Reinventing primary health care in the Greece of austerity: the role of health-care workers

Background: The Greek primary health-care system (PHC) seems to be suffering the most from the economic crisis because of understaffing and misdistribution of the health workforce and the shortage of medical supplies and diagnostic equipment. Aims: The objective of the paper is to present for the first time in public national health-care workforce census data for the first two years of the economic recession and the adopted bailout mechanism (2010 and 2011) (a) to evaluate the adequacy of the governmental effort in terms of organization and management of the health-care workforce in PHC; and (b) to identify constraints and opportunities for the development of an integrated PHC ensuring access to health-care services for all. Methods: Data were drawn from the national project 'Health Monitoring Indicators System: Health Map' coordinated scientifically by the National School of Public Health, Department of Epidemiology. They referred to the 202 PHCs and their regional surgeries (with 98% response rate). Descriptive statistics and frequency distributions were used for the analysis. Findings: The findings pointed that PHC absorbs a very limited part of the national health system's workforce. Important inequalities in the numerical and geographical allocation of the PHC health workforce specialties across the country in favor of the medical profession and to the detriment of rural areas and the islands were identified, raising concerns about the policymakers' ability to meet the emerging needs of the population, as the retrospective study of the health-care workforce, since 2010, reveals that the numerical and per type allocations remained almost unchanged. These results were in line with previous studies showcasing the lack of holistic approach for PHC questioning the restrictive spending policy (ie, salary and benefit cuts for the health-care professionals, important discharges and nonrenewal of the personnel) adopted in the public health-care sector.