The CHWs say their working conditions are bad and their salary remains a paltry R2 500 a month.

Late last year the Gauteng Department of Health paid R7.8 million to 1332 CHWs to settle moneys owed to them. But more of them are still waiting to be paid as the payment process involves a facility-based verification and validation to confirm the work done against the list submitted by the union representatives.

According to Gauteng Health Chief Director Nomsa Mmope, there are about 350 CHW’s that are still due to receive their outstanding payments which are expected to be processed by the end of February.

Zoleka Mbotshelwa, chairperson of the forum representing the CHW’s, said they have been waiting since last year to receive their settlements, and that the verification process was taking too long. This was made worse by unexplained deductions by Smart Purse, a company contracted by the department to pay the health workers.

Mbotshelwa said the CHWs had won an arbitration case that resulted in the department being ordered to absorb them into their system according to regulations in the Labour Relations Act. This will make them permanent employees entitled to benefits.

Dragging their feet

But the department has been slow in implementing this order, and if they continue to drag their feet the CHWs will be forced to return to court.

“We are not being taken seriously here. Yet we provide the most essential service to the department. We are the ones taking medications to our patients in the communities and make sure that they adhere. But in the end we struggle like this,” she said, explaining that some CHWs had been working for years with no benefits and poor working conditions that have not improved.

Responding to questions over the permanent employment of CHW’s, Health MEC Gwen Ramokgopa said in a statement: “The National Department of Health has been in consultation with provinces and different stakeholders in the development of a policy framework for the community health care worker programme. This policy framework intends to clarify and standardise employment conditions of CHW’s across all provinces in the country.”

Highlighting the plight of CHWs, Marije Versteeg-Mojanaga, Director of the Rural Health Advocacy Project (RHAP), said CHWs were critical cadres in the fight for health rights for all.

“In our broken health system, community healthcare workers not only play a role in health promotion and the prevention of illness, but they also function as a safety net to identify and follow-up with people who have missed appointments, vaccinations due to stock-outs, and who may delay seeking healthcare due to barriers such as high travel expenses,” she said.

“It is time CHWs get the recognition they deserve through decent working conditions. This would include a fair wage, job security, access to essential equipment and supervision and support. We cannot on the one hand laud the important work of community health workers, and on the other hand treat these cadres as second-rate healthcare workers. They are essential to our goals of equality, dignity and health for all – and this acknowledgment should be reflected in their working conditions.”