I attended the World Health Assembly in Geneva earlier this year. Dr Margaret Chan, the
Director General of WHO is truly inspiring. As one speaker said 'When Dr Chan speaks, the world listens.' Progress has been made on the Millenium Development Goals (see below), but much remains to be done, especially in reducing child mortality and improving maternal health. 'Universal Health Coverage' is the new buzz-word, and many speakers referred to this – healthcare for everyone independent of the ability to pay, a blurring of the boundaries between the roles of different types of health professionals, and the effective deployment of community health workers. Non-communicable diseases, such as diabetes and the obesity epidemic are WHO priorities for the future.
Dr Jhin Khim, President of the World Bank, was an outstanding guest speaker. He is a physician
and anthropologist, and has led several of the WHO initiatives on AIDS treatment. Results-based funding is one of the priorities of the World Bank, so that payment depends on delivery of outcomes. This is increasingly the basis of WHO funding, which is causing some anxiety at the WHO and considerable restructuring. As Dr Khim said 'It is inspiring to see more and more countries taking charge....we must hold each other accountable....we must make bold commitments... we can bend the arc of history and build health equity, dignity and prosperity'.
Two fringe meetings were of particular interest. One was on Violence Against Women. A speaker from the Indian Ministry of Health told us of all the positive steps that have been taken following the horrific rape in Delhi in 2012. Worldwide, the prevalence of violence during pregnancy ranges from 1% in urban Japan to 28% in provincial Peru (most areas 4-12%). Remarkably, Japan also does well on the rate of forced first sexual intercourse, at 1% as compared to nearly 30% in rural Bangladesh. A huge problem in many countries are the social and cultural norms that support violence against women: 'physical violence is an acceptable way to resolve conflict in a relationship' 'sexual intercourse is a man's right in marriage' 'there are times when a woman deserves to be be
aten' 'sexual activity, including rape is a marker of masculinity' 'girls are responsible for controlling a man's sexual urges'.
The other meeting of special interest related to the Safe Childbirth Checklist. The refinement and evaluation of this checklist is an area where MWIA (and you individually and the institution where you work) could become involved. The checklist has been developed by the WHO and the Harvard School of Public Health, funded by the Bill and Melinda Gates Foundation. It follows on from the Aviation Checklist and the Surgery Checklist which have proved very successful in developed as well as underdeveloped countries in reducing morbidity and mortality. For the Safe Childbirth Checklist 29 interventions around childbirth have been highlighted, including appropriate maternal infection management, appropriate hand hygiene, improved maternal blood loss assessment. A pilot scheme in northern India has been very successful in reducing maternal and infant mortality. WHO is inviting partners to participate in a collaborative field-testing exercise to explore implementation and usability of the checklist in multiple settings. What training would be required? Does the checklist need to be modified? Which health worker should fill in the checklist? What is the best format (at present 2 sides of A4)? These are some of the questions that might be asked. Projects would need to be self-funded. If you are interested, click here for more information, or email
And finally, i should like to say a few words about the 29th MWIA Congress held in Seoul in July. The hospitality we were shown was so touching. When I discussed 'Family Friendly Policies in the NHS' and presented the results of our Family Friendly Survey, the contrast with what occurs in Korea was an eye-opener. We complain about lack of adequate notice of junior doctor rotas, lack of locum cover for maternity leave, inadequate help with childcare, while the Korean women doctors barely get 3 months off to have their babies. An important social problem in Korea (as well as Japan) is the falling birth rate. Perhaps making parenthood more compatible with work would help. Further details of the Congress will be described elsewhere.
Millenium Development Goals (to be achieved by 2015)
1. Eradicate extreme poverty and hunger
2. Achieve universal primary education
3. Promote gender equality and promote women
4. Reduce child mortality
5. Improve maternal health
6. Combat HIV/AIDS, malaria and other diseases
7. Ensure environmental sustainability
8. Develop a global partnership for development'
Clarissa Fabre, GP East Sussex, former MWF president
