Twenty year perspective
Report to Wonca World Council May 2001
CEO 1981 - May 2001
Wonca began officially at the Fifth World Conference on General Practice in Melbourne in 1972, so it is now approaching its 30th Anniversary. It is a timely coincidence that the Fifth Wonca World Rural Conference will be held in Melbourne in 2002. It will provide a good opportunity to celebrate 30 years of Wonca.
Prior to 1972 Wonca existed as an unofficial body with an 'Interim Council' that met at the time of the first four World Conferences. In Melbourne, Wonca Council as we now know it, was inaugurated and the doyen of family medicine education in Australia, Monty Kent Hughes, was elected the first President. David Game was appointed the first Honorary Secretary/Treasurer.
The Wonca Secretariat
At that time I was working as a medical educator for the Royal Australian College of General Practitioners, and was therefore involved in the organization of the Wonca Conference. This was my first role in Wonca. At the first Council meeting an Examinations Committee was formed and I was appointed Chairman. At the 1974 meeting of World Council in Mexico City I represented the RACGP for the first time, and did so until 1980 at the New Orleans meeting. At that meeting David Game was elected President Elect, and since he could then not continue as Honorary Secretary/Treasurer, a new one was needed. Don Rae was nominated, but when my name was put forward, Don withdrew. That left me as the only nomination; there was not much competition then!
In late 1980 I motored to David Game's home in Adelaide where the Wonca Secretariat was situated. There I picked up the files; they fitted easily in the trunk of my car. As I was working full-time for the College, I needed a part-time secretary to manage the day-to-day affairs of Wonca. So in early 1981 Marian began as part-time Secretary, three days a week. Wonca then had a room in the Melbourne offices of the RACGP, where it continued until 1993. The RACGP was very supportive over the 13 years Wonca was there, providing accommodation and many other facilities at very modest cost.
By 1993 the RACGP was running out of space in its Melbourne offices, and so Wonca had to move. To save on rental costs, the Secretariat was transferred to a room in our West Melbourne apartment, where it stayed for several months until we moved to Hong Kong where I took up the position of Professor of Family Medicine at the Chinese University of Hong Kong. The Wonca Secretariat then relocated to our apartment on the campus of Chinese University, where it remained until we returned to Melbourne in 1997. Fortunately, we were then able to obtain low-cost rooms in Melbourne's central business district. Wonca will remain there until the Secretariat is transferred to Singapore in May.
Alfred Loh the new CEO
Marian and I had indicated that we wished to retire from our Wonca positions at the meetings of Wonca in Ireland in 1998. However, since there was no obvious replacement available at that time, Executive persuaded us to continue for a further three years. A Search Committee headed by the President was established and the CEO position was advertised. It was hoped that in addition to nominations for CEO, there would also be the offer of a venue for the Secretariat and support staff. There were a number of expressions of interest in the position, and four firm applications. These were reduced to a shortlist of two, and the candidates were interviewed at the Vienna meeting of Executive Committee. Alfred Loh was selected.
He has had vast experience in the Wonca Organization, having been Regional Vice President Asia Pacific, and a member of Executive Committee and Honorary Treasurer until 1998. Until recently he was President of the Singapore College of Family Physicians, a post he held for eight years. He has held almost every available position in the College. He has also had wide experience in business, having built up his medical practice from a two-man partnership to the largest group in Singapore, employing around 100 doctors and 300 nurses. He has now disposed of his financial interest in his practice, and is working there part-time as a family doctor and also overseeing quality assurance in the practice. He has freed up time to devote himself to Wonca.
In addition to this hands-on business experience, Alfred has recently acquired an MBA from York University, which will provide him with theoretical underpinnings for his practical business knowledge. He is an ideal one to carry the Wonca baton in the years ahead. Not only has Alfred been appointed as CEO, but also the Singapore College has offered part of its premises for the Secretariat, and will make available its Administrative Manager, Ms Yvonne Chung, to become the new Administrative Officer of Wonca to take Marian's place. Wonca is very fortunate to be able to obtain the services of someone with such a high level of 'tribal knowledge' as Alfred has, together with the experience of Yvonne, and the convenience of a place in the Singapore College to house the Secretariat.
Already, Alfred and Yvonne have visited Melbourne twice as part of the handover process, and visits to Singapore are planned. A second laptop computer has been purchased for Wonca. It will be handed over, complete with Wonca's files, at the beginning of the Executive Committee meeting in South Africa in May. After our return from South Africa, the physical files will be packed up and dispatched to Singapore. We are planning for a seamless transition.
When Marian and I took over the Secretariat in 1981, there were 23 Member Organizations and about 250 Direct Members. Records were kept on 5 x 3 inch cards and all accounts were typed on an old typewriter. Later we thought we were in clover when we acquired an IBM 'golf-ball" typewriter. All correspondence was by post. The only other facility was telex, which we could use only if recipients had a similar facility. Wonca moved slowly, committees were few and restricted by lack of funds. From the beginning the most active were the Executive Committee and the Classification Committee. Wonca could be maintained readily on a part-time basis; the busiest time of the year was preparing for meetings of Executive Committee and writing the minutes afterwards.
Communications continued at a leisurely pace while post was the medium, but when fax arrived, the tempo increased significantly. This pace accelerated even more with the advent of email, through which about 99% of Wonca correspondence is now exchanged. As a result, work patterns in the Secretariat changed dramatically.
In the late eighties, as Direct Membership increased, we thought a Directory would be a useful reference. At that time we had acquired Wonca's first computer, a portable 'Dot' that weighed about 18 pounds. It had two floppy drives but no hard drive, a tiny screen and an in-built thermal printer. On this we mounted the first Direct Member database, which we used to arrange names in alphabetical order to produce the printout for the Directory. Because we had to feed this into an old-fashioned printer that could not handle columns, we had to print one column at a time, photo-reduce them, and then cut and paste to get the final hard copy for photocopying, a long and tedious process. Finally, the database gave up after about 350 entries; its limited memory was overwhelmed. So we then acquired a Toshiba portable with 20MB of hard drive, a computer that served Wonca well for many years. The database was tediously re-entered as it was not possible to copy it from the Dot to the Toshiba.
