The document summarizes challenges facing comprehensive healthcare services and the role of family medicine in healthcare reform. It notes that 400 million people lack access to essential health services. Non-communicable diseases are a growing epidemic causing over 40 million deaths annually. Maternal mortality remains high in some regions. The population is aging in many developing countries. It argues for a healthcare system focused on primary care delivered by well-trained family physicians to improve health outcomes and control costs. Expanding family medicine training programs is a key part of the solution to addressing doctor shortages and achieving universal healthcare coverage.

1. Comprehensive HealthCare
Services:
Challenges Facing It
Prof Faisal Abdullatif Alnaser FPC, FRCGP, MICGP, FFPH, FAM (USA), 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
Faisal Alnaser 2019 1

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Famine: Over 17 million of Yemen's population are at risk
UN Food relieve agency 2017

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• 400 million people do not
have access to essential
health services.
Faisal Alnaser 2019
• 6% of people in low- and
middle-income countries
are pushed further into
extreme poverty because
of health spending.
WHO and World Bank Group

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.
World Health Organization, 2018
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Prevalence of high blood pressure among adults (≥25 years),
by sex, in selected countries
WHO, 2013
Youness El Achhab et al 2017

8. Faisal Alnaser 2019 8Diabetes Epidemic WHO, 2014

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Tawfiq Khoja et al 2017
Prevalence of obesity in Gulf Cooperation Council (GCC).
Alhamad N etal 2015

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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
67.757.0
Islamic Republic of
Iran
7956.4Bahrain
5679Kuwait
41.043.8Egypt
74.942.5
Libyan Arab
Jamahiriya
43.540.5Oman
21.737.2Morocco
39.925.5United Arab Emirates
43.746.0Jordan
41.913.1Tunisia
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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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Expansion of universal health coverage
in the EMRo Region
Is critical

14. 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

15. Improve Health
Responsiveness to needs
Financial Protection
And its Goals:
WHO C Centre, Imperial College London
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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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In UK:
•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
Source: Rawaf, Dubois, 2007 WHO Collaborating Centre, London
Cost of health services
In Bahrain:
•Heath center visit cost $ 14-25
•Hospital OPD visit cost $ 130 ( 500%)
•Admission per night cost $ 530-660
•Admission intensive care $ 1300
Alnasir F, 2009Health cost in the Arab World will rise
to 60 Billion within 10 yrs
WHO

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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.
Each One US$ spent in preventive care is equal
to 7 US$ in curative
www.gov.uk/government/publications, 2018

19. 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 Alnaser 2019

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Comprehensive and not disintegrated
Health coverage:
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Family Medicine
By A Well Trained
Family Physician

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• 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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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
Faisal Alnaser 2019

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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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Oman (POP 4.8) needs now 2400 FD

25. 50% of the
physicians’ work force
in any country should
be constituted of
Family Physicians.
Barbra Starfield
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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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Reiter Syndrome

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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

29. • 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.

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

31. Solution:
To focus on 4 areas:
• Policy makers, MPs and the
public
•The doctors (trainer & trainee)
•Training Centers/ Programs
•General
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Mariam’s Dx

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

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Thank
you
Family Doctor
leads the way
Faisal Alnaser 2019