 Okay. So good evening. Namaskar and Assalamu alaikum to all of the participants to this regional spice food webinar. I welcome you all on this World Family Doctors Day. I am Dr. Veena Kumari, National Secretary of the spice food movement, and I will be the moderator of this event. So you will be hearing me today for this one hour. So before we begin this session, just a brief introduction to World Family Doctors Day. So basically World Family Doctors Day, initially this day was started back in 2010 by the World Organization of Family Doctors Wonka. Since then it has been celebrated globally every year to pay tribute to the family doctors to give tribute to their contributions and to recognize family physicians and to increase their morale and highlight their role in the healthcare system. So this day we also thought the same theme and the theme for this year's World Family Doctors Day is family doctors always there to care. So today, so all those who have joined right now, so I welcome you all on behalf of the spice food team on World Family Doctors Day. So now I would like to start the session. So before starting, I think it's Dr. Tariq Kalbiz has joined. Wait a minute. Okay. So before starting the session. Okay, so before starting the session, I would like to ask Dr. Sankha, who is currently the lead of the Young Doctors Movement and who has served as the regional chair of the spice food movement also. So I would like to ask Dr. Sankha to say a few words, share his thoughts on this World Family Doctors Day. Dr. Sankha, can you unmute your mic and say a few words. Thank you. Thank you very much, Veena. Good evening everybody. First of all, I would like to wish you all a very happy World Family Doctors Day 2022. And as Veena correctly mentioned this year's team is family doctors always there to care. And to note something very interesting, this team is also one that's suggested by Young Family Doctors, where the executive committee was given the task to collect for the this year's family doctor day. One of our Young Doctors movement only suggested this team, family doctors always there to care. So this is mainly, we are talking about three pillars always that's the continuity of care. They are the availability of family doctors in different places, different scenarios, and to care, the care, the accessible, sustainable, and all the cost effective care that it is provided by the family doctors. So based on these three pillars only this year's World Family Doctors Day is celebrated. So I'm really happy that the Spice Road movement is celebrating as usual in style. So, because I know that out of a lot of other Young Doctors movement, the Spice Road is the first Young Doctors movement to go for a webinar on this special day on the same day. So congratulations, all of you, Zainab and Zainab, the team, all the country. And I'm sure that this webinar would be a very useful one in order to mark this very important event. Thank you very much for inviting me to talk to you. And I wish you all success and a good, very successful year as well. Thank you very much. Thank you Dr. Sankha for sharing your words of wisdom and inspiring all the Young Doctors of the region. So now I would officially start this webinar. So today our first speaker is Dr. Rabia Saeed. So I think that most of you will be annoying Dr. Rabia Saeed also. Dr. Rabia Saeed is from Pakistan. She is the fellow of College of Physicians and Surgeons of Pakistan. She is the Consultant Family Physician. And also she served as the National Chair of Spice Road Movement of Pakistan also. So currently she is the Head of the Department of Family Medicine at Liyakat National Hospital Karachi. And she's also leading the Outreach Centers of Liyakat National Hospital. Today she will be delivering talk on the Family Medicine, the backbone of healthcare. Over to you Dr. Rabia Saeed. Dr. Rabia. Thank you, Veena. I would like to first of all thank all of your team, the team of Spice Road Movement for celebrating this World Family Doctor Day and organizing such a wonderful webinar. Including all the leads from South Asia to share their thoughts and to work together and develop a way forward for promoting and developing the field of Family Medicine in our region. Not only in our region but in fact globally because we have participants from all over the world who are attending this webinar. Affiliation with Spice Road is not new so it's something, it's something close to my heart so because in the 2016 we started this movement with full zeal and enthusiasm in Pakistan. And I'm so glad to see the progress that has been made under the leadership of Veena Nishad and other members of Spice Road Movement from Pakistan. Also I would like to acknowledge the contribution of our other colleagues from India, Sri Lanka who are always there, Nepal, Bhutan who are always there to support the team of young family doctors and always, you know, encouraging to organize such efforts towards promotion of Family Medicine. So let's start with today's talk. So my topic when I was asked to deliver a talk on Family Medicine, family medicine as a backbone of healthcare system. So it actually raised few questions. So I think we all on this day when the whole world is celebrating and acknowledging the role of family physicians all around the world. It's high time that we all should recall and we all should review the role and scope of Family Medicine and the impact it has in our healthcare system. So there are always changes, challenges that we faced worldwide, but there are some unique challenges that are pertaining to developing worlds and especially in South Asian countries. So I think it is very important to address those challenges as well. So my talk is about addressing those challenges and also to develop a way forward on how we can strengthen this backbone of our primary care, which is Family Medicine with family doctors on the forefront. So let's discuss. So why we say that it is, why we, you know, call Family Medicine as a backbone of healthcare system. So it's something that everything relies upon. So it's starting from the diagnosis, not only from diagnosis, so we start from prevention. I think not from prevention also, but we start from health promotion. So we work as the primordial level of prevention, and then starting from the preventive role, we go towards the curative aspect of medicine. And our role does not end here. We also manage the rehabilitative role of healthcare system, where we are involved in the rehabilitation of patient care. Not only patient, our scope is not limited to patients. Our scope is limited to their families, not only to families, but