Primary health care: the bridge to universal health coverage in Greece

Mohammad, a Syrian refugee reached Greece from Turkey on his 10th attempt, a journey made even more difficult as he has been partially paralyzed since he was 6 months old. He spent 3 years travelling from Syria to Greece, and arrived in September last year. He now lives at Eleonas Camp in Athens, where he volunteers teaching English, as well as working as an English teacher outside the camp. He is also learning Greek. In addition to using a wheelchair, Mohammad takes medicine to manage his diabetes, high blood pressure and heart problems. An engineer by training, he hopes to be reunited with his wife and two daughters, who he has not seen for 3 years, and return to Syria when the conflict ends.

Mohammad, together with the other 60 000 migrants and refugees currently living in Greece has access to primary health care (PHC) services, coordinated for migrants and Greek citizens alike by the Ministry of Health. This approach means that migrants can access medical support, as well as cultural mediation to ensure that services are appropriate. They are also guided in navigating the health system so that they can, for example, receive the medication they need to manage chronic conditions. Greece has invested in PHC, despite experiencing a severe financial crisis.

Mohammad met Dr Tedros Adhanom Ghebreyesus, WHO Director-General, and Dr Zsuzsanna Jakab, WHO Regional Director for Europe, when they visited the camp on 21 June 2018.

Primary health care in Greece

As part of its health system reform, Greece has – for the first time – developed unified PHC services based on community PHC units. Known as TOMYs, these units are staffed with multidisciplinary teams of general practitioners, paediatricians, nurses, health visitors, social workers and administrative staff. They work in collaboration with already existing ambulatory care units, health centres that provide specialized, diagnostic and dental health-care services.

“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,” said Dr Jakab during the recent visit to Greece.

The Primary Health Care Reform Plan was approved by the government in December 2015, and implementation started after the law was passed by Parliament in August 2017. WHO has been working with Greece on a European Union-funded project to ensure that the reform plan follows WHO policy recommendations. The first TOMY opened in Thessaloniki (Evosmos) in December 2017, and there are currently 94 units in operation. Each unit has a capacity to serve approximately 10 000 people, and they are likely to reach this capacity within a year.

Dr Jakab and Dr Tedros visited a TOMY on 21 June, meeting its multidisciplinary team of health professionals. During the visit, the Director-General emphasized the importance of health promotion activities, and suggested that the TOMY teams map the health needs of the communities they serve.

“I’d like to congratulate the Prime Minister for his commitment to universal health coverage, and to ensuring that all residents of Greece can access the health services they need, when and where they need them, without facing financial hardship…. The investments you are making will generate a return not only in terms of better health, but also in terms of poverty reduction, job creation, inclusive economic growth and health security,” said Dr Tedros.

About Eleonas Camp

In operation since 2015, Eleonas Camp is an open accommodation centre for asylum seekers, 1 of 37 camps in Greece. Residents are free to move in and out of the camp, and even leave if they wish. It has a village-like atmosphere – open doors, children riding bikes, playing and going to and from school, people cooking dinner. It is the second largest camp on the mainland, hosting 1700 people in 348 containers, trailer-like homes that accommodate 5–8 people per container.

PHC is provided by the Hellenic Centre for Disease Control and Prevention (KEELPNO) through its European Commission-funded PHILOS project, a specially designed project to address the health-care needs of migrants and refugees. The clinic is open Monday to Friday, with a general practitioner, a paediatrician, a psychiatrist, 2 nurses, 2 midwives and 4 cultural mediators. It examines 24 patients on average a day. In addition, KEELPNO runs a dental clinic, with 2 dentists for adults and 1 specialized dentist for children.

The most common diseases and conditions recorded recently have been respiratory infections (upper and lower) and asthma, musculoskeletal issues, chronic diseases such as diabetes mellitus, thyroid disorders, heart disease and other circulatory disorders, hypertension, gastrointestinal infections and scabies. A relatively large number of people experience mental health issues and take psychiatric medication and/or receive psychological support.
Four vaccinations campaigns have been conducted at the camp. The last 2 in August 2017 and April 2018 were the largest, vaccinating more than 350 children against measles, mumps and rubella (MMR) and pneumonia.

About WHO’s work on migration and health

WHO/Europe works to strengthen the capacity of countries’ public health services to deal with large influxes of migrants. The Public Health Aspects of Migration in Europe (PHAME) programme conducts assessment missions in the Member States that are receiving or may receive large undocumented populations, to coordinate the health response to migration by identifying best practices and potential gaps in the public health sector before establishing contingency plans. WHO has conducted 2 assessments of the Greek health system, in 2011 and 2015.

In September 2016, Member States in the WHO European Region adopted a strategy and action plan for refugee and migrant health to address the public health and health system challenges related to migration. WHO supports countries in identifying the priority actions to take in this area.

Primary health care in focus

PHC is health care received in the community, usually from family doctors, community nurses, staff in local clinics or other health professionals. It provides comprehensive and continuous care to individuals throughout their lives, from prevention and treatment to rehabilitation and palliative care. It is the foundation of an effective health system and key to achieving universal health coverage.

This year marks the 40th anniversary of the Declaration of Alma-Ata, which called on countries to introduce, develop and maintain PHC to achieve health for all. It was adopted at the International Conference of Primary Care in 1978. On 25–26 October this year the world will come together in Astana, Kazakhstan to reaffirm the principles of the original Declaration and underline the importance of PHC for the 21st century.

WHO official visit to Greece

Dr Tedros and Dr Jakab visited Greece on 20–21 June 2018, at the invitation of Alexis Tsipras, Prime Minister of Greece.

The Prime Minister reiterated his commitment to improving health in Greece when they met in Athens, “Health is my government’s priority, and we need to do more. WHO’s presence in Greece will be significant for our strengthened collaboration. We want your advice, and monitoring too,” he said.

During the visit Dr Tedros and Dr Jakab were joined by Dr Andreas Xanthos, Minister of Health of Greece, at the inauguration of the new WHO Country Office in Greece, which will facilitate collaboration with the Ministry of Health and other stakeholders on national health priorities, as well as supporting multicountry cooperation programmes. It is the 149th WHO country office worldwide, and the 30th in the European Region.