‘They fail us year after year’: Why community health workers are abandoning unions

  • Community health workers in South Africa say they are disillusioned with unions in the country.
  • Aside from those working in Gauteng, most of these health workers earn around R4,000 a month but have no benefits such as pensions or medical care.
  • A 2018 agreement on CHW contracts was extended to 2025. Workers say unions and the health department are simply pushing back on their dreams of ever becoming conscript workers.
  • For more financial news, go to tea News24 Business front page.

Community Health Workers (CHWs) say they have lost “all faith” in unions as they fight for contracts that include pension and health insurance benefits for nearly a decade.

Gauteng is the only province where these health workers enjoy the same protections as other permanent government employees, e.g. B. Nurses. In 2020, CHWs in Gauteng were classified as Level 2 civil servants, meaning they are entitled to pension and health insurance benefits, and earn between R9,000 and R11,000.

Elsewhere in the country, CHWs have one-year contracts with provincial health departments or work for (and are employed by) non-profit organizations that have business with the state. Since there is no limit to the number of times the contract can be renewed, these employees often remain in their role for years. But at 60 they must retire – and then leave with no compensation for their long service.

CHWs receive a payout of about R4,000 a month, as part of a 2022 agreement reached between three unions and the Government’s Negotiation Council for the Health and Social Development Sectors, set up to assist in brokering deals or settlements of disputes between workers (or their workers’ unions) and the state. The 2022 deal is the third extension of a deal first set in 2018.

Margaret Gale Mookroof, 41, a CHW with 16 years’ experience, says many of her colleagues have left their unions. For example, although these bodies managed to change the status of workers in KwaZulu-Natal from volunteers to formal employees in 2014 and helped solidify the original 2018 agreement, many of these workers are disillusioned with the renewed agreement would. by 2025 instead of unions fighting to have their services advertised by the government. Recognition as permanent employees — with pensions and medical assistance — will help them gain financial stability, they say.

Mookroof says: “They let us down year after year.”

Johannes Dyasi*, 57, agrees. In the North Cape, where he works, unions only pay attention to CHWs when it suits them, he says – like when they need to increase the number of protests over issues facing permanent health workers.

In South Africa, unions have traditionally been a powerful ally of workers fighting for more than workers’ rights. Although more than 13 million workers are still registered as union members in the country, researchers have found that many perceive the organizations’ leadership as corrupt and out of touch with the aspirations of their people.

Dyasi agrees, saying that CHWs in particular do not reap any benefits from membership and that their terms of employment have not changed in years.

“We no longer have activists, just traitors who take advantage of vulnerable workers to get to the top.”

Union perspective

But union bosses don’t agree.

CHWs typically belong to one of four labor organizations (or their affiliates): the National Education, Health and Allied Workers Union (Nehawu); The Public Employees Association of South Africa (PSA); The South African Union for Health and Other Services Workers (Hospersa); or the National Union of Public Service and Allied Workers (Nupaw).

According to Nupsaw general secretary Solly Malema, Nupsaw was “instrumental” in the 2014 agreement that led the KwaZulu-Natal Health Board to recognize CHWs as contract employees entitled to standard services in place of volunteers.

That case, he says, laid the groundwork for including CHWs in the government pay system rather than employing them at NGOs, giving them greater bargaining power to sign the 2018 collective bargaining agreement.

Malema says they will continue fighting in the Western Cape, where community workers are still employed by NGOs because “they are acting like a state”.

Asked whether Nupsaw opposes a planned Labor Department investigation into wages and conditions of CHWs, Malema explains that setting a minimum wage for CHWs would prevent any chance of incorporation.

He continues, “CHWs are public employees and they must enjoy the same benefits as public employees [like in Gauteng]. That’s the way we want to go, not this minimum wage process.”

More work for less pay

In countries like South Africa, where there is a serious shortage of doctors and nurses, CHWs help shoulder the burden through “task shifting,” which means they take on some of the simpler but time-consuming tasks performed by professional health workers (eg. Follow-up for HIV or tuberculosis patients to ensure they are taking their medication correctly).

South Africa has just over 54 000 CHWs and ideally each should be able to reach 150-250 households per year depending on the area in which they operate.

Despite an already heavy workload, her to-do list has widened since 2011, when the Health Department mandated that CHWs should spend a lifetime caring for people’s primary health care needs – from prenatal care to palliative care and everything in between, such as: B. the prevention of lifestyle diseases such as diabetes, and help people to recover from strokes or heart attacks. Her responsibilities also include contributing to support groups, wellness programs and activities at early childhood development centers.

South Africa’s planned National Health Insurance (NHI) scheme will rely heavily on well-trained CHW teams to provide essential health services.

Through the NHI, the government will seek to provide all South Africans and documented immigrants and refugees with access to the same basic healthcare services, free of charge.

The NHI law is currently under review by the National Assembly.

But while CHWs are written into the future of South Africa’s healthcare system, the workers themselves don’t have much to look forward to.

Mercy Ngwenya*, 55, for example, will have to quit her job in five years. CHWs can only work for the state until their 60th birthday, says Tebogo Lekgethwane, spokesman for the North West Health Department.

She has been CHW in the Western Cape for more than two decades but has never held a position of any advantage. Ngwenya worries about what her life will be like when her time as a civil servant is up.

“When I retire, I won’t have anything,” she says.

In the North Cape, Dyasi is hoping the government’s retirement grant (which pays out a maximum of R1,980 a month) will be enough to support him and his family.

“There is no worthy tomorrow.”

An uncertain future

There is no talk of employing CHWs permanently in the Western Cape until the national health agency presents a plan outlining CHWs’ responsibilities and pay, says Mark van der Heever, a spokesman for the province’s health agency.

In October 2022, the National Health Agency received additional funding for staff expenses after the tax official raised more money than expected.

However, Finance Minister Enoch Godongwana warned that much of the additional government spending would depend on the outcome of a battle over public sector wage bills.

Union demands for a 10 per cent wage increase were rejected and the government instead agreed to a 3 per cent increase and a monthly allowance of between R458 and R1,695 depending on the worker’s salary level, which will run until the end of March.

In the Northwest, Joyce Maseko*, 37, believes nothing will change until she retires. “You will just give [us] Forms to request money from the UIF [Unemployment Insurance Fund].”

In her province, the health department also has no plans to purchase CHWs because “provinces have been told not to make any changes to the way they use CHWs [until the National Health Council decides on it]so Lekmethwane.

For now, the national health agency is treading water, saying it is awaiting the outcome of the inquiry into CHWs’ employment conditions proposed by its colleagues.

And in the meantime, most CHWs will just get on with their jobs – at great personal risk.

Says Dyasi: “Many of our colleagues have died during the COVID pandemic, but for those at the top it is like a dead fly dropped. But we are the foot soldiers. We are the ones who are sent out into the streets and homes, unaware of the danger ahead.”

*Three of the four CHWs Bhekisisa who spoke for this article asked not to be known for fear of losing their jobs. Your identity is known to the center.

This story was produced by the Bhekisisa Center for Health Journalism. Sign up for the Newsletter.

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