Solidarity Clinics and social work in the era of crisis in Greece

Abstract

After the eruption of the crisis and the imposition of strict austerity measures, a number of grassroots solidarity initiatives emerged in Greece. The growth of Solidarity Clinics (SCs) emerged as an answer to the lack of primary health care for around 2.5 million people who were excluded from the national health system. This article presents and discusses the findings of a research project conducted from May 2014 to September 2014 in Greece. The aim and profile of SCs as well as the involvement of social workers in the initiatives are presented and discussed within the framework of the role of social work.

Keywords

Crisis Greece social movements social work Solidarity Clinics

Introduction

This article addresses the role of social work in the Solidarity Clinics (SCs) emerging in Greece in the era of the crisis and its neoliberal management. A number of solidarity initiatives emerged in order to address the various facets of the crisis and the growing social needs. The focus of this article is on initiatives offering primary health care services to a growing population excluded by the national health system. The main contribution of this article is related to the emphasis on the role of social workers in these initiatives as emerging in the framework of a research project conducted in Greece during the time of crisis and comprising all detected and operational SCs regardless of the type of the founding team behind their development (social movements or institutional actors).

In the first section, we describe the context of crisis in Greece as it is manifested in health. In the second section, we describe the methodology of the research project and some basic features of the detected initiatives. In the third section, we present and analyze the main results with regard to the role of the social workers. In the final section, we offer policy insights.

The context: Health care in the era of crisis

Since the eruption of the crisis in Greece, a deterioration in the overall health of the population has been observed. In particular, scholars indicate a decrease in self-perceived health (Zavras et al., 2012), deterioration of mental health (Ifanti et al., 2013), a significant increase in the number of people reporting lack of access to health care while in need and an increased number of human immunodeficiency virus (HIV) infections among drug-users (Ifanti et al., 2013; Kentikelenis et al., 2011). Even though the exact causality between the crisis and suicides is contested (Fountoulakis et al., 2012), Kentikelenis et al. (2011) report a 25 percent increase in suicides from 2009 to 2010, and quote evidence provided by the Ministry of Health for a 40 percent increase in suicides during the first semester of 2011 as compared to the first semester of 2010. According to the national suicide helpline, 25 percent of callers in 2010 faced financial difficulties (Katsadoros et al., 2011).

Despite increasing health risks directly or indirectly linked to the crisis, the austerity orthodoxy did not leave health care unaffected. Against the crisis, all governments responded by adopting a policy mix affecting health expenditure and/or revenue (World Health Organization [WHO], 2012). The Greek government opted mostly for immediate cuts in public health spending (Kentikelenis et al., 2014). The health care budget was reduced by 30 percent from 2011 to 2012. Public hospitals’ budgets witnessed a significant reduction even though there was a reported 30 percent increase in public hospital admissions, as more people turn to the public health system when incomes shrink (Ifanti et al., 2013). The public health system was found to operate with fewer health workers (figures range from 10% to 40%), whose salaries have been decreased by 40 percent (Simou and Koutsogeorgou, 2014). On the revenue side, direct payments and co-payments have multiplied. In particular, user fees for visits to outpatient clinics were raised from €3 to €5 (Karanikolos et al., 2013). Co-payments were introduced for chronically ill and disabled people in residential and day-care facilities and for clinical tests and prosthetic devices in parallel with the imposition of ceilings for the provision of certain consumables.

With regard to social work and social services, according to the research by the Greek Association of Social Workers (SKLE in Greek) there were 221 empty posts in public hospitals, understaffed social services departments in the rest of them, while in 24 out of the 125 hospitals there were no social workers at all (SKLE, 2013a). Furthermore, 35 social workers were placed under suspension status in the main social insurance fund, the National Insurance Foundation (IKA in Greek) (SKLE, 2013b), within the framework of downsizing the public sector, which finally resulted in the abolition of social work in this fund. As Ioakimidis and Teloni (2013) argue, the crisis was used as the perfect alibi for the neoliberal attack on the already frail welfare sector in Greece. In general, as the report by SKLE (2014) reveals, there was a tremendous reduction of social services in Greece in a context and at a time when the country was facing a humanitarian crisis.

