Home-based health care is about to replace the system whereby community health workers are the primary care givers to communities in the Western Cape that do not have immediate access to hospitals and clinics.
The move follows a decision by the European Union to end its five-yearR90-million association with the community health workers.
From next month the EU will direct its funds to the national government to build district health systems that are closer to communities in need. And home-based care is at the core of these systems.
Community health workers have been operating in the informal settlements around Cape Town and the rural communities of Ashton, Montagu and Zolani. A similar project has been running in Winterveldt in the North West province.
The community health worker movement operates under the Zanempilo Trust, which incorporates several community health NGOs, including the South African Christian Leadership Assembly Health Project, the Health Care Trust and the Zibonele Health Workers Project. Besides providing primary health care to community members, the community health workers provide a rehabilitation and referral system to social workers for counselling.
Antonette Richardson, CEO of the Zanempilo Trust, says the African National Congress “back-tracked” on its early enthusiasm for community health workers.
“When it realised the expense, community health worker projects disappeared out of policy,” says Richardson.
“The EU’s flagship [projects] are about to sink,” says Richardson. “Unless a miracle [in] funding occurs, Zanempilo will have to close its doors by the beginning of November.”
Though provincial governments are supposed to consult organisations such as Zanempilo before allocating the funds, Richardson says this has not happened. Instead, the Western Cape government has announced it will channel all the EU money into home-based care for HIV patients.
Joey Cupido, provincial coordinator for home-based care, confirms that the Western Cape Department of Health has submitted a work plan to the EU. He says the plan is to split the funds among the four regions of the Western Cape, with the largest share going to the metropolitan area.
Cupido says: “I am aware of [Zanempilo’s anxieties] … but my major beneficiaries are my clients and I don’t care who gets the money, as long as there is monitoring and evaluation.”
Ivan Toms, Zanempilo’s chairperson and director of health in Cape Town, says the closure of Zanempilo will be a waste of infrastructure and experience. But he sees home-based care as the way for the future.
Toms says Zanempilo has not yet produced hard data proving the effects of its millions of rands on its target population. “It needs to be able to convince a district health manager that a R5-million to R8-million project, for instance, makes more sense than building a clinic for R2-million.”
One of Zanempilo’s options appears to be to apply for funding for specific projects, such as for its tuberculosis programmes, HIV support and a rehabilitation project for the disabled poor. Otherwise it will have to streamline the organisation to cut costs.
Zukiswa Mkutshwana, a community health worker, says if Zanempilo closes shop there will be no social workers or probation officers with local knowledge. “The government has no equivalent for Zanempilo’s rehabilitation programme for disabled people and their families.”
Mkutshwana says the same applies to the programme involving medical students from Western Cape universities, who worked closely with community health workers on township health issues.