WMJ 2024 03

Official Journal of The World Medical Association, Inc. Nr.
3, September 2024
vol. 70
Contents
Editorial 3
Interview with the WMA Secretary General 4
Invitation to the WMA General Assembly in Helsinki, October 2024 7
Report on the Roundtable Discussion on Antimicrobial Resistance –

Looking Towards UN High-Level Meeting on AMR and Beyond 9
Reflections on the Value of the UN High-Level Meeting on Pandemic,

Prevention, Preparedness, and Response One Year Later 14
Junior Doctors Network’s Leadership at the World Health Summit 2023 19
Junior Doctors’ Perspectives on Barriers and Solutions to Equitable Access

to Global Health Opportunities 23
Pharmaceutical Policy in Afghanistan 27
African Health Leadership: A Physician’s Perspective 29
Interview with National Medical Associations’ Leaders of the African Region 32
Interview with National Medical Associations’ Leaders of the European Region 42
WMA Members Highlight National Initiatives to Safeguard Patient Safety 49

WORLD MEDICAL ASSOCIATION OFFICERS,
CHAIRPERSONS AND OFFICIALS
Dr. Lujain ALQODMANI Dr. Ashok PHILIP Dr. Osahon ENABULELE Dr. Jung Yul PARK
President President-Elect Immediate Past President Chairperson of Council
Kuwait Medical Association Malaysia Medical Association Nigerian Medical Association Korean Medical Association
123 Fifth Avenue, 4th Floor, MMA House, 8 Benghazi Street, Samgu B/D 7F 8F 40
1202 124 Jalan Pahang off Addis Ababa Crescent Cheongpa-ro,
Kuwait 53000 Kuala Lumpur Wuse Zone 4, P.O. Box 8829 Yongsan-gu
Malaysia Wuse, Abuja 04373 Seoul
Nigeria Republic of Korea
Dr. Otmar KLOIBER Dr. Tohru KAKUTA Mr. Rudolf HENKE Dr. Steinunn
Secretary General Vice-Chairperson of Council Treasurer THÓRDARDÓTTIR
World Medical Association Japan Medical Association German Medical Association Chairperson,
13 chemin du Levant 113-8621 Bunkyo-ku, Tokyo (Bundesärztekammer) Medical Ethics Committee
01212 Ferney-Voltaire Japan Herbert-Lewin-Platz 1 Icelandic Medical Association
France (Wegelystrasse) Hlidasmari 8
10623 Berlin 201 Kópavogur
Germany Iceland
Dr. Jack RESNECK Dr. Zion HAGAY Dr. Jacques de HALLER

Chairperson, Chairperson, Chairperson,
Finance and Planning Committee Socio Medical Affairs Committee Associate Members
American Medical Association Israeli Medical Association Swiss Medical Association
AMA Plaza, 330 N. Wabash, 2 Twin Towers, 35 Jabotinsky St., (Fédération des Médecins Suisses)
Suite 39300 P.O. Box 3566 Elfenstrasse 18, C.P. 300
60611-5885 Chicago, Illinois 52136 Ramat-Gan 3000 Berne 15
United States Israel Switzerland
www.wma.net
OFFICIAL JOURNAL OF THE WORLD

MEDICAL ASSOCIATION
Editor in Chief
Dr. Helena Chapman
Milken Institute School of Public Health, George Washington University, United States
editor-in-chief@wma.net
Assistant Editor
Mg. Health. sc. Maira Sudraba
Latvian Medical Association
lma@arstubiedriba.lv, editor-in-chief@wma.net
Journal design by
Erika Lekavica
dizains.el@gmail.com
Publisher
Latvian Medical Association
Skolas Street 3, Riga, Latvia
ISSN 0049-8122
Opinions expressed in this journal – especially those in authored contributions –

do not necessarily reflect WMA policies or positions
Editorial
Editorial
Over the past few months, extreme weather events, disease debates on timely global health and medical ethics topics and
outbreaks, and infodemic management have collectively build connections with other NMAs. As WMA members have
challenged health professionals in their daily practice. Reports of participated in several regional expert meetings on the WMA
record-breaking high temperatures during the summer months, Declaration of Helsinki revisions in Johannesburg, Munich, and
torrential rainfall in Africa, Asia, and Europe, and projections Washington, DC, they can articulate any final comments for the
of the most active hurricane season on record demonstrate the overall consensus and subsequent consideration for adoption.
observable impacts of climate change on the delicate balance
within our planet’s ecosystems. The emergence of disease In this issue, Dr. Otmar Kloiber shared his perspectives
outbreaks, such as mpox, oropouche virus, and highly pathogenic on WMA activities as well as his leadership achievements
avian influenza virus, has helped drive global discourse about over his tenure as WMA Secretary General. Ms. Marr,
health system preparedness and response, as well as the Dr. Julia Tainijoki, Dr. Caline Mattar, Dr. Lesley Ogilvie, and
evaluation of national action plans for pandemic preparedness Mr. Ashrit Challa offer a high-level summary of the
(including reducing risk of potential zoonotic transmission). roundtable discussion on AMR ahead of the UN
The rapid spread of misinformation and disinformation hinders High-Level Meeting on AMR in September 2024.
the delivery of accurate health recommendations with patients, Dr. Mike Kalmus Eliasz, Dr. Yassen Tcholakov, Dr. Maria Inês
families, and communities, as well as the opportunity to build Francisco Viva, Dr. Marie-Claire Wangari, and Dr. Wenzhen
public trust and rapport. ( Jen) Zuo presented reflections on the UN High-Level Meeting
on Pandemic, Prevention, Preparedness, and Response in
To address this global burden, WMA leaders underscored the September 2023. Dr. Jeazul Ponce Hernández, Dr. Francisco
urgent need for global solidarity as a means to quickly respond Franco Pêgo, Dr. Flora Wendel, Dr. Marie-Claire Wangari, and
to climate change adaptation and mitigation efforts, support the Dr. Balkiss Abdelmoula described the Junior Doctors Network
negotiations of the Pandemic Agreement, improve global health ( JDN)'s participation in the World Health Summit 2023. Dr.
workforce training, and streamline public health messaging. Marie-Claire Wangari, Dr. Deena Mariyam, Dr. Lekha Rathod,
As the impacts of anthropogenic phenomena on the aquatic, and the WMA-JDN Working Group on WHO Activities
atmospheric, and terrestrial ecosystems cannot be overlooked, examined JDN perspectives on barriers and solutions to the
alterations or loss of natural biodiversity and animal habitats, equitable access of global health opportunities. Finally, Ms.
chemical and plastic pollution, and the introduction of non- Tabasom Fayaz described pharmaceutical policy in Afghanistan.
native species remain significant threats to humanity. Hence, the
question remains: How can global health professionals leverage WMA members are inspirational leaders who contribute
their expertise, develop robust One Health collaborations to their clinical and surgical expertise in daily practice and at
address these endemic and emerging health risks, and fortify national and international meetings. As they are acutely
medical education and training across our countries? aware of challenges facing medical education and training,
ethics, and public health across their countries, we encourage
As global leaders attend the 79th session of the UN General them to prepare scientific analyses and commentaries for the
Assembly from 20-30 September 2024, which consists of World Medical Journal. In this issue, two remarkable articles
High-Level Meetings on the Summit of the Future, General from eight NMAs in Africa and Europe described leadership
Debate, Sea-Level Rise, Antimicrobial Resistance (AMR), experiences, ongoing NMA activities, and perceived strengths
and Elimination of Nuclear Weapons, they share the urgent and challenges in medical education. Dr. Johannes Steinhart,
message for international cooperation and collaboration to Dr. François Arnault, Dr. Philippe Cathala, Dr. Simon Kigondu,
combat diverse global crises and conflicts that affect public Dr. John Baptist Nkuranga, Dr. Mvuyisi Mzukwa, Dr. Tomás
health and environmental sustainability. Over these next Cobo Castro, Dr. Sofia Rydgren Stale, and Dr. Herbert
months, additional key global meetings will highlight Luswata, representing the NMAs from Austria, France,
innovative strategies to accelerate progress to achieving the Kenya, Rwanda, South Africa, Spain, and Sweden, respectively,
Sustainable Development Goals, including the Group on Earth expressed their valuable viewpoints for ongoing discourse. Also,
Observations (GEO) Symposium and Regional Meetings WMA members representing 14 countries of the African,
(Africa, Americas, Asia-Oceania, Europe), World One Health Americas, Eastern Mediterranean Region, and South-East
Congress, and the UN/WHO Regional Conference on Space Asian regions highlighted national policies and activities that
Technology for Advancing Global Health. These timely events promote patient safety practices related to World Patient Safety
– together with reports from leading agencies like the multi- Day 2024.
agency’s United in Science 2024 – support knowledge exchange,
propel interactive debates, and allow for expanded networks We look forward to exciting discussions and networking
for collaborative climate action. opportunities at the WMA General Assembly in Helsinki!
The Finish Medical Association invites WMA members and

relevant guests to attend the WMA General Assembly in Helena Chapman, MD, MPH, PhD
Helsinki, Finland, from 16-19 October 2024. At this event, Editor in Chief of the World Medical Journal
WMA members can offer their perspectives to scholarly editor-in-chief@wma.net
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Interview with the WMA Secretary General
leadership achievements over the the cornerstone of research

past decade? ethics worldwide [4]. Second, in
collaboration with regional and
First, we have made major changes national physician organisations, we
in the WMA governance, which strongly advocate for our professional
corrected the perception of the autonomy. Over time, we have
WMA as a club of wealthy countries. witnessed that professional autonomy
We now represent the largest portion has been under attack from multiple
of physicians globally. Second, we stakeholders. Some governments and
have engaged in addressing major commercial entities have attempted
global health challenges, such as to commoditise healthcare and
Otmar Kloiber social determinants of health, One subordinate medical decision-
Health, climate crisis, and research making to commercial interests,
ethics. With the Declaration of rather than serving the interests of
For this interview, Dr. Otmar Kloiber, Taipei, we have provided a blueprint patients or communities. Finally,
the WMA Secretary General, shares for transferring our principles of we lead efforts to raise attention to
his perspectives on WMA activities research ethics into the research world human rights violations in individual
as well as his leadership achievements of large databases and biobanks [1]. or national cases, and although not
over his tenure with Dr. Helena always successful, we remain vigilant.
Chapman, the WMJ Editor in Chief. Finally, we have held global Most recently, we participated in
discussions to defend, develop, and a movement that convinced the
How would you describe your role as update our core documents, including Parliament of Gambia to maintain
General Secretary, and how has the the Declaration of Geneva and the the prohibition of female genital
WMA evolved as an organisation International Code of Medical Ethics mutilation [5].
over your WMA tenure? [2,3]. We also needed to adapt to
new developments in medicine and How does the WMA manage
As Secretary General, my role is adopt a more modern language, while international discourse throughout
to operationalize the aims of the remaining true to our principles the year, including contentious
WMA, promote the application and traditions of caring, ethics, and debates and disagreements that may
and development of medical ethics, science. This year, I am confident that arise on complex medical ethics
and advocate for better patient we will finalise discussions on one of topics? Please share two examples
care and equity in order to protect our key documents, and will complete of how contentious debates were
human rights in healthcare. I joined the revision of the Declaration of addressed during your WMA
the WMA after many countries, Helsinki in October 2024. tenure.
especially in central and eastern
Europe, became democracies or How would you describe the There have always been, and probably
at least less authoritarian, and old observed impact of the WMA always will be, divergent opinions
blocks of power had disappeared. declarations, resolutions, and on ethical questions, particularly
The world was opening up statements in the health sector? concerning the beginning and end
politically, which helped significantly Please share two examples that you of human life. It is important to
to increase our membership. Since have observed during your WMA note that divergent views on medical
that time, the WMA has become a tenure. ethics issues often exist within
more vibrant community, with more countries rather than just between
active engagement in global health During my WMA tenure, I have countries. Over the past decades, our
activities and healthcare advocacy at observed three specific examples approach has been to engage in open
all levels. with significant global impact. and inclusive debate on these issues.
First, the Declaration of Helsinki, Although a lengthy and resource-
What do you consider to be the which is referenced in national intensive process, we are convinced
WMA’s top three most important and international law, has become that this approach produces the
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best results. For example, we have However, if pressing concerns arise References
discussed issues ranging from gamete in several countries simultaneously,
donation, embryo transfer, and NMAs may be unaware that 1. World Medical Association.
surrogate motherhood to abortion, they are affected by issues, Declaration of Taipei on Ethical
physician-assisted suicide, and such as the commoditization Considerations regarding
euthanasia. Although controversial of healthcare and the increasing loss Health Databases and Biobanks
topics, we were able to discuss them of professional autonomy. For [Internet]. 2016 [cited 2024 Aug
thoroughly and eventually address example, some governments are 10]. Available from: https://www.
them through the development of prohibiting their medical residents wma.net/policies-post/wma-dec-
WMA policies. from seeking employment abroad, laration-of-taipei-on-eth-
rather than offering decent working ical-considerations-regar-
How can the WMA help support conditions. These actions that target ding-health-databases-and-bio-
specific national challenges faced professional groups represent civil banks/
by national medical associations conscription, and may qualify as
(NMAs), including medical forced labour and constitute a human 2. World Medical Association.
education and training and health rights violation. Declaration of Geneva [Internet].
policy reform. Please share two 2017 [cited 2024 Aug 10].
examples of how the WMA has Please describe three ongoing Available from: https://www.
helped support NMAs during your WMA initiatives that help address wma.net/policies-post/wma-dec-
WMA tenure. specific challenges facing the global laration-of-geneva/
medical community over the next
When managing diverse five years. 3. World Medical Association.
national issues, the WMA acts International Code of Medical
at the request of our NMAs. By the nature of the WMA, most Ethics [Internet]. 2022 [cited
If in a country there is no NMA in initiatives are focused on identifying 2024 Aug 10]. Available from:
our membership, then the WMA pressing global challenges in medical https://www.wma.net/policies-
may speak out independently. ethics and collectively developing a post/wma-internation-
Over the past year, the WMA has relevant and timely policy to help al-code-of-medical-ethics/
supported several specific situations guide NMAs in their advocacy,
of significant concern. For example, decision-making, and educational 4. World Medical Association.
the WMA supported the Indian activities. Over the next five years, Declaration of Helsinki: Ethical
Medical Association in their struggle three specific focus areas include Principles for Medical Research
against a government policy that supporting pandemic preparedness, involving Human Subjects
grants traditional healers more reducing risks of antimicrobial [Internet]. 2013 [cited 2024 Aug
rights to practise modern medicine resistance (AMR), and combatting 10]. Available from: https://www.
and surgery without any relevant the climate crisis. To that extent, we wma.net/policies-post/wma-dec-
education and training. Similarly, the have revised our policies on emergency laration-of-helsinki-ethical-prin-
WMA joined the Korean Medical preparedness and engaged actively ciples-for-medical-research-in-
Association in their objection with the World Health Organization volving-human-subjects/
against the government’s attempts on fostering action against AMR. We
to either satisfy a small group of have also actively participated in the 5. World Medical Association.
voters or place pressure on Korean Conference of the Parties (commonly WMA Council Resolution
physicians by allowing practitioners called COP) of the United Nations Calling for the Immediate
of traditional Korean medicine to Framework Convention on Climate Withdrawal of the Bill Lifting
use western medical technologies Change (UNFCCC), where we the Ban on Female Genital
without appropriate education [6]. collectively advocate for more Mutilation in Gambia [Internet].
The WMA has also supported political action on climate adaptation 2024 [cited 2024 Aug 10].
Korean physicians in their protest and mitigation, noting the direct or Available from: https://www.
against nearly doubling the number indirect consequences on health and wma.net/policies-post/wma-
of medical students without first well-being. council-resolution-calling-for-
creating the necessary university the-immediate-withdrawal-of-
resources [7]. the-bill-lifting-the-ban-on-fe-
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male-genital-mutilation-in-gam- lective-action-and-con- post/wor ld-medic al-associ-

bia/ demns-government-interfer- ation-stands-firm-in-sup-
ence-in-korean-medical-associa- port-of-korean-medical-asso-
6. World Medical Association. tion/ ciation-amid-government-in-
World Medical Association duced-crisis/
clarifies position on collective 7. World Medical Association.
action and condemns government World Medical Association
interference in Korean Medical stands firm in support of Korean
Association [Internet]. 2024 Medical Association amid Otmar Kloiber, MD
[cited 2024 Aug 10]. Available government-induced crisis Secretary General (2005-current)
from: https://www.wma.net/ [Internet]. 2024 [cited 2024 World Medical Association
news-post/world-medical-asso- Aug 10]. Available from: otmar.kloiber@wma.net
ciation-clarifies-position-on-col- https://www.wma.net/news-
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Invitation to the WMA General Assembly in Helsinki, October 2024
Invitation to the WMA General Assembly

in Helsinki, October 2024
Dear Colleagues and Esteemed around the world to discuss how we fitting location for this important
Members of the World Medical can collectively work towards more dialogue. Over the course of the
Association (WMA), equitable health systems, ensuring meeting, we will reflect on the
that everyone, regardless of race, progress made since the Declaration’s
It is with great pleasure that we gender, socioeconomic status or adoption in 1964, as well as hear the
invite you to join us for the WMA geography, receives the healthcare results of a two-year renewal process
General Assembly, which will be they need and deserve. and explore how we can apply its
held in Helsinki, Finland, from principles to the challenges of today
16-19 October 2024. This year’s Celebrating 60 Years of the – particularly in advocacy efforts for
gathering will be particularly Declaration of Helsinki equal access to healthcare.
significant as we celebrate the 60th
anniversary of the Declaration of The Declaration of Helsinki has A Comprehensive Program
Helsinki, a foundational document stood as a pillar of ethical guidance
that has guided the ethical standards in medical research for the past six The event will serve as a vital
of medical research for the past six decades, shaping the conduct of platform for physicians to connect,
decades. clinical trials and the protection of share knowledge, and influence the
research participants worldwide. future direction of medical ethics
Theme: Equality in Healthcare Its principles have become the and medicine. It is comprised of
cornerstone of ethical medical the General Assembly proceedings
Our theme for this year – Equality in practice, ensuring that the rights, as well as preceding meetings of
Healthcare – reflects one of the most safety, and well-being of patients the Statutory Committees and the
urgent and pressing issues of our time. remain paramount in research efforts. Council. We encourage all WMA
Despite tremendous advancements in This anniversary is timely to reflect members to take part in this historic
medicine, disparities in healthcare on the Declaration’s profound impact event. Your voice and your expertise
access and quality continue to persist on global health, as well as renew are essential in shaping the future of
across populations, communities, and our commitment to upholding its global healthcare and ensuring that
countries. This assembly will bring values in an ever-changing medical the principles of equality, dignity,
together thought leaders, healthcare landscape. Helsinki, the birthplace and ethical responsibility remain at
professionals, and advocates from of the Declaration of Helsinki, is a the core of our profession.
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Invitation to the WMA General Assembly in Helsinki, October 2024
The Host City and Association Assembly that the Finnish Medical for 16-19 October 2024, and join
Association (FMA) has hosted. us in Helsinki, as we celebrate 60
We invite you to explore our Established in 1910, the FMA is a years of the Declaration of Helsinki
beautiful capital and its surroundings. professional organisation and trade and reaffirm our commitment to
Helsinki is known for its blend union representing more than 90% advancing equality in healthcare for
of modern urban culture, history, of Finnish physicians. It plays a all.
architecture, design, and natural significant role in the development
beauty. As saunas are a significant of the medical profession in Finland,
part of Finnish culture, Helsinki advocating for the rights and interests Warm regards,
offers many opportunities to of physicians and ensuring high
experience them, including on the standards in medical practice. Niina Koivuviita, MD
way from the official meeting hotel President,
to the conference centre in the We are proud of this opportunity to Finnish Medical Association
harbour. host this event, and we will do our niina.koivuviita@laakariliitto.fi
best to make your visit successful https://www.laakariliitto.fi/
This will be the third WMA General and memorable. Mark your calendars
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Report on the Roundtable Discussion on Antimicrobial Resistance
Report on the Roundtable Discussion on Antimicrobial Resistance –

Looking Towards the UN High-Level Meeting on AMR and Beyond
Kristy Marr Julia Tainijoki Caline Mattar
life expectancy by 1.8 years by 2035

