How to build resilient health systems, by Enabulele
The newly inaugurated President of, the World Medical Association (WMA), Dr. Osahon Enabulele, has pledged to help build resilient health systems globally.
Enabulele, a family health physician working at the University of Benin Teaching Hospital (UBTH) and former President of, Nigerian Medical Association (NMA), in his inaugural presidential address at the 73rd General Assembly of WMA in Berlin, Germany, last Friday, said, in building resilient health systems, the WMA will have to continue global solidarity in health, equitable access to vaccines and drug treatments, including research and development, appropriate investments in health infrastructure and well- being, and protection of physicians and other health professionals.
Coming from an under-represented and poorly understood African continent that is largely deprived of quality healthcare, Enabulele considers his election to the office of President of WMA as a propitious opportunity and call to make a positive impact through leading initiatives that shall enhance the fortunes of the WMA as a whole, the well-being, rights and professional autonomy of physicians across the globe, and strengthen healthcare systems of countries, to help them achieve Universal Health Coverage (UHC) and the Sustainable Development Goals (SDG 2030), through actions on the socio-economic, commercial and environmental determinants of Health and mitigation of climate change.
Enabulele said as the World transits to a post-COVID-19 pandemic era, he will like to draw the world’s attention to a few critical areas, particularly following lessons learnt during the COVID-19 pandemic era; such as: building resilient health systems; human resources for health; safety of physicians and other health care providers; public communication and engagement of physicians.
Enabulele said the WMA will have to continue to promote physician-led multi-disciplinary primary health care, ethical and person-centred care based on best evidence, and appropriate communication with patients, families and the public (in a way that secures their trust at all times).
He said during his tenure, the leadership would uphold the vision and mission of the WMA and implement WMA strategic plan, as contained in Article 2 of the WMA constitution.
The WMA mission states: “The WMA is to serve humanity by endeavouring to achieve the highest international standards in medical education, medical science, medical art and medical ethics, and healthcare for all people in the world.”
Enabulele further explained: “This will be our starting point; we can only move higher. In line with the WMA strategic plan, the WMA would be an untiring advocate of Global Public Health interventions to reduce or eliminate the staggering health inequities and inequalities, across the globe.”
According to World Health Organisation estimates (WHO), by the year 2030, the world will need about 18-20 million more health workers, to attain Universal Health Coverage. Therefore, Enabulele said to achieve UHC and SDG, the critical issue of Human Resources for Health, which afflicts every country, even though worse in lower, low- and middle-income countries (LLMICs), needs to be addressed robustly.
He said the WMA should advocate that countries take urgent steps to invest more in the well-being, working and living conditions of physicians and other health professionals. This, the physician said is to help reduce or eliminate physical and mental burn-out of physicians, and the brain drain of physicians and other health professionals, especially from already underserved countries.
To motivate physicians and other health professionals, Enabulele said the WMA should seek to establish a WMA Global Healthcare Excellence Award Scheme to reward excellence, and a sense of duty, diligence and uncommon commitment.
He added: “WMA shall strongly promote and advocate a template on physicians’ rights, to go along with physician responsibilities, as a countermeasure to the increased risk and cases of violence against physicians and other health professionals. We shall also promote the practical implementation of the WMA safe healthcare initiative.
“WMA is a rich repository of policy documents on various health issues and continues to do important work in the area of medical ethics.
“While we shall promote ongoing efforts to revise the Declaration of Helsinki, we shall also seek to promote the practical application of the Declaration of Geneva and the revised International Code of Medical Ethics, in the work we do as physicians.
“Undoubtedly, WMA has been doing great work since its establishment in 1947, in line with its objectives. But it is worrisome that many members in its regions still have little or no knowledge and appreciation of the work the WMA does.
“To address this situation, the WMA shall encourage its constituent member NMAs, to engage their members more on the important work of the WMA, while as WMA President, we shall endeavour to create more visibility for the WMA, and take the WMA to individual physicians through the organisation of a quarterly Regional Roundtable to be called ‘Meet the WMA President.’
“This roundtable shall hopefully, create greater awareness about the WMA, deepen membership integration and inclusiveness, and drive greater participation of physicians, and our constituent members in the affairs of the WMA.
“Furthermore, the ‘Meet the WMA President’ Roundtable shall serve as a platform to receive and share the ideas and experiences of individual physicians and members of the WMA, no matter their location, and resolve wrong perceptions about the WMA.
“Sustained efforts shall also be made to strengthen and promote the work of the Junior Doctors Network and the associate members of the WMA.
“As the largest physician organisation in the world, we shall continue to strengthen our partnership and collaboration with governments and bodies, such as the WHO, the Medical Women International Association, the International Committee of the Red Cross, the World Organisation of Family Doctors, the Commonwealth Medical Association, the World Veterinary Association, the International Committee of Military Medicine, the International Federation of Pharmaceutical Physicians, and many other organisations we cooperate with.”
He added: “It is commonly said that at times, history and fate meet at a single place to shape a turning point. Surely, after 75 years, we are now at such a point in the life of our association, where if we must achieve our individual and collective dreams, we must be prepared to continuously organise for positive action.
“As we journey through the next one year and seek to advance the fortunes of the WMA, our noble medical profession, and Health systems around the world, let us realize that our individual and collective actions will surely shape the course, character and destiny of the WMA.”
Enabulele urged all physicians and members of WMA to commit to putting WMA first, and make the needed efforts to pilot it, and health systems in the world, to more progressive levels.
He called on governmental and non-governmental bodies to join hands with the WMA in their collective quest to address various challenges confronting the health and well-being of citizens, physicians and other health professionals.
MEANWHILE, an updated version of the International Code of Medical Ethics has been agreed upon and published by the World Medical Association.
The revised Code, regarded as the foundation of ethical principles for physicians worldwide, defines professional duties of physicians towards their patients, other physicians and health professionals, themselves, and society as a whole. Physician leaders from almost 60 national medical associations adopted it, last week, in a unanimous vote at the WMA’s yearly General Assembly in Berlin.
The Code was first adopted in 1949 and last revised in 2006 and the new version includes for the first time sections on patient autonomy, physician well-being, remote treatment and environmental sustainability.
The revision process has taken the WMA three years and involved several expert regional conferences and public consultation.
During the debates, the most contentious proposal concerned mandatory referral, obliging doctors who object to controversial procedures such as physician-assisted suicide or abortion to refer to a willing doctor. After considerable debate, a compromise agreement was reached that does not require doctors to refer in case of a conscientious objection. Rather, the compromise says: “Physician conscientious objection to the provision of any lawful medical interventions may only be exercised if the individual patient is not harmed or discriminated against and if the patient’s health is not endangered.
“The physician must immediately and respectfully inform the patient of this objection and of the patient’s right to consult another qualified physician and provide sufficient information to enable the patient to initiate such a consultation in a timely manner.”
The Code says that physicians must respect not only the dignity and the rights of patients, but also explicitly mentions their autonomy. For the first time, the Code refers to environmental health, saying: “The physician should strive to practise medicine in ways that are environmentally sustainable with a view to minimising environmental health risks to current and future generations.”
Remote treatment is included for the first time. The Code says: “When providing medical care remotely, the physician must ensure that this form of communication is medically justifiable and that the necessary medical care is provided. The physician must also inform the patient about the benefits and limitations of receiving medical care remotely, obtain the patient’s consent, and ensure that patient confidentiality is upheld. Wherever medically appropriate, the physician must aim to provide care to the patient through direct, personal contact.”
And finally, the Code declares that physicians must attend to their own health, well-being, and abilities, and seek appropriate care to ensure that they are able to practise safely.