The National Union of Public Service and Allied Workers in Nelson Mandela Bay and the Cry of the Xcluded Demand the Immediate Permanency of CHWs as Workers in the Public Health Department. End this Government’s Austerity Policies and the Exploitation of CHWs!
The National Union of Public Service and Allied Workers, together with the Cry of the Xcluded in the Eastern Cape, will on 12 April 2024 be in Nelson Mandela Bay Health District to march for the permanency of Community Health Workers (CHWs) and call for an end to their exploitation. This will also be a day to call for an end to this government`s neoliberal austerity policies through budget cuts and its murderous impact on service delivery. As we speak, security officers have not been paid for over three months now.
Communities cannot even call for ambulances as none of the Department of Health’s phones are working. The Health Department’s phones have been cut off by service providers due to non-payment. A huge question for us remains. How is this possible with all the income streams the department is receiving outside of the treasury? Including the millions worth of claims from the Road Accident Fund for maintenance of hospitals.
As we speak, the district office does not have an Assistant Director, a DD, or an HR, and all these are critical positions that would assist the district in dealing with employment and closing gaps in vacant positions in various facilities. Whether this is austerity or a result of corruption is a matter that should be subject to a forensic investigation of the entire department. We are thus calling for an urgent forensic investigation of these issues.
The story of CHWs in South Africa is tantamount to the story of many health workers in Palestine. It must be understood as a story of gendered exploitation and the marginalization of women. This is also a story that depicts just how austerity, like any feature of capitalism, is dependent on the exploitation of women to achieve its intended objectives. CHWs, 98 percent of whom are women, have been highly casualised and precarious for over 32 years now. Many often survive with a one or three-month contract if they are lucky.
Precarious contracts have subjected many CHWs to many vulnerabilities including intimidation by employers to work outside the obligations of their position. Employers exploit CHWs to the extent that they are even forced to work long hours with no compensation for overtime. These workers also cannot complain because they run the risk of not having their contract renewed the next month.
These highly exploited CHWs are the same women who cannot qualify for government RDP houses because they are now on persal, an indication that they are government employees, although with lower pay. It must be noted that CHWs have endured since they began working in 1991. From that time until the early 2000s they were only paid with a loaf of bread. It was after nearly ten years that they started to receive monetary pay. Therefore, CHWs are people who, against all odds, have shown their loyalty and faith in our health system.
Moreover, because of this same persal CHWs cannot even get their kids to tertiary as they do not qualify for NSFAS, while their stipend could in no way allow them to afford university fees. This predicament has driven many care workers into depression. Besides this, many are retiring without anything to show for their years of work or their contribution to the South African Health system. Many have lost their lives during COVID-19 without any proper funeral policies for their families to bury them.
We know Community Health Workers. We have seen them walking everyday in the communities of the working class (although sometimes being barked at by working class dogs) tracking treatment defaulters whether from TB or HIV. We have seen them on the front lines during the deadly COVID-19 pandemic. The response from the Eastern Cape government toward the valiant efforts of CHWs is zero-based budgeting, which is an advanced way to practice budget cuts that are both brutal and murderous as depicted in this statement.
This is why NUPSAW and CryX are moving with this action and demanding for:
1. RESPECT, RECOGNITION AND LEGITIMACY FOR CHWs
• Community Health Workers are not respected as adults and key cadres to primary health care. Some operational managers ill-treat these workers, which adds to the frustration they already have and takes advantage of their vulnerable position.
• Some are threatened daily about being dismissed or that their contracts will not be renewed.
• Some officials address them in a manner where it makes them feel unimportant, demotivated and small.
2. WE DEMAND ALL TOOLS OF TRADE
• Community Health Workers must be supported with the necessary equipment to execute their work efficiently.
• Protective gear for weather and protective equipment must be supplied.
• Uniforms should be of good quality.
• A dedicated and conducive space should be made available for administration work of CHWs.
3. WE DEMAND TRANSPORT AND SAFETY
• Community Health Workers work in socio-economically poor environments with high levels of violence. Sometimes they face resistance and abuse from the same patients they are attending.
• Community Health Workers are poor. The department should make provisions for transporting them to their areas of work.
4. WE DEMAND OPPORTUNITIES FOR CHWs TO APPLY FOR VACANCIES AT THEIR FACILITIES
• Community Health Workers have no job security, and in some facilities, they are disregarded when they apply for vacant posts despite meeting all requirements.
• We demand that they are also considered for recruitment and selection processes.]
• We also demand transparency in these selection processes, where there is a high level of corruption and nepotism, and CHWs are the ultimate victims.
• NUPSAW will be embarking on campaign to stop these cruel acts of corruption and nepotism and expose those involved.
5. WE DEMAND THE TIMEOUS RENEWAL AND PROCESSING OF CONTRACTS
• Firstly, we are making a call to the department to do away with the yearly renewal of contracts and adopt a permanent contract for Community Health Workers.
• Our experience in the Eastern Cape is that on a yearly basis, Community Health Workers are subjected to a situation where, for some, they will not receive their salaries for April, May, and June after their contracts have been completed. This leads to the financial obligations of CHWs being missed, and worse, it leaves their families without food.
6. WE DEMAND OPPORTUNITIES FOR EDUCATION AND TRAINING
• CHWs are excluded from skill development programs when they are part of the public service set-up and critical to health sector service delivery. Opportunities for advanced training and education should be made available.
7. WE DEMAND PERMANENT ABSORPTION OF CHWs TO THE DEPARTMENT OF HEALTH
• We demand the urgent implementation of Resolution 1 of 2018, which ensures the development of standard operating procedures for recruitment selection, appointment, placement, remuneration, skills development, dispute resolution, occupational health and safety, process and absorption of community health workers. We have witnessed the union bashing and intimidation done to our members and advise the department to immediately cease its wrongdoing.
• NUPSAW still maintains that there is no rational or legal basis for the continued exclusion of CHWs from being absorbed as public servants because the type of work they do is of a permanent nature.
• All CHWs must be permanently absorbed and enjoy benefits in relation to their permanent status.
• The province must show the political will to absorb these workers and follow the example of Gauteng province.
• We want decent salaries for CHWs and improved conditions of service as a matter of urgency.
8. WE DEMAND A STOP TO THE EXPLOITATION OF CHWs
• It is reported that in some facilities, exploitation of the CHWs is evident, wherein they are forced or made to do work outside their scope of work. With some reports, we are made aware that in some facilities, newly employed lay counsellors are made to do data capture or administration clerk work, thus closing employment opportunities for those who are unemployed. This conduct is tantamount to exploitation at the highest level, as they are not remunerated for the work they are forced or made to do.
• NUPSAW and CryX shall embark on a campaign to expose those facilities perpetuating such acts.
For enquiries, contact:
1. Mzikazi Nkata, NUPSAW Provincial Secretary on 072 242 3263
2. Pumlani Matinise, NUPSAW Deputy Regional Secretary on 071 303 2939
3. Vuyokazi Made, Cry of the Excluded Provincial Coordinator on 073 325 7009
