A health centre for a neighbourhood based on solidarity

Interview with activists from 'Poliklinik Freiburg - Solidarische Stadtteilgesundheit'

Initiatives from several cities that want to set up solidarity-based health centres or polyclinics have joined forces in the Polyclinic Syndicate. Such health centres already exist in Hamburg, Berlin and Leipzig. Development work is underway in several other cities. Katharina and Salome from Solidarische Stadtteilgesundheit Freiburg spoke to Care Revolution about the aims, motivation and concrete steps.

I: We're talking about the Freiburg Polyclinic project or Solidarische Stadtteilgesundheit. Perhaps we could start by you telling us a bit about yourselves.

K: I am Katharina. I trained as a nurse and worked in the profession and then went on to study medicine. I had been frustrated with the healthcare system for a long time and then came across the polyclinic movement, the solidarity-based district health movement, through various organisations. We then founded ourselves in Freiburg in 2019.

S: I am Salome. I'm also a nurse and nursing educator. I found out about the polyclinic around 2016, when there was an initiative to set one up in Hamburg. I then received a brochure from them and I was impressed by their approach. When I came to Freiburg, I found the Poliklinik group here and have been a member for maybe four years.

I: You said that you were founded as an initiative in 2019. Is it correct that you really started with a project in the Brühl-Beurbarung district in 2022?

K: The first few years were mainly concept development, concept development. We used the social atlas of the city of Freiburg to see which neighbourhood we should get involved in. Ultimately, it would be cool if there was a solidarity health centre in every district. But we looked at which neighbourhoods are in a precarious position and used this as a guide. In 2022, we then started working practically in Brühl-Beurbarung, not just doing concept work and research.

I: And you also founded an association.

K: We founded an association. Together with seven other cities, we also founded the nationwide association, the Polyclinic Syndicate.

I: You said that you go to places where the situation of the residents is particularly precarious, where you are needed. But you certainly don't just want to plug holes. What is your approach, what makes you a neighbourhood health centre based on solidarity?

S: I would like to say that the concept behind the polyclinic, the big goal, is that we don't just understand health as: If you are ill, you go to the doctor and then the illness is treated. We see health as something more holistic, in particular that we also look at the social determinants of health: What makes people ill in society, where can we start? Health definitely has the component that poverty makes people ill, i.e. that poorer people are sicker and die earlier, on average by ten years, and under these conditions health and healthcare must be thought of differently. In other words, we need to focus and take action in areas where people's lives are particularly characterised by precarity.

K: It is often the case that there are already many programmes that are paid for by the municipality or the state. But these programmes often fail to reach the people who need them most. We want to resolve this with the solidarity-based health centres. We want prevention and health services to be able to reach people at a low threshold. That is why we are also striving for interdisciplinarity. This means that there is not only health, general practitioner or paediatrician care, but that it is combined with psychosocial and legal advice. Because these topics are interlinked.

S: Another aspect is community work, i.e. involving the people themselves who live in the neighbourhood. In other words, a participatory approach: Not just thinking about what you can offer people yourself, but working it out with those who are affected.

I: What are you doing to reach people?

K: We started with a survey in the neighbourhood. The questionnaires came back in the three-digit range because we were able to remunerate participation. We gave them out in different languages and distributed them in all kinds of places in Brühl, but also in letterboxes, in the neighbourhood office of the neighbourhood work, etc. We asked what resources there were. We asked what resources were available, but also what people felt. Specifically, loneliness was often mentioned as an important aspect in Brühl. This is also reflected in what the social atlas shows, for example that many single parents live there. After the survey comes the next step in terms of participation: multipliers. There are a few different concepts and approaches on how to find people in the neighbourhood who can be seen as multipliers. There is the concept of health pilots, people who can guide people in their community through the system, have a certain level of expertise and can report things back. We are currently working on this approach. Of course, it takes a bit more work: a participatory approach is always more time-consuming because it requires dialogue to establish a basis of trust. We don't want to go into the neighbourhood paternalistically and think "You need this and this and this is what we're going to do now." Rather, our aim is for this to be named from within the neighbourhood.

