“Although austerity has not “worked” in the sense of achieving its stated goals across history (e.g., reducing debt or boosting economic growth), it has nonetheless been employed by governments over and over again.” – Mark Byth
The National Union of Public Service and Allied Workers together with the Cry of the Excluded in the Eastern Cape will on 08 March 2023, in East London (Buffalo City) 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 of solidarity with health workers in GAZA who continue to resist the Nazi-style ethnic cleansing by the Israeli government. Tomorrow’s March is taking place during Human Rights Month, which is a very important month in SA. We remember it was 21 March 1960 when the Sharpeville massacre took place where women in particular took to the streets against Apartheid laws. On that day the Apartheid regime tragically took the lives of 69 people.
The story of CHWs in South Africa is tantamount to the story of many health workers in Palestine and 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 3 month contract if they are lucky.
Precarious contracts have subjected many CHWs to many vulnerabilities including intimidation by employers into doing 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 1991 while only being paid with a loaf of bread and that it was only in the early 2000s 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 every day 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.
On the other hand: we see the ongoing bloodbath in Gaza and what the Israeli Apartheid machinery is subjecting the people in Palestine. The dehumanization and demonization of the people of Palestine have culminated in genocide. Palestinians have been stripped of their basic rights to shelter, food, clean water, land, and health care among many others while the world watches their extermination.
As healthcare providers, we are also raising our voices and showing support and solidarity to our healthcare colleagues in Gaza. The killing of nurses, doctors, and the bombing of hospitals and ambulances must Stop Now!!!
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 adding to the frustration they already have, taking advantage of their vulnerability.
• Some are threatened daily about being dismissed, or they will not be recommended during the renewal of contracts.
• 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 poor socio-economic environments with high levels of violence, sometimes they get resistance and get abused by 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 a 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 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, as 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 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 while employed as a lay counsellor, 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:
Mzikazi Nkata: 072 242 3263 NUPSAW
Vuyokazi Made: 073 325 7009 Cry of the Xcluded