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Co-responsibility to ensure health to all

Issues surrounding healthcare in European states is of growing concern in today’s society: having the means to live a good quality of life and being able to take care of yourself and your loved ones is essential to well-being, not only in physical terms but also in terms of mental health.

Health and access to healthcare in Europe however, are strongly determined by socioeconomic status, which puts the most socially disadvantaged groups in an unequal position. Access to health services can be significantly restricted or conditional, and the types of services provided may be inappropriate for some social groups. This situation is only worsening with the economic crisis where governments continue to make cutbacks on public health services and welfare in order to relieve pressure on growing debt burdens.

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Photo courtesy Yaniv Golan CC2.0 BY-SA

According to the WHO (World Health Organisation), the right to health means that governments must generate conditions in which everyone can be as healthy as possible. Such conditions range from ensuring availability of health services, healthy and safe working conditions and nutritious food. It is important to note that the right to health has been enshrined in international and regional human rights treaties as well as national constitutions all over the world. Nevertheless, this right has not been (and is still not being) respected by many of the members states.

What is the solution then, or a remedy at the least? Below are presented actions/projects - currently running in different regions across European states – that could offer an alternative to people in crisis. These types of actions should be seen as an incentive for governments to promote and facilitate new paths towards enabling people their right to health.

Eléments essentiels

La coresponsabilité pour le bien-être de tous sans exclusion ni discrimination (et y compris les générations futures) implique un certain nombre de principes orienteurs de base en matière de santé.

Des soins pour tous

Le premier est d’offrir à tous l’assurance de pouvoir, le cas échéant, bénéficier d’une offre de soin adaptée et accessible

Des soins garantis et maintenus

Le deuxième est de garantir, en vue des générations futures, le maintien d’une offre de soins accessible et de qualité. Les créations de structures solidaires et sociales ne doivent pas servir d’excuse aux autorités locales, pour se retirer du domaine de la santé, qui constitue un élément premier et incontournable du bien-être et de la dignité humaine et un droit fondamental pour tous.

Des choix de santé démocratisés

Enfin, un principe transversal est celui de la concertation et de l’évaluation participative pour les choix qui sont faits. Le processus est élaboratif (il part des personnes concernées) et non pas uniquement incitatif.

Processus général :

1Une association d’habitants d’un territoire (quartier, commune, collectivité etc. ou encore un ensemble d’organismes (publics, privés, associatifs) pré-existantsse constitue dans un esprit de coresponsabilité entre tous les habitants pour le bien-être de tous (y compris des générations futures). Il s’agit de la création d’une plate-forme multi-acteurs, servant de point de départ et de base à la création d’un cycle de projets, incluant les citoyens.

2Ensemble, ils retiennent des actions pilotes à mener en matière de santé. A noter, que celles-ci doivent prendre parti des spécificités de leur territoire (lois existantes, facilités ou obstacles locaux etc.) et les exploiter de manière imaginative.

3Ils déterminent les actions à mener en tenant compte de leur impact en termes de bien-être et de l’étendue d’utilisation des ressources non renouvelables qu’elles impliquent (Cf Fiche méthodologique T13-2 SPIRAL : La co-évaluation participative d’une initiative). Dans le cas de la santé (qui est très règlementée), ils doivent aussi être attentifs à être conformes aux normes en vigueur (des instances telles que l’Ordre des médecins etc. peuvent poser problème en cas de non-respect de la réglementation).

4Ils sont en outre attentifs à offrir un service complémentaire des services publics, qui n’a pas vocation à remplacer définitivement ceux-ci, mais simplement à en renforcer l’action dans le sens de la cohésion sociale.

5Constatant l’exclusion grandissante de l’accès aux soins de première nécessité de certaines catégories de la population sur son territoire ou encore l’engorgement croissant des services publics hospitaliers, la plateforme décide de créer un service médical de proximité, assurant des soins de premier niveau (c’est-à-dire, a minima médecine généraliste, soins infirmiers et suivi kinésithérapique) afin de garantir le bien-être de tous. Ce service pourra s’adjoindre des initiatives plus spécifiquement destinées aux personnes vulnérables ou en grande détresse. Les locaux pourraient, en outre, être mis à disposition par les collectivités territoriales locales.

