Interview with People's Health Movement national coordinator, Tinashe Njanji

During the crisis precipitated by Covid-19, SWOP is engaging in conversations with Community Health Workers as well as organisers and other activists working with them. These conversations are part of our ongoing attempts to facilitate, and contribute to collective understandings of this moment and responses to its various problems and challenges.

On 8 May, SWOP director, Dr Prishani Naidoo, spoke with Tinashe Njanji, national coordinator of the People’s Health Movement in South Africa. In the interview, Njanji reflects on the historical and current work being done with Community Health Workers by the movement. He also touches on some of the challenges being faced by these workers today, when their centrality to the health of all is finally being recognised as a result of the pandemic, whereas previously it had been largely disregarded or undervalued by state and society. He begins to speak about the importance of a Primary Health Care approach in which CHWs are the fulcrum of a health system driven by prevention rather than cure. But, unfortunately the interview ends quite abruptly as Njanji’s electricity was unexpectedly cut at the end. We hope to pick up our conversation with him in the near future.

Links

• Coronavirus – Statements and responses from PHM worldwide

• Alma Ata 1978 conference report: Primary Health Care [2.8MB pdf]

• Susan B. Rifkin, Alma Ata after 40 years: Primary Health Care and Health for All—from consensus to complexity

Interview transcript

0:01:30

... Thank you to Tinashe for giving us your time this afternoon and sharing with us your experiences and views. In relation to the position of community health workers i'd like to start by just asking you to tell us a little bit about your experiences of changes in your everyday life as we are experiencing this crisis brought on by the covid-19 pandemic. We know you as coordinator of People's Health Movement but you're also a father you're a family man you're a community member so feel free to reflect on any of those issues.

Thank you so much for giving me and the organization the opportunity to feature on this platform. Look the covid-19 has brought a new normal that we didn't expect, that things would tend to be like this. The unfortunate part about it it's not sparing anybody's life it's affecting everyone's life which is very bad. Everyone is affected by it and everybody is affected in very very difficult ways. We have seen limitations in gatherings as social movements. We know we no longer do physical

meetings; we no longer are meeting face-to-face. As family members we have to now exercise precautions. Make sure that kids are taken care of you have to keep an eye on wherever they are; you have to make sure that when, the difficult part, you cannot hug you cannot touch i mean it's as african people it's our norm that when you meet your brother you greet them you hug them you know you touch them to express your love, the relationship their bond you know. So it's quite difficult that we can't do all that and we used to go to do groceries shopping with the kids they're all family and all that it's something that we can't even do now we're now limited to send one parent to do the shopping and before they come into the house and make sure that they have to wash their hands and sanitize all the groceries before they get into into the house and so forth you know. this is something that just is difficult and now people are even i mean as i've told you, my wife was not feeling well. she had toothache, she was even afraid of going to the dentist herself. So this life that we are now living is now difficult and the rate at which um it's spreading

It's just scary and in this difficult and scary context we have people like yourself and others in the people's health movement and you know community health workers who are putting yourselves on the frontline and continuing to struggle. I wanted you to reflect a bit on the role that community health workers in particular are playing at the moment and the role that the people's health movement is playing in relation to addressing some of the problems that you've raised.

So community workers historically in south africa they've played a very crucial role, which is very important from the hiv and aids pandemic. they've also played a very important they're currently playing a very important role in our current health health care system whereby they are reaching to very marginalized, poor areas to make sure that there is service, there is delivery of healthcare services in those particular areas. Most of this of this time, most of these communities, these are poor townships with a lot of informal settlements where people are overcrowded and some of the areas are actually rural areas whereby these chws have to go down the hill, up the mountain, get snake bites get stuck in the mud, and all those - it's very difficult for them. So at this juncture we have now put them as the army to respond to the covid. We know that they are going into the houses, doing the screening doing and referring the patients to the testing centers into the clinics and so forth but it's quite difficult for them because they are from their experience they're saying they don't have sufficient information. The information that they have they're saying it's quite limited and they get to a point where they get asked a lot of questions but can't answer all of the questions. So as People's Health Movement, we've asked them to forward the question that they have been asking and all the questions thatthey are not sure to answer from thecommunity. So they've sent those questions to us and instead of us developing a pamphlet,we said no: you know, if you develop a pamphlet you have to hand it by your hand and it ends up getting into a number of hands which might be a problem in spreading the virus So we said thiese questions that they've sent us, we've drafted the answers and we are now sending the answers back to them. There are about questions but we have merged the questions together and there are about questions, whereby each question we are now responding with two questions a day so every day we send them a question, this is what they asked us and this is your question so we're doing this via Whatsapp groups, sms's and social media platforms.

