23 APRIL 2019 / SNF Health Initiative - 4th Regular Quarterly Progress Update

The Stavros Niarchos Foundation’s (SNF) Health Initiative encompasses a series of major new grants related to healthcare in Greece, with a budget totaling over $339 million.

In cooperation with the Greek Ministry of Health, which identified the greatest needs in the field, the initiative aims to strengthen the country’s public health sector.
 
Specific projects within the Health Initiative include creating the new General Hospital of Komotini and the Children’s Hospital of Thessaloniki, both of which will bear SNF’s name; supporting nurses and nursing; enhancing the National Center for Emergency Care’s (EKAV) medevac capabilities; supplying specialized equipment to public hospitals throughout the country; and realizing educational programs related to pressing health issues. Components of the Health Initiative are described in detail at www.SNF.org.
 
In the spirit of transparency that is of particular importance to SNF in projects involving cooperation with the public sector (such as the creation of the Stavros Niarchos Foundation Cultural Center, an update overviewing progress in each project within the Health Initiative is published every quarter. In this update is included a review of the activities of the past year, from the signing of a Memorandum of Understanding (MoU) between the Greek state and SNF for the implementation of the Health Initiative on March 21, 2018, to today.
 
In the months following the signing of the MoU, SNF assembled a team of partners to ensure optimal design and implementation of the infrastructure projects. Hill International has undertaken the management of the infrastructure projects, while Johns Hopkins University and Johns Hopkins Medicine act in an advisory capacity to share the expertise of a major U.S. health institution in Greece. Architectural firm Renzo Piano Building Workshop has taken on the design of the infrastructure projects in collaboration with Greek architectural firm Betaplan and British company Llewelyn Davies, which specializes in hospital design.
 
On September 20, 2018, the Grant Contract between SNF and the Greek state was ratified by law by the Greek Parliament. The Contract sets out the framework and the general terms and conditions for the implementation of these grants by SNF. Following the ratification under law of the Grant Contract, the non-profit Special Purpose Vehicle (SPV) “Health Initiative SA” was established to oversee the coordination, management, and implementation of the projects until their delivery to the Greek state, upon which it will cease to exist. A Special Advisory Committee of the Greek state was also established, aiming to keep all parties effectively informed and involved and to manage any issues that might arise. The 1st Regular Meeting of the Special Advisory Committee took place on September 28, 2018, and a total of eight meetings have been held so far.
 
Continuing our commitment to providing timely, regular, and comprehensive information to everyone on the progress of the grants, the 4th Regular Quarterly Progress Update on the Health Initiative is presented below. This update comes outside the SNF-set standard timetable to reflect last-minute developments relating to the educational component of the initiative.
 
Over the past year, the individual projects within the Health Initiative have made significant progress:
 
>New SNF General Hospital of Komotini
Following finalization and approval of a building and clinical program for the new SNF General Hospital of Komotini by the Ministry of Health, as well as the launch of studies for complementary infrastructure projects, the project is now in its preliminary study phase. Per the current timetable, this phase will last four (4) months, reaching completion in June of this year. Upon completion of the preliminary study, the final study, estimated to take six (6) months, will follow. According to current timeline, completion and delivery of the new General Hospital of Komotini is expected in June of 2024.
 
> SNF Children’s Hospital of Thessaloniki
A strategic plan for the SNF Children’s Hospital of Thessaloniki has been finalized and approved by the Ministry of Health. Development of a detailed building and clinical program by the team of consultants collaborating in the project is now underway. When this is complete, which is expected within the month, it will be submitted for final approval to the Ministry of Health. According to the current timeline, completion and delivery of the SNF Thessaloniki Children’s Hospital project is expected in October 2024.
 
> Support for Nurses and Nursing
(Procuring equipment and designing curricula for three Educational Nursing Units at Evangelismos General Hospital and at the School of Health Sciences of the National and Kapodistrian University of Athens)
As reported in the 3rd Regular Quarterly Progress Update, the Board of Directors of Evangelismos Hospital declined to move forward with the construction of the proposed building which would have functioned as the headquarters of the Department of Nursing of the School of Health Sciences at the hospital. Consequently, following extensive discussion, the construction grant has been cancelled.
 
However, at the initiative of SNF Co-President Andreas Dracopoulos and in line with the effort to support nurses and nursing in Greece, the three Educational Nursing Units at Evangelismos General Hospital and the School of Nursing of the National and Kapodistrian University of Athens (NKUA) were asked to submit new proposals for equipment procurement and education programs. These would be included as individual grants under the Health Initiative.
 
Representatives of the Nursing Units at Evangelismos General Hospital and the Department of Nursing at the School of Health Sciences at the NKUA presented their proposals. With financial support from SNF, a team of nurse representatives from both organizations visited Johns Hopkins Hospital in Baltimore to exchange ideas on equipment and designing curricula in the field of nursing. At present, these proposals and a timeline are in the process of being finalized.
 
> Procurement and Installation of Equipment at Evangelismos General Hospital
The task of supplying and installing equipment at Evangelismos General Hospital is progressing smoothly and in accordance with the prescribed procedures. Following the ratification of the individual grant agreement under law by the Greek Parliament on September 20, 2018, SNF, in coordination with the Hospital’s Board of Directors, divided the procurement project into sub-stages to ensure coordinated implementation.
 
A call for tenders for all the specified medical equipment, as drafted by the Hospital and the Health Ministry, has been put out by SNF. Procurement and installation of the medical equipment is expected to be completed by March 2020, provided that the Hospital's obligations are fulfilled within the established timetable.
 