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Photo courtesy Poudre Valley Health System CC2.0 BY-SA

A. Première étape : Création d’une maison médicale de proximité, permettant de désengorger les soins hospitaliers d’urgence et d’assurer des soins de proximité inclusifs, participatifs et accessibles à tous.

6Pour favoriser la coresponsabilité de tous, la plateforme met en place une structure de santé communautaire, gérée de manière collégiale. Les modalités peuvent varier, mais il est recommandé que cette structure soit autogérée par les praticiens eux-mêmes, sur le modèle des Maisons médicales belges.

7Elle peut aussi offrir à ses patients la possibilité de rejoindre les instances décisionnelles ou de réflexion internes à l’organisme (Assemblée générale, Conseil d’administration, groupes de réflexion thématiques etc.) et de s’impliquer, ainsi, à différents degrés, selon leurs possibilités ou leurs envies.

8Cela n’est possible, qu’à la condition que ces patients soient engagés durablement dans la structure. Cet engagement peut prendre la forme d’un contrat tacite ou explicite de leur part, garantissant, qu’ils consulteront principalement dans cette structure précise (concernant les affections liées aux soins qu’elle propose). Ce contrat multipartite devrait dans l’idéal être reconnu par l’Etat, de manière à sortir du modèle du cabinet libéral, pour aller vers un modèle plus solidaire d’offre de soins, orientée vers les besoins réels des patients d’un territoire donné. Cette reconnaissance est aussi nécessaire au sens où elle doit permettre d’assurer un financement des rétributions des praticiens autre que le financement à la consultation..

9Car pour éviter les rapports mercantiles entre soignants et soignés (qui pèsent sur les coûts), la structure doit trouver une manière de financer ses praticiens par la capitation plutôt que de les payer à la consultation. Ce système est solidaire parce que la facturation forfaitaire repose sur une compensation des écarts. Les dépenses (plus importantes) des personnes malades, sont compensées par les forfaits des personnes en bonne santé non-utilisés. En Belgique ce système repose sur un engagement des autorités publiques, qui reconnaissent le statut des Maisons et ont permis la mise en place de contrats tripartites. Ailleurs, d’autres manières d’associer le Public doivent pouvoir être développées, selon les spécificités de chaque pays.

10Pour favoriser la cohésion sociale, ils installent la structure de santé, dans un territoire déterminé et pas trop étendu –si possible, à cheval sur plusieurs quartiers. Cela permet d’ancrer localement leurs activités. Cet ancrage assure aux médecins, une meilleure connaissance de leurs patients et aux habitants, un service de proximité favorisant la mixité sociale. Il est souhaitable par ailleurs de mener des études de terrain en amont de la création du lieu, en vue de déterminer, où se situent les autres Maisons et quels sont les territoires qui ont le plus de besoins (déserts médicaux etc.), où les lieux stratégiques qui permettraient le mieux d’accueillir des populations socialement mixtes ;

11Pour améliorer le suivi des patients, ils s’assurent d’une offre de services pluridisciplinaire et transversale, qui permet d’étudier la situation de chaque patient de manière globale. Des réunions régulières des équipes peuvent ainsi être mises en place, pour réfléchir ensemble sur les différents cas de patients. Cela permet aussi aux praticiens de bénéficier de conditions de travail plus intéressantes : ils ont des horaires plus viables et peuvent être remplacés par leurs collègues, en cas d’absence. Les équipes pluridisciplinaires peuvent en outre être renforcées par la présence d’une assistante sociale, déléguée par les instances locales et susceptible d’aider les patients plus effectivement.

12Les groupes de réflexion propres à la structure, assurent une veille régulière des spécificités du quartier, des demandes et besoins des habitants, mais aussi des avancés dans le domaine de la santé communautaire et solidaire.

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Photo courtesy Keith Myerscough CC2.0 BY-SA

B. Deuxième étape : pour garantir l’accessibilité de tous aux soins, la structure peut s’adjoindre des services supplémentaires, spécialement dédiés aux personnes vulnérables et/ou exclues du système de soin traditionnel.

Plusieurs solutions sont possibles ; elles dépendent des spécificités de chaque territoire, mais aussi du contexte social.

