Solidarity Outpatient Clinics in Greece: a Massive Social Movement as a Response to the Economic Crisis

[This post refers to the article "Solidarity outpatient clinics in Greece: a survey of a massive social movement" published by ISGlobal researchers Manolis Kogevinas and Iro Evlampidou in the Gaceta Sanitaria journal]

As a response to the crisis, numerous health personnel and other volunteers created spontaneously numerous solidarity clinics and pharmacies throughout Greece

The economic crisis in Greece started around 2008 and resulted in a 25% reduction of the GDP, a massive increase in unemployment particularly in young ages and an increase in migration outflows, including biomedical personnel. Around three million persons were uninsured in a population of 11 million until 2016. A new law at 2016 provided access to health care to all uninsured persons living in Greece. As a response to the crisis, numerous health personnel and other volunteers created spontaneously after 2009 numerous solidarity clinics and pharmacies throughout Greece (in Greek, KIFA -ΚΙΦΑ - from “Κοινωνικά Ιατρεία Φαρμακεία Αλληλεγγύης”).

Solidarity clinics in Greece (n = 92). The map includes all reported functioning solidarity clinics in 2014 irrespective of size. In red the 19 solidarity clinics responding to the questionnaire. Published in Gaceta sanitaria.

The Greek healthcare and social security systems are semi-public/semi-private and have been chronically malfunctioning. Following the crisis, the funding of public hospitals and the number of health professionals in the public sector decreased while shortages of drugs and medical material are reported, including childhood vaccines. About 30% of the population (long term unemployed, new generations entering the labour force) and more than 700,000 undocumented migrants were excluded from the health and social security system. The uninsured were covered by the national health system (NHS) only for emergencies. The acute effects of the austerity measures on the access to healthcare and the health of the population include increases in child poverty and under-nutrition, HIV infections among drug users, stillbirths and suicides.

This grassroots movement of the solidarity clinics developed after 2009 and covered essential needs of the population

This grassroots movement of the solidarity clinics developed after 2009 and covered essential needs of the population. After 2016 when The Syriza government passed a law providing health care to all uninsured residents and the solidarity clinics developed in a new role. Today, they continue covering medical care of refugees and immigrants without legal documents. The solidarity clinics also provide pharmaceutical coverage of a wide spectrum of the insured population many persons cannot support medication costs (even though they are subsidized). They finally cover services such as dental and psychiatric care that are not covered by the Greek NHS. 

Solidarity pharmacy in Thessaloniki, north of Greece. Source: HSI Blog.

It is surprising that this magnificent massive solidarity movement has been very little known outside Greece

It is surprising that this magnificent massive solidarity movement has been very little known outside Greece. For one thing, the solidarity clinics because of their grassroots development and assembly type functioning were not interested in promoting their activities in the wider media but rather concentrated in their contact with the population.

It is characteristic that when the European Parliament awarded the European Citizen’s Prize to the Solidarity Clinic in Elliniko (a municipality in wider Athens and one of the largest KIFA) in 2015, they refused to accept it claiming that the Europe they are envisaging of solidarity and unity between populations, was not the one represented by the EU.

It is also characteristic that to secure the participation of the solidarity clinics in our survey many of them had to decide in an assembly discuss whether they would complete the questionnaire. So this massive movement that was covering the health needs of a large population in Greece reflected the way they were created. The genesis of this movement is connected to the reaction of the Greek society against the imposition of extreme austerity measures in a very short time period that did not allow the state or the society to adapt. The solidarity clinics were therefore characterized as a social movement with a strong wider political character, although they were not formally connected to political parties or other institutions. 

Solidarity clinic in Thessaloniki, north of Greece. Source: HSI Blog.

We identified 92 solidarity clinics big and small. The largest clinics examined more than 500 uninsured or partly insured patients per month

In the survey we conducted (that took a long time) we identified 92 solidarity clinics big and small, spread all around Greece. We managed to get responses to a questionnaire and talk personally to 19 including all the largest solidarity clinics. A characteristic of the 92 active solidarity clinics is the autonomous collective functioning, free services, and funding from non-governmental sources. The largest clinics examined more than 500 uninsured or partly insured patients per month. Clinics covered a wide range of clinical and preventive services. Funding, availability of drugs, vaccines, medical material and their legal status are main problems identified. The solidarity movement involved thousands of health professionals covering essential population needs.

It was an outstanding example of solidarity and it alleviated temporarily the health needs of a large part of the population

In the study we conducted in 2014-15, we provide the first comprehensive description of the outpatient solidarity clinics in Greece and gave information on functioning, type of activities and patients examined. The solidarity outpatient clinics provided, temporarily, an alternative to the malfunctioning national health care system in Greece but could not be a long term option for the provision of health care. The massive community outpatient clinics were an outstanding example of solidarity and alleviated temporarily the health needs of a large part of the population.

Reference

Iro Evlampidou, Manolis Kogevinas. Solidarity outpatient clinics in Greece: a survey of a massive social movement. Gaceta sanitaria, 2018.10.1016/j.gaceta.2017.12.001