Every Small Gesture: Turning Patient Stories into Global Policy | Prof Maria Pilar Astier Peña

Uh hi dear colleagues, greetings from Wonka special interest group on policy advocacy and uh welcome from around the world to our first webinar uh in this year. um uh probably in the last bionium we had many webinars and I have to uh always acknowledge our previous my previous co-chair professor Amanda Ha for giving leadership and being very active with me in the uh special interest group and making it one of the most active special interest groups uh in Bona um for for this year after a little break with regard to the webinars. We are back today uh with a very important guest. We are here with the Wonka uh president elect professor Maria Pilah Astia Pñena um who is here with us now. Welcome uh Pillar to this uh webinar and thank you very much for uh accepting our invitation. So good morning, good afternoon, good evening colleagues and wherever you are joining us from. Thank you for spending a part of your day with the Wonka policy advocacy special interest group webinar. A special thanks uh to Sanka for his invitation to participate in this webinar. >> Thank you. So so welcome everyone. Um and uh today uh just before starting our webinar proper just to uh address some of the housekeeping rules um um you can uh post any of the questions you have on our chat box and uh we will answer them after the at the end of the talk and uh we have Spanish translations today. Uh we have uh Anna Perez uh our young doctor lead from Ibra America region who's always with us always say yes when I ask her um as the Spanish translator. So you can uh just go to the translations and switch on your Spanish translations if you want to listen to this in Spanish. And um so after the after the talk you can of course uh ask any questions we will allow you to even talk because we have a smaller group as usual so it's not a problem. So thank you dear friends for joining and uh today webinar is about uh okay I I'll say the topic it says every small gesture how family doctors turn patient stories into global policy most of us or many of us have stories to tell and we have done some changes little small changes in our practices and some of them would be the first step uh to go for a bigger policy change. So we will listen to uh uh Pilah today about that. uh to introduce Pilah. I I know that she doesn't need much of introduction but let me tell about her uh from her uh bio. Professor Maria Pila Aopena is a specialist in family medicine, family and community medicine and preventive medicine and public health with a PhD in medicine and more than two decades of clinical experience in the Agon public health service spanning both rural and urban primary care setting. She also has seven years of experience in hospital management. Pila is currently a tenureant professor at the University of Saragoa and a researcher at IIS Aragon. Her academic and research interests focus on healthcare quality, patient safety, health systems and primary care. She has provided international leadership in quality improvement and patient safety in primary health care and had held executive positions in leading Spanish scientific societies including Sika and SIM FYC. Dr. Pena has made significant contributions to Wonka Europe and Wonka world through her involvement in several working parties and special interest groups. Her leadership roles within Wanka include chair of the Wonka working party on quality and patient safety. Wonka WH leers officer that was the last term I if I'm not mistaken and finally now as the president-elect of Wonga world and in the next two years as the president of WA her extensive clinical academic research management and international leadership experience has established as a prominent voice in the advancement of quality patient safety and primal care globally. Uh I got to know pillar in Korea in 2018 in SE seal uh WKA and we both served as what is that I can't remember this tellers >> yes >> in the WKA election so I was this teller for Southeast Asia and Pil was seller for Europe so that's the first instance I saw and from that in that point onwards for last eight years I have associated her closely and I have served in the executive with her and I know how great leader she is. So Pilah over to you to talk about your experience how you the small gestures were converted into larger policy changes over to you. Thank you. >> Okay. Thank you very much Sana for your nice words. It's true. We met we met first time in 2018 in SE Korea. That that's good memories for us too. I'm going to share the screen. Please just uh let me know if the screen is um properly presented. So are you able to watch my screen? >> Yes. Lovely. >> If you can go it. Thank you. >> Wonderful. So as you mentioned before my talk is called every small gesture how familiar doctors turn patient histories into global policy and I speak from two perspective as you mentioned before I've been trained first in public health and then in family medicine. So it gave me a dual lens. Public health teach me to zoom out to see patterns. Environmental drivers in equity gaps across the whole population and family medicine teach me to thin to sit with one person reality inside a 10 minutes consultation. So today I want to show you how that film lens micro to macro interact for the benefit of the patients. So I'm going to introduce a definition who might frame all the lecture. What's a medical doctor advocacy role? Erns W and Fedric define doctor advocacy as the action by doctors to promote social, economic, educational and political changes that emlarate the suffering and threats to human health and well-being that doctors identify through their professional work. and expertise. That means is based on the knowledge of the reality is anchor advocacy directly in everyday clinical practice not as a extracurricular add-on for the motivated. You do not need a mandate to start. You need a patient