13La structure peut ainsi s’adjoindre un dispensaire et/ou une pharmacie sociale. Ceux-ci auraient pour vocation d’accueillir les populations les plus vulnérables et notamment, celles touchées par la crise (chômeurs, immigrés sans papiers, personnes sans couverture sociale etc.). Les locaux peuvent être mis à disposition par les autorités locales ;

14Il est important que les activités sociales du dispensaire se fassent au sein des structures usuelles (soit par l’établissement de consultations gratuites menées bénévolement par les médecins à l’hôpital ou dans leurs cabinets, soit par la réservation d’un quota de visites gratuites au sein de la structure de proximité elle-même. Cela permet d’éviter de stigmatiser les personnes concernées.

15Concernant les populations en grande difficulté ou non couvertes par la sécurité sociale, il faut aussi songer à leur trouver des solutions pour les maladies plus lourdes et durables. Certains dispensaires grecs, ont ainsi par exemple réussi à négocier avec des hôpitaux, l’accès gratuit à certains des soins qu’ils ne peuvent fournir eux-mêmes : accès ponctuel à la maternité ou au service d’oncologie etc.

17En concertation avec les acteurs locaux (services sociaux locaux, associations de médecins, élus, pharmaciens, services hospitaliers, entreprises etc.), la structure se donne aussi la possibilité d’assurer la délivrance de médicaments gratuits (en s’adjoignant une pharmacie sociale).

17Les médicaments peuvent être collectés de deux manières. Soit par donation (il faut alors sensibiliser les habitants et organiser la collecte des médicaments non-utilisés), soit par de nouveaux modes de financements solidaires.

18Un de ces modes de financements solidaire peut être la mise en service par la mairie, d’une carte de crédit, spécifique aux soins de santé et utilisable dans un certain nombre de pharmacies, ayant accepté de travailler avec la collectivité. Ces pharmacies pourraient faire aux possesseurs de la carte, une réduction automatique de 10 à 15% et bénéficieraient en retour, d’une hausse de leur clientèle et d’une déduction de leurs charges fiscales locales. Une partie de ce pourcentage pourrait ainsi être reversée à la pharmacie sociale, qui fournirait en médicaments gratuits les patients en difficulté (le plus souvent adressés chez eux par les services sociaux).

Inventary

Social pharmacies and medical offices

Social Pharmacy-Social Medical office in Kavala The social pharmacy –social medical office of Kavala, is a result a common effort of the Municipality of Kavala along with the city’s Pharmacists Union and the Doctors Union. The project URBACTII-TOGETHER was the trigger that initiated the attempt to establish this structure and it’s the one supporting since the campaigning of its operation. The social pharmacy-Social medical office is housed at the 2nd floor of the Municipal Market Hall and has already opened up to the public. The social pharmacy-Social medical office was founded to provide health services to underprivileged citizens of Kavala. The medicines’ kept at home- in no use- collection and management under the supervision of the local pharmacy warehouse in cooperation with local NGO’s working on social welfare provision. The social pharmacy-Social medical office comes to overcome the gap that exists in state social provision and support our co-citizens lacking health insurance and are in need of medical and pharmaceutical support. It is specifically addressed to: • Underprivileged • Unemployed • Uninsuranced • Immigrants without official permission • To all that comply with the operation legislation of the social pharmacy-Social medical office The ones that receive the official social pharmacy-Social medical office card will allow them to make use of the above listed services. How can I help? The social pharmacy-Social medical office is based on you, all of you that support this attempt. Besides the voluntarism of the doctors, pharmacists, social services municipal staff and volunteers from local NGO this structure is in need of also your voluntarism. This volunteering act is translated into medicines offer and also time offer in servicing the operation of the social pharmacy-social medical office. How you can offer your support in social pharmacy-social medical office: 1. If you know people close to you that are in need of medical and pharmaceutical support and belong to the above mentioned categories (unemployed, underprivileged, without insurance, immigrants etc.) please inform them on the operation of the social pharmacy-social medical office or let us know about them and let us approach them. 2. Offer medicines that you have at home and not use due to the conclusion of your therapy or are in excess. The medicines that you have at home and are expired you may recycle them in any pharmacy of our city or at the social pharmacy. 3. The ones that can, may also support us financially or may provide us some of their free time; volunteering at the operation of the social pharmacy-social medical office servicing bureacratical procedures of the structure necessary for its prompt operation. OPENING HOURS OF THE SOCIAL PHARMACY-SOCIAL MEDICAL OFFICE MONDAY-TUESDAY-THURSDAY 10.00-13.00 TUESDAY AND THURSDAY 17.30-19.30 CONTACT DETAILS Τηλ: 2510 2513 500 030 PUBLIC BENEFIT ORGNAZATION OF THE CITY OF KAVALA-“DEMOFELIA” Address: 117, Omonia str., P.C.: 65403, Kavala. Τel: (+30) 2510 831388,(+30) 2510 831358, Fax: (+30) 2510831378 Email: kavalagreece à kavalagreece.gr MUNICIPALITY OF KAVALA 10, Kyprou str PC 65403 Kavala Tel: +30.2513500100 Email: program à dkavalas.gr PHARMACEUTICAL ASSOCIATION OF KAVALA 2, Dagkli & Anagenniseos PC 65403 Kavala Tel: +30 2510 834200 E-mail: sfarmak à otenet.gr DOCTORS ‘ UNION OF KAVALA 9, Filikis etaireias str Tel: +30 2510 223172 Email: info à iskavalas.gr

