WHO facilitates knowledge transfer on primary health care contracting in Greece


A WHO mission to Greece on primary health care (PHC) contracting and key performance indicators (KPIs) in service delivery took place on 7–10 October 2014. The mission team included senior experts from the Ministry of Health of Portugal, the Portuguese Catholic University and WHO’s Programme Management Team in Greece.

The mission’s main objective was to kick start the ad-hoc Primary Health Care Contracting Workgroup, set up recently through a Ministry of Health decree. Additional objectives were to:

  • share Portugal’s experience on the architecture of the information system and the use of KPIs;
  • discuss with Greek policy-makers the possibilities for a study visit and/or internships in Portugal, in the context of starting up family health units in implementation of the PHC Law.

The mission team met with key stakeholders, visited relevant institutions including health services providers, and attended policy workshops dedicated to priority issues under the PHC reform: one on contracting and another on Portugal’s health information architecture and experience with KPIs.

Each of the two workshops brought together over 30 representatives of the Ministry of Health, regional health authorities, the National Organization for Provision of Health Services (EOPYY), service providers, professional associations, academia, WHO and the German Agency for International Cooperation (GIZ). The presentations and panel discussions focused on the process of issuing PHC contracts, the balance between the various components of remuneration, contract follow-up and the role of information systems and KPIs in all these processes. 

Opportunity for change in the Greek health system

“Many people in Greece would say that our health system is as it is because of the crisis, but we all have to admit that the severe distortions we have in our health system have actually contributed to the crisis,” said Dr Pavlos Theodorakis, Senior Adviser to the minister and PHC Focal Point in his opening speech. “We have currently a unique opportunity to make a fundamental change in the system by developing a sustainable PHC network, and we have also full support of the Ministry of Health’s leadership and of the WHO Regional Office for Europe.”   

Professor Wim Van Lerberghe, WHO’s Senior Advisor on Health Systems and team leader of the WHO Programme Management Team in Greece added: “The family doctors and nurses will be at the core of the PHC network to be put in place, but you cannot proceed with their recruitment, training, licensing, etc. until you establish clear parameters for contracting. The timeframe available for this exercise is very tight and we’ll have to put maximum effort to finalize the analyses and identify alternative contracting options by the established deadlines.”

Participants and members of the Primary Health Care Contracting Workgroup exchanged opinions on the priority issues discussed and approved by consensus a short plan of activities for the next 2 months, aimed at producing a draft policy paper on PHC contracting. Representatives of professional organizations welcomed the initiative, stressing that implementation of the establishment of family medicine was long overdue.

Ongoing collaboration with WHO

Greece’s Ministry of Health began the Health Reform Support Programme (HRSP) 2013-2015 within its Framework of Health in Action Initiative. It consists of 10 actions, called “pillars” to strengthen the development, performance and sustainability of its health system by improving the quality of care and financial protection, with primary health care as its cornerstone. The Ministry of Health requested WHO/Europe to play an extensive and active role in this effort and the partners signed a Contribution Agreement on 18 July 2013.

The most important result of the first year of collaboration was the development and approval of the new PHC Law in February 2014, which is currently under implementation.