encounter that'll show you the gap. Sarah Dobson and colleagues give us some vocabulary. Agency is working with the system on behalf of one patient and activism change the system changing the system itself for the benefit of the population. So every case situation I'm going to show you today began as an agency and Google app into activism. That's the same escalation for all the four cases. The first will be local, the second national in Spain, the third European and the four globally. So three frameworks h from different decades coverage exactly the same idea. The World Organization in 1986 launched the Otawa chapter in health promotion. Names advocacy is one of the three core strategies for health promotion to build political, social and economic conditions in favor of the health of the populations. Then in 10 years, the Canadian Medical Association state the health advocate or doctors as their responsibility to use their expertise, our expertise and influence to advance the health and well-being of individual patients, communities, and populations. not to chosen between the bed size and the population but all together. Then in 202 and then renew in 20 and 11 and in 20 and 23 we have the family medicine core values of WKI Europe that is stated that our own disciplines names community orientations is one of the six core competencies requiring us to reconcile the health needs. of a person with the healthiness of the community they live in. And we are the advocates. And moreover, in 2019, we have some scientific evidence that links structure advocacy training to a stronger professional identity and lower burn out also among family doctors. And nowadays, no major body treats this as an option. not the same thing policy advocacy and lobby. So today we are going to talk about advocacy. Advocacy means the journey at the end in some of the cases we will have a big success but in other is still going on. So time is also a key issue on policy advocacy and we consider also the levels of influence the levels of change in this turn patient communities and healthcare professional histories into global policy. Every global health policy begins with an individual patient history inside our consultation room by recognizing recurring patterns at the primary care level. Family doctors can scale these human experiences outward using quality improvement techniques, community partnership, national colleges, and global coalitions as levers of change. And ultimately you turn daily clinical observations into actionable data that requires to reshape healthcare system worldwide. So I want to introduce you a key concept on this journey. What is the notion of a policy window? A key issue on the policy advocacy journey. Policy change only happens when three elements get together. Clearly define a problem from our clinic encounters, a practical evidence-based solution, co-design it with the community and the political will or funding or support to it that lead us in time to the success of our proposal. As family doctors, our advocacy role is to keep pragmatic solutions ready so we can push them through the moment that the political window open. And this is what I'm going to explain to you based on my own experience. Community orientation is not just a line in my curriculum. For me it has been a working method. Practice one consultation, one coalition, one campaign at a time. What I'm going to share with you is not theory. It's the patient consultations turn into four different campaigns. Local, national, European, and global. The same method apply four times four scale. So we are going to jump into the local one. So here is my health center and the neighborhood. And then in my consultation an elderly patient with several chronic conditions arrived at my clinic. She was active in the local resident association and she brought me a piece of news that no health planner had flagged that thousands of new apartments were going up in our neighborhood and no one square would reserve for a primary health care center in a Spanish primary care system. Every health center is set up in a neighborhood of around 5,000 to 25,000 inhabitant. So when the population increases a lot, we need to set a new health center. What the patient said to me is that over 10,000 new citizens was were be arriving into the health map and hadn't been updated nor planet. So the neighbors start protest. They had been on and off for several months and even one and two years. So we need to act. The street protests run from 2015 to 2018 without traction. So we need to move from patient to a former case. So then health professionals with family doctors and the community leaders made an evidencebased health report to the ombbudsman. policy leaders didn't pay attention to the protest, but we needed to find a new independent real policy member that may help us. So, we went to the regional man and present a document with the health needs and assessment and demographic progressions at that time. And that links the strategic pilot community legis legitimacy plus institutional great evidence take to an independent oversight body when the direct political channel has sto neighborhood representatives here the coordinator of the health center and here the ombus man and we finally get our health center in the region. Four year later the health center of bario Jesus opened the door. The ombbudsman identify suitable public land. construction began and after these four years across at least one change of regional government the center opens the 15 March 2023. So we have some key messages with this policy advocacy journey. Stay with the community process across political cycles. Back community passion with hard needs assessment and epidemiological epidemiological data as the health prof health care professionals of the of my health center. we did with the community and then direct political channels and use independent institutional alliances as the ombbudsman to address local advocacy