Social Pharmacy-medical office in Katerini “Alekos Ftikas”

The Social Pharmacy- medical office is a voluntary action of social solidarity. It is addressed to all un insuranced, unemployed people the ones without access to the heath provision system In order for someone to be benefited from it has to acquire a “family card”. To obtain a “family card” you need to submit a request to the secretary of the Social pharmacy-medical office of Katerini. The secretary will book you an appointement with the social workers of the structure in order to get your profile and evaluate your needs in health provision. The social workers will assess all the requests and provide the respective family cards. The secretary operates every Monday, Wednesday, Friday from 18.00-21.00 from Monday 14th of October 2013 Location The Social pharmacy-medical office of Katerini is located at the Tobacco Station of Katerini, 8 Fleming str, next to the Court of Justice’s parking space. It operates since the 2nd of December 2013. Medicines are prescribed only after the examination of the patient by the network’s doctor. Necessary for that is that the patient has a “family card” Conditions Each family-beneficiary of the structure has to offer one hour of voluntary work per month for every member of the family. Excepted from the conditions are the elderly and the incompetent people. Doctors are offering their services either at the Social medical office or at their private offices. The shift starts at 18.00-21.00 supported by a 4 people supporting team: a nurse, a pharmacist, a secretary and a volunteer. Contact details Tel: +0030.2351039000, 6981665158 info à otoposmou.gr http://www.otoposmou.gr

Municipal medical office of Pefkakia- Athens Contact details 88, Panagouli & Kretes str, St. Paraskevi Tel: +0030.210 6011955 info à iatreia-ap.gr http://www.agiaparaskevi.gr/Default.aspx?tabid=276

Solidarity medical office Piraeus The Solidarity medical office of Pireus is providing to un-insuranced citizens for free: medical and dental health provision, medicines, occupational therapy, speech therapy, physiotherapy as well as social and psychological support. We operate everyday from 9.30-20.30, at 5, Xenofontos & Pelopida str, on the 3rd Floor, Memou sq. Koridalos, Athens. Contact details 5, Xenofontos & Pelopida sq. Koridalos Pireaus Τel: +0030.2104960790 Email: gramateia2013 à gmail.com http://a-iatreio.blogspot.gr/

Open Solidarity Committee Tinos Island The aim of the Social Pharmacy of the Solidarity Committee of Tinos Island is providing free medicines to un-insurances citizens as well as people excluded form public health in general. Contact details Organizing Committee V. GAVRIELATOU +0030.6980446759 M.DEDEMPILI +0030. 6972223412 P. KOUSOUNADIS +0030.6932463222 G.MARTOULAS +0030.6955778797 B.MPAKTIS +0030.6948063690 anoikthepitrophallhlengyhs à gmail.com http://all-tinos.blogspot.gr/

Citizen’s Open dialogue of Sch. Tiflon, Evzonos areas and Faliro Contact details 4, kolokotroni str , basement Thessaloniki Tel: 0030.2310888048 syneleysi_stef à yahoo.gr http://syneleysistef.files.wordpress.com

Municipal Medical Offices at Aigaleo Athens The Municipal medical offices are operating since 1998 without state contribution at a renovated space of 250cm² at the Municipal Stadium and is addressed to poor people, un- insuranced and insuranced at the farmers fund. Contact details Aigaleo stadium Αιγάλεω Τηλ: 210 5319 741 http://www.aigaleo.gr

