Community Health Workers (CHWs) in South Africa are mobilizing to demand formal, stable employment. Throughout May, these workers and organizations supporting them have organized rallies in several regions, in an effort to secure guarantees from the government ahead of the May 29 election.
Amid South Africa’s health worker shortage, CHWs often fill the roles of nurses, pharmacists, and public health educators. “They are sometimes the only accessible health workers, especially in more rural areas where communities are far from health services,” warned Melanie Alperstein from the People’s Health Movement (PHM) South Africa during a protest held on May 17 in Western Cape.
In a comment for People’s Health Dispatch, Tinashe Njanji from PHM South Africa highlighted that CHWs are currently considered the lowest rank of health workers and are often sent to work without necessary protection. According to Njanji, CHWs are usually the last to receive adequate personal protective equipment (PPE) and are often expected to secure it themselves. The same applies to work uniforms.
The struggle of CHWs should not be seen as separate from that of other health workers. Trade unions point out that while CHWs are forced to take on the roles of pharmacists, there are unemployed pharmacists unable to find posts due to limited budgets and employment freezes. These financial constraints affect CHWs in multiple ways, Njanji explains. They are forced to take on more tasks as their colleagues and other health experts leave due to poor working conditions. Additionally, they anticipate a further increase in workload as budget cuts lead to longer waiting times and, consequently, more patients to visit at home.
Under these conditions, it is difficult to see how the government’s publicized dedication to guaranteeing access to healthcare—including the new National Health Insurance Act—can be honored.
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PHM South Africa is a long-standing ally of CHWs’ cause, consistently highlighting their contributions during the COVID-19 pandemic and in the fight against tuberculosis, HIV/AIDS, non-communicable diseases, and maternal and infant health. Yet, many CHWs do not receive a salary for their work, only a stipend far below the earnings of other public services workers: CHWs in KwaZulu-Natal earn a monthly stipend of about 4,000 rand (approximately USD 215).
Many CHWs are employed through non-governmental organizations on precarious one-year contracts that do not offer any stability. Additionally, often they are not entitled to essential rights like maternity leave or pensions.
The denial of many essential rights to CHWs does not stop different levels of government from praising their importance in building a primary healthcare-based system. Recent government plans have identified priorities in reaching rural and other hard-to-reach areas, but CHWs have been implementing these practices for years, building trust and sharing crucial health information in communities cut off from other parts of the health system.
According to the National Union of Public Service and Allied Workers (NUPSAW), CHWs “play a fundamental role in bridging the gap that exists in accessing primary health services, especially in the most downtrodden and toiling communities where clinics and hospitals are often located far from them.”
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While communities and the health movement recognize the vital contribution of CHWs to health care in South Africa, the same cannot be said for policymakers. For example, the National Health Insurance Act claims it will make primary health care its “heartbeat.” Yet, according to Tinashe Njanji, CHWs will remain in policy limbo. “They are given no clear role in the NHI,” he warns, despite their obvious importance in realizing primary health care.
The only way the government can truly address the situation for CHWs is by integrating them into the formal health system and ensuring decent working conditions for all workers, NUPSAW suggested. This approach has been successfully implemented in Gauteng, which has moved away from the precarious CHWs employment model used in other regions. To extend these improvements to more CHWs, the trade union has announced its readiness to continue mobilizations, with another round of protests held on May 26-27 in Eastern Cape.
People’s Health Dispatch is a fortnightly bulletin published by the People’s Health Movement and Peoples Dispatch. For more articles and subscription to People’s Health Dispatch, click here.
