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Pakistan PM Imran Khan Endorses Successful APPNA MERIT Conference Objectives

APPNA MERIT Conference “Building Primary Care Capacity: Pakistan’s Critical Need” held jointly with Pakistan Higher Education Commission (HEC)and Rawalpindi Medical University (RMU) at RMU, March 4-5, 2020 was highly successful and was followed by debriefing and next-steps meetings with Prime Minister Imran Khan and Federal Health Minister Zafar Mirza. Both enthusiastically endorsed the vision of pivoting strongly towards primary care and the PM asked his ministerial team to work with APPNA to chalk out a plan to bring this vision into reality.

Additional meetings were held during the week of March 8 with federal and provincial officials to sketch out the launch of Family Medicine training programs and implementation of primary care model projects to give impetus to this movement. APPNA can be justifiably proud of being a catalyst for this!

Review: APPNA MERIT Conference held jointly with Pakistan Higher Education Commission (HEC)and Rawalpindi Medical University (RMU) at RMU, March 4-5, 2020

Title: Building Primary Care Capacity: Pakistan’s Critical Need

Discussion Areas:

  1. Establishing Family Medicine training programs across Pakistan to create a cadre of trained general practitioners. Also address the severe shortage of faculty in FM
  2. Creating tiers of training to build trained Family Medicine capacity quickly:
    1. 1-2 year diploma program, possibly based on WHO guidelines to create certified Family Medicine practitioners to staff Basic and District health units
    2. FCPS certified Family Medicine Fellows with 3-4 year residency to staff faculty positions at teaching hospitals
    3. CME-based certification to raise the standard of in-practice general practitioners who started practicing after just their basic MBBS and 1-year house-job
  3. Incentives for doctors to undertake Family Medicine training by providing
    1. Preferential treatment in appointments and promotions in primary care jobs, especially in Basic and District Health Units and private clinical setups
    2. Reimbursement payments for primary care under health insurance cards
    3. Funded training slots
    4. Granting status of Family Medicine Specialist to trained FM practitioners
  4. Standardize Coursework and Certifications
    1. Standardize on a single curriculum that is followed by all training programs across Pakistan for each tier of training (for diplomas, CME, )
    2. Create certification exams and criteria that is uniform across the country
    3. Provide a pathway for Family Medicine diploma holders to achieve FCPS Family Medicine Fellowship faster by receiving credit for diploma coursework
    4. Incorporate Family Medicine teaching in undergraduate MBBS curriculum, so students are exposed early to this field
    5. Ensure preventive care including environmental health is part of FM
  5. Collaboration between APPNA and Pakistani institutions on FM
    1. APPNA Family Medicine residency directors and faculty have courseware and curriculum that will be shared with teaching hospitals and regulatory bodies
    2. APPNA MERIT online platform will make available online FM courseware
    3. APPNA FM visiting faculty volunteers will work with specific teaching programs that set up FM diploma and Fellowship programs
    4. APPNA Alumni Associations (KEMCAANA, DOGANA, RMCAANA, KMCAANA, etc.) will create MERIT FM Resource Teams to work with their institutions on FM
    5. APPNA MERIT will collaborate with regulatory bodies and Federal/Provincial ministries of health to develop policies for development for primary care
  6. Family Medicine Practice and Role of Technology
    1. Encourage public-private partnerships to raise level of primary care nationwide. Establish quality of practice indicators for quality-based funding incentives and pay-per-performance, audit processes, and escrow funding accounts
    2. Implement Electronic Health Record across primary and tertiary care
    3. Utilize Telemedicine for supporting remote and underserved areas
    4. Induce stay-at-home female doctors to rejoin profession in FM roles
  7. Nursing Development
    1. Grow nursing capacity and Advance Practice Nurse and Midwife model for remote and underserved areas to deliver primary care
    2. Community nursing team or primary care nurses in family medicine cadre should be established for preventive and primary care delivery.
    3. Primary and Secondary School-based nurses to achieve higher prevention and serve Pakistan’s young

Attendees
APPNA MERIT Conference brought together stakeholders from medical universities, regulatory bodies, Federal and provincial ministries, primary care associations, and APPNA physicians from US and Canada.  Rawalpindi Medical University students and faculty also eagerly participated. Notable attendees included:

Vice Chancellors,  Principals, Deans of Medical Univ. & Colleges VC: Rawalpindi MU, Khyber MU, Nishtar MU, NUMS, Shifa MU
Principal: Army MC, Shifa, MC
Dean: Aga Khan MC, Khyber MU, Indus Hospital
Head of Depts. FM Aga Khan U, Khyber MU, Jinnah Sindh MU, King Edward MU, Shifa, Rashid Lateef (Med. Education), Rawalpindi MU, MH/CMH
Government Leaders Federal Minister of Health, Chairman of Higher Education Commission, Surgeon General, Federal Secretary NHRC, Chair NIH, Secretaries of Health Punjab and KPK, PM Health Taskforce
Associations, NGOs President Pakistan Nursing Council, CEO Medical Emergency Resilience Foundation, Convener Natl Family Med. Committee
APPNA Delegates Naheed Usmani (President), Shahid Rafiq (Chair MERIT), Danish Bhatti (Co-Chair  MERIT), Naureen Rafiq (MERIT FM Lead), Tehmina Munir Kazmi (NYU Abu Dhabi FM Chair), Fizza Gillani (MERIT HIV Lead), Zahid Rafiq (FM Calgary Canada, RMCAANA), Bushra Dar (FM MN),