[2,3]. Moreover, the burden of
AMR is unequal, with low- and
middle-income countries (LMICs)
disproportionately affected by drug-
resistant infections. As LMICs
often have the greatest unmet needs
for diagnostics, therapeutics, and
vaccines, AMR only widens these
gaps in healthcare access and bolsters
existing inequities.
Lesley Ogilvie Ashrit Challa
In 2016, the first UNGA HLM on
AMR stressed the urgency of action
The World Medical Association perceived gaps in the Zero Draft of in the resultant political declaration
(WMA) collaborated with the the UNGA HLM on AMR political [4]. In response, several initiatives
Global Antimicrobial Resistance declaration, as discussed during the were launched, and progress was
(AMR) Research and Development roundtable. well underway until the coronavirus
(R&D) Hub to host a roundtable disease 2019 (COVID-19) pandemic
discussion on AMR on the sidelines Background on the AMR Situation brought efforts to a standstill.
of the 77th World Health Assembly Resources were diverted from
in Geneva, Switzerland in May 2024. AMR is estimated to have been AMR efforts, with surveillance and
This event was held in preparation directly responsible for 1.3 million stewardship programs also falling by
for and anticipation of the United deaths globally in 2019, with the wayside, resulting in increased
Nations General Assembly (UNGA) approximately 4.95 million deaths global rates of AMR incidence
High-Level Meeting (HLM) on associated with AMR in the same [4]. Currently, we are at a critical
AMR, which will take place on year [1]. In addition to mortality junction in the aftermath of the
26 September 2024, in New York. figures, AMR also results in COVID-19 pandemic, with another
Invited participants represented a significant economic burden, with the UNGA HLM on AMR rapidly
range of sectors and backgrounds World Bank estimating that AMR approaching. While it is crucial that
and were brought together to could result in a 3.8% reduction the resultant UNGA declaration
discuss four key themes: Access in global gross domestic product reflects the necessary progress, much-
and Innovation, Health Systems (GDP) by 2050, amounting to needed political commitments, and
and Health Workforce Education, a US $3.4 trillion loss each year [2]. defined monitoring targets, the
Stewardship, and One Health. AMR could push 24 million more implementation path post-UNGA
This article aims to summarise people into extreme poverty by 2030 remains challenging. Multiple
the key messages and highlight if left unchecked and reduce global avenues of collaboration and
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alignment among global actors are targets. However, the role of this Theme 2: Health Systems and
essential if we hope to accelerate Panel and its relationship with the Health Workforce Education
progress at all levels and facets of the Quadripartite organisations would
AMR challenge we face today. need to be clearly defined. Participants acknowledged that
strong health systems and a well-
Outcomes of Roundtable Participants also highlighted that the resourced workforce are fundamental
Discussions declaration should include specific to combat AMR through prevention,
wording on supporting existing diagnosis, treatment, and public
This invitation-only roundtable global initiatives, acknowledging education. The Zero Draft placed
event was convened to unite the progress that has been made on insufficient emphasis on education
stakeholders in the AMR field to access and innovation since 2016. For and training of medical professionals
share expertise, explore synergies, example, this progress has included related to AMR. They agreed that
and make recommendations for next initiatives such as CARB-X (https:// there must be a greater emphasis
steps. An overview of the discussions carb-x.org/), GARDP (https://gardp. on and investment in preparing the
from the expert dialogue as well as org/), the Global AMR R&D Hub workforce for AMR, both within
the suggestions for strengthening (https://globalamrhub.org/), and the language of the Zero Draft and
the UNGA political declaration on country-specific pull incentive pilots through the strengthening or
AMR are provided below, with the aim [5,6]. They highlighted the call to establishment of education
of driving action against AMR at the recognise the WHO pipeline analyses frameworks. Participants stressed
highest political levels. Suggestions and priority lists as foundational to the importance of educating patient
are categorised into four key thematic ongoing work in this area [7-9]. communities alongside medical
areas, which were the basis of our professionals, including engaging
discussion subgroupings and were In the Zero Draft, participants patients in discussions about AMR
handpicked to ensure diversity in commented that financing was and the development of NAPs.
geographic representation, sector, largely siloed around National Action Participants believed that creating
and professional background among Plans (NAPs). The requirement stronger systems for sharing
roundtable members. to establish financing targets for information can propel health
new antibacterials and give greater personnel and patient communities to
Theme 1: Access and Innovation of considerations to the complexities spearhead government-level change
AMR Diagnostics and Treatment of diagnostic funding from an R&D in combat AMR.
perspective was expressed, given that
Recognising that the lack of new diagnostics often exceed the costs Participants also expressed the
antimicrobials and rising resistance of antibiotics. They agreed on the need for greater levels of education
endangers vulnerable populations, importance of increased emphasis during training, including significant
necessitating urgent prioritisation on push and pull incentives as investment into health infrastructure
and incentives for development and sustainable strategies for long- for all healthcare roles. They
access, participants raised that the term innovation and new economic commented that physicians, dentists,
access and innovation sections of the models de-linked from revenues. nurses, and pharmacists tend to
Zero Draft of the political declaration Participants inquired about how represent the majority workforce,
required a clearer statement of to appropriately signal these next often overlooking ‘invisible personnel’
intent and greater ambition. While steps towards resource mobilisation in the health workforce, such as
including specific global research through the G7 and G20. administrators, patient escorts,
and development (R&D) targets Furthermore, it was emphasised that and cleaners. Improving education
in the declaration was thought to most prescribed antibiotics today systems and enabling healthcare
be challenging, they suggested that are generics, and the supply chain professionals to spend more time
– at a minimum – a mechanism remains unstable due to manufacturer with patients were seen as essential
for establishing such targets in the consolidation. The discussion ended steps to strengthen healthcare team
future should be outlined. There was with pragmatism, underscoring the collaborations in AMR initiatives.
general consensus that this could urgency to plan for the replacement Furthermore, they shared their
involve a political mandate and of life-saving antibiotics, as failing to concern about the lack of investment
commitment for the forthcoming do so would leave nothing to preserve in dissemination of available
Independent Panel on Evidence for their access in the future. information including tools to
Action against AMR to develop these enhance understanding of AMR.
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One suggestion was to include the participants hoped that the system would account for the varying
terms “Investment” and “Patient declaration would offer an impacts of different antibiotics
Voice” in the Zero Draft to reflect the opportunity to broaden the scope and classes on AMR, emphasising
importance of these concepts. of AMS, advocating for a holistic, the importance of appropriate use.
society-wide approach that includes Second, the term “integrated
Theme 3: Stewardship to Reduce stewardship at the community surveillance” was questioned due to
the Burden of AMR level, consideration of behavioural the challenges in its implementation,
changes, and attention to commercial noting that a more suitable approach
Discussions centred on the fact that determinants. Civil society might be mono-sectoral surveillance
antimicrobial stewardship (AMS) is organisations and health professional with integrated or coordinated
essential to combat AMR, addressing associations can play a key role in analysis.
overprescription, misuse, and this expanded approach to AMS.
educational gaps, while promoting The discussions ended with Some participants viewed the
global collaboration and policy the recognition that the draft inclusion of global targets as
reform within the health system. The declaration does not adequately polarising and a potential barrier
political resolution should clearly recognise how women and children to adoption of the resolution,
define and outline the key components disproportionately bear the impacts recognising that targets should
of AMS. Participants acknowledged of AMR, facing higher risks and be evidence-based, inclusive, and
that clear, accessible guidelines challenges in accessing adequate appealing to politicians. They
should extend beyond physicians treatments, such as paediatric believed that such targets could
to include nurses and community formulations. be adapted by regions or countries
health educators, considering the and reevaluated over time. This
disparities between high- and low- Theme 4: One Health Approach conversation emphasised the
resource settings. A simplified set of necessity of true multisectoral
guidelines was viewed as essential to Participants suggested that the collaboration, with participants
ensure effective implementation of term “One Health” be replaced with raising that the Quadripartite
AMS principles at the community “intersectoral,” “cross-sectoral” or organization’s One Health AMR
level, supported by meaningful “multisectoral” in the draft political Priority Research Agenda had not
surveillance data that reflect local declaration, as it may minimise been included in the declaration
resistance patterns. They highlighted any potential political setbacks [10]. In the research arena, the
that guidance on usage, especially or challenges associated with benefits of considering the social and
for new antibiotics coming to the definitions of “One Health”. Other behavioural aspects of AMR and
market, should be aligned with the participants commented that the a greater focus on implementation
implementation of an appropriate term “One Health” could be used in research to improve the delivery of
stewardship plan. the introduction or preamble and interventions was voiced. Overall,
removed from the main text. This participants agreed that the “One
Participants stressed that access to discourse was highlighted as the Health” concept should be integrated
essential antibiotics is foundational “One Health” term and concept into all aspects of AMR policy, not
to successful stewardship and should are not yet well entrenched in some simply treated as a separate entity.
be prioritised in the declaration’s countries, with additional translation
opening paragraphs. Without issues in other languages. Key Messages and
access, healthcare professionals face Recommendations
the difficult dilemma of balancing Participants also discussed how
stewardship measures with patient other relevant terms are defined and • The lack of new antimicrobials
health needs, as well as recognising incorporated into the declaration. and rising resistance endangers
direct links between human and First, the term “animal” was found vulnerable populations,
animal health. They also emphasised to be often poorly defined and necessitating urgent prioritisation
that universal health coverage is a oversimplified in the context of AMR. and incentives for development
vital component of AMS, to ensure A need for antimicrobial use to be and access.
the effective implementation of species- or sector-specific, potentially
diagnostics or infection prevention through the introduction of an • Urgent planning is needed to
and control. animal-focused version of the WHO ensure adequate supply of generic
Access, Watch, Reserve (AWaRe) antibiotics and address the
Building on this narrative, the Classification was raised. This consolidation of suppliers.
11
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• Strong health systems and a well- Bank; 2017. Available from: ment-of-new-antibacterial-treat-
resourced workforce are essential to https://www.worldbank.org/en/ ments/
combat AMR through prevention, topic/health/publication/drug-
diagnosis, treatment, and public resistant-infections-a-threat-to- 7. World Health Organization.
education. our-economic-future WHO bacterial priority patho-
gens list, 2024: bacterial patho-
• Education frameworks for 3. Global Leaders Group on An- gens of public health importance
healthcare professionals, patients, timicrobial Resistance. Towards to guide research, development
and communities at large should specific commitments and action and strategies to prevent and
be more widely disseminated, in the response to antimicrobial control antimicrobial resistance.
and governments should ensure resistance. Geneva: Global Lead- Geneva: WHO; 2024. Available
patient voices are included in NAP ers Group on Antimicrobial Re- from: https://www.who.int/pub-
considerations. sistance; 2024. Available from: lications/i/item/9789240093461
https://www.amrleaders.org/re-
• AMS is essential to combat sources/m/item/glg-report 8. World Health Organization.
AMR, addressing overprescription, 2023 antibacterial agents in clin-
misuse, and educational gaps while 4. United Nations. United Nations ical and preclinical development:
promoting global collaboration General Assembly (71st session; an overview and analysis. Gene-
and policy reform. 2016–2017). Political declara- va. WHO; 2024. Available from:
tion of the high-level meeting https://iris.who.int/bitstream/
• Ensuring access to essential on antimicrobial resistance: res- handle/10665/376944/978924
antibiotics is the foundation olution/adopted by the Gener- 0094000-eng.pdf
for successful stewardship, as al Assembly. A/RES/71/3. New
healthcare professionals face York: UN; 2016. Available from: 9. Gigante V, Alm RA, Melchi-
difficult choices between applying https://digitallibrary.un.org/re- orri D, Rocke T, Arias CA,
stewardship measures and cord/845917 Czaplewski L, et al. Multi-year
safeguarding the health of their analysis of the global preclinical
patients. 5. Global AMR R&D Hub. In- antibacterial pipeline: trends and
centivising the development of gaps. Antimicrob Agents Chem-
• A greater focus on behaviour new antibacterial treatments: other. 2024; 68(8):e0053524.
change and implementation 2023 progress report by the
science would assist in improving Global AMR R&D Hub and 10. World Health Organization,
the delivery of AMR interventions. WHO. Geneva: Global AMR Food and Agriculture Organ-
R&D Hub and WHO; 2023. ization of the United Nations,
Available from: https://glo- United Nations Environment
balamrhub.org/publications/ Programme, World Organi-
References incentivising-the-develop- sation for Animal Health. A
ment-of-new-antibacterial-treat- One Health priority research
1. Antimicrobial Resistance Col- ments-2023/ agenda for antimicrobial resist-
laborators. Global burden of bac- ance. Geneva: WHO; 2023.
terial antimicrobial resistance 6. Ogilvie L, Beyer P. Incentivis- Available from: https://www.
in 2019: a systematic analysis ing the development of new an- who.int/publications/i/item/
[published correction appears in tibacterial treatments: 2022 pro- 9789240075924
Lancet. 2022;400(10358):1102]. gress report by the Global AMR
Lancet. 2022;399(10325):629-55. R&D Hub and WHO. Gene-
va: Global AMR R&D Hub;
2. World Bank. Drug-resistant in- 2022. Available from: https://
fections: a threat to our economic g l o b a l a m r h u b. o r g / p u b l i c a -
future. Washington, DC: World tions/incentivising-the-develop-
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Authors Julia Tainijoki, MD Lesley Ogilvie, PhD

Medical and Advocacy Advisor, Director of Secretariat,
World Medical Association Global AMR R&D Hub
Kristy Marr, MIPH julia.seyer@wma.net Berlin, Germany
Scientific Programme Officer, lesley.ogilvie@dzif.de
Global AMR R&D Hub Caline Mattar, MD
Berlin, Germany World Medical Association Ashrit Challa
kristy.marr@dzif.de caline.mattar@wma.net Intern, World Medical Association
ashrit009@gmail.com
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Prevention, Preparedness, and Response One Year Later
Reflections on the Value of the UN High-Level Meeting on

Pandemic, Prevention, Preparedness, and Response One Year Later
Mike Kalmus Eliasz Yassen Tcholakov Maria Inês Francisco Viva
The only tangible outcome of the

political declaration was a future
UN Secretary General’s report and
a subsequent meeting to take place
in 2026 [4]. Two questions remain:
What was the added value of having
health negotiations in New York? To
improve PPPR at the global level,
would it have been better to invest
efforts into ‘real action’ happening in
Geneva-based processes or following
Marie-Claire Wangari Wenzhen ( Jen) Zuo discussions at the G7 or G20?
Participants
In September 2023, Member States Assembly (WHA) in May 2024 and
gathered at the United Nations (UN) ahead of the UN General Assembly For a meeting labelled as ‘High-
High-Level Meeting on Pandemic in September 2024. Level,’ the meeting surprisingly
Prevention Preparedness and lacked the expected stature, especially
Response (PPR) in New York, against In September 2023, members of when compared to representation at
the backdrop of the UN General the World Medical Association previous High-Level Meetings. Only
Assembly [1]. The meeting was (WMA)’s Junior Doctors Network 13 Heads of State and 16 Ministers
supposed to provide leadership at the ( JDN) collectively analysed all 114 of Foreign Affairs participated
‘highest level’ to reset the system for statements delivered at the UN High- in this meeting. Over half of the
PPR in the wake of the coronavirus Level Meeting on PPR to understand representation were Ministers of
disease 2019 (COVID-19) pandemic Member State’s stated priorities on Health, which somewhat diminishes
and was called for by the Independent PPR and the level of prioritisation the purpose of a High-Level
Panel for Pandemic Preparedness and within governments. JDN members Meeting outside of the World Health
Response (IPPPR) and other parties subsequently agreed with the post- Organization (WHO). Notably,
[2]. Hence, it is worth reflecting on meeting consensus from academics except for the President of the
the impact of High-Level Meeting, and civil society, which concluded European Union Council, none of the
as negotiations continue in Geneva that this event was particularly Heads of State present represented
to try and develop a pandemic underwhelming, in terms of keeping G7, G20 or BRICS countries [5].
agreement or convention following pandemic threats on the agenda of This potentially signifies that health
the extension of the International heads of government, delivering new is considered lower on the priority
Negotiation Bureau (INB) (https:// policy commitments, and creating list of country leaders than during
inb.who.int) at the World Health new accountability mechanisms [3]. the COVID-19 pandemic. Notably,
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leaders from four (France, the United Over half of the speakers supported General Assembly received a letter
Kingdom, Russia, and China) of amendments to the International from seven countries (Belarus,
the five permanent members of the Health Regulations (IHR) and Bolivia, Cuba, Eritrea, North Korea,
UN Security Council chose not progress for the INB, yet they did Russia, Syria, Venezuela, Zimbabwe)
to participate in the UN General not articulate specific expectations for opposing any attempt to formally
Assembly at all [6].The gender balance the negotiations in Geneva. During adopt any draft outcome documents
of representation also remained a such negotiations, there was little of four of the UN High-Level
cause of significant disappointment, to no mention of the High-Level Meetings taking place in New York.
whilst better than most WHAs: only Meeting, and it would be hard to link This response prioritised meetings as
one-third of representatives were the updated IHR adopted in May an opportunity to push back against
women, despite the overwhelming 2024 to this process. Unfortunately, what they described as universal
evidence of the gendered impact of most statements focused on what coercive measures (sanctions).
the recent pandemic [7]. national governments had done Although the declaration was
during the recent pandemic, rather ultimately adopted by consensus
Meeting Discussions than looking forward to the future. in September 2023, widespread
This was highlighted by the lack of dissatisfaction remained. The
The High-Level Meeting was notable engagement with the Global Health frustrations included attaching
more for what was unsaid than said. Threats Council as a proposed reservations ranging from opposition
Specific calls to action were scarce, concrete outcome of the meeting, to the inclusion of gender and
with only a handful of countries which was acknowledged by only intellectual property, matters to
(United Kingdom, Australia, one Member State. The definitive unilateral coercive measures, and
Germany, Uganda, Sweden, Angola, outcome was the decision to convene process issues such as countries
Spain) making new commitments, another High-Level Meeting on expressing that the voice of the Global
often without clear financial pledges PPR in 2026 [4]. South was ignored [10].
or reiterating previous promises
from forums like the G7 or G20 The Political Context The meeting occurred against a
[8]. Countries from the Global backdrop of strained multilateralism
South vocalised their discontent over Holding a High-Level Meeting for and multiple competing crises such as
vaccine access during the COVID-19 health and shifting health discussions inflation, conflict and climate change,
pandemic, highlighting the need to New York seem less effective in for which global consensus remained
for stronger local manufacturing galvanising global health actions elusive and exhausted needed political
capabilities. than in previous years, leading to bandwidth. Concomitantly with
broad, lowest common denominator, the High-Level Meeting on PPPR,
With simultaneous High-Level non-specific political statements. important meetings of the UN
Meetings on Tuberculosis and Negotiators in New York in private Security Council on Ukraine and
Universal Health Coverage taking will often cite a lack of competence a Climate Ambition Summit were
place on the same day, there was and technical expertise on health also held with greater engagement by
very limited integration with PPR topics, which is shown in the senior government leaders, reflective
with very few statements cross meeting’s outcomes, especially noting of the pandemic fatigue and how the
referencing the other meetings. a handover of decision-making to world has moved on [11].
There were nods by many Member Geneva. The lack of relevance is
States to incorporate a One Health also exemplified by how German These events underscore the current
approach, and some did allude delegates articulated their redlines on complexities of international
to interlinkages between climate intellectual property in discussions cooperation, particularly in health
change, but references to upstream around the Pandemic Accord much policy, and prompt critical questions
prevention were mostly missing from more clearly at the World Health about the future of multilateralism
the discussion. Some Caribbean Summit in Berlin in October 2023 and the pursuit of global health goals
nations also reiterated reforms from than in New York in September 2023 in a fracturing world and distrust
previous debates, including a halt on [9]. between the Global North and South.
debt repayments during pandemics. The adoption of the updated IHR in
On 18 September 2023, two days Geneva in May 2024, demonstrated
prior to the High-Level Meeting that agreement can be achieved on
on PPR, the President of the UN contentious issues [12]. It remains to
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be seen whether the INB can reach the Cold War), including smallpox References
a Pandemic Agreement finalised and eradication and the adoption of key
overcome key issues on issues such as UN conventions including the 1979 1. United Nations. Adopting
intellectual property, benefit sharing, Convention on the Elimination of landmark declaration, General
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Women and the 1989 Convention on high-level international
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driving changes for interagency work international declarations to funding statement on the UN high-
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and BRICS are comprised of WHO for pandemic discussions
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even during tense periods (such as September 2023): espeaker list
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off icials/82737462-22ca-4a7c- international-health-regulations- child-rights-convention
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response to global health Nations, divided [Internet].
challenges, adopting declarations Carnegie Endowment for
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Yassen Tcholakov, MD, MScPH, MIH Marie-Claire Wangari, MBChB

Authors Assistant Professor, Department Graduate student in Global Health,
of Global and Public Health, Liverpool School of Tropical Medicine,
McGill University Liverpool, United Kingdom
Mike Kalmus Eliasz, MBBS, Montreal, Canada Independent Global Health Consultant
MSc, MRCPCH, DTM&H yassen.tcholakov@mcgill.ca WMA-JDN Chair (2023/2024)
Honorary Clinical Fellow Nairobi, Kenya
The Pandemic Institute, Maria Inês Francisco Viva, MD mcwangari.wm@gmail.com
University of Liverpool NOVA Medical School
Liverpool, United Kingdom Lisbon, Portugal Wenzhen ( Jen) Zuo,
mkeliasz@liverpool.ac.uk inem.viva@gmail.com MD, CCFP, MPH
Resident, Public Health and
Preventive Medicine,
University of British Columbia
British Columbia, Canada
wenzhen.zuo@gmail.com
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Junior Doctors Network’s Leadership at the World Health Summit 2023
Junior Doctors Network’s Leadership

at the World Health Summit 2023
Jeazul Ponce Hernández Francisco Franco Pêgo Flora Wendel
coverage (UHC); 4) sustainable

