Preventive medicine Mobile Units for women and children in islands
Region of Crete

A. Problem Analysis

 1. What was the problem before the implementation of the initiative?
Many women living in the island region of Crete (approx. 621.000 inhabitants) – especially women living in mountainous and remote areas – had never been informed about breast cancer and had never been 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. Early diagnosis, from mammography testing, is the finest way to prevent and 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 largely dealt with by providing dental testing, informing on healthy diet, and raising such awareness to children at a young age, as well as to their parents. According to assessments of the Region of Crete, the main reasons that had discouraged women and children from using important tools of preventive medicine 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. Therefore, promoting preventive medicine, for free, and improving the delivery of services to women and children in island, mountainous, and faraway areas, was the problem and thus the main purpose in the implementation of this initiative.

B. Strategic Approach

 2. What was the solution?
To overcome the burdens described above, the Region of Crete defined as a priority the operation, continuation and constant improvement of the use of the first Mobile Mammography Unit for women (since July 2008), and the first Mobile Preventive Dentistry Unit for children (since March 2010) in the region of Crete and surrounding smaller islands such as Gavdos island – the furthest inhabited little island of Europe. The specific tasks were mainly 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 raise awareness to children and to their parents regarding general dental hygiene and healthy diet. These solutions were initially proposed by the Prefecture of Heraklion (for the Heraklion area). The newly established (since 2011) Region of Crete – encompassing and continuing the work of all 4 ex Prefectures – has now developed this “Preventive Medicine” project further to run throughout the whole island region (Heraklion, Rethymnon, Lasithi and Chania), including surrounding smaller islands. The initiative has largely contributed to solving the main problems, and still operates with own resources and with the valuable help of volunteers, despite economic burdens.

 3. How did the initiative solve the problem and improve people’s lives?
According to the policy officers involved in the 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. The success is that women from the region of Crete (approx. 621.000 inhabitants) take the breast cancer screening in their own communities, for free, at the Mobile Mammography Unit. Similarly, the Preventive Dentistry Mobile Unit for children visits schools as well as institutions with children with special needs, providing them with free general dental health services, giving out important information on dental hygiene as well as on healthy diet. Since July 2008, the Mobile Mammography Unit has realised more than 15.300 mammography tests around Crete, the islands of Gavdos, Santorini, Karpathos, Kastelorizo, contributing considerably in serving women that live in islands, faraway and mountainous regions, while informing them about the benefits of preventive healthcare. Additionally, the Preventive Dentistry Mobile Unit has welcomed, examined and informed more that 5.200 children thus far, and their parents.

C. Execution and Implementation

 4. In which ways is the initiative creative and innovative?
According to the evaluation documents of the Prefecture and later Region of Crete, 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. The strategy was one: to reach every corner of the large island region, mountainous, faraway areas, as well as smaller islands at the edge of Europe.

 5. Who implemented the initiative and what is the size of the population affected by this initiative?
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. Without these stakeholders, without these collaborations, such projects of extreme importance to our areas would not have been possible and successful.
 6. How was the strategy implemented and what resources were mobilized?
Both Mobile Units rely a great deal on volunteering. Other costs such as petrol, medicine equipment, cleaning etc. are provided by own resources, of the Region of Crete, which makes it even more significant during times of economic burdens. Doctors volunteer at the Venizeleio 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.

 7. Who were the stakeholders involved in the design of the initiative and in its implementation?
According to assessments of the Region of Crete, A) From the mammography tests on the Mobile Unit, 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 One output that contributed to the success of this initiative was is in the fact that half of the women who were never informed about preventive medicine and had never done a mammography test, now have done so, and there are many more to examine and inform. A second one was that certain women had biopsy test and have been treated from the diagnosis that took place. B) From the dental tests of the Mobile Unit, results show that: 44% of children 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 we have distributed relevant booklets addressed to children and to their parents, providing essential information on dental hygiene, on healthy diet, as well as a concise presentation of the results of the dental examination of each child. So a third output that contributed to the success here is in the fact that children are beginning to understand about dental hygiene, general hygiene and healthy diet, from a young age, and a fourth one is that their parents are being informed too as awareness is being raised to them as well. 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. And thus, a fifth output that contributed to the success of the preventive medicine project is that it has brought organizations, NGOs and associations together, to collectively give their efforts to the needs of citizens, bringing services closer to them, especially to the ones in greater need and to citizens living in mountainous and faraway regions. Such projects should be promoted in other regions as well as they are a good practice for other public entities to follow. This project needs to be encouraged to continue.

 8. What were the most successful outputs and why was the initiative effective?
The Region of Crete has concrete data from all the projects since the beginning, from assessment and evaluation reports made public. All doctors and volunteers have statistic tables that they fill in after each visit, after each examination. Every term there is an evaluation from the monitoring of the preventive medicine project. Consultations also take place with regard to constantly developing partnerships and the overall strategy.

 9. What were the main obstacles encountered and how were they overcome?
The policy officers of the 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 whole region).

D. Impact and Sustainability

 10. What were the key benefits resulting from this initiative?
The key benefits of this initiative may be summarized as follows: - Free preventive medicine for all women and all children, everywhere - Free information provided relating to the project's social tasks - Public awareness for early diagnosis and for the benefits concerning a more healthy life - Extensive cooperation with various stakeholders - Continuous development, despite economic issues - Ability to happily nominate this project to the United Nations Public Service Awards, for a possible much appreciated recognition.

 11. Did the initiative improve integrity and/or accountability in public service? (If applicable)
This initiative is certainly both sustainable and transferable, largely due to the collaboration and the enormous aid of volunteers. The Region of Crete and everyone involved in this vital project may well feel proud to have collectively contributed to the needs of our citizens, bringing services closer to them, especially to the ones in great need and to everyone living in mountainous and faraway regions. We too believe that this is a best practice for other public entities – and not only – to learn about, to pursue and to practice.

 12. Were special measures put in place to ensure that the initiative benefits women and girls and improves the situation of the poorest and most vulnerable? (If applicable)
One of the main lessons learned from these 2 projects is that women and children tend to suffer more heavily the burden of geographical distance or isolation in mountainous and faraway regions. Past and current economic and social factors play a major role as well. This way, projects that seek to overcome these obstacle, for the sake of health and thus by improving the delivery of such services to everyone regardless who and where, have special potential in society.

Contact Information

Institution Name:   Region of Crete
Institution Type:   Government Agency  
Contact Person:   Georgios Pitsoulis
Title:   President of the Regional Council  
Telephone/ Fax:   +30.2813.400375/+30.2810.342588
Institution's / Project's Website:  
Address:   Region of Crete
Postal Code:   71201
City:   Heraklion
State/Province:   Crete

          Go Back

Print friendly Page