Strong Support for Family Medicine Initiative at the Conference:

  • The three dimensions of universal health coverage include right of every citizen, ability to afford it and health care of good quality. To achieve that it is important to define essential health care services and find a way to deliver it. Primary Care and Family Medicine is likely the most cost-effective way of doing it. ( Zafar Mirza, Minister for National Health Services, Regulation and Coordination)
  • We want to bring up the quality of the care being provided and expand access. Processing access and quality together is fundamentally important. Family Medicine (FM) has to be a desirable field; people should be interested and can be successful as a career. ( Tariq Banuri, Chairman Higher Education Commission of Pakistan)
  • We all want quality health care, curative and preventive health care integrated. We want it governed locally. We have an initial structure of primary care access that needs to be enhanced and improved in quality. This huge thing can pivot on ‘sehat card’. This could be used to provide some balance of load on health resource utilization. ( Faisal Sultan, CEO Shaukat Khanum, Member PM HealthCare Task Force)

Post Conference Meetings With Prime Minister Imran Khan & Federal Health Minister
Prime Minister Imran Khan received the APPNA delegation at the PM Office on Friday, March 6, together with Federal Minister of Health and Chair HEC. The PM enthusiastically endorsed the goal pf building primary care and recounted the experiences of Iran and Cuba who had transformed healthcare for their populations by focusing on primary care. He asked the ministers in attendance what the specific policies and programs will need to be to bring about a focus on primary care, in addition to improving Family Medicine training. PM praised the work of APPNA and spent about 45 minutes in discussions  with APPNA delegates.

Federal Minister of Health, Dr. Zafar Mirza, also met separately with APPNA President and MERIT Chair and Co-Chair on Thursday March 5 to discuss plans for Family Medicine training and policies needed to implement primary care. He suggested looking at the WHO one-year FM course as a way to fast track FM training in Pakistan. He also set up a follow-up meeting on March 11 for additional discussions with APPNA President and MERIT Chair, following the strong endorsement of the effort by the PM.

Media Coverage
The APPNA MERIT Conference received extensive positive coverage in Pakistan media including a Pakistan Radio program that featured APPNA President and MERIT Chair. See links below:

  1. http://www.radio.gov.pk/programme/05-03-2020/discussion-on-conference-on-building-primary-care-capacity
  2. https://www.thenews.com.pk/print/624058-conference-on-building-primary-care-capacity-begins-at-rmu
  3. https://www.dawn.com/news/1538456
  4. https://www.dawn.com/news/1538695/mandatory-family-medicine-diploma-for-doctors-sought
  5. https://tribune.com.pk/story/2170348/1-family-medicine-doctors-backbone-primary-care/
  6. https://nation.com.pk/03-Mar-2020/hec-appna-to-hold-moot-on-family-medicine
  7. https://www.urdupoint.com/en/education/conference-on-primary-healthcare-concludes-at-856071.html
  8. https://www.hec.gov.pk/english/news/news/Pages/Conference-Primary-Care-Capacity.aspx
  9. https://nowpakistan.com/city-news/conference-on-building-primary-care-capacity-begins-at-rmu/
  10. https://academiamag.com/conference-on-primary-healthcare-concludes-at-rmu/
  11. https://twitter.com/hecpkofficial/status/1235218724556288000
  12. https://www.app.com.pk/hec-appna-to-hold-conference-on-primary-healthcare/
  13. https://www.medicalnewspk.com/pakistan-tops-the-world-in-negative-health-indications/

APPNA Alumni Associations and Family Medicine Faculty – We Need Your Support!
Now that the Family Medicine initiative is off to a roaring start with this conference, we need your support to bring about the change we all want in Pakistan healthcare.

  • Alumni Associations – MERIT FM Resource Teams: We are requesting each Alumni Association (KEMCAANA, DOGANA, etc.) to create FM Resource Teams that will include FM faculty and initiative coordinator who can work with your teaching institution min Pakistan to help implement FM training programs. The APPNA MERIT FM Team will work closely with these Alumni Resource Teams to bring this about.
  • Family Medicine Faculty in US/Canada: We invite FM faculty in US/Canada to become involved as part of APPNA MERIT FM Initiative, including the Alumni Resource Teams, to volunteer their time and expertise to help shape training programs in Pakistan and volunteer as short-duration visiting faculty.

This first APPNA MERIT Conference has been an amazingly well organized and impactful effort on a critical topic for Pakistan’s healthcare and medical education. On behalf of APPNA membership I want to thank Dr. Shahid Rafiq (APPNA MERIT Chair), Dr. Danish Bhatti (APPNA MERIT Co-Chair), Dr. Naureen Rafiq (MERIT FM Lead), and all the other organizers and delegates who traveled to Pakistan for this conference or otherwise contributed to its success.

We hope this will be another effort for which APPNA will be known for in a positive way!

Our best wishes from Pakistan!

Naheed Usmani
APPNA President 2020

Shaid Rafiq
APPNA MERIT Chair

Danish Bhatti
APPNA MERIT Co-Chair[/vc_column_text][/vc_column][/vc_row][vc_row][vc_column][vc_btn title=”Back to March 2020 Newsletter” color=”primary” align=”center” link=”url:https%3A%2F%2Fconta.cc%2F3abLez9|||”][/vc_column][/vc_row]