Now Wonca needs the fastest computer it can get, with lots of memory to handle Wonca's database requirements. We maintain large Member Organization and Direct Member databases on Access 2000. Producing the Directory is now a much easier process. Our daughter Rebecca, who has received training in Access database management, is now responsible for maintaining these databases, which is now virtually a full time job.
Bookkeeping was initially simple; Marian kept accounts manually in a large multi-column ledger. Later, with the increase in Member Organizations and Direct Members, a computerized accounting system was installed, but this died of Y2K at the end of 1999. So Wonca now has a sophisticated accounting package, Pastel Partner, which can handle multiple currencies and the complexities of Australia's Goods and Services Tax (GST). Accounting now takes a significant amount of time each month, and each quarter when business activity statements have to be sent to the Australian Tax Office. Although Wonca enjoys tax-free status in Australia, it still has to pay GST and claim input credits on acquisitions.
There are now 65 Member Organizations in 56 countries and six Organizations in Collaborative Relations. The total number of full members of Wonca's Member Organizations is close to 150,000, and if one adds the other members in its Member Organizations, such as trainees, students and so on, the number is nearer 200,000.
There are over 1,500 Direct Members. This number rose sharply as organizers of Wonca conferences began to offer discounted registration for Wonca Direct Members, beginning in 1992 at the Vancouver Conference. Since then membership has remained somewhat static, with a number dropping out each year, replaced by those joining, particularly to obtain discounted registration at Wonca conferences.
Over the years we have found it difficult to recruit and retain Direct Members, although there are now many concessions, including discounted subscriptions to a number of journals. If a substantial increase in the number of Direct Members is to be a target, a great deal of effort will need to be put into marketing and selling Wonca Direct Membership. In two regions, Wonca Region Europe and the Asia-Pacific Region, part of the Direct Membership subscription now goes to the region, while a modest administrative fee is retained at the World Secretariat.
Council and Executive
World Council is the governing body of Wonca. It is representative of Wonca's Member Organizations, and is responsible for setting dues, changing the Bylaws and Regulations, establishing global policy and goals, and electing office bearers. For some years there was, in addition to World Council, a 'General Assembly' with four delegates from each Member Organization. Since this body seemed to largely duplicate the work of Council, it was deleted from Wonca's organizational structure. Although originally World Council met every two years at the time of World Conferences, when the latter were held three yearly, the interval between Council meetings extended to three years. Some feel this is not often enough, but attempts to increase the frequency of Council meetings have not been successful because it appears to be necessary to coincide meetings of Council and World Conferences. The idea of holding World Conferences more often than three yearly has proved to be infeasible. As Wonca's regions developed, there has been an increasing need to hold Regional Conferences. If World Conferences were to be held more often than three yearly, there would not be sufficient opportunities for the holding of Regional Conferences. So for the time being, meetings of World Council are held every three years at the time of World Conferences. As many or most members of World Council attend the corresponding World Conference, this arrangement is the most convenient for Council members.
Meetings of World Council are impressive. Now, around 100 attend. There are the representatives of Member Organizations and Organizations in Collaborative Relationship with Wonca, Executive Committee, Presidents of Member Organizations, and many observers, particularly Past Presidents of Wonca and convenors of Wonca's working groups.
Managing such a large group has proved to be difficult in the past. There have been complaints that many members have not had the opportunity to speak. This has been particularly the case among those who do not have English as their first language. Speaking in such a large forum can be forbidding, especially for those who are not familiar with the procedures of Wonca. To overcome this, at the Killarney meeting of Council in 1998, for the first time group discussion was introduced into the meeting format. A total of just over one day of the two and half days of the meeting was devoted to small group discussion of a number of issues important to Wonca, and to the development of goals for the ensuing triennium. These discussions were a great success and warmly appreciated by members of Council.
It is proposed that a similar time period be allotted to group discussion at the meeting of World Council at Alpine Heath this May. Moreover, it is planned that there will be an informal meeting the evening before Council begins to explain to new members the procedures used in Council. Hopefully, with everyone well informed about how to make a contribution in Council, more will be able to do so than in the past.
Any suggestions about how to involve more fully each member of Council in its deliberations would be warmly welcomed.
Keeping in touch between meetings
A job description for members of Council has been formulated which will be placed before Council for consideration. Executive felt that it was important that Council members are active between meetings of Council; part of the job description covers this aspect. It is recognized that it is difficult for members of Council to keep in touch with Wonca activities between meetings, but with improved communication, and the clear delineation of responsibilities in the job description, it is hoped that Council members will be able to contribute actively between meetings.
'Minutes in Brief'
Since the Killarney meeting Member Organizations and Council members have been sent 'Minutes in Brief' of meetings of Executive Committee with the purpose of keeping Council members up-to-date. This will continue.
Review of goals
Council will review progress towards the implementation of the goals set in Killarney. The contribution of Member Organizations to these goals will also be reviewed. The goals will be revised and new ones set for the next triennium. Other issues of importance to Wonca will also be discussed, including the issue of proportional representation, about which Member Organizations have already been informed and opinions sought. Although several Member Organizations have a strong viewpoint on this issue, it is hoped that representatives will keep an open mind until the matter is presented in Council, discussed in small groups and subsequently debated in open Council.
Because Council meets only three yearly, it is necessary for Executive Committee to be active in managing the affairs of the organization between meetings of World Council. Over the 20 years that I have attended meetings of Executive, I have been very impressed with the commitment and diligence of Executive members. As I recall it, there has been only one occasion in the last 20 years when there was not a full attendance at Executive Committee, and on that occasion only one member was absent for reasons beyond his control. There can be few committees that have such a splendid attendance record.
The duration of Executive meetings has extended in recent years because of the large amount of business that needs to be transacted. It is now usual for them to take about four days, and in the last triennium it has been necessary to hold more than one meeting each year. The need for this has been occasioned by Wonca's increasing complexity. It has been necessary to review Wonca's organizational structure and to set down clear job descriptions for all positions in Wonca.