All these developments, together with the escalating unemployment rates leaving many citizens without health insurance, urged the development of numerous solidarity initiatives regarding food, education, culture, and so on (Solidarity for All, 2014), leading to the so-called ‘solidarity movement’. One prominent example of this movement involved the emergence of Solidarity Clinics (SCs) addressing the primary health needs of the population lacking formal access to the public health system. Given the increased numbers of uninsured Greek citizens, these clinics faced expanding demand for their services. SC activities are not only limited to medical services, but they also develop a multifaceted profile of actions including social work services.

Research methodology

The first methodological step was the identification of the population of SCs in Greece. This was the first challenge of the research project, given the following considerations:

the emergence of novel initiatives during the period of research implementation and the discontinuity of existing ones;

the lack of databases and official records of SCs;

the provision of both medical and pharmaceutical services (social pharmacies) by some of the SCs;

the difficulty in discriminating SCs from municipal medical centers and non-governmental organizations (NGOs) which were operational prior to the crisis;

the difficulty in discriminating SCs from initiatives that were developed and operated by the same host organization, which could potentially lead to overrepresentation of the same characteristics given the identical modus operandi.

In order to address these difficulties, the researchers

cross-checked any available public databases and records;¹

directly communicated with all the initiatives in order to confirm their on-going operation;

directly communicated with ‘key-persons’ actively involved in SCs;

treated as one multiple cases run by the same host structure in order to avoid overrepresentation.

Initiatives operating exclusively as social pharmacies, municipal medical centers and structures developed by third sector organizations before the crisis were all excluded. The medical centers developed by municipalities during the crisis with the use of volunteer work were, however, included in the study.

After the above initial steps, we identified a total number of 72 actively operational SCs. Qualitative research through field visits and structured interviews with at least one representative of each of the SCs were conducted. The research questions involved the following:

What is the profile of these initiatives and how do they operate given potential idiosyncrasies of the structures and the (local) society?

What is the range of their actions and provided services?

How are SCs connected with the national health system?

What is the relationship of SCs with movements for collective advocacy?

In order to obtain access to the structures, a letter explaining the aim and procedure of the research was first sent electronically followed by telephone communication. Four initiatives developed by teams belonging to broader social movements asked for the presentation of the aims and methodology of the research project within their general assemblies in order to decide on their inclusion in the research project.

In total, 56 structured interviews and field visits were conducted from May 2014 until September 2014. A total of 16 SCs did not participate in the research, either due to inability to identify and communicate with a representative and/or attend the scheduled meetings (6), or due to having been denied participation mainly for ideological reasons (10).² A total of 54 interviews were recorded (two representatives out of the 56 refused to be recorded). All the participants participated voluntarily in the research and signed a consent form (informed consent); anonymity was maintained throughout the research procedure. The interviews were recorded and transcribed in the following way:

The interviews were listened to fully.

The interviews were transcribed verbatim. Punctuation marks were inserted and pauses were noted according to the instructions provided by Dunn (cited in Iosifidis, 2003).

The interviews were listened to for a third time in order to ensure accuracy.

We analyzed qualitative data by categorizing them into groups based on the origin of SCs and their secondary characteristics (see Tables 1 and 2). Graphs were used for quantitative data.

Table 1.

Composition of the SCs in health care and other professionals (frequency and number of initiatives found)

Specialty	Number of Social Medical Centers
Pharmacists	31
Nurses	24
Psychologists	26
Social workers	24
Physiotherapists	14
Radiology technicians	11
Speech therapists	9
Nutritionists	4
Others (sociologist, psychotherapist, reflexologist, priest, economist, and cancer survivor)	1–2

SC: Solidarity Clinic.

