Navigating the political and technical challenges of developing a national HRH strategy: a case study in Greece

Healthcare workforce reforms to enable implementation of government health policies require government leadership, and commitment of various stakeholders, but workforce reforms often meet resistance from powerful stakeholders. We use Kingdon's Multiple Streams framework to explain how in 2017, in Greece, the interplay between problems, policy and politics led to government marshalling support from experts to develop a National HRH Strategy. A window of opportunity for healthcare workforce reforms occurred because of the Ministry of Health's acknowledgement of structural workforce problems (problem stream), the introduction of policies and decrees on Primary Health Care and Public Health, and availability of globally formulated HRH policy solutions (policy stream). Additionally, interest of the government in Universal Health Coverage combined with reform requirements from European loan providers provided political opportunities (politics stream). This experience shows 1) the opportunity for change presented by circumstances; 2) the importance of creating healthcare workforce capabilities within the government to implement a health policy agenda. However, windows of opportunity are short-lived political interest is fleeting, competing problems may arise, alternative solutions may be proposed or governments may change. We conclude with a key challenge for success: how to assure continued government commitment to HRH reforms in a changing political context.