to communities, but to the society as a whole. So the range is very vast. So it's actually the pivot on which every other things relies upon. So that is why there's no doubt about it that the whole scope of Family Medicine is actually inevitable for any healthcare system. So the system of healthcare in any country should stand and must stand on Family Medicine as a primary care specialty. So as you know, every specialty has its own attribute. So this is the diagram that again is very close to my heart. So it actually summarizes the dynamic role of a family physician. So starting from the clinical competence and the cost effectiveness in managing the patients, providing the comprehensive healthcare, focusing more on the common problems to address the base of pyramids, fair coordination, including the importance of community healthcare, including the importance of counseling, patient advocacy, which ensures the continuity of care. The whole circle of Family Medicine or the whole circle of family physicians competence actually play a very vital role in improving the healthcare indicators of any community. So when we talk about that Family Medicine is a bad one. So we talk about preventive care. So family physicians are not only in action when the disease occurs, we don't follow only the illness based approach, but we follow the wellness based approach. So we focus on risk factor assessment, and we work before the disease starts, before the risk factors emerge and then we work jointly with the patient to address those risk factors and work towards modification of those risk factors. We talk about screening. So actually, so even if the patient has risk factors, or even if the family has risk factors and we are working on the risk factor modification, we don't stop here. We move one step ahead. And when the disease occurs, and it is not producing any symptoms, we focus on screening. We focus on immunization. We focus on secondary prevention. If disease occurs, then we provide the best possible care to minimize the complications. And then even for those patients in which the complications occur, in which the disability occurs, family physicians are again leading the show, and they are the main leads in providing the rehabilitative care of patients. So just imagine the vast scope of family physicians in providing preventive care. Other rules of family physicians when we talk about primary care networks, so it's important to understand that. So it is basically targeted on five main factors. So let me share the recent example of COVID pandemic who utilizes their primary care services. They were far better in managing the COVID pandemic. So triage and treatment comes at the primary allocation, primary care level. Disease surveillance can easily be done at a primary care level. Affordable care can be easily managed. Hospitalization risk can be easily minimized if a proper primary care team or a primary health care network is available in the system. So we say that family physicians are the gateway to health care. So whenever there is any illness or when we talk about even wellness. So the first point of contact that all the patients should have and they must have should be the family physicians. So initial triage and screening can easily be done and can easily be well managed at primary care level. It will not only result in reduced cost to the patient but also to improve the health outcomes as well. Urgent care services can easily be provided at primary care level. When we talk about family physicians, so they are the care coordinators and the intellect different levels of health care services to provide better care to patients. We all know that when in a country or in places where the health care system is fragmented, if a patient has chest pain, so they will go to the cardiologist will say, no, it's not my problem. They will go to a gastroenterologist then they will say, no, it's not my problem. They will go to an orthopedic. They will say, yeah, probably it's because of any issue related to that. So what happens this this problem can easily be managed if the patient comes to a family physician right from the beginning and the family physicians after evaluating them and after managing them probably would be the better person to coordinate the referral of services between different level of care. So this kind of coordination is important at government level as well for health care stakeholders as well because it is going to ultimately minimize the burden of secondary and tertiary level of care, who ultimately will get to see only those patients that are actually and genuinely genuinely deserve their care. Unnecessary referrals and burden in hospitals can be minimized, and the hospital resources can be utilized more efficiently if majority of the problems can be dealt at primary care level. So bringing care at home through domicile again another very emerging field of family medicine that has been recently that has been recently more active during COVID pandemic where most of the people would try to consult health care from their home. So Edison tell you with you home health care service. So these are the avenues which family physicians can explore more to improve the quality of care to their patients for their patients. So again, we never leave a patient without providing any education so I think so all of you all of the family physicians must agree, even if if the patient comes to us. So I think it's in our blood that unless you provide a piece of advice, a small piece of education to our patients. So we feel that the consultation is incomplete. So we believe on the holistic care approach. So we call it so when I teach my residents. So when they are with us and they are seeing a patient and presenting a patient problem. So I would say please utilize family medicine. So what is family medicine? It is actually the whole person approach. It's not dealing with a problem, but dealing with a person. So it is such a unique and such a beautiful feature, which actually builds the foundation of our specialty. So I think this is something we should proud we should feel proud upon. So we never leave any opportunity so just like when we are when we plan to when anyone plans to travel. So they they arrange their vaccinations. They stay up to date on their medications. So they plan something they pack their bags. So likewise we family physician never leave an opportunity to provide to work upon the health improvement of our patients. Even if they are coming for so example for example if there is a 50 year old patient coming for hypertensive follow up in our clinic. So we never leave this opportunity