Seven years after over 100 community healthcare workers (CHWs) were arrested during a vigil at the provincial health department's headquarters, Bophelo House, the struggles of CHWs in the Free State continue.
In 2014 the CHWs, all desperate for job security, held a vigil to demand permanent employment. They were arrested and charged with a suspended sentence of an R600 fine or three months imprisonment for participating in an illegal gathering. In 2015 94 of them were convicted in the Bloemfontein Magistrate's Court, but the convictions were overturned in 2016 in the Bloemfontein High Court, in a ruling described by one commentator as "a victory for protestors and the right to freedom of assembly under our Constitution".
In the years since, national-level policy has generally moved in the right direction for CHWs. Most are now supposed to be directly employed by the state, with the job security and other benefits that come with that. Previously, many CHWs were employed by NGOs paid by government. CHWs are also supposed to be paid a minimum of R3 500 per month - in the past, they were often paid less.
And yet, today many CHWs in the Free State are still desperate for job security.
Martha* who has been working as a CHW for the last 15 years, celebrated her 60th birthday this year. She says she has now been told not to go back to work because her contract will not be renewed.
"I am in pain," she tells Spotlight. "I was told telephonically that I must not go back to work because I am now a pensioner.
"I was chased away just like that. I dedicated my life to this work, but today I have nothing to show for it. I am so sad. The lady that called me told me to go and apply for the old age grant with SASSA. So just like that I am out of work and I have a family that I still need to take care of," she says.
As a CHW, Martha earned R3 500. As a pensioner, she qualifies for an old age grant of R1 890, almost half of her usual income. She is the breadwinner in her family and supports her unemployed husband and four unemployed children.
Provincial Chairperson of Hospersa Peggy Motlokoa says even the R3 500 stipend the CHWs are paid, "is peanuts". "Sometimes they only receive R2 000 and sometimes nothing at all and when we enquire about this at the human resources (department), we are told that there was an error in capturing.
"Now the worst part is that when these workers have to retire and because they are still not formally employed, they will not get a retirement package and they will also not be able to claim from the unemployment fund (UIF)," says Motlokoa.
"They would like to get houses but they cannot afford it and when they apply for RDP houses, they appear on the system as public servants (who do not qualify)."
Working without pay
Mapule Moloi (48) works at the Qholaqhwe clinic in Qwaqwa. She has been working as a CHW for six years but now says she has not received her stipend for four months.
"Waking up every morning to go to work and having no salary at the end of the month is painful. I am a single mother of two children and my kids have no food but their mother goes to work every morning. One of my children has been diagnosed with TB (tuberculosis) and I cannot even buy her nutritious food," Moloi says.
"All my funeral policies have now lapsed and when I call HR, I am told that my contract can be terminated at any time or sometimes they change their story to say that they are awaiting appointment letters. I really do not know what to do anymore. I will continue to report for duty because honestly, I need this job. Even though I have not been paid for four months, I am still hopeful that I will get my salary. I cannot lose this job. It is all that I have and know."
Better than nothing
A 28-year-old CHW, who wants to remain anonymous, says she has also not been paid for the last four months.
"Working without a salary is very painful. I have one child and I am the breadwinner at home. I am not satisfied with the R3 500 stipend but it is better than the nothing that I am currently getting.
"I wake up every morning to risk my life by exposing myself to COVID-19 because when we do the door-to-door we are not provided with PPEs. The only protection we are given is the masks. I just wish that the employer can place themselves in my shoes. I need that money and I also need job security."
Motlokoa says the current conditions that have been brought about by COVID-19 have proven that services rendered by CHWs are critical to providing quality healthcare services in communities, but the department of health continues to drag its feet in permanently employing CHWs.
"CHWs are marginalised and exploited by the department. They are the backbone of primary health care and they are doing an excellent job. And right now their relevance is even more visible because apart from screening for TB and HIV they now have to go to households looking for elderly people so that they can register them for vaccination," Motlokoa says.
"These workers are even putting their lives at risk as they are exposed to COVID-19 because of the door-to-door [visits] they make to ensure access to healthcare. They have given their lives to serve the health care system but they are not appreciated."
Motlokoa tells Spotlight that it is a big problem that some of the CHWs have not been getting their stipends and some have not had their contracts renewed.
"All we are asking is for the employer to absorb the CHWs on a level two salary scale just so that they can have job security and benefits. Gauteng did it, why can't the Free State do it?"
Waiting on national department
Spokesperson for the Free State Department of Health Mondli Mvambi, however, says it is the National Department of Health that decides on permanently employing CHWs.
"Permanently employing CHWs is going to be a long process. We have to look at all avenues. We do want them to be permanent but our challenge is that the department has too many personnel [members] and as a result, Human Resource is taking up a lot of the budget," Mvambi says.
According to him, the Free State Department of Health values the service and contribution of community health care workers. "These workers serve the community in various responsibilities that include following up on patients in their homes, ensuring that they take their medication and referred to appropriate health facilities in case of need," he says. "The Free State Department of Health has been keen to absorb them and give better conditions of service and benefits. However, this is a nationally coordinated function. The Public Health and Social Development Bargain Council must still pronounce on their permanent employment which will determine levels of their employment and service benefits."
But Spokesperson for the National Department of Health, Popo Maja says provinces do not have to wait for a mandate from the national department for community health workers to be employed.
"The provinces are the ones who are supposed to employ the CHWs if they can afford to do it as other provinces have done. National department does not need to give a province the go-ahead for them to employ CHWs permanently," he says.
According to Nehawu's provincial secretary Khauhelo Mnqibisa, there is a resolution signed in November last year by the department promising to absorb all the CHWs in the province
"We are aware that they have not been absorbed as agreed. We actually expected them to have been employed by 1 April. A resolution was signed so we are no longer begging the employer. They are expected to give workers permanent employment," Mnqibisa tells Spotlight.
CHWs 60 and older
"Now our concern lately is that there are those CHWs who are 60 years old and have been told that they cannot be employed because they are old and have reached a retirement age. As Nehawu, we cannot accept that. Those are the people that started with the CHW programme. They cannot be neglected like that," Mnqibisa says.
But according to Mvambi, the department fulfilled this promise to absorb the CHWs and the workers are now employed on extended contracts.
"As for now, they are on extended contracts which are renewable annually. They are removed from NGOs and now remunerated R3 633 from the previous R3 500 which was given to them from April 2020," Mvambi says.