The Greek Government launches a broad policy dialogue on primary health care reform

WHO

The Ministry of Health of Greece together with WHO/Europe organized a policy dialogue on primary health care reform that took place on 9–10 May 2016 in Athens, under the "Strengthening capacity for universal coverage" (SCUC) initiative. The policy dialogue aimed at bringing various actors in the Greek health care system together to:

  • share the Government's vision for primary health care services;
  • discuss the different directions that the reforms may take;
  • exchange experiences of European countries that have successfully reformed their primary health care services; and
  • generate practical options to ensure that the reforms improve access to basic health care and contribute to better health outcomes.

Well over 200 participants, who actively engaged in dynamic discussions and openly expressed their views, attended the policy dialogue, among them representatives of the Government, the Ministry of Health, other ministries and state agencies, local authorities, professional and patients' associations, academia and nongovernmental organizations.

The right to universal, free health care

The opening session demonstrated strong and compelling political support for the reforms at the highest national and international levels. The Prime Minister of Greece, Mr Alexis Tsipras, shared his concerns about reduced access to health care services for Greek citizens, particularly the poor and the most vulnerable as Greece in recent years has experienced substantial budget cuts especially in the health care sector.

He affirmed the Government's goal to make access to health services truly universal and to give the 2.5 million uninsured citizens the right to universal, free health coverage. The Prime Minister termed the two-day long policy event "an essential call to open dialogue on a necessary reform effort". He also stated, "The aim is to spread the new system to every neighbourhood in the country, to guarantee equal and quality health care for all, without discrimination and exclusions."

More people-centred care

In his opening address, the Minister of Health, Dr Andreas Xanthos, called for more patient- and people-centred care, and spoke passionately about the need to reinvigorate and expand primary health care with the longer-term goal of making it the cornerstone of the Greek health care system. He also emphasized the need to improve integration of care to better meet the health needs of the people in Greece. Establishing family medicine as a specialty, retraining expecting primary care providers and improving the career prospective for all health professionals at the primary care level will be necessary to attract the requisite staff at the new neighbourhood family health units that will be established.

A sustainable and integrated primary health care system

The WHO Regional Director for Europe, Dr Zsuzsanna Jakab, reaffirmed WHO's support to the on-going reforms in Greece, which are developed within the spirit of the Sustainable Development Goals and the values and principles of Health 2020, the European health policy framework. The Regional Director emphasized that "the stepping stone towards better health and equity and universal health coverage is the building and strengthening of a sustainable and integrated primary health care system". She said that extensive policy dialogue and good communication are necessary for reaching consensus on and strong ownership of the reforms on the part of all the stakeholders, particularly the citizens of Greece.

Lessons learnt from other countries' reform efforts

After the opening session, the policy dialogue turned to more technical reform topics. The Director of the Division of Health Systems and Public Health at WHO/Europe, Dr Hans Kluge, provided an overview of health care reforms across Europe. Professor Alexis Benos, Head of the Primary Health Care Committee, described the principles and values that underpin the vision for the establishment of a national network of neighbourhood family health units in Greece.

The day closed with a panel discussion with representatives from Italy, Lithuania, Portugal and Scotland (United Kingdom) who described critical elements of their primary health care reforms and discussed the key lessons that they had learned from their experiences. They stressed the need to ensure that the reforms address what really matters to people and that they involve everyone affected by the changes. The international experts emphasized the need for additional investment in training health professionals in the area of teamwork and to support the delivery of people-centred care. They also encouraged that participation in the reforms be made voluntary and that the primary health care providers be given considerable autonomy at the beginning of the reforms.

The second day of the policy dialogue was devoted to communicating the strategy and plans of the reforms, and to exchanging views on the different reform elements. Participants were optimistic that the reforms provided an important opportunity to reinforce Greece's commitments towards universal health coverage and people-centredness. Dynamic discussions emerged on specific aspects of the reforms such as:

  • the nature of services that should be part of the primary health care package
  • financial and nonfinancial incentives for family health teams
  • mechanisms to assure quality of care and better outcomes
  • the creation of new allied health professionals
  • the need to revise the education and training of doctors and nurses
  • ways to educate both providers and the population of the merits of the reform.

Background

The SCUC action is carried out with funding by the European Union through a grant agreement between the European Commission and WHO/Europe. Its general objective is to contribute to improving health and health equity in Greece, especially among the most vulnerable in the population, by helping the Greek authorities to move towards universal coverage and to strengthen the effectiveness, efficiency and resilience of their health system.