President Bob Higgins has enlisted the help of Reg Perkin and Dan Ostergaard in conducting a series of organizational development and strategic planning workshops during Executive Committee meetings. They have been invaluable, and the outcome is in the agenda papers, namely a new organizational structure for Wonca, and a set of job descriptions. Strategic planning has also occurred at these workshops, and at the most recent ones, plans have been laid for the transition from the current Secretariat to the new one in Singapore that will take over in May of this year.
Apart from the routine issues discussed at Executive, there have been many extraordinary issues, some quite difficult, with which Executive has grappled. A perennial issue is the maintenance of Wonca's financial stability. More of that later, but a recent attempt to address this, as well as making Wonca a leader in the field of information technology, has been the development of a plan to expand Wonca's website, so that it becomes the 'first port of call' for family doctors around the world seeking information in the field of family medicine. Recently a Request for Proposal (RFP) seeking proposals to develop Wonca's website has been sent to Member Organizations and other interested parties.
As will be highlighted later in this report, there is a continuing need for Wonca to secure its financial situation. To this end Executive is considering holding a special meeting to consider marketing strategies for Wonca, which will not only extend and enhance its profile, but hopefully also attract more secure funding.
At this meeting of World Council, a number of members of Executive retire from their positions. Some are eligible for another term or election to another position, but others are not. So there will be a substantial turnover of Executive members at this meeting and thereby a number of new faces.
As we leave Executive Committee after an association of around 20 years, we play tribute to the many members with whom we have worked, all of them committed to Wonca's aims. We have appreciated their dedication to the cause, and have enjoyed their friendship and continual support. We wish the new Executive every success as it carries Wonca into the next millennium.
Perhaps the most important recent initiative in Wonca has been the development of the regions. Although Wonca identified its regions almost at its inception, it has been only in recent years that the regions have developed in a substantial way. Wonca has now five active regions: Africa, The Americas, Asia Pacific, Wonca Region Europe and Middle East South Asia. Each region has a Regional Council that meets at the time of World and Regional Conferences, and sometimes between. It is now the Regional Council that elects the Regional Vice President, and Regional Vice Presidents constitute half the membership of Executive Committee. Regional Conferences are now held regularly, often in several regions in the one year. They have proved to be very popular and have been well attended, not only by doctors from the region, but from other parts of world. The standard of these Conferences continues to rise, as does the quality of the papers, workshops and posters. They have good academic standing among departments of family medicine around the world, and participants from these departments receive due academic credit for their contributions. Some conferences are accredited by some Wonca Member Organizations, thereby allowing participants from those organizations to receive CME credits.
Several regions have held workshops on family medicine, many of which have been specifically designed to support the development of family medicine in the country in which the workshops have been held. Examples in the last triennium include workshops in Nepal, Thailand, Mongolia, India, Bangladesh and Vietnam.
Wonca Region Europe has held a number of meetings, conferences and workshops through its associated Network Organizations, EURACT, EGPRW and EQuiP, and the recently formed EUROPREV. A successful joint meeting of these organizations was held in Mallorca in 1999.
Two regions now have their own bylaws, and their own organizational structure, office bearers, and budget. Development of the regions has been applauded and encouraged by Wonca Executive, which sees this development as advancing Wonca's aims and influence, while at the same time strengthening its structure and function. Executive has paid much attention to ensuring that as this regional development is occurring, the global unity of the Wonca organization is preserved. This has not always been easy, but to date has proved to be successful, largely due to the collaborative effort of the five Regional Vice Presidents: Alan Fatayi-Williams, Reg Perkin, Zorayda Leopando, Chris van Weel and Nurul Islam, to whom a great debt of gratitude is owed.
Regional development will continue in the future, particularly in the Africa Region, which held its first Conference in 2000 in Abuja, Nigeria, and in the Middle East South Asia Region, which will hold its first Regional Conference in 2002 in Sri Lanka.
Wonca Region Europe has its own journal, The European Journal of General Practice, and during 2001 the Asia Pacific Region will publish its own journal, Asia Pacific Family Medicine. The Africa Region and the Middle East South Asia Region publish their own newsletters.
It is anticipated that in the near future there will be a merging of the Americas Region with a long-standing organization in South America, the Confederacion Iberoamericana de Medicina Familiar -CIMF, (Iberoamerican Confederation of Family Medicine - ICFM), and that there will be a sixth Wonca region, Region Latin America. Recent negotiations between Wonca officers and officers of CIMF have been very fruitful.
Regionalization has added a new dimension to the Wonca organization; continuing development in the regions is an important task for Wonca in the years ahead.
Wonca's working groups
Wonca has been fortunate to have a number of excellent working groups composed of talented and committed people who have devoted countless hours to the work of Wonca, initially with no financial reward at all. Although Wonca is now financially stronger and better able to support its groups, there is still much that is done for Wonca without any thought of recompense.
The Statutory Committees: Bylaws, Finance, Membership, Nominating and Awards, and now Publications and Communications, have attended with diligence and care to their responsibilities, and have scarcely ever received any recompense for their efforts. The Chairs: David Game, Bruce Sparks, Zorayda Leopando, Michael Boland and Göran Sjönell, are to be commended for their sterling services to Wonca for so long.
Apart from these, the most long-standing working group in Wonca is the Classification Committee. It has been active since the beginning and has contributed to Wonca's stature through its preparation and publication of a series of books on classification, beginning with ICHPPC and ICProcessPC, then progressing to ICPC, which is now in its second edition and in an electronic form suitable for use in electronic medical records.
Wonca owes great debt of gratitude to the large number of dedicated Classification Committee members who have devoted countless hours to the development of the classification systems which are now used worldwide, and which thereby bring Wonca's name into daily prominence. Their work continues to this day. At present this Committee and the Secretariat is grappling with the issue of licensing ICPC-2-E to national governments, software developers, coding developers, and individual end users. This has proved to be a complex and difficult issue for Wonca, unaccustomed as it is to negotiating in the commercial world. Hopefully, some of the licence arrangements will result in significant income for Wonca.
