Health-e (Cape Town)

15 October 2012

South Africa: Gauteng Discusses Future of Lay Counsellors - Living With Aids # 537

The Gauteng Health Department held talks with lay HIV counsellors and other community health workers this week to discuss options of managing and incorporating them into the health system. Currently, they are employed through various non-governmental organisations and are not recognised as employees of the department.

Lay counsellors, care givers and other community health care workers say they are sick and tired of being regarded as volunteers. This cadre of workers supports various government health programmes, including HIV counselling and testing, TB treatment and home-based care for very ill patients. They say they want to be treated with fairness and respect.

"Community health workers are doing a very good job, but they are being treated unfairly. We need to be respected. We need to be recognised", says Lucky Mokone, a member of the task team for community health workers in Gauteng.

After many years of serving the government they are still being regarded as volunteers and are being paid a monthly stipend of only R1 500, whereas their counterparts in provinces such as KwaZulu-Natal have been incorporated into the provincial health department and are receiving better pay, support and other benefits of being a formal employee.

"It is unfair to hear that our fellow colleagues in KZN don't get stipends, whereas we are doing the very same job. They get debriefings. They get retreats. We don't get anything. That is so painful", laments Balise Mahlangu, another member of the task team.

The outgoing head of Gauteng's health department, Dr Nomonde Xundu, says the Department is considering options of how best to manage and incorporate community health workers into the formal health system.

"We're working closely with KZN just to look at that model whether it is a thing that we could consider", Xundu says.

But she says this has huge implications financially.

"You must remember we are a department that is criticised for having bloated the establishment from about 52 000 to a whopping 65 000 within a period of four to five years and the impact of that on the budget. Basically, the first charge of your budget goes to compensation of employees, which, in most instances, will eat off your budget on goods and services. Also what are the financial implications? What are the different permutations to consider because if you bring people on board, it means that you must pay for their medical aid, pensions, all these other things? It's a matter that we are still looking at", she says.

"I don't want to say: 'Definitely, we are going to absorb them or not' because that is dependent on availability of resources that we have at hand. Absorbing over 6 053 that we're talking about has got huge financial implications. And I'm sure all of us know that the Department of Health in Gauteng has been on the news for the challenges that it has been experiencing with regard to funding and cash flow. If we were to consider it, it will not be something that will happen in this financial year. This needs proper costing so that we know how much it will cost us. And if it is something that we can afford and the principals agree with it, of course, why not?", adds Nomsa Mmope, the head of the HIV and AIDS programme in Gauteng.

According to Mmope, the matter is being discussed among the departments of health, labour and public service and administration to look at establishing a standard model of employment that will apply across the country. Community health workers in Gauteng say they want the issue of their incorporation resolved. They say they were promised incorporation as early 10 years ago.

"We are not supposed to be fighting for the very same thing up to now. The Department of Health promised us in April 2002 that they are going to absorb us when they asked us to move into their clinics and their hospitals as their workers. It was in April (2002) and, then, they said in May they are going to absorb us. We became patient up until 2004. That's when we started to approach them that: 'People, we've been waiting for more than two years for you to absorb us'. They saw that we are challenging them about that. In 2005, they started to regard us as volunteers", says Balise Mahlangu.

Her colleague, Lucky Mokone, says it is wrong that services offered by community health workers are classified as volunteerism.

"We are not volunteers. A volunteer is somebody whereby you spend your own time – three seconds or three minutes. That's what you can call a volunteer", he says.

Balise Mahlangu, who also works as a lay HIV counsellor, says community health workers need to be recognised as a crucial segment of health service personnel as they are integral to the country's health outcomes.

"We are working eight hours a day, five days a week, which is unfair for a counsellor to work eight hours, five days a week, whereas you are supposed to be de-briefed, you are supposed to be motivated and we don't get none of these. I get burn-out. I counsel more than seven people per day or 10 or 15 per day and I get burn-out. Tomorrow I'm supposed to come back to (the) clinic. Trust me when I come back tomorrow, the only people I will counsel with fair counselling are four. The rest, it will be: 'Come in. Oh, this is that. Go!' because I'm tired and nobody cares about that. That's what we are fighting for", Mahlangu says.

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