Western Cape healthcare workers want what they have in Gauteng – permanent employment

During an indaba held at Isivivana Centre in Khayelitsha on the eve of Workers Day, community healthcare workers (CHWs) shared stories about how they continue to play a pivotal role in the provision of primary healthcare but that the government does not want to employ them on a permanent basis.

Dozens of CHWs from the Western Cape said they want to be employed permanently, as is the case in Gauteng where this has been won. The Gauteng Department of Health absorbed the province’s community healthcare workforce in 2020 after years of unsuccessful negotiations between the workers and the department. In the Western Cape, most CHWs are employed by non-profit organisations.

Earlier this year, the Johannesburg Labour Court ruled in favour of permanent employment of the workers and an end to the current one-year, recurring contract. This was after the National Education Health and Allied Workers Union (Nehawu) took the Department of Health to court to review an arbitration award that ruled against Nehawu’s application to force the employer to appoint CHWs permanently.

Speaking to Elitsha, Nehawu spokesperson, Lwazi Nkolonzi said that they are in negotiations with the department about the absorption of careworkers, and the minister of health has confirmed that this will be done, but they are not sure of how many careworkers will be employed as that number will be decided by the budget.

Bulelwa Sakhela, a CHW in New Crossroads in Cape Town said that they deliver an important service to patients as they go to their houses, deliver medication, dress their wounds and do basic physiotherapy.

Recovered TB patient, Albert from Bonteheuwel testified that he was able to recover because of the help he got from CHWs. “I got TB two years ago but I have recovered now because the community healthcare workers came to my house and helped me,” he said.

Nonkululeko File from the Gugulethu Health Forum told the crowd that her bedridden neighbour was looked after by her grandson, until CHWs came to assist after she reported her case to them. “The grandson was doing everything for his granny and even bathing her. Imagine an elderly woman being bathed by a young man. In between his chores, the grandson had to also fetch the medication from the clinic. But, when I noticed this and told the community healthcare workers, the grandson does not need to fetch the medication or bathe his grandmother now. All of that is being taken care of by the community healthcare workers,” she said.

Social policy researcher and director of Dennis Goldberg House for Hope, Debbie Budlender said that a study conducted by the Medical Research Council in 2017 found that a strong community healthcare system would improve the health of the population cost effectively. Moreover, the study found that the economy would improve because of the increased employment of mainly poor women.

CHWs, however, do not earn a living wage. Currently, according to Budlender, the minimum wage for CHWs is R4,990 which is below the threshold to qualify for a child grant.

Professor Uta Lehmann from the School of Public Health at the University of the Western Cape said that the community healthcare system started in the early 1940s in South Africa and now there are 45,000 CHWs in the country, with the majority being women.

The national Department of Health, Prof Lehmann said, supports the professionalisation of the CHWs but claims not to have the budget for it. Lehmann proposed that the National Health Insurance would be one way of making sure that the CHWs are absorbed by the government.