health for people and the planet; 5)
G7/G20 measures to strengthen
global health equity and security; 6)
digital technologies for global health;
7) WHO’s 75th anniversary; and
8) innovations to combat tuberculosis
[1]. Attendees were able to reflect on
the WHO’s achievements over the
past 75 years, while they recognised
that universal health coverage serves
Marie-Claire Wangari Balkiss Abdelmoula as the cornerstone to global health
equity and novel technology can help
expand access to care and ultimately
The World Health Summit (WHS) different sectors and improve health outcomes. Notably,
2023, held from October 15-17, disciplines. This distinctive format the launch of the global financing
2023, in Berlin, Germany (https:// allows participants to engage with facility pledging event was a crucial
w w w.world hea lt hsummit.org/ ), a broader spectrum of ideas and moment for securing financial
stands as one of the most significant initiatives, making the WHS a crucial commitments to support global
conferences dedicated to global platform for shaping the future of health initiatives.
health. This prestigious event gathers global health.
a diverse array of stakeholders, The WHS 2023 YouTube channel
including representatives from the Under the theme, “A Defining Year ( h t t p s : // w w w . y o u t u b e . c o m /
scientific, political, private, and for Global Health Action,” the WorldHealthSummit) captured key
public sectors, to address pressing WHS 2023 program delved into discussions during the conference
global health challenges. Unlike the eight critical topics that align closely sessions, offering further insight
World Health Assembly (WHA) with the mandates and priorities into the decisions that will shape
and the World Health Organization of the World Medical Association the global health landscape in the
(WHO) meetings, which have more (WMA) and the Junior Doctors’ coming years. The JDN delegation
rigid formats, the WHS offers a Network ( JDN). These agenda gained insight on these pressing
unique program structure. It features topics included: 1) learning lessons health topics and contributed to the
parallel sessions that not only from the coronavirus disease 2019 dialogue, particularly in areas where
encourage in-depth scientific (COVID-19) pandemic for future junior doctors can lead and drive
discourse, but also provide prevention efforts; 2) preparedness local and global change. Their active
ample networking opportunities and response to address global crises; participation highlighted the crucial
and foster collaboration across 3) emphasis on universal health role young professionals play in
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developing innovative solutions for Highlights on Health Workforce by two networking events. These
the future of healthcare. By learning and Youth Engagement activities provided essential updates
updates on scientific and policy on expanding youth engagement in
initiatives to address the current This article will describe high-level both clinical and public health sectors
challenges in global health topics, highlights on four WHS sessions, as well as equipping participants with
junior doctors can identify ongoing including early career engagement, the skills and connections needed
projects, align their professional future of global health, global health to drive meaningful change in
interests, and join leadership research and policy, and UHC. It their respective fields. Additionally,
teams across their countries. This will also underscore the critical role delegates emphasised the importance
engagement can empower them to of youth leadership and engagement of professional networking
make meaningful contributions to in shaping the future of global and fostered meaningful youth
the evolving landscape of global health. These sessions provided a participation within the WHS and
health, ensuring that their voices are platform for the JDN delegation to the wider global health community.
integral to shaping the future. actively contribute to discussions that
were directly aligned with the JDN Post the High-Level Meetings: Youth’s
JDN Participation mission, where they could advocate Vision for the Future of Global Health:
for and empower early-career Organised by the International
During the WHA in May 2023, the physicians on the global stage. Federation of Medical Students’
WHS organisers contacted the JDN
leadership, as they had proposed an
agenda that would highlight youth
engagement at the WHS in October
2023. The WMA Secretariat agreed
with these plans, and the JDN
secured five placements to attend the
WHS for the first time. Although it
was challenging to attend the WHS
immediately following the JDN
Management Team term transition,
an open call among the JDN
Management Team and Working
Groups Chairs resulted in a prompt
assembly of three participants –
Dr. Francisco Franco Pêgo (Portugal),
Dr. Jeazul Ponce Hernández (Spain),
and Dr. Flora Wendel (Germany).
At the event, the JDN delegation
networked with several health
organisations to identify synergies
and foster connections for future Photo 1. Dr. Jeazul Ponce Hernández, Dr. Francisco Franco Pêgo, and Dr. Flora Wendel (left to right) as the JDN delegation at the
collaborations. They attended various World Health Summit in May 2023. Credit: JDN
scientific sessions on WMA primary
topics and prioritised sessions that Youth Side Program: Hosted by Associations (IFMSA) and the
explored strategies for increasing the the German Medical Students’ International Pharmaceutical
capacity of healthcare professionals Organization, the Youth Side Students’ Federation (IPSF), this
globally, addressing workforce Program is quickly becoming a session was a cornerstone of the main
shortages, and ensuring that junior central platform for empowering program, dedicated to amplifying
doctors are actively involved in early-career professionals through youth voices and ensuring their active
policy-making and leadership roles. targeted capacity-building, advocacy involvement in shaping global health
training, and representation. During policies (https://www.youtube.com/
the WHS, the program featured watch?v=EopfaijotXs). The session
an intensive two-day capacity- specifically focused on sharing critical
building session complemented perspectives and the vision of youth
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in accelerating progress towards Global Health Research, is funded institutions in turning research
UHC and applying innovative by the German Federal Ministries into actionable policies. Delegates
technologies for global health for Education, Research, and emphasised successful country-
security, which are central topics Economic Cooperation, dedicated to specific approaches and the
toward achieving health equity. strengthening global health research necessity of critical enablers such as
Junior doctors and stakeholders met in Germany. The session centred infrastructure and networks. They
to brainstorm on timely solutions on tackling the complex challenges also highlighted steps on how
related to UHC and global health and opportunities in global health government institutions can integrate
security as well as identify crucial research and policy, with a strong lessons learned from previous
action points following the High- emphasis on fostering South-South programs as well as provide financial
Level Meetings during the United collaborations among academics, support for research opportunities.
Nations General Assembly. The policymakers, and communities.
session offered an opportunity for It convened a diverse range of A Promise Forgotten? Putting Universal
delegates to reflect on the growing perspectives from researchers, public Back into Health Coverage: The
recognition within the WHS health institutes, and policymakers, political will to promote UHC
community that youth engagement addressing issues spanning from was widely debated, building
is essential for building sustainable infectious diseases to health systems upon the conference discussions
health solutions. and implementation research. One on UHC-related topics and the
key focus was on the importance Political Declaration adopted
Research and Policy in Global Health of policy training for early career at the United Nations General
(GLOHRA): The GLOHRA alliance, professionals and the pivotal Assembly in September 2023.
organised by the German Alliance for role of national public health Delegates made a call to join
Photo 2. Group photo of the youth attendees at the World Health Summit in May 2023. Credit: World Health Summit
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international efforts that promote participation of JDN members in

primary health system development, upcoming WHS events, which is Francisco Franco Pêgo, MD
highlighting the importance of essential for advancing the agenda WMA-JDN Socio-Medical
health professionals working directly of meaningful youth involvement in Affairs Officer (2023/2024)
with affected populations and global health. These efforts will not General Training Resident, Central
understanding community needs. only strengthen JDN’s presence at Lisbon University Hospital Center
To further emphasise the urgency these global health meetings, but will Lisboa, Portugal
of strengthening health systems also lay the groundwork for impactful ffpego@gmail.com
globally, delegates also stressed the participation in WHS 2024.
critical role of fostering community Flora Wendel, MD
trust and ensuring equitable access to WMA-JDN Working Group Chair on
care, recognising that UHC cannot Primary Health Care (2022/2023)
be truly achieved without addressing Reference Resident, General Practice
the unique challenges of vulnerable and Family Medicine
populations. Additionally, there 1. World Health Summit. World Research Assistant, Chair of
was a strong appeal for sustained Health Summit 2023: “a defining Public Health and Health Services
global solidarity and cooperation year for global health action” Research, LMU Munich
to guarantee that international [Internet]. 2023 [cited 2024 Aug Munich, Germany
commitments translate into tangible 10]. Available from: https://www. florakuehne@gmail.com
improvements in health outcomes for worldhealthsummit.org/about/
all. history/2023.html Marie-Claire Wangari, MBChB
Graduate student in Global Health,
Conclusion Liverpool School of Tropical Medicine,
Liverpool, United Kingdom
As emerging leaders in global Independent Global Health Consultant
health, JDN members have a unique WMA-JDN Chair (2023/2024)
opportunity to collaborate and Authors Nairobi, Kenya
engage actively in future WHS mcwangari.wm@gmail.com
events, thereby amplifying the voice Jeazul Ponce Hernández,
of junior doctors on the global stage. MD, MPH, MSc Balkiss Abdelmoula, MD, MPH
By developing a strategic advocacy WMA/JDN Publications WMA-JDN Deputy
plan aligned with JDN priorities Director (2023/2024) Chair (2023/2024)
and the WMA’s policy papers and PhD student in Public Health, Family Medicine Specialist and
position statements, JDN members University Complutense of Madrid Global Health Consultant
can effectively articulate physicians’ Madrid, Spain Sfax, Tunisia
perspectives and secure prominent jeazulponce@gmail.com abdelmoula.balkiss@gmail.com
roles as speakers or trainers in scientific
forums. Additionally, identifying
and securing funding opportunities
is crucial to ensure the sustainable
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Junior Doctors’ Perspectives on Barriers and Solutions to Equitable Access to Global Health Opportunities
Junior Doctors’ Perspectives on Barriers and Solutions

to Equitable Access to Global Health Opportunities
Marie-Claire Wangari Deena Mariyam Lekha Rathod
Global health conferences and challenges before, during, and after Furthermore, financial and
meetings are crucial for knowledge the conference. First, young people administrative barriers remain a
exchange and professional growth, are often unaware of engagement significant hurdle for junior doctors
but recent reports suggest that opportunities with key stakeholders, to travel and contribute to global
there is an underrepresentation of have inadequate support and health meetings. Indeed, junior
stakeholders from low- and middle- guidance from mentors and doctors’ access to global health
income countries (LMICs) due senior staff, and observe limited opportunities, including attending
to neo-colonial patterns in global transparency and reporting from the World Health Assembly (WHA)
health [1]. Decolonizing global international organisations [5]. In sessions, is considerably impacted
health, a concept that has recently fact, junior doctors may lack by logistical complexities, namely
gained traction, aims to remove all continuous mentorship when they those associated with cross-border
forms of supremacy within global first start on their global health and international travel. This is
health practice and create a future journey. Second, understanding the especially relevant since many High-
with no more pervasive remnants pathways for attending meetings, Level Meetings take place in New
of colonisation [2,3]. In addition, including navigating the registration York City or Geneva, for which an
with more than half of the world's process, can be laborious due to entry visa is needed for participants
population being under 30 years of bureaucratic and non-transparent from LMICs [8]. Visa procurement
age, increased youth representation procedures. Third, strict conference can be a costly and time-consuming
at global health conferences is agendas may hinder speaking endeavour, with no guarantee that
essential for the meaningful opportunities for young participants, complete documentation will be
engagement of young people to who are often assigned an observer available in time for scheduled travel.
accelerate progress toward the status and are limited to verbally [9,10].
Sustainable Development Goals as sharing their perspectives. Fourth,
well as contribute to timely policy most United Nations (UN) Applying a gender representation
and health decision-making [4]. member states and World Medical lens, cultural, social, and institutional
The following article explores junior Association (WMA) country variables may also influence the
doctors’ perspectives on barriers and delegations do not include or invite unequal participation of male and
solutions related to the equitable young people to form part of the female delegates at WHA sessions
access to global health opportunities. meeting delegations [6]. Finally, [11]. Between the 74-year span
junior doctors, who represent from 1948 to 2021, although more
Existing Barriers different languages and cultures, female delegates have attended
are constantly challenged when WHA sessions, more males (83%)
As junior doctors seek additional engaging with stakeholders, than females (30% at its peak
learning experiences at conferences, especially due to language and in 2017-2018) have represented
in order to complement their medical structural barriers [7]. these delegations [11]. As women
training, they can experience diverse represent more than 70% of the
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health workforce, working across priority given to candidates from technology (e.g. mobile applications,
clinical and community settings, their LMICs. Also, the WHO and the interactive web applications) to
collective leadership role in global WMA may be able to offer fast- facilitate the engagement of global
health governance continues to be track support for visa processing, audiences in major conferences.
significantly overlooked. including providing visa letters Since these applications have
that confirm the selection of youth provided a platform to organise
Recommendations representatives and the key role that conference agendas (instead
youth representatives play in ensuring of printed booklets), hybridise
Junior doctors have faced financial meaningful conference engagement. conference sessions, and network
challenges, administrative Organising committees of scientific with colleagues, junior doctors can
complexities such as visa procedures, conferences, together with global effectively plan their conference
difficulties in taking time off organisations (including national agenda and travel logistics. As junior
from clinical responsibilities, and medical associations), should provide doctors attend these hybrid meetings
knowledge and language barrier gaps; ample time for attendees to navigate and conferences, albeit lack of in-
nevertheless, these lived experiences the visa application process. person engagement and networking
have helped shape their commitment opportunities, they can expand their
to continuous learning and WMA and JDN leaders can promote international networks without the
professional development. The WMA an open dialogue to better understand logistical conundrums of complicated
Junior Doctors Network ( JDN) explicit barriers that hinder junior travel processes including visa
Working Group on World Health doctors’ participation in global acquisition [9,10].
Organization (WHO) Activities scientific events and subsequently
conducted an internal evaluation of develop novel approaches to empower Mobile or web applications can
JDN members’ perspectives to better their future contributions. For support the session hybridisation,
understand the specific challenges example, essential networking offering a space for junior doctors
related to junior doctors’ attendance and professional development to contribute online and in-person,
at global health meetings. Between opportunities can help guide junior and hence increasing engagement
September 2022 and February doctors in their training, including in sessions by asking questions and
2023, Working Group members establishing a mentorship or buddy sharing lived experiences. Taking
developed and shared a preliminary system that can match experienced into consideration the benefits of
questionnaire with JDN and WMA doctors with junior doctors. Also, digital technologies, committees of
members, reviewed the submitted the promotion of equitable gender scientific conferences should ensure
responses, and developed a consensus representation should remain on that hybrid conferences are engaging
on three potential recommendations the forefront of global dialogue for all attendees. Furthermore,
to address existing challenges. and conference proceedings toward junior doctors who represent their
ensuring equal participation in national medical associations or other
Recommendation 1: Incorporating plenary and scientific sessions, organisations (like the WMA) can
and empowering youth representatives interactive workshops, and other request guidance from authorities on
in conference delegations and offering networking opportunities. specific expectations and deliverables,
financial and administrative support. as a result of their participation in
Recommendation 2: Supporting these external meetings.
To increase youth representation hybrid platforms and digitalisation of
in global health conferences, global conference materials Recommendation 3: Improving
health and youth organisations communication and dissemination
should offer junior doctors partial or With technological advancements, of opportunities to junior doctors to
complete funding to cover visa and lessons learned during the coronavirus represent their lived experiences at
travel costs, especially for participants disease 2019 (COVID-19) pandemic, relevant conferences.
living in LMICs or geographically and the push for environmental
distant from the meeting location sustainability, the world has embraced Communication efforts towards
[12]. WMA members can advocate the digitalisation of conference potential conference attendees,
for the establishment of a fundraising materials, hybrid conferences, and including junior doctors, should
sub-committee to work with national live streaming. These adaptations be diverse and incorporate various
member associations and disseminate have helped committees of scientific channels (e.g. emails, newsletters,
timely funding opportunities, with conferences use digitisation social media, website updates). Since
24
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official communications and activities References 15]. Available from: https://

are conducted in diverse languages, blogs.bmj.com/bmj/2019/06/21/
junior doctors can help promote 1. Vervoort D, Ma X, Bookholane dominique-vervoort-the-visa-
inclusivity and cultural exchange H, Nguyen TC. Conference conundrum-in-global-health/
and even pursue language training cancelled: the equitable flip side
as part of their continuing education of the academic surgery coin. Am 9. Smeeth L, Kyobutungi C.
[13,14]. As junior doctors may J Surg. 2020;220(6):1539-40. Reclaiming global health. Lancet.
choose to participate in international 2023;401(10377):625-7.
events, like the WHO Simulation 2. Hommes F, Monzó HB, Ferrand
or pre-WHA workshops, they can RA, Harris M, Hirsch LA, 10. Velin L, Lartigue JW, Johnson
also register for keynote lectures, Besson EK, et al. The words SA, Zorigtbaatar A, Kanmounye
roundtable discussions, skills- we choose matter: recognising US, Truche P, et al. Conference
based courses, communication and the importance of language in equity in global health: a
diplomacy activities, and simulation decolonising global health. Lancet systematic review of factors
exercises. Glob Health. 2021;9(7):e897-8. impacting LMIC representation
at global health conferences. BMJ
Conclusion 3. Abimbola S, Pai M. Will global Glob Health. 2021;6(1):e003455.
health survive its decolonisation?
Junior doctors call upon local, regional, Lancet. 2020;396(10263):1627-8. 11. Van Daalen KR, Chowdhury M,
and global health organisations to Dada S, Khorsand P, El-Gamal
develop strategies that enhance their 4. World Health Organization. S, Kaidarova G, et al. Does
access to global health opportunities Engaging young people for health global health governance walk
integral to their professional growth. and sustainable development: the talk? Gender representation
The current barriers, such as financial strategic opportunities for the in World Health Assemblies,
constraints, extensive administrative World Health Organization and 1948-2021. BMJ Glob Health.
procedures, and lack of departmental partners. Geneva: WHO; 2018. 2022;7(8):e009312.
approval, hinder their participation Available from: https://iris.who.
in international conferences, adding int/handle/10665/274368 12. Basile FW, Petrus J, Gates C, Perry
to the anxiety and strain experienced SH, Benjamin J, McKenzie K, et
by these health professionals. As 5. Rhee DS, Heckman JE, Chae SR, al. Increasing access to a global
observed at previous WMA and Loh LC. Comparative analysis: health conference and enhancing
WHA meetings and findings from potential barriers to career research capacity: using an
the JDN internal evaluation, JDN participation by North American interdisciplinary approach and
members embody a strong desire physicians in global health. Int J virtual spaces in an international
to contribute to solutions that Family Med. 2014;2014:728163. community of practice. J Glob
promote their inclusion in global Health. 2022;12:03038.
health meetings. To address these 6. Khorsand P, Chowdhury M,
challenges, it is essential to initiate Wyns A, Velin L, Wangari MC, 13. Svadzian A, Vasquez NA,
an open dialogue within Cipriano G, et al. Envisioning Abimbola S, Pai M. Global health
organisations (like WHO and sustainable and equitable World degrees: at what cost? BMJ Glob
WMA) that focuses on providing Health Assemblies. BMJ Glob Health. 2020;5(8):e003310.
financial and administrative Health. 2022;7(5):e009231.
support, digitising conference 14. Adams LV, Wagner CM, Nutt
registration processes, and enhancing 7. Binagwaho A, Allotey P, Sangano CT, Binagwaho A. The future of
communication about available E, Ekström AM, Martin K. A global health education: training
global health opportunities. By call to action to reform academic for equity in global health. BMC
implementing these strategies, we global health partnerships. BMJ. Med Educ. 2016;16(1):296.
can move towards decolonizing 2021;375:n2658.
global health and ensure equitable
participation, thereby amplifying 8. Vervoort D. Dominique
the voices of junior doctors from all Vervoort: the visa conundrum
backgrounds and fostering a more in global health [Internet]. BMJ
inclusive global health community. Opinion. 2019 [cited 2024 Aug
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Acknowledgements: Authors
Deena Mariyam, MBBS,
The JDN-WMA Working Group Marie-Claire Wangari, MBChB MSc Public Health
on WHO Activities (now retired) Graduate student in Global Health, General Practitioner & WMA-
collectively prepared this article as Liverpool School of Tropical Medicine, JDN Secretary (2023/2024)
one final project, with the guidance Liverpool, United Kingdom Bangalore, India & Dubai,
of the Working Group Chair from Independent Global Health Consultant United Arab Emirates
2021-2022. The Working Group WMA-JDN Chair (2023/2024) deenamariyam4@gmail.com
members include: Jamie Colloty, Nairobi, Kenya
Laura Jung, Laura Charlotte mcwangari.wm@gmail.com Lekha Rathod, MBBS, MIH
Kalkman, Deena Mariyam, Caitlin WMA-JDN Planetary Health Working
Pley, Pablo Daniel Estrella Porter, Group Co-Chair (2022/2024)
Lekha Rathod, Mehr Muhammad lrathod95@gmail.com
Adeel Riaz, Yassen Tcholakov,
Wunna Tun, Marie-Claire Wangari,
and Mercy Wanjala.
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Pharmaceutical Policy in Afghanistan
Pharmaceutical Policy in Afghanistan
neighbouring countries and placing Corruption Monitoring and

millions of people at risk [3]. As Evaluation Committee noted that
a result of this weak governance the trade in illegal imports
and corruption, illegal activities thrives because of corruption,
frequently occur in Afghanistan, border issues, quality assessments,
including smuggling, importation, and poor governance [3]. The
and alteration of medications committee found that at least
for communicable and non- half of the country’s pharmaceutical
communicable diseases. import market comprises illegally
imported products. Although this
Afghanistan’s National Health illicit importation and smuggling
Tabasom Fayaz Policy 2015-2020 was adopted could be reduced if rules and
in 2015, highlighting five policy regulations were followed, the
areas: governance, institutional financial incentives have led to
After 40 years of war and political development, public health, health increased production, importation,
unrest, the Afghan people are services, and human resources [4]. and distribution of low-quality
suffering from incalculably adverse According to this policy, the National pharmaceuticals throughout the
medical complications that are Medicines and Health Regulatory country. With an estimated 450
worsened by extreme weather Authority was strengthened and foreign pharmaceutical suppliers,
events (like drought), impacts of updated to help mitigate nationwide of which 250-300 suppliers are
conflict (resulting in internally public health risks [5]. With the in Pakistan, medications that are
displaced populations), and attacks governmental transition in 2021, this prohibited from being sold in
on healthcare facilities (increasing national policy has not been updated Pakistan are frequently shipped to
trauma cases). The country’s low life to reflect pressing health issues. Afghanistan [3]. Prescription drugs
expectancy of 63 years, coupled with (e.g. benzodiazepines, opioids)
the high annual infant mortality rate The lack of evidence-based and heroin were the most reported
of 58 deaths per 1,000 live births, regulations existed even before the drug types used among the Afghan
are clear indications of severe public most recent government came to population [6]. Although the
health issues and a lack of adherence power; however, the isolation of healthcare system is unprepared
to medical regulations [1,2]. To make the new government makes any to address drug dependence and
matters worse, citizens must contend external involvement impossible. addiction, developing solutions to
with a healthcare system that lacks Poor regulatory oversight has enabled manage altered medications and
treatment options and funding, illegal imports, impacting the substance use will help reduce public
including limited assistance from quality of medication in accessibility.
international health organisations. Afghanistan. In a global self-
benchmarking assessment, which As high-quality, safe, and effective
Although it is recognised that was established to rate national medications are a pillar of the
patients’ medical concerns can healthcare systems on a scale of 1 healthcare system, compromised
be promptly addressed through (lowest) to 5 (highest), the World medications can lead to a major
evidence-based medical practices Health Organization (WHO) collapse of its infrastructure. It can be
for diagnosis, treatment, and concluded that Afghanistan scored challenging, however, to distinguish
prevention, there is limited universal 2 for pharmacovigilance and 1 in between legitimate and fraudulent
adherence to the healthcare system’s quality control, inspection, and pharmaceuticals, especially since
regulations in Afghanistan’s health clinical trials in 2017 [5]. The scores labels and directions may not be in
facilities. Healthcare professionals from the benchmarking assessment Dari (official language of
in Afghanistan have highlighted are still extremely low running the Afghanistan). In addition,
that weak governance, lack of supply national healthcare system. incompliance to regulations and
chain management, and corruption guidelines can further complicate
are giving rise to a thriving trade in In addition to poor regulatory the scenario and lead to major public
altered medications coming from authority, Afghanistan’s Anti- health adversities. This dilemma
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calls upon physicians and leading from: https://data.worldbank.org/ who.int/countryplanningcycles/
health organisations worldwide to country/afghanistan planning-cycle-files/afghanistan-
help create a system that connects national-health-policy-2015-2020
healthcare professionals to patients 2. United Nations International
to ensure that correct medications Children’s Emergency Fund. 5. World Health Organization.
are prescribed. Additional pressure Country profile: Afghanistan WHO Afghanistan country
on Afghan health leaders can help [Internet]. 2024 [cited 2024 Aug office 2019 [Internet]. 2018
prioritise the purchase of medications 15]. Available from: https://data. [cited 2024 Aug 16]. Available
imported from countries in the unicef.org/country/afg/ from: https://www.emro.who.
Eastern Mediterranean and int/images/stories/afghanistan/
European regions, which can 3. Independent Joint Anti- who_at_a_glance_2019_feb.pdf
reduce illegal importations. Robust Corruption Monitoring and
efforts to strengthen the healthcare Evaluation Committee. VCA 6. Hall WD, Degenhardt L.
systems of low-income countries report on pharmaceuticals Afghanistan has a sizeable
(like Afghanistan) can lead to the importation process [Internet]. problem with opioid use. Lancet.
prioritisation and adherence to 2014 [cited 2024 Aug 16]. 2014;2(1):e577-8.
evidence-based clinical practices and Available from: https://www.baag.
regulations, and most importantly, org.uk/sites/default/files/resources/
improve patient health outcomes. a t t a c h m e n t s / 2 0 14 _ 11 _ 19 _
Pharmaceutical_VCAENGLISH. Tabasom Fayaz, BSc, MSc
pdf Northeastern University
Boston, Massachusetts, United States
References 4. World Health Organization. fayaz.t@northeastern.edu
Afghanistan national health
1. World Bank. Country: policy, 2015-2020 [Internet].
Afghanistan [Internet]. 2024 2015 [cited 2024 Aug 27].
[cited 2024 Aug 15]. Available Available from: https://extranet.
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African Health Leadership: A Physician’s Perspective
opportunities abroad, which are often training, followed by a mandatory

