During the Covid-19 pandemic, SWOP is engaging in conversations with Community Health Workers (CHWs) as well as organisers and other activists working with them. These conversations form part of an ongoing attempt to facilitate and to contribute to collective understandings of this moment as well as possibilities for change.
On 21 April, SWOP director, Dr Prishani Naidoo, spoke to Solly Malema, the national organiser of the National Union of Public Sector and Allied Workers, NUPSAW. In the interview, Malema discusses some of the challenges faced by CHWs, who are estimated to form between 17 and 18000 of the union’s membership. He reflects on struggles faced by this group of vulnerable workers in SA and some of the organising challenges that the union has had to overcome in relation to them, both historically and in the current moment of crisis, including how plans for national strike action across the public sector have been stalled by the lockdown.
Links
Health workers demand safer conditions, Phiri Caw, Vukani News
Community healthcare workers demand recognition as public servants, Vincent Lali, GroundUp
Interview transcript
0:01:24
We're really grateful to you Solly for sharing your time with us. This coronavirus has changed our lives in really dramatic ways and I wanted to start by asking you to just share with us some of the changes in your everyday life. Give us a sense of what your life at the moment is and what are the changes you're experiencing, what are the challenges.
Eish, it's true, the covid-19 pandemic has changed everything for instance, the capitalist, although at the same time they're affected but the issue of the campaigns against the exploitation of the working class is also affected because for instance before the covid-19, we were planning for a strike for community health workers in the country in demand for DPSA salary level 5 so because of the covid-19 we were unable to proceed with the industrial action. We were also busy mobilizing the EPWP workersin the country. For sure if you follow our Facebook page you will see the night vigil that would embark at the union building around the 12th of February to 13 February and other department. So it is a huge impact: we can't visit our members, in particular the essential services workers because of the lockdown regulations
How are you dealng with this at a personal level - as a father, as a community member?
What we are dealing with an invisible enemy in such a way that you can't even... it is
difficult just to go buy your basic needs, you can't visit your friends you can't visit your family, so it's bad it's very bad so yeah extremely affected by this. The children as well they can't go to school and it's a mess. Those who can't afford for instance now the teachers have resorted to this Whatsapp - to continue teaching our children but those who can't afford to have data, it is a challeng, a huge challenge to everyone. In terms of community health workers, what are some of the challenges that they are facing at the moment? Just before I come to the challenges, I mean I just want...
I mean it is incontrovertible that the community health workers are the most important health workers in the fight against the covid-19 pandemic. The community health workers are on the frontline in terms of detecting the virus early through the screening and the tracing of those who are showing symptoms of the virus and refer them for testing and treatment. The government's only plan to combat the covid-19 is to increase screening and the testing in communities as part of an aggressive strategy to curb the virus in the country. The government is relying more extensively on the community health workers to establish this objective. So I just wanted to tell you the background, how important is the community health workers in the world not only in South Africa, but the most exploited workers. This is corroborated by the Minister of Health Dr Zweli Mkhize who acknowledged the importance of expanding the screening and testing where people focus first on high density and high risk areas and as a result, the government deployed more than 28,000 community health workers going from one house to another in vulnerable communities to screen and test people. So their reliance on community health workers to provide health care service is not new. If you remember in much the same way that interventions are central to the TB and HIV responses, so they have also played a major role in dealing with the TB and HIV. So today the community health workers are doing a critical work in South Africa, even at this conjuncture in response to covid-
It's sad that it's taken a pandemic to show just our central community health workers are to the delivery of adequate health care, necessary health care. You know in all of the press briefings as you've mentioned already, we've seen government acknowledging the critical role that community health workers are playing in relation to health in South Africa and the world. I am hopeful that we can see a change in how community health workers are treated by government and by society more generally. What are your thoughts in relation to this and how do you view this recognition of this role at the moment?
