TOMYS and the rapid growth of primary health care in Greece

In just over a year, Greece has established almost 120 new community-based primary health units, free at the point of access and known locally as Topikes Monades Ygias or TOMYs.

The units are key elements of Greece’s newly implemented primary health care (PHC) system and are the first point of contact and the main coordinator of care for people in the area.

Since registrations started at the end of 2017, more than 300 000 people have registered with TOMYs and benefit from their services, and more than 1 million have registered in the rest of the PHC services network, including health centres and private practices. A recent patient satisfaction survey conducted with WHO support reveals that TOMYs have been well received – there is high user satisfaction and demand has exceeded expectations.

At the TOMYs, multidisciplinary teams – general practitioners/family doctors, paediatricians, nurses, health visitors and social workers – provide a continuum of health care, offering disease prevention, health promotion, diagnosis, treatment, monitoring and care. The new units are also gradually establishing clear referral mechanisms. This is a major change from the otherwise fragmented network of different public and private health providers and primarily specialists, providing care upon request and with little coordination.

The impact is keenly felt. As 80-year-old Pantelis Leousis from Metamorfosi, Attica, says, “TOMYs are clearly a big, big, big service and a major breakthrough in health. Better health for all!”

Collaboration reaps rewards

Greece’s health system was deeply affected by the financial crisis, which had a direct impact on access to health services, quality of care and financial protection. Pressure from the crisis revealed long-term problems in areas such as health governance and PHC provision.

In response to this, WHO and the Greek Ministry of Health joined efforts to develop a proposal for comprehensive reform of primary health care, as part of their mutual commitment towards advancing universal health coverage. The new TOMYs are the outcome of this collaboration.

“This reform aims to shift the focus from treatment to prevention. It is an evidence-based response to the health system’s crisis and to societal demand for the elimination of health inequalities,” says Minister of Health Andreas Xanthos.

The newly-established community-based PHC network in Greece complements the Greek government’s efforts to ensure access of the uninsured population to public health care services. This not only underlines that primary health care is still relevant and a necessary path towards achieving universal health coverage, but it also sets the example that investing in people-centred care helps countries to build sustainable health systems.

“Standing shoulder to shoulder with the Ministry of Health, we have made significant efforts that will continue to contribute to improving the health of the Greek people, including the most vulnerable,” says Dr Zsuzsanna Jakab, WHO Regional Director for Europe.

The successful collaboration between WHO and the Ministry of Health led to the inauguration in 2018 of a WHO Country Office in Athens to ensure continued collaboration on the PHC reform efforts. The opening of the new Country Office has also enabled WHO to expand its collaboration with the Ministry of Health into other important areas in public health.