Could you give us a sense of how many community health workers are part of people's health movement and a sense of what some of these questions are?

We've got about of them that are on our database but we have asked them to extend the olive branch so that others can come to the platform. That's the number that we currently have then what some of the questions that they were asking the means the facts around the covid - is covid a man-made, how curable is it? if i recover from covid will i be reinfected again? - and they were asking like, if i'm staying at home and i'm locking myself in there in the house do i need to wash my hands - you know those kind of questions. And earlier on they were asking why do we have to ban the gatherings before they understand why the public gatherings had to be banned.

Just in relation to the current position of community health workers could you tell us what some of the challenges and problems are that they're facing at the moment?

Some of the problems that they are facing at the moment is this: they lack social psycho support. Right, they work under stressful conditions; the work that they do it's a work that requires them to have a good system to support them, mentally a good system to support them physically, but then it's something that they don't have and it's going to be worse when they now get to a level whereby they're getting infected it's going to be serious because they need that support that maintains them due to the pandemic because of this support system because of the lacking of this support system we're going to face some serious challenges that's the challenge number one number two we know that globally PPEs are in short supply. they are given one mask to work with for a couple of days, for the whole day they're given one pair of gloves to work with they're not given aprons and we know some of them they're dealing with bedridden patients whether they need a problem i mean can you imagine having one pair of gloves i get into this household with one pair of gloves i put it on then i leave i put it off then in the next household i wear this very same particular gloves, which is a risk of now spreading the virus itself you know both to the household and to themselves, and they are actually being exposed themselves. Right now we have seen the health department are assigning the community workers now to do medical deliveries instead of chronic patients coming to the clinic, they said no some of the community care workers have to deliver the medicine to chronic patients' homes so that we lessen the number of people who are coming to the clinics.

So this is what it's own challenges because in this community that they are working, these are dangerous communities. They are at a risk of getting mugged. We know the issue around the abuse of of arvs by by nyaope people, you know it's not putting their lives at risk and hteir lives has been already previously been at risk because they the community that they work in there they get. They are prone to be assaulted, they are prone to be mugged, all those things. So these are some of the challenges that they face. i mean previously we know the issue of uniform, the issue of remuneration that they've been getting very little money, and i mean as their salaries. you know um it's quite a number of issues that they are they are facing. Previously, these community workers were at the peripheral of the health system; we were not acknowledging the importance of their work, but now with this covid we've we now could see them as troops we're not giving them these names they're the troops they're the agents of change they are the front line workers but previously where were we putting them?

My point is this it's only now that we're seeing their importance. If we had been investing in them for the past 20 years we could have had a good strong force of community care workers who are well educated, who are working, who love their job. Currently, they are demotivated because of these issues of the problems and challenges that they are facing, both in the community, in their workplace and at home. We know very well that they are not supported nurses and community workers they don't support each other. They are not recognized. our health system does not recognize it at all but i'm glad that this covid actually showed us a new a new era, a new dimension a new importance of community healthcare workers.

Thank you and just the information to your last point have i mean has this recognition because we've we have seen government celebrating community health workers in this moment and yet we also know that there's been a long struggle before covid- for community health workers to be taken more seriously, as this particular moment shifted the position of government in any way? i'm not sure how much of the shift happened you know, i think there's been a shift but i don't think it's a significant shift. You know, soon after covid i'm sure they will still be put at the periphery of the health system.

In relation to your role and the people's health movement more broadly, in the organizing of community health workers, what is the role that you're playing in organizing both in this moment but also prior to this and how do you see it going forward?

Look we're not really directly involved in organizing community healthcare workers but we encourage community workers to join a progressive union. right we don't prescribe to which union but we would definitely show them or they know themselves these are the union. We also encourage them to be part of those structures so that they can learn politically and their rights as workers and so forth. What we do mainly is as PHM we see community health workers as agents of change. This is the foundation. They are the foundation of successful primary healthcare so we do train, we do take them on a training where we train them on the issues related to the political economy of health trying to explain to them why our health system is where it is, the different policies that we have in the country that is affecting our health system. We train them on the history of primary health care; we take them back to the to the KZN ... on to the Alma Ata declaration, the importance of primary healthcare and why we need it, and what it means to have successful primary healthcare. And most importantly, we take them on the issues of social determinants of health, why people are getting sick and we ask them to look at the small things that they can do as CHWs instead of them addressing the sickness but what is it that they can do to prevent a sickness as CHWs. i mean we cannot speak of things like health education or promotion, the role that they've been doing and how they can do it differently. In that training another important point is issues of advocacy: how they can advocate for themselves, how they can advocate for the community, how can they can advocate for for the health system themselves for their patients and so forth you

/ends