until the end. So regarding the policy window we found we have a specific problem new housing increased population and lack of new primary care services people neighbors citizens were aware and we needed a feasible solution planning for a new pren but we didn't have political will we need support from independent civil society stakeholders as the ombus man and the support of the health care professionals in the prenare team and all together make these policy windows a reality and the new health center built in four years. We can also talk about now to climb another level to national policy. A medication error cause harm and my colleague the doctor wanted to apo a apologize and participate in a root cause analysis to do the right thing. be honest, apologize, and take part in a root cause analysis so it never happen again. However, legal council warned that the apology itself might be used as evidence in a legal proceeding against the doctor. So we were with my colleague in a legal liability on one side, psychological safety and non-punitive reporting in the other side and in Spain a lack of national regulations guaranteeing patient safety in addressing these situations. It means that fear not only silence doctors but also prevents the ent system from learning. So we decide to move from a personal experience to a national issue and start working on this topic to try not to happen again for any other health care professional. We were aware that when an adverse event occurs, there is a first victim that is the patient and the family which deserve by the ontology and medical ethics an apology. We have professionals became second victims because we do not want that to harm patients. We we want to pl plan the care and sort it out in the best way possible and a third victim that is the healthcare organization would lose the trust of the population. The global action plan on patient safety 2021 2030 involves all governments and stakeholder on its strategic o objective high re reliable systems to build together high reliable systems and health organizations that protect patients daily from harm. But to get that situation we need transparency to speak up, openness and no blame culture. So we can learn from mistake, we can analyze them and we can express to the patient our eology. So we decide to response structurally and then we unite different scientific societies among family doctors ones as well partner directly with the health ministry legal experts and regional health directors to draft national guidelines in 2019. The message was tailored for an audience of doctors, nurses, health professionals who needed an actionable legal framework, not a moral appeal. The comit is to shift the legal framework from individual blame to organizational learning. We are now aware on the global patient safety report 2024 that 13% of countries had enacted nonpunitive gas culture incident reporting laws as of 2024. So that means many countries do not have these guarantees to be able to address properly when things go wrong and we need to express an apology and study the situation and make improvements to avoid happening it again. So in the meantime, legislative changes are taking place. We develop recommendations jointly with the ministry of health, with legislators and also with healthcare organizations. We launched this book about recommendations on the analysis of patient safety incidents with harm. how doctors and nurses and health care professionals should behave and how to learn from demiscate through cost root analysis anonymize. We also launched in Spanish National Health System some papers to address what health organizations were doing to try to promote no blame culture and to increase patient safety cultures among health care professionals. We are still on the way. We have no finish because we have not get the patient safety low. However, we did some steps and we are still working with the health ministry in this issue and is one of the strategic objective of the patient safety national strategy in Spain 2025 2035. So our policy advocacy journey is still going on. And what was the policy windows we found to launch this strategy, this campaign? first to realize through a situation, a case study that we have a lack of legislation and we have no sorry law, no patient safety law, but we could develop some recommendations for health care professionals with the Ministry of Health and Legislature. Well, legislative changes are taking place and we have the support of the World Health Organization, the support of the global action plan on patient safety 2023 2030 and the every two years assessment that the world organization do with the countries. We can move now to the European region and what happens in the European region. With the Wonka Europe policy advocacy working party, we identified that a family doctor fully trained in one European country can move to serve a rural underserved community in another, but then her his specialization vanish at the border because family medicine in the European Union is not in the panel of professionals qualification directive. So we need to campaign for that and we need to campaign together. Wy Europe, the organization of family doctors in Europe and also the WH Europe support this process. So we start the need for the recognition of family medicine as a specialty in the European Union with the context that the specialty of family medicine is recognized at national level in many European member state. However, within the European directive 2005, family doctors are listed separately and medical specialists are included in another annex. So we think that this is clearly an issue to highlight the relevance of high qualification for family doctor and the recognition at European level. So we join forces from the wonky Europe networks from UIO from W from European forum of primary care. We all together committed to improving family medicine in Europe. We need at least 11 countries to