Table 2.

Classification of social workers’ participation

Category	Type of involvement	Number of SCs	Total number of social workers	Profile of SC
A	Volunteer work	24	84	Movement (12) Multi-stakeholder partnerships (5) Church (1) Medical association (1) Third sector (2)Municipality (3)
B	Employees in municipalities and NGOs (permanent staff or staff working on short-term contracts through funded programs)	10	15	Institutional (NGOs, municipalities, church, and multi-stakeholder partnerships)
C	Indirect social work: referrals by public social services and vice versa	44	Unspecified	Both (by movements and institutional SCs)

SC: Solidarity Clinic; NGO: non-governmental organization.

Findings

We first present the analysis results of the profile of the SCs, classifying them into two main categories. We then describe the involvement of social workers from an organizational perspective and how social work is conducted in the context of the SC classification. Finally, we dissect the roles of social workers and their activities.

Profile of the SCs

Concerning the institutional affiliation of the SCs, there is a clear difference between those that were spontaneously derived by the social movements and those developed by institutional actors. Interestingly, almost half of the SCs were derived by initiatives of the movements while the rest varied to those that were derived by the municipalities, the church, third sector organizations, medical associations, union of hospital doctors, municipal party and multi-stakeholder partnerships formed by more than one actor (Figure 1).

Figure 1.

The profile of the SCs as captured in the year 2014.

In general, all SCs provide services to those excluded from the national health system, as is evident from the following representative response given below:

This is a social medical clinic. It cannot cover people that have national health insurance, given that these people can use public health services. As far as I know, all SCs provide services to those that are excluded from the national health system. (1)

The rise of the SCs was an attempt to address the unmet primary health care needs of the population affected by the consequences of the austerity measures. However, as the findings revealed, the aim of the initiatives is in conjunction with the broader ideological perception of the initial founding team. Therefore, SCs that have their origins in broader social movements emphasize their dual role as providers of health care services as well as advocacy channels for the restoration of universal public health care. On the other hand, SCs developed by institutional actors such as a municipality perceive their role in a rather more philanthropic manner which is distinct from the solidarity context of the movement-derived SCs (Adam and Teloni, 2015). The organizational and ideological background seems to affect the activity of the SCs and particularly social work, as will be discussed later.

In any case, SCs provide their services for free and the hundreds of individuals involved are largely volunteers. It seems that during the crisis a great wave of people became activated in the solidarity movement. The volunteers in SCs are both people who just wanted to help and health and welfare professionals. Concerning the profile of the health professionals, the dominant health specialty is doctors who range in the order of magnitude of thousands, although the exact number is difficult to estimate. Interestingly, a significant number of additional health and welfare professionals, such as nurses and social workers, are also involved (Table 1). Specifically, as shown in Table 1, the most common specialty was pharmacists, while some initiatives also involve nutritionists and cancer survivors. In at least 4 of the 31 SCs that involve pharmacists, the entire local association of pharmacists was voluntarily involved.

As shown in Table 1, in most SCs the services are not only limited to the provision of primary health care and the prescription of medicines, but also expand to other health and social services such as physiotherapy, nursery, speech therapy and social work. The reasons behind this diversity are multifactorial and range from the intrinsic heterogeneity of volunteers to the diverse needs of the users and the intentions of the structures to offer multilevel and holistic service rather than only focus on medical issues. In this context, the study of social workers’ involvement provides some interesting observations for the field of social work sciences which are presented and discussed in the following.

Social workers’ involvement in SCs

Interestingly, the research findings demonstrate the involvement of social workers in grassroots welfare structures in Greece. In order to analyze in more depth the type of involvement, we categorized the individuals involved in SCs into three groups based on their frequency in all initiatives, the number of social workers, as well as the general profile of the structures (Table 2).