to tell that lady that see you need to get your screening mammogram. See you need to get this back this vaccinations updated. See you need to get your blood sugars screen for diabetes. So, so that's how our opportunistic care or our preventive care actually produce a huge difference in the quality of life of our patients and their families obviously. So, a family physician or a family doctor. There's a lot of gaps. So, he's a great he or she's a great provider, but at the same time, they are clinical trainers, they're supervisors, they're training students they're training teams. So they are working with a team of multi disciplinary health care professionals or maybe sometimes non health care professionals to to develop the clinical governance of the setup to work with the community leaders to improve the health care system or to improve the health care outcomes of the community. So they are actually leaders who are working towards capacity building. They are mentoring the healthcare staff during the course of clinical service. So, so, so the backbone is so strong that it has it plays multiple roles at the same time. So now, so now we all are definitely it's always good to revive the good qualities. Or the special and unique features of our speciality and especially on this world family doctor day, we should feel pride in to be a part of this is to be a part of this team to be a family doctor. So when we talk about the challenges so despite of the huge benefits and advantages family medicine has or the position of family medicine in the primary care system. There are certain challenges so why it is not accepted the way it should be being such an important part of the healthcare system, why it has not been given the place it deserves. So there are certain challenges. Today we are going to talk about the challenges that we face in developing countries, particularly in South Asian region so that we all can relate to it. So first of all, there is a gap in recognizing family medicine as a specialized. Graduates can practice as a family physician can get the license to work as a general practitioner. So people can equate general practitioners with the train family physicians. So ultimately, the quality of gear that the patient gets is not at the same level is not at the same standard that a trained family physician can provide. So we have a major barrier in developing a sound concept of family medicine for a layman for common people. So lack of training opportunities so even if the, if they are doctors who would like to get training in family medicine. So we have limited training opportunities. We have limited trained family physicians in, in different parts of the world, especially when we talk about developing countries, because of its recent acceptance as a specialized field. So definitely, there's also lack of consensus on degrees and eligibility to practice as I said earlier, sometimes, sometimes the practices even without training. And also allocation of health care budget on primary care training is actually very important, not only on training but actually on the health service delivery at primary care level. This is actually a very important part, which is unfortunately lacking in many of the developing countries. So it's actually the base of pyramid of health care so majority of the problems as you know comes to family physicians. So obviously, as per the demand that it has on the family, as it has, according to the demand that we have on the health care system it is very important that the resources are also allocated accordingly. And unfortunately, this is not true in our case of family medicine. So yes, we need to work jointly towards recognition of field as a specialty in our own countries. Then it is important that government should be very serious in allocating budget for development of primary care. The capacity building for family physicians and providing them with the adequate training and probably on job professional development opportunities is very important, and it is very important for the survival of health care system. So we're talking about WHO universal health coverage and achievement of the goals of universal health coverage. It is very important that we should invest in scaling up primary health care services in low and middle health care. As you can see the figure, it would potentially save 60 million lives, increase life, average life expectancy, and definitely contribute significantly to social economic development. So let's summarize the talk of the care provided must be comprehensive, it should address all health problems and all patients at all stages of life and continues over time, just continuity of care. There must be accessible to each and every member in the local community. So we, being the initial part of the healthcare system or as the entry point of healthcare system, we should be always be available family physicians should always be available to assess patient rep to other healthcare providers or services. The training must be based predominantly in primary care setting so the family physicians should be trained in a primary care setting as well. Despite of the fact that most of the training which are available in family medicine are hospitable so it is important to get hospital training as well, but a major part of training should also focus on primary care setting where their actual domain and scope of practice should policy support should always be available. Otherwise, it is not possible to achieve the universal health coverage. Equitable payment of primary healthcare providers should be there. Healthy compensation should be provided as compared with their colleagues which are working in hospitals and other areas of special specialization. Thank you so much. So I would be happy to answer any question. Thank you, Dr. Abia for a wonderful talk. So, if anyone has questions, here she can ask now. And before moving on to the next talk, I would take this opportunity to introduce Dr. Raman Kumar from India. I think he's here with us. So Dr. Raman Kumar is an inspirational leader for all of this region and he also served as the president of Wonka South Asia. So Dr. Raman, can you hear me? Good evening. Thank you, Dr. Veena. I hope you can hear me. Yeah, yeah. Dr. Raman, Namaskar, can you please say a few words and share your experience on this day? Thank you for inviting me. Thank you, Dr. Jainab and all Spiceroot leaders. I'm really happy to be here, especially on this day of World Family Doctors Day. So we just heard Dr. Abia speaking so nicely comprehensively about the concept. So I need not repeat that and we all stand for this concept, not