The Rural Health Advocacy Project (RHAP) supports the plight of the Free State Community Health Workers and calls for an urgent resolution to the unfair expectations on this essential primary health care cadre
Tomorrow Monday 1st September, over a 100 Free State Community Health Workers (CHWs) will appear in court to be charged in relation to their peaceful protest gathering after their contracts were not renewed. This incident does not take place in isolation but is symbolic of the on-going maltreatment of community health workers countrywide, who work under trying conditions, receive meagre stipends and often get paid irregularly if at all. Yet, this cadre of health workers is expected to fulfil a critical role in the country’s efforts to improve health outcomes and achieve equity, as part of the Re-engineering Primary Health Care Strategy.
The Rural Health Advocacy Project (RHAP) calls for an end to this situation and expresses its support to the Stop the Free State Health Crisis Campaign, which has taken on the plight of the Community Health Workers as part of its broader campaign. For the past two years the RHAP and several other organisations have closely followed the Community Health Worker Policy developments and we have a number of concerns that need to be urgently addressed:
RHAP calls on the National Department of Health for the finalisation of the long overdue CHW policy. There has been a delay since the launch of the PHC re-engineering strategy in 2011 to provide a final CHW policy that clearly delineates CHW scope and resource allocation.
The Community Health Worker Programme should cater for care at home due to physical incapacitation (acute and chronic), mental health/illness support, palliative care and treatment and other health needs that exist in the community.
Dr Prinitha Pillay from the RHAP comments that “We are deeply concerned that there is only an emphasis on prevention and promotion and not enough on accessing care and treatment at household level. Step-down care and treatment, through the provision of ‘community beds’ is still desperately needed in South Africa’s context of a quadruple epidemic”.
The policy needs to speak to the rural context as many more CHWs are needed in rural areas where distance is a real factor. The proposed ward-based community health worker/population ratio of 1:250 households is lower than similar initiatives in other developing countries, insufficient, and places an undue burden on the Community Health Worker. Rural communities stand to be the most disadvantaged with such low ratios – as it takes longer to move in between households and transport services are unreliable.
There is a need for fair working conditions for all CHW categories (WBOT, home care, HIV counsellors) that play a critical role in the delivery of Primary Health Care. They must be recognised as skilled workers and their challenging working conditions demand fair pay, benefits, access to occupational health and safety compensation, proper training, supervision and support similar across provinces through their formal adoption into the health system.
In a country plagued by high unemployment levels, the CHW programme should be championed as a National Government priority that can provide an opportunity to create jobs while improving health. It is surprising indeed that there is no multi-departmental support to finance and roll-out this initiative on a large scale.
Access the full position statement.
Dr Prinitha Pillay: cell 0826186538, email: firstname.lastname@example.org
Marije Versteeg-Mojanaga: cell 0741063800, email: email@example.com.
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