Media Statement: Dignified Employment for Community Healthcare Workers in Eastern Cape

10 July 2020
For immediate release

The Eastern Cape Working Group of the C19 People’s Coalition unequivocally stands with the Community Healthcare Workers (CHWs) of our province in their struggle for dignified employment, fair wages, full benefits and safe and stable working conditions.

In the middle of a global pandemic, just as the number of infections and deaths due to COVID-19 are rising sharply in our province, it is unacceptable that our community healthcare workers are still having to fight for basic dignified employment! CHWs commitment to their communities takes them right to the heart of this virus’s impact in our lives. This is the work of real-life superheroes, who work daily to extend our struggling healthcare system in the Eastern Cape to those most in need of the right to healthcare, and yet they are treated with contempt by our elected leaders and civil servants.

A Struggle for Recognition and Dignity

Community healthcare workers have long played a critical role in comprehensive primary healthcare, yet their contribution to this system has not been acknowledged. The nature of their employment and the circumstances in which they work are proof of this. 

CHWs are not offered permanent employment, even after years of service. They are expected to sign precarious contracts annually and accept minimum wages.  Whilst we recognise that, after years of campaigning, government agreed to increase the pay of CHWs, it has only been increased to the minimum wage of R3500 per month, and includes no pension fund or benefits. In addition, while registered as government employees but paid a pittance and with no benefits, CHWs are now denied social grants, RDP houses and NSFAS for their children. 

The work is tough and requires enormous commitment. CHWs work in hospitals and clinics with limited resources, have to walk long distances to bring healthcare to poor communities, and often work in areas where crime is rife. They struggle to access uniforms so that they are recognisable as health workers in the community, and do not have appropriate PPE to protect them when caring for patients with communicable diseases. CHWs often provide food and other basic resources out of their meagre incomes, to help their patients take their medicine. The precarious and hazardous nature of their work creates a tremendous financial and psychological strain, yet these workers have no access to counselling services. 

Despite these conditions, however, when COVID-19 reached the shores of South Africa, community health workers heeded the call and are currently at work undertaking Covid-19 screening and doing house visits for TB/HIV /MDR and other related illnesses, assisting with treatment and motivating defaulters. The shortages of PPE seen across the healthcare system only exacerbate the already hazardous working conditions of our CHWs, many of whom have had to work not just with limited protection but with no protection all, with some becoming infected and a number dying as a result. 

This is No New Struggle

The COVID-19 pandemic has exposed a system that has been broken for some time, and left CHWs even more vulnerable. In the context of what has widely been referred to as a collapsed healthcare system in the Eastern Cape, all healthcare workers are expected to perform their duties within exceptionally pressured and high-risk conditions. Yet there are many workers who remain invisible – the risks of their work not prioritised enough to afford them protection. These are the cleaners, the drivers, the porters, and other support staff, as well as our community healthcare workers.

Health Systems Change

As far back as 2011, the Health Systems Trust published a document outlining their experience of  CHWs and in which they put forward key recommendations to strengthen the CHW programme. At the heart of their proposal is the call for a single uniform national policy approach to CHWs to support their career development, and that would enable appropriate governance, evaluation, supervision, mentoring and coaching, and research to support the effective operational work of the CHW programme.

It is an indictment in itself that 9 years later, no such plan has been implemented – these recommendations are still as relevant and reflect the problems of a divided health system. The precarity of CHWs is a symptom – recognisable throughout our country and indeed globally – of the failure of neoliberal policies to prioritise public spending on social sectors such as health and education. This system is fundamentally hostile to public services and this is reflected, for example, in the persistent underfunding of public health care, preposterous health worker-patient ratios, particularly that of CHWs, and in the refusal to fully incorporate CHWs in the health system and pay them a fair salary with benefits. 

Our Demands

We recognise the importance and value of the work of CHWs and their critical role in ensuring the right to health of all. Therefore we support the struggles of CHWs and call on government to end their exploitation and to:

1. Partner with civil society organisations and CHWs for consultation on the  implementation plan for the Ward-Based Primary Healthcare Outreach Teams (WBPHCOT) policy. 
2. Take the necessary and urgent planning and budgetary steps to ensure the high quality, standardised training and retention of community healthcare workers, and the implementation of a national policy to guide the work of CHWs.
3. Ensure that CHWs are employed, recognised health workers with full benefits.
4. Expedite the finalisation and release of the policy on Occupational Health for Health Workers In respect of HIV and TB.
5. Provide adequate PPE for all health workers as mandated by the Occupational Health and Safety (OHS) Act of 1993.

Issued by the Eastern Cape working group of the C19 People’s Coalition

Tlamelo Mothudi, Public Service Accountability Monitor, 071 256 8254
Nicole Collier-Naidoo, Extinction Rebellion NMB, 082 838 8659