Community Health Workers Push For Recognition And Change

Community health workers (CHWs) play a crucial role in delivering essential healthcare services to communities across South Africa. Yet, a year after the Labour Court ruled that CHWs should be deemed permanent employees, their employment status remains precarious. Some health districts in various provinces have begun to absorb them into formal employment, but many CHWs are still contracted employees who earn stipends rather than salaries.

One such worker is Lucky Mthombeni from Allanridge in the Free State. Growing up, Mthombeni became increasingly aware of the poor health outcomes in his community. He saw people struggling with preventable diseases, which deeply troubled him.

“I looked around and saw the need for healthcare services in my community,” he says. “I wanted to be part of the solution.”

He began volunteering as a community health worker in 2002, immediately after completing matric. 

“My father was a pastor who loved helping people spiritually, and I took that same spirit and applied it to healthcare.” 

No permanent employment

In 2006, after four years as a volunteer, Mthombeni received his first stipend of R500 while working under the Department of Health as a community health worker. More than two decades later, he remains deeply passionate about his work.

“There’s nothing more fulfilling than making a difference in my community,” he says. “I go the extra mile, even on weekends, to help those in need – whether it’s elderly people struggling with chronic conditions or young initiates who need medical attention.”

Despite their dedication, thousands of CHWs like Mthombeni remain trapped in a cycle of short-term contracts that are renewed periodically, with no clarity about long-term employment.

For Mthombeni, permanent employment would mean financial stability and dignity.

“A stable income with benefits such as medical aid, a pension and leave would allow me to plan for the future and support my family,” he says. “It would give me peace of mind, knowing I can provide for my loved ones without worrying about my contract ending.”

He adds that job security would also allow him to focus fully on his work. “I would be able to plan long-term projects and continue serving my community without the stress of uncertainty about my own future.”

Organising for recognition

Bulelwa Faltein, national chairperson of the South African Care Workers Forum (SACWF), understands these struggles well. Faltein works at a public clinic in Mdantsane in the Eastern Cape, where she provides HIV testing, counselling and treatment support.

“It’s challenging but rewarding work,” she says. “I feel proud to be making a difference in my community.”

 The SACWF was formed in 2014 in response to the widespread challenges faced by CHWs, including poor working conditions, lack of recognition and inadequate compensation.

“We needed a platform where CHWs could speak for themselves and fight for their rights,” she explains.

Together with the National Education, Health and Allied Workers’ Union (NEHAWU), SACWF took the matter to the Labour Court. This led to a landmark ruling on 23 January 2025, found that the repeated use of fixed-term contracts for ongoing and essential services violates the Labour Relations Act.

“This judgment is a major victory for CHWs,” Faltein says. “We are now calling on the Department of Health to implement the ruling without delay and formally recognise CHWs as essential healthcare workers.”

Calls for urgent action

Another CHW, Xolani Ngcobo from Welkom in the Free State, echoes these demands.

“I’m not asking for much. I just want recognition for the work I do. I want to plan for my future, support my family and retire with dignity,” Ngcobo says.

“These recurring contracts don’t guarantee permanency,” he adds. “Tomorrow, we could be left without work.”

Nina Benjamin, a facilitator at Labour Research Services (LRS), says her organisation works closely with care workers, including CHWs, to promote decent work and fair labour practices.

“I’m shocked that people have been working for more than 10 years without job security or employee benefits,” she says. “It highlights the urgency of this issue.”

Benjamin says LRS believes community health workers deserve fair compensation and benefits that reflect the essential services they provide.

“CHWs are the backbone of primary healthcare in many communities,” she says. “They deserve dignity, stability and recognition.” – Health-e News