Improving Access to Gynecological Check-Ups and Screening Among Vulnerable Groups of Women: Developing a Midwives Network for Primary Healthcare Services

Key Contextual Factors

• The creation of Networks of Primary Health Services for Midwives at national level was legislated in 2017 (Law 4486/2017). By decision of the Manager of each Healthcare Region (totally 7 in Greece), a network of Midwives-Obstetricians was established with members the midwives serving in all public health care structures of each region. 
• During the period 2011-2015, a national screening program for cervical cancer and breast cancer was implemented with the coordination of the Ministry of Health and the Healthcare Regions.
• Perinatal and maternal care services were provided at regional level through midwives working in public healthcare units, mainly in primary healthcare.
• The following diagnostics and medical actions are reimbursed by the National Organization for Health Care Services:
  • vaccinations of children and adults;
  • prenatal examinations for women and men for the purpose of giving birth to healthy children (e.g. hematological examinations for the detection of heterozygous Mediterranean anemia, ultrasounds);
  • for the early detection of breast cancer, mammography every two (2) years in women aged forty (40) to fifty (50) years, and every year in women over fifty (50) years or in women over of thirty five (35) years, if the latter belong to a high risk group;
  • for the early diagnosis of cervical cancer, PAP test every year for all women from the beginning of sexually active life, or detection of high risk types of HPV-DNA test, every five (5) years from the age of twenty one (21) years old up to the age of sixty (60) years.
• The diagnostics for cancer, as any other examination, have to be prescribed in the e-prescription system in order to be performed and they are offered free of charge for citizens.
• The networks target vulnerable populations with less access to screening (low-income groups of women, women residing in rural areas away from health centers, refugees, etc) and facilitate:
  • counseling during pregnancy and childbirth by providing holistic and timely information and by preparing the pregnant woman and her family for normal birth;
  • the provision of health prevention and promotion services, as well as support for breastfeeding and Family Planning;
  • the receiving a cervical smear (Pap test) in cooperation with community stakeholders in order to provide services at remote or inaccessible places.

Key Components/Steps

• Each network, 7 in total at each healthcare region, has an elected president and vice-president, responsible for the coordination of actions and appointed by voting amongst the members of the network. The participation of each midwives working in all public healthcare units is compulsory.
• The organization and coordination of the operation of the Network, the actions and the programs that are carried out is performed under the supervision and control of the Manager of the respective Healthcare Region.
• Each network facilitates the implementation of life-long learning and training programs, such as breastfeeding, umbilical cord blood donation etc.
• Cooperation with local government authorities (municipalities, regions) and bodies active at local community level (e.g. schools) in carrying out health promotion activities.

Main Impacts / Added Value

• The activation of the Networks of Primary Health Services for Midwives at national level facilitated the recognition and promotion of the particularly important contribution of midwives in the field of primary care of women and newborns while connecting all public health service units under a single per healthcare region network. The coordination of actions, the implementation of programs with a homogenous identity, templates and orientation, the saving and better use of human resources and the monitoring of outcomes are amongst the added value provided by the implementation of the midwives networks.

Lessons Learned

• Teamwork, interconnection between organizations, coordination at regional and national level and standardization of documents, procedures and guidelines are key factors of success.
• Midwives Networks have to cooperate with GPs in and outside the healthcare units they operate at in order to provide better quality healthcare services and promote prevention.
• Guidelines at national level facilitate the deployment of actions.
• System/IT support is a necessity in order to support cancer screening programs.

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