submit a proposal, a request to the European Union to recognize family medicine as a specialty. As today more than eight countries have already submitted documentation in the core European curriculum for family medicine is being developed with h the working party of policy advocacy and u at European level. We are not yet there but the coalition building method is a transferable lesson. No one country advocacy voice was loud enough alone but altogether we can get this new achievement and what was a policy window for this case study. We detected a specific problem. The lack of recognition of family medicine specialty at the European level, a physible solution to request to European Union to recognize the specialty and we needed at least 11 European countries requesting this recognition. And what was the political will and resources? We had the government commitments to strengthen primary health care services within European health systems. We had reports from the WHO Europe office recognizing the relevance of welltrained and qualified family doctors within prenare teams to offer a qualified prenan. This case study is not yet in. However, this is our policy advocacy journey. We want to share with you and analyze what are the weaknesses and what are the strengthenings. The strengthenness to be together to build a big coalition. The weakness that it takes time. It takes a lot of small meetings with different countries. It takes time to support the countries to upload the documentation to the EU platform and then have the final recognition. So time is also a key issue in a policy window. [sighs] And now we just go a bit uh to we just go to another level that is a global level taking the message of for the world health assembly and what message? Well the global message is really relevant. We have patients at our own consultation room with multiple chronic conditions and multiple medication. In my case, Maria and all the patient arrive overwhelmed with diabetes, with COPD, hair failure, depression. 14 medications a day, each prescribed by a different hospital specialist, each following regulous evidence-based single disease guidelines and each guidelines blind to the other three. The advice sometimes was contradictory. The risk of dangerous track interactions was constant and there are hundreds of that type of patients in jaw consultations daily. So this is the global pattern behind the epidemic of NCDS. Our patients live with multimobility. Our guidelines, funding streams and specialist trainings are still organized around isolated diseases. But as we all know the case of primary care services research most based on barber staff studies show that population served by a strong person center prenic care have better health outcomes lower cost and greater equity than those relying on fragment specialist le disease silot care. However, we also know that continuity with a family doctors for more than 15 years might help to increase survival to reduce hospitalizations and emergency care. And when it comes to specific diseases, diabetes, high blood pressure, COPD, you have better results when a family doctor is coordinating the care. So we need to advocate for the role of family doctors in dealing with NCDs. So this is the other policy advocacy journey that won't started. We take the message to the white house of say assembly. The message that family medicine is the safest most trusted way to guide NCD patients from first diagnosis to compassionate end of life care. the labor via the official of the world health assembly statements as wa w solations Dr. Abibana Martine Bianke Dru and myself had been advocating with Dr. Anna Stadal about Wonke inc um position on highlighting the role of family doctors and currently we have been stepped up and through the Wonka NCD working special interest group and the creation of the NCDS fellowship. We are trying to generate evidence of the role of family doctors with NCDS and convincing through our messages at the World Organization that the role of family doctors is essential in the universal health coverage and premier care services along the world. And what was the policy windows we found out? The first was the impact of NCD's ben of care. There has been different United Nations high level meetings focus on NCDS in mental health. So we have a specific problem that covers all over the countries around the world. But also we have visible solution to address the burden of care of entities and make possible for a safer health care reorienting health systems to primma health care and strengthening family doctors and multidisiplinary teams to address NCDs. So a qualified family doctor who can have a capacity of resolutions through prescribing controlling symptoms and signs in using test and diagnosis tools at the point of care my health to accompany patients with chronic conditions along the time till the end in a safer way. And what was the political will our resources? We had different reports from W, OECD, World Bank that it was really effective and safe investing in primary care systems and investing in qualified family doctors working within multidisiplinary teams. So here we are. This is a policy advocacy journ not not finished. We invite you all to address this NCD's policy advocacy message on the role of family doctors as well as the patient safety regulations in your countries to ease the possibility of a no blame culture of a patient safety culture and to be able to apologize freely. about our own mistakes in the practice and also committed with you to work on the recognition of family medicine specialists in your countries as we have highlighted through these four examples. So what is the myth across the global pren advocacy literature and my own experience as I express now it rest on two pilots that have to work together. The first piler is strategic and evidence. Use epidemiological and health need evidence. Know exactly who your target audience is. Map the loca the