Community health workers belong in the public sector!

The trade unions representing and organising community healthcare workers have come out against a proposed sectoral determination by the Department of Employment and Labour. The National Union of Public Service and Allied Workers (Nupsaw) and the National Education Health and Allied Workers Union (Nehawu) say that the sectoral determination, which the department says is intended for the protection of community healthcare workers (CHWs), “will not make the workers less vulnerable”. The unions were responding to the public hearings being conducted by the department of employment and labour in the Western Cape, Eastern Cape and Gauteng this week.

“It will not make the workers less vulnerable”

Nupsaw’s provincial office manager in the Western Cape, Vuyani Shwane said that the sectoral determination undermines rather than protects workers. “It will undermine the historic and current role they play in the provision of primary healthcare in South Africa. It will reduce them to a group of people who are outside of healthcare meanwhile they are central to primary healthcare provision. This will strip them of their dignity and recognition within the health sector,” he said.

Nehawu’s provincial head of organising in the Western Cape, Shaun Wildschut told Elitsha that the proposed sectoral determination will make things worse for them. “The sectoral determination is not going to make them less vulnerable. They won’t have a right to strike under the sectoral determination as the minister can through his powers gazette against the strike and decide on the law,” he said.

Both unions said that the Department of Health is at the centre of the proposed sectoral determination and are using the Department of Employment and Labour to push that.

Community careworkers are still struggling to be employed permanently by the the Eastern Cape health department, as has already happened in other provinces. Archive photo by Nombulelo Damba-Hendrick

According to Nupsaw, the unions and the government signed a historic resolution in 2018 on the integration of CHWs into the healthcare system, the standardisation of their work and their inclusion in the Public Health and Social Development Sectoral Bargaining Council. “You cannot take them away from that regulatory framework. We see that as reversing the gains that they have made,” said Shwane.

“We are not going to allow these hearings to proceed. We are not going to dwell on the reasons because we have communicated them to the department.”

During the hearings, Kekulu Padi from the Department of Employment and Labour said the proposed sectoral determination would not include the workers that are already covered by the bargaining council.

The public hearings were disrupted even before they started in East London. Just as an official from the provincial office was concluding his opening remarks, Nupsaw regional organiser, Thembile Mgwatyu stood up and interrupted him. “We are not going to allow these hearings to proceed. We are not going to dwell on the reasons because we have communicated them to the department.” He was applauded by all the CHWs in the hall who started singing and cheering anti-government slogans.

Working as a community healthcare worker

Salaama Abrahams, a member of Nupsaw told Elitsha that the investigation into the protection of CHWs does not take into consideration the magnitude of the scope of their work as they do much more than what is required. “We do much more than what a registered nurse is expected to do. They say our scope is to care for patients with TB, HIV and cancer but we also bath and give physiotherapy to the patients. We see a pregnant woman up until the baby is two years old. We work under the worst conditions as we duck bullets in the communities we work in and we are at risk of being robbed. The R4,400 minimum wage that we receive is not justifiable. We should be earning half of the salary that a registered nurse gets,” she said.

CHWs are paid the national minimum wage, now set at R4,400. Nompumelelo Kapu said the salaries they receive are a symbol of exploitation and disregard by DOH.

“Every year, around February and March before we sign new contracts, they always threaten us with being unqualified in that we do not have home-based care certificate and matric but they end up taking us in anyway because they don’t have much of a choice,” said Olive January, a 55-year-old worker from Bonteheuwel in Cape Town.

During the early days of the Covid-19 lockdown in 2020, the community care workers were not issued with adequate gloves and masks to perform their duties safely. Archive photo by Lilita Gcwabe

Nozuko Nelani (63), who has been working as a caregiver for 30 years in East London, said that they are not sure who their employer is between the department of health and the NGOs. “They want to throw us back to NGOs so that we lose the little rights we have. We don’t trust the NGOs; they can terminate our employment at any time,” she said.

We don’t trust the NGOs; they can terminate our employment at any time

For Thobeka Faltein, who works at Beacon Bay Clinic, the move to remove them from the bargaining council is a strategy by the Department of Health to dump them and worsen their conditions of employment. “We want to remain in the bargaining council. The removal from bargaining council is a strategy by DOH to run away with our benefits and oppress us even more,” she said.

“We are working under very terrible conditions and are underpaid despite having worked for many years. The department of health is determined to outsource us. We are working for nobody else except for DOH,” said Thembisa Mkonqo from Westbank mobile clinic.