S: As part of the needs assessment, we conducted a survey of the population, but we also organised a kind of round table with - we called them experts - people who are active in the Brühl-Beurbarung district as part of their professional work, but also their voluntary work. We brought them together and tried to work out with them what the needs of the population are from the perspective of those who are involved in the neighbourhood, for example as GPs or those who work for the AWO. And we also asked: How could we approach the people in the neighbourhood, what is important from the perspective of those taking part in the round table?

I: That sounds like you need a lot of staying power. Have you already seen any success in people approaching you or developing self-confidence when dealing with the authorities, for example?

K: We are definitely noticing that we are becoming better known in the neighbourhood and that people are slowly starting to perceive us as a group. We have started offering outreach counselling and we also have the feeling that we are being perceived as a group, that a basis of trust is developing and that the meetings have been very well received so far. We have also initiated a parent-child café, especially for single parents. This will take place from the beginning of May. It's a very, very long road. If we try to involve the residents in the neighbourhood, it can only happen slowly. We can't impose it from the outside. An intercultural brunch is also planned. This may also lead to further discussions. That's also something against loneliness, an attempt to bring the neighbourhood together.

I: This means that you also work together with semi-governmental organisations such as the neighbourhood office. Is this a good collaboration or is it also fraught with conflict?

K: The collaboration was really good right from the start. We had also put out feelers to other districts and in Brühl it was such good cooperation with the Nachbarschaftswerk and the neighbourhood office right from the start. That's very good.

I: But ultimately you want to have your own premises and a cash desk and all that?

S: There are long-term and short-term goals. The long-term goal is to have the polyclinic as a district health centre where different professional groups can work and the whole project can be implemented. That is still where we want to go in the long term. It has become clear in recent years that the polyclinic as an overall project will take a very long time and that many different aspects play a role here. We want to start being active now so that everything can develop organically. Building the polyclinic is something that is happening in parallel.

K: It's also the case that we are a nationwide movement. There are now 12 or 15 cities in Germany where there is a group. Leipzig, Berlin and Hamburg already have a centre where they are already working, and Dresden will also have one from May. This allows us to see a bit of where we're heading, we can also learn from each other; that's very beneficial. We also learn from each other as a movement. It's good to hold on to this because you have something like a common thread and know that the steps we're taking now make sense and can lead to the goal.

I: Maybe it's a stupid question because it's so obvious to you: the whole thing sounds like a process that is tough, that is precarious in the sense that you don't know whether it will work or fail. What is it that makes you and people in so many cities stick with it?

K: For me, it's definitely the nationwide movement. We just had the general meeting in Dresden at the weekend and there were 100 people there. There are eight groups that are officially in the association and three new ones that are being accepted as trial members. It's cool to see that Berlin now has 43 paid positions at the centre, so just like in Hamburg, it's now paid work. The attempt is of course always to remunerate all occupational groups without a pay gap: Everyone earns the same or according to need - there are different concepts. It's definitely something that really convinces me, because I can see how well it can work and what a difference it can make to a district if there is a centre like this. Here in Freiburg, too, so much has been created in the last six months to a year and so much good feedback has come from the neighbourhood. So I have the feeling that we are starting to change something in the direction of Brühl-Beurbarung becoming a neighbourhood based on solidarity.

S: I would also like to mention the need for such centres, that they are needed. We also have a problem with social inequality in Germany and the existing healthcare structures are not able to deal with this sufficiently. And I don't see that anything will change if we don't do it ourselves. For me, the concept of polyclinics and the idea behind them, the different view of health, is simply a counter-concept that needs to be developed.

I: If people read the interview now and want to get started - would you be able to give them any tips?

S: We would say: definitely come along! We are a very open group and are always happy to hear from people who are interested in our work and who are interested in getting actively involved themselves. You don't need to be put off by the fact that it's about health. It is not a prerequisite that you work in the health sector yourself or have the relevant training. It doesn't matter where you come from professionally, what we do in our group can be connected because it covers so many areas.

K: I would definitely advise people in another city to get in touch with one of the geographically closest groups. We actually have a nationwide buddy system, so that you can support new groups when it comes to founding an organisation or non-profit status or how to get started. The support system actually works very well; there is also a lot of solidarity within the movement. It is structured in such a way that there is a lot of knowledge transfer and that there is a common platform where you can exchange ideas.

I: Thank you very much!