty of Medicine, 21 September
University (21UMAS)
Sana’a, Yemen
N’dri Anderson, MD
Psychiatry resident, Psychiatric
Hospital of Bingerville,
University Felix Houphouët
Boigny of Cocody
Chair person, JDN Ivory Coast
Abidjan, Republic of Côte d’Ivoire
Bonnke Arunga, MBChB
Convener, Social Responsibility
and Welfare Committee,
Kenya Medical Association
Nairobi, Kenya
R. V. Asokan, MBBS, MD
(Internal Medicine)
National President,
Indian Medical Association
New Delhi, India
Dabota Yvonne Buowari, MBBS
Department of Accident and Emergency,
University of Port Harcourt
Teaching Hospital
Port Harcourt, Nigeria
Maria Minerva Calimag,
MD, MSc, PhD
Departments of Pharmacology
and Clinical Epidemiology,
University of Santo Tomas,
Faculty of Medicine and Surgery
Manila, Philippines
Brian Chang, MD
Secretary General,
Taiwan Medical Association
Taipei, Taiwan
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
Jorge Coronel, MD
President, Confederación Médica de
la República Argentina (COMRA)
Buenos Aires, Argentina
Amuza Dhabuliwo, MBChB
JDN Member,
Uganda Medical Association
Clinical Lead, MariTest
Kampala, Uganda
Cheng-Chung Fang, MD
CEO, Joint Commission of Taiwan
New Taipei City, Taiwan
Associate Professor, Department
of Emergency Medicine, National
Taiwan University Hospital
Taipei, Taiwan
Mario Godino, MD
Member, Sindicato Médico del Uruguay
Montevideo, Uruguay
Herbert Luswata, MBChB,
M.MED (OB GYN)
President, Uganda Medical Association
Kampala, Uganda
Anilkumar J. Nayak,
MBBS, MS (Ortho)
Honorary Secretary General,
Indian Medical Association
New Delhi, India
Mhlengi Vella Ncube, PhD
Head, Unit for Health
Policy and Research
South African Medical Association
Pretoria, South Africa
65
WMA Members Highlight National Initiatives to Safeguard Patient Safety
BACK TO CONTENTS
Prima Maria Niwampeire,
MBChB, MPHc
JDN Member,
Uganda Medical Association
Member of the Founding
Council, Patient Centered
Care Movement, Africa
Kampala, Uganda
John Baptist Nkuranga, MD,
Med Paeds, MMASc GH
President, Rwanda Medical Association
Kigali, Rwanda
Maria de Lourdes Noboa-Lasso,
MD, MHA
General physician
Quito, Ecuador
Doctoral student, Department
of Occupational Safety and
Health, University of Porto
Porto, Portugal
Wunna Tun, MBBS, MD
Fellow, Medical Education
JDN Secretary
Yangon, Myanmar
Shivkumar Utture, MBBS, MS,
FICS, FMAS (Gen Surgery)
National Vice President,
Indian Medical Association
New Delhi, India