There is no other committee with which I have had such a large amount of interaction. Scarcely a day goes by when there is no Classification Committee business to which to attend. There is now a Classification Committee in the Asia Pacific Region.
I pay tribute to Niels Bentzen, who has worked with the Secretariat tirelessly in managing the Committee's business, and to the members of his Committee who have provided such good advice and strong support over the years. Since the Committee has asked Executive to retain its name in the process of the re-structuring Wonca, in recognition of the many years of sterling service of this Committee, and its high international standing, Executive has agreed that it retain the name 'Wonca International Classification Committee' (WICC).
The Informatics Working Party has also been a powerful force within Wonca. In this age of information technology, its role is very important to Wonca. The Working Party has overseen the development of Wonca's website in Newcastle, where Rob Wilson is the Webmaster, and has conducted workshops at World and Regional Conferences to inform Wonca members about developments in this important area. It played a significant role in the development of the RFP mentioned above. There is now an Asia Pacific Regional Informatics Working Party.
Michael Kidd and his group are to be commended for what they have done, and strongly supported as they continue these important IT developments for Wonca.
The Quality in Family Medicine Working Party has also contributed in a major way to Wonca. This began with the publication of a Wonca book Quality assurance for family doctors (now being updated and expanded by the Working Party with the title Family Doctors' Journey to Quality) and has continued with extension of its activities in the regions, particularly in Wonca Region Europe, where EQuiP has been particularly active. Already it is active in the Asia-Pacific Region, and has planned for expansion in the other regions. Its work is so highly regarded that Executive Committee has asked the Working Party to evaluate the effectiveness of this Council meeting. Three members of the Working Party have been assigned this responsibility. Rich Roberts and his group are to be commended for their continuing good work.
The Working Party on Rural Practice, although formed only in 1992, has been very active in promoting rural practice and the needs of rural people and their doctors throughout the world. Already the Working Party has initiated four World Conferences on Rural Health, and has plans for a fifth in Melbourne in 2002, 30 years after the formation of Wonca in that same city. They are also planning an invitational conference in collaboration with WHO to be held at the time of the Melbourne meeting, in pursuance of Wonca's Rural Health Initiative, which is part of its Memorandum of Understanding with WHO.
Roger Strasser and his group are to be congratulated on their success, and the production of several excellent publications on rural health, which have been keenly sought after around the world. Since most of the world's population lives in rural areas, the work of this group will be needed well into the future.
The Working Party on the Environment was formed in 1992, but, for a variety of reasons, has not yet really got going. Executive Committee has persisted with this group because of its great importance. Recently Paul Wallace of the UK and Alan Abelsohn of Canada have been appointed co-convenors. The Working Party will seek support at the Durban Congress. Progress in the next triennium is anticipated.
Ad Hoc Task Forces
During discussions of organizational restructuring, the concept of the creation of Ad Hoc Task Forces to undertake specific tasks in a limited time frame was seen as a solution to addressing issues or problems within Wonca without creating an ongoing group that required continuing support. There are now several Ad Hoc Task Forces.
The Task Force on Communications, formed during 2000 and headed by Göran Sjönell, has done a splendid job in developing plans for the re-development of Wonca's website, and is the group responsible for the preparation of the RFP mentioned above. Göran has recommended that since it has completed its job, it be now disbanded.
There is also a Task Force on CME headed by Michael Boland that is to examine the role of Wonca in providing CME, in particular through its website. Although there have been Wonca working groups in the past that have addressed education, none have established a permanent niche, and have eventually been disbanded. Hopefully, this newly formed Task Force will identify a realistic role for Wonca.
There is another Task Force to Review Wonca's Role in Research. Although Wonca has had a Research Committee since its inception, it has experienced periods of inactivity interspersed with periods of intense activity. When Chris van Weel was Chairman, the Committee actively collaborated with the Classification Committee, and subsequently trailed the use of the COOP/Wonca Charts for measuring functional status. These were published and are now available on the Wonca website. In recent times the Committee has experienced some difficulty in ascertaining its role, and this is why a Task Force, headed by Chris, has been formed to resolve this.
Another Task Force, convened by myself, is working on a new logo for Wonca. This will be completed by the time Council meets, when the Task Force will be disbanded. Although this exercise has involved overseas members of the Task Force and members of Executive Committee, because a Melbourne design house was engaged to undertake this work, it has been my fellow Australian, Geoff Martin, Member at Large of Executive, who has contributed greatly to this task. He has travelled from Adelaide to Melbourne several times to meetings at the design house. I thank him for his valuable contribution.
Special Interest Groups
Another category of working group in Wonca is called the 'Special Interest Group'. SIGs, as they are called for short, are designed to allow individuals who have a common interest in an aspect of family medicine to communicate, particularly by email, and to meet at conferences. At present there is an active SIG on Health Behaviour Change, headed by Rick Botelho, who has conducted workshops at Wonca Conferences, and who has undertaken to convene a Task Force on Tobacco Cessation. It will feature prominently at the Durban Congress.
There are also SIGs on Women in Family Medicine convened by Marilyn McMurchie, which will be active in the women's stream at the Durban Congress, and on Care of the Elderly, which is now becoming active. SIGs receive no financial support, but once they become very active, they can be re-categorized as working parties, and thereby receive financial support.
Many of the above groups will have a business meeting the day before the Durban Congress begins.
Groups now past
Some working groups, having done their job, have been discontinued. The Examinations Committee disbanded after producing a handbook on examinations and a manual on multichoice questions. A committee on community-oriented medical education never really got going. There were also committees on teacher training, accreditation, undergraduate, postgraduate and continuing education, and on psychological medicine, which functioned for a short time and then foundered. All were formed with the best of intentions, but through lack of interest, or lack of leadership, or because they were not relevant to contemporary needs, or because there was insufficient finance to support them, they disappeared. It was this experience that persuaded Executive to exercise closer supervision of newly formed groups, and to give them a limited brief and no financial support until they proved that they were both relevant and active.