just because, you know, this is what we do, but because this is also largely required for our communities, families, and the population that we serve. And I'm very happy to see you all as upcoming leaders. You already are leaders of your own identity. So my best wishes to all of you. And may you all progress and gain all in your career and personal lives. You all are very young and long way to go ahead ahead in life. I wish best and all success for all of you. So I won't take time. I understand that there is a, you know, a lineup of all other speakers and very good to see around 40 participants from our region, in spite of all the political problems we connect, we stay together. And that is a very, very healthy and good academic environment. So congratulations to all of you and my best wishes to all of you. Thank you. Thank you Dr. Raman for saying nice words for all of the young doctors of this region. So now I'm moving to the next talk as there are no questions till yet. So we can answer the questions if there are any at the end also. So now the next speaker of today's webinar is Dr. Jyothika Gupta. She is from India, and she is DNP in family medicine and MRCGP international. She is a practicing family physician in Bangalore, India and an executive member of the AFBI Karnataka chapter. She is also serving as a national secretary of the spice movement of India, and she has a special interest in the management of chronic diseases, preventive medicine and infectious diseases. So today, she would be giving a stop on the family medicine and universal health coverage. So over to you, Dr. Jyothika. Hi. Good evening, everyone. Happy World Family Doctors Day to everybody here. Is my screen visible? Yes. Okay. Good evening to one and all, all my colleagues from South Asia who have joined us, respect to Dr. Raman and all senior colleagues who have joined me here. So on the occasion of World Family Doctors Day, let's see what is universal health coverage. So actually, this is quite a new topic that I've really never spoken about. Usually I speak on clinical topics. So this was a good learning as well. And what better occasion than the World Family Doctors Day. So universal health coverage. We will be touching about these points. What is universal health coverage? How did it all start? Why is it essential? And what is our role in achieving universal health coverage? So I thought I'll bring in a little bit of clinical part in this. Let's see a few scenarios where, which we come across on a regular basis in our practice. So the patient says, doctor, I've missed my diabetic and heart medicines because I have to buy my stock after I get my pension. I'm sure all of us have seen this in our practice. Another example, the parent says I will get my child's appendix surgery next month as I cannot afford it now. We have seen, heard and probably experienced a pregnant lady could not reach the hospital on time and hence lost her life by delivering en route. A victim of snakebite in a rural area could not get access to anti snake venom and hence lost his life. So why am I bringing out these examples is this is what is lack of universal health coverage. What is universal health coverage? It means all people have access to health services that they need, where they need it and when they need it without any financial hardship. So the core word here is financial hardship. And I think in South Asia, we see it day in and day out, whether we are in a rural setup or an urban setup or a semi urban setup. It is a common challenge for us. Universal health coverage includes the full range of essential health services, whether it's from health promotion or prevention, treatment, rehabilitation and palliative care. All these points have been highlighted by Dr. Rabia as well, that as a family physician, this is what we can provide to all our patients. Statistically speaking, about 100 million people all over the world are pushed into extreme poverty each year because of out of pocket spending on health. And this is where we are failing on providing this health coverage to the population of the world. So it's easy to speak philosophically, but in reality, what is it that we really need if we have to achieve universal health coverage? So there are three main pillars that are required. One is we need skilled healthcare workers. We need individuals and communities who are able to achieve and access quality healthcare services. And finally, our policymakers who are committed to investing in universal health coverage. Also, as Dr. Rabia had said that we need more investment in terms of GDP from the country, from any countries on Asian side to invest into healthcare. And skilled healthcare workers who can provide quality care, people-centric care, and it should also be affordable. So till these three verticals do not work hand in hand, realistically achieving universal health coverage is going to be a challenge for all of us. But when we do it at our individual level, when we fulfill the needs for the society in the form of providing care in the community, we will be doing our part. The individuals and communities also should have access to high quality healthcare services, whether it's in their community, whether it's in their town, in their district, or in their country. And that's where our role comes in. It should be based on strong people-centered primary healthcare. Because primary healthcare, as we all know, we are all in that, we are rooted in the communities. And we not only focus on treating the illness, but on health awareness, prevention of diseases, mainly primordial prevention of diseases. And after a person has been diagnosed of some illness, we also help in providing rehabilitation services, whether it's palliative care. Basically, we intend to improve the quality of life through our healthcare. And that is what is the key role of universal health coverage. A few facts. Over 930 million people all over the world spend at least 10% of their household income on healthcare. 