limited in their home countries. one-year licensing internship under
Additionally, political instability, the Ministry of Health, and then they
inadequate healthcare infrastructure, either select to pursue general practice
and limited career advancement or postgraduate training [6,7].
prospects further contribute to
this exodus (“brain drain”), which African physicians often seek
exacerbates healthcare challenges in valuable professional development
already resource-strapped regions. and networking opportunities for
knowledge exchange on best practices
Despite the high number of emigrant in health systems strengthening.
Marie-Claire Wangari physicians from the continent, Specifically, they have the
efforts have been made to train more opportunity to join and contribute
physicians in the continent’s medical as associate members to the various
The Coalition of African National schools. In East Africa, universities organisations, such as the CANMA
Member Association (CANMA) have allowed cross-border training at the regional level, Commonwealth
came into inception in 2018, with of undergraduate health professional Medical Association (CMA) at
the sole vision of uniting African students in Burundi, Ethiopia, the sub-regional level, and World
National Member Associations Rwanda, Somalia, South Sudan, Medical Association (WMA) at the
(NMAs) to have one common Tanzania, and Uganda [4]. Although global level. Despite opportunities
voice in the advocacy and policy this initiative is a start, more adaptive to join regional and global medical
arena. Currently, the coalition is leadership and governance systems associations, few African physicians
composed of 20 member countries nationally and regionally are needed have held senior leadership positions
including Kenya (interim chair), to bridge the low physician-patient in these organisations since their
Cote d’Ivoire, Democratic Republic ratio in the Africa region. inception. Reflecting upon the
of Congo, Ethiopia, Gambia, historical timeline, the WMA and
Ghana, Lesotho, Malawi, Mali, The Physician’s Journey to the Junior Doctors Network ( JDN)
Mozambique, Namibia, Nigeria, Leadership have had less than 10 African
Rwanda, Senegal, Somalia, South physicians serve in senior WMA
Africa, Tanzania, Uganda, Zambia, Traditional medical students take an or JDN management leadership
and Zimbabwe. average of six years of undergraduate positions since 1947 and 2010,
training, where the first two years respectively. Given the rise in
The Landscape of Health focus on pre-clinical sciences (e.g. physician numbers from the African
Leadership in Africa human anatomy, medical physiology, continent, specialist associations
biochemistry), followed by four should provide more sensitisation
Currently, the main issue plaguing years of clinical training in various on the importance of regional
African NMAs is the rise of clinical departments. After these six representation in global health
physician migration out of the years of medical school, graduates leadership.
continent. From Nigeria’s mass proceed to complete a one- to two-
migration of citizens including health year licensing internship year, as Future Directions in African Health
personnel termed “Japa” to Kenya’s required by their country’s Ministry Leadership
bilateral health professional exchange of Health. After the internship is
with Cuba and the United Kingdom, completed, physicians can practice Looking to the future, empowering
many nations have their physician- as General Practitioners or proceed the next generation of African
patient ratios plummeting due to to a post-graduate specialisation that healthcare leaders is essential to
volatile working conditions in their lasts between one to seven years, address the continent’s unique
countries [1-3]. Physician migration depending on the specialty challenges. By fostering innovative
in Africa is largely driven by the requirements and modality of training approaches and inclusive leadership,
pursuit of better working conditions, [5]. In Kenya, medical students African health systems can be
higher salaries, and advanced training undergo six years of undergraduate strengthened to improve access
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and equity. As the global landscape healthcare systems [11]. Mentoring ensuring a brighter future for health
evolves, African leaders can drive specifically involves the informal to over 1.5 billion persons living on
sustainable health solutions that meet conveyance of knowledge, social the continent.
the needs of their communities. The capital, and support, that recipients
African region, given the potential perceive to be pertinent to their work, References
for cross-cultural collaborations career, and personal or professional
through various health associations development. During their formative 1. Okunade SK, Awosusi OE. The
and coalitions, has a bright future of academic training, health professional Japa syndrome and the migration
producing future global health leaders students can benefit from mentorship of Nigerians to the United King-
through two specific actions. programs, which provide guidance, dom: an empirical analysis. Com-
career development, and emotional parative Migration Studies.
Identifying emerging trends and support. Notably, it can ensure that 2023;11(27).
promoting cross-border collaborations: new professionals are well-prepared
The African continent serves as to meet the complex challenges of 2. Nyambura MW. Kenya ends
the cradle of primary healthcare, modern healthcare systems. Despite doctors-swap deal with Cuba
and with the rise of telemedicine, these observed benefits of mentorship [Internet]. 2023 [cited 2024 Jul
the region has a chance to pave the programs, however, many institutions 6]. Available from: https://na-
wave to new frontiers of medicine in in Sub-Saharan Africa have not fully tion.africa/kenya/news/kenya-
implementation science and primary embraced the inclusion into their ends-doctors-swap-deal-with-
healthcare services. In conjunction programs [12]. By fostering a culture cuba--4398520
with the national Ministries of of mentorship, experienced leaders
Health’s efforts, this is further can share their knowledge, 3. Ministry of Labour and Social
amplified by the efforts of regional experiences, and insights across Protection, Government of
health bodies, such as the Africa generations, which helps build a Kenya. Speech during the
Centre for Diseases and Control resilient and capable future workforce. first joint meeting between all
(Africa CDC)’s New Public Health agencies involved in the
Order for Africa and the World Conclusion implementation of the Bilateral
Health Organization Regional Agreement between Kenya
Office for Africa (WHO AFRO)’s The article underscores that and the United Kingdom for
multisectoral strategy to promote adaptive leadership, cross-border collaboration on health care
health and well-being [8,9]. These collaborations, and robust mentorship workforce [Internet]. 2021
positive strides can help propel efforts programs, can effectively address [cited 2024 Jul 6]. Available
to expedite the attainment of universal challenges and foster the next from: https://www.labour.go.ke/
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Furthermore, by addressing complex Concerted efforts are needed to Speech-during-first-joint-meet-
national and regional challenges, increase African representation in ing-on-UK-BLA-18th-au-
African countries are pursuing global health leadership and harness gust-2021.pdf
stronger regional integration to reap innovative approaches that can
the benefits of larger markets [10]. strengthen health systems across the 4. Nyaga B. EAC nationals qualified
Through collaborative efforts, leaders continent. By bridging generational to work as doctors in Kenya
can tackle issues such as infectious gaps and promoting knowledge [Internet]. KBC TV. 2017
disease outbreaks, inadequate transfer, mentorship programs [cited 2024 Jul 6] Availa-
healthcare infrastructure, and health can support a resilient healthcare ble from: https://kbctv.co.ke/
disparities more effectively and workforce that can drive sustainable blog/2017/03/19/eac-national-
efficiently. improvements in global health doctors-qualified-to-work-in-
systems. Moreover, promoting cross- kenya
Supporting key mentorship opportunities border collaborations is essential to
for professional development: Direct leverage expertise to improve the 5. Odongo CO, Talbert-Slagle K.
mentorship and coaching in the quality of healthcare at the national Training the next generation
health professions are pivotal and regional level. Now is the time of Africa’s doctors: why medi-
towards supporting education for African healthcare leaders to cal schools should embrace the
and training and strengthening unite, collaborate, and mentor, team-based learning pedagogy.
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BMC Med Educ. 2019;19:403. ricacdc.org/wp-content/up- across the five Population Health
loads/2022/09/Call-to-Action- Implementation and Train-
6. Kenya Medical Practitioners NPHO-Final-CTA-20-Sep- ing partnership projects in sub-
and Dentists Council. Bachelor Edited.pdf Saharan Africa. BMC Health
of Medicine and Bachelor of Serv Res. 2017;17(Suppl 3):831.
Surgery core curriculum 9. World Health Organization
[Internet]. n.d. [cited 2024 Sep Regional Committee for Africa. 12. Tamale E, Atuhairwe I,
1] Available from: https://kmp- Regional multisectoral strategy to Ssemwogerere A. Muhimbura B,
dc.go.ke/resources/mbchb.pdf promote health and well-being, Atimango L, Malinga PD, et
2023–2030 in the WHO African al. Knowledge, attitudes, and
7. Kenya Medical Practitioners Region: report of the Secretariat practices of health professions
and Dentists Council. National [Internet]. 2023 [cited 2024 Aug students on mentorship: a
guidelines for internship training 14]. Available from: https://iris. cross-sectional study at a sub-
of medical and dental officer in- who.int/handle/10665/372393 Saharan African medical school.
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es/NATIONAL%20GUIDE- in Africa [Internet]. 2023 [cited
LINES%20FOR%20INTERN- 2024 Aug 18]. Available from: Marie-Claire Wangari, MBChB
SHIP%20TRAINING%20 https://www.worldbank.org/ Graduate student in Global Health,
OF%20MEDICAL%20 en/results/2023/12/08/region- Liverpool School of Tropical Medicine,
AND%20DENTAL%20OF- al-integration-removes-barri- Liverpool, United Kingdom
FICER%20INTERNS.pdf ers-to-development-in-africa Independent Global Health Consultant
WMA-JDN Chair (2023/2024)
8. Africa Centres for Diseases and 11. Manzi A, Hirschhorn LR, Nairobi, Kenya
Control and Prevention. Call Sherr K, Chirwa C, Baynes C, mcwangari.wm@gmail.com
to action: Africa’s New Pub- Awoonor-Williams JK, et al.
lic Health Order [Internet]. Mentorship and coaching to
2022 [cited 2024 Jul 31] support strengthening health-
Available from: https://af- care systems: lessons learned
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Interview with National Medical Associations’ Leaders of the African Region
Interview with National Medical Associations’

