Community Healthcare Workers are used to strengthen the Primary Healthcare system through illness prevention, the monitoring of postpartum mothers and babies, the supervising of recovery after illnesses, while also ensuring treatment adherence especially in TB and HIV cases and in providing end-of-life care.
Generally these workers provide a vital link between the community and the provincial healthcare structures and, crucially, the home based care services they provide encourage communities to take ownership of their health needs. They also provide education and awareness programs and identify numerous community health problems including environmental health issues.
In South Africa small scale projects have yielded better results than national initiatives because of a lack of national policy and funding from the ministry.
Community Healthcare Workers are often erroneously seen by both the public and provincial departments of health as a cheap and inferior type of healthcare worker, which couldn’t be further from the truth and much needs to be done to correct this misconception.
In Gauteng, Community Health Workers were initially employed by NGO’s and NPOs. Some Community Healthcare Workers complained that a few NGO’s were illegally withholding payment or decreasing the quantum of meager stipends and this led to the then MEC for Health, Hope Papa, undertaking to remunerate Community Healthcare Workers directly from the Gauteng Department of Health although they have never been fully integrated into the Department and lack GDHS Persal numbers.
Following the GDH’s assumption of this payment responsibility to Community Healthcare Workers, there have been ongoing disputes regarding late or non-payment of stipends which leaves the workers no better off than when NGOs paid them. Payment by provincial departments of health is not universally the way these workers are remunerated with many still being successfully remunerated through NGOs in other provinces.
Community Healthcare Workers need to be responsive to community needs and to do this they require back-up from state healthcare structures which is often not forthcoming. In fact these workers are often denied the basic barriers to cross infection such as masks, gloves and hand swabs. This is not conducive to good healthcare and must be remedied immediately. Additionally they must walk long distances in carrying out their duties though scorching summers and freezing winters.
Similarly, Community Healthcare Workers have no real career pathway and seem doomed to be entry level workers indefinitely, despite many years of loyal and productive service. Advanced training is also lacking and these deficiencies must be rectified too.
In other countries Community Healthcare Workers have been of inestimable assistance in providing effective healthcare interventions and they are rewarded accordingly. In this country Community Healthcare Workers also provide positive health outcomes but remain out on a limb with no proper recognition for their services.
If we want to increase the footprint of Community Healthcare Workers in our communities, we must prioritize their skills development and their career paths and ensure that their services are decently and consistently rewarded with regular guaranteed pay packages. We must provide them with the tools they need to carry out their work including infection control measures. National government has shown little leadership regarding Community Healthcare Workers and it is necessary to develop nation-wide norms for the treatment of these much needed workers.
We believe that rather than dictating the path that the Department must take as detailed in this motion, it would better address the many problems of these workers if a national imbizo was held to clarify the many contentious issues raised and to prevent the exploitation of Community Healthcare Workers.
Through such an inclusive strategy, solving problems together we can improve the quality of Primary Healthcare and bring it closer to the communities we serve throughout the country.
I thank you Madam Speaker