In the first group (category A), there is a significant number of social workers voluntarily involved in SCs with about³ 84 social workers being involved in 24 out of the 56 SCs in total. With regard to the profile of these structures, they mostly (12) derive from a movement’s initiative and the rest are developed by municipalities, multi-stakeholder partnerships, the church and the medical association. Additionally, an interest issue in this category is that almost half of the social workers (40 out of the 84) are involved in just two structures (for more see next section).

While social workers in category A are part of the volunteer team, the characteristics of social workers in category B are different. As shown in Table 2, there are about 15 social workers as paid staff in the structures. Naturally, this is the result of the profile of the initiative. The health professionals of institutional structures related to municipalities, multi-stakeholder partnerships, NGOs and the church are employees of these bodies, a concept that strongly discriminates them from the movement-derived SCs (Adam and Teloni, 2015). Social workers in this group either are permanent staff, work on short-term contracts in programs funded by the European Union (EU) such as the ‘Home Care’ project for the elderly, or are employees of NGOs, the church, and founding bodies of multi-stakeholder partnerships.

The characteristics of social workers in the third group (category C) reveal a rather indirect social work activity. According to the findings, 44 out of the 56 SCs operate with referral channels mainly with public social services. In particular, SCs provide information for users regarding their health and welfare rights and direct them to the public social services. The SCs that are derived by the movements seem to refer users mainly to public social services, such as social services departments in hospitals, municipalities or to the ‘Home Care’ project for the elderly.

An important aspect of solidarity as developed during the crisis should be underlined here. The austerity measures led to the exclusion of more than 2.5 million people from the national insurance system (Petmesidou et al., 2014) and to the continuing shrinkage of the national health system as significantly less health and social workers have been employed since the introduction of the austerity program. Thus there is a growing number of uninsured people, while many hospitals and public medical centers are unable to perform and deliver even the basic procedures. As a result, it comes as no surprise that even public social services refer users to the SCs where primary health care is provided free of charge.

This so-called indirect social work illuminates the involvement of social workers mainly for referrals with no further issues emerging through the research procedure. On the contrary, data illustrate further roles for social workers in categories A and B and we will focus on these two categories in the following section by presenting novel aspects for the future direction of social work in general.

The role of social workers in SCs

To the best of our knowledge the current project reveals for the first time the active involvement of social workers in SCs in Greece and their classification (Table 2). In this section we further analyze their roles and actions in categories A (social workers providing voluntarily service) and B (social workers as paid staff). Our study revealed the following interesting points.

First, there are fundamental differences in the nature of social work activities between the two categories. The findings for social work in category B demonstrate that these social workers (paid staff) are mainly involved in a bureaucratic and inspection role toward the claimants. As will be presented in detail below, interviewees presented the inspection of the claimant and his/her proof of documentation as their main duty. On the other hand, social workers of category A participate voluntarily and their roles range from holistic assessments of the claimants and social support to advocacy, collective action, information on welfare rights and activation of the users.

Second, there is correlation and potential causation link of social work activity with the organizational/political background of the SCs. In more detail, category A social workers in SCs developed by social movements and multi-stakeholder partnerships face more flexible criteria for the claimants in conjunction with their political/ideological affiliations (Adam and Teloni, 2015). This in turn seems to affect social workers’ roles where they have more ‘freedom’ to act on unrestricted terms and conditions. The SCs in category B, derived by institutional initiatives, have specific criteria for the claimants that make access stricter. It is also possible that the focus of social workers in bureaucratic procedures is actually demanded by their employers.

Third, the comparison and juxtaposition of findings disclose social workers’ activity in grassroots welfare structures as innovative with regard to Greek official social work, as will be further discussed in the following section.

In order to facilitate comparisons and incorporate broader considerations, the presentation is divided into two parts; we first present and discuss the findings in category A and then the results in category B.

A true solidarity paradigm is SCs derived by movements and multi-stakeholder partnerships

Almost half of the social workers (40 out of the 84 social workers in category A) are involved voluntarily in only two out of the 24 SCs. For those two structures a more detailed examination is provided below.