As the union NUPSAW, we've been in this struggle I think since 2010 because the community health workers were employed by various NGOs, some were not paid, they will tell them - they used to call it dry season, whereby poor workers will work for three to six months. We had to fight tooth and nail up until they were recognized. That's why in 2018 we signed a resolution in the Public Health and Social Development sectoral bargaining council just to standardize. so all CW's in the country are placed on the Persal system by the government and that was only to standardize. It was not our demand of salary level five for all the CHWs. So it is disturbing and disgusting how
the capitalist, barbaric, and evil and cruel government is, it's exploiting the very same workers who are commended for playing an important role in the entire health system.
What are some of the immediate challenges that you think need to be addressed? I recognized the ongoing struggle, the long-term struggle that you're speaking about, but in spite of these struggles we've seen community health workers continue to come to the fore and take take up this challenge of being at the frontline. What are some of the immediate challenges that need to be addressed and link those to what you said about the longer term struggles.
The first challenge is the issue of the PPEs. We had a meeting with the minister of health, Dr Zweli Mkhize, all the MECs and the HODs on the 7th of April via a zoom/video call and in that meeting we raised the issue of the protective clothing and we agreed, the meeting agreed that no community health worker or no worker that is in the frontline must do the screening and monitoring without a proper training in the PPE; so that was the first because you need to make sure that those who are on the frontline at the front line are protected. So for instance, we stopped Limpopo from embarking on a door-to-door campaign only because there was no PPE and there was no proper training. So the second issue, the challenge that the CHWs are facing is the issue of - remember that the majority of the CHWs are women – so I mean, they face significant danger in the course of their work and the government must prioritize their safety. So as they go house to house... there was an incident in Gauteng where CHWs were raped on the line of duty, so we are very serious about the issue of the safety. We're saying the government must protect the CHWs. Two, the CHWs are at risk of being stigmatized by community members who are hostile towards the people with covid- infection. For sure you saw, in fact, I think it was around Attridgeville where CHWs were chased away by members of community and even in Mpumalanga. So the government must assist with awareness by reiterating the message through community radios to say these people, I mean the CSWs, are going into the community to assist or to help. So, three, the issue of education is very very important because if the government can educate the community about the importance of the CHWs the communities will be protected... I mean the CHWs will be protected by the same community as they perform their duties of screening. So the work of community health workers is stressful under normal circumstances in light of the above, the risk that the pandemic poses they will be under even more emotional and physical stress. In this, it is imperative that the CHWs are provided with psychological support during this period just in terms of them.
I wanted to focus a little on the issue of challenges faced by women who you've said the majority of your members. Are there any attempts amongst women in your union to come together to take up their issues, even prior to this in a focused or particular way?
Prior the covid-19 we were in a process of establishing a women's structure, especially those who are within the CHWs so that they can focus on the challenges that they are confronted with
in their sector but we are also having sector committees, CHW sector committees across provinces. They are also discussing all these challenges that they are facing while all duty. Just as you've been mentioning you know sector committees, this is a different group of workers or a different kind of group of workers that you're organizing: very vulnerable, the most precarious, not protected in the same ways as your traditional workers in traditional forms of unions. Could you speak a little bit about how you or what ways you've developed to organize this particular group of workers. Look, what we have done, because remember these workers were normally called volunteers. Before we came in, they were not recognized at all so we had to give them a desk in the union. Each and every province must have regional structures, CHW structures. Out of original structures they must form, establish the provincial sector committee of the CHWs. So the regions will normally discuss issues and they meet the provincial level to consolidate and after consolidating they will then confront either the HOD or the Premier in that particular province or the MEC so that's how we managed to to to organize and make sure that we bring the unity within the CHWs.
And then just in terms of relationships between the community health worker sector committees and the union more generally with other groups - I'm also going to be speaking to members of the People's Health Movement and the Gauteng community health workers forum - do you have any relationships with those kinds of groups that are not conforming to the traditional trade union way of organising?
Look our view is that community health workers must unite irregardless of their affiliation because the enemy is one. The enemy is government so we welcome any organization that serves the interest of the CHWs so that we can unite all the CHWs in the country and and with that strength, we'll be able to defeat the government. As the Union, we've got an advantage because we are sitting in councils. The issue of resolution 1 of it was NUPSAW that pushed for it. That resolution on itself is a recognition of CHWs as employees in the Department of Health. So what we are fighting for as NUPSAW is salary level five which is equivalent to twelve thousand five hundred and all other benefits that state employees are fighting. As much as we are having the certificate to strike in demand for DPSA salary level 5 but we also have an opportunity because a strike is an extension of negotiation. We also have an opportunity to table this matter ....