Leaders of the African Region
Simon Kigondu Herbert Luswata Mvuyisi Mzukwa
the challenge, and one hope for the to an increase in the numbers of
future of medicine. trained doctors, specialists, and
subspecialists and hence improve
Kenya: The Kenya Medical quality healthcare. One of the most
Association (KMA) had the privilege important pillars of a healthcare
and honour to host the World system is adequate doctor-patient
Medical Association (WMA)’s ratios.
223rd Council Session, which
was held from 20-23 April 2023. Rwanda: One memorable experience
Following many months of planning was when the Rwanda Medical
John Baptist Nkuranga and preparation, the KMA welcomed Association (RMA) hosted the
guests from all over the world to successful 74th WMA General
the Ole Sereni Hotel, a scenic hotel Assembly, which brought together
overlooking the Nairobi National leading medical professionals from
Dr. Simon Kigondu, Dr. John Baptist Park. WMA meetings were around the world and fostered
Nkuranga, Dr. Mvuyisi Mzukwa, and successfully conducted, and WMA collaboration and knowledge
Dr. Herbert Luswata, the Presidents members participated in the opening exchange among more than 50
of the national medical associations dinner at the Kenyatta International national medical associations. It was
(NMAs) of Kenya, Rwanda, South Conference Centre, one of Nairobi’s rewarding to showcase Rwanda's
Africa, and Uganda, respectively, iconic venues. They also had a fruitful development and recovery progress
join the interview with Dr. Helena tour to the Nairobi National Park 30 years after the genocide against
Chapman, the WMJ Editor in Chief. that culminated in a dinner within the Tutsi as well as RMA’s continued
They share their perspectives on the park at the club house. contributions to the global medical
their leadership experiences, ongoing community. The experience left a
NMA activities, strengths and At the same time, the KMA has lasting impression on organisers,
existing challenges in medical experienced diverse challenges over the and coupled with positive feedback
education, and how the World past few years, including widespread from participants, RMA members
Medical Association (WMA) can inflation, lawsuits related to large loan gained confidence and built trust with
support NMA initiatives in the repayments, and financial challenges the Ministry of Health and other
African region. directly connected to reduction of participating government agencies.
pharma industry support. However,
As you reflect upon your journey there is hope for a good future of When coronavirus disease 2019
as NMA president, please describe medicine in Kenya. The number of (COVID-19) cases surged in Rwanda
one memorable experience, one medical schools has grown from two in early 2022, RMA members aimed
challenge and how you resolved in 2000 to 13 in 2024, which has led to support the government response
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measures through the “Operation leadership and advocacy capabilities healthcare system is sustainable.
Save the Neighbour” initiative. in a time of crisis. The SAMA’s Moreover, the SAMA aspires to see
They integrated doctors into home- commitment to improving access to a stronger emphasis on mental health
based care teams, incorporated life-saving medications showcased services, recognising the critical role
data with patients' and doctors' its dedication to public health and that mental well-being plays in overall
geolocations, and aligned this solidified its role as a key player in health. By fostering a collaborative
information with community health South African healthcare. environment among healthcare
professionals who could visit, assess, professionals, policymakers, and
and treat COVID-19 cases in their One significant challenge, however, communities, the SAMA aims to
neighbourhood. Within two weeks, was the health workforce shortage build a resilient healthcare system
home-based visits had increased from that was exacerbated by the that can adapt to future challenges
30% to 92%, with 82% of patients emigration of medical professionals and continue to improve the health
having regular oxygen monitoring seeking employment and academic and well-being of all South Africans.
from home, contributing to decreased opportunities abroad. This “brain
mortality rates. This approach drain” left the public health sector Uganda: As President of the Uganda
strengthened support and rapport understaffed and overburdened, Medical Association (UMA), I am
among doctors, community health affecting the quality of care provided honoured to have led our dedicated
professionals, and patients, which to patients. Using a multi-faceted and resilient team through successful
has increased overall confidence in approach, the SAMA called upon advocacy efforts to improve the
telemedicine consultations. the government, advocating for better welfare of health professionals in
working conditions, competitive Uganda. As a result of negotiations and
One significant challenge in Rwanda salaries for healthcare professionals, industrial action during December
is the retention of doctors within and policies that would encourage 2021, Ugandan health professionals
the health workforce, primarily due current students to pursue the achieved a salary increment of over
to poor remuneration, incentives, medical profession. Additionally, 100%, and they are still advocating for
and sometimes poor working the SAMA launched initiatives adjustments concerning specialists’
environments. As this “brain drain” to support and retain medical salaries. Collective advocacy has
has increased demand for medical professionals within the country, also led to policy developments that
professionals in the country, the including continuous professional have resulted in new public service
RMA is focusing on advocating for development programmes and structures in the health sector, and
better compensation and working partnerships with international the creation of doctor positions at
conditions for doctors, in efforts to medical associations to foster the parish level (e.g. Health Center
promote the retention of a sustainable exchange programmes that allowed 111 in May 2024). These national
health workforce. RMA members for professional growth without achievements will help to address
actively engage policymakers, permanent relocation. Through these unemployment among junior
contribute to research initiatives that efforts, the SAMA managed to stem doctors and improve access to quality
examine the driving factors of health the tide of emigration and helped to health care services for the observed
workforce retention, and strengthen rebuild a robust health workforce. population growth of 24.2 million in
RMA membership services including 2000 to 47.25 million in 2014.
establishing a career guidance Looking to the future, the SAMA
program and fostering a supportive hopes for a more equitable healthcare The UMA is leading efforts to explore
membership network. system where all South Africans have two specific challenges for healthcare
access to high-quality medical care, professionals in Uganda. First, the
South Africa: One recent memorable regardless of their socioeconomic UMA’s Human Resource survey
experience that highlighted the status. This vision includes the conducted in January 2024, which
South African Medical Association integration of advanced medical aimed to examine human resource
(SAMA)’s influence occurred during technologies and innovations that coverage and gaps, highlighted the
the COVID-19 pandemic, namely can improve patient outcomes and 21-62% (average of 42%) human
the rollout of the vaccination streamline healthcare delivery. The resource coverage and 58% human
programme. As the pandemic swept SAMA envisions a future where resource gap in public health facilities
across South Africa, the SAMA preventative care is prioritised, in Uganda. To address this gap,
played a crucial role in shaping the reducing the burden of chronic the Uganda government is been
national response, demonstrating its diseases and ensuring that the actively involved in negotiations to
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expand recruitment of healthcare The Abuja Declaration, which practice, and licencing within
professionals. In June 2024, the emphasises the need for 15% healthcare institutions. Finally, the
Uganda Ministry of Health indicated allocation of the health budget to KMA serves as a member of the
that they can only employ 38% of the health sector, represents the most National Health Insurance Fund
available healthcare professionals in advanced health policy (including (NHIF) and proposed as a board
the country, and that more strategies the national health insurance member of the new Social Health
should be embraced to combat this scheme) in the African region to Authority. The KMA’s input is
unemployment challenge such as date. Moving forward, the UMA useful to help guide and oversee the
exporting health professional services hopes to advocate for expanding the management of healthcare financing
to other countries and supporting current 8.2% allocation of the health in Kenya.
training and recruitment for the budget in Uganda, to align with the
private health sector. recommended 15% allocation, and Rwanda: The opportunities for
hence increase access of healthcare advancing healthcare are enormous,
Second, the Uganda government services to the public. Although an particularly in the context of ongoing
adopted a proposal to stop paying alternative financing model for the advocacy efforts that influence key
allowances to medical interns and health sector was introduced to the decision-making and policies. The
introduce self-sponsored internships Parliament of Uganda, the national COVID-19 pandemic has placed the
in May 2023, which was prompted health insurance scheme legislation role of healthcare professionals in the
by reduced external funding due to was formulated in 2023, but not yet spotlight, underscoring their critical
the controversial anti-homosexuality approved or adapted into the health contributions to the healthcare
bill. However, the UMA believed sector. system. In response to pressing
that alternative solutions existed, society needs, Rwanda has initiated
such as increasing local funding How would you describe the current the 4x4 strategy, as a comprehensive
and prioritising wages for these opportunities for NMA members to plan designed to quadruple the
allowances, which consider the help influence health care policy- number of healthcare professionals
valuable contributions of medical making activities in your country? over the next four years and engage
interns to the health sector. UMA the health workforce to address
members vigorously advocated for Kenya: First, the KMA has various unmet healthcare needs for citizens.
the prioritisation of these allowances, thematic committees that focus on
and our efforts were met with different aspects of healthcare. The The threat of the health workforce
initial resistance, leading to hospital thematic committees can develop loss (due to physician migration) has
crises based on delayed deployment policy position papers for the prompted a renewed commitment
and a lack of medical interns. The Association that are submitted to to consider the welfare of healthcare
situation escalated to the point the Ministry of Health and other professionals, including concerted
where Ugandan doctors considered relevant health authorities for review effort to enhance monetary incentives
launching a nationwide industrial and policy guidance. A case in and improve working conditions.
strike in 2023. However, through point is the drafting of memoranda To address this challenge, the
persistent negotiations, the UMA to the Parliament and Senate of Rwanda Ministry of Health is taking
and the health system successfully Kenya on pressing issues including significant strides towards building
secured the deployment of medical human resources for health and a resilient healthcare system that
interns (doctors, nurses, pharmacists) healthcare financing. Second, KMA meets the needs of its population.
with a negotiated pay. This members are frequently requested Leaders have established policies and
outcome demonstrates the UMA’s to serve as members of various guidelines that foster collaborations
commitment to fighting for the Ministry of Health task forces and with RMA members, to ensure that
rights and welfare of health share their professional opinions on the voices of healthcare professionals
professionals, even in the face of various thematic areas related to the are integrated into the development
adversity. taskforces. Third, since the KMA of policies and decision-making
has representation in the Kenya processes, which can foster a sense
The future of medicine is promising Medical Practitioners and Dentists of ownership and commitment
in Uganda, with robust relationships Council (KMPDC), members can among the health workforce.
between the government and help improve medical training and
healthcare professionals and good medical practice by contributing to
political will towards the improved the Council’s mandate of regulating
welfare of healthcare professionals. the medicine and dental training,
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South Africa: The SAMA views key stakeholder, UMA members professionals and patients, the
the current landscape as ripe with are regularly consulted by the Rwandan government created the
opportunities for its members government to formulate and review Patient Rights Charters, which serves
to play a crucial role in shaping health-related policies, as they are as a code of conduct with roles and
healthcare policy in South Africa. well-positioned with expertise and responsibilities for both healthcare
As a respected body representing technical knowledge to influence professionals and patients. It aims to
medical professionals, SAMA policy changes that benefit the health ensure that patient care is delivered
members can advocate for meaningful sector and the Ugandan population. in a respectful and ethically sound
change and engage in policymaking The Ugandan government values our manner, reinforcing the positive
through various channels, including inputs and recognises the importance dynamics necessary in the physician-
leveraging their clinical expertise of our contributions to national patient relationship.
through active participation in discourse. I am truly humbled and
governmental advisory committees. proud to lead the UMA, as an It is evident that the physician-
By serving on these committees, organisation that plays a vital role in patient relationship is evolving
members contribute to the shaping the future of healthcare in towards a more collaborative and
development of health policies that Uganda. communicative model. However,
are both practical and informed by significant imbalances remain,
real-world challenges and solutions. How do perceive the physician- primarily due to patients' lack of
patient relationship and rapport in awareness of their rights and available
Additionally, SAMA members the clinical setting in your country? protections within the healthcare
can engage in public consultations system. Many patients may not
and forums organised by the Kenya: Kenya leaders have feel empowered to ask questions
government and other stakeholders. recognised that physician-patient about their medical conditions,
These platforms allow medical relationships vary within the public often relying on unreliable sources
professionals to voice their opinions, and private sectors. Public facilities (e.g. friends, family members,
provide feedback on proposed are characterised by high client flow, social media), which can lead to
policies, and suggest improvements. high workload, and less than optimal misconceptions about medications
The Association regularly organises human resources for health capacity. and treatment. Additionally, the
engagements, workshops, seminars, The physician-patient relationship power dynamics in these relationships
and conferences, where members can and rapport tend to be short in can hinder effective engagement, as
discuss pressing healthcare issues and order to minimise patient queues. many clinicians may feel that they
formulate collective positions that the Management is less influenced by have authority over patients’ care. To
SAMA can present to policymakers. patients, and treatment is often improve this dynamic, it is crucial to
This collaborative approach ensures constrained by limited diagnostics educate patients about their rights
that the insights and expertise of a and resources. On the other hand, and ensure that healthcare providers
wide range of medical professionals private facilities are generally for- are trained on patients right and
are considered in the policy-making profit, and therefore physician- effective communication strategies,
process. The SAMA also encourages patient interactions tend to last longer which can ultimately foster a culture
its members to engage directly and with greater rapport, and patients are of mutual understanding and respect
build strong relationships with directly involved in diagnostics and as well as improve patient satisfaction
local communities and civil society various treatment modalities. and health outcomes.
organisations to better understand
the health needs and concerns of the Rwanda: In Rwanda, the physician- South Africa: The physician-patient
population. Through this grassroots patient relationship is generally relationship and rapport in the clinical
engagement, SAMA members can characterised by high levels of trust setting is fundamental to the delivery
advocate for inclusive and effective and mutual respect, which fosters a of quality healthcare. The SAMA
policies that address the specific positive rapport in clinical settings. recognises that this relationship is
health challenges faced by different This trust contributes to an overall built on trust, communication, and
communities. sense of safety and confidence in mutual respect, which are essential
the medical care received, with for effective diagnosis, treatment, and
Uganda: Currently, the UMA has patients adhering to their physicians’ patient satisfaction. In South Africa,
a significant opportunity to shape recommendations. To support the where the healthcare landscape
the country's health policies. As a relationship between healthcare is diverse and often strained by
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resource limitations, maintaining a and Dental Practitioners Council Rwanda: First, the RMA anticipates
strong physician-patient rapport is promptly address the ethical and significant gaps in knowledge
crucial yet challenging. The SAMSA professional standards by discussing acquisition, as medical schools,
acknowledges the pressures faced by the incident and agreeing upon teaching hospitals, and research
physicians, including high patient appropriate actions (including centres are not rapidly evolving to
volumes and administrative burdens, sanctions). As President of the UMA, meet the current and future public
which can strain these relationships. I am committed to upholding the health challenges. With the rapidly
However, the Association advocates highest standards of medical practice evolving technology, we foresee
for a patient-centred approach that and ensuring that our patients receive shortages in incorporating essential
prioritises empathy, active listening, the care that they deserve. training resources, including
and cultural competence. By simulation lab resources, robotic, and
promoting continuous professional How would you describe the other advanced training technologies,
development and ethical practices, anticipated challenges in medical into medical education. Second,
the SAMA strives to enhance the education over the next decade in there is a growing concern about the
quality of interactions between your country? shortage of medical school faculty in
physicians and patients, ensuring that the basic sciences, as these positions
every patient feels heard, respected, Kenya: The quality of medical are often less attractive for
and cared for by physicians. This education and training remains a professionals to pursue advanced
commitment is seen as a cornerstone challenge in Kenya. Medical schools studies and such teaching careers.
for improving health outcomes and are domiciled in universities that do As a result, this continued shortage
fostering a more humane and effective not have university hospitals. Medical of qualified faculty could hinder
healthcare system in South Africa. students and trainees complete their the quality of medical education.
clinical rotations in hospitals that are Third, many trained professionals
The physician-patient relationship not administratively linked to the are migrating to middle- and high-
is constantly evolving due to various university. Over the past few years, income countries to seek improved
factors, including technological many public universities dependent work environment and incentives,
advancements, increased access to on the exchequer, have had funding which could result in a depletion
online medical information, and the challenges from government. In of trained professionals within
integration of artificial intelligence. efforts to increase their revenues, the country (“brain drain”) and
As one notable example, the they have increased admissions of further exacerbate the health system
Health Professionals Council of medical students to their programs challenges.
South Africa’s swiftly responded to even beyond their quality capacity.
the pandemic by allowing virtual The Commission of University South Africa: Over the next decade,
consulting, resulting in a shift that Education (CUE), which oversees the SAMA anticipates several
fundamentally transformed the university education, adopted a law significant challenges in medical
physician-patient relationship. that made the input of the KMPDC education, reflecting on broader
Hence, it is essential to acknowledge concerning medical training not issues within the healthcare system
and adapt to these changes to ensure mandatory. The KMA has observed and the evolving landscape of
the relationship remains effective and that hospital programs have an medical practice. First, there is an
patient-centred. excess number of medical students urgent need to address the growing
contrary to what the KMPDC demand for healthcare professionals
Uganda: The physician-patient would recommend as capacity for amid an ongoing shortage of medical
relationship in Uganda is built on quality training. The trainees thus educators and clinical training
a strong foundation of efficient complete their clinical rotations with facilities. As the South African
communication, mutual respect, inadequate patient contact time, population increases and the
confidentiality, and empathy. Our decreasing the quality of education burden of communicable and non-
healthcare professionals strive to and training. The KMA, through its communicable diseases continues to
provide excellent care, and the representatives in the KMPDC and rise, the strain on medical schools
majority of patient interactions in Parliament, continues to advocate and academic hospitals will likely
are positive and respectful. When for mandatory input of the KMPDC intensify. This shortage could hinder
instances of inappropriate conduct on medical training in the CUE Act. the ability to provide high-quality
are observed, however, the UMA training and practical experience,
Ethics and Professionalism which are crucial for preparing future
Committee and the Uganda Medical physicians.
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Second, the integration of practice evolves, ethical and From the medical education
advanced technology and digital professional dilemmas faced by perspective, how has your NMA
health solutions into the medical healthcare professionals are expected responded to the existing and
curriculum will require additional to become more prominent. If emerging health challenges within
training for educators and students. medical education places a stronger your country?
While technological advancements emphasis on bioethics, professional
offer significant potential to conduct, and legal aspects of medical Kenya: The KMA serves as a leading
enhance medical education practice, students will be prepared institution in Africa, maintaining
through simulation-based learning, to navigate issues related to patient robust health professional training.
telemedicine, and electronic health autonomy, informed consent, and First, during the COVID-19
records, ensuring that both educators ethical use of emerging medical pandemic, the KMA partnered with
and students are proficient in these technologies throughout their career the Ministry of Health and other
technologies will require substantial path. leading health agencies to develop
investment and adaptation. To a curriculum for training the health
incorporate these tools effectively, Finally, the demanding nature workforce on infection prevention
the SAMA foresees the need for of medical education, coupled and control. Second, as the CUE Act
comprehensive training programmes with the high levels of stress and clause restricts the consideration of the
and updates to the curriculum, burnout experienced by healthcare KMPDC’s contributions to national
ensuring that graduates are well- professionals, necessitates a proactive discourse, the KMA has continued to
equipped to navigate a technologically approach to supporting medical advocate for the KMPDC’s valuable
advanced healthcare environment. students’ mental health and well- input on institutional requirements
being. Some strategies include related to medical education and
Third, the SAMA recognises the providing access to counselling training programs.
necessity of adapting medical services, promoting a healthy
education to the evolving healthcare work-life balance, and fostering a Rwanda: The RMA is actively
needs of the South African supportive and inclusive educational advocating for increased incentives
population, including a greater environment. for medical doctors and improving
emphasis on primary care, working conditions of its members
preventative medicine, and chronic Uganda: The medical education and other healthcare professionals.
disease management. Medical system in Uganda faces significant Since the beginning of this year, the
education must therefore shift to challenges, notably the inadequate RMA initiated an ambitious career
produce physicians who are skilled supervision of medical students during guidance program to promote the
in acute care, managing long-term graduate training and post-graduate good of the profession, inspire young
health conditions, and promoting internships and residency. This is professionals and create a support
health and wellness. This shift will largely attributed to the unregulated network. It is also working on a
entail changes in the curriculum, number of admissions to medical capacity building initiative to raise
as well as increased opportunities schools, which can compromise the awareness on patient rights, medical
for students to gain experience in quality of healthcare professionals in ethics and ethical practices intended
community health settings. the future. As President of the UMA, to promote professionalism among all
I am concerned about the potential cadres of medical doctors. The RMA
Additionally, efforts to increase consequences of this observed trend is also partnering with the Ministry
diversity in the medical profession, and urge health leaders to address of Health on its ambitious 4X4
especially from underrepresented this issue promptly to ensure the reform program to increase the
and disadvantaged backgrounds, production of competent and skilled number of health workforce and
are essential to better reflect healthcare professionals to support bridge the gap especially in rural areas
the population's demographics the Ugandan health system. Over and primary healthcare settings.
and effectively address health the past few years, the UMA has
disparities. Some strategies may been working collaboratively with the South Africa: The SAMA has
include providing financial support, Ugandan government to develop an pushed for a medical education that
developing mentorship programmes, internship policy related to medical is comprehensive and reflective of
and targeting recruitment efforts to residents’ training and secured the country’s health landscape, as
ensure that the medical workforce financial compensation and good it recognises the urgent need to
is diverse and inclusive. As medical welfare. address the high burden of both
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communicable (HIV/AIDS, workforce is essential for delivering were confined in their homes.
tuberculosis, emerging zoonoses) culturally competent care and Although virtual learning platforms
and non-communicable (diabetes, reducing health disparities. were used for alternative clinical
hypertension, mental health disorders) training approaches, medical
diseases. By ensuring that medical Uganda: I am proud to highlight students’ clerkships were disrupted
students receive extensive training that our contributions and advocacy due to restricted hospital access. The
in these critical areas, the SAMA is efforts are aimed at maintaining emergence of telehealth education
helping to equip future healthcare high-quality medical trainings in platforms provided an opportunity
professionals with the knowledge and Uganda and producing competent to effectively adopt virtual education
skills needed to effectively manage healthcare professionals who can platforms, and to this date, a
these health challenges. To keep pace provide high-quality care to our significant number of training courses
with the digital transformation of citizens. The proposals include: continue to be delivered virtually.
healthcare, the SAMA supports the 1) adding a standardised national Although the pandemic hindered
integration of modern technologies curriculum for all medical schools; growth of the health workforce, it
into medical education, including the 2) implementing a national entry spurred innovation with medical
adoption of simulation-based learning exam and exit exam into medical students participating in COVID-19
tools, telemedicine training, and the schools; and 3) requiring that research, adapting to new academic
use of electronic health records in the national medical councils effectively learning modalities (e.g. hybrid
curriculum. Additionally, the SAMA supervise medical students during education models), gaining interest in
encourages practising physicians to their clinical training and post- digital health applications.
pursue professional development graduate internships. Currently, the
opportunities to keep them updated UMA is actively advocating for the South Africa: The COVID-19
on emerging technologies and finalisation of the internship policies pandemic significantly disrupted
innovative practices. and the development of postgraduate medical education in South Africa, as
training regulations. traditional in-person lectures, hands-
The SAMA places a strong on clinical training, and practical
emphasis on research and evidence- From your perspective and assessments were abruptly halted due
based practice as a cornerstone of national experiences, how has the to lockdown and social distancing
medical education. By encouraging COVID-19 pandemic affected measures. It presented unprecedented
and supporting medical research medical education in your country? challenges that forced educational
initiatives, the SAMA aims to cultivate institutions to adapt swiftly, and
a culture of inquiry and continuous Kenya: During the COVID-19 simultaneously accelerated the
learning among medical students pandemic, most medical education integration of digital tools and
and professionals. As research can programs were virtual, which e-learning in medical education. To
help generate local data and insights enabled faculty to continue teaching enable continuity in education, the
that are crucial for addressing South their course and their training for SAMA supported the adoption of
Africa’s specific health challenges, faculty and students. This virtual virtual classrooms, webinars, and
the SAMA promotes the prompt format worked well for theoretical online simulation tools to replace
dissemination of research findings subjects, even noting increased class traditional teaching methods. As
through conferences, publications, attendance. Skills-based courses not all students had reliable internet
and collaborations with international (including physical examinations access or suitable devices for online
medical communities. Hence, South with patients) and other soft skills learning, recognised as the “digital
African healthcare can benefit (like building rapport with patients) divide”, the SAMA advocated for
from these global best practices that required physical contact, solutions to these disparities, such as
and innovations. Furthermore, the however, were limited by their nature providing data subsidies and lending
SAMA has advocated for policies of requiring physical contact, and technological devices to students in
and programmes that promote equity hence affected the quality of learning. need.
and inclusion, such as providing
scholarships and financial support Rwanda: Like other disciplines, One of the most significant impacts
to students from disadvantaged medical education faced significant of the pandemic on medical
backgrounds, to increase diversity disruptions during the COVID-19 education was the disruption of
within the medical profession. The pandemic in Rwanda, as institutions clinical training. With hospitals
SAMA believes that a diverse health were closed and medical students overwhelmed by COVID-19 cases
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and the high risk of infection, many other medical schools remained health outcomes. To build capacity
medical students faced reduced access opened, halting in-person academic within the medical community,
to clinical rotations and hands-on lectures for over one year, the shift RMA members focus on establishing
patient care experiences. The SAMA to virtual learning limited hands-on leadership development programs
recognised the critical importance training and physical interactions and training initiatives, designed
of clinical training in developing with mentors and patients. The lack to equip members with the skills
competent physicians and worked of practical experience and direct necessary for ethical leadership and
with healthcare institutions to supervision compromised the quality advocacy. Mentorship programs
develop alternative training methods, of training, posing a significant risk pair experienced professionals with
such as virtual clinical rounds, to the competence of future emerging leaders to guide their
telemedicine consultations, and healthcare professionals. As the development, while workshops and
simulated patient interactions. health system recovers from the seminars incorporate the topics of
pandemic’s impact on medical ethics, human rights, and professional
The COVID-19 pandemic prompted education and training in Uganda, conduct. This collaborative approach
a comprehensive evaluation of UMA members are working tirelessly helps build a cohesive and informed
medical curricula and educational to mitigate its effects and ensure medical community, aligned with
models, to better prepare academic that our healthcare system emerges WMA principles and committed to
programs for such disruptions and stronger and more resilient. advancing healthcare standards.
future doctors for public health
crises. The SAMA advocated for the How does your NMA leadership South Africa: SAMA leadership
inclusion of public health emergency implement the WMA policies in the actively integrates WMA policies
preparedness, epidemiology, and organisation? into its strategic planning and
infectious disease management operational activities. This process
in medical education, in order to Kenya: As active member of the begins with a thorough review and
equip students with the knowledge WMA, the KMA endeavours to have contextualisation of WMA guidelines,
and skills necessary to respond as many as possible of its leaders and to ensure that they align with South
effectively to future pandemics or members attend WMA activities Africa’s unique healthcare landscape
health emergencies. The pandemic like the Council Meetings, General and needs. SAMA’s leadership
also underscored the importance Assemblies, and regional meetings. disseminates these policies through
of research and collaboration in In this manner, KMA members official channels, including meetings,
addressing global health crises. The can learn about WMA policies, seminars, and training sessions, so
SAMA supported efforts to involve provide input at meetings, and that all members are aware of and
medical students in research related disseminate relevant policy guidance understand the WMA’s standards
to the pandemic, fostering a culture for implementation at the local and and recommendations. Additionally,
of inquiry and evidence-based national levels. the SAMA incorporates WMA
practice. Collaborative projects, policies into its advocacy efforts, as
both within South Africa and Rwanda: RMA leadership actively a framework to influence national
internationally, provided valuable advocates for the adoption and healthcare legislation and policy
learning opportunities and integration of some WMA policies development. The SAMA hopes to
contributed to the broader into national health policies, by influence these principles as globally
understanding of the virus and its engaging with government bodies recognised best practices, thereby
impact on global health security. and stakeholders and submitting enhancing the quality and integrity
policy proposals. They participate in of healthcare delivery in South
Uganda: I can attest that the national health forums to ensure that Africa.
COVID-19 pandemic had a relevant WMA policy statements
devastating impact on education and guidelines can inform their Uganda: The UMA has been
(especially medical education) in decision-making processes. The represented at the WMA General
Uganda. Some medical schools RMA works to influence health Assemblies, and members actively
were forced to close, creating a policies that align with international participate in shaping WMA policies
significant gap in human resources, standards and ethical practices set and resolutions that guide the global
as many hospitals relied heavily on by the WMA, ultimately aiming to medical community. Notably, the
post-graduate medical residents for improve healthcare quality, patients’ UMA adopts relevant WMA policies
health service delivery. Although rights protection, and patients’ and advocates for their integration
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into Ugandan health policies research, the WMA can help improve support for South Africa’s healthcare
through our engagement with the the quality of medical training system from international donors
Parliament of Uganda. Through and research in Rwanda and equip and organisations, which can lead
this collaboration, we ensure that healthcare professionals with essential to improved healthcare facilities,
Uganda’s health policies align with skills needed to advance quality better access to medical supplies, and
international best practices and medical education and evidence- enhanced support for public health
standards, as we aim to improve based practices. Third, the WMA can initiatives, thereby strengthening the
the health system that benefits our facilitate partnerships with Rwandan overall healthcare system in South
patients and the community at large. professional medical associations, by Africa. Furthermore, with the recent
enhancing collaborative efforts that Declaration of Helsinki African
How can the WMA support the would positively impact healthcare Regional meeting, WMA’s support
ongoing NMA activities in your systems in Rwanda. Finally, the for SAMA’s hosting has enabled the
country? WMA can serve as a resource organisation to foster networking
for consultation, allowing RMA and collaboration opportunities with
Kenya: As KMA leadership, we members to seek guidance on complex other national medical associations.
occasionally request that the WMA issues where they may lack expertise, By facilitating connections and
provide a statement on ongoing issues thus benefiting from the broader partnerships, the WMA can help
affecting the medical profession in WMA network and opportunities for the SAMA share best practices,
Kenya to influence policy makers as knowledge exchange. learn from other nation’s experiences,
well as help connect the KMA with and collaborate on global health
potential resource partnerships. We South Africa: By leveraging its initiatives. This network can enhance
request that the WMA continue this global influence, the WMA can SAMA’s ability to manage local
financial support as it is particularly help amplify SAMA’s voice to health challenges while contributing
important for junior doctors who garner attention and resources from to the global medical community.
may not have adequate resources global health organisations and
to participate in WMA and Junior governments for pressing health Uganda: We are pleased to leverage
Doctors Network ( JDN) activities. challenges in South Africa. WMA our membership with the WMA
Second, as the WMA supports leaders can offer expert guidance and request guidance on how to
capacity building activities, the on policy development, helping obtain financial and asset support
WMA could offer leadership courses the SAMA to craft and implement from international agencies for UMA
to KMA leaders, which can help policies that align with international initiatives. Currently, the UMA is
strengthen their advocacy skills in best practices and address local health launching a fundraising campaign
health leadership. Furthermore, needs. Also, the WMA can assist the to construct the headquarters
the WMA could offer exchange SAMA by offering capacity-building building, which will serve as a hub
programmes between the various programmes and training initiatives for our activities. With the WMA’s
national medical associations inside that can enhance SAMA members’ guidance, we hope to secure the
and outside of Africa, which could knowledge and skills in medical necessary resources to complete this
help improve knowledge sharing ethics, leadership, public health, and construction, which can enhance our
and foster collaborations within the research. This support is especially capacity to advocate for the optimal
medical profession. valuable in areas like emergency welfare of healthcare professionals
preparedness and response, where and high-quality healthcare in
Rwanda: The WMA can support global expertise can significantly Uganda. The UMA has developed
the ongoing activities of the RMA strengthen local capabilities. Still, initiatives to explore working with
in several key ways. First, the the WMA can help secure funding international partners to expand
WMA can enhance the overall for collaborative research projects, healthcare collaborations – including
growth of the RMA by providing especially through international the United Kingdom’s National
adaptable policy frameworks that research grants and partnerships, Health Services’ Royal College of
expand capacity building through which can generate data and insights Physicians and Rwanda Ministry
continuing professional development on specific health issues. of Health – as well as promote
and strengthen its advocacy efforts. opportunities for health professional
Second, by providing leadership The WMA can help advocate for services to be exported to other
support in medical education and increased resources and infrastructure countries. We request the guidance
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of WMA on how to identify and Authors

facilitate reliable connections with Mvuyisi Mzukwa, MBChB
other countries, as one strategy President, South African
to address unemployment and Simon Kigondu, MBChB (ObGyn) Medical Association
underemployment among healthcare President, Kenya Medical Association Pretoria, South Africa
professionals in Uganda. Nairobi, Kenya ceo@samedical.org
simonkigondu@gmail.com
John Baptist Nkuranga, MD,
Herbert Luswata, MD Med Paeds, MMASc GH
President, Uganda Medical Association President, Rwanda Medical Association
Kampala, Uganda Kigali, Rwanda
luswataherbert@gmail.com rmasecretariat@gmail.com
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Interview with National Medical Associations’ Leaders of the European Region
Interview with National Medical Associations’