Doctor’s Solidarity network of Kifisia-Athens Contact details Tel: +0030.210 8078353 chchra à otenet.gr

Social Solidarity network-Herakleion Crete The NGO: Social Solidarity Network of Herakleion” has established a social medical office to provide basic health care provision to un- insuranced- poor citizens of Herakleion. The structure operates on fixed appointments with the beneficiaries and is located at the former University building, Knosou Boulevard It operates on appointment every day form 10.00 – 12.00 in the morning. Contact details Knosou boulevard, (University building, M Sector) P.O.BOX 71409 Herakleion Crete Island Tel : +0030.2813-008525 Email: info à koinoniaher.gr http://www.koinoniaher.gr

Social Solidarity volunteers medical office The structure offers free medical examinations, medicines and vaccination for the children. Eligible beneficiaries are all uninsuranced and poor citizens of Rethymno. Contact details 12, Kolokotroni str Old Town Rethymno Crete Tel:+0030.2831042120 ethiatreio à gmail.com http://www.ethiatreio.com/

Volunteers ‘ Social medical office –social pharmacy in Rhodes Island 85, Konstantinou Paleologou str Rhodes Island Tel: +0030.2241036110 ekif.rodos à gmail.com http://ekif.blogspot.gr/

Social Solidarity Medical Office-Pharmacy of Preveza It is a structure providing free medical examination and medicines prescription to un insurances citizens and poor people and is supported on a volunteering base by a group of doctors offering their services for free. Contact details Th. Parla str Preveza Tel:+0030.26820 89805 http://koinonikoiatreioprevezas.wordpress.com/

Social medical office of Magnisia It is supported by the Doctor’s union of Magnisia. It offers free examinations. It operates every Monday-Wednesday-Friday from 3 to 6 in the afternoon. Every Wednesday from 3 to 6 the structure is operating with a Psychiatrist and a cardiologist. Contact details It is located at the Diavlos 54, Topali str, basement of Skendrani str. Volos

Kozani’s Social Medical Office Contact details 11, Plakopiti str. (KIFI Kozanis, building 40 Martires 50100 Kozani Tel: +0030.2461 042257 koinwniakoz à gmail.com

Social Solidarity Medical office of Peristeri Athens Contact details 1, Chrysoclora str Peristeri iatreioallperisteriou à gmail.com http://iatreioallperisteriou.wordpress.com/

Solidarity Pharmacy in Peristreri It operates on Monday & Wednesday 17.00-19.30, Thursday from 10.00-12.00 Contact details 60, Taegetos str (at the entrance of the Grava Cultural Centre), Tel: +0030.6978539803 e-mail: k.farmakeio5 à gmail.com,

Social Medical Office in Agrinio “Georgios N. Papaioannou” Contact details 20, Palama str Agrinio Tel: +0030.2641025392 Social network of Doctors and Pharmacists of Ilion It provides free examinations and free medicines prescription to people that lack access to hearth care provision. It also collects medicines that are offered by the citizens. Contact details 32, Idomeneos str – 3rd floor (besides the OTE building) Ilion Τel: +0030.217 - 7024011 koinonikoilioy à gmail.com

Social Pharmacy of Kilkis It is addressed to the poor, uninsured, immigrants without permission to stay It is a structure based on the voluntarism of the local doctors and pharmacists as well as the members of the social service of the Municipality. Contact details 13, Spartis str Kilkis Tel: +0030.23410-22114 / 23410- 23285 / 23410-25817 info à fskilkis.gr

Solidarity Social Pharmacy Social Medical Office in Athens http://www.anoihtipoli.gr/ 33, Kaniggos Str & Stournara str (1st floor) Tel : +0030.210 3802037 kifa.athina à gmail.com http://www.anoihtipoli.gr/

Solidarity Social Pharmacy Social Medical Office in Drama Contact details Drama Labour Centre 2, Ipirou str Drama Tel :+0030.2521.777.038 politesdramas à gmail.com http://www.politesdramas.gr/

Solidarity Social Pharmacy Social Medical Office in Chania Contact details 10, Kolokotroni sq. Chania Crete Island Tel: +0030.28215-02755