100 million people are driven into poverty each year because of out-of-pocket health spending. About 75% of the national health policy strategies and plans are now aimed at moving towards universal health coverage, but we really have a long way to go. And ironically, after all of this, half of the world's population does not have access to the healthcare that they need and the healthcare that they deserve. So, where did all this start from? So way back in 2012, so we're talking about 10 years back on 12th of December, a resolution on global health and foreign policy was recommended to include universal health coverage in the discussions. When the UN met for formulating policies along with the World Health Organization, it was recommended to include it. But till 2015, there was no fixed agenda and no fixed protocols that were actually released. Although the nations which participated, they recognized the importance of this coverage, which should be included in every nation's policies in their national programs. But they also realized that all this can be achieved through primary healthcare and social protection mechanisms. Especially if we are targeting the poor segments of the population because financial constraint is the most common reason for lack of achieving this universal health coverage. And to mark this, 12th of December every year is celebrated as International Universal Health Coverage Day. It was said to increase global awareness, international solidarity, international cooperation and action towards the achievement of universal health coverage by promoting national, regional and global collaborative frameworks and forums. So if you can see this little logo, it actually symbolizes the umbrella of healthcare that can be provided by family physicians and by primary care physicians to promote and to achieve universal health coverage. Everything under one umbrella. So in 2012, when things were recommended up till September 2015, nothing really moved forward. But in 2015, the resolution on transforming our world that is the 2030 agenda was actually released. And like we all know the sustainable development goals were announced. And in that the third sustainable goal actually was dedicated for healthcare. And this also included financial risk protection, access to the quality essential healthcare services, and it should be easily available, especially the preventive care like vaccines. Last year in 2021, the logo, rather the mission was leave no one's health behind invest in health systems for all. So to promote physical mental social well being and to extend life expectancy, not just in the number of years but in the quality of life that we all look forward to we must achieve universal health coverage and access to quality healthcare. Hence, we must leave no one behind money or the social or the economic background or cultural reasons should not be a reason for anyone to be to have in no access to healthcare. So the international universal health coverage day it aims to raise an awareness for the need for strong and resilient health systems. This can be done with multi stakeholder partners. So whether it's the primary care physician, whether it's the patient, people in the community, NGOs, the policy makers, the governments of various countries, and with the support of you and and so when all these come together is when we can achieve this. And this means making more smarter investments in the foundations of health system as well. And that's where we need to emphasize on primary healthcare essential services for the and marginalized populations also. And I think COVID pandemic has shown us more than enough about the need for primary care because we all were, we stepped forward and stood in the frontline when the pandemic hit us unexpectedly. And we don't many roles, whether we provided home care services, whether we took on roles of interns, internists in the ICUs, whether we provided rehab care. We also educated and trained every patient we trained our nursing staff, our paramedical staff, we don't different hats, and we prove that a family physician is what is who can take this forward. So, in continuation with that, there is the global movement called the UHC 2030, which is aimed at building stronger health systems in a way to achieve this universal health coverage. So it is like a global movement where in different stakeholders they gather, they discuss about different policies and contribute to advocacy tools guidance knowledge and learning as to how things can be changed, and challenges can be overcome to achieve universal health coverage. And it needs the support of more and more countries on a larger level and at the community level, everybody needs to be a part of this so that nobody is left behind. Like I said, whether it's the government, international organizations, global health initiatives, the philanthropic foundations, the civil society and the private sector, everybody needs to work in tandem, only then this goal can be achieved. And through this global platform that is the UHC 2030, the aim is to achieve these goals by the year 2030, and every year this is also celebrated like I said in December. So, to summarize on the UHC 2030, the idea is to not leave anyone behind, to be transparent and accountable for any result or any policy that is made, use evidence based national health strategies and leadership, and to make health systems everybody's business and whether it is the citizens, the communities, the civil society, the private sector, the policy holders at every level. And there is international cooperation on this. I think nothing is going to stop us. So, very interestingly this is PHC for UHC, so primary healthcare for universal health coverage. So, this symbol is the symbol for the third sustainable development goal which was just announced by the United Nations. And this goal is called for good health and well being. They have totally 17 goals, the SDGs, and they focus on various things like safe water, education, equitable responsibilities, and climate change, and education, and adding poverty. So in that, in line with this integrated vision of the SDGs, the targets under this third goal, it relates directly to health and well being. While being influenced by and influencing the other development goals. So, what they're trying to say is everything goes hand in hand. If we want to achieve one of those development goals, everything has to work in tandem and everything has to be integrated. And this can be done in a no better way than by improving and achieving through primary healthcare. So, they had another slogan, all people everywhere deserve the right care, right in their community. So, this is what primary healthcare actually wants to achieve and in a way, we all are doing it at our own personal level or at the community level. Every patient who comes to us irrespective of the age and irrespective of the complaint or whatever issue they have, everybody deserves a care from us and right there in the community. They shouldn't be denied any type of services for any reason. So even primary healthcare was not clearly defined in the initial time, but in the declaration of Alma Ata in 1978, which was where the declaration was made. And 40 years later, the global leaders actually