LISBON, Portugal — At the 25th World Organisation of Family Doctors (WONCA) World Conference 2025, Hans Kluge, the World Health Organization (WHO)’s regional director for Europe, urged governments and clinicians to rethink primary care as the cornerstone of global health and social resilience, insisting it must be elevated from a secondary project to the foundation of every health system. His keynote address drew strong praise from hundreds of general practitioners (GPs) and health professionals gathered from around the world.

Addressing the packed hall, Kluge opened with a striking reminder: “Together, we are delivering 45 million consultations every single day. That is 45 million moments of trust, of hope, and often of fear, placed in your hands.”

Yet behind these numbers lies a crisis. Progress toward universal health coverage has stalled. Nearly 4.5 billion people still lack access to essential services, and 2 billion face financial hardship when they need care. “Primary health care is under strain across the world,” Kluge continued, citing medicine shortages, staff burnout, and deep inequalities both between and within countries.

A Workforce Under Pressure

Kluge described bleak conditions in Tajikistan, where he regularly meets family doctors: In just 7 years, the density of GPs has dropped by 21%, and 1 in 3 positions now sits vacant. Similar trends are emerging elsewhere, driven by workforce migration, chronic underinvestment, and declining interest in family medicine among students.

Globally, the shortfall could reach 11 million health professionals by 2030. “Family medicine must become a profession of choice,” Kluge insisted, calling for fair pay, stronger recruitment, and clear career pathways. He pointed to Ghana as an example, where a 3-year family medicine specialization program combined with salary increases has successfully expanded rural coverage.

Four Pillars for Transformation

To chart a path for the future of primary care, Kluge proposed a framework built on “four Ps”:

• Precision: Harness data, digital tools, and artificial intelligence to better understand populations, while ensuring technology narrows gaps rather than widens them.
• Pathways: Develop integrated care models, from telehealth and self-management tools to team-based approaches for complex conditions. In Kazakhstan, he noted, adding psychologists and social workers to primary care has already reduced hospitalizations and premature deaths.
• Professionals: Invest in the workforce at the heart of primary care — family physicians, nurses, and allied health professionals.
• Participation: Involve communities as genuine partners in designing, cocreating, and taking ownership of their health systems.

Primary Care on the Front Line

Kluge emphasized that primary care is at the heart of today’s major health challenges. It is where the effects of climate change first appear, where emergencies are detected, and where healthy aging can be supported. “Primary healthcare is more than clinics,” he said. “It is the bridge between people and their health systems. It is where trust is built.”

His keynote also took a personal turn when addressing violence against women. As WHO regional director for Europe and father of two daughters, Kluge pledged to make tackling gender-based violence a flagship initiative of his second term at WHO. “Too often, it is a family doctor or nurse who is the first and only person a woman turns to,” he said. “Never close your eyes. Say it when you see it.”

WHO Commitments

Looking ahead, Kluge announced that the next WHO European Programme of Work (2026-2030) will place primary care at its center. WHO will aim to embed primary care into national health policies and budgets, while also providing country-specific support, fostering transnational learning networks, and leading efforts in digital health and artificial intelligence integration.

He also revealed that Portugal will host WHO Europe’s first technical advisory group on artificial intelligence and health, underscoring the region’s role in digital innovation.

Kluge closed by urging health leaders to view health not as a cost but as the most important investment in society’s future. Citing Nobel Peace Prize laureate Wangarĩ Maathai, he called for “a new level of consciousness” in how health and human dignity are defined.

“With WHO, you will never walk alone,” he promised, vowing to ensure the voices of family doctors and nurses are heard at the highest political levels, including during an upcoming presidential panel at the United Nations General Assembly.

Finance, Conflict, and Moral Distress

After his speech, Kluge joined an “Expert Corner” discussion with family doctors. A Portuguese GP spoke with emotion about the humanitarian crisis in Gaza: “We are family doctors, and we care about the community; we care about the world. But there is a genocide; children are being amputated. I have three kids; I cannot sleep. This is not political; it’s humanitarian.”

Others pressed Kluge on chronic underfunding. While policymakers often express support for primary care, budgets rarely follow. “Shouldn’t we set minimum percentages of national health budgets for primary care?” one doctor asked. Kluge acknowledged the urgency of the issue and called for collective action.

Several physicians raised concerns about systemic barriers, particularly the lack of recognition of medical diplomas across Europe and Africa, which hampers mobility and worsens shortages in underserved areas.

An Irish GP highlighted the plight of 15,000 migrants in her country who lack access to regular care, calling for clinics tailored to their needs. Kluge admitted he was not fully aware of the scale of the problem but pledged to raise it: “It’s timely, because WHO must set priorities, even as donor funding shrinks.”

Finally, a South African physician working in Canada asked whether family doctors have a greater role in low-income countries than in wealthier ones.

“There is a purpose everywhere,” Kluge replied, reflecting on his own varied international career. “In Europe too, there is immense vulnerability — poverty, suicide, and sexual violence. In Africa, community workers and nurses carry a huge responsibility. The complexity is different, but misery is misery. No one should suffer,” he concluded.

This story was translated from MediQuality.