Social Medical office-Pharmacy in Larisa Contact details 117, Papanastasiou str Larisa Tel: +0030.2410619073 koinwnikoiatreiolarisas à gmail.com http://koinwnikoiatreiolarisas.blogspot.gr/

Solidarity Social Medical office for people with special needs Contact details 8, Kazantzaki & Andronikou str Ag. Anargyroi Attiki 135 61 Tel:+0030.210 2691834 Fax: +0030.210 2691834 http://www.anixtiagkalia.gr

Thesprotia’s Solidarity Medical Office Contact details The structure is located at the basement of the former students dormitory (besides the Health Centre of Igoumenitsa) Igoumenitsa Tel:+0030.6940403400 koiafigoumenitsa à gmail.com http://www.kiathesp.blogspot.com

Social Medical Office Thessaloniki Contact Details 24, Aisopou str Vardaris Thessaloniki Tel:+0030.2310 520386 koinwniko.iatreio à gmail.com http://www.kiathess.gr/

Solidarity medical office of Korinthos Contact Details 83, Adeiamantou str Korinthos Tel:+0030.2741 112 112 kiakorinthou à gmail.com http://www.kiakorinthou.blogspot.gr/

Social medical office in Bironas Contact Details 12, Ellispontou str Bironas Athens Tel: +0030.210 76 28 209 souldim1937 à gmail.com http://k-iatreio.blogspot.gr/

Reference models/modèles de référence

1- In a territory of co-responsibility the multiactors platform (coordination group) and citizens are interested in developing co-responsibility for the health of all (the idea can come from the multiactors platform itself in the 1st cycle of SPIRAL or from the homogeneous groups of citizens in the 2nd cycle of SPIRAL). 2- Their first objective (in a first step) is to ensure access to health care and medicines to people who are excluded from the insurance system. To achieve this objective they organize a Social Pharmacy and Social Medical Office (SPSMO) (inspired from Greek experiences). The second objective (in a second step) is to foster co-responsibility between all actors and citizens for a healthy long life to all. To achieve this second objective they organize a Medical House (inspired from Belgium experience).

Fist stage: the Social Pharmacy and Social Medical Office (SPSMO) 3- In order to launch the SPSMO, a small research is done first to identify the needs. Applying SPIRAL methodology helps to do it. 4- If the need of a SPSMO is confirmed the multiactors platform (coordination group) invite all of the local stakeholders that are considered as dynamic in health provision or close to the grassroots level-meaning having a good feedback of the citizens opinion. In most cases listed in our inventory the institutions leading the effort in either local authorities or the church ie:institutions/ decision makers with power in actually implementing the proposed policies. This work is undertaken by the stakeholders that engaged themselves to be members of the multiactors platform and therefore are binded with this task until the project fully operates. 5- This small team of people enlarge by inviting people more relevant to the subject- if they are not already represented in this team- and make them co- responsible to the task, i.e. the pharmacists and doctors unions of the city as well as NGO’s with experience in health services provision to all such as the medicines du monde or some local NGO collecting medicines and vaccinate for free children etc. 6- Once all of these stakeholders come together and feel co-responsible in safeguarding public health they have to agree on the rules and conditions that will apply on the establishment and operation of the SPSMO (see in attached file the constitution of SPSMO translated as a prototype for use of interested parties) 7- The SPSMO in its constitution includes the creation of an organizing committee one that is responsible to set the criteria according with which someone could be eligible in having such a service as well as to take important decisions in changing these criteria if necessary as well as find ways in promoting the structure and finding the necessary resources to run it. 8- The citizens participate in the co-responsibility in 2 ways: One is identifying the people who need SPSMO and helping/encouraging them to go there. The second is collecting medicines in houses which are not used any more.