political window of opportunity in every case. and deliver a message any policy may can repeat in one sentence. Family doctor role in NCDS no blame culture for all health care professionals that's our key messages that we need to learn a qualified family doctor recognition in every country and the second pillar is relational. We need to lead with humility rather than authority. Share ownership of the campaign with the community they to bring them together with us and with the PAC team build alliance sometimes with people who don't naturally agree with us. However, we think they might help us if we explain and clarify our message, our will and commit to the long game. That is crucial because as leader I've learned that trust builds slowly but is spent quickly and many of the policy advocacy journey takes a lot of time. Much of them we can start and contribute to but we need to join more people join young family doctors who take the lead and help pass to get the final achievement along the time. Well, sit back with me and look at what these four very different cases actually have in common. Because this is where the research and the real world history get together. A patient history that makes an abstract static impossible treature. That is key. The entry point research calls issue framing. The evidence ledger it onto emotion and needs assessment, a guideline, a comparative outcome study. So the campaign survives contact with skeptical policy makers that we might find along the way and even policy maker that change along the time because the policy cycle change it if the policy advocacy journey lasts for many many years and then persistence multi-year followup across Because political turnover, every campaign here took years. So we need you. We need one that made the first step up, then another who will take the lead and follow the journey and involve young family doctors that at the end will get will reach out with our h challenge get a reality. >> [snorts] >> So we think that family doctors are ideal health policy advocate. We look in parallel and that's is key. Clinical training and health policy work. Evidence-based medicine is evidence-based policy. We need to support the policies and the evidence. Seeing the big clinical picture while tracking small details is exactly what connecting a policy vision to it detail next steps requires. So we know to do that we already appreciate the social root causes of poor health. We don't need convincing that solution must address health and health care together. The health and the services. We are also comfortable with complexity, ambiguity, uncertaintity which is what changing a health system feel like because is tedious and often unexplored territory. We need to navigate and we are used to navigate it in our own consultations. We are trained to narrow a consultation down to the real question that is also key which is the same skill narrowing a unravel policy problem to its core to the essential essential area we have to go for. We already work in teams and know the stakeholder buying matters. We know how to involve to bring together people on the same will on the same goal on the same challenge and our care is anchored in relationship on trust relationship with our patients and trusted relationships are the currency of policy work as well of policy advocacy work. We have learned patient helping patients change their lives along the time. We are compounding the patient until the end which turns out to be exactly the patience we have to have with the policy work. stepping up over policy cycles and be persistent to get the results of our demands, our challenge, our transformation project to improve the health and the well-being of our population. So let's finish with some family doctor advocates kind of checklist just some tips uh to have in in your consultation room. Look into your consultation room as a policy advocacy journey as well. Anchoring in clinical reality with patient histories that reveal the structural gaps we have. How many patients and countries put in evidence what is the structural gap of the health system that is not addressing the reality of the health needs of the population. build a case with evidence-based health data. We have the training to build this report to join people to join civil society with our evidence-based health data that back their challenges that back their goals and we can be adaptable strategy for years of followup. We need to build broad coalitions, family doctors, penicare teams, civil society, other scientific societies, legal expert, governments, all these stakeholder we need to merge together. And then practicial leadership. We are not a solo leadership. We know how to hand campaigns with younger colleagues, with civil society, with any key stakeholder we need on board. And remember, the value beyond the numbers is priceless and the long-term health gain is amazing for the whole population. So I think this is really relevant and personally three things have carried me through and I invite you to consider patience persistent and perspective global perspective linking to locally roots. So thank you for listen and remember that every campaign starts with a small gesture. A patient who trusted you with an inconvenient truth and then and a decision for your part not to let go but to start shorting out the gap. invite you to start with the Wonka special interest policy advocacy support, the Wonka regional policy advocacy groups that might been supporting you. And now we can share recurrent patient frustrations in the chats and describe in a single sentence if if you find the gap, if you find the deficiency, if you think of it as a policy advocacy opportunity erh to improve the health and the well-being of the population. So thank you very much for your presence here and listen to the this conversation. Muchas gracias. Uh thank you very much Pilah. What a lovely presentation that was and uh I just u if I uh go through