ratified on this. And at the conference in Kazakhstan in October 2018, this was formally announced and protocols were set in place to work towards achieving primary healthcare. So, this is a very interesting diagram, which shows us the real integration between primary healthcare between the sustainable goals set by the UN and how these can work together to achieve universal health coverage. And once universal health coverage is achieved, which actually falls under the third sustainable goal, can primary healthcare also be strengthened. So these are the 17 goals which have been defined by the UN in that the third one, like I said, which is for the good health and well-being. Primary care with its three strong pillars and which we all have been working towards when that is strengthened, it will help in access quality and financial protection of every individual and we will be closer in achieving universal health coverage. The advantage of primary care or family medicine is that we can solve any type of medical issue, whether it's related to maternal and children health, whether it's sexual and reproductive health services, prevention, prevention of chronic diseases, prevention of diabetes, educating the people about diabetes and hypertension so that other complications can be prevented, treatment of substances you abuse, preventing and treating on non-communicable diseases, treating all the communicable diseases of course like any viral infections, COVID being our closest example, malaria, tuberculosis, HIV, bacterial infections like typhoid. So it is a one-stop shop which also helps in achieving financial, I mean, it helps in eliminating financial constraints. So everybody of the family can see the family doctor and get access to healthcare, like I was saying, it addresses the majority of a person's health needs throughout their lifetime. So we not only have access to, I mean, we are not only good in having a depth of a particular subject, but also the breadth of a subject. This includes whether physical, mental, social well-being and family physicians have this knack and the special ability I would say that we work towards people-centered treatment than disease-centered treatment. So we will treat the person as a whole, probably we will also be taking into consideration their family, their economic background, their cultural restrictions, everything will be thought about when a family physician does the consultation. And like even Dr. Rabia said, that before we end our consultation, we always make it a point to educate or empower our patient in whatever little way we are able to do. So this whole society approach is what is our USP and hence strengthening the family medicine network, the primary healthcare is going to go a long way in achieving universal health coverage as well. So the three main components which we work on, one is meeting people's health needs throughout their lives, of course. So the slogan which has been used this year, always, always there to care. So we are always present throughout their lives, addressing the broader determinants of health through multi-sectoral policy and action, and then empowering the individuals, the families, the communities wherein we educate them to take charge of their own health. Once we empower one person or we educate one person, the entire family can be taken care of. So what are the components of primary healthcare? Two main things that is we provide personalized service and it's also population-based service. So under the personal services, we are always the first point of contact. Since we are available in the community, we are in the neighborhood, the person can reach out to us at the start of any illness. And once a patient has reached out to us, we always provide care in a comprehensive manner. We do not treat the disease alone, we treat the person. Always there to care, we provide continued services, continued support, whether it's mental and social well-being as well. Coordination, this is another very important aspect that we specialize in. We always coordinate with other specialists, with the patient, with the family and our own network. And our services are always person-centered that we have always tried to achieve. And when we are trying to achieve this personalized care, we always look at the population-based services as well. So we always focus on health protection and health promotion. We think about disease prevention and not just about treatment. So ours is more of a proactive care than a reactive care. At the same time, we are also involved in surveillance and responses. So whether it is communicable diseases, disaster management, non-communicable diseases, everything goes under the scrutiny of a family physician. There is nothing that a family physician cannot do. And like I said, even disaster and emergency preparedness is also our quality. So I wanted to summarize by saying that primary healthcare is the best and the easiest form of achieving universal health coverage. Dr. Veena, I just wanted to share one small video which also will summarize my entire talk. Just give me a minute. Is this visible? Yes. So I just want to end my talk with this and leave everybody with these thoughts. Can you get treatment that helps you get better and is safe? Can you get the medicines and other health products you need? Pay for it. Are there policies in place to ensure the services you need are available to you, your family and your community next time and every time? Does your government have accurate information about the whole system so they can make the right decisions to keep everything working the way it should? Health means people, policies, products, finances, policies and information. And it means all of them to work together even in times of crisis. Health systems don't just treat sick people. They help to promote healthy living and prevent people from falling ill in the first place. The World Health Organization is working around the world so that all people and communities receive the quality services they need and are protected from health threats without suffering from financial hardship. That's what we call universal health coverage. Thank you everyone. So thank you Dr. Chotika for giving us a brief introduction on the universal health coverage. Now, without wasting time, I would like to ask our next speaker, who is Dr. Kinnele Bhutty from Bhutan. Dr. Kinnele Bhutty is a practicing GP at the Paro General Hospital in Bhutan and aspired representative at the spice root movement. She is also the national chair of the spice root movement Bhutan. Dr. Bhutty has done her MBBS from the Chittagong Medical College Bangladesh and MD in the general practice. MD in the general practice from the Kesar Jibalo University of Medical Sciences of Bhutan. Dr. Bhutty also presented her research work on the 10 years CVD risk assessment and patients attending to the National Raffle Hospital of Bhutan at the Vankar Oral Conference in Abu Dhabi. So today, Dr. Bhutty will be presenting a talk on the family medicine past, present and the future. So over to you, Dr. Bhutty. Good evening to everyone. Is my slide visible? Hello. Yes, we can see the slide. Thank you for giving this opportunity. I am Kinnele Bhutty from Bhutan. My topic to speak for tonight is family medicine, the past, present and the future. So it's a very short presentation. The outline of the presentation is basically to talk about past, the present, the challenges we face in the present time and the future. So in the past, there were no GPs at all in Bhutan. All the general services were provided by the MBBS graduates, who were very fresh, but they lacked experience. So there was no adequate care in the rural areas and all the rushing to urban highest centers, overwhelming the health centers in the urban areas. And also many of the population of the rural and unreachable people were not getting access to the health. And in the past, the GPs were not recognized. So they were less interested candidates. So if we talk about the present, present, there's a Bhutan recognized GP just recently about four years ago. So it first started in 2017 and I was the first and the only candidate who took up the GP program. So there needs to be lots of advocates to inspire more doctors to take up GP. And to do that, there is terms of references laid out very clearly for the future. And also for all the responsibilities that GPs will do when they head the district hospitals. And the fellowship opportunities attack the young doctors to take up the GP program. So when there's a clear career ladder, it makes the young MBBS graduates to take up this GP. So there needs to be more policies to make the GPs more attractive, because as we have already heard two speakers ahead of me who spoke about the universal health care and the wholesome primary health care. We are the whole, we are the ones who give the whole care to the patients and which we formed the base of the pyramid management management of the patients. So in Bhutan we have total of roughly 342 doctors and MBBS graduates working in district hospitals, which are activated and I work in one of the district hospitals in Bhutan. In the rural areas, mostly the basic health units, it is meant by the health assistants, they are about 500 plus health assistants in Bhutan. And we have only four trained GPs, including myself, my seniors are being trained in India and Nepal and I'm the first one to be trained in Bhutan. And we have three undergoing GP trainings at present in Bhutan. So if we, I tried to look at data in the South Asian region but I could not find but there is one data found in the NHS where we can see the number of GPs. There are a number of GPs being in England. So we can see that they're about almost 20,000 plus GPs which are partnered with other specialized doctors. There are a few number of other doctors which functions as locoms to GPs to provide the general service. So if we look at the work commitment of qualified or permanent GPs per week, this is also the data taken out from NHS England. So we can see that very less number of GPs they have, their working hours is less than 15. Mostly the most of the GPs, their working hours is from 15 hours to 37 hours in a week. So including myself, my usual normal working hours is usually it's most of the 36 hours but for my on call week it will be almost 100 plus. If there is one study conducted in Indonesia, GP was very newly being stipulated in the Medical Foundation Act as number 20. It was stipulated only in 2013 and they changed the terminology from the primary health physician, which is equivalent to specialist. So when they made it as equivalent to other specialists, there were more doctors who took up the GP, so which helped these doctors to gain more insight and skills to provide primary health care to the populations. So if we look at this diagram, so there are various forces which needs to activate the general pool of doctor, so we can see that there's massive information promotion of general practice needed, and then support systems are needed in terms of scholarships and facilities and which is incentives in terms of money, and then there's also support needed from the government and higher education sector. So even with all these three forces available for a pool of doctors, most of the doctors are unfavorable with the GP practice and some are not sure whether to take this GP or not, and very few they take up the GP career. So how do we retain this GP like GP and family medicine the same so I'm using because the general practice is a term used in my country, so I will be using this term more frequently. So how can we retain these general practitioners of the GP in the rural areas this is such there was a study done in rural Nepal, so they found that they are various. There were many, many factors that that that were hammering or that were leading to the leading to leading to the immigration of doctors from rural areas to urban areas. One was the first one was the financial incentives. The financial needs. So when they were paid a little bit of incentives they were willing to stay in rural areas. Another one is clinical autonomy. They were, when they were given a clinical autonomy to practice in rural areas and given some form of auto autonomies they were staying there and the community support them, because we are the ones giving the public primary health services. So community health support was the must and then also another one was transfer arrangements, and then even the nursing workforce when we have a strong nursing workforce to help general practitioner so the more general practitioners before the strong and skilled nursing to work nurses to be helping them and the perception of quality and allied to workforce and GP workforce stability so these are the few factors that can help retain the GPS in rural areas. Okay, so. And some of the issues that cost the GPS to migrate from rural to urban where the management issues, even the workload alone GP, like myself was made to men at the stick hospital. So some of the management issues the work workload and even even the spouse satisfaction and child education because education is more like more advanced and more better in urban areas so we tend to move from rural areas to urban area, and even to access to basic utensils and shopping and other services. So challenges we face as a GP is the search in department demand for appointments. So we don't have capacity to meet the demand demands due to lack of workforce and poor infrastructure. And then this over the past few years because of the pandemic, the workload increased in size and complexity about 10% more. And so how can we fix this challenges if if a greater investment is done in the primary health management and this can relieve lots of problems, since general practice can provide complex person centered care and and we can prevent most of the worsening conditions. So in the future, in the future for GP in Bhutan, we are to extend to all the states to be meant by GPS and then to community to the basic health unit, enhance all primary health care services and improve and CDs and all other health promotional services. And we can also follow up on all the tissue health care and strengthen over all health care services like all primary health care universal health care and everything. But then the issue is where is the pool of doctor. So, where is the future now. So that still lies a question. So that's it. Good night. Thank you. For such a nice talk. So as I can't see any questions till now so if anyone has any question from the audience from any of our speakers just raise your hand on us directly. I don't think so there are any questions. Okay, so there are no questions from any of the speakers. That's very good. So, thank you all speakers for taking out time and giving us your valuable feedback and talk on important topics on family medicine and general practice. So, I would like to say all of you are very happy World Family Doctors Day. And now I would like to invite Dr. Zainab Muhammad, who is the National Chair of the Pfizer movement of Pakistan and also the regional chair of the Vanka South Asia Young Doctors movement. So I would like to ask Dr. Zainab to say a few words and concluding remarks for this today's webinar. Over to you, Dr. Zainab. Thank you, Vina. Thank you. So this is happy World Family Doctors Day to all the young doctors who have joined us today. I think Dr. Feroz Khan has raised his hand so I would like to give him an opportunity to speak. Hi. Sorry. I'm sorry to bother you. I'm Dr. Feroz working as a physician here in Dubai actually. I've been practicing here for the past seven years as a specialist family medicine. I mean, I'm just having suggestions actually like see I have been going through this actually I have made many of the various departments in family medicine in the USA, UK and different areas where actually we could still increase the scope of family medicine practice like post family medicine specializations actually like mean like see they have been actually huge increase in requirement of doctors in intensive care in emergency in post COVID actually means even during the COVID actually I have been working in the ICU because I have also done my fellowship in critical care. I mean, there isn't any official program actually like post, there is a kind of post family medicine specializations actually like which you will be officially recognized by the governments of particular any of the countries it could be India or any other countries where we are actually so where the scope of family medicine can be extended not just limited to the family medicine practice actually we could also have such kind of officially listed programs so that you not limit ourselves only to the family medicine practice. I mean, I do have my own spirometric clinic and sleep medicine as well but we need an officially recognized program, so where we could also have a recognized degree. I mean, this is an humble solution actually where we all can work together so that you could see more people get more involved into the family medicine because I feel it's a broad specialty degree. It's compared not that because I heard in family medicine but if you see an internal medicine or an anesthesia or a penalty doing a critical care program, compared to family medicine actually who has done critical care program, the scope of knowledge and the scope of practice will be huge impact actually I mean this is my humble suggestion that's it. Thank you Dr. Faroze I think that's a wonderful suggestion I had this suggestion of yours in the chat box also. I guess I think family physicians can do I think most of the even people who specialize they also cannot do because we have been trained to be connected with the people and empower people when it comes to their management plan. So what we can do is, I think, whatever we can do at our level is almost and always I believe and maybe I'm biased because I'm a family physician myself, but I strongly feel that this specialty if it's if the if a GP is well trained. They can do things in a much better way than any other specialized person would do any other cardiologist maybe would do would go to an ICU fellowship. And a family physician would go so I think I believe that a family physician would do a much better job at it. I love that be counseling the family counseling the patient and everything. If anybody wants to add on to the answer so we will be most welcome, we will welcome anybody who wants to comment on the question and the suggestion but I strongly feel that this is a wonderful suggestion and more specialization would not limit family medicine in I feel limit the family physician it will empower family physician to do more for the patient. So thank you for the wonderful suggestion I think if we all work together so this could also be achieved in hopefully near future. And so, as I can see I can't see many questions, neither I can see any raised hands. So, and also we have crossed a little bit of your offer a little beyond a little time that we had selected for our for the webinar that we were doing. So thank you all the young doctors of the region India Pakistan Nepal Bhutan Sir Lanka Bangladesh, who have joined us today I think it was wonderful meeting you all in a very happy world family doctor, world family doctorate to all of you. Thank you all the country leads for always supporting and for always actively contributing and participating in all this by suit activities. Roshan and serene specially for the active contribution be enough for the moderation, Jyothika and can live for the, for the presentations that they did. And Dr. I think probably is not I can't see Dr. but thank you Dr. also for the wonderful talk that you did I think all of the speakers and all the participants. It was great interacting with all of you today. So we'll conclude the session now. Thank you so much.