In the first structure 10 social workers are involved in a multi-stakeholder SC operated by the medical association, the Union of Hospital Doctors and the Medical Department of a university. These social workers (practitioners, academics and students) were members of the Greek Social Work Action Network which promotes critical and radical approaches.⁴ The social workers in this structure were not part of the team in its initial steps, but they became involved gradually in the provision of services as well as in the general assemblies of the SC. Their activities include social support and empowerment of the users, community work, information on welfare rights, and advocacy as well as research and participation in collective action for public health issues (demonstrations and campaigns).

In the second SC, which was clearly derived by a social movement initiative, a significant number of social workers (30) is involved exclusively in the SC. Interestingly, according to our findings, this is the only SC with such a big number of actively involved social workers. Moreover, the role of social workers is described by the interviewees as ‘vital’ and includes various levels of activity such as holistic assessment of claimants’ needs, information on welfare rights, activation of the users for collective action in demanding health rights, but also agitation for public social services. As the representatives/interviewees (doctor and social worker) of the initiative describe,

In our initial steps we (doctors) wanted social workers to be involved in the structure. We put this as a prerequisite for the function of the SC. Our dream was to create a structure, which won’t function similar to the national health system. What I mean by that is that we wanted people, when they visit us, to feel that there is someone that cares for them. We wanted people to feel that they can trust social workers. First of all, the claimants discuss with the social worker and then the social worker refers the user to the doctor … We wanted the social worker to be the link between the patient and the doctor … (47, Doctor)

Many of the SCs derived by social movements perform a dual role: on the one hand, expression of practical solidarity to the people in need and on the other, advocacy for a universal public health care system. In line with this, the interviewee above added a further goal of the structure – the promotion of an ‘alternative’ primary health model in the community. It is beyond the scope of this article to discuss elements of social innovation in SCs, but still we need to take into consideration that the above goals of the SC can further enhance the role of social workers as well as other health professionals and volunteers. However, and as it is mentioned in the quote above, social workers are the first professionals that users meet and their role is vital. Furthermore, the second interviewee of the SC also mentions the activation of the users as part of social work interventions:

We (social workers) do not substitute the state social services. There is a huge lack of social workers in the public social services and we are not here to substitute them. On the contrary, our aim is to activate people to demand collectively for their rights. (47, social worker)

Additionally, as in the majority of the SCs, social workers have an additional role which is the initial assessment of the claimant:

We also wanted social workers to ensure that people that come here are excluded from the national health insurance system. They (social workers) can understand who is really in need and who is not. From this point of view we also wanted the social worker to do this first important screening. (47, doctor)

This does not mean discrimination. On the contrary, this SC urges users to take action:

The vast majority of the claimants are in need. Through the interview we understand their needs. We do not ask from them proof of documentation. We haven’t put in force any financial criterion. The basic criteria are for someone to be in poverty and excluded from the national health insurance system. We want to be flexible. We have the experience to understand peoples’ needs. If someone has the right to obtain national health insurance, we inform them and from this perspective we try to activate them to gain their welfare rights. We are trying to have a holistic approach to peoples’ needs and not be bureaucratic. (47, social worker)

In the above structure, the interview by the social workers with the users is a tool for social support, while at the same time it is the link of users to the medical care provided by the SC. Social work, here, aims at the holistic assessment of users’ needs, informs them about their welfare rights, and activates them in order to demand their rights.