Recently Executive appointed from its membership an Executive Liaison Person for each working group in Wonca whose role is to maintain contact and keep themselves well informed about the group's activities and to report to Executive and Council.
Wonca's working groups are its lifeblood. Is gratifying that in recent years Wonca's financial position has allowed it to provide a higher level of financial support than was previously possible. It is hoped that in the future, with closer supervision of newly formed groups, and with financial support commensurate with Wonca's financial resources, its working groups will be even more active and productive.
Relationship with WHO
Wonca has had a continuing relationship with the World Health Organization, especially over the last decade. Initially it was difficult to establish sustained meaningful contact with the WHO organization, which had a public health mind-set that largely excluded family doctors from its arena. Despite visits to Geneva by Wonca officers, doors were seldom open, and the going was hard. Nonetheless, realizing the importance of a close association with WHO, Wonca officers persisted, and finally there was a significant breakthrough. Dr Charles Boelen, who occupies a senior position at WHO headquarters in Geneva, has been a good friend to Wonca and a close collaborator over the last several years. As a result, there are now many collaborative endeavours in which both organizations are involved.
London, Ontario Conference
Among the most important of these has been the joint WHO/Wonca Invitational Conference that was held in London, Ontario in 1994. Organized so well by Michael Boland, it resulted in the publication of the WHO/Wonca Working Paper Making Medical Education and Medical Practice more Relevant to People's Needs; the Contribution of the Family Doctor, which was edited by Marc Rivo and Jeff Heck. It has now been translated into several languages, and a Progress Report has been published. There has been follow-up Strategic Action Fora in several countries, and at Wonca conferences. A 'Physician Funding Conference' hosted by the RCGP in 1997 was part of this follow-up, and resulted in a WHO/Wonca/RCGP publication Physician Funding and Quality of Care.
Another significant initiative is the WHO/Wonca World Survey of General and Family Practice, which is in the hands of Larry Culpepper of Boston. It promises to be a major ongoing source of information about family medicine/general practice around the world.
Memorandum of Understanding
Soon after her appointment, President Bob Higgins and President Elect Michael Boland met with the Director General of WHO, Dr Gro Harlem Brundtland to discuss Wonca and family medicine. They received a good hearing, and came away with the impression that there was an understanding of, and support for family medicine at WHO. Soon after, a 'Memorandum of Understanding for Collaborative Activities for the period 1998 - 2001' between Wonca and WHO was formulated by Bob and Michael and signed by Charles Boelen. It is in the agenda papers.
Towards Unity for Health
Wonca is collaborating with WHO in its 'Towards Unity for Health' (TUFH) initiative, which purposes to bring together clinical medicine and public health in a collaborative way to the benefit of patients and communities. Wonca will hold a TUFH Consultation immediately after the Durban Congress, to which about 25 experts, mainly from the field of family medicine, have been invited. A publication will follow. Dr Ilse Hellemann, Member at Large of Executive Committee and current Wonca Liaison Person to WHO, is to be commended for all the effort she is putting into the organization of this seminal event.
Currently, Wonca and WHO are collaborating to produce what is colloquially known as the 'Guide', a manual to assist those wishing to introduce family medicine into a health care system where it does not yet exist. It will probably be titled 'Improving Health Systems: the Contribution of Family Medicine - A Guidebook'. Ilse is overseeing this project, which is planned to be completed before the end of 2001.
Ilse is also overseeing the preparation of a brochure detailing Wonca's collaborative endeavours with WHO which will be distributed at Council and at the Durban Congress.
Although Dr Boelen will be retiring soon, it is anticipated that strong collaboration with WHO will continue. WHO is planning to engage a family physician on its staff at Geneva to liaise with other officers of WHO at the Geneva and Regional offices. This is an important move, and Wonca has been given a role in the selection of a suitable candidate.
Through its regions Wonca has made meaningful contact with WHO Regional Offices. In Europe this has resulted in the development of documents that describe the role of the general practitioner in Europe. In the Asia-Pacific Region, two Wonca officers have undertaken WHO consultancies in China. Good liaison has been established in all regions, and Regional Vice Presidents have attended WHO Regional Committee meetings.
It is considered essential for Wonca's future collaboration with WHO that strong relationships are maintained between officers in WHO Regional Offices and officers of Wonca in the regions, particularly its Regional Vice Presidents.
Wonca's Regional Conferences have been mentioned above. They now attract between 500 and 1,500 participants, and generate substantial levy income for Wonca. At least one of these Conferences in each triennium in a given region has to be a so-called 'Designated Regional Conference', for which Wonca World and the Region concerned share the conference levy. For Regional Conferences that are not so designated, the levy goes exclusively to the region. So Regional Conferences have not only a substantial academic impact, but a significant financial one too.
Wonca World Conferences
These have been a part of Wonca since its inception. Initially, they were Wonca's only means of exposure. They became a popular meeting place for family doctors around the world, good occasions to learn about developments in family medicine, and a great place to establish friendships and networks that could be used in the years between World Conferences.
Since those early days, World Conferences have grown in size and importance, and are now considered the most important conferences in the field of family medicine the world over. The last World Conference, organized in Dublin by Michael Boland and his team, was the largest with over 4,000 participants and 1,000 accompanying persons.
Organizers of the Durban Congress were hoping for over 3,000 participants, but to date registrations have been slow. Garth Brink, Bruce Sparks and their team are working feverishly to make this a spectacular event. The Orlando Conference in 2004, to be organized by Dan Ostergaard and his team, promises to be the largest ever, combined as it is with the Annual Scientific Assembly of the AAFP.
Organizing a Wonca World Conference is now a major exercise that extends over a period of six years, and involves substantial financial risk on the part of the host organization. Because of the surfeit of Wonca Conferences, Executive has discussed how best to coordinate the many conferences, so as to reduce competition and the possibility of financial loss.
