In November, community health workers (CHWs) affiliated to the National Education, Health and Allied Workers’ Union went on strike in Port Elizabeth, demanding to be employed by the National Department of Health. Health Minister Dr Zweli Mkhize received their demands and acknowledged the issue, saying “it needs a whole discussion on policy”.

That a workforce that has played a critical role in the fight against Covid-19, going door to door to screen households for the deadly virus at great personal risk to themselves, has to go on strike simply to be recognised as employees of the Health Department, illustrates how these foot soldiers continue to be undervalued by our health system.

The stipends they receive are wholly inadequate – the minimum wage of R3,600 a month for eight hours a day of work.  And yet despite years of poor support, difficult working conditions and job insecurity, these workers continue to take much-needed healthcare to the stoeps of our country’s most vulnerable households, sometimes at the risk of their own safety and often without the protective equipment that they require, but doing so nonetheless and ensuring that even the farthest-flung household gets access to basic healthcare.

South Africa is estimated to have a workforce of about 60,000 CHWs, who if properly supported, adequately trained and sufficiently and consistently paid, could play a critical role in helping us regain the lost ground in maternal, child and chronic care outcomes that we now grapple with due to the Covid-19 pandemic and lockdown. However, as academic Dr Beth Vale writes (in a 2018 scoping study of CHWs in SA) “while CHWs hold significant potential for bolstering community-based primary healthcare, difficult working conditions, poor support and an unclear policy environment undermine their success”.

The reality is that the most vulnerable children don’t get to clinics and must be supported in their homes. Local evidence suggests that when CHWs are adequately trained and supported they can play a significant role in improving maternal and child health outcomes.

A study conducted in Khayelitsha in 2016 found that households routinely visited by CHWs working for the Philani Maternal, Child Health and Nutrition Trust, an NGO that specialises in training and supporting CHWs, demonstrated statistically significant improvements in reduced stunting levels and child health compared with households that did not benefit from a Philani CHW.

The recent NIDS-CRAM survey estimates that as many as 25% of babies missed immunisations during the lockdown, 11% of mothers living with HIV ran out of antiretroviral therapy (ART), 5% of mothers whose children needed acute care did not seek care and child hunger almost doubled over the period. Even before Covid-19, South Africa was struggling with high levels of chronic malnutrition and could ill afford to regress on immunisation or ART coverage. Now we cannot afford to neglect the workforce that is best placed to identify those who will slip through the cracks of our health system.

Now more than ever, with a second Covid-19 wave upon us, we owe it to our country’s CHWs and the vulnerable communities who depend on them, to provide this essential workforce with the income security, training, support and equipment that they deserve to continue their valiant fight at the front line.

To the government, we say: train our CHWs for present and future health crises and offer them full employment so that they too can have sustainable livelihoods. Protect them, not only from the illnesses they keep us safe from, but the indignity of often having to work without sufficient pay. CHWs are the cornerstone of our health system and it’s now time to treat them as such. DM/MC

Ofentse Mboweni is a communications officer at Grow Great. He holds an honours degree in political studies from Wits University.