Leaders of the European Region
François Arnault Tomás Cobo Castro Johannes Steinhart
institutions.
France: There have been many

significant moments in our French
Medical Council (Conseil National
de l’Ordre des Médecins, CNOM)
activities, including the development
of robust policies and the management
of challenging negotiations on
pressing health issues. Specifically, one
memorable experience (highlighted
Philippe Cathala Sof ia Rydgren Stale by Dr. Philippe Cathala) is the
implementation of our mentorship
policy with junior doctors, as they
Dr. Johannes Steinhart, Dr. François challenge and how you resolved are the future of medicine, and it
Arnault, Dr. Tomás Cobo Castro, and the challenge, and one hope for the is our collective responsibility to
Dr. Sofia Rydgren Stale, the Presidents future of medicine. contribute to their medical training.
of the national medical associations To support this mentorship policy,
(NMAs) of Austria, France, Spain, Austria: In 2023, Austria witnessed an annual ceremony has been
and Sweden, respectively, as well as widespread negotiations on healthcare established in the local council,
Dr. Philippe Cathala, Delegate for reform with political leaders, and a chaired by Dr. Philippe Cathala,
European and International Affairs first draft gave rise to fears of negative where council members invite all
of the NMA of France, join the consequences for the healthcare junior doctors from the region
interview with Dr. Helena Chapman, system. Only when the Austrian and present them with the most
the WMJ Editor in Chief. They Medical Chamber (AMC) finally symbolic tools of our profession:
share their perspectives on their became involved, these negotiations the stethoscope and code of
leadership experiences, ongoing took place in a constructive and ethics. We are very pleased that
NMA activities, strengths and existing purposeful atmosphere, and hence the this initiative has inspired other
challenges in medical education, and involvement of the AMC prevented doctors at all levels of training, and
how the World Medical Association major healthcare dilemmas. These now several councils have followed
(WMA) can support NMA initiatives timely improvements were related to in our footsteps.
in the European region. future patient care, such as eliminating
end dates for the implementation of Spain: One of the most memorable
As you reflect upon your journey standardised nationwide contracts experiences during my term as
as NMA president, please describe and committing resources to reduce president of the Spanish General
one memorable experience, one administrative burden in health Medical Council (CGCOM) was the
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approval of the new Code of Medical would be in opposition to the healthcare reform of 2023 shows
Ethics. This document, which is important ethical principle that care the important role that the AMC
aligned with the WMA Code of must be provided on the basis of plays in healthcare policy activities
Medical Ethics, is the result of clinical need alone, regardless of the (including constructive cooperation
years of work and multi-stakeholder care seeker´s legal status. It also goes with politicians and advocacy for
consensus, and sets the ethical and against the International Code of healthcare improvement) that focus
professional principles that will Medical Ethics and threatens patient on patient care and the medical
guide medical practise in Spain. The safety. As health professionals and as profession. As the professional
approval ceremony, which was held an NMA, it is important to speak out organisation representing all Austrian
in 2023, was a moment of pride and against any proposal that prevents us doctors, the AMC is committed to
celebration for all persons involved. from fulfilling our duties. My post positive developments in the Austrian
Upon signing the document, I went viral in Sweden, and many healthcare system by implementing
remember that I felt a deep sense of physicians as well as representatives innovative approaches to offer the
responsibility and commitment to from other professions and employers best possible medical care for patients.
the values that the code represents. raised their voices in support. I The AMC is comprised of various
This achievement not only reinforced believe that this community response committees that collectively advocate
our commitment to medical ethics, demonstrates the importance of for socially-oriented, modern
but also enhanced public confidence our medical ethics, how strongly we healthcare that is accessible to the
in the medical profession. Over my feel about them, and how we can entire population through doctors
tenure, one of the most significant hopefully make a difference when we working in public and private sectors.
challenges was the implementation of come together and use our collective
the Continuing Medical Education voice on pressing health issues. At France: The CNOM, established in
(CME) credits of the European the same time, it offers an example 1945, is the only institution in France
Union of Medical Specialists of a challenge that we face and one that unites all doctors, regardless
(UEMS) in Spain and in Latin approach to resolve the issue, by of their status, practice mode or
America, as it comprised of a formal working together with our SMA specialty. It was created by law
agreement between CGCOM, members as well as organisations and entrusted with several public
the European Union of Medical from different parts of the healthcare service missions, defending the
Specialists (Union Européenne des sector and society. independence and honour of the
Médecins Spécialistes, UEMS), medical profession throughout
and the Medical Confederation My hope for the future of medicine French society. Upon my election as
of Latin America and the is that we will see a development president of the CNOM, I committed
Caribbean (Confederación Médica towards a more equal healthcare to strengthening our contacts and
Latinoamericana y del Caribe, and universal health coverage, where working relationships with all
CONFEMEL). We envision a future everyone can benefit from medical institutional partners, including
where medicine will be more precise, advances and take full advantage public authorities, doctors’ unions,
less invasive, and more focused of new research findings. It is health profession councils, patient
on prevention and personalised important that the trust in research associations, members of the French
treatment, which will significantly and science remains high (and, where parliament, and elected officials from
improve patient quality of life and life necessary, increases) in society and various regions.
expectancy. the general public, and specifically
among patients, politicians, and As a key player in discussions on the
Sweden: One memorable moment decision makers. Healthcare needs evolution of the healthcare system,
as the Swedish Medical Association to be governed by science and ensure CNOM members actively contribute
(SMA) president was when I strong professional autonomy for to numerous committees and serves
posted, “I´m a physician, not a border- the best of all patients. as experts with ministries, regional
policeman,” on social media, in health agencies, and French public
response to the government starting How would you describe the current health organisations (e.g. National
an investigation to examine the opportunities for NMA members to Agency for the Safety of Medicines).
possibility of demanding physicians help influence health care policy- As a leading speaker for public
and other employees in municipalities making activities in your country? authorities, the Council provides
and regions to report undocumented opinions on health-related bills and
migrants. Such an obligation to Austria: The forementioned decrees as well as conducts periodic
report undocumented migrants involvement of the AMC in the surveys on pressing topics such as
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medical demographics, physician How do perceive the physician- individual medical consult, and must
safety, and continuity of care. patient relationship and rapport in require the doctor’s supervision, the
the clinical setting in your country? CNOM is currently preparing an
Spain: Currently, we have a direct ethical and deontological framework
and collaborative relationship with Austria: As doctors, our top priority for the use of these new tools.
the administrations of central is to be actively present for our
and regional association in Spain. patients, offering quality time for Spain: The doctor-patient
Following the coronavirus disease direct interactions to learn about their relationship is and will continue to
2019 (COVID-19) health crisis, the personal needs and concerns. Trust be the basis of medical practice, and
CGCOM has led timely national is the be-all and end-all in the it is well safeguarded in Spain. This
efforts that continue to strengthen the relationship between doctors and fundamental bond remains visibly
medical profession, including forming their patients, and hence those who strong among doctors in Spain, as
the State Public Health Agency, trust their doctor will also adhere evidence of their strong vocation and
developing and advocating for the more precisely to recommended professionalism in medicine, albeit
approval of the emergency medicine treatment. Since doctors acknowledge experiencing multiple challenges like
specialty training, supporting an that significant time is wasted on non- infection control during the pandemic,
increased number of specialist medical work such as documentation, hospital surges, and overburdened
training placements. As an the AMC has been a long-time schedules. As the CGCOM is
organisation, we recognise that our advocate for reducing bureaucratic absolutely committed to protecting
members represent experts in their activities (e.g. writing discharge this doctor-patient relationship, we
clinical and surgical specialties, who letters, personnel management) launched an initiative in 2016, to make
are frequently requested to provide and expanding digital options the doctor-patient relationship part of
input to help national discourse on such as a standardised information the intangible heritage of humanity.
pressing health issues. Upon each technology infrastructure (e.g. Despite technological advancements,
request, we are increasingly aware extramural and intramural areas), medicine must continue to revolve
of our important role, working development of digital apps, and around this intimate and trusting
with leading stakeholders (like the national documentation assistants relationship between the doctor and
government) in order to support that support electronic health records the patient.
health system resiliency. (elektronische Gesundheitsakte,
ELGA). Sweden: A good patient-physician
Sweden: The SMA, a labour union relationship is necessary for optimal
and professions association, is a well- France: The CNOM is the guarantor care. Of course, there are patients who
respected organisation in Sweden. of the patient-doctor relationship in are dissatisfied with their healthcare
Our representatives at local and France, serving doctors in the interest and their physician. Even threats and
national levels are elected by our of patients. We understand that violence against health professionals
members, and we encourage active today’s doctors face several challenges occur, which is never acceptable and
participation by individual members. in building a strong patient-doctor something that we must work hard to
We work hard to prioritise the needs relationship, including limited time prevent. In general, though, I would
of physicians and patients as well to conduct clinical responsibilities say that the relationship between
as promote the continued positive due to the burden of administrative patients and physicians in Sweden is
development of Swedish healthcare. tasks, working in large health teams, a positive one. With the continuous
The SMA is often consulted as subject patients who are more informed and development of new treatments and
matter experts for national inquiries in control of their health, increasing the strengthened position of patients
on healthcare issues, and we have technicalities of clinical practice, in healthcare, today´s patients often
recurring meetings with the Minister and the development and use of have high expectations of what
for Health Care. Although regional novel technologies (e.g. artificial healthcare can do for them. This
and state representatives vote on final intelligence). Some solutions to can stimulate cooperation between
decisions related to the adoption of these challenges may include health patients and physicians as well as
healthcare policies, guidelines, and professionals’ training, improved team encourage patients to be more active
legislation, SMA members offer coordination and communication, and participants in their care. At the same
robust perspectives to such discourse the responsible use of technologies time, increased patients’ expectations
that can help influence policy-making in clinical practice. Since novel necessitate that physicians are well
activities. technologies cannot replace the trained and given sufficient clinical
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time with patients to discuss the significantly over the past generations: intelligence and telemedicine into
management plan in a respectful 100-hour work weeks for example training programs will require that
and sensitive manner that fosters used to be common schedules in teachers and students refine their
understanding and trust. hospitals. Positions in the public skills of this rapidly changing
healthcare sector were highly sought discipline. Third, it is important
How would you describe the after amongst doctors, who would to maintain rigorous and high-
anticipated challenges in medical face stiff competition in the selection quality training standards to
education over the next decade in process. However, these job offerings ensure patient safety. This is
your country? have failed to keep up with the shift crucial, especially in the context of
in priorities and expectations of increasing international mobility
Austria: There is what has been younger generations who value among doctors.
referred to as an “unbalanced flexibility in the workplace, seek a
mobility” of students in the European better work-life balance, and desire Spain: As doctors, we recognise that
Union (EU). Austria, in particular, more time with their families as well there are enormous challenges in
has a disproportionate number of as time to pursue interests outside the field of medical education and
international medical students, of work. For this reason, part-time training at national, regional, and
who leave the country after having work models have risen in popularity. international levels. First, limited
acquired their degree. Notably, most We cannot afford to ignore these time and incentives are offered to
medical students in Austria come professional changes in Austria doctors to pursue regular continuing
from Germany, as medical students and recognise that if contracts with medical education, including
seeking opportunities to study abroad. social security providers and hospital updates on clinical guidelines for
According to the German Minister administration do not offer more diagnosis, treatment, and prevention.
of Health, however, the nation has flexible and more attractive work For example, Spanish doctors may
trained an estimated 50,000 fewer conditions, fewer doctors will seek be granted five days to complete
doctors than the country will likely employment in the public healthcare such important training, which can
need for the next decade. Hence, system and the existing workforce gap negatively influence the provision of
the AMC supports reforms like the will grow even larger. high-quality healthcare services to
suggestion of the Austrian Minister patients and ultimately the health
of Education, Martin Polaschek, France: In France, there are three system as a whole. Second, it is
who proposed that EU member major challenges that the health important to harmonise medical
states should be required to provide system will face over the next training in Spain, Europe, and
a minimum quota of university decade. First, junior doctors who the world, ensuring that health
placements, with states who meet complete their training do not often professionals are well-trained with the
or surpass their quotas being identify with the available types knowledge and skills to treat patients.
compensated by those states who are of medical practice. Young doctors Hence, together with UEMS, we
unable to meet these quotas. who complete their training do not must promote a list of competencies
identify with the type of medical that represents a benchmark for all
Also, we need to ensure that young practice being offered to them. This countries, as well as guarantee that
doctors in Austria choose to stay and is particularly evident in general medical training has received the
work in the country. There are high practice within local communities, respective accreditation without any
demands internationally, particularly which should be at the core of conflicts of interest.
among Austria’s neighbours healthcare for the population. The
(Germany and Switzerland), where appeal of this specialised field is Sweden: In 2021, the government
a common language and geographic declining, and young doctors are of Sweden initiated fundamental
proximity present appealing increasingly inclined to choose changes to our system of medical
alternatives for Austrian doctors. We salaried positions or roles that do education. Up until 2021, all doctors
have to stay competitive in the light not involve direct patient care, such received a medical degree upon
of the global migration of health as aesthetic medicine. This is where leaving the university (e.g. duration
professionals, developing programs the real issue lies! It is pointless to of 5.5 years), and after an 18-month
and incentives to encourage doctors significantly increase the number of internship, they could register as
to remain in Austria. medical students if we do not create medical practitioners and start their
a strong appeal for the care sector. speciality training. However, the
The medical profession has changed Second, integration of artificial average waiting time to start the
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internship has been 11 months after France: The CNOM proposes Spain: Health leaders across Spain
graduation, and this delay to educate the implementation of innovative, are leading efforts to identify and
new specialists (e.g. duration of five modern, and simple solutions to address health challenges with
years) has exacerbated Sweden´s bring more flexibility to expand sustainable solutions that strengthen
shortage of specialist doctors. Since healthcare services, meet patients’ medical education and training as
2021, the new system includes needs, and increase the attractiveness well as the health system. In 2022,
specific changes, where basic medical of the medical profession. After the Government of Spain approved
education (medical degree and license the COVID-19 pandemic, the the Decree 589/2022 (Real Decreto
to practice medicine) is completed CNOM launched the “Healing 589/2022), which sets the foundation
at the university in six years (e.g. Tomorrow” (“Soigner demain” for all stages of competence-
addition of six months). Specialty campain) in 2021, offering several based medical training, including
training then follows and incorporates recommendations to national coordinating annual exams for
a new introductory training period leaders on how to optimise medical specialty training and establishing
(e.g. total duration of a minimum of education and training in France. the role of professional organisations
5.5 years). Eventually, the 18-month Regarding academic coursework, [1]. This regulation is pivotal as
internship will be removed when the national leaders can support the an important first step, and our
previous system has been phased out curriculum reform that emphasises CGCOM is enthusiastic to
and replaced with the new system. infection control and prevention in contribute to advancing this
During this transition period, we the first year of studies, and medical regulation and medical education and
are closely monitoring (and working ethics and CNOM missions in the training in Spain and Europe.
to remove any unnecessary delays) second cycle of studies. Encourage
related to the implementation of second cycle medical study Sweden: There is significant ongoing
the new system. Overall, these internships in public and private policy discussion regarding our
changes are timely for Sweden to healthcare sectors, including changing demographics, such as
better harmonise with our European outpatient settings. Promote how an ageing population will affect
neighbours’ education systems. internship placements in private healthcare demands, a predicted
clinics and hospitals, during the third future Sweden shares with many
From the medical education cycle of medical studies, distributed other countries. One key issue is to
perspective, how has your NMA across the coutry, regardless of balance our physician workforce,
responded to the existing and specialty, to help students understand especially since Sweden faces a
emerging health challenges within how professionalisation is closely nationwide shortage of specialist
your country? aligned with local community needs doctors. The current imbalance is
Leaders can support doctors who partly due to the unnecessary delays
Austria: Conducting an annual wish to pursue part-time practice for medical graduates to begin
academic evaluation for training within their designated specialty the internship, which is required
within hospital departments, the field, as well as authorise the presence to receive a license to practice
AMC analyses the current status of value mixed and shared practice and continue with their specialist
and can therefore react quickly models without impairing social training. Swedish healthcare should
to incorporate any necessary rights, regardless of status (e.g. offer enough training positions
modifications. For years, the AMC hospital, salaried, private). In order to and ensure sustainable working
has advocated for a quality training, meet local community needs, national conditions for doctors, which will
where senior-level doctors are leaders can also offer physicians a also help recruit the next generation
assigned to each training program, five-year community placement, of doctors. The SMA has published
and sufficient resources are available with significant salary, indemnity, several reports with experiences of
to allow time for teachers and contractual incentives, and retirement poor and unsustainable working
trainees to complete their training benefits. Finally, complementary conditions from our members, noting
and adopt an optimal work-life topics (e.g. “One Health” concept, that almost one-third of junior
balance. If we can guarantee high- domestic and family violence) can be doctors have considered leaving the
quality training, then we can incorporated into reflections on the medical profession. Moving forward,
guarantee that our patients will be collective and social responsibility employers should act to improve
cared for by highly trained doctors. of doctors, economic and social these working conditions and offer
implications of prescriptions, and fair compensation for all doctors.
critical analysis of emerging health
threats.
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From your perspective and Spain: Although the pandemic professional, social, and economic
national experiences, how has the slowed (and halted) the development interests of doctors working in
COVID-19 pandemic affected and adoption of regulations and Austria, the AMC’s mission
medical education in your country? legislation in medical education, statement promotes socially
we have uncovered positive aspects orientated, modern healthcare
Austria: Due to the 2nd Covid-19 Act such as telemedicine advancements, by doctors in public and private
of 2020, all deadlines in connection greater training in digital skills, and practice that is accessible to the
with medical education, training, and even virtual learning. The CGCOM entire population. Our doctors are
advanced education as well as medical insists on the need for the measures committed to a high standard of
practice were suspended for the to be directly coordinated so that medical care, with a particular focus
duration of the COVID-19 pandemic. training remains a prioritised pillar on ongoing quality management to
This action is in accordance with within the reformed Spanish health increase patient safety.
§ 36 b par. 4 of the Austrian Medical system. As medical professionals are
Act 1998, namely for pandemic- the main asset of the health system, France: Once WMA policies are
related measures such as quarantine, training is imperative to providing adopted at the WMA General
leave of absence or childcare. In order quality medical care. Although the Assembly or Council Meeting,
to ensure the quality of training, the pandemic slowed down such progress, CNOM leaders disseminate the
responsible attending physicians we should collectively push forward statements and recommendations
documented and assessed trainees’ and support advancements to medical within all levels of the CNOM.
acquired knowledge, experience, education and training. These policies offer valuable support
and skills. Furthermore, faculty used and help reinforce our scientific
digital teaching formats to teach Sweden: The COVID-19 pandemic positions at the national level. Prior
coursework, resulting in a massive stressed one valuable lesson for to implementing these WMA
increase of online training courses, the medical discipline to protect policies within the CNOM, members
and many congresses were cancelled healthcare teams and patients in the carefully examine and analyse each
or postponed. All in all, I believe that case of any catastrophic situation (e.g. of the WMA’s proposals, initially
everything possible was done, even armed conflict, pandemic). Long- within the CNOM’s delegation for
during the pandemic, to offer junior term planning within the healthcare European and International Affairs
doctors the best possible medical system requires ample storage for (chaired by Dr. Philippe Cathala)
training. medical supplies and medicine as well and subsequently by members in
as regular training and continuous section and session with all CNOM
France: During the COVID-19 medical education for all healthcare members.
pandemic, formal academic personnel. My concern is that we
coursework could not be delivered via are beginning to forget some of the Spain: As the WMA has adopted
in-person format for several weeks. lessons that we learned during the various initiatives, positions, and
Students in clinical internships were COVID-19 pandemic. However, in statements, our CGCOM members
focused primarily on prevention and light of Sweden’s recent entry into can use this information to broaden
care activities, and albeit increased North Atlantic Treaty Organization their knowledge and simultaneously
workloads, they were fully committed (NATO) and its demands on adapt content to the context of
to assisting their senior colleagues. preparedness, these issues continue to the medical profession in Spain.
The pandemic highlighted both be highly relevant. Throughout my tenure as CGCOM
the resilience and vulnerabilities of president, designated delegates of
the medical education in France, How does your NMA leadership different committees have prepared
emphasising the importance of implement the WMA policies in the and shared reports with internal
adaptability, mental health awareness, organisation? governing bodies, which can serve as
and the integration of technology a reference point for working groups
in training future healthcare Austria: The AMC is fully committed or guiding documents for national
professionals. The medical curriculum to the WMA’s commitment to health authorities. As the medical
has incorporated an emphasis on providing people with the highest profession transcends frontiers, we
public health, infectious diseases, international standards in medical must leverage our expertise and
and emergency preparedness topics, education, medical science, ethics, skills within national, regional, and
reflecting on the lessons learned and healthcare. In addition international settings.
during the pandemic. to representing the common,
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Sweden: The SMA strives to actively such as CONFEMEL and the Reference
participate in the WMA policy Conference of Medical Councils
activities, noting that the WMA- from French-speaking countries (la
adopted policies can be quite useful Conférence Francophone des Ordres 1. Boletín Oficial del Estado,
in our daily activities. Specifically, des Médecins, CFOM). Government of Spain. Real
the SMA refers to WMA policies, Decreto 589/2022 [Inter-
especially the ones on ethical issues, Spain: In Spain, the WMA is highly net]. 2022 [cited 2024 Sep 1].
when we contribute to interviews respected as a leading international Available from: https://www.boe.
by the media, present at meetings, group of medical experts who es/eli/es/rd/2022/07/19/589
prepare scientific commentaries advocate for high ethical standards in
or articles, and discuss topics with medical practise by adopting codes of
SMA members. In fact, the WMA’s ethics and organising ethics training Authors
core ethical policies, such as the activities. As the WMA General
International Code of Medical Assembly passes different emergency François Arnault, MD
Ethics and the Declaration of resolutions and declarations in any President, French Medical Council
Geneva, have inspired our own field, the CGCOM forwards these (Conseil National de l’Ordre
national code of medical ethics. documents to legislators within des Médecins, CNOM)
the Congress of Deputies, Senate, Paris, France
How can the WMA support the Autonomous Communities, and international@ordre.medecin.fr
ongoing NMA activities in your the Ministry of Health, who in
country? turn review and even post these Philippe Cathala, PharmD, MD
documents on institutional websites. Delegate for European and
Austria: The fundamental framework By providing this valuable support, International Affairs, French
and central guiding principle of our the WMA can help strengthen the Medical Council (Conseil National
medical activities is to help patients, capacities of NMAs, improve the de l’Ordre des Médecins, CNOM)
behind which all political and quality of medical care, and foster a President, Conseil Départemental de
economic considerations take a back collaborative environment for global l'Hérault de l’Ordre des Médecins
seat. The strong international co- medicine. Montpellier, France
operation within the WMA helps us cathala.philippe@ordre.medecin.fr
to achieve these goals in Austria as Sweden: The WMA plays an
well as internationally. important role in developing and Tomás Cobo Castro, MD
communicating international President, Spanish General
France: The WMA is an important policies, especially in the area of Medical Council (CGCOM)
organisation for the CNOM, and we medical ethics, as well as in speaking Madrid, Spain
are proud to be one of its founding internationally against violations internacional@cgcom.es
members. Today, the WMA provides of medical ethics and health-
support by strongly reaffirming the related human rights. As a global Sofia Rydgren Stale, MD
role and place of physicians in the organisation representing physicians President, Swedish Medical Association
healthcare pathway, emphasising from over 110 countries around Stockholm, Sweden
ethics in clinical research, and the world, the WMA has a strong ordforande@slf.se
launching awareness campaigns on international voice. Its policies and
crucial public health issues such as statements regarding current events Johannes Steinhart, MD
vaccination, disease prevention, and threatening physicians, healthcare President, Austrian Medical Chamber
mental health. Furthermore, it plays systems, and human rights are often Vienna, Austria
a major role by adopting guidelines very helpful, offering a reference j.steinhart@aerztekammer.at
and policies based on best practices for our NMA when developing
in medical ethics. These actions are policies or addressing international
only made possible with the support events. Hence, we would like to
of all NMAs and by strengthening encourage the WMA to continue
dialogue with other organisations, its important work in these areas.
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WMA Members Highlight National Initiatives to Safeguard Patient Safety
WMA Members Highlight National Initiatives

