The cross-border area has similar geographic conditions with high rough mountains and disperse small villages with difficult access to urban centers. Furthermore, no local primary healthcare facilities exist in these areas. As a result, the rural population of the cross border area does not have access to primary healthcare services as they are provided only in the large urban centers. Municipality of Oraiokastro includes in its territory areas with difficult access to urban centers, e.g. villages of Petroto, Mesaio, Filaphelphia, Neoxorouda, Pentalofos. These villages are mainly inhabited by elder people as well as immigrants with low income.
Municipal Authority of Oraiokastro is aware of this problem and always wished to provide their rural citizens with these type of health services. After the announcement of the GR-BG Programme, LB realized that one of its objectives (specific objective 8 namely) corresponds exactly to their need. LB realized that it is also a great opportunity to cooperate with a Bulgarian partner facing the same problem. Such a cooperation could greatly contribute to the transferability of the project approach in other regions or countries with similar characteristics. The area of municipality of Petrich and municipality of Sandanski is served by MPHAT “SOUTHWEST HOSPITAL”. The territory includes plenty mountainous and remote villages. These villages are also inhabited by elder and low-income people.
Authorities in the regions are interested in confronting this common problem. The methodology to be followed in order to realize the project objective (the provision of healthcare services to the rural population) is the development of mobile healthcare units that staffed with a multidisciplinary team that will visit the target population on a regular basis. The mobile unit will be supported by innovative ICT tools for recording patient’s health history and data.
The main target group of the project is the rural population that don’t have easy access to healthcare providers of the urban centers, mainly the elderly, the unemployed, the disabled and the poor people of the rural areas. The project directly contributes to specific objective 8 “improve access to primary and emergency health care (at isolated and deprived communities) in the CB area” as it provides the rural deprived population with primary healthcare services on a regular basis.
The project has multiple effects: improvement of the residences’ health, decrease of hospital admissions and reduction of health costs.
The starting point for determining the project was the common planning. Partners’ previous experience in implementation of cross-border projects had created the adequate cooperate conditions, in order to submit the proposal. Some technical meetings took place where the partners prepared and submitted the proposal of the project, taking into account context, priorities, joint objectives and key measures, so as to reflect their own needs.
They analyzed the areas of intervention, effectiveness and lessons learned from the previous period, and finally, the needs and priorities set by the recent economic crisis. During the partners’ meetings, the project idea was step-by-step developed and consolidated, the proposing partnership was formulated, the roles among the partners were determined, and, finally, the project was structured and the activities was shared among the partners, in accordance with the specific needs of each area and the experience and capacity of each partner. As both partners have a low experience but are eager to learn to deal with the advantages digital ICT devices offer, the support of Demokritos was requested and accepted to support them with their ICT know-how by developing a digital system for the recording and monitoring of the patients’ health status. To underline their intention of joint collaboration in the future, a joint committee of both regions was proposed to ensure to work from a common view, finding common guidelines for the new way of organizing of health services in combination with utilizing the advantages the nowadays digital ICT technology offers.
It is noted here that well-known medical protocols for recording patients’ data, e.g. HL7, Peppol standards, will be utilized. These standards will be adjusted to the specificities of the CB area.
The proposed project aims to improve access to primary health care in the rural cross border areas where population has difficult access to healthcare units. In particular, in both regions a mobile health care unit will be purchased. Each mobile unit will be properly configured and equipped with medical and ICT equipment. Additionally, each unit will be staffed with health care professionals. An information system for recording the medical history and the exams of the patients will also be developed. The system will utilize well-known medical protocols for recording patients’ data, e.g. HL7, Peppol standards.
The mobile units will operate through a regulated plan (protocol, under supervision of the installed joint committee on both regions), with responsible care professionals who place an emphasis on early diagnosis and prevention (e.g. not only vaccination but also learning elementary self-management techniques to remain healthy) and utilizing the nowadays Information and Communication technologies. Within the framework of a common strategy (roadmap), each region will formulate its business plan for the mobile unit service including the service-, the technical- unit’s soft/hard ware requirements. According to this plan, the pilot application of the mobile health units is set up in order to form a well-functioning network with the other primary health care organisations.
The project promotes social inclusion and combats poverty and discrimination as it provides healthcare services to people of remote areas who do not have easy access to healthcare structures. Consequently, it reduces inequalities in terms of health status.
However, RemoteCare’s more significant contribution to the Programme is the improvement access to primary health care at isolated and deprived communities in the cross border area.
The project’s added value stem from the similar living conditions (many remote villages populated mostly by elderly and deprived families) in the CB area.
The project partners will share human and economic resources, competences and know-how, experiences and best practices in order to achieve the optimum results.
In particular, the approach we follow in this project is the primary integrated healthcare, an innovative concept that has been implemented with success in many European countries. However, Greece and Bulgaria have not implemented such an approach yet.
The expected results from the project’s implementation could be described as follows: Improvement of cooperation to respond to common problems regarding social integration issues, exchange of best practices, networks creation and joint health & social integration protocols, improvement of provided primary health services and elimination of the conditions excluding sensitive social groups, by the introduction of mobile units for those social sensitive groups which are not able to reach the nearest primary health centers. Project’s results are mainly focuses on equal opportunities and battling discrimination, as the project aims to improve services and conditions providing on sensitive social groups.
In particular, the project leads to: a) the reorganization of the healthcare institutions: MPHAT “SOUTHWEST HOSPITAL” and the healthcare provision unit of the Municipality of Oraiokastro, b) the development of two health ICT systems, one for Greece and one for Bulgaria and c) the provision of primary healthcare services to the rural population of the area, i.e. 24.686 Bulgarian and 16.584 Greek citizens, total 41.270 citizens that live to the rural cross border areas.
Furthermore, the project will implement an innovative approach for the provision of primary healthcare services by a local authority and a hospital in the CB area. Thus, we will come to useful conclusions that could be used in the future.
The proposed expected outputs are tangible and measurable, relating to the project activities and objectives. According to the work packages and to activities that the project contain, the expected outputs are the following:
- Decrease of the number of hospital admissions and consequently decrease of secondary and tertiary health costs
- Protection of vulnerable social groups from hospital infections and provision of information to these groups about self-management techniques to handle their own health situations
- Improvement of the psychological condition of vulnerable social groups
- Improvement of the quality of life for the habitats of the rural areas
- Promotion of prevention and early diagnosis
- Reduction of health care costs
- Training of the caregivers and health professionals to incorporate a professional responsible attitude and to handle ICT smart devices,
- Collection and production of the documentation procedure of the patients’ medical history and the medical treatments they received from the mobile unit.
- Developments of a feasibility study of the mobile health units.
- An interregional MoU and forming the starting points for further joint actions.
It is noted here that the project main objective is the provision of primary healthcare services to remote population. One of the pillars of the reformation of the health system in Greece is the authorization of municipalities to provide health care services. Therefore, the project offers a great opportunity, among others, to test the feasibility of this type of intervention. Even more, the cross border approach will give the Consortium the opportunity to evaluate and compare the provision of primary healthcare services by a local authority and a hospital and come to useful conclusions that could be used in the future.