A register of conferences has been compiled, and regions have agreed to check first with the register to ensure that clashes are minimized, and that there is a minimum time gap between conferences. It is clear that there is a high demand for Wonca conferences, and therefore restrictions on them have been avoided. However, the need for coordination has been recognized and addressed.
Almost since its inception, Wonca has had the benefit of its newsletter, Wonca News. This modest, low budget publication has been distributed to Member Organizations, Direct Members of Wonca, editors of family medicine journals, academic bodies and medical societies outside of the Wonca organization. It has a circulation of approximately 2,000. It contains news from Member Organizations, from Council, Executive Committee and Direct Members, and features regular columns from the President and the CEO, details of upcoming Wonca conferences and conferences of Member Organizations, and material contributed by members of the editorial board and a few who have undertaken to contribute material from their own country.
The current Editor, David Game, has filled this demanding role with distinction for many years. He tells a rather sad story of the difficulties that he has had over the years in obtaining sufficient copy for each issue. While he is pleased to have a small group who regularly send him copy, his regret is that this group is so small. If Wonca News is to continue as a good vehicle for communication within Wonca, is essential that someone be appointed in each Member Organization to liaise with the Editor, and send him copy regularly. Marc Rivo, who will be taking over the position of Editor from this meeting of Council, will need, and will certainly welcome, the support of each Member Organization as he sets about the task of maintaining the standard of this important Wonca publication. We thank David for his great contribution to communication in Wonca for so many years, and welcome Marc as the new Editor.
The Family Doctor
The Family Doctor is a more recent publication. Designed as a newsmagazine, it has a very wide circulation to 130,000 family doctors around the world. It was conceived by Göran Sjönell, who obtained the funding for it, first from Glaxo and more recently from Pharmacia. As Chief Editor he has designed an attractive twenty-four page magazine, in full colour, which publicizes Wonca activities, particularly its conferences and the activities of its working groups, and now regularly features 'Minutes in Brief' of Executive meetings. This newsmagazine has promoted Wonca around the world in a way not previously possible. Thousands of doctors who had never heard of Wonca now know about it and what does. The publicity that it gives to upcoming conferences has no doubt resulted in increased attendance. We are indebted to Göran for his splendid contribution to Wonca.
While previously the sponsors of the magazine required space for their articles, in some recent issues the entire space has been made available to Wonca. It may not seem a difficult assignment to fill two, twenty-four page issues per year, but as any editor would be able to testify, it is not possible unless the editor receives copy from a variety of sources. A perennial problem for Göran has been lack of copy. His repeated requests for articles, news and views have fallen largely on deaf ears. It is unfair to any editor to expect him to produce a high-quality publication with relevant content without strong support from the editorial board, Wonca's committees and working groups, and from its Member Organizations. If this publication is to continue to be a meaningful one, relevant to its readers, if it is to continue to promote the mission and the work of Wonca on a global scale, more support must be provided.
Printing is undertaken in Singapore where Alfred Loh has overseen production. He has been able to negotiate very keen prices with his printer, and this has resulted in a surplus with each issue. That The Family Doctor is appreciated by its recipients is evidenced by the large number that notify Alfred of their change of address, while only a tiny number ask to be taken off the mailing list.
It has been proposed that from 2002 The Family Doctor be published online on Wonca's website. Göran has already secured funding for 2002.
Wonca's other publications
Wonca also has many individual publications: for example on classification, the role of the general practitioner/family physician in health care systems, on rural health, quality assurance, functional status measurement, education, clinical teaching and assessment. Several have been 'Proceedings' of Wonca workshops held in the Asia Pacific and Middle East South Asia Regions. Another was produced jointly with WHO, as mentioned above. Several publications have been translated into a number of languages. Many are now available for downloading from Wonca's website.
Through the Sowerby Centre for Health Informatics at Newcastle-upon-Tyne (SCHIN), Wonca has established a comprehensive website, which attracts a continuing audience. It displays information about Wonca and its Member Organizations, Direct Membership, committees, working groups and conferences, as well as its publications, many of which can be copied using Adobe Acrobat Reader. There are numerous links to other medical websites. Many enquiries we receive at the Secretariat emanate from the website. The Webmaster, Rob Wilson, and his team deserve our thanks for all that has been done to make this a valuable site for family doctors.
The website has been such a success that substantial expansion is planned. As mentioned above, an RFP has been promulgated; hopefully it will attract a good response from vendors.
Although we knew well the early Presidents, Monty Kent Hughes, Don Rice, Stuart Carne and Ed Kowalewski, the first President with whom we worked was Arthur Hofmans of the Netherlands who held this office from 1981 to 1983. He was a dedicated President, committed to the ideals of Wonca. He communicated with us regularly by post, using an ancient typewriter to prepare his letters. He attended very diligently to Wonca activities, which were not so intense in those days. He could always be relied upon for a sound opinion and good advice. After his presidency he was editor of Wonca News for a time. He remained a good friend of ours after his presidency, and often visited Australia during the cold winters in Europe. A measure of his commitment to Wonca was signaled at the time of his burial, when he went to his final resting place wearing his Wonca Direct Member tie.
Next followed David Game, an Australian and a personal friend for well over 30 years. It was a great pleasure working with David, whose attention to detail was always meticulous. He was a first-class chairman of meetings. We always knew what was being debated, and the outcome was always clearly defined. David has been one of the most committed and long-standing workers for Wonca. Beginning with Wonca before its inauguration as Chairman of the Host Organizing Committee of the Fifth World Conference, he was first Honorary Secretary/Treasurer for eight years, then President, and after he retired from Executive Committee after 17 years of service, he continued as Editor of Wonca News up until this Council meeting, when he will retire from this post. For many years he has been the Chairman of the Bylaws and Regulations Committee, a busy job as Wonca became a more regionalized organization. He also authored Wonca's history. Wonca - The First Twenty Years 1972 - 1992. David was one of the early recipients of Wonca's highest award, 'Fellow of Wonca'.
