Evaluation of primary health care and improvement of the services provided

Primary health care (PHC) is a central pillar of health systems internationally, based on the view of health as a universal and socially established right.The PHC services in Greece have been characterized over time by disintegration, and inefficiency, high levels of fragmentation and inequality, in terms of their access to the general population and geographical distribution, with incomplete implementation of the state health system. The recent, ongoing financial crisis, coupled with economic policies to reduce health expenditures, have exacerbated these problems and magnified the systematic weaknesses of PHC in Greece, as reflected by population health indicators, the financial burden of patients and the deteriorating quality of the services provided. These social inequalities in health, which developed in previous years, were intensified by the COVID-19 pandemic, which further highlighted the need to improve the health services provided and to promote a public health development strategy. Reform of PHC based on systematic evaluation can be a way of responding to its chronic weaknesses and meeting the urgent health needs of the population emanating from the crisis situation and the turbulent economic environment. Although several attempts have been made over the years to develop and implement a PHC system, these have been fragmented, and initiated from a technocratic perspective, diminishing the role of evaluation to a financial tool. The main characteristic of systematic evaluation should be continuous repetition of a circular process, consisting of collection of information, evaluation, and formulation of proposals for improvement and change. This process will support the universality of care and establish health as a social good, but it presupposes interdisciplinary and inter-professional cooperation, with the active involvement of patients.