There are similar findings in other SCs with regard to the role of social work. Although there is a degree of control by social workers – through interview of the claimant – still the procedures are flexible, allowing social work to act on various levels. For example, in one of the SC in category A, volunteers do the check-in and social workers mainly focus on the provision of social support for the claimants. Additionally, social workers focus on the needs of people and the interview is a means of including and correctly guiding rather than excluding the claimants. Given that SCs in this category have set flexible criteria for the claimants, it seems that social work activity is not restricted by bureaucratic procedures, but expands to advocacy and provision of information concerning welfare and health rights of the claimants, as the findings reveal:

The intake of the claimant is done by volunteers. We only ask for a proof document on the lack of national health insurance. The volunteers refer many people to the social worker to provide them information and support. People do not know their welfare rights in many cases. The social worker is valuable for us. He works a lot, informs and supports people but he is also great in advocacy. He demands, with our support, the rights of the users from the public health system and he puts pressure on those in power. (51)

There are two social workers and one sociologist, a team. So they check those cases in which we are not so sure if they can be users of the SC such as people that could use public health services. So in these cases we might ask for additional proof documents such as the unemployment card. Still we do this for protecting the SC and not for excluding people. Even if someone does not have the proof documents we can accept them. For example there are people that have national health insurance but they cannot afford to pay for their medicines, or refugees that have no documents. We want to be flexible, not bureaucratic. We mainly do this for protecting the SC. (11)

Overall, the findings concerning social work activity by the rest of the 44 social workers (in category A) have been grouped in the following categories:

interview of the claimant;

information for welfare rights;

advocacy;

social support of the user;

participation in campaigns and actions for access to rights in the health sector;

in one case, involvement with other volunteers in the administration of the SC (provision of information, registration of the users, and appointments);

in one case the social worker was the co-ordinator of the SC.

It seems that social workers’ roles are largely consistent across category A SCs, such as interviewing the claimant, providing information on welfare rights, collective action, advocacy, and social support. However, there are differences among SCs concerning the interview of the user/claimant. First, the social workers – members of the Social Work Action Network (SWAN) – are not involved in the procedure of checking the criteria for the users. This is probably due to the fact that the specific SC had no strict criteria for providing services. Although there is a degree of checking procedures control, this is secondary and the interview is used as a tool for holistic assessment and provision of social support. Second, social workers’ activities include advocacy, information on welfare rights, and collective action in at least some SCs. Finally, the process of the assessment of who is eligible for service provision seems to be flexible and based on the needs of the claimants rather than on bureaucratic procedures. This is correlated to the profile of the SC. Specifically, as Adam and Teloni (2015) argue, the institutional structures have stricter criteria, while those associated with social movements have more flexible conditions such as not requiring proof of documentation or even no criteria at all. Undoubtedly the organizational context affects social work practice (Satyamurti, 1981), and the research in social work in Greece has revealed the close link of social work with politics (Ioakimidis, 2008; Teloni, 2011a). More specifically, the findings of a study concerning social work practice in municipalities and county welfare departments in Greece revealed that politics of welfare are apparent in every aspect of social work: legislation and organizational level, resources, social policy, social problems of the users, and so on, which in turn significantly affect social work practice (Teloni, 2011a).

Social workers as paid staff in institutional SCs complicate bureaucracy

In total, in category B, 15 social workers are paid staff in 10 SCs (see Table 2). These SCs either co-operate with state social services or/and the SC is under the umbrella of municipalities, multi-stakeholder partnerships, or the local church. Interestingly, the findings disclose that social workers – employees of institutional SCs – are mainly involved with the social investigation of the claimant:

The social workers in the social work department of the municipality do the investigation in order to provide the user with the card by which they can receive the services. (9)

The assessment and investigation is done by the social worker. She checks the proof documents and if the claimant fulfills the preconditions, then the social worker provides them with a card by which they can receive the services. (29)

The social services department of the municipality investigates and defines who is without national health security and who is in poverty. So it is possible for someone to be rejected. The claimants always visit the SSD [Social Service Department] before we accept them. (38)

The social worker checks the claimant, asks for the proof documents and then refers them to the SC. (40)

The claimants come to the SSD … if they are already registered here we just refer them to the doctors. If they are not registered in the SSD, they make an application with regard to a number of justificatory documents, they bring these to us and then we send them to the doctors. However, in case they can also claim for a benefit we inform them about the procedure. (40, social worker)

