The teachings of HIV, TB and Covid: Value community healthcare workers more

Community healthcare workers have been absorbed as permanent employees of the department of health only in Gauteng and work in the other provinces under the most precarious conditions. Archive photo by Lilita Gcwabe

Community healthcare workers are indispensable to fighting health epidemics yet most are treated as volunteers deserving only of a stipend.

World Health Worker day, which falls in the first week of April each year, aims to commemorate the work of healthcare professionals. As they do every year, Grow Great, a campaign committed to mobilising South Africans to halve stunting in young children by 2030, marks the day by celebrating the contribution of community healthcare workers (CHWs) to providing health services and counsel to their communities. This year, the day was celebrated on the 5th of April.

Bringing together a group of community healthcare workers in Diepsloot South on Friday, Grow Great honoured and acknowledged the role of community caregivers. Dr Edzani Mphaphuli, director of Grow Great, said that the work that CHWs do in their communities is immeasurable. 

Over 50 community healthcare workers from different areas in Gauteng gathered in Diepsloot South to celebrate their work. All photos by Lilita Gcwabe.

“Delivering door-to-door care to community members means that those who cannot afford to go to the clinic, who are delaying care because they don’t have information, and many other groups, can still access health services. We especially appreciate them because through their visits, they are able to identify children who are malnourished and are stunted sooner and can refer them to the nearest clinic for further help,” said Mphaphuli.

Grow Great works in partnership with the Gauteng Department of Health (GDoH) on The Grow Great Champions Club. The programme aims to train and equip CHWs with the skills and tools such as growth charts to test for malnutrition and stunting, identify vulnerable children and families at risk, and to advise what course to take in necessary cases. The programme serves as a resource hub and offers access to a dedicated national information line, continuous mentorship, and resources to empower CHWs to provide sustained support to the families in their care. 

Flourish is a nutrition campaign by Grow Great that supports moms and babies in their first 1,000 days of life.

Workers, not volunteers!

“As the first province to absorb their CHWs, Gauteng is an example that we would like to see other provinces adopt. This can assist in the reduction of stunting all over the country. We would like to partner with other provincial departments to continue equipping the community health force with the resources to do this,” said Mphaphuli.

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The GDoH absorbed the province’s community healthcare workforce in 2020 after years of unsuccessful negotiations between the workers and the department. A number of unions and organisations see this as a partial win because the struggle for recognition as permanent employees of the health department continues for CHWs in all the other provinces.

Winnie Shabangu has been a CHW in Gauteng since 2011. She spoke at the event about being a community healthcare worker: “I see a lot of children and pregnant women who struggle to access healthcare services because the facilities are located too far away from them. As a result, many teenage girls struggle to access contraceptives. As CHWs, we deliver these kind of services to them,” said Shabangu passionately. She works in informal settlements where she educates young girls and women (as she told the audience) about sex and contraceptives.

“Before we were absorbed by the department, it was challenging. We did not have any benefits and there were seasons when we were concerned about our salaries. Since we became absorbed into the workforce by the department of health, we are seeing positive changes like having tools to test and inform our patients,” she said. The benefits Shabangu refers to include medical aid and housing allowance.

CHWs in Khayelitsha, Cape Town, handing out condoms to residents.

Asanda Vuso has been a CHW at the Diepsloot South Clinic since 2009. As someone who grew up in Diepsloot, she said that she always knew that she wanted to serve her community. “I know the sections so well. I know the corners where I can find people that need services. Such as the elderly: they are not able to travel long distances to get to the clinic. We have BP [blood pressure] machines and scales that we get from the department to take with us to their homes to test them there. This support makes our jobs so much easier.”

The struggle against volunteerism continues

Unlike Shabangu and Vuso, healthcare workers in other provinces of the country are still waiting to be absorbed by their provincial departments, limiting the impact their work can have on their communities. Thembile Mgwatyu, provincial organiser of the National Union of Public Service and Allied Workers (Nupsaw) in the Eastern Cape, said that the struggle of CHWs has been burning since 2016. Nupsaw is one of a few trade unions that organises and represents community healthcare workers. He emphasised that their absorption by the province’s health department is long overdue because of the increasing support they provide to the department.

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“Access to healthcare remains a challenge, so much so that shifting to CHWs is increasingly used to mitigate this. They are key in ensuring that society meets their health needs by driving prevention strategies and providing primary healthcare services. But despite their important role, they are one of the most vulnerable groups in the health sector, uncared for by their departments,” said Mgwatyu.

Nupsaw has been handing over petitions for the permanent absorption of CHWs to departments in all the provinces in 2023. The Eastern Cape Department of Health received theirs on the 8th of March, listing demands on behalf of CHWs that include transport and safety, as well as tools and equipment for them to conduct their work efficiently. This has led to a proposed meeting date between the department and the trade union to discuss the future of the community healthcare workforce in the Eastern Cape.

“We are still not valued enough
to be employed by the department”

Elitsha spoke to Nompumelelo  Kapu who has been a CHW in the Eastern Cape for 23 years. Although she is committed to her job out of her love for it, she wishes that she could be better supported by the department of health. “Not being permanent means that there are so many things that affect us. If you are employed, the employer is supposed to ensure you are working in a safe environment and securing your job. It’s not like this for us – we have been working for years on contracts. Although we have skills and knowledge of treatment, testing HIV and TB, identifying illnesses and more, we are still not valued enough to be employed by the department.”

Kapu prays that she doesn’t retire or pass away before she gets absorbed into the department so that she can also leave something for her children and reap the work of her life.

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