New book captures stories and struggles of CHWs


The Gauteng Community Health Care Forum (the Forum) and Khanya College have produced a new book that captures the stories and struggles of Community Health Workers in South Africa. The book comes after almost 10 years of organising by CHWs in Gauteng and across the country. The book captures stories of 16 CHWs, all of them members and leaders of the Forum.

The rise of the Hiv/Aids pandemic in South Africa heightened the crisis in the national health system, and was the imperative for the state-supported employment of lay or community health workers in the mid 1990s. The lay health workers were employed and based in non-governmental organisations (NGOs), as home based carers and peer educators. The state’s employment of volunteer or lay health workers was a neoliberal solution to bailout the poor national healthcare system. In response to the health crisis (both HIV/Aids and TB), the national government declared 2002 as the ‘year of the volunteer’. This practice of using “volunteers’ was extended to other areas of social service provision. Nine community-based worker categories were noted that have been brought under the government’s Expanded Public Works Programme (EPWP).Currently (2017/8) there are about 70 000 CHWs who provide care to patients in communities and bolster the national healthcare system.

 What writer and activist Shamim Meer said about the book: “These powerful interviews give searing testimony to what it means to be woman and worker in South Africa today. Read as community health workers relate, in their own words, their struggles, their loves, their hopes and dreams.”

CHWs have not taken the abuse and neglect by the government lying down. They have taken up a series of struggles that have led to important short-term victories and to the growth of organisation. CHWs in Gauteng began working with Khanya College and organising in earnest in 2010. A successful strike in 2012 led to a 100% increase in their stipends, from R1 000 to R2 000, although the stipend was still far from a living wage. The 2012 strike also led to CHWs being transferred from NGOs to clinics under the Gauteng Department of Health (GDoH) in 2013, and their stipends were paid directly by the Department. This was a long-standing demand of the CHWs, and this struggle gave them experience in self-organising. Together with Khanya the CHWs focused on their political education, improving quality healthcare for communities, self-organisation and engaging different organisation models to respond to their specific needs as women workers and their concerns for quality healthcare service provision to the communities where they are located.

What activist and Professor Sarah Mosoetsa said about the book: “The life stories of these workers inspire and shine light on what it means when women engage with their communities, rebuild and contribute to their wellness even under difficult circumstances. The healthcare system can only improve if the working conditions of healthcare workers also improve. Aluta continua!”

The level of self-organising among CHWs continued to increase, and by 2014 they decided to form an organization that would cater to their needs – the Gauteng Community Health Care Forum (GCHCF, or the Forum). In February 2016, under the leadership of the Forum, the matter of CHWs’ employment status was tested in the Labour Court in Gauteng. In March Judge Paul Benjamin of the Labour Court, ruled that the CHWs are indeed employees of the DoH. This landmark victory for CHWs was short-lived. The GDoH’s response was to outsource the CHWs to a private company, Smartpurse, in May 2016. Since then the CHWs have been locked in a lengthy drawn-out arbitration with the GDoH in the Public Sector Bargaining Council. The DoH has used various tactics to wear-down the CHWs, including non-payment of stipends and ‘locking out’ CHWs from their clinics. The CHWs continue to take up the struggle for permanent employment with the GDoH, and have engaged in various non-violent but militant actions to ensure their voice is heard. These have included marches, pickets, demonstrations and shutting down the World Aids Day in December 2016.

What Professor and eco-socialist feminist Jacklyn Cock said about the book: “In this moment of cynicism and political disappointment, this is an inspirational book. This book is a reminder of working class women’s strength and solidarity, qualities much needed in the struggle to redistribute power and resources in South Africa”

The CHWs organized in the Forum now see themselves as part of a broader movement and have linked up with other CHWs nationally, and are also involved in solidarity actions with other workers and communities.

The book represents an important step in the growing consciousness and organisation of CHWs. It is unique in that it is not just a story of activists struggling against low wages and working conditions. It is also a book about the stories of black working class women’s struggle against patriarchy and violence against women in South Africa. In this book we see that the struggles of black women for self-liberation as working class women goes far beyond the ritual of 16 Days of Activism, and involves daily struggles for organising, struggles at a personal level and for a society that will liberate women from oppression, patriarchy and capitalism.

[Book is available at Khanya College. For a copy email jozibookfair@khanyacollege.org.za]

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