Health needs politics - Newspaper article

The Polyclinic Syndicate

Challenges and prospects of a growing movement. Since the founding of the first Solidarity Health Centre on the Veddel in Hamburg in 2017, eight permanent groups with social sponsorship have been established in various cities across Germany: in Cologne, Freiburg, Göttingen, Berlin, Dresden, Jena and Leipzig. The centres are at different stages of development, but they are all united by a common vision: to promote a solidary, emancipatory and discrimination-sensitive society that manifests itself through transformative and neighbourhood-based healthcare in the respective districts.

In May 2023, the umbrella organisation of solidarity-based healthcare centres, the Poliklinik Syndikat, was founded in Leipzig. The syndicate supports the establishment of new centres in particular. These are developed on the basis of a policy paper and the specific needs of the respective neighbourhood. An important part of the supportive process is the exchange of best practice approaches, which takes place twice a year at the syndicate's association meeting, to which each member group sends a delegation. The syndicate is growing steadily. In addition to the permanent groups in various cities and municipalities, there are currently eight loose groups that already have candidate status in the syndicate: Munich, Tübingen, Frankfurt, Marburg, Nuremberg, Bonn, Berlin 2.0 and Lübeck. Projects are also forming in rural areas in Demmin and Wahlsdorf, where a small cultural and health centre will be created in the future, which is still open for conceptual design. Despite the growing spread and public perception of solidarity-based health centres, for example in election manifestos, in reality they are still predominantly self-organised and precariously working, but jointly fighting model projects.

A long-term, sustainable, comprehensive and realistic financing concept is still lacking. This applies both to the local groups and at syndicate level. To date, the syndicate's work has been financed primarily by contributions from the individual member groups; however, the first foundation grants have been available since last year, and in future the syndicate is to be financed primarily by raising its own funds. The syndicate's work is mainly realised through activist commitment from the local groups, but also through part-time paid employment. The centres are usually financed by a patchwork of grants, donations and sponsoring memberships. What makes this already shaky funding more difficult are the changing political majorities in recent years. The state elections in Saxony and Thuringia have exacerbated this, making it more difficult to acquire municipal funding in the future. One aim could be for the syndicate to step in in precisely such precarious political situations and support the local groups financially so that they can carry out their work locally with less pressure. To this end, the syndicate will also be launching a fundraising campaign in the near future, for example to facilitate start-up financing for projects by contributing its own funds.

The Polyclinic Syndicate also aims to formulate and publicly represent health policy demands. Part of this is nationwide and cross-local lobbying in order to improve both the centre's work and the healthcare system as a whole in the long term and thus implement the basic transformative idea.

At present, the long-term implementation of polyclinics as primary care centres is also failing due to legal hurdles. The financing of the health centres is based on contribution payments and follows a different financial logic than the building blocks of community work and counselling, which are also essential components of the polyclinic concept. The latter can be sensibly financed through municipal and foundation-based funding via non-profit organisations. However, there is currently no legal form that combines all of the planned components. Therefore, polyclinics can only be realised through a combination of different legal forms and different wage and accounting systems. The syndicate can play an important role here by representing the interests of the centres and formulating requirements. One example of this would be the demand that associations that are firmly anchored in the neighbourhood should also be able to offer primary care under their sponsorship.

In addition to financial challenges, there are also idealistic questions, such as which doctor or psychologist is prepared to work for a standard wage that is significantly lower than what these professional groups earn outside the organisation. At the centre of the Poliklinik Syndikat's self-image is an internal reduction in hierarchy. The historically evolved supremacy of the medical profession, which has also manifested itself along intersectional categories such as race, gender and ability in different salaries in the healthcare system, is to be critically scrutinised and replaced by an interdisciplinary and egalitarian approach in which all professions are accorded the same expert status. The debate on this topic is being taken up at syndicate level, for example through the composition of the steering committee, which is organised according to professions and gender, in order to sharpen the perspectives of the umbrella organisation towards interdisciplinarity and intersectionality.

The idea of solidarity-based health centres is not only increasingly manifesting itself in Germany, but networking is also gaining momentum internationally. The syndicate has been represented at the annual International Network of Social Clinics (INOSC) networking meeting since 2022, and last year a manifesto was drawn up and signed in which the members agree on their work and present their centres and working methods. Looking beyond the German horizon is often very inspiring. What would it be like if demand-orientated concepts for outpatient care were already firmly anchored in the existing healthcare system, as is the case with "Médecins pour le Peuple" in Belgium? What would our collaboration look like if everyone earned exactly the same, as in the "Village Santé" in Grenoble? Or what would it mean for our political work if we worked autonomously and without state funding, like the "Social Clinic" in Thessaloniki? Over the last ten years, solidarity-based health centres in Germany have developed into an important authority in the discourse on emancipatory healthcare. Through their daily work, they contribute significantly to the realisation of the shared vision. With the founding of the Poliklinik Syndikat, they have now created a political umbrella organisation that bundles synergies, promotes the professionalisation and long-term establishment of the centres and represents the movement both nationally and internationally. The Polyclinic Syndicate looks to the future with confidence and, thanks to the diverse experience of its members, believes it is well equipped to master the challenges that lie ahead.

Mari Zeller, occupational therapist in paid employment, Poliklinik - Solidarisches Gesundheitszentrum Leipzig e.V.