Decent Employment and Integration into Health Systems for Community Health Care Workers. 14/07/09

The AIDS Law Project and other organisations are calling for an urgent meeting with several Ministers to review the employment of community health care workers at lawfully-commensurate pay rates, with a view to ensuring permanent jobs within the Departments of Health and Social Development.

Many community health care workers (CHCWs) are the stewards of public health in hospitals and clinics throughout the country. These individuals are essential if these departments are to succeed in the implementation of national strategic plans to combat HIV and TB - and, ultimately, in the attainment of national health and development goals.  The deployment of community health care workers in HIV and TB service provision accords with the provisions set out in the National Strategic Plan for HIV/AIDS and STIs.  At issue, is employment conditions which are fair, particularly regular pay, for CHCWs.

These groups of health workers, largely women, are the bulwarks of service delivery in many public clinics and hospitals:  CHCWs assess and prepare patients for antiretroviral treatment readiness; provide adherence counselling; provide counselling for pregnant women regarding infant feeding choices; and identify patients who qualify for antiretroviral treatment. They also provide advice on obtaining grants, and some provide home-based care.  At present, the Department of Health makes payments to the NGOs and the NGOs, in turn, administer a monthly stipend.  A number of concerned organisations are responding to numerous complaints made by community health care workers who cannot afford transport to work or food unless sufficient, regular pay is received.

The concerned organisations include Congress of South African Trade Unions (COSATU), the Treatment Action Campaign (TAC), the AIDS Consortium and several university-based medical and social research units. The Ministers being called on to intervene include those from the departments of Health, Social Development, Economic Development and Labour.

All of the concerned organisations are involved in health systems research and work on HIV/TB. They request Ministers to alter the role of the approximately 1 600 community non-profit organisations involved, to become one of training, support, monitoring and management - rather than their current role as employers of, or labour brokers for, community health care workers. The organisations also call for legally-commensurate employment conditions that govern the scope of work, provision of adequate training for HIV service delivery, health benefits and other employment benefits, career development and trajectory, psychological support, protection against infection and ill-treatment, and other forms of statutory and constitutional protections afforded employees under South African labour law.

Both the Department of Health and Social Development are currently revising their community health care worker employment policies (including community health workers, and social development care workers). The department however still envisages limiting community health care workers to short-term stipends (which are often delayed or unpaid for months). Research has shown that this leads to declining morale of CHCWs, absenteeism, while negatively affecting patient care, and even health outcomes.  

The concerned organisations assert that community health care workers should receive appropriate debriefing, training and mentoring, with clearly-defined job descriptions and roles that would allow them to be integrated into the health team. This will result in better care of patients and the moral and economic empowerment of CHCWs. This change would also contribute to the President’s goal of creating half a million new job opportunities by the end of the year, allowing for better patient care; and assisting in the attainment of national health and development goals.

For more information contact Mark Heywood at 0113564100