Of course social workers check the applications of the claimants and we interview those where we might suspect that something is going wrong. In many cases, the doctors tell us that some of the users might have hidden that they have national security, so the social workers check them. We need to do this in order to protect the credibility of the SC. (45, social worker)

Traditionally, social services of the local authorities in Greece use social investigation accompanied by strict financial criteria and proof documents for providing minimum welfare benefits to the claimants in poverty (Teloni, 2011a). Therefore, it might be the case that this role of social work has been maintained to some extent in these SCs. The research concerning social work practice in municipalities and County Welfare Departments in Greece has revealed that social workers in Social Services Departments (SSDs) were limited due to lack of staff and resources in hard-working conditions, in general described as abandoned SSDs by the state, even in the era before the crisis (Teloni, 2011a). This research revealed that social workers did their best in supporting the users (Teloni, 2011a) and it is also possible that social workers in institutional SCs also act in other levels as well. In general, as it was beyond the scope of the research, it is unknown to what extent the procedure of social investigation for the claimants in SCs resembles the one in official social work provided by the municipalities, and further research is needed. Still, the findings of this research reveal differences in social work involvement in the SCs that derive by social movements and the ones developed by institutional actors.

Finally, as far as SCs run by NGOs are concerned, the social workers are also involved in the procedures concerning volunteers. Specifically, in an SC run as a multi-stakeholder partnership (municipality, pharmaceutical association, and medical association) the social worker interviews the candidate volunteer:

We also do the interview with the candidate volunteer to find out if he/she truly wants to offer or there are some issues, sometimes there are psychological problems … We might also ask for some certifications. Still, in any case the final decision is upon the Mayor, who co-operates with the Presidents of the Pharmaceutical, Medical and Dentist’s Association. (45)

The involvement in volunteers’ procedures was also found in one NGO – out of the two that run a SC with social workers being involved as employees. This SC exclusively focuses on the prevention of cancer;⁵ the social worker organized it in its initial steps, but also trains and supervises volunteers who are cancer survivors. Therefore, the social worker has a multi-task role, providing social support, training, and supervision, but also involved in organizing the SC, at least in its initial steps.

Overall, in this section, the findings of social work activity and its role in SCs have been presented and discussed. In the following section, the main findings of the research presented here are discussed with regard to the challenges for social work.

Discussion

The SCs developed following the eruption of the crisis in Greece, as an answer to the unmet health needs of the population. The plethora and variety of these initiatives are in conjunction with the general rise of the solidarity movement during the first years of crisis in Greece. As it was discussed particularly for the health sector, the austerity measures had tremendous consequences for the population (Asimopoulos, 2012) and about 2.5 million people had no access to primary health care services (Petmesidou et al., 2014). In this context the SCs provide free primary medical care, mainly to those excluded from the health insurance system but also to the undocumented migrants (Adam and Teloni, 2015). Still, the aim of the structures differentiates with regard to the profile/political background of the initiative. Specifically, as mentioned earlier, the initiatives that are derived by social movements have the twin aim of solidarity and agitation for a universal public health system, while the institutional SCs have a more philanthropic approach. Naturally, the total activity of the structures reflects its aim.

Another important finding is the involvement of hundreds of volunteers across Greece in these initiatives, but also the involvement of other specialties such as speech therapists, social workers, psychologists, and so on. In this article we have presented and discussed some of our research findings focusing on the involvement of social work. Social workers are actively involved in the SCs voluntarily, or as employees of the local government/NGOs, or indirectly through the co-operation (mainly through referrals) with public social services in hospitals, local government, and so on. Undoubtedly there is a need for further research in the field concerning the role of social workers in each of the structures. Still, this research has revealed some interesting issues concerning social work’s involvement in the solidarity movement in Greece. First, the findings reveal that social work is actively involved in SCs. Second, the type of involvement differentiates with those who are voluntarily involved, social workers as paid staff, and a rather indirect social work involvement through referrals. The findings for social workers as volunteers disclose a variety of social work interventions such as interviews with the users, information on their welfare rights, advocacy, community work, and organizing volunteers. Importantly some social workers are also involved in the solidarity movement of the SCs, demanding rights to public health services and participation in demonstrations and campaigns.

