Improving delivery of preventive medicine services through innovation
Region of Crete

The Problem

Promoting preventive medicine and improving the delivery of services to citizens in mountainous and faraway areas was the main issue. The specific tasks were 2: a) to inform women about breast cancer and to encourage preventive testing, and, b) to encourage children to visit the dentist at a young age and to give out information regarding general dental hygiene and diet.

According to assessments, the main reasons that had discouraged women and children from using important tools of preventive control were:
Geographic: Since the main cities situated on northern Crete concentrate an important part of health infrastructure, some women and some children needed to cover up long distances take a mammography test or have a dental exam respectively.
Economic: Transportation to and from the health centers needs to be covered from own expenses, and certain tests are costly.
Social: Generally speaking, it is difficult for children and for women (particularly elderly women), to move from a provincial village to a pubic central health unit or to a dentist in order to have a dental exam or go through breast cancer screening. At the same time, the work load in public hospitals is sufficiently high.

Solution and Key Benefits

 What is the initiative about? (the solution)
Women from the region of Crete (approx. 621.000 inhabitants) take the breast cancer screening in their own communities, for free, at the first Mobile Mammography Unit in Crete.

Similarly, the first Preventive Dentistry Mobile Unit for children visits schools as well as institutions with children with special needs throughout our region, providing them with free general dental health services, giving out important information on dental hygiene as well as on diet matters.

Additional information provided by the policy officers involved and their assessments:

- Many women living in the Region of Crete and specially women living in the countryside, between the age of 40 and 70 years, were not submitted to a mammography test. Breast cancer constitutes for women the most frequent form of cancer and the second cause of death from cancer in Western societies. It is a fact that the early diagnosis, which is achieved with the mammography, is the best way to treat the illness.

- As for children, general hygiene is very much connected with dental hygiene. Dental illnesses, diseases and other considerable and complex problems such as obesity can be in part dealt with by the services provided by the volunteer dentists of the Mobile Unit.

- Since July 2008, the Mobile Mammography Unit has realised more than 10000 mammography tests around Crete, the islands of Santorini, Karpathos and Kastelorizo, Gavdos, contributing considerably in serving women that live in islands, faraway and mountainous regions, while informing them about the benefits of preventive healthcare.

From the tests, results have shown that:
50% of women have had a mammography test for the first time and were informed of the prevention of breast cancer
30% of women were asked to take additional tests
10% of women were asked to proceed to biopsy testing

- Since March 2010, the Mobile Dentistry Unit has examined and given advice to 1700 children, mainly aged 10-12, in schools all over the region.

From these tests, results show that:
– 44% of children have decay, and from those
• 45% έχουν dental problems
• 24% brush their teeth once per day
– 63% have healthy dentals, and from those
• 39% have decay
• 27% brush their teeth once per day
– 28% have never visited the dentist

In parallel with the general dental examination provided by this Mobile Unit, the young volunteer dentists have given important advice to the children, and have distributed relevant booklets addressed to children and to their parents, providing important information on dental hygiene, on diet, as well as a concise presentation of the results of the dental examination of each child separately.

Actors and Stakeholders

 Who proposed the solution, who implemented it and who were the stakeholders?
The solutions were proposed by the Prefecture of Heraklion (for the Heraklion area), and have now been developed further to run throughout the whole region (Heraklion area, Rethymnon, Lasithi and Chania areas) by the "Region of Crete".

For the Mobile Mammography Unit, the Region of Crete collaborates closely with Hospitals, Health Centers, Municipalities, Cultural Associations and NGOs throughout Crete.

For the Mobile Dentistry Unit for children, the Region of Crete collaborates closely with Dentists’ Associations, the Directorate of Primary Education and schools throughout the whole region.

(a) Strategies

 Describe how and when the initiative was implemented by answering these questions
 a.      What were the strategies used to implement the initiative? In no more than 500 words, provide a summary of the main objectives and strategies of the initiative, how they were established and by whom.
According to the policy officers involved in the Prefecture/Region of Crete, the main strategy was to make use of the mobile component of these initiatives to makes them an innovative intervention in the sense that they promote responsiveness to the needs of women and to children.

(b) Implementation

 b.      What were the key development and implementation steps and the chronology? No more than 500 words
According to the assessment of the Prefecture/Region, to overcome the burdens described above, they defined as a priority the use of the first Mobile Mammography Unit and the first Mobile Preventive Dentistry Unit in the region of Crete, which make tours across the Region of Crete since July 2008 and since March 2010 respectively. These Mobile Units also move to other neighboring and remote islands (i.e. Kastellorizo, Gavdos, Santorini, Karpathos).

According to their assessment, in terms of implementation steps for the Mobile Mammography Unit, the first one was to procure a van and the necessary medical equipment (year 2007). Then, the van was transformed into a mobile mammography unit and medical devices and instruments were safely placed on it (April 2008). At the same time, the appropriate licenses were by the qualified Ministry of Health. Finally, the appropriate personnel was employed and the unit was finally set in operation (August 2008). A Similar procedure was followed for the implementation of the Mobile Preventive Dentistry Unit, until it could become fully operational in March 2010. Both units are still being run, developed and maintained.

(c) Overcoming Obstacles

 c.      What were the main obstacles encountered? How were they overcome? No more than 500 words
The policy officers in the Prefecture/Region of Crete point out that the main obstacles encountered were the search of financial resources (which in the end where provided by the regional public entity’s own budget), the transformation of the vans into secure vehicles (especially for the Mobile Mammography Unit taking into account the complexities of incorporating instruments with radiation – which was overrun with the help of the National Centre for Scientific Research “Demokritos”), and, the engagement of specialized personnel (which was overcome with the assistance, cooperation and voluntary offer of Hospitals and the Dentists Associations in the region).

(d) Use of Resources

 d.      What resources were used for the initiative and what were its key benefits? In no more than 500 words, specify what were the financial, technical and human resources’ costs associated with this initiative. Describe how resources were mobilized
Both Mobile Units rely a great deal on volunteering.
Doctors volunteer at a hospital to diagnose the mammography tests. Similarly, dentists from the Dentists’ Association volunteer to take part in the school visits. Mobilization and participation of these doctors and of everyone else that contributes to the successful management and operation of these unique projects is achieved through information provided by the Region of Crete, through public awareness, and then from the increase of the sense and motivation of volunteering.

Sustainability and Transferability

  Is the initiative sustainable and transferable?
Improving delivery of preventive medicine services through innovation, by creating and functioning of these 2 Mobile Units serving women and children throughout the region of Crete, has been a success for this public entity. It is important to have collectively contributed to the needs of citizens, bringing services closer to them, especially to the ones in great need and to citizens living in mountainous and faraway regions. Such projects are a good practice for other public entities to follow.

Lessons Learned

 What are the impact of your initiative and the lessons learned?
According the the policy officer involved in the "Region of Crete" and their assessments, one of the main lessons learned was that women and children tend to suffer more heavily the burden of geographical distance or relative isolation. This way, projects that seek to overcome this have special potential. In these cases, geographical considerations are an important reason used to explain why women were discouraged from using preventive controls such as a mammography test, and why children had not yet visited a dentist. Economic considerations are also significant, and are derived mainly as a consequence of transportation and examination costs.

Contact Information

Institution Name:   Region of Crete
Institution Type:   Public Organization  
Contact Person:   Georgios Pitsoulis
Title:   President of the Regional Council of Crete Region  
Telephone/ Fax:   +302813400300/ +302810342588
Institution's / Project's Website:
Address:   Region Of Crete
Postal Code:  
City:   Heraklion
State/Province:   Crete
Country:   Greece

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