There are many challenges facing against the full establishment of Family Medicine

1. Universal Health Coverage:
Challenges Facing Family
Medicine
Prof Faisal Abdullatif Alnaser
FPC, FRCGP, MICGP, FFPH, PhD
Imperial College London, UK
Chairman; Home Health Care Centre
General Secretary & Treasures; International Society
for The History of
Islamic Medicine
Temp Advisor for WHO EMRo
WONCA Direct Member
Former Chair; Dept. Of Family & Community Medicine
Former President; Scientific Council Family & Com. Medicine Arabian Gulf University
Former President Family & Community Medicine Council. Arab Board for Health Specializations
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Famine: Over 17 million of Yemen's population are at risk
UN Food relieve agency 2017

5. 5
• 400 million people do not
have access to essential
health services.
• 6% of people in low- and
middle-income countries
are pushed further into
extreme poverty because of
health spending.
WHO and World Bank Group
Faisal Alnasir 2018

6. NCD epidemic
Leading to serious
implications and a negative
impact on socioeconomic
development.
Kill 41 million people/year
(37% of them before the
age of 60). (It consist of 70%
of all deaths worldwide)
The anticipated deaths will
increase to 52 million in
2030. 6Faisal Alnasir 201
The prevalence is 26% affecting 125 million individuals.

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Prevalence of overweight and obesity in EMR countries
(WHO.2004)
Overweight +
obesity (%)
Country
FemalesMales
70.064.0Saudi Arabia
53.060.0Lebanon
67.757.0Islamic Republic of Iran
79.056.4Bahrain
5679Kuwait
41.043.8Egypt
74.942.5Libyan Arab Jamahiriya
43.540.5Oman
21.737.2Morocco
39.925.5United Arab Emirates
43.746.0Jordan
41.913.1Tunisia
Faisal Alnasir 2018

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In EMR:
Maternal mortality rate
remains high.
With 350 maternal deaths
occurring per 100 000 live
births.
(Maternal mortality in Somalia and
Afghanistan among the highest in
the world).
Regional Committee for the EMR
September 2008
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Ageing population:
The prevalence of people
above the age of 60 is
increasing in the developing
countries while almost
stable in the developed
world.
In Bahrain the anticipated
percentage will reach to
15% by the year 2025 and
25% by the year 2050.
Alnasir, 2011
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World Population Prospects – 2017 Revision

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Insufficient Health Workers:
Low and lower-middle income countries
need 18 million more health workers if
they are to achieve UHC.
Marie-Paule Kieny,
WHO Assistant Director-General, 2016
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Doctors’ Shortage is an invisible problem
CNBC 2015
The doctor shortage is real
Association of American Medical Colleges(AAMC)
The USA nation’s shortage of doctors will
rise to between 46,000 and 90,000 by 2025
Forbes March 2015
It is estimated that between 12,500 and
31,000 Primary Care Doctors will be
needed in the USA
Association of American Medical Colleges(AAMC)

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More than million people are registered
with a GP serving more than 3,000
patients(almost twice the average list size of 1,600).
Rowena Mason ,The telegraph December 2011
England has 25,000 FDs. But there are
growing concerns that the NHS faces a
retirement crisis.
One in eight GPs is planning to retire within two years.
Survey by the British Medical Association published in June 2011
,
In UK

13. What is the Ideal Health
System?
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Is the one that:
“Secure the Health of the
Whole Population”
WHO C Centre, Imperial College London

14. Improve Health
Responsiveness to needs
Financial Protection
And its Goals:
WHO C Centre, Imperial College London
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UK: NHS on the
5th November
2018 to change
the health
system strategy
from curative to
preventive
And allocated 20
billion sterling
pounds for that
purpose.

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Expansion of universal health coverage
in the EMRo Region is critical
Health cost in the Arab World will rise to 60 Billion within 10 years
WHO

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Comprehensive and not disintegrated
Health coverage:
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Family Medicine

18. Universal Health Coverage
Will not only improve the health of
millions, but will also contribute to
reaching many of the other
Sustainable Development Goals
(SDGs).
Marie-Paule Kieny,
WHO Assistant Director-General,2016
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By A Well Trained
Family Physician

19. Family Medicine is not
new.
Ancient doctors used holistic
approach while practicing
medicine.
Avicenna, Alrazi and other
implemented family medicine
concepts while caring for their
patients.
However, with the
disintegration of medicine into
various specialties and sub-
specialties this concept was
lost overtime
Alnasir Faisal ,2010
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20. • Family Medicine Should
Shape the Reform of any
Health System Not Vice
Versa.
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Barbara Starfield ,2009
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• Family physicians have
to be in the forefront of
any health care reform.