your presentation I uh noted down few things. I loved that you started with some theory the the the commonly used words like policy, advocacy and lobbying which is very important. I think people even who have joined for the first time and who have no idea about what policy and advocacy is and uh thank you for uh going through the the journey advocacy journey policy advocacy journey starting from local advocacy then through regional to global advocacy and I really love this concept of the policy window and uh then uh I love the comparison of the family medicine and uh the the journey of policy advocacy and about your two pillars. I think uh very important thing was about finding out the political window and also sharing the ownership with the community. I think that was the great idea. And finally uh thank you for that family doctor's advocating family doctors uh sort of checklist of advocating which is also important. So very thank you very much. Um Pilah for that interesting presentation. Um colleagues before uh forgetting I'm just posting the link to Wonka special interest group on policy advocacy web page which also could be uh found on Wonka website when you go to the groups if you miss it from here but we can just open it and keep it and join the policy advocacy group for more webinars more news and more resources. Um so while thanking you um do you have any questions this the time to get the answers in the meantime uh there was one comment or I would say suggestions that uh which has been or less the policy framework and experience from European Union could be offered to the Americas to initiate regional family medicine specialty recognition. I think a very good idea >> completely supporting it. Yeah, I I think that um the the process in in Europe might be an example for other regions to guarantee a process on recognizing family medicine in different countries in a region because the mobility of family doctors in in the different world regions are quite frequently and then it would guarantee that we develop a common curriculum of family medicine residency programs in countries and having a recognition and will ease the recognition in other countries. That might help family doctors to improve by comparison and to push the government on investing in uh qualified family doctors uh residency programs that led a high level primary care health services. and colleagues. Of course, the meaning of these webinars uh is to share and learn from each other. So, we don't need to reinvent the wheel rather we can learn from the others how the how we could advocate. Uh so definitely this would be a really realistic uh suggestion and you can try that and I'm sure that pillar would help you. >> Yes. and also all the members of the W working party of Wonki Europe on policy advocacy also are leading together this project. So any of us can help address any doubts or any comments that might help uh other regions to advance their for sure >> and I can see that Raquel is here. Kim is there. Uh, >> wonderful Raquel. She's one of the leaders of the Wonka Europe Policy Advocacy Working Party. So, great to have you here. >> And Kim is the WHO lean of the Wonka executive. She's has also joined. >> Yes, Kim is is now doing the NCD's h policy advocacy role. So, thank you Kim. we you you take the lead and and we are just h improving and and making the message h in everywhere assembly. >> Um we have a question um April has uh raised his hand. April [snorts] over to you. >> Oh yeah, sorry. C can I ask the questions right away or I should write it down on the text chat? Okay. So um thank you Zanka and thank you uh professor Pina for for the uh wonderful presentations and sharing. Uh I just I just curious about um I'm from Indonesia by the way. I'm I'm curious about um what is the main issues that in in in the regions uh based on your experience uh the issues on not recognizing the uh family medicine as a special what is the uh three biggest issues for example or even one uh that that we can that can enlighten us in a way that even in in the uh European Union that has uh strong history of uh good uh practice of family medicine and strong example in a way in the educations of of uh medicine still struggling to find that uh recognitions and uh consensus. So yeah, thank you very much. >> Thank you for your question. um th this situation in my um well it comes from many years ago when uh the family medicine residency program were not so common in in the European Union. So it was easier just to have general practitioners. So um without specialties that leads doctors being contracted in different settings. However, as we are qualifying family medicine and the way we are working now with a high capacity of resolution, dealing with chronicity and dealing with complexity and uncertensity, this um improve the qualification and improve the results. So we are focusing mainly on to offer a high quality perman services in all Europe and we are just highlighting that the way all European citizens deserve a high quality premier healthcare service through a qualified family doctors in every country. So we are just moving through the positive part and making the message for the European Union that way and also to the governments because uh the governments are the ones who have to ask to European Union to recognize family medicine specialty on the European directive. >> Yeah. Uh thank you for for for clarifying that. Uh but the questions remain is about uh how I mean what issues does the European Union uh policy makers for not um recognizing such uh you know uh long history of roles uh uh provided by by the family physicians and the training that you have provided uh because we're talking about about a union, right? So there is examples on one countries or even more than uh five countries for examples and uh of I I I appreciate the the hardship of you your advocacy but I I'm just uh still curious on on what makes this uh policy maker so strongheaded