Family physicians and other health workers across Turkey stopped work for three days on November 5-7 against an amended regulation attacking their working conditions. The new conditions came into force on November 1. Health workers have announced they will stop work for five days between December 2 and 6 if the regulation is not withdrawn. A protest rally in Ankara by family physicians on October 19 was joined by thousands of people.

The new regulation imposes many administrative tasks on family physicians that are not part of their professional duties. In addition, a change in payment coefficients and increased performance quotas mean physicians will face serious salary cuts.

The work stoppage on November 5-7 was called by the Turkish Medical Association (TMA) and other health organisations at Family Health Centres (FHCs) across the country. Physicians and allied health workers stopped work at thousands of FHCs across Turkey and protested in city squares and in front of health directorates.

Health workers have demanded the regulation be withdrawn and are calling for improvements to working conditions and public health services. These include public provision of equipment and infrastructure for FHCs, including a maximum of 2,000 patients for each family doctor, and the hiring of more nurses, midwives and technicians on secure employment terms.

Dr. Ahmet Kandemir, President of the Family Health Workers’ Trade Union (AHESEN), said, “Although we organised a big rally in Ankara and a three-day work stoppage against the ‘Oppression’ regulation, the Ministry of Health chose to ignore us. We decided to stop work for another five days for our professional honour and the future of public health.”

Kandemir said the regulation changes the patient-physician relationship into a customer relationship, and made clear the Ministry of Health will be responsible for any suffering arising from it.

Dr. Sibel Uyan, secretary of the Family Physicians Branch of the TMA, said the solution to health problems is to strengthen primary health care services, adding: “Many problems, such as the lack of appointments, the lack of medicines, the commercialisation of health care and the problems caused by the performance system, have arisen because of the preferences of the political will [the government]. In the face of these problems, we are again faced with a regulation that includes the imposition of performance and penalties.”

Uyan said that basic public health services including vaccination were already suffering, “Today, the family health care system is no longer workable for family physicians, midwives and nurses. This regulation, far from improving public health and the rights of health workers, will deepen the existing problems. Our struggle will continue until the regulation is withdrawn.”

Emrah Kırımlı, head of the Family Physicians Branch of the TMA, told Artı Gerçek that the regulation will deepen problems in the health system and render preventive health services ineffective. Kırımlı explained that “family health centres have bigger problems physically, administratively and financially”, adding that “the proposed regulation does not respond to any problem”.

In response to protests from family physicians and health organisations, Health Minister Kemal Memişoğlu has defended the new regulation. Memişoğlu said claims that “family physicians will not be able to prescribe medicines” were not true, saying: “The regulation does not interfere with diagnosis and treatment; it does not remove the freedom to prescribe.”

Health Minister Memişoğlu’s statements defending the regulation are nothing but an attempt to hide the bankrupt state of the health system. The recent scandal of 12 newborn babies being sent to their deaths in private hospitals for the sake of profit has dramatically revealed how the capitalist health system sacrifices human life for the sake of profit. The almost complete subordination of health services to the capitalist market has created the material basis for such crimes.

With the “Health Transformation Programme” launched in 2003, the Justice and Development Party (AKP) government accelerated the transfer of public services to the control of big banks and private companies. Since 2002, the number of public hospitals has increased by only 12 percent, while the number of private hospitals has increased by 110 percent. The share of private hospitals in the total number of hospitals has increased from 23 percent to 36 percent, while 52 percent of intensive care beds for newborn babies are in the private sector.

The public health system is in a similar state of collapse, not only in Turkey but all over the world, a consequence of the subordination of public health to capitalism. The pandemic has exposed the fragility of health systems around the world and the devastating consequences of profit-driven policies.

Staff shortages and austerity measures are further weakening health systems, while large hospital chains refuse to provide adequate wages and staffing for their workers. In every country capitalist governments are slashing health budgets to fund the military and to transfer greater wealth to the financial oligarchy through corporate tax cuts and bailouts.

The struggles of health workers in Turkey must be organised as part of the growing working class resistance internationally against social inequality, austerity, war and the capitalist system that is their source.

Workers’ determination to struggle is growing despite the efforts of the trade union bureaucracy to obstruct and undermine it. Recent strikes by municipal workers to defend their living conditions against the rising cost of living, despite the trade union apparatus, are an example of this.

A strike by Kartal Municipality workers in Istanbul at the end of October was ended with a sell-out contract signed by the Genel-İş Trade Union (affiliated to the Confederation of Progressive Trade Unions of Turkey/DİSK). The workers’ de facto attempt to continue the strike was prevented by the union leadership. The determination of the workers to fight and the destructive role of the trade union apparatus was repeated in the Maltepe and Buca municipal strikes.

Workers must build rank and file committees to take the struggle into their own hands, independent of the trade union apparatus which collaborates with the companies and the state. These committees will enable workers from all sectors, including health and local government, to coordinate and unite their strikes and call in support from other sections of the working class.

The recent formation of rank-and-file committees of health care workers in the US, Sri Lanka and Australia demonstrates the potential for building transnational networks of struggle and solidarity independent of the unions. The International Workers’ Alliance of Rank-and-File Committees (IWA-RFC) has been formed to bring together struggling workers in all workplaces, sectors and countries on this basis.