M K Rajakumar
Then came M K Rajakumar of Malaysia, whom we fondly called Raja, a deep thinker and philosopher who brought much wisdom to Wonca. He was the first President from Asia, from 1986 to 1989. In his quiet yet effective way he guided Wonca at the end of the eighties. It was a pity that he was unable to attend the 1989 World Conference in Jerusalem because of his country of origin. Even after his presidency concluded, he continued to be involved in Wonca affairs, and as recently as 1999 was the Chairman of the Organizing Committee of the Third World Rural Health Conference held in Kuching, Malaysia. His mind continually teems with brilliant ideas. He was one of the very earliest to propose that Wonca should redevelop its website to make it into the 'first port of call' for family doctors around the world. Raja remains a close friend.
Don Rae followed Raja from 1989 to 1992. Don was a fine President, deeply dedicated to the aims of Wonca. It was he who designed the current Wonca logo, a reflection of his lifelong interest in heraldry. When family medicine began to develop in China, he was one of a delegation that visited that country to pass on his extensive knowledge of the discipline. He was able to bring 30 years of experience as a family physician in a rural township in western Canada. It was always a great pleasure working with Don; communicating with him was a joy. It was sad that he died shortly after his retirement from Wonca and his practice, just as he was about to enjoy the rewards of many years of service to his patients, the community and the international scene, especially through Wonca and St. John. Shortly before Don's death, current President Bob Higgins, in company with Past President Peter Lee and Regional Vice President Reg Perkin, presented Don at his home with Wonca's highest award, Fellowship of Wonca, in recognition of his outstanding contribution.
Peter C Y Lee became President in 1992. Prior to that Peter had had a long association with Wonca. He had been the founder of the Hong Kong College of General Practitioners in 1975, and had been the leader of the first delegation to China, which introduced the doctors there to the concepts of family medicine. From then steady progress was made in introducing family medicine to China through conferences held in Beijing and Shanghai, through visits of Wonca teams to develop curricula for training in China, and through Peter's personal contribution to those developments over many years. As a result of his contribution, and the contribution of Wonca generally, family medicine has been embraced by the government of China as the basis of its future health care system. Wonca is revered in China, and much of this is due to Peter Lee. Our friendship with Peter continues; we still often see him in Hong Kong and at his Cebu apartment.
Göran Sjönell became President Elect in 1992. From that time onwards, Wonca's financial position improved steadily. Göran negotiated with Glaxo sponsorship of the Wonca publication The Family Doctor. This newsmagazine has been one of the most significant mechanisms for promoting Wonca worldwide, and improving its financial stability. So 1992 was the starting point of new era for Wonca, during which it has expanded in a matter that never could have been imagined previously. Not only did Göran find sponsorship; he also undertook the role of chief editor of The Family Doctor, a role he continues to this day. When Glaxo sponsorship terminated, he negotiated a similar arrangement with Pharmacia, which is still in place. It is anticipated that The Family Doctor will be published on Wonca's website next year. Wonca owes a great debt of gratitude to Göran for enabling it to move from a rather impoverished state to one where Wonca has been able to achieve great things because it had the funds to do so. When he became Immediate Past President, Göran took responsibility for convening the Ad Hoc Task Force on Communications, which has met in two workshops to develop the Request for Proposal for the development of Wonca's website. Working with Göran is a great pleasure; he is our close personal friend.
The current President, Bob Higgins, has been a very mobile President. Recently retired from the US Navy, and well used to travel, Bob has been prepared to accept most of the invitations he has received from countries all over world to attend their conferences and meetings, and advise them on family medicine. His high visibility has brought great benefit to Wonca. Wonca has been seen to be active and involved in many initiatives around the world, not just within its own organizational structure, but also in countries where there are no Wonca members. He has developed a productive relationship with other world bodies. The relationship with WHO has been greatly enhanced during Bob's presidency, and is now more active and collaborative than it has ever been in the past.
Bob has also overseen the organizational restructuring of Wonca as it underwent regionalization, and the development of job descriptions for all who work within the Wonca structure. He has promoted Wonca's development through strategic planning workshops in Executive Committee and small group discussion at the Killarney meeting of World Council. It is a pity that under the Bylaws adopted in 1998, Göran, he and all subsequent Presidents have only one year in Executive Committee after the conclusion of their presidency. We look forward to continuing friendship with the Higgins' in the years ahead.
Michael Boland, President Elect
The President Elect, Michael Boland, has a fine tradition to follow as he takes up office at the conclusion of the Durban Congress. We wish him every success.
Working with these presidents has been most rewarding. Each has been very different from the others, yet each has had his own vision of what Wonca could become, and has worked tirelessly to achieve the targets set. Wonca is fortunate to have had such a succession of gifted, committed and dedicated people to lead the organization. We pay tribute to them all.
Is Wonca political?
Politics is part of every organization, no less in Wonca. People working together for a common cause usually have a 'political' view of what the organization should be and do, and how it should operate. But in Wonca, even this benign aspect of politics has never been very prominent; it has seldom intruded into debate or action. The 'hard-nosed' politics one sees in many organizations is absent in Wonca. I have been amazed how small an effect 'politics' has had. Wonca's leaders have focused on its lofty mission to improve the health of the peoples of the world, and the organization has followed willingly. Workers in Wonca have been so intent on reaching the goals that have been set, that politics has not intruded. I consider myself fortunate to have not had to deal with hard-nosed politics or hard-nosed politicians.
But Wonca should be aware that it is now of such stature that it is an inviting prospect for 'the politicians'. If Wonca is to maintain its largely apolitical nature, and continue to remain focused on its mission, care will need to be exercised. Voting is an aspect of any organization's activities where politics can be played. So far Wonca has avoided 'block voting' over issues, and in elections for office. Every precaution should be taken to avoid it in future. Should this happen, the atmosphere of meetings and the modus operandi of Wonca will change dramatically.
So my answer to my own question is: "No, Wonca is largely apolitical". I hope it stays this way.