Do you think that the immediate crisis created by the corona virus is going to shift anything in terms of that organizing context, that negotiating context, that political context, for community health workers but also for NUPSAW and more broadly?
It is incontrovertible that the systems are doing crucial work within the health fraternity. The CHWs are not supposed to be punished or exploited the way they are at this point or juncture, so the challenge is that we are being led by a barbaric, capitalist government. So right, the government now, they were supposed to do the right thing and recognize the CHWs and pay them accordingly. So we are still going to push the struggle after the lockdown. We are ready to embark on a national strike and we know that victory is certain as long as all the community health workers can unite irregardless of which organizations they belong to, that we will be able to achieve that objective of total liberation of the CHWs.
Just one final question in relation to that: you've spoken about the capitalist system being the problem, you've spoken about the exploitation of community health workers and other essential workers, workers more generally in terms of the continued existence of of capitalism. How do you see the immediate work of organizing in relation to community health workers and essential workers more generally, and other public sector workers, making a challenge to the system that we find ourselves in? Is there anything that you think might have changed?
Some people have been arguing that even though we're in a crisis state, some of the changes in the attitude of government, in the behavior of government, has shown that what they were saying in the past was not possible can be possible, *is* possible. They were saying in the past there is no alternative to neoliberalism but at the moment we are seeing certain shifts in terms of policy that's being spoken about and certain actions that have been taken by government. What would be your response to that or how do you feel about those kinds of arguments? Look, the problem that we are facing or the crisis is man-made. I'll give you an example: the politicians have looted, the evidence is overwhelming through Zondo Commission and other - the PSI – commissions but no single politicians is behind [bars] or is wearing a yellow overall as we are speaking. The evidence is there and the reason why not a single politician is wearing a yellow overall is because they're colluding. When they bring Cyril as the leader of the ANC, to us it's like when you are using the same medicine and just changing the container. The medicine, it's still the same. when the working class can change the status quo, for instance let me give you... we are fast approaching that what we call the 15 May 2011 in Spain. This very same government has provoked the public sector workers by failing to implement the last phase of the wage agreement, so now even if we are under a long term we are mobilizing. We are going to unite the workers across the public sector, CHWs are regarded as public servants, the EPWP are public servants - it is just a way of government trying to exploit the workers by not filling up the positions, the vacant positions in the public sector. So they are using the EPWPs, exploiting workers in the name of the EPWP, so we are mobilizing workers. After the lockdown, you will see the changes in the public sector.
I have taken a lot of your time already. I wanted to end with one last question from me and then if there's anything else you want to add. We are a research institute at the university. I mean we're trying to bring different groups together in this time of crisis and we're gonna try to reorientate some of our research to assist unions, to assist groups that are using this moment to strengthen and expand struggles of the working class, struggles of the poor, struggles against the capitalist system. So I wanted to hear from you if you thought there was anything we could do from the space of the university to support your efforts or to contribute to some of these struggles.
Look what I can say is that, for instance, we can have video conference calls through zoom where all the representatives of all these organizations come together, like what we are doing currently, so that we discuss this and we we come up with the solutions to this what the capitalist is doing to the poor people in this country. And for sure we can't fold our arms and say we are now under lockdown and therefore there's nothing we can do. We need to discuss this issue so that once we are free to move, at least we have done the groundwork and for us it will be to implement and overthrow the capitalist system. We also have the unemployed people. We've got those organizations; they need to come because they fall under the working clas; you can't separate them from the working class. So I'm saying, it is very very important to bring all these groups together so that we talk about this. We're having organizations who are representing the homeless people; we need to engage all these people if we are serious about organizing, forming a broad movement because the only solution for us is to form a broad movement that will challenge face and challenge, dismantle capitalism. So we will appreciate that if if we can be able to facilitate such kinds of meetings.
Thank you very very much for your time and good luck with your ongoing work and I'm sure we will continue to engage.
/ends