that needs those efforts so hard for for for uh your team to you know with the with the efficacy. So uh but I I I I uh I really uh appreciate the the uh you know the story that you share because it's really new for me to to understand that because in my opinion I I I look up a lot with uh uh to European countries and uh it's it's still um you know has spinning sometimes to to notice that oh you still haven't been recognized. as as as you should be as you deserve. Meanwhile, here uh in our regions also but uh yeah I need you to enlighten a bit about why this uh policy makers the politicians are so strongheaded >> that requires you to do that. >> Well this is the first time that countries will require the recognition of the specialty. So they didn't ask before. So we are just grounded this situation the we have um different family medicine residency programs that last from two years until six years. So the the training programs are quite different along Europe and they contend also. So at the same time we are just asking for the recognition for the government part. We as the 1K euro policy advocacy with other stakeholders, we are just defining a common curriculum and competencies for family medicine that will helps um policy makers at the European level to know uh the role of family doctors in primary healthcare to recognize a high level competency program and then to the to guarantee that every European citizen and deserve a well-trained family doctor. So that is the the the three key elements of our um challenge of our policy journey. But it's true that we we knew that in 2018 when it was um the the Astana declaration family medicine as a specialty were not there h in the declaration. So the that one of the coy that h seems to be have an effect was that was not recognized by the region by the European region. So then we start to make a campaign once we have been recognized that um although in most of the countries of the European Union there was a kind of family medicine training program that was different in content and different in length. um at European level erh we hadn't the recognition so then we start the the journey >> okay so yeah >> thank you very much >> very clear very clear thank you very >> thank you thank you uh because I think u even though it's a union European Union it's it's it's not similar the countries are not very similar as you told I mean the the needs are different the systems are different so it's not easy but but we really appreciate what you have done and but the the continuous trying to change things do we have any questions and same time we have to um yeah okay um regarding uh the recordings okay yes we we have recorded the the webinar and uh of course we I'll show you now uh yes to show you that uh uh Wanka special interest group on policy advocacy has a uh playlist a special playlist on uh Wanka YouTube. So if you go there you can see not only this soon we will also post this soon but we also have the other webinars we did for last two two two years you can see them and different stories and all all of them like experience of our speakers so you will really appreciate that. Uh so let me also share the link of the sorry uh link of the uh YouTube playlist here and Kim would you like to elaborate on your what you have told it's quite >> yes I I would I would like just Kim to talk about what she she has postant >> yeah you know I think it's really important to know and apologies I cannot be on camera right now but I think it's really good to know that there are some member organizations who actually meet with their government or meet with legislators either at a state level or at a national level and I know that for um for example the AFP we have the family medicine advocacy summit which is a 3-day conference that's held in DC and Washington DC and we talk about the issues that are important Um each year there's usually three to five topics that get brought up and that we have to go to talk to legislators and then we go maybe you know 15 20 people per state uh maybe more sometimes 30 um we'll go to all the different legislators that work for that state in DC and we meet with them um individually we have a whole day on the hill as they call it Um, and it's a really good way to understand how we can advocate as family physicians for our patients, more importantly for our specialty and for those who are coming after us. We know that the future of family medicine is so bright and general practice throughout the whole world. And we want everyone to understand what it is very clearly. And that's part of why it's so exciting to hear about uh the work being done in Europe. Um I think that it's really a model for the rest of the world to understand how we can better advocate for our specialty and for ourselves. And a lot of it also comes down to funding as um primary care physicians. often times um in different countries of the world um payment reform is is needed and necessary to be able to attract the best and brightest medical students to our specialty. And so being able to go to our legislators and say we need to provide for more residency training spots for our family doctors. We need to have more um scholarships and grants and funding for teaching health centers and for um medical school loan repayment for those that go into primary care is a way that we can really help our future generations of family doctors. So um I encourage you to reach out to your member organization to see if they have something like this and maybe uh spearhead something if if there isn't one you know to talk to the leaders about is it possible um I know that in our state of California we have an all member advocacy summit which all member advocacy meeting which occurs usually in March or April each year and we do the same thing we have three days where we meet together and the last day we go to the the capital to meet with legislators. It's a really wonderful meeting and I invite you all to