Workers in Turkey’s primary health system have launched a five-day protest to oppose new regulations that prioritize commercialization and profit over care, and impose financial penalties on health staff. Beginning on January 6, the protests have included rallies across the country, culminating in a general healthcare strike on Wednesday to amplify the workers’ demands.
The demonstrations are coordinated by a coalition of a dozen professional associations and trade unions, including the Turkish Medical Association (TTB), the Union of Health and Social Service Workers (SES), and the Federation of Associations of Family Health Workers, Midwives, and Nurses. These organizations have called for public provision of primary care, reduced patient loads for family physicians, and adequate staffing levels to meet patients’ needs.
This is the third time since November 2024 that health workers have staged work stoppages and taken to the streets to oppose the regulation. They warn that the government is undermining the essence of healthcare by introducing performance evaluation systems into primary care, after doing the same in hospitals. “We view health as a fundamental right, but the Ministry treats it as a sector, with performance criteria based on profitability,” said Dr. Emrah Kırımlı of TTB’s Family Physicians Branch steering committee in a conversation with Peoples Health Dispatch.
Read more: Turkish health workers intensify protests amid soaring inflation and poor working conditions
The new regulation also imposes time limits on patient visits, allowing mere minutes for appointments, including those for managing chronic diseases. Under this framework, each primary care physician in a family health center is expected to see at least 64 patients daily to reach a full salary. This patient overload will inevitably compromise the quality of care, leaving those with complex conditions behind or forcing them to pay for the care they need. “This system incentivizes more patient visits, equating to higher payments. Consequently, less time is allocated per patient, prioritizing curative over preventive care,” explained Dr. Kırımlı.
While the Ministry of Health has claimed to expand healthcare coverage, the reality has been far more complicated. Primary health care, intended as the access point to the health system, is often bypassed, with patients seeking consultations directly at other levels. At the same time, space has been crafted for private sector involvement through outsourced services or standalone institutions. Over time, the strengthening of this trend has led to devastating consequences. One of the latest examples of this involved health workers transferring infants from public to private hospitals for unnecessary procedures, resulting in the deaths of at least ten children.
For years, primary health care workers have struggled against the dominant profit-driven logic to protect people’s health and wellbeing, says Dr. Kırımlı. Despite their efforts, policy trends have moved in the opposite direction: reforms, such as the introduction of capitation-based payments, have prioritized revenue-generating activities over health needs. In general, this has included outsourcing laboratory and imaging services to private firms and an increasing focus on health tourism. “We oppose the implementation of such systems in primary care,” Dr. Kırımlı asserts.
Read more: 5th People’s Health Assembly calls for the transformation of health systems
Facing the looming threat of financial penalties for failing to meet visit quotas, the nature of general practitioners’ work is expected to change drastically. Strike organizers described the new system as reducing doctors to “video game characters collecting points,” undermining their professional independence and dignity. “We are doctors, not shopkeepers,” the associations stated, highlighting the increased administrative burden and efficiency demands. “We do not want to be forced to think about anything other than the health of our patients.”
The groups most affected by these changes will be those who rely heavily on primary health services, including migrants and populations facing barriers to healthcare access. “The already fragile primary care system will lose its capacity to address inequalities,” warned Dr. Kırımlı. Previously free services are now subject to fees, with most migrants being required to pay for care. “These changes undermine accessibility, disproportionately affecting the most vulnerable,” the physician emphasized.
Ripple effects to be felt across the health workforce
The workforce is also expected to feel the ripple effects of these changes. According to estimates from TTB’s Family Physicians Branch, out of Turkey’s 1.5 million health workers, fewer than 70,000 are employed in family health centers—and their earnings lag behind other parts of the healthcare sector. Under the new regulation, nurses and midwives at this level face salary cuts of 20-30%, Dr. Kırımlı noted, compounding pre-existing financial pressures. Persisting with this model, he warned, “will drive healthcare workers away from primary care, further weakening an already fragile system.”
Rather than pursuing the current path, family physicians and other primary health care workers are calling for a reevaluation of the role of primary health care within the system. They also want more investment and a shift in focus toward prioritizing patient health. Dr. Kırımlı highlighted some of the key measures needed, such as reducing the number of patients per physician from 3,500 to 2,000, improving the physical infrastructure of family health centers, and reallocating budgets to strengthen primary care instead of prioritizing the construction of new hospitals.
These steps, he added, must include increasing salaries for primary health care workers and expanding their overall numbers. Employing social workers, psychologists, dietitians, and physiotherapists to address local needs is crucial for creating a more robust primary health care system.
If the workers’ demands are not adopted, Turkey’s health system will face even greater deterioration. This would force more healthcare workers to emigrate and leave patients with limited options: either pay for care in the private sector or go without it entirely.
People’s Health Dispatch is a fortnightly bulletin published by the People’s Health Movement and Peoples Dispatch. For more articles and subscriptions to People’s Health Dispatch, click here.
