An outsider in the Greek civil service

By Tassoula Karaiskaki Kathimerini he State is not an easy adversary. It has been known to defeat even its own political leaders; it is a machine with many rusty and malfunctioning parts. Evrydiki Hadziandreou, a technocrat from the private health sector who accepted the post of deputy governor of the health sector at the state Social Security Foundation (IKA) for the past three years, has a lot to say about the state sector that she loves – «We all have a duty to help improve public administration» – now that her term is completed. She learned a lot from her time in the civil service: that you can’t please everyone if you want to get the job done, that you have to fight for things that are self-evident, and that only actions can outweigh misinformation and superficial knowledge. She is satisfied with what she has achieved with the help of her associates. Yet if the civil service is to improve, it requires ceaseless hard work, deep changes and breaks with the past. Why did you decide to leave the private sector for the civil service? I have always been interested in public health, administration and health policy. It was a conscious choice to study this after completing medicine. I always wanted my work to affect a large number of people, to link knowledge and theory with practice. So I couldn’t say no to the job. What about the experience you acquired? It was terrifying to suddenly come down to earth and try to see how you can do what is necessary and self-evident. What was your first impression at IKA? IKA is a giant. The first few months I had mixed feelings of admiration for the incredible potential, then anger that this potential was not being exploited as it should. IKA offers a lot, but its image spoils everything. I feel great affection for it. What disappointed you? The partisan veil that sometimes alters criteria. Also the lack of specialized staff which leads to difficulties in implementing decisions. On the other hand, what impressed me was the good will, conscientiousness and professionalism of some employees on whose shoulders much of the burden of the foundation’s functioning rests. One of the must crucial factors in the modernization of public administration is to highlight these diamonds. It is no easy task. I have to say that I met with a great deal of resistance when I tried to transfer people simply because I was absolutely convinced that they were not doing their job properly and were obstacles to improvement. I eventually managed it with the support of the governor, to whom I am very grateful, first of all because he went to a great deal of trouble to bring in an associate – myself – who had no partisan links, and secondly because it requires a lot of courage to support that person when he or she is attacked. We broke some eggs, because it was the only way, but we did a lot of work. You can’t please everyone when you are trying to improve something. Someone is bound to be displeased. What made you the angriest? The ease with which truth and reality are distorted and violated by means of misinformation and slander. It is a shame when you are trying to transfer a person to another position because he or she is proving to be a major obstacle when that person invokes party affiliation, claiming to be the victim of political persecution. It is a pity when you are trying to improve two hospitals (the Third IKA Clinic and the Georgios Yennimatas) for people to say that I was doing the work to get kickbacks from the contractors, and then saying that I was fixing the hospitals with IKA money in order to sell them to the private sector (specifically, to my former employer, Dimitris Kontominas). What was obvious, that they would have to close if they were not refurbished and modernized, was of no concern to these people. But to be fair, this is only the one side. There is another side, of sincere and conscientious people who rallied and worked together to complete these projects within a year and a half. And in the end? In the end, we all are judged by our actions and those alone. Only work remains to protect you, even in Greece, above all in Greece. My greatest satisfaction now that I am leaving is that most of the reconstruction and modernization programs in IKA’s health sector have either been completed or are under way. For example? The best example I can give is the telephone appointment system (184) for medical consultations (soon to be extended to medical tests). It began on the initiative of Mr (Miltiades) Nektarios in March 2000 and is available across 70-80 percent of the country. At present, about 45,000 to 50,000 appointments are made every day, meaning an end to those terrible lines, and an important part of the integrated information system that began in the social security sector is gradually being extended to the health sector. A large part of it is the prescription management center. Every month about 2 million prescriptions from around the country are dealt with there so that pharmacists can be paid. Other data is also collected to assist in monitoring. For example, we found one person for whom 240 different prescriptions had been written. The phenomenon of oversubscribing… The phenomenon of abuse of everything because of the bureaucracy, the lack of infrastructure and systematic checks. I think it is in our nature to think that we can beat the system but this is deeply undemocratic. But you can’t change everything from one minute to the next. You need to work hard and persistently. We had to make a tremendous effort to implement the 10 immediate improvement measures recently announced (such as simplified approval for transport costs, abolition of a second signature on prescriptions of drugs costing over 60 euros, three-monthly prescriptions for vulnerable population groups). We had to make a tremendous effort to upgrade those two hospitals, the Third IKA Clinic, which is for short-term stays, and the cancer clinic. There was enormous opposition. We are afraid of change. It is a pity for the Greek spirit. Abroad, nothing fazes Greeks, but in their own country, Greeks have a very conservative spirit. What is the difference between the Greek and American public sectors? Here the pace is very slow, and there is a lack of organization and infrastructure, of procedures and regulations. The American civil service is more just, more democratic. The difference between the state and private sector? Greek private companies have, though to a lesser degree, some of the same problems that plague the state sector. The private health sector in Greece also needs a lot of work, it has developed without any restrictions, and unfortunately there has been an emphasis on hotel-quality accommodation. We are going to have a period of crisis in the next few years, combined with the economic recession and an inability by private insurance companies to cover costs. Private healthcare is unacceptably expensive in Greece. At some point something will have to give. Will the state sector ever improve? I’m not sure. Its problems originate in entrenched, anachronistic ideas. For there to be results, there has to be a break with the past, consciously, I hope.