Late payments to thousands of care-givers are weakening South Africa’s battle against HIV/Aids and tuberculosis.
Nearly 39 000 community care-givers are employed to cater for the 40-million South Africans who are dependent on public healthcare. The majority of care-givers (57%) are involved in critical HIV/Aids and TB-related activities such as voluntary counselling and testing, drug adherence counselling and home-based care.
Employed via government-funded non-profit organisations (NPOs) that operate as labour brokers, members of South Africa’s corps of care-givers are considered “volunteers” and are paid a small monthly stipend.
The Health Department has contracts with 1 636 NPOs. In the 2007-2008 financial year the department allocated R62-million to the support of national NPOs involved in the response to HIV/Aids and TB.
A chief failure of the system lies in the health department’s late payments to NPOs. When the department fails to pay NPOs on time, the NPOs stop paying the care-givers.
“They call it the dry season of government funding,” Denise Hunt, executive director of the Aids Consortium, told the Mail & Guardian. “Year after year, a few months in, government ceases to pay the grant to the organisations.
Sometimes the counsellors don’t get paid for four months.”
During this time some counsellors are unable to scrape together the transport money to get to work. Others continue to turn up day after day in the hope that they will eventually be reimbursed through back pay.
The stipends themselves are inadequate, said experts. “Care-givers are exploited; you find that people are paid R500 or R600 a month. They call it a stipend but it’s just a way for government to get cheap labour,” said S’khumbuzo Maphumulo, an attorney with the Aids Law Project.
He said that care-givers have no labour rights. “The majority of them should be considered as employees, not volunteers, because they meet all the requirements of our labour laws in this regard. Government is trying to run away from its responsibilities.”
Dr Vivian Black of Wits University’s Reproductive Health and HIV Research Unit (RHRU) believes the unreliable volunteer corps drastically affects mother-to-child transmission of HIV, which is one of the key contributors to South Africa’s high maternal mortality rate.
“Counsellors are key to the HIV programme. They provide pre- and post-test counselling. Without counselling we can’t test for HIV,” she said. If care-givers are not paid and do not report to work to provide counselling, clinics have to ask people seeking HIV testing to return at a later date.
RHRU research has shown that for each extra week of antiretrovirals a pregnant mother receives, the chance of her baby contracting HIV drops by 27%. “So the later you put in an intervention the less effective it is,” said Black.
Mark Heywood, executive director of the Aids Law Project, said the role of care-givers and counsellors will increase, given government’s ambitious National Strategic Plan for combating HIV/Aids and sexually transmitted diseases.
For Heywood the solution is that care-givers should be integrated into the formal healthcare system and provided with adequate training, support and supervision.
“Millions of people benefit from community care-givers as a point of access to healthcare,” Heywood said. “We need to rethink how we envisage health services in this country.”
Health Department spokesperson Fidel Hadebe did not respond to M&G requests for comment.