21. Health Care Reform
(With PHC Concept)
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Medical model Primary Health Care
 Illness  Health
 Cure  Prevention, care
 Treatment  Health promotion
 Episodic care  Continuous care
 Specific problems  Comprehensive care
 Individual practitioners  Teams of practitioners
 Health sector alone  Inter-sectoral collaboration
 Professional dominance  Community participation
 Passive reception  Joint responsibility
Barbara Starfield, Johns Hopkins University, 2009Faisal Alnasir 2018

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The optimal health care provision
SHC: Secondary Health care
THC: Tertiary Health Care
PHC: Primary Health Care
Alnasir F,2014
Family Medicine is the foundation of
any health system

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Well-trained FD is able to deal with
80% of health problems that affect
the human being, whether the
person is a child, adult, male or
female.
AUB Dept of Family Medicine
•Greater equity
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•Each one additional FD per 10,000
people is associated with a 5.3%
reduction in mortality.
Ian Scott, Goldis Chami CCFP

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Reiter Syndrome

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Cost of health services in Bahrain 2009
Heath center visit cost US$ 14-20
Hospital OPD visit cost US$ 130 ( 600%)
Admission per night cost US$ 530-660
Admission intensive care US$ 1300
Alnasir F, 2009
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Each One US$ spent in preventive care is equal to 7 US$ in curative

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Cost-Effectiveness (Intervention cost/case):
•Telephone Call £16
• Family Physician £15
• Walk-in-Centre £55
• FP with Special Interest £75
• Hospital Outpatient £150
• Day Care £500
• One-Day Admission £1,000
• Inpatient (2ndary Care) £5,000
• Tertiary Care £20,000
PHC
2 Care
3 Care
WHO Collaborating Centre, London Source: Rawaf, Dubois, 2007
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29. 50% of the
physicians’ work force
in any country should
be constituted of
Family Physicians.
Barbra Starfield
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30. • Establish by decision of the Arab Health
Ministers in Kuwait in February 1978
• Up to 2014 Only 1567 FDs have
graduated since its foundation 28 years ago.
ABHS 2014
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Arab Board for Health Specializations

31. • World-wide, the optimal
Family doctor/patient
ratio is 1800 people.
• With the realization that
its population is over 410
million, the Arab World
now needs more than
228000 FD specialists.
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32. Continuation at the current production
rate of Board qualified FDs by the
ABHS, (150 to 200 per year);
Arab countries would require
years
to have optimum number of
immediately required FDs!!!
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1138

33. Why there is shortage of
FDs?
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What is the solution?

34. Solution:
To focus on 4 areas:
•Policy makers, MPs and the public
•The doctors (trainer & trainee)
•Training Centers/ Programs
•General
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35. 1)Policy makers, MPs and the public:
 Importance of FM
 FM is the foundation of health services
 FM is the fifth specialty in Medicine
 Political determination to implement FM
 Increase budget pertained to FM (training, health centers)
 Increase public awareness about the importance
of FM.
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36. 2)-The Doctors
 knowledge of Family Medicine
 Interested in joining the program
 FD status is no less than other specialty
 Continuous medical education programs
 Self satisfaction (payment, rewards, working
environment)
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37. 3)-The Training Programs/Centers:
 Increase number of training programs
 Increase the capacity of existing ones
 Establish ideal training PHC centers
 Improve the work environment
 Increase the incentives to FD
 Opportunities for FD to acquire foreign
experience
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38. 4)-General:
 Increase number of medical schools and its
intake
 Establish departments of Family Medicine in
every medical school
 Adopt Community oriented curriculum
 Support Arab Board for Health Specialties
 Admire Arab Board Qualification do not
downgraded
 Intensive training programs for the existing
PHCs’ doctors
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Mariam’s Dx

41. Primary care everywhere in the
world is most of the care, for most of
the people, most of the time.
Barbara Starfield
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In conclusion

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Thank
you
Family
Doctor leads
the way
Faisal Alnasir 2018

43. Cost of a program with the intake capacity of 20 intake:
 Number of trainer to trainee 1 to 4 (Total 5 Trainers FD)
 Cost of 5 Trainers salary US$ 10500 x5= 52500 /month =630000/year)
 Cost of trainee (Monthly salary=US$ 2200x 20=44000 per month= 528000 per year)
 Arab Board fee US$ 250/candidate per year= 300 x20= 6000
 Administrative expenses US$ 100000 per year
 Total= 630000+528000+100000+ 6000= US$ 1264000
Cost per Graduate = 1264000/20= 63200x 4 years= US$252800
Per Year $63200
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