come. >> Wonderful. Kim I Alen Spina also talk about Philippines and it's really very relevant the relationship that they have with the Ministry of Health and Social Health Insurance Corporation. Can you say some words Elen to all? Hi everyone. Good evening, good morning or good afternoon. Um I I just would like to share that uh in in our country in in the Philippines, we actually had um support from our ministry of health way back in 2013 um to establish family medicine residency training programs in all the governmentowned national government-owned hospitals. And because of that um program that we had, so that the department of health issued um uh a department order mandating that all hospitals that they own and operate must establish residency training programs in family medicine. And it has expanded in 2021 in the middle of the pandemic that they are now requiring all the doctors to the barios which are employed by the DO to undergo um the practice-based training program that that we have and every time there is a new leadership in the ministry of health and in our social health insurance corporation, it is a practice for our academy to uh have a visit with them, a cortisy call so that we could um advocate for uh our specialty. But one thing that we learned especially during um the advocacy work that we were doing uh in the runup to the passage of the universal healthcare law is the lack of local data. So it is something that we feel that we really need to to work on and and this um webinar is is very helpful for me because it uh showed us um it reinforced what we actually are doing here in our country. So thank you par and thank you to the SI. Thank you Shanka for organizing this. Okay, your your example is also really relevant. >> Thank you. Uh and thank you for joining. I think it's late night for you. And uh regarding this uh evidence part, I was just wondering would uh uh Barbara Star feels fields work uh be useful because she has shown lot of evidence and I know that Philippines has longstanding uh uh connection to the the USA as well. So probably you can uh use those evidence as well. Um actually that was what we were carrying. We were we were bringing a lot of of data like Barbara Starfield's work but what our legislators was actually asking for was the local evidence. >> Local evidence. Oh, I think that's what Par was saying earlier that it's the patients that we see in our day-to-day practice because it's very contextualized and these are the data that we really need to gather and and really document and um I I I think it is something that that we can do in in the Wonka regions like um for us in Asia Pacific we're we're very diverse but I know that in other countries like for Malaysia uh Indonesia like in in Indonesia Inda uh is a national leader and she's in the ministry of health and in Malaysia also like uh I think Husni before was working closely with the ministry of health and uh even Brian in in Taiwan. So we all of that and um I I I think it's high time for for all the member organizations of Wonka in in a specific region to to copy what the European uh Wonka region has done in in coming up with that. So um I I think it's it's something that we can do as an organization as well. Yeah. Um just to share also uh we have what we have uh what we call now as the Philippine Pacific initiative or pill pack and it's really about primary care strengthening in the Pacific island countries and this is being spearheaded by the Philippines with whipro and so we are active there and uh just to share pillar I attended that meeting and I was wearing my my hat as Wonka APR and I told the regional director that um that we are very in Wanka is very keen on expanding um into the other Pacific island countries because at the moment we only have Australia, New Zealand and Fiji in that part of the world. So we're hoping to to help um primary care uh strengthening and um organize the primary care doctors in like in Papa Newu Guini, in Kibbash or in uh Micronia and in those countries in the Pacific Islands. Thank you. >> Thank you. Thank you. And I think it's high time to not only be advocates but also to be in be in the policy makers uh good. So I mean some of our colleagues I know that recently uh Peru's uh our colleague Sophia Kuba uh became the the deputy health minister in Peru. So there are instances where we can breach that. Um so if we are in the the the policy maker situation the the things would be much easier. So yes totally agree with you. Mhm. We we we really support Eileen on their work with the Wanka and the Pac Asia Pacific region and supporting the Pacific Island on a on advancing in family medicine. That's and primary care. That's really relevant but and also congratulate on the work you are doing regarding uh promoting research among family medicine residency programs and medical students that we saw in the APR conference in in Iloilo and also the year before in Busousan. So you are doing an amazing work that it will h bring to you the data you need to back the um health assessment the local health assessment to guarantee a success on the advocacy journey on primary care and family medicine. >> Thank you. Thank you very much. So I think uh we we have almost uh spent uh 1 hour and 15 minutes or more than that 20 minutes probably. So yes it was an interesting discussion. So thank you very much dear all for participating from around the world despite it's late night some of you and thank you very much Pilah. Uh we were honored by your presence and accepting my invitation. So thank you very much for that. and Anna much gracias a uh you have been always uh telling yes to me whenever I asked. So thank you for that. Uh so dear colleagues uh thank you all for joining and wish you all a good day. Uh gracias to particip Thank you very much S. Thank you very much Anna and all your all the attendees all members of Thank you very much. >> Thank you. Thank you. Thank you much. Gracias. See you all.