Wonca's financial position has always been precarious. In the early days, it existed 'on a shoestring'. The Honorary Secretary/Treasurer received no payment, and his secretarial staff received a modest wage for the part-time work they did. As the tempo of Wonca activities increased, so did the need for more secretarial time. Staff costs were covered out of Member Organization and Direct Member dues, augmented by levies from Wonca Conferences. Indeed without these levies, it would not have been possible for Wonca to survive financially.
As the workload increased, Wonca began to struggle to find sufficient funds to pay its way. As mentioned above, it was not until 1992 that there was a breakthrough in the financing of Wonca when Göran Sjönell negotiated with Glaxo a sponsorship arrangement whereby Glaxo would support the publication of The Family Doctor. Because costs were kept to a minimum, and good printing prices were obtained by Alfred Loh, there was a surplus after each issue, which was put to good use supporting a number of Wonca activities, particularly the work of its working groups. Without this surplus, such support would have not been possible. The surplus also enabled the payment of the CEO. The Honorary Secretary/Treasurer had been paid a small annual honorarium for some years, but in 1993 when the position of CEO was established, a more substantial payment was possible. This has continued ever since, but has been possible only because of the continued sponsorship of The Family Doctor by Glaxo and more recently, Pharmacia. If and when this sponsorship is discontinued, Wonca will need to find a substantial financial substitute to continue to support its committees and its Secretariat and CEO.
Apart from the desire to provide a service for members and to increase Wonca's influence, one of the objectives of re-developing Wonca's website was to provide an additional source of income. Initially, hopes were high that substantial additional funds would be generated, but with the failure of so many dotcoms around the world, the prospect of generating large sums has diminished significantly. While it is still believed that this could be an income source for Wonca, income predictions are now much more modest. It is recognized that it would be unwise for Wonca to embark upon website development using its own funds. Therefore Wonca will be attracted by proposals from vendors that enables the development of Wonca's website at little or no cost to Wonca.
While Wonca has been very fortunate to be able to maintain strong sponsorship from a small number of pharmaceutical firms since 1992, it would be unwise to believe that this will continue indefinitely. Wonca must have contingency plans to cover the inevitable discontinuance of the current sponsorship. These plans must include the diversification of sponsorship so that more firms are involved. Approaches should be made to commercial enterprises outside of the pharmaceutical industry and to other funding sources, including those in the public sector. Within the pharmaceutical industry, approaches should be made to a variety of firms. As the corporate world takes on a mind set which favours collaboration, alliances and networking as much or more than it does competition, pharmaceutical firms are taking the view that it would be better for Wonca to have multiple sponsors rather than rely on one or two. Some have indicated that it enhances their credibility if they are one of a number of sponsors, rather than being a sole sponsor.
As Göran Sjönell has already indicated that the Pharmacia sponsorship has a limited time frame, one of the important tasks for the new CEO and President will be the seeking out of additional sources of funding. Having made such major strides in the last decade because of enhanced funding, it would be a tragedy if Wonca slipped back into an impecunious state similar to what existed prior to 1992, where it was not able to support its working groups with other than token amounts, and was not in a position to support the Secretariat it now needs to remain an influential force in the world of family medicine. President Bob Higgins has plans for a workshop on the marketing of Wonca, which hopefully will take place later in 2001. At this workshop it will be essential that plans be developed for promoting Wonca worldwide to commerce, industry and public funding sources, as well as in academic circles. Strategies will need to be developed for approaching the sources of funding, and expertise gained in preparing and presenting submissions.
Although, as will be seen from the financial reports that Wonca is currently in a sound financial position, it would be folly to assume that this will continue without external funding in the form of sponsorship or grants. Some see grants from public funding agencies as an answer, or at least a partial answer, to Wonca's long-term financial stability. This confidence is questionable. Although Wonca has received grants from funding agencies such as the Kellogg Foundation, the US Department of Health and Welfare, and more recently from WHO, these are specific purpose grants intended to be expended only on the project for which they have been granted. While this enables Wonca to undertake and complete these specific projects, no surplus is possible for use in other areas of Wonca activity. To support the working groups, few of which generate their own income, and to support the Wonca Secretariat, a style of funding (such as sponsorship) is needed which generates a surplus that can be used for these purposes.
The consequences of inadequate funding need to be clear in our minds. With insufficient funding to support working groups, their activities must necessarily decrease, and their impact in the field of family medicine must diminish. The value of building up their status and influence over the years would be lost. If there is insufficient funding to support the Wonca Secretariat, the services it provides will decrease and Wonca's influence will fall away. It has taken Wonca 30 years to build its influence and stature; this must not be lost because of lack of funds.
The financial reports below give the details of Wonca's current financial situation. Honorary Treasurer Bruce Sparks will comment on this in his report to Council.
At its Killarney meeting World Council established a set of six goals on which to focus over the triennium. These worthy goals have set the pattern of activity within Wonca and have been taken up by some of its Member Organizations. This Council meeting will hear a progress report and will fine-tune the goals, perhaps adding to them. With its eyes focused on these laudable aims and its gaze fixed on its lofty mission to improve the health of the peoples of the world, Wonca must succeed as it move into the next millennium.
This is my last report to Council. At this meeting, Marian and I leave Wonca after 20 years of service. On almost every day of that time Wonca has been on the agenda, especially so over the last 10 years. We have enjoyed our time with Wonca. We have appreciated working alongside so many gifted people, so dedicated to Wonca's mission. We have developed many close friendships with colleagues that we cherish. We shall miss the regular contact we have had with them.
We have watched with pride the steady, and at times spectacular development of Wonca. We have seen it grow from a tiny unknown organization into the most influential and significant world organization in family medicine in the world today.
We wish it every success as it faces a future filled with exciting possibilities, yet one that will demand an even greater devotion and commitment of its members and officers than in the past, and even greater resources to achieve its lofty mission. We are gratified that we are able to hand over the Secretariat to such a competent and committed team - Alfred Loh and Yvonne Chung. We wish them a satisfying time with Wonca and offer our support and advice at any time in the handover phase.
To all in Wonca we say simply - thank you, goodbye and Godspeed.