Nomvula Nkabinde (56)  is a community health worker at Tladi TB Clinic in Tladi, Soweto. Everyday she and her colleagues traverse the streets of Naledi, Moletsane, Jabulani and Tladi. From as early as 7 am these community health workers walk door-to-door, visiting TB patients to ensure that they are adhering to treatment. 

While many of these workers are stationed in the communities they live in, their job isn’t without risk. 

On the 6th of April 2020 – at the height of the COVID-19 lockdown – Nkabinde and her colleague were visiting patients at Tladi Camp informal settlement. They were walking through a narrow passage when they were accosted by two men “who looked like they smoke nyaope” 

“We saw them when we were halfway through the passage. They walked towards us, one of them pulled out a knife under his blanket and they demanded our cellphones, money and bags,’’ she recalls.

Nkabinde says she felt confused and angry because of how quickly everything happened. And there was no other alternative exit point at the informal settlement, they had to use this route. 

Tladi informal settlement is a community of mostly Sotho-speaking people from Lesotho. It’s not uncommon to see men walking around the informal settlement dressed in traditional Ba-Sotho blankets. 

Being essential workers meant that Nkabinde and her colleagues had permits to move around during the hard lockdown imposed by the government. 

‘’During the lockdown, our workload increased because we had to trace TB patients in informal settlements, test them for the coronavirus and make sure that they don’t default on their medication,’’ says Nkabinde.

Who are community health workers

Community health workers are an essential part of primary health services. This group of health workers may not have formal qualifications such as a certificate or degree, they are trained in intervention. The scope of their work is wide and includes checking in on elderly and frail patients who are on chronic medication for diabetes and hypertension. And also pregnant women and mothers who have given birth in the past six to eight weeks. 

Their work is to deliver health services in the community, away from health facilities. Often they walk over 10kms per day, knocking on patients’ doors based on the cases they are assigned to by local clinics. 

Over the past decade South Africa has seen a lot of protest action by community health workers against the department health. Some of their grievances included being permanently employed by the department, salary increment and benefits, better working conditions and crime that they are faced with. 

Most community health workers are still underpaid, not absorbed by the Department of Health. Not much is said about the safety of community health workers, most of whom are women. 

‘’As a community health worker I am required to trace patients who default on their medication and check ups at the TB clinic. My partner and I are women who have to walk into homes where we are unsure what will happen to us,” Nkabinde tells Health-e News.

She says that the Community Policing Forum members only patrol the streets at night. During the day they are not there and this leaves community health workers at risk of being victims of crime. 

‘’When we go to our patients we say a little prayer first. When we get there we can’t ask to sit outside because patients must be treated in private rooms so that their rights are not violated. We need to go in the house. This compromises our safety because we enter into people’s homes without knowing what awaits us there.” 

It’s difficult to quantify the levels of crime committed against community health workers because the numbers are unavailable. 

Sibusiso Ndazala from the representative of the Public Servants Association says that most of their members, especially community health workers, have lost hope in them.

‘’Our members have been complaining about the dangerous and sorry working conditions that they find themselves in on a daily basis  – especially when going into informal settlements and high crime areas,” says Ndazala. 

 “As a union we are trying to assist them because we understand that they are not just workers but parents and breadwinners.”  

He says the union has been working towards making sure that community health workers feel safe in their line of work. 

The trade union represents a total of 245,000 members in the public sectors across the country.

‘’People in our communities know that we see a lot of TB and HIV patients and we have become targets because they mix antiretroviral treatment with what they are smoking,’’ she adds.

In November of 2023 Nkabinde and her colleague were nearly mugged again. But this time, two community members of Tladi came to their rescue.

Nkabinde says that she has communicated her concerns with the clinic manager, but not much can be done because this is the scope of their work.  

Precarious working conditions 

Another community health worker from Springs clinic in Ekurhuleni says she’d had thoughts of resigning because of their working conditions. Getty Mahuma (33) works in the communities of Springs, Never Never informal settlements, Wright Park and Phola Park. 

Mahuma says going into any informal settlement is a risk because the shacks are built close together. This, she says, makes it easy for thieves to make a quick getaway and hide. 

‘’I love taking care of sick people, however, going into their homes and walking into informal settlements is my biggest fear. ’Imagine going into a place that you are not used to, where you don’t know anyone, at the same time looking for a person that you can’t identify and relying on the patient’s information given at the clinic.’’   

Mahuma and her colleague were mugged in 2019 in Wright Park just near Never Never informal settlement. They did not report the incident to the police.

‘’We went to trace a patient who defaulted on her TB treatment. We arrived at her house and found her with her friends. Three of them physically attacked us and took our belongings,” she recalls.

‘’Another time, it was around 8am on a Tuesday, when we went to Never Never informal settlement, three men came from a passage. They began approaching us and because the informal only has one entrance and exit point which was a bit far from where we were, we began running and screaming. People came out of their shacks and helped us. Those men could have raped us on that day,’’ says Mahuma.

As a way of protecting themselves, Mahuma says that they google search the addresses that are listed on patient records helping them to identify which places are high risk. She adds that some addresses are just open fields while others are spaza shops. 

‘’When we leave the clinic we know exactly where we are going and that prepares us mentally for danger that we may come across, she adds. 

Though she may want to resign from her work, she can’t because she has two children that she needs to provide for and South Africa is faced with an ongoing problem of unemployed healthcare workers. – Health-e News