to Safeguard Patient Safety
Credit: PeopleImages.com - Yuri A / shutterstock.com

Patient safety, defined as “a framework robust policies to guide health and outcomes, contributing
of organised activities that creates professionals in the delivery of factors and hazards, organisational
cultures, processes, procedures, behaviours, high-quality healthcare services. In outcomes, detection, mitigating
technologies and environments in 2002, the World Health Assembly factors, ameliorating actions, actions
healthcare that consistently and (WHA) approved the WHA 55.18 taken to reduce risk) for analytical
sustainably lower risks, reduce the (Quality of care: patient safety), purposes [4].
occurrence of avoidable harm, make to encourage Member States to
errors less likely and reduce the impact of establish evidence-based approaches Notably, the WHA adopted the
harm when it does occur”, underpins the to improve healthcare service delivery resolution WHA 72.6 (Global action
foundation of global health systems [2]. In 2004, the World Health on patient safety) in 2019, which
[1]. Health professionals, who adhere Organization (WHO) launched the established World Patient Safety
to the “first, do no harm” (primum non World Alliance for Patient Safety, Day annually on 17 September [5].
nocere) ethical principle, understand to offer a platform for global health The past two themes – “Engaging
their indispensable role in leading stakeholders to share resources and Patients for Patient Safety” for
and contributing to high-quality collaborate on important patient 2023 and “Improving Diagnosis
healthcare services that improves safety initiatives aligned with for Patient Safety” for 2024 –
patient outcomes. However, common six main action tracks (global have underscored patient safety
adverse events can include diagnostic patient safety challenge, patients as a collaboration between health
or medication errors, nosocomial for patient safety, reporting and professionals and patients and have
infections, and unsafe clinical or learning, research, solutions, encouraged the continued dialogue
surgical procedures (including blood taxonomy) [3]. Subsequently, in on existing barriers to achieving
transfusions), leading to more than 2009, the WHO published an patient safety and high-quality
three million annual premature international conceptual framework healthcare services [6]. The Global
deaths [1]. for patient safety to improve the Patient Safety Action Plan 2021–2030,
collection and organisation of patient launched in 2021, was comprised of
Over the past two decades, global safety data (e.g. incident type and seven strategic objectives: 1) engage
leaders have developed and adopted characteristics, patient characteristics patients and families as partners in
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safe care; 2) achieve results through report such errors. Health institutions 2022, providing concrete strategies
collaborations; 3) analyse and must adopt a culture of patient and actions for organisational
share data to generate learning; 4) safety to reduce and prevent patient strategies in patient safety as well
translate evidence into actionable and safety errors, offering continuing as proposed indicators for program
measurable improvement; 5) base education opportunities for health evaluation [14].
policies and action on the nature of professionals to refine their clinical
the care setting; 6) use both scientific skills, avoid diagnostic errors that are COMRA supports all initiatives
expertise and patient experience to underestimated, including hospital- that seek to prioritise patient safety,
improve safety; and 7) instil a safety acquired infections. Aligned with the as a fundamental step in the design,
culture in the design and delivery of theme associated with World Patient execution, and evaluation of national
healthcare [7]. To support this action Safety Day 2024, improving health and global health systems. We
plan, the WHO launched the Patient professionals’ diagnostic capabilities believe that healthcare professionals
Safety Rights Charter and the Global can help avoid preventable errors that must help prevent incidents by
Patient Safety Report 2024, which lead to harm, disability, mortality, making appropriate decisions that
outlines patients’ rights and offers a and affiliated malpractice lawsuits. avoid unnecessary risks to patient
comprehensive review and evaluation safety in the clinical and community
of national patient safety initiatives, Over the past decade, the Argentina workplace. As health leaders improve
respectively, in 2024 [8,9]. Ministry of Health has strived to monitoring systems for adverse event
develop relevant legislation and reporting across institutions, they can
Health leadership and sustainable guidelines that promote patient design evaluation tools to identify
political investment are crucial safety. First, the National Program for gaps and address any limitations
to develop multidisciplinary and Quality Assurance in Medical Care in reporting schemes. We can also
multisectoral approaches to reinforce (Programa Nacional de Garantía de la develop capacity building
health systems and support shared Calidad de la Atención Médica) was workshops that can facilitate
decision-making between health adopted by Secretarial Resolution No. knowledge sharing as well as
professionals and patients in 432 (Resolución Secretarial N°432) establish a culture of continuous
healthcare service delivery. In this in 1992, endorsed by the National learning and interdisciplinary
article, physicians from 14 countries Executive Power (Poder Ejecutivo teamwork that prioritises patient
– Argentina, Côte d’Ivoire, Ecuador, Nacional, PEN) Decree No. 1424 care.
India, Kenya, Myanmar, Nigeria, (Decreto PEN Nº1424) in 1997, and
Philippines, Rwanda, South Africa, ratified by the PEN Decree No. 178 Côte d'Ivoire
Taiwan, Uganda, Uruguay, and (Decreto PEN N°178) in 2017 [10,11].
Yemen – offered insight on local These laws called for the development The Republic of Côte d'Ivoire, a sub-
and national initiatives that of high-quality instruments to assess Saharan African nation of 30 million
highlight the need for robust quality management and patient residents, shares its border with five
patient safety practices across four safety [10,11]. Second, the Actions countries (Burkina Faso, Ghana,
geographic regions. They described for Patient Safety in the Healthcare Guinea, Liberia, Mali) and the Gulf
relevant public policies, community Field (Acciones para la Seguridad of Guinea has an abundance of natural
engagement activities, and de los Pacientes en el Ámbito de la resources (e.g. copper, diamond,
professional development trainings Atención Sanitaria) was adopted in gold, petroleum) and agricultural
to empower health professionals and 2019 and updated in 2021, followed crops (e.g. cocoa beans). Since
patients alike across global health by the Tools for Self-Assessment of the first (2002-2007) and second
systems. Good Practices for Improving Quality (2010-2011) civil wars, the nation
in Healthcare Services (Herramienta has experienced a rapid economic
Argentina para la Autoevaluación de Buenas growth to become classified as a low-
Prácticas para la Mejora de la Calidad middle-income country. However,
The Argentina health system, which en los Servicios de Salud) in 2021, poverty (35% of the population
supports 44 million residents, does presenting tangible measures to living below the poverty line), food
not collect reliable statistics on enhance healthcare service delivery insecurity and malnutrition (23% rate
patient safety and errors, due to and ultimately patient outcomes of stunting), and gender inequalities
limited infrastructure for monitoring [12,13]. Third, the Manual of remain significant challenges for
adverse health events as well as health Patient Safety (Manual de Seguridad health leaders [15]. In 2015, the
professionals’ general reluctance to del Paciente) was published in July Government of Côte d’Ivoire
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launched the universal healthcare must promote a culture of safety by development of targeted interventions
program, and more recently has encouraging open communication and policies, more robust patient
established mobile enrollment among healthcare teams, patients, safety monitoring and reporting
centres to expand access across and their families to ensure that safety systems should be established and
the nation [16]. For this reason, concerns are addressed promptly and tailored to the needs of the Ecuador
healthcare professionals in the effectively. Second, all healthcare healthcare system.
country recognise World Patient professionals should receive regularly
Safety Day as a unified global training on the latest safety protocols To address this burden, the Ecuador
commitment to minimising risks and best practices in patient care. Ministry of Health has implemented
and preventing harm in healthcare Third, health leaders should advocate numerous initiatives to promote
settings as well as ensuring that every for policies that support resilient patient safety. First, leaders have
patient receives safe and effective care. health systems capable of responding implemented the use of care audits
to emergencies and daily healthcare as an independent mechanism to
Over the past decade, the Government challenges, without compromising investigate patient harm, which is a
of Côte d’Ivoire has implemented patient safety. Finally, partnering step toward improving accountability
several initiatives to promote patient with international and regional and care standards [9]. Second,
safety across the population. First, organisations can offer a global they have developed patient safety
the implementation of the National platform to exchange knowledge guidelines aligned with international
Health Development Plan (Plan and resources that can help improve standards, including the Patient
National de Développement Sanitaire, patient safety. Together, by making Safety Manual in 2016, which aims
PNDS) was adopted in 2011, and patient safety a priority, we can ensure to improve care quality and reduce
then updated in 2015 and 2021, as that healthcare is safe for everyone, adverse events [21]. Third, they have
a comprehensive plan with specific everywhere. integrated patient safety education
measures aimed at improving patient modules into the medical and nursing
safety (e.g. enhancing the quality Ecuador school curricula, which can foster a
of healthcare services, increasing safety culture from early academic
access to essential medicines, World Patient Safety Day holds training before clinical rotations.
strengthening health infrastructure) significant importance for physicians Fourth, healthcare professionals
[17]. Second, the Ministry of in Ecuador, as it highlights the critical – including doctors, pharmacists,
Health, in collaboration with various need to address gaps in patient safety dentists, nurses, midwives, as well
non-governmental organisations, has within our healthcare system. While as patients themselves – can report
launched community campaigns to global patient safety initiatives are suspected adverse drug reactions,
educate the public on promoting safe recognized, Ecuador faces unique therapeutic failures, medication
practices (e.g. proper medication use, challenges, such as limited resources errors, and events supposedly
infection prevention, importance of and varying levels of healthcare attributable to vaccination or
seeking timely medical care), as well quality across regions. According immunization through a web portal
as seek to reduce common healthcare- to the WHO, 134 million adverse managed by the National Agency
associated infections and improve events occur annually due to unsafe for Health Regulation, Control, and
patient outcomes. Finally, use of care in hospitals, particularly in Surveillance (ARCSA) [22]. Finally,
mobile technology, social media low- and middle-income countries, the emergence of patient advocacy
platforms, and digital health tools resulting in 2.6 million deaths [9]. groups, although primarily focused
serve as a platform for sharing best The IBEAS study was conducted on specific conditions like cancer,
practices, reporting safety incidents, across selected Latin American has the potential to evolve into
and educating both healthcare countries (Argentina, Colombia, broader patient safety movements, as
providers and the public about the Costa Rica, Mexico, and Peru) to observed with patients participating
importance of patient safety [18,19]. assess the prevalence of adverse in safety protocol role-playing
health events in hospitals, building exercises in Spain. However, despite
As physicians in the Ivory Coast, the on the ENEAS study (involving these robust initiatives, more
African continent, and the world, Spain) [20]. Without comprehensive attention to government policies and
our call to action is clear: we must data reports on patient safety public awareness campaigns must
advocate for and implement robust incidents in Ecuador and the wider expand these efforts.
patient safety practices at every Latin America and Caribbean
level of healthcare delivery. First, we region, which directly impede the As Ecuador physicians, our call
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to action remains to actively build than 250,000 Health and Wellness (IMA), in collaboration with the
a patient-centred safety culture Centres [24]. As leaders continue to Patient Safety and Access Initiative
that adheres to established safety scale-up and strengthen the health India Foundation (PSAIIF), adopted
protocols and advocates for creating system to address emerging health the Bangalore Declaration on 30
national patient safety registries risks, they recognise the health June 2024, which aimed to bridge
and improved communication burden of adverse reactions (e.g. gaps and enhance collaborations
strategies with patients. We must hospital-acquired infections, unsafe between doctors and patients across
prioritise health professionals’ surgeries and medications, faulty the nation. IMA members believe
training on delivering difficult medical devices) can affect millions that all physicians have an obligation
news with empathy to patients and of patients each year, leading to to advocate for patient safety and
their families, recognizing that our increased health expenditure, lack of should collectively address existing
approach to health communication trust within health institutions, and challenges, including limited health
can significantly impact clinician- potential demoralisation and burnout system infrastructure (including
patient rapport, patients’ adherence of health professionals [25]. health workforce shortages) and
to clinical recommendations, incompliance with evidence-based
and overall patients’ physical and As patient safety has gained clinical protocols (including infection
mental health outcomes. Moreover, increasing attention in India, several prevention and control) [27]. We
fostering a collaborative environment initiatives have adopted to enhance recognise the urgent need for robust
where patients are seen as integral patient safety across the health patient safety initiatives, including
healthcare team members can system. In 2018, the India Ministry offering continued education courses
continue to strengthen the clinician- of Health and Family Welfare on clinical guidelines and research for
patient relationship. By empowering launched the National Patient Safety health professionals and accelerating
patients with accurate knowledge and Implementation Framework 2018- the use of digital health technology
ensuring their active participation in 2025 (NPSIF), a comprehensive for reporting adverse events in health
their care, we can enhance trust and guideline and roadmap with six institutions.
improve safety outcomes, ultimately objectives, 21 priorities, and 81
leading to a healthier and more interventions, toward strengthening Kenya
resilient healthcare system. patient safety at all levels of
healthcare service delivery [26]. This Patient safety remains a critical
India document covers legal aspects, quality challenge in Kenya, with adverse
assessments, workforce development, events affecting three in 10 patients
Since the United Nations reported infection control, and research, in hospital care settings [28]. Despite
that India had the world’s largest aiming to reinforce institutional having strong clinical policies and
population (1.429 billion residents) frameworks, build a competent health documentation, the Kenya Ministry
in 2023, when compared to China’s workforce, and establish reporting of Health faces significant challenges
population (1.426 billion residents), systems of adverse effects. Also, over with their implementation, including
this demographic trend presents the past decade, the Government high unemployment among doctors
additional challenges for the national of India has established regulatory and insufficient training for health
health system, including primary bodies and legislature to monitor and professionals, which ultimately
care services and patient safety [23]. implement patient safety initiatives, impede patient safety initiatives
Over the past 75 years, independent including the National Accreditation and quality of care for the Kenyan
from British rule, national health Board For Hospitals and Healthcare population. One national study
leaders have successfully strengthened Providers (NABH) in 2005, National reported that suboptimal systems
health indicators (including reducing Accreditation Board for Testing and hindered the prompt identification
maternal and child mortality rates) Calibration Laboratories (NABL) of critical illnesses, limited resources
[24]. With significant disruption in 1982, National Health Systems for continuity of care, and disrupted
to healthcare services during Resource Centre (NHSRC) in 2007, the flow of care, as major causes of
the coronavirus disease 2019 as well as the Clinical Establishments the delays in the healthcare service
(COVID-19) pandemic, leaders Act of 2010, Pharmacy Practice delivery in Kenya’s public hospitals
implemented successful vaccination Regulations of 2015, and the Drug and [29]. These findings highlight the
campaigns, supported digital Cosmetics Act of 1940. need to reinforce strong clinical
technologies and telemedicine policies related to standardised
consultations, and established more The Indian Medical Association effective and reliable healthcare
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priorities in Kenya. particularly at the community level, is bombings have resulted in widespread
crucial to improving patient outcomes, casualties, with over 18.6 million
The Kenya Ministry of Health, which reducing medical errors, and building persons seeking humanitarian need
envisions a nation where safety and a resilient healthcare system. This (including 2.8 million internally
quality are valued and promoted, has approach will ensure that healthcare displaced persons) [32]. With
launched significant efforts to promote providers are equipped with up-to- overburdened healthcare facilities
patient safety for 51 million residents. date skills and resources, enhancing for war-related injuries and routine
First, leaders adopted the National the quality of care delivered across all medical care, this violence has
Policy on Patient Safety, Health Worker healthcare system levels. Additionally, resulted in serious injuries and long-
Safety, and Quality of Care in 2022, prioritising community-level term health consequences, including
which is rooted in the Constitution interventions will empower local increased health expenditure on
of Kenya 2010, Vision 2030, and the health professionals and promote physical and mental health challenges
Kenya Health Policy 2014-2030, aims patient safety from the ground up, [33,34].
to ensure the provision of respectful fostering a culture of accountability
and responsive quality healthcare and excellence in healthcare delivery. The Myanmar junta forces have also
for a healthy, productive, and To further enhance these efforts, the established blockades and restricted
globally competitive country [29]. Kenya Ministry of Health should access to critical medical supplies
Second, Kenya prioritizes universal actively seek collaborations with and humanitarian relief, which
health coverage (UHC), to provide other African countries to share have discouraged Myanmar health
every citizen with access to quality best practices, innovative solutions, professionals, local aid workers, and
healthcare services without financial and regional safety standards. By volunteer humanitarian responders
difficulties or undue burden. Thus, working together, African nations from saving lives on the frontlines
the policy emphasises strengthening can collectively strengthen their [35]. They have demolished
governance, protecting patients healthcare systems, address common important roadways that connect
from avoidable harm, ensuring challenges, and drive progress towards various towns and cities, which hinders
health professionals’ well-being, and achieving safer and more efficient access to healthcare institutions
maintaining high-quality healthcare care for all patients. [36]. This forced displacement,
services. The Kenya Community Health resulting in huge numbers of refugees
Strategy, recognized as one of the key Myanmar living in transitory, overcrowded,
initiatives for UHC implementation, and unhygienic circumstances,
emphasises preventive measures by In Myanmar, patient safety initiatives can promote infectious disease
recognising that community health is supported by the National League transmission and challenge to
the foundation of healthcare delivery for Democracy (NLD) government provision of effective healthcare to
and providing policy direction for leadership have been promising. patients.
community health services [30]. Based on recent patient safety baseline
Kenya has robust community health assessments and recognition of To address patient safety concerns,
units (serving defined geographical patient safety champions in 2018, leading international organisations
areas) that are supported by Myanmar’s State Counsellor Daw like the United Nations, World
community health assistants and Aung San Suu Kyi has led efforts Medical Association (WMA), and
volunteers who provide promotive, to increase medical standards in Junior Doctors Network should take
preventive, basic curative and public hospitals and improve patient immediate action beyond issuing
rehabilitative services. safety including blood transfusions, statements and declarations. They can
immunisations, and surgical help provide essential medicine and
To improve patient safety strategies, procedures. The Ministry of Health equipment directly to local frontline
the Kenya Ministry of Health and Sports was drafting a new humanitarian responders, including
should enforce compliance with National Health Policy in 2021, to ethnic civil society and community-
international safety standards, replace the 1993 policy, with patient based organisations, via locally led
enhance healthcare professionals’ safety as one of the nine areas one, cross-border channels. These efforts
employment practices, and when the Myanmar's military and can help repair and restore destroyed
strengthen medical licensing and security forces systematically attacked hospitals and clinics, ensuring that
accreditation systems. Investing civilian hospitals and clinics [31]. medical facilities have adequate
in healthcare infrastructure and These Myanmar military and security equipment, supplies, and reliable
continuous professional development, forces indiscriminate violence and power and communication supply.
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Also, they can provide continued launched the National Policy and services. In the Philippines, existing
education courses and training Implementation Strategy on Patient healthcare system challenges include
(including relevant mental health Safety and Healthcare Quality in 2023, high patient-nurse and patient-
resources) to Myanmar healthcare as guidelines to improve the safety of physician ratios, limited medical
professionals, so that they can all medical procedures and enhance supplies, insufficient safety incident
effectively manage emergency and the quality of healthcare delivery [41]. reporting systems, and inconsistent
trauma care and other conflict-related Also, health leaders have directed opportunities for professional
health issues. significant efforts to educate health training on pressing health topics,
professionals and the general public, all of which directly impact the
Nigeria including regular participation in quality of healthcare service delivery.
World Patient Safety Day events. In Hence, the celebration of this day
Patient safety is essential for effective 2023, the Nigeria Federal Ministry establishes a space for exchanging
healthcare delivery across the world, of Health and Social Welfare, in ideas, best practices, and updates to
and although the African continent collaboration with the Dr. Aneyo encourage collective involvement
is comprised of low- to high-income Stella Adadevoh Health Trust of patients and health professionals
nations, many remain challenged (DRASA), organised a public walk in ensuring safe and high-quality
to meet patient safety standards and public press briefing session as patient-centered care.
[37]. The Nigerian health system, well as a two-day review workshop
serving 195 million residents, has on policies and implementation To promote patient safety and harm
reported inadequate resources, strategies that promote patient safety reduction, the Philippine College of
poor administrative regulations, in Nigeria. Surgeons implemented the WHO’s
insufficient training opportunities in Safe Surgery Saves Lives program
patient safety for health professionals, As Nigerian physicians, we should in 2008. By 2010, the adoption of
obsolete medical equipment and collectively enforce current patient the Safe Surgery Checklist was still
supplies, and limited technologies safety policies and advocate for new low, however, and compliance rates
incorporated into healthcare visits government policies, strategies, ranged from 0.15% to 3.6%. In
[38]. Notably, two studies across and initiatives that expand health fact, hospitals with lower checklist
Nigeria have reported poor healthcare sector funding, strengthen infection utilization experienced higher
professionals’ adherence to patient prevention and control measures, mortality rates [42]. Similarly, clinical
safety measures. First, in one hospital and reinforce the implementation of misdiagnoses among urban obstetric
in Enugu (eastern Nigeria), 51% clinical guidelines through regular providers were estimated at 30%
of surveyed surgeons perceived clinical audits. Also, health institutions in 2016, and specifically 25% for
poor patient safety during surgical and professional medical and nursing cephalopelvic disproportion, 33%
procedures and 38% regularly used associations can develop capacity for postpartum hemorrhage, and
available institutional protocols training sessions on best practices in 31% for pre-eclampsia conditions
(including 11.3% to prevent wrong- patient safety, as part of the continued [43]. Despite the establishment of a
site surgery). A positive correlation professional development for all national pharmacovigilance system in
was associated with the duration of health professionals. This national 1994, researchers explored the use of
surgical practice and their perception call for patient safety should be a text-based versus traditional paper-
of patient safety [39]. Second, in four priority for all health professionals based systems to report adverse drug
public hospitals in Kaduna (northern across Nigeria, encouraging medical reactions for resident physicians in
Nigeria), 55% of participating professional associations and a tertiary-level hospital in Manila,
health professionals (doctors, nurses, societies to collectively contribute concluding that paper-based
pharmacists) responded positively to minimising medical errors and systems were preferred due to fewer
that they consistently use strategies empowering patients as active challenges (e.g. proper reporting
that enhance patient safety, 36.8% recipients of healthcare services. syntax, internet connectivity) [44].
frequently reported adverse events, With additional support from the
and 51.4% perceived that hospital Philippines Department of Health (DOH),
managers and administrators support many hospitals across the country
patient safety [40]. World Patient Safety Day calls on reported notable improvements in
Filipino physicians to prioritize achieving patient safety goals by
To address patient safety concerns, patient safety, address gaps in 2018 [45].
the Nigerian Federal Ministry healthcare service delivery, and
of Health and Social Welfare enhance the quality of healthcare
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The National Center for Patient enhance medication safety across the commitment to ensuring that each
Safety, within the Government of nation. patient receives safe and quality care
Philippines’ DOH, launched the across health institutions [52,53].
Safe Care Initiative in 2018, which As World Patient Safety Day
supported health professionals’ emphasises the importance of patient- To prevent unintended harm or
training, development of safety centred care and advocacy for patient adverse consequences to patients and
protocols, and auditing to improve safety standards, Filipino physicians their community, Rwandan leaders
patient safety. In 2008, the DOH view this moment as an opportunity have developed strategies, policies,
established the National Policy on to reaffirm their commitment to and initiatives to improve and advance
Patient Health (Administrative Order promote patient-centred care in a patient safety. First, the Rwanda
No. 2008-0023), and later released safe and effective healthcare system. Fourth Health Sector Strategic Plan
the Revised Guidelines on Continuous Therefore, Filipino physicians are was launched in 2018, with strategic
Quality Improvement (Administrative urged to adopt and promote patient emphasis on quality and people-
Order No. 2020-0034) in 2020, to safety protocols, utilise systems for centred healthcare as a foundation for
ensure patient safety in healthcare reporting and learning from adverse promoting patient safety [50]. Each
facilities [46,47]. In observance of events, and engage in continuous hospital has pharmacovigilance and
World Patient Safety Day 2023, training in patient safety. Specifically, drug and therapeutic committees,
the DOH promoted the “Engaging they can collaborate with regional which are instrumental to monitoring,
Patients for Patient Safety; Elevate and international organisations and reporting, and overseeing initiatives
the Voice of Patients!” theme to advocate for stronger health policies that prevent harm due to unintended
underscore the importance of patient- that prioritise safety across the adverse reactions from medications
centred healthcare and decision- Philippines, Asia, and the globe. [49]. Second, the Rwanda Ministry
making, diversity and inclusion of Health developed Patient Rights
within the healthcare system, and the Rwanda Charters and mandated the public
need for essential partnerships with display of patients’ rights to care
medical professionals to create a safe In Rwanda, physicians recognise in all health facilities, in efforts to
healthcare environment for everyone that patient safety is an integral ensure transparency and trust in
[48]. part of high-quality healthcare health services. Third, the Ministry
service delivery, which must support of Health initiated the hospital
To support academic training on sustained vigilance, foster a culture accreditation process in 2012, first
patient safety for health professional of continuous improvement, and with referral hospitals and then all
students, trainees, and specialists, promote health professionals’ health facilities, as a mechanism for
the Philippine Medical Association adherence to best practices and improving quality and accountability
(PMA) and the Philippine Nurses standards designed to protect as well as patient satisfaction [52].
Association (PNA) offer workshops, patients' health and well-being Leaders established customer care
webinars, and professional [49,50]. Although no published data services in all hospitals to support
development programs on patient on adverse events exist at the national the timely responses to patient
safety. The Philippine Alliance for level, individual hospitals submit concerns, allowing patients to give
Patient Safety (PAPS) hosts the annual incident reports that help shed light on feedback on service received as well as
National Patient Safety Congress, the burden of adverse events, which in anonymous reporting of unpleasant
and the Philippine Alliance of turn can inform government policies experiences, which can objectively
Patient Organizations (PAPO) is and strategies on patient safety. In one inform improvement efforts. Finally,
actively involved in policymaking, recent study conducted with hospital stakeholders representing the local
as part of the Health Technology managers from 47 public hospitals in government, non-government
Assessment Council, ensuring Rwanda, authors concluded that the agencies, and civil societies supported
the adoption of safe and effective prevalence of adverse events and other capacity building on professional
healthcare technologies and incidents was less than 1%, namely ethics and patient rights, such as
medicines. Finally, the Philippine due to adverse drug incidents (25%), the Health Development Initiative
Coalition Against Fake Medicines loss to referrals and follow-up (25%), (https://hdirwanda.org/) as a local
(PCAFM) and the Safe Medicines and surgical site infections (20%) non-governmental organisation
Network (SMN) are two multisectoral [51]. Together with other countries, that recently organised an inter-
coalitions that lead advocacy efforts Rwandan health leaders recognise professional workshop on patients’
for strong legislative protections and celebrate World Patient Safety rights.
that combat counterfeit drugs and Day every year, to represent a shared
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Rwandan leaders understand interventions in the private sector Africa, which represents collaborative
that ensuring patient safety is a [54]. In South Africa, patient efforts on patient safety between the
continuous process, noting that safety within the health sector is DoH, OHSC, and the Office of the
there are always risks associated with comprised of protection for medical Health Ombud [58].
medication errors and healthcare- and surgical procedures as well as
associated infections [50]. Despite physical health and well-being. First, To promote the culture of patient
robust measures to improve quality of although evidence-based guidelines safety culture in South Africa and
care and minimise healthcare-related are followed by health professionals the wider African continent, it is
risks to patients, Rwandan health in clinical practice, ranging from imperative for all health professionals
leaders call for reinvigorated efforts prescribing medications to performing to understand the evidence-based
to collaborate with all stakeholders surgical procedures, adverse events clinical guidelines that are appropriate
to implement more systemic changes may occur resulting from procedures for their daily clinical responsibilities
that prioritises patients’ interests. or infection [54]. In fact, medico- to patient care. Continuous
As Rwandan physicians understand legal liabilities in South Africa were professional development on the best
their critical role and contributions reported to exceed US$5 billion in practices for infection control and
to upholding and safeguarding the 2020, with a 30% annual growth adverse event reporting, coupled with
fundamental “do no harm” principle, rate, in the public sector, while the health system financing for products
they call for continued investment in criminalisation of medical errors has and supplies, can equip health
actions that further promote patient become rampant in the private sector professionals with the knowledge
safety. Such efforts can include [55,56]. Second, the physical safety of and tools to uphold administrative
designing comprehensive initiatives patients and health professionals has policies. Since inadequate security
for patient and community education been affected by robbery in medical systems in health facilities can impact
and empowerment, improving facilities across the country, leading patient safety, security assurance
safety within the clinical workplace, to physical and psychological trauma models for healthcare should be
requiring rigorous monitoring [57]. developed to improve the safety of
of incidents and transparency patients seeking healthcare in public
in adverse event reporting, and To maintain high-quality patient and private facilities in South Africa
promoting positive physician-patient safety management across the nation, [57].
communication. Rwandan physicians three leading stakeholder institutions
agree that they can educate and manage the administrative and Taiwan
encourage patients to contribute to policy requirements. First, the South
community-wide advocacy efforts Africa Department of Health (DoH) The Patient Safety Committee of
that hold the healthcare system manages quality improvement the Taiwan Ministry of Health and
accountable for the implementation through the National Health Welfare has continued to lead robust
of evidence-based safety measures. Quality Improvement Plan, as well as patient safety initiative across health
They also highlight that self implementation of the Ideal Clinic institutions for over three decades.
reflection and continuous medical and the Ideal Hospital Frameworks In 1999, the Ministry of Health
education are essential ingredients (https://www.idealhealthfacility.org. and Welfare (previously recognised
for cultivating behaviour change in za/). Second, the Office of Healthcare as the Department of Health until
the clinical setting and commit to Standards (OHSC) (https://ohsc. 2013), Taiwan Hospital Association,
increased vigilance and adherence org.za/) helps develop regulations Taiwan Non-Government Hospitals
to clinical policies and guidelines for patient safety, inspections and and Clinics Association, and Taiwan
(including standard operating enforcement, and health facility Medical Association established the
procedures) that protect patient safety certifications, to support quality Joint Commission of Taiwan ( JCT)
across health institutions. healthcare assurance. Finally, the (https://www.jct.org.tw/mp-2.html),
Office of the Health Ombud, which to promote patient safety through
South Africa is directly linked to the OHSC, the delivery of quality of healthcare
leads investigations of reported services. This initiative led to the
Patient safety incidents often result patient safety incidents across health establishment of the Taiwan Patient
from poorly implemented safety facilities. All reported incidents Safety Reporting System (TPR) in
policies and a culture that overlooks adhere to the National Guideline for 2005, as an anonymous, voluntary,
patient safety in the public health Patient Safety Incident Reporting and confidential, and collaborative
sector and human error in high-risk Learning in the Health Sector of South learning-based medical accident
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reporting system in Taiwan [59]. and pregnancy-induced hypertension compromised with high clinician-
Specifically, a total of 16,043 and preeclampsia bundle care, based patient ratios, including a doctor-
facilities (including clinics) have on international obstetric care patient ratio of 1:25,725 and a
joined the TPR in Taiwan, and an models (including six key obstetrics nurse-patient ratio of 1:11,000,
estimated 957,310 adverse events and gynaecology risk management overburdened schedules, limited
were reported between 2005 and principles). In 2023, postpartum documentation, and inadequate
2022 [60]. After the launch of the haemorrhage educational leaflets healthcare infrastructure [65]. At the
Taiwan Patient Safety Culture Survey were designed to help healthcare same time, as healthcare services have
Project in 2009, the JCT highlighted professionals and the general public limited accessibility and availability,
the improvement of patient safety understand prenatal, intrapartum, long distances from communities,
indicators in community and regional and postpartum care, and hence and high costs, patients frequently
hospitals (including staff ) from 2009 aim to lower the risk of postpartum seek non-traditional services that
to 2016 [61]. haemorrhage and improve its clinical may contribute to self-medication
management. and unregulated herbal remedies. In
Over the past decade, the Taiwan 2014, one national report highlighted
Ministry of Health and Welfare has The Taiwan Medical Association that 5-20% and 28% of hospitalised
adopted legislature and coordinated supports the ambitious goals of the patients in Ugandan health
national projects to address patient Taiwan Ministry of Health and institutions had experienced adverse
safety concerns across health Welfare published in the Annual drug reactions and hospital-acquired
institutions. First, the Childbirth Goals for Patient Safety, 2024- infections, respectively [66]. Common
Accident Emergency Relief Act of 2025 [64]. These goals include medical errors were described
2015, namely Article 22, mandates enhancing healthcare teamwork and as delayed or failed diagnoses,
that health institutions establish communication (including clinician- interoperative complications, and
internal risk event management and patient rapport and engagement accidental needle stick injuries [66].
reporting mechanisms to analyse with families), improving surgical
the primary causes of significant and medication safety, ensuring Uganda leaders have undertaken
childbirth accidents, reduce the adherence to infection control several initiatives to promote patient
risk of childbirth accidents, and measures, preventing severe safety for health institutions serving
propose action plans [62]. Second, injuries (including patient falls), the 45 million residents. First, the
the Medical Accident Prevention and protecting vulnerable populations Ugandan Patient Safety Symposium,
Dispute Resolution Act of 2022, which (including pregnant women and which was held in September 2018,
was enacted in 2024, requires the infants), and ultimately fostering aimed to foster inclusive dialogue,
prompt reporting of any significant patient safety culture (including evaluate current and past patient
harm or death resulting from medical reporting mechanisms of patient safety initiatives, and develop a
errors for subsequent evaluation safety incidents) [64]. As Taiwanese framework for future action [67].
by authorities. This policy aims to physicians provide compassionate Second, the Uganda Ministry of
promote an efficient medical dispute- care to over 23 million residents, Health, together with community
handling mechanism, harmonious they recognise World Patient Safety stakeholders, adopted the Patient
doctor-patient relationships, and Day each year and collectively and Client Rights Charters in 2019,
patient safety culture across health focus on best clinical practices and as a legal and regulatory framework
institutions in Taiwan [63]. policies to improve patient safety and to improve healthcare service delivery
clinician-patient engagement across and ultimately health indicators in
Furthermore, the Taiwan Ministry of health institutions in Taiwan. Uganda [68]. Third, the Uganda
Health and Welfare has prioritised Ministry of Health launched the
three specific activities over the past Uganda Health Facility Quality of Care
decade. In 2012, the Pilot Program Assessment Program in 2020, to
for Managing Childbirth Accident In Uganda, health professionals ensure standard of care in hospitals
Disputes was established, allowing recognise World Patient Safety Day through quarterly evaluations, which
participating institutions to conduct as a day to reflect upon the “do no has been implemented in 85% of
inspections and submit regular harm” principle and discuss strategies the districts. Finally, the Patient-
quality reports. In 2022, experts that can help improve patient safety Centred Care Movement Africa
were invited to create checklists on across health institutions. However, (PaCeM-Afro), led by health
postpartum haemorrhage bundle care the quality of healthcare is severely professional students and recognised
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at the 74th WHA in May 2021, has safety tend to be conducted annually evaluations related to the compliance
continued to advocate for patient- by non-governmental organisations of patient security measures across
centred care through education, and professional associations, noting institutions have not been conducted
research, and social media campaigns that 14 April offers reflections on since 2019.
[69]. patient safety and 17 September
provides formal activities to engage As Sindicato Médico del Uruguay
As physicians across Africa and the audiences on patient safety. (SMU) members representing diverse
world, we must collectively advocate clinical and surgical specialties,
for comprehensive patient safety Uruguay Ministry of Health leaders our call to action is to promote
guidelines and policies, as well as contribute to strengthening the the integration of safety protocols
healthcare systems with Ministry national health system through into clinical management (“safety-
of Health oversight to ensure that legislation and initiatives that inspired clinical management”) of
patients are free from harm and promote high-quality health service all healthcare activities. Notably,
avoidable risks. We can continue delivery for its 3.4 million residents. we recognised National Patient
to educate patients on their rights First, health leaders were using a Safety Day on 14 April 2024 (and
and responsibilities and support self-assessment and guidance tool, will commemorate World Patient
sustained health professionals’ adapted from the United Kingdom’s Safety Day on 17 September 2024),
training. Specifically, we can help National Health Service seven-step as events that will help align our
engage communities through the tool, to evaluate institutional needs local and national efforts to reduce
Patient and Client Rights Charters, and establish primary guidelines for adverse events in health settings [75].
and empower patients to work preparing and implementing patient Uruguayan physicians, together with
collectively with health professionals safety plans across institutions until our WMA colleagues, can continue to
in the delivery of high-quality 2019 [71]. Second, the Ordinance lead efforts that empower the entire
health services across Uganda [68]. 660/2006 (Ordenanza 660/2006) of healthcare team to prioritise high-
the Ministry of Health was adopted in quality patient-centred care across
Uruguay 2006, outlining that the Commission public and private sectors, as well as
for Patient Safety and Prevention directly involve family members in
Over the past two decades, the of Medical Errors (Comisión para the clinical decision-making process.
Uruguay Ministry of Health has la Seguridad de los Pacientes y
guided the patient safety initiatives Prevención del Error en Medicina, Yemen
based on international data sources COSEPA) has the responsibility of
(like the WHO), since national strengthening the culture of safety For Yemeni physicians, World Patient
reports have not examined incidence for health professionals, patients, and Safety underscores the urgent need
and prevalence rates of adverse their families in Uruguay [72]. They to address critical issues within the
health events. Taking the lead, also approved the Ordinance 804/022 healthcare system, which has endured
Uruguay leaders joined the WHO (Ordenanza N° 804/022) in 2022, ongoing conflict and resource
Patient Safety Alliance in 2006, which reinforced previous legislation shortages since 2015 [76]. The WHO
and participated in the first global on patient safety and surveillance of has highlighted that preventable
challenge (“Clean Medicine is Safe adverse events [73]. Finally, Uruguay medical errors are a leading cause
Medicine”) that promoted the leaders conducted the first national of harm to patients globally, and the
importance of optimal hand hygiene survey on the impact of disruptive situation in Yemen is particularly
practices in healthcare settings. To behaviours in the health sector to dire. The Yemen Ministry of
support the initiatives of the national over 4,000 health professionals from Population and Public Health
health system, leaders adopted Law the national health system in 2014, reported that hospital-acquired
18.995 (Ley 18.995) in 2012, which noting the need to address the high infections and medication errors
ensure the annual recognition of incidence of negative behaviours were estimated at 20% and 15% in
National Patient Safety Day on 14 (e.g. derogatory comments, anger 2021, respectively, emphasising the
April, in addition to the WHO’s episodes) that hinder effective urgent need to improve patient safety
annual celebration of World Patient teamwork, communication, and practices and infrastructure across the
Safety Day on 17 September [70]. safety for health professionals and nation [77,78].
However, with changing leadership patients alike [74]. Although these
within the Ministry of Health, achievements have helped lead patient Despite its challenging
widespread initiatives on patient safety efforts across the country, circumstances, Yemenis leaders have
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adopted two significant policies and accountability, and dedication to high-quality healthcare services,
initiated several efforts to improve excellence in patient care, physicians essential partnerships with health
patient safety. First, Law No. 26 was can lead the way toward a safer and stakeholders, provider-patient
adopted in 2002, which criminalised more resilient health system for the rapport and communication, and
health professionals who refrained global population. public awareness, and hence optimal
from treating patients in emergency patient outcomes. Specifically, it
or disaster response scenarios [79]. Conclusion highlights clear examples of timely
Law No. 4 was approved in 2009, health leadership and political
which dually defined roles and World Patient Safety Day 2024 offers commitment across the African,
responsibilities related to an opportune moment for global Americas, Eastern Mediterranean,
infectious disease prevention and health leaders to evaluate current and South-East Asian regions that
control, criminalising actions that patient safety initiatives within health exemplify global solidarity and action
intentionally hinder appropriate systems, identify risks to adverse to promote patient safety.
reporting measures or increase risk of events, and reinforce their political
disease transmission, and guarantee commitment to promoting a safety
patients’ rights to immediate medical culture. Together, they can endorse
care in emergency scenarios [80]. the Patient Safety Rights Charter References
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Porto, Portugal National Vice President,
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Official Journal of The World Medical Association, Inc. Nr.

