Published on: 18 June 2019

The following commitment was published by WONCA Africa

Kampala Commitment 2019:

The commitment by family doctors to universal health coverage, primary health care and building the capacity of primary health care teams at scale in Africa.

We, the 181 delegates from 32 countries gathered in Kampala (4th to 8th of June 2019) at the WONCA Africa Regional Conference on Family Medicine (including Primafamed Pre-Conference Meeting) and actively developing the discipline of family medicine (the medical ‘specialty’ of primary care) in Africa state the following:

• • • We confirm our support for the “Declaration of Astana”, adopted at the Global Conference on Primary Health Care in Astana (25th-26th October 2018), stating that “..strengthening primary health care (PHC) is the most inclusive, effective and efficient approach to enhance people’s physical and mental health, as well as social well-being, and that PHC is a cornerstone of a sustainable health system for Universal Health Coverage (UHC) and health-related Sustainable Development Goals”. We will actively support it in Africa.

• • • We remind the international community of the potential explosive growth in African population and massive urbanisation of Africa by the turn of this century based on UN Population Prospects 2017 and the need to address PHC in Africa with great urgency. UHC should go beyond financing, to include service delivery reforms that create relevant, accessible, responsive, person-centred, quality, cost-effective, sustainable first contact care. UHC (with PHC as a priority) should incorporate strategic purchasing and a whole system approach (inclusive of non-state actors and human resources) to create such a system.

• • • We believe overly-simplistic solutions for PHC through vertical diseased-based and risk-oriented approaches are dangerous, and we welcome the move towards meeting health needs across the life course of individuals with services that are integrated, continuous and people-centred.

• • • We remind the international community of its commitment “to train and retain adequate numbers of health workers, with appropriate skill mix, including primary health care nurses, midwives, allied health professionals and family physicians, able to work in a multidisciplinary context, in cooperation with non-professional community health workers in order to respond effectively to people’s health needs” in WHA resolution 62.12 (Primary Health Care, including health system strengthening, 22 May 2009).

• • • Whilst we are acutely aware of human resource and other resource challenges for PHC in Africa we are convinced that family doctors should be located within community-based inter-professional PHC teams that may vary in team composition and size of population enrolled by country. Whilst we are usually placed with other healthcare professionals in the primary care setting, family doctors actively promote community-oriented primary care (COPC), as a strong combination of personal care and public health, so that we enable the PHC team to also address social determinants of health at a population level. We commit to integrate working life in the delivery of people-centred care in line with the WONCA/ICOH statement on workers’ health and their families.

• • • We, as family doctors in Africa, are actively exploring how we can contribute to strong PHC teams through scaling family medicine training for doctors and building the capability of all PHC team members. We are preparing to scale up quickly to match the needs and challenges within Africa, including ensuring such plans are rural-proofed. Europe (through the Expert Panel on Effective Ways of Investing in Health, advising the European Commission) and China (through the contract system) offered some very useful insights into building family doctor-led teams to scale and appropriate to the resources available, and with potential support to Africa. We urge governments to take measures to provide decent working conditions and occupational services for all PHC providers.

• • • We are convinced that scaling up of PHC-teams in Africa can only happen in a sustainable way through a concerted and integrated effort addressing PHC capacity building and migration. The consequences for the rest of the world will be grave if access and quality of primary health care services are not addressed in Africa. Migration, climate change and fair trade (with their consequence on health) must also be addressed in an integrated way to ensure that Africans do not remain victims of global inequity.

• • • We welcome the commitment by WHO to work with WONCA, the World Organisation of Family Doctors, through the Memorandum of Understanding signed on the 28th January 2019. We are very encouraged by the active relationship established between WHO and WONCA in Africa at this conference and will support WHO AFRO in its quest to leave no one behind in Africa. However, we are concerned that there is limited commitment and/or ability by African governments to include family doctors in the PHC team and to train the PHC team in family medicine.

We urge the United Nations General Assembly high-level meeting on UHC in September 2019 in New York to make practical commitments to invest in PHC as a priority, especially on service delivery reforms that includes the family doctor in the PHC team in Africa. Our desire is person- and people-centred primary health care.

Kampala 8th of June 2019.
Issued by WONCA Africa
www.WONCAAfrica.org

This commitment is supported by the following organisations and groups:

• Primafamed network (www.primafamed.ugent.be)

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