Third, social work’s role seems to be correlated with the organizational/political context of the structure. Therefore in the institutional SCs, where social workers are paid staff, their role is mainly the social investigation/interview of the claimant, accompanied by proof documents and bureaucratic procedures. On the contrary, in the SCs that are derived from social movements and/or are developed by multi-stakeholder partnerships, social workers work voluntarily as part of the team. In these structures there are flexible procedures for the claimants, contrary to the institutional SCs. Although there is some kind of control through the interview, it seems that the concept of the ‘deserving/undeserving poor’ has been overcome by the SCs associated with broader social movements, which are based on trust in the users, avoiding judgments of ‘who deserves’ the services, and focusing on the needs of the people. The interview of the claimant is often used as a tool for a more holistic approach and assessment of the needs, focusing on inclusion rather than exclusion of the claimants within the humanitarian crisis attributed to the imposed austerity measures.

While bureaucratization, managerialism, and alienation in social work seem to dominate in the neoliberal context (Ferguson and Lavalette, 2004; Jones, 2001), grassroots initiatives challenge social work. Historically, social movements and users’ movements informed social work in both theory and practice, such as the feminist movement, Black movement, disabled movement, and so on (Ferguson, 2009; Langan and Lee, 1989; Lavalette and Ferguson, 2007). In the Greek case, as Teloni (2011b) and Teloni and Mantanika (2015) argue, the antiracist movement has shown innovative ‘paths’ for social work with an emphasis on multiple interventions and actions at both micro and macro levels. The authors (Teloni and Mantanika, 2015) claim that the example of antiracist movement feeds social work and vice versa, and in any case is in line with the basic aims and principles of the profession, meaning social change, political agitation for social change and social justice, and protection of human rights. Papadaki (2005) discussed the ‘culture of silence’ of the practitioners in public social services in Greece. This research revealed that social workers are involved in the solidarity movement and to some extent they are participants in advocacy for basic rights in health services. Although their participation was based on individual initiatives rather than collective initiatives (with the exemption of Greek SWAN), as Ioakimidis et al. (2014) have also shown, there are signs of radicalization of social work in the southern countries of Europe.

In these times of crisis, it is important for social work to critically re-examine its responses to the peoples’ needs (Dedotsi et al., 2016). In the Greek context, flourishing collective action through neighborhood assemblies, collective kitchens, free preparation courses for schools, and recently the growth of the solidarity movement for the refugees are signs of a society that, despite the crisis, seeks and creates structures of solidarity but also acts politically and demands social justice. The grassroots welfare initiatives are a valuable ‘social laboratory’ created by the people and for the people. SCs are one of the facets of grassroots initiatives that have flourished in the era of crisis in Greece. In our opinion, these initiatives associated with the solidarity and antiracist movement constitute an example of community action. As Popple (1995) claims, community action is mainly applied by activists, but historically has affected community work and social work significantly (Graig et al., 2011).

Linking social work with progressive social action can be a key issue for social work’s development in conjunction with its aim and values.

Footnotes

Funding

The research was funded by the Observatory of Social and Economic Developments, Institute of Labour Studies, General Confederation of Greek Labour.

Notes

Author biographies

Teloni Dimitra-Dora, MA, PhD is Assistant Professor (Adjunct) in TEI of Athens, Social Work Department. Her publications and research interests focus on radical social work, poverty and social services, social movements and social work and community development.

Sofia Adam is an economist with a PhD in social economy and social policy. She has worked extensively as an independent researcher on issues related to the third sector, and social and solidarity economy from an applied policy perspective.

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