Second stage: The Medical House for a healthy long life of all 9- The SPSMO is a good way to launch co-responsibility for the health of all and to prepare its enlargement to all population through “Medical House”. Medical House is an institution where all professionals of health sector work together, in co-responsibility with the citizens to ensure a healthy long life to all. To do so they include not only doctors and pharmaceutics but also alternative medicine as naturopaths and educators for prevention and healthy life. 10- The main particularity of Medical House is that the professionals are not paid according with the number of treatment services they provide but they receive a global salary (paid by the insurance social system). If the inhabitants are healthy they work less and have the same salary. So they are encouraged to ensure a healthy life to all. 11- This work well if the citizens share this co-responsibility and are aware about how to maintain themselves in good health, that’s why education for prevention and healthy life is a main dimension of this system. 12- The co-responsibility between health professional and citizens is also about the health cost. Together they try to reduce the health costs in order that the insurance system is able to cover all expenses. This include for instance reducing medicine use, collecting medicine not used (as they to for the SPSMO)

Supports for exchanges/transfers/ Appuis aux échanges et transferts

Social Farmacy and Social Medical Organization (SFSMO)

In order to establish a SFSMO it is necessary that you create a core of stakeholders (local support group as we usually name it) that prior to that have diagnosed the need of the community on such a service. You cannot invent services to the citizens that do not respond to their idea of well being in health! (this has to be further analysed under the fourth task, right?)

How you structure your local support group. You have to be honest and invite all of the local stakeholders that you consider as dynamic in health provision or close to the grassroots level-meaning having a good feedback of the citizens opinion. In most cases listed in our inventory the institutions leading the effort in either local authorities or the church ie:institutions/ decision makers with power in actually implementing the proposed policies . Once you openly invite those stakeholders and introduce them to what you have in mind on doing you have to let them express their availability and will to be part of it. After this first introduction and providing them the informative material that we provide on how to built a SFSMO you give some time to conduct a small research and cross check what the local community this as important in safeguarding heath to all. How you confirm the need for a SFSMO The small research can be even more profound and well rooted if you use the SPIRAL methodology.

Where you start from The results are there, the community needs a SFSMO and the preparation has to start. This work is undertaken by the stakeholders that engaged themselves to be members of the LOCAL SUPPORT GROUP and therefore are binded with this task until the project fully operates. This small team of people will have to enlarge the team by inviting people more relevant to the subject- if they are not already represented in this team- and make them co- responsible to the task. By this I mean the pharmacists and doctors unions of the city as well as NGO’s with experience in health services provision to all such as the medicines du monde or some local NGO collecting medicines and vaccinate for free children etc. Once all of these stakeholders come together and feel co-responsible in safeguarding public health they have to agree on the rules and conditions that will apply on the establishment and operation of the SFSMO. (here I can provide the constitution of SFSMO translated as a prototype for use of interested parties) The SFSMO in its constitution has to include the creation of an organizing committee one that will be responsible to set the criteria according ot which someone could be eligible in having such a service as well as to take important decisions in changing these criteria if necessary as well as find ways in promoting the structure and finding the necessary resources to run it.

To whom this structure is addressed The SFSMO usually are established to proved access to health for people excluded from it due to conditions. Those conditions are different in every country (it depends on the legal framework that each country has applied for their health provision) and sometimes differ even within the same country (eg. the primary health provision needs are vaster and broader in Athens than at the cities of the Greek periphery and include also other groups of populations such as immigrant children illegally in the city without their family here). In general those all the SFSMO share the below mentioned beneficiaries • Poor • People in lack of health insurance • Single mothers • Immigrants • Orphans • Special needs people The criteria are always subjected to changes since such a structure must be dynamic and there to immediate respond to the local health needs. However, the changes of the criteria must be a result of the citizens response and feedback to the structure. The body able to differentiate those criteria is definitely the organizing committee of the SFSMO.

What a SFSMO needs to be established: • A space-even a small room- that should be provided for free in order for the SFSMO to be viable the first few months of its operation • A set of shelves –those can be offered by citizens or the municipality or the stakeholders participating at the local support group • A small fridge –again this has to be offered- • A computer and with the support of the local pharmacists union the software that can assist them in following the medicines supplies. • A first small supply of medicnes necessary for the start-up of the structure-these can be provided from the citizens though a public invitation and can also be assisted by the volunteers pharmacists. Fortunately the medical office needs less things a volunteer secretary to keep the appointments and a small bed for the examination to take place. The roles of the stakeholders involved The whole operation of the structure is base on the specialists ie: the pharmacists and the doctors. Those are responsible for providing the examinations and the medicines. All the other members are there to support the operation the SFSO: • The Municipality provides the space and facilities (shelves, pd, telephone and internet connection etc) • The NGOS provide their volunteers to run the operation • The local media promote the service and invite people to offer the resources and their free time and experience if they have


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