> Procurement and maintenance of equipment for the National Center for Emergency Care’s (EKAV) air ambulance services
The details of this grant were modified following a suggestion by the relevant Project Team of the Greek state to include the repair of two (2) AGUSTAA109E helicopters rather than three (3) as originally planned. The decision to modify the number of helicopters to be repaired was made on the basis of a cost estimate report by companies in the industry, which indicated to the Greek state that the cost of repairing one of the three made doing so financially and functionally unproductive.
 
In addition, the grant includes the purchase of two (2) new airplanes for medevac operations for which cost estimate reports have been completed. As a next step, approval by the Greek Parliament of the individual donation contract is required, then the selection of a contractor for the repair of the helicopters and the supply of two new airplanes will be made by SNF with the approval of the Greek state. The aim is delivery to the Greek state in March 2021.
 
> Procurement and Installation of Specialized Medical Equipment across Greece
Following a joint evaluation by SNF and the Ministry of Health, the exact details of the grant for the procurement and installation of PET (positron emission tomography) equipment, as well as for the creation of radiopharmaceutical manufacturing units in selected public hospitals, were established.
 
According to the Ministry of Health’s original plan, the installation of PET equipment was to be carried out at the University Hospitals of Heraklion, Ioannina, and Larissa. SNF had put forward a proposal to consider the inclusion of the University Hospital of Alexandroupolis in the project as well, and it was approved by the Greek state’s Project Team. At the same time, a decision was reached to create radiopharmaceutical units at the University Hospitals of Heraklion, Ioannina, and Larissa and at the Papageorgiou General Hospital of Thessaloniki. A framework clearly defining the obligations of the parties involved is now being finalized so that this specific grant contract can be ratified under law. This grant is expected to be completed in August 2020.
 
> Design and Implementation of Educational Actions
At approval, this grant involved the design and implementation of two distinct educational on, respectively, the treatment of trauma and in-hospital infections.
 
Following the previous regular quarterly update, the National Center of Advanced Trauma Life Support (ATLS), based at Athens Attikon Hospital, in collaboration with the NGO Regeneration & Progress and representatives of the Ministry of Health, developed a proposal for educational programs for medical and nursing students, as well as medical staff.

The proposal comprises four individual programs: the ATLS program for the training of medical students in the treatment of trauma; the ATCN program for the training of nursing students in the treatment of trauma; the Scholarship Program for the training of doctors in the treatment of trauma at the world’s largest trauma center, the Chris Hani Baragwanath Academic Hospital in South Africa; and a training program for surgeons, with the use of laparoscopic surgery and arthroscopy simulators.

Since a number of issues have emerged regarding the implementation of the ATLS and ATCN programs, SNF is reexamining whether the grant component pertaining to these programs is implementable within the current operational framework. In the event that no agreement is reached between the parties, this component of the grant may be canceled.

The scholarship program in South Africa and the training program for surgeons with the use of laparoscopic surgery and arthroscopy simulators is proceeding as originally agreed with the Ministry of Health.

The portion of the grant related to in-hospital infections came about when the SNF proposed to the Ministry of Health including a comprehensive proposal for their treatment in the Health Initiative. The incidence of infections in hospitals contributes to increased mortality rates in Greece. With the agreement of the Ministry of Health, the SNF has worked over the past fifteen months to find an optimal solution for the design of this project. However, the relevant Greek Project Team did not submit a fully developed proposal for implementation to the SNF for evaluation. Furthermore, it recently came to SNF’s attention that a similar educational initiative is already being implemented by a Greek governmental body, with resources from the Greek government. Consequently, SNF has informed the Ministry of Health of its decision to cancel the specific component of the grant related to infectious diseases.
 
SNF’s decision to undertake a landmark Health Initiative stems from our desire to help improve Greece’s public healthcare system, to the extent possible. Recognizing the critical need for the establishment of an impactful program addressing hospital infections and their devastating outcomes, SNF will continue to examine the possibility of helping to address this serious issue in collaboration with other institutions.
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Appendix
 
SNF Health Initiative milestones so far
September 6, 2017: Announcement of the Health Initiative by the SNF
March, 21 2018: Signing of a Memorandum of Understanding between the SNF and the Greek state
June 20, 2018: Presentation of preliminary building plans by Renzo Piano to the Prime Minister at the Maximos Mansion
September 20, 2018: Ratification under law by the Greek Parliament of the Grant Contract for the Health Initiative
September 27, 2018: First Meeting for the Special Advisory Committee for the Health Initiative (so far, eight meetings of the Special Advisory Committee have taken place)
 
A few words on SNF’s support for healthcare in Greece
 
The Health Initiative follows a $15 million SNF grant to the National Center for Emergency Care (EKAV) last year for the acquisition of 143 state-of-the-art ambulances and their full maintenance for a period of eight years, as well as for digital upgrades to EKAV’s operations center. Since 1996, when it began its grant making activity, SNF has provided grants totaling more than $130 million for the support of healthcare in Greece. Past grants in the health sector include a $23 million grant for the procurement and installation of ten linear accelerators in seven public hospitals across Greece; a grant for the renovation of all Pediatric Intensive Care Units (ICUs) in Greece; and a grant for the construction and outfitting of hostels for the relatives of patients in hospitals around the country including in Alexandroupoli, Ioannina, Patras, and Crete. In addition, SNF initiated the Mobile Medical Units program in collaboration with Regeneration & Progress to provide free specialist medical care to the inhabitants of islands and remote regions in Greece, including Kastelorizo, Schinousa, Astyplea, Agathonisi, Kasos, and Prespes, among others. For more information, please visit www.SNF.org.