For the day of the health department

Politicians have recently been supporting the public health service with a lot of money. But there are doubts whether the gifts from Berlin will solve the problems in the long term

© W & B / Nina Schneider

What do people who work in health departments actually do? Not everyone knows for sure. The corona pandemic is currently focusing primarily on infection protection. But that's just one of the many tasks of the public health service, or ÖGD for short. These range from the monitoring of drinking water or hygiene in care facilities to school entrance examinations to medical care for socially disadvantaged people, including children and adolescents. Actually, the ÖGD is therefore an important pillar of our health system. And yet he led a shadowy existence for a long time.

Saved German health authorities for years

Then came Corona. The neglected health authorities became beacons of hope. They are "the linchpin in the fight against Corona," emphasized Federal Health Minister Jens Spahn. “The attention is nice. Unfortunately, in recent years she had never stopped long enough to improve the situation, ”says Gudrun Widders, head of the health department in the Berlin district of Spandau.

For a long time, many offices have been lacking qualified staff: “In recent years, many tasks have been saved in some places,” says Widders, who is also involved with the state association of doctors in the public health service of the states of Brandenburg and Berlin.

Merkel announces financial support

In September, Chancellor Angela Merkel met with medical officers and mayors to discuss the future of public health. A “Pact for the Public Health Service” was announced. The federal government wants to advance the project with more than four billion euros by 2026. They wanted to "take a lot of money in hand," said the Chancellor afterwards. Dr. Ute Teichert, chairwoman of the Federal Association of Doctors in the Public Health Service (BVÖGD) called the pact a "historic opportunity".

The numbers sound good: by 2022, 5,000 new jobs are to be created for doctors, specialist and administrative staff.New technology should help to “make the work of the ÖGD more efficient and accelerate processes”, as it is called. The fact that corona infection data is still sent by fax in Germany has been repeatedly cited in politics as evidence of the lack of digitization and networking.

Is it enough for everyone?

But there are doubts whether the pact alone will be enough to make up for all the failures. This also has to do with the structure of the ÖGD. The approximately 400 health authorities differ depending on the state or district. Even with the staff, says Dr. Peter Tinnemann, who conducts research at the Institute for Social Medicine, Epidemiology and Health Economics at the Berlin Charité: "Distributing a lot of money according to the watering can principle will not solve the existing problems due to the different equipment of the health authorities."

It is difficult to say where the need is greatest. There is no superordinate institution that records how many people are currently working in the public health service. That is why there is no reliable information about which office most urgently needs help from the pact.

Inconsistent data creates confusion

And the tasks that the offices fulfill are also inconsistent. Years ago, Berlin began to record all tasks of the authorities on the basis of federal and state laws. This means that Berlin is the only city so far that has a so-called “model health office”. An important basis for planning that other municipalities have so far lacked.

There are already different answers to the question of how many medical professionals are currently active in the public service. The employers' side, i.e. the district and city council, speak of around 2,900 full-time doctors. According to figures from the German Medical Association, there are only 2,561 doctors who work in the ÖGD.

Unequal distribution of salaries

The fact that the Marburger Bund doctors' union is arguing with the municipalities about such numbers has to do with an ongoing conflict over the ÖGD. So far, specialists in health departments have earned less than doctors who are employed in a municipal hospital. The Marburger Bund puts the difference in salaries at 1,500 euros per month. Teichert from BVÖGD says that this is "explosive" that cannot be eliminated with the pact alone.

On the employers' side, i.e. the municipalities, an extra tariff for doctors has so far been rejected. The fear: Such a regulation could also trigger covetousness among other groups in the public service. The Association of Municipal Employers' Associations (VKA) sees no reason for negotiations with the medical union. "These collective bargaining regulations are appropriate for the public health service and have been tried and tested for many years," said a VKA spokeswoman.

Salary differences put off young doctors

Doctors see such statements as pure mockery. They are convinced: If nothing changes in the payment, the “Pact for the ÖGD” could do little either. For years, the ÖGD has been plagued by young doctors among doctors. Often positions remain vacant for a long time when older colleagues retire, says Gudrun Widders from Berlin: "The differences in salaries scare off young colleagues who we urgently need."

In North Rhine-Westphalia and Rhineland-Palatinate, the Marburger Bund wants to negotiate directly with 78 responsible mayors. Ute Teichert hopes that the multi-billion dollar pact could help ensure that there is finally a "jolt through the municipalities": "Now nobody can say that this is too expensive."