Interview with the WMA Secretary General 4

Invitation to the WMA General Assembly in Helsinki, October 2024 7

Report on the Roundtable Discussion on Antimicrobial Resistance –

Reflections on the Value of the UN High-Level Meeting on Pandemic,

Junior Doctors Network’s Leadership at the World Health Summit 2023 19

Junior Doctors’ Perspectives on Barriers and Solutions to Equitable Access

Pharmaceutical Policy in Afghanistan 27

African Health Leadership: A Physician’s Perspective 29

Interview with National Medical Associations’ Leaders of the African Region 32

Interview with National Medical Associations’ Leaders of the European Region 42

WMA Members Highlight National Initiatives to Safeguard Patient Safety 49

Dr. Jack RESNECK Dr. Zion HAGAY Dr. Jacques de HALLER

OFFICIAL JOURNAL OF THE WORLD

Opinions expressed in this journal – especially those in authored contributions –

The Finish Medical Association invites WMA members and

Interview with the WMA Secretary General

leadership achievements over the the cornerstone of research

male-genital-mutilation-in-gam- lective-action-and-con- post/wor ld-medic al-associ-

Invitation to the WMA General Assembly

Report on the Roundtable Discussion on Antimicrobial Resistance –

Kristy Marr Julia Tainijoki Caline Mattar

life expectancy by 1.8 years by 2035

Authors Julia Tainijoki, MD Lesley Ogilvie, PhD

Reflections on the Value of the UN High-Level Meeting on

Mike Kalmus Eliasz Yassen Tcholakov Maria Inês Francisco Viva

The only tangible outcome of the

Yassen Tcholakov, MD, MScPH, MIH Marie-Claire Wangari, MBChB

Junior Doctors Network’s Leadership

Jeazul Ponce Hernández Francisco Franco Pêgo Flora Wendel

coverage (UHC); 4) sustainable

international efforts that promote participation of JDN members in

Junior Doctors’ Perspectives on Barriers and Solutions

Marie-Claire Wangari Deena Mariyam Lekha Rathod

official communications and activities References 15]. Available from: https://

Pharmaceutical Policy in Afghanistan

neighbouring countries and placing Corruption Monitoring and

African Health Leadership: A Physician’s Perspective

opportunities abroad, which are often training, followed by a mandatory

Interview with National Medical Associations’

Simon Kigondu Herbert Luswata Mvuyisi Mzukwa

of WMA on how to identify and Authors

Interview with National Medical Associations’

François Arnault Tomás Cobo Castro Johannes Steinhart

France: There have been many

WMA Members Highlight National Initiatives

Credit: PeopleImages.com - Yuri A / shutterstock.com

6. World Health Organization. 12. Ministry of Health, Government nessgroup.com/reports/cote-

mentos-esavi-ram-ft-em National_Policy_On_Patient_ itar y-juntas-atrocities-caus-

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