The Besrour Centre for Global Family Medicine at the College of Family Physicians of Canada 2021: A Year in Review
Why Global Health
A Message from Dr. Francine LemireNever has a time for global cooperation been so critical. COVID-19 has shown the importance of knowledge sharing across borders and the benefits of family physicians worldwide collaborating and learning from each other to find solutions to global problems.
Until herd immunity is reached globally, COVID-19 variants will continue to emerge. This hit close to home for those at the Besrour Centre. Early last year, Dr. Patrick Chege, considered a founding father in family medicine in Kenya, died from COVID-19 while waiting for his first dose of the vaccine. Today, 80 per cent of people living in Canada have been vaccinated, many with third doses, while only 10 per cent of people in low-income countries have received even one dose.
Read our 2021 report to learn how the Besrour Centre is connecting with family physicians globally and creating a world where everyone can access quality primary care. Family physicians in Canada have knowledge and experience to share and we are proud to help improve health care around the world. We also learn from our colleagues in other countries, which is a significant benefit of our work at the Besrour Centre.
We hope you enjoy reading the highlights of our work in this year’s report.
Francine Lemire, MD CM, CCFP, FCFP, CAE, ICD.D
Executive Director and Chief Executive Officer
The College of Family Physicians of Canada
Reflections on the Pandemic
A Message from Dr. David PonkaThe idea of the Besrour Centre for Global Family Medicine was born out of the tragedies of the Banda Aceh tsunami in Indonesia and the humanitarian crisis in Darfur Sudan, and then the Haitian earthquake of 2010.
Since the official opening of the Besrour Centre in 2015, we have matured both as a discipline and as a Centre. Today we not only advocate for family medicine and its role in improving patient care, but also for the models of care throughout the health system that are based on family medicine principles. Over the last six years our focus has shifted from building family medicine capacity in low-middle income countries to studying and promoting family-medicine led models around the world.
The global COVID-19 pandemic has reinforced the importance of our work. It continues to highlight that global problems require global solutions—it is not just an urgent moral issue. It is a global public health issue. The pandemic also highlighted gaps in and between health systems around the world. Capacity has been stretched everywhere, revealing areas where access remains problematic, and where integration at the system level is still lacking. At the same time, it revealed incredible innovation and perseverance.
As the pandemic continues to vacillate between infectious and chronic impacts, improved integration and the adaptability of family medicine will be key in all health system contexts, including Canada. All of Besrour Centre’s initiatives are exploring or demonstrating how family doctors are leading at this time.
Our collective journey highlights that capacity building takes time, and determination. To continue this work, we need your ongoing engagement, partnership and help. We are deeply appreciative of the funding provided by the Foundation for Advancing Family Medicine and all our partners that helps to fuel our work.
Together, we are a vibrant network of community-based leaders and partners that continue to learn from one another. Our collective efforts are strengthening family-medicine led models that are at the heart of health systems around the world and in turn improves equitable access to care.
Dr. David Ponka
The Besrour Centre for Global Family Medicine
A Spotlight on ImpactThe Besrour Centre for Global Family Medicine (Besrour Centre) at the College of Family Physicians of Canada™ (CFPC) is a hub of international collaboration dedicated to our shared mission of advancing family medicine and promoting health equity. Driven by family physicians with a passion for global health, we are a connector for knowledge sharing and best practice around the world.
We are guided by our strategic plan (2018 to 2022) that places a strong focus on education, research, and community engagement to strengthen family medicine and primary care models worldwide.
At the outset of the pandemic, the Besrour Centre pivoted to better support the diversity of roles in family medicine to respond to the global COVID-19 pandemic. In 2021, we continued this strategic support with a particular focus on the importance of the integration of family medicine with public health and other specialities, and with community members and groups.
Global Co-RIGThe Global COVID-19 Pandemic Response and Impact Grant Program (Global Co-RIG) seeks to reduce morbidity and mortality associated with COVID-19 through supporting innovation in primary care and family medicine in vulnerable communities.
In 2021, two inaugural recipients of Global Co-RIG grants launched innovative programs that are already making an impact. Both projects tackle challenges of chronic disease management that were made more acute by the pandemic.
Both programs leverage the power of community health care approaches and trusted relationships to bring education and care to patients in their homes, while strengthening the integration of primary care with community programs.
Global Co-RIG Phase 1 grants of $50,000 per project were made possible through the generous support of the FAFM and the Fondation Docteur Sadok Besrour, and the hard work of staff and volunteers of both the FAFM and the Besrour Centre.
About the Projects:
Family Health Cadre Empowerment Program: An innovation for chronic disease management during the COVID-19 pandemic in low-and middle-income countries.
Project lead: Dr. Ichsan Ichsan, Aceh, Sumatra, Indonesia
Essential health services were significantly disrupted by the pandemic around the world. People living with chronic diseases have a greater risk of serious disease and death from COVID-19 in addition to the increased risks associated to their chronic diseases and the new challenges of accessing care.
Early in the pandemic, Dr. Ichsan introduced a Family Health Cadre Empowerment Program to support patients with chronic illness in the province of Aceh, in northwest Sumatra, Indonesia.
Using a community medical home approach, Dr. Ichsan and a team of 18 family physicians recruited and trained cadre coordinators to work with individual patients on health promotion, prevention, and disease management of tuberculosis, hypertension, and diabetes.
Involving family caregivers as critical members of the health care team helps to establish trust and enhances knowledge translation between physician, patient, and family member. The program should be fully implemented throughout the region by 2023.
“Family members and community leaders have well-established trust with patients. By teaching and empowering these individuals to be partners in patient care, we can better support chronic disease management and shift people’s relationship with health, wellness and family medicine.” Dr. Ichsan Ichsan, Family Physician, Prince Nayef Hospital and Public Health Centre, USK – Banda Aceh and Professor, Universitas Syiah Kuala
Innovations to reduce morbidity and mortality amongst people with diabetes in vulnerable communities in Cape Town, South Africa
Project Lead: Klaus von Pressentin, Cape Town, South Africa
With Global Co-RIG funding, Dr. Klaus von Pressentin and colleagues conducted an evaluation of a primary care community program that supports vulnerable patients in the Cape Town area.
The program uses a network of 2,500 community health workers to support households impacted by chronic diseases in at-risk communities. Community health workers deliver pre-packaged medication, provide disease and pandemic-related education, and actively screen households for COVID-19. Health workers also connect patients with counselling and support as required.
The program is expected to reduce the morbidity and mortality of people with diabetes who live in neighbourhoods with low socio-economic status. Evaluation will ensure community supports reach those in most need and provide lessons to support the scale and spread of similar initiatives in South Africa and other countries.
“With seed funding from the Besrour Centre, our team has been given the grace to pause and reflect on the impact of the pandemic on vulnerable populations and to take a learning approach to think better and work together toward improved primary health care for individuals in need.” Dr. Klaus von Pressentin, Associate Professor, University of Cape Town
FM Vax: An International Survey of COVID-19 Vaccination CampaignsBy late 2021, less than five per cent of the eligible population in lower income countries had received even one dose of a COVID-19 vaccine. Optimizing vaccination rates is key to preventing future waves of COVID-19 around the world.
Experts understand that global vaccination is not just a moral issue, but a public health one that requires a worldwide community approach to ensure variants do not continue to multiply and circulate. What is less clear is the precise role of primary care and family medicine in partnering with public health to deliver these vaccines.
The International Primary Health Care Research Consortium is seeking answers to this question and supporting the research study FM Vax: An international survey on the integration of public health and primary care in COVID-19 vaccination campaigns.
Launched in 2021, the study is sponsored by the Consortium and led by the Besrour Centre. The study is surveying primary care providers around the world with a focus on low- and middle-income countries, with the aim to understand the primary health care approach used by different countries in implementing their vaccination programs for COVID-19.
The lessons learned from this study will inform understanding of the nature of cooperation between public health and primary care/family medicine in the implementation of COVID-19 vaccination campaigns and other programs. This collaboration is key in reaching priority populations, tracking vaccination status at the individual and population levels, and ensuring a coordinated response.
“If effective public health and primary care cannot be delivered in one region, the reverberations are felt worldwide. If vaccine equity is not achieved, we will continue to see virus variants emerge. As the WHO said – no one is safe until everyone is safe.” Honourable Jane Philpott, Dean, Faculty of Health Sciences and Director of the School of Medicine, Queen’s University
Family Medicine Pivot Educational Module SeriesThe goal of the Family Medicine (FM) Pivot Educational Module Series is to improve the resilience of our global and local health systems through capacity building of family physicians in responding and adapting to future global health emergencies.
Building on the experience and knowledge of the global family medicine community throughout the COVID-19 pandemic, five teams developed a series of free FM Pivot courses. Each team includes a Canadian and at least one international family physician or primary care provider.
Topics address specific global health emergency-related competencies across five themes: chronic disease, community- based research, disaster preparedness, mental health, and virtual education.
Content is thematically based, with a focus on low- and middle-income countries to provide opportunities for participants to develop and apply within their own contexts.
The first course launched in 2021 and focused on identifying great research questions in pandemics and other crises. The second course is expected to launch by spring 2022 and will focus on chronic disease management during the pandemic. To register: fmpivot.ca.“How we collaborate, especially in times of crisis and emergency, is not about beating our own drum, but rather about building on the communal strengths of our colleagues to integrate into the wider health system.” Dr Ghazanfar Khan, Lead, COVID-19: Health Services Learning Hub, World Health Organization (TBC)
Medical Education Research FellowshipThe Besrour Centre, through the generosity of Scotiabank and MD Financial and administration by the FAFM, is offering a learning opportunity to its global network in the form of a fellowship program that will advance primary care around the world. The fellowship funding is part of a five-year partnership between the CFPC, FAFM, Scotiabank, and MD Financial and is in collaboration with the Canadian Medical Association.
The first Fellowship in Medical Education Research was awarded to Dr. Trinidad Rodriguez, a family physician from Santiago, Chile, who works in the Department of Family Medicine at the Pontificia Universidad Católica de Chile.
The project is a capacity building initiative that engages multidisciplinary health teams in improving and enhancing care for infants, children, and adolescents, and their families. The aim is to create a health care strategy for children that emphasizes family and community health and focuses on attachment theory and nurturing relationships with caregivers.
With the support of Dr. Clayton Dyck and Dr. Sumeet Sodhi, the Besrour Centre’s Medical Education and Research leads, Dr. Rodriguez accomplished the following:
- Redesigned the training program from an in-person to an online format due to the COVID-19 pandemic
- Developed a Logic Model Framework for the training program to permit effective monitoring and evaluation
- Presented a poster at Family Medicine Forum (FMF) 2021, focusing on lessons learned from developing an educational intervention for primary care during the COVID-19 pandemic, and shared her experience on research implementation.
The Besrour Centre is proud to have Dr. Rodriguez as our inaugural Fellow and to support colleagues working to demonstrate the importance of comprehensive and integrated care models to improve access to primary care.
The Besrour Centre on the Global Stage
- • Today, our global family medicine community links 7 regions and is strengthened by members from 43 countries.
- • The Centre hosts many working groups and teams comprised of health system and community leaders from Canada and member countries, and partners with international health organizations including the World Organization of Family Doctors (WONCA) and the World Health Organization (WHO).
Global Health at the Family Medicine Forum 2021The annual Family Medicine Forum(FMF) is a highlight for both Canadian and international colleagues as they gather to learn about each other’s ideas and perspectives and broaden their network.
The tagline for FMF 2021—Let’s prepare for the future together—reflected the Besrour Centre’s push to identify how the global community can better advance family medicine and equip itself for the challenges ahead.
Global health and the work of the Besrour Centre were highlighted during several FMF 2021 sessions:
- The Four Principles in the Time of COVID-19: The Besrour Centre’s Director Dr. David Ponka, together with Dr. Victor Ng, CFPC’s Associate Director, Programs and Practice Support, explored the impact of family medicine’s rapid and ongoing response to the pandemic and what defined practice means in a public health emergency.
- Implementation Research for Family Medicine: Taking an idea to action: Two thought leaders from the Besrour Centre—Research Lead Dr. Sumeet Sodhi and Medical Education Research Fellow Dr. Trinidad Rodriguez—shared implementation research basics and practical applications in family medicine to help bridge the research-to-practice gap.
- An Introduction to Advocacy: Dr. Samantha Green talked about the role of advocacy in family medicine and the important role of health care providers, and shared a six-step toolkit for launching evidence-based advocacy campaigns at the community and system level.
- Global Perspectives on Family Medicine Education: Dr. Victor Ng and Dr. Marcelo Garcia Dieguez facilitated an informal hour-long chat during the FMF Teachers and Preceptors Knowledge Café that explored themes relating to family medicine principles during the pandemic
2021 Dr. Patrick Chege Memorial Research Award Poster PresentationDr. Patrick Chege, a leader in Kenyan family medicine, who passed away from COVID-19 in the early days of the pandemic, was a beloved Besrour Centre colleague. In honour of Dr. Chege, the Besrour annual poster competition is now named the
Initiated in 2017, the annual poster session celebrates global collaboration with an intent to inspire vibrant dialogue among FMF participants. There were a record number of submissions for this year’s contest, each a prime example of the integrative learning that defines our discipline.
The winners of the 2021 Dr. Patrick Chege Memorial Research Award Poster Presentation:
- Learning Conditions in General and Family Medicine Residents During the COVID-19 Pandemic in Argentina presented by Dr. Marcelo Garcia Dieguez, Universidad Nacional del Sur, Bahia Blanca, Argentina
- Mental Health Stigma and Telemedicine presented by Dr. Nazmi Hussein Alsawalhi, Al Dhafra Family Medicine Center, Abu Dhabi, United Arab Emirates
The 23rd WONCA World Conference of Family DoctorsWONCA is a global not-for-profit professional organization representing family physicians and general practitioners from all regions of the world. In 2021, WONCA virtually hosted the 23rd World Conference of Family Doctors.
A highlight of the conference was the presentation of the first WONCA/Besrour Early Primary Care Researcher Prize, a program developed by the WONCA Working Party on Research and the Besrour Centre to encourage primary care researchers in low- and middle-income countries.
The winners were:
- Dr. Beesan Maraqa from Palestine for Prevalence of SARS-CoV-2 antibodies among Palestinian population: A primary health centers-based, cross-sectional study.
- Dr. I Md Ady Wirawan from Indonesia for Feasibility of using telehealth in primary care for risk stratification and health education among high-risk groups during COVID-19 pandemic.
Strategies for Engaging Communities in Primary Health Care Globally: Besrour Centre Community Engagement lead Dr. Alan Pavilanis guided a workshop focused on the role of community engagement in family medicine and solicited feedback on how to improve it from a global perspective. Global Health & Primary Care Policy: Family doctors in primary health care teams for universal health coverage: Dr. Shabir Moosa, Dr. Viviana Martinez-Bianchi, and Dr. David Ponka shared their experiences on developing family physician leadership and invited workshop participants to think about global family medicine at the policy level and the implications it has on achieving universal health coverage. Maximizing Co-learning between Global FM Partners: Exploring innovative approaches: A dynamic workshop facilitated by the Besrour Centre’s Medical Education lead Dr. Clayton Dyck as well as Dr. Innocent Besigye, Dr. Russel Dawe, and Dr. Katherine Rouleau, who explored the benefits of global co-learning to develop innovation and to research ideas that optimize the co-learning process.
Emirates Family Medicine Society 2021 CongressThe virtual Emirates Family Medicine Society (EFMS) 2021 Congress hosted physicians and health care professionals from around the world to expand their knowledge and develop long-term collaborative partnerships in family medicine. As a scientific partner at the Congress, the Besrour Centre contributed to four talks that focused largely on health system integration.
Global Health Networks and Collaborative Learning During the COVID-19 Pandemic: Dr. David Ponka underlined the need for sustained partnerships and multilateral efforts in combating global health crises now and in the future. During this and other sessions, Dr. Ponka also emphasized the need for urgent reflection on how family physicians view their discipline in relation to patients, public health, and the wider health system. Adolescent Medicine and the Importance of Continuity of Care: Reflecting on the importance of continuity of care for this age group, Dr. Alan Pavilanis also described the characteristics of the adolescent patient and strategies to approach caring for adolescent patients. Defining Family Medicine – the Canadian Journey: The focus of Dr. Nancy Fowler’s presentation was to share the CFPC’s approach to defining family medicine in relation to education leadership and standard-setting by tracing the evolution of family medicine as a discipline in Canada, how CFPC has defined and advanced it, and its plans for training. Are We Producing the Type of Family Physicians our Countries Needs? Dr. Ivy Oandasan shared lessons learned from the Canadian context regarding the aim of family medicine residency programs, the use of
competency-based medical education approaches in the design of family medicine training, and the importance of a purposeful evaluation plan to acquire data to support family medicine advocacy.
“Global family medicine partnerships are more important than ever. The pandemic has reinforced that to deliver effective person-centred care and improve health equity, we need primary care hubs that are close to home and provide access to strong, multi-professional teams that function seamlessly with public health services, community supports, and hospitals. This requires both education for health professionals and engagement of health system planners. It is best achieved through our collective efforts.” Dr. Harris Lygidakis, CEO, WONCA