HIV and AIDS Human Resources Public Health & Health Systems Social Services

The plight of community health workers Living with AIDS # 459

A cadre of about 65 000 men and women work in the public health sector under various titles. Commonly known as community health workers, they are often the foot soldiers and the eyes and ears of the health department at grass-roots level. But there are concerns that this cadre of health workers is not appropriately recognised ‘€“ both in terms of payment and the development of further career prospects.

You may know them as care-givers, DOTS supporters, lay counsellors, masupatsela, and so on. Lucky Mokone of Ekhuruleni, on Gauteng’€™s East Rand, is one of them. He has been an HIV counselor since the early 2000s. He is also the chairperson of the community health workers association in the province. Mokone, together with 65 000 other people are largely responsible for providing counseling services in the government’€™s HIV Counselling and Testing (HCT) programme which aims to test 15 million South Africans for HIV by April next year. Many other government health programmes also rely on this cadre of workers for their success. Most of them are employed by non-governmental organisations through funding from provincial health departments and others. Their continued dedication, however, is not guaranteed as they complain that their efforts have not been adequately rewarded over many years, as Lucky Mokone explains.

‘€œSince 2000, NGOs were the ones who were paying counsellors. But the Department of Health decided that we have to go work at the clinics as permanent posts. We were working there and we were earning R1 000. Along the way they took us to NGOs again to go back and get paid from NGOs. Each and every month they give us that which they call a stipend’€¦ which is R1 000 per month, which now has increased to R1 500. They put money into NGOs quarterly, which they call (a) tranche, until the end of the financial year. So, this year, unfortunately some of our colleagues didn’€™t get paid from those NGOs. But at the same time they’€™re expecting those people to work and they are working normal hours like a full-time employed person, which is very sad for us to work without any payments. Sometimes, we spend six months without any payment. But at the end of the day they’€™re expecting us to deliver the service, as we know that HIV is everybody’€™s issue and it’€™s a daily issue that needs to be targeted each and every day’€, Mokone says.

His namesake, Lucky Sibisi, has been a VCT counselor in Region C, in Roodeport, west of Johannesburg, for seven years. This year she went without pay for three months.      

‘€œThis kind of life is destroying. And if I go to work not having food and having these problems, my immune system drops ‘€“ even if I’€™m HIV-positive or negative. And I have to work with people with TB. It’€™s easy for me to get those infections and nobody cares about me. It’€™s devastating because the passion doesn’€™t pay. The passion doesn’€™t fill your grocery cup-boards. Now we have to go and find work somewhere else, meanwhile having this passion to do this work. It’€™s really disturbing’€, she laments.

Hospitals Personnel Union of South Africa’€™s (HOSPERSA) representative, Edna Bokaba, expressed disdain at what community health workers are paid for their contribution to health care.    

‘€œWhat do you understand by a living wage? Is R1 500 a living wage? No, it is not. What do you understand by decent work? Is that decent work? No, it is not decent work. But you want a quality service’€.

‘€œThe majority of them are committed to what they do and they work extremely hard with very little reward or remuneration. This whole cadre of people has to be correctly employed. We, as civil society, have to drive and lead and advocate for that process. I think first of all, we’€™ve got to do whatever it takes to get people paid. And I know there are issues of no money and all those things, but we also know that money is spent in all the wrong places’€, added Denise Hunt, Executive Director of the AIDS Consortium.

The Health Department registered its concern about the treatment of this work-force. Health Department Director-General, Precious Matsoso, said the department is working on a solution to the problem.

‘€œThey’€™ve got different levels of skills, they are paid different salaries, others are hardly paid. It’€™s a key concern for us. But there are two different levels of engagement of these groups. Forty-thousand of these are directly employed via the provincial health services. The remaining 25 000 are actually employed through the Social Development services as well as donor development aid. What we are trying to do with this is to ensure that we have a common profile ‘€“ at least, a standard profile for each community health worker. I’€™m hoping that by early next year we will be able to come up with a report’€, Matsoso said.

It is hoped that the report will come up with a decent uniform pay structure for community health workers. Matsoso said it will also seek to create a work-force that will respond to